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PubMed1978