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PubMed2006

Association between bone density and fractures in children: a systematic review and meta-analysis.

OBJECTIVE: The objective of this article was to systematically review all published studies that investigated the association between bone density and fractures in children. DESIGN: Potentially relevant articles were identified by searching electronic databases. Duplicates were removed, abstracts were inspected, and relevant articles were obtained. Studies were included in the systematic review if participants were <16.0 years old, were healthy, had extractable data on bone mass, and had fractures as the outcome. RESULTS: Ten case-control studies were identified. No prospective studies were found. There was no evidence of heterogeneity between studies or of funnel-plot asymmetry. Eight of the studies were included in the meta-analysis, because they presented results as means and standard deviations of bone density in cases and controls. The pooled standardized mean difference for bone mass in children with and without fractures, from a fixed-effects model, was -0.32 (95% confidence interval: -0.43 to -0.21). CONCLUSIONS: Evidence for an association between bone density and fractures in children is limited. The results from this meta-analysis suggest that there is an association between low bone density and fractures in children. Although there was no evidence of heterogeneity or publication bias, this meta-analysis is based on case-control studies that are prone to bias. Large, well-conducted prospective cohort studies are required to confirm the association between bone density and fractures in children.

Bone Density↗

PubMed1995

Decreased bone density in inflammatory bowel disease is related to corticosteroid use and not disease diagnosis.

Although corticosteroid therapy is associated with the development of osteopenia, it is unclear whether the cause of osteopenia in inflammatory bowel disease (Crohn's disease and ulcerative colitis) is related to corticosteroid therapy or other disease-related variables. Patients with Crohn's disease (a diffuse gastrointestinal disease) could have greater osteopenia than patients with ulcerative colitis because of small bowel disease and secondary malabsorption of calcium and vitamin D. A cross-sectional analysis of consecutive patients with Crohn's disease and ulcerative colitis was undertaken. Bone density was determined by measurements of the L2-L4 spine, the total hip, and Ward's triangle using dual energy X-ray absorptiometry (DXA). A number of clinical parameters were recorded prior to bone density evaluation and analyzed by univariate and subsequently multivariate analysis to determine possible predictors of osteopenia. Of the 26 patients with Crohn's disease, diminished bone density (a Z score of at least -1) was found at the hip in 64% and at the spine in 44%; and of the 23 patients with ulcerative colitis diminished bone density was found at the hip in 43% and at the spine in 48%. Among all the variables tested, only corticosteroid use was a statistically significant predictor of diminished bone density (p = 0.025 for the spine and hip and p = 0.005 for Ward's triangle). Disease diagnosis (Crohn's disease compared with ulcerative colitis) did not predict or correlate with diminished bone density. No obvious associations were seen between the measurements of any serum hormones or biochemistries and bone density, although the patients using corticosteroids had lower serum calcium levels than the nonusers.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗

PubMed2001

Osteoprotegerin and bone density.

Aim of study was determine if a correlation exists between bone mass density and concentration of osteoprotegerin. We examined the group of 199 patients of mean age of 63 years. Of the group under study, 31 patients had normal bone density (T score > -1 and < 1) and 168 probands had osteopenia or osteoporosis (T < -1). Persons with normal BMD values had median values of OPG 60.8 ng/l, while patients with reduced bone density had median values of 73 ng/l OPG. Cut-off for reduction of bone density was 128 ng/l OPG. We demonstrated that OPG concentrations vary inversely with bone density values (correlation coefficient -0.31). These results suggest that determination of OPG could allow discrimination of individuals with normal bone density and those with reduced bone density.

Adult↗

PubMed1996

Short-term effects of high dose oral medroxyprogesterone acetate on bone density in premenopausal women.

Despite the widespread use of the C21 progestin medroxyprogesterone acetate (MPA) in hormone replacement therapy and gynecological practice, its effects on bone density are uncertain, with contradictory reports in the literature. We have examined the short term changes in bone density at the lumbar spine (a predominantly trabecular site) and the femoral neck (a predominantly cortical site) in 13 premanopausal women prescribed high dose MPA (50 mg/day) for gynecological disorders and in 12 control subjects. Compared to basal values, lumbar spine bone mineral density (measured by dual energy x-ray absorptiometry) fell progressively by a mean 2.4% at 6 months and 4.1% at 12 months (both P < 0.01); in five subjects who continued the drug, it had fallen by a mean 5.9% at 20 months (P < 0.002). The spinal bone loss in the MPA users was significantly greater than that in controls (P < 0.005 at 6 months; P < 0.01 at 12 months) and occurred despite a significant gain in body weight in the women using MPA (median, 3.5 kg at 6 months; P < 0.01). In four subjects in whom bone density was measured 6 months after cessation of MPA, spinal bone density showed significant recovery (mean increment, 2.8%; P < 0.025). Femoral neck bone density measurements did not differ between the groups. MPA induced amenorrhea in all subjects who continued with it beyond 6 months, and the amenorrheic subjects were estrogen deficient (median plasma estradiol, 70 pmol/L). We conclude that, when given in doses sufficient to induce hypogonadism, MPA use is associated with significant early loss of trabecular bone, which is probably the consequence of estrogen deficiency.

Administration, Oral↗

PubMed2002

Nicotine and bone density around titanium implants: a histometric study in rabbits.

This study investigated the influence of nicotine on bone density around titanium implants inserted in rabbits. Thirty-two New Zealand rabbits were included. After anesthesia, the tibiae surfaces were exposed and two screw-shaped, commercially available, pure titanium implants of 7.0 mm in length and 3.75 mm in diameter were placed bilaterally. A total of 128 implants were inserted: 64 blasted with Al2O3 particles (group 1) and 64 with a machined surface finish (group 2). The animals were randomly assigned to one of four treatment subgroups, and daily subcutaneous injections of nicotine were administered. After 42 days, the animals were killed and undecalcified sections were prepared. The bone density was measured in the cortical passage of the implant. Statistical analysis (two-way analysis of variance) revealed no significant difference neither regarding the effect of nicotine nor the effect of surface design on bone density around the implants (P > 0.05). Within the limits of the present study, it can be assumed that daily nicotine administration may not statistically influence bone density around titanium implants.

Aluminum Oxide↗

PubMed1999

Association of collagen type 1 alpha1 gene polymorphism with bone density in early childhood.

Osteoporosis is a disease characterized by the development of nontraumatic fractures, most commonly in the vertebrae of elderly women. Approximately 500,000 elderly women in the United States are newly diagnosed with vertebral fractures every year, as the compressive strength of the vertebra, mainly determined by the density of cancellous bone and its cross-sectional area, declines with age. A recent study in women suggested that a polymorphism in the Sp1 binding site of the collagen type I gene (COLIA1) was related to decreased vertebral bone mass and vertebral fractures. Determining the phenotypic trait(s) responsible for this relationship and whether this association is manifested in childhood would further define the structural basis for decreased bone mass and help identify children "at risk" for fractures later in life. We therefore studied the COLIA1 gene polymorphism and measurements of the size and the density of vertebral bone in 109 healthy, prepubertal girls. On average, 22 girls with the Ss genotype and one girl with the ss genotype had 6.7% and 49.4% lower cancellous bone density in the vertebrae than girls with the SS genotype. In contrast, there was no association between the size of the vertebrae and the COLIA1 genotypes.

Aging↗

PubMed2006

Numerical estimation of bone density and elastic constants distribution in a human mandible.

In this paper, we try to predict the distribution of bone density and elastic constants in a human mandible, based on the stress level produced by mastication loads using a mathematical model of bone remodelling. These magnitudes are needed to build finite element models for the simulation of the mandible mechanical behavior. Such a model is intended for use in future studies of the stability of implant-supported dental prostheses. Various models of internal bone remodelling, both phenomenological and more recently mechanobiological, have been developed to determine the relation between bone density and the stress level that bone supports. Among the phenomenological models, there are only a few that are also able to reproduce the level of anisotropy. These latter have been successfully applied to long bones, primarily the femur. One of these models is here applied to the human mandible, whose corpus behaves as a long bone. The results of bone density distribution and level of anisotropy in different parts of the mandible have been compared with various clinical studies, with a reasonable level of agreement.

Bone Density↗

PubMed1992

Fat mass is an important determinant of whole body bone density in premenopausal women but not in men.

We recently reported that total body fat mass is the principal determinant of bone density in normal postmenopausal women. We have now reexamined the relationships among these variables and lean mass in 68 healthy premenopausal women and 51 men. Areal bone density (BMD), fat mass, and lean mass were measured in total body scans by dual-energy, x-ray absorptiometry. In women, BMD was correlated with weight (r = 0.69), fat mass (r = 0.60), and lean mass (r = 0.55). In men, the respective correlations were 0.56, 0.26 (NS), and 0.51. Multiple regression analysis confirmed a codependence of female BMD on fat and lean masses, whereas male BMD was related only to lean mass. Because BMD is an areal not volumetric density, it is dependent on body size. The analysis was therefore repeated using BMD/height as an index of "true" density. Correlations with fat mass were little changed but those with lean mass were reduced (women) or eliminated (men). By multiple regression, female BMD/height was related to fat mass alone, and in men there was a borderline effect of fat (P = 0.05) but none of lean mass. As a second method to exclude a scale artifact, fat mass was expressed as percent body weight. It was related to BMD (r = 0.48) only in women. It is concluded that bone density is closely related to fat mass in premenopausal women, but less so in men. In both sexes, apparent relationships between BMD and lean mass are artifacts attributable to the use of areal density (which is dependent on body size) as a surrogate for volumetric density. The mechanism of this fat-bone density relationship is an important question to be addressed in bone biology.

Adipose Tissue↗

PubMed1998

Alkaline phosphatase levels and osteoprogenitor cell numbers suggest bone formation may contribute to peak bone density differences between two inbred strains of mice.

Previous studies have shown that C3H/HeJ (C3H) mice have higher peak bone density than C57BL/6J (B6) mice, at least in part because of differences in rates of bone resorption. The current studies were intended to examine the alternative, additional hypothesis that the greater bone density in C3H mice might also be a consequence of increased bone formation. To that end, we measured two presumptive, indirect indices of bone formation and osteoblast number in these inbred strains of mice: alkaline phosphatase (ALP) activity in serum, bones, and bone cells; and the number of ALP-positive colony-forming units (CFU) in bone marrow stromal cell cultures. We found that C3H mice had higher serum levels of ALP activity than B6 mice at 6 (118 vs. 100 U/L, p < 0.03) and 32 weeks of age (22.2 vs. 17.2 U/L, p < 0.001). Tibiae from C3H mice also contained higher levels of ALP activity than tibiae from B6 mice at 6 (417 vs. 254 mU/mg protein, p < 0.02) and 14 weeks of age (132 vs. 79 mU/mg protein, p < 0.001), as did monolayer cultures of bone-derived cells from explants of 7.5-week-old C3H calvariae and femora (8.2 times more, p < 0.02, and 4.6 times more, p < 0.001, respectively). Monolayer cell cultures prepared by collagenase digestion of calvariae from newborn and 6-week-old mice also showed similar strain-dependent differences in ALP-specific activity (p < 0.001 for each). Our studies also showed more ALP-positive CFU in bone marrow stromal cell cultures from 8-week-old C3H mice, compared with B6 mice (72.3 vs. 26.1 ALP-positive CFU/culture dish, p < 0.001). A similar result was seen for ALP-positive CFU production at 6 and 14 weeks of age, and the difference was greatest for the CFU that contained the greatest numbers of ALP-positive cells. Because skeletal ALP activity is a product of osteoblasts and has been shown to correlate with rates of bone formation, and because the number of ALP-positive CFU is believed to reflect the number of osteoprogenitor cells, the current data are consistent with the general hypothesis that bone formation may be greater in C3H than B6 mice because of a difference in osteoblast number. Our data further suggest that peak bone density may be greater in C3H mice than B6 mice due to a combination of decreased bone resorption and increased bone formation.

Alkaline Phosphatase↗

PubMed1989

Spinal bone density following spinal fusion.

Spinal bone densities were assessed in 25 patients following lumbar fusion and bracing, in an attempt to study bone remodeling by noninvasive methods. Dual-photon densitometry was used to study specific areas of autologous bone grafts and adjacent vertebrae above the fusion mass. Measurements were made preoperatively and at 6-week intervals postoperatively. The data for the first 12 months postoperatively are reported here. In all patients there was at first a consistent loss in density in the vertebrae above the fusion mass, averaging 15.7%. This was followed by a gradual density increase such that by 1 year postoperatively, in 60% of the subjects, the density of these vertebrae was higher than the preoperative level. In the grafted areas, bone changes were cyclical, demonstrating a remodeling pattern consistent with that described in animal literature for graft healing and also consistent with modern bone remodeling theory. There was a general tendency toward a gradual increase in the density of the fusion mass.

Adult↗

PubMed1996

Quantitative digital subtraction radiography for assessment of bone density changes following periodontal guided tissue regeneration.

OBJECTIVES: The quantitative assessment of alveolar bone density changes in periodontal defects following guided tissue regeneration (GTR). METHODS: Twelve patients with 30 intrabony lesions and 16 furcation defects took part. Standardized radiographic and clinical examinations were carried out immediately before and then 5 and 13 months after surgery. Intra-oral radiographs were evaluated by means of digital subtraction radiography (DSR). Within the subtraction images, a window ('experimental region') was defined covering the visible density changes in the defect area. Background noise was measured by using a similarly sized window ('control region') located in an area not affected by GTR. Bone density changes were quantitatively evaluated by calculation of the mean, standard deviation and maximum and minimum values of the grey-level histogram within these windows. RESULTS: DSR revealed significant bone density gain after GTR in intrabony and furcation defects. While a continuous increase was observed over the 13 month period in intrabony defects, changes in furcation defects occurred mostly in the 5-13 month period. Clinically, a distinct vertical and horizontal attachment gain was found. The correlation coefficients between changes in radiographic density and clinical parameters were low, indicating a difference in the information obtained by the two diagnostic methods. CONCLUSION: Quantitative DSR is a valuable, non-invasive, objective method to obtain information on density changes in intrabony and furcation defects treated by GTR. However, a full assessment of soft and hard tissue changes requires both clinical evaluation and DSR.

Alveolar Bone Loss↗

PubMed1981

Effects of supplementation of the diets with calcium and calcium-rich foods on bone density of elderly females with osteoporosis.

Diets of 20 elderly females with osteoporosis were supplemented daily with 2.25 oz of processed cheese, and 3 capsules of dicalcium phosphate + vitamin D containing 350 mg Ca, 270 mg P, and 399 IU vitamin D, for a 6-month period. The bone density of the 3-2 phalanx was measured densitometrically from the hand x-ray taken with a standard aluminum stepwedge. Fasting blood and urine were analyzed at the beginning and end of the experimental period. The mean bone density increased (p less than 0.05). There were 11 subjects with increased bone density, three with no changes and six with reductions in bone density. Calcium, P, and alkaline phosphatase in serum and Ca/creatinine and P/creatinine in urine were unchanged. The changes in bone density were correlated to the changes in body weight (r = 0.6529). The results suggested that, even with a mean age of 70 yr, some elderly persons can benefit from supplementary Ca and Ca-rich foods to improve bone density.

Aged↗

PubMedDate not supplied

Acceptability of pharmacy-based bone density measurement by women and primary healthcare providers.

OBJECTIVES: To assess women's information sources regarding, and monetary value placed on, pharmacy-based bone density screening. In addition, we evaluated clinicians' response to peripheral bone mass measurements. DESIGN: We recruited 197 women 50 years of age or older in four rural Midwestern community pharmacies. Each woman completed a questionnaire and underwent calcaneal bone density testing. Results were sent to participants' primary care providers. These providers, and others practicing within a 50-mile radius, were surveyed anonymously to evaluate usefulness of bone density data provided by this program or pharmacy-based osteoporosis screening in general. In addition, clinicians were asked how they would manage a woman with a calcaneal T-score of -1.3. RESULTS: Fifty-six percent of participants [95% CI, 49%-63%] became interested in screening through the media, and only 6% (CI, 3%-9%) became interested through contact with their primary care provider. Women were willing to pay a median of $25 for screening. Of 18 responding clinicians with patients in this study, 72% (CI, 47%-90%) found the results useful. Of the 67 responding clinicians, 51% (CI, 39%-63%) supported pharmacy-based bone mass measurement. For a case scenario of a woman with a calcaneal T-score of -1.3, 57% (CI, 46%-68%) of clinicians indicated that they would have ordered central dual-energy x-ray absorptiometry, and 20% (CI, 11%-29%) would have prescribed antiresorptive therapy. CONCLUSIONS: This study suggests that (1) women are an important force in obtaining bone density testing outside the clinic setting, both by self-education and willingness to pay, and (2) primary care clinicians receiving such results find them useful and indicate willingness to use them in decision-making.

Aged↗

PubMed1995

Estimates of volumetric bone density from projectional measurements improve the discriminatory capability of dual X-ray absorptiometry.

To determine whether estimates of volumetric bone density from projectional scans of the lumbar spine have weaker associations with height and weight and stronger associations with prevalent vertebral fractures than standard projectional bone mineral density (BMD) and bone mineral content (BMC), we obtained posteroanterior (PA) dual X-ray absorptiometry (DXA), lateral supine DXA (Hologic QDR 2000), and quantitative computed tomography (QCT, GE 9800 scanner) in 260 postmenopausal women enrolled in two trials of treatment for osteoporosis. In 223 women, all vertebral levels, i.e., L2-L4 in the DXA scan and L1-L3 in the QCT scan, could be evaluated. Fifty-five women were diagnosed as having at least one mild fracture (age 67.9 +/- 6.5 years) and 168 women did not have any fractures (age 62.3 +/- 6.9 years). We derived three estimates of "volumetric bone density" from PA DXA (BMAD, BMAD*, and BMD*) and three from paired PA and lateral DXA (WA BMD, WA BMDHol, and eVBMD). While PA BMC and PA BMD were significantly correlated with height (r = 0.49 and r = 0.28) or weight (r = 0.38 and r = 0.37), QCT and the volumetric bone density estimates from paired PA and lateral scans were not (r = -0.083 to r = 0.050). BMAD, BMAD*, and BMD* correlated with weight but not height. The associations with vertebral fracture were stronger for QCT (odds ratio [QR] = 3.17; 95% confidence interval [CI] = 1.90-5.27), eVBMD (OR = 2.87; CI 1.80-4.57), WA BMDHol (OR = 2.86; CI 1.80-4.55) and WA-BMD (OR = 2.77; CI 1.75-4.39) than for BMAD*/BMD* (OR = 2.03; CI 1.32-3.12), BMAD (OR = 1.68; CI 1.14-2.48), lateral BMD (OR = 1.88; CI 1.28-2.77), standard PA BMD (OR = 1.47; CI 1.02-2.13) or PA BMC (OR = 1.22; CI 0.86-1.74). The areas under the receiver operating characteristic (ROC) curves for QCT and all estimates of volumetric BMD were significantly higher compared with standard PA BMD and PA BMC. We conclude that, like QCT, estimates of volumetric bone density from paired PA and lateral scans are unaffected by height and weight and are more strongly associated with vertebral fracture than standard PA BMD or BMC, or estimates of volumetric density that are solely based on PA DXA scans.

Absorptiometry, Photon↗

PubMed2000

Bone density and metabolism in patients with viral hepatitis and cholestatic liver diseases before and after liver transplantation.

OBJECTIVE: Osteoporosis is frequently found in patients with cholestatic liver disease (primary biliary cirrhosis/primary sclerosing cholangitis) and chronic viral hepatitis. There is limited information about the long-term effect of liver transplantation (OLT) on bone metabolism. The aim of this study was to investigate the effect of liver transplantation on bone metabolism in patients with cholestatic and viral liver diseases. METHODS: We randomly recruited 193 patients with chronic viral hepatitis or cholestatic liver diseases. Bone density (Z-score) and markers of bone metabolism (intact parathyroid hormone [iPTH], PTH 70-84, osteocalcin, procollagen, telopeptide, and vitamin D) were determined before and at time points (< and > 24 months) post-OLT. RESULTS: Before OLT, bone density (Z-score) was decreased in patients with cholestatic (-1) and viral (-0.4) liver diseases. In both groups bone density continued to decrease in the periods up to and more than 24 months after OLT. In the cholestatic group, bone density decreased significantly compared to pre-OLT (p < 0.05) and to the viral hepatitis group (p < 0,001). Markers of bone metabolism showed that after OLT, bone metabolism was enhanced and shifted versus bone resorption. Immunosuppressive drug therapy (glucocorticoids, cyclosporin, FK 506) directly correlated with increased bone metabolism post-OLT. CONCLUSIONS: Bone loss is a long-term problem after OLT, particularly in patients with cholestatic liver diseases. Drug therapy is a main factor of bone loss. Pre- and post-OLT therapy to reduce bone loss is recommended.

Adult↗

PubMed1999

The effects of progressive resistance training on bone density: a review.

Osteoporosis is a major public health problem that is characterized by low bone mass and increased susceptibility to fractures, primarily of the hip, spine, and wrist. It is estimated to cause 1.5 million fractures annually in the United States in people aged 50 yr and older. Physical activity, particularly weight-bearing exercise, is thought to provide the mechanical stimuli or "loading" important for the maintenance and improvement of bone health, whereas physical inactivity has been implicated in bone loss and its associated health costs. Both aerobic and resistance training exercise can provide weight-bearing stimulus to bone, yet research indicates that resistance training may have a more profound site specific effect than aerobic exercise. Over the past 10 years, nearly two dozen cross-sectional and longitudinal studies have shown a direct and positive relationship between the effects of resistance training and bone density. Conversely, a handful of other studies have reported little or no effect on bone density. However, these results may be partially attributable to the study design, intensity and duration of the exercise protocol, and the bone density measurement techniques used. High-intensity resistance training, in contrast to traditional pharmacological and nutritional approaches for improving bone health in older adults, has the added benefit of influencing multiple risk factors for osteoporosis including improved strength and balance and increased muscle mass.

Aged↗

PubMed1997

[The alveolar bone density in rats with experimental diabetes].

The alveolar bone turnover in rat with experimental diabetes was investigated. The serum osteocalcin concentration in diabetic rat was shown to increase as determined by radioimmunoassay; while alveolar and femur bone density decrease as determined by Dual Energy X-ray Bone Densitometer; histological examination showed that bone resorption was increased and bone formation decreased in the alveolar bone in diabetic rat. It is suggested that the alveolar bone in rats with diabetes mellitus have a tendency to develop osteoporosis.

Alveolar Process↗

PubMed1991

Normal bone density of the wrist and spine and increased wrist fractures in girls with Turner's syndrome.

Turner's syndrome is associated with multiple skeletal abnormalities, including osteoporosis. We evaluated the hypothesis that girls with Turner's syndrome may have deficient bone density before the expected age of pubertal onset (9-13 yr) by comparing the bone mineral content of the wrist and lumbar spine in 78 girls with Turner's syndrome (4-13 yr old) and 28 normal prepubertal girls who were matched for age, bone age, body mass index, or height age. The bone mineral content of the wrist and spine was measured by single photon absorptiometry (SPA) and dual photon absorptiometry (DPA), respectively. SPA values for girls with Turner's syndrome vs. normal subjects (4-6.9, 7-9.9, and 10-12.9 yr old) were (mean +/- SD) 0.27 +/- 0.05 vs. 0.36 +/- 0.05, 0.35 +/- 0.06 vs. 0.41 +/- 0.06, and 0.41 +/- 0.05 vs. 0.45 +/- 0.03 g/cm2, respectively. SPA values in the Turner's syndrome girls were decreased compared to those in normal prepubertal girls, matched for age (P less than 0.0001), bone age, (P less than 0.001), and body mass index (BMI; P less than 0.0001), but not for height age. DPA values for girls with Turner's syndrome vs. normal girls in the same age categories were 0.65 +/- 0.06 vs. 0.70 +/- 0.09, 0.77 +/- 0.08 vs. 0.79 +/- 0.09, and 0.83 +/- 0.12 vs. 0.78 +/- 0.07 g/cm2. DPA values in Turner's syndrome girls (as a group) were decreased compared to those in normal prepubertal girls matched for age (P less than 0.05) and BMI (P less than 0.02), but not for bone age or height age. The annual incidence rate of wrist fractures in Turner's syndrome girls (9.1 of 1000) was significantly increased compared to the reported annual incidence rate in normal children (3.5 of 1000; P less than 0.003). We conclude that prepubertal-aged girls with Turner's syndrome (less than 13 yr old) have normal bone density for height age, but significantly decreased bone density of the wrist for chronological age, bone age, and BMI. They also have significantly more wrist fractures than normal girls, but it is not clear that this is related to their bone density.

Absorptiometry, Photon↗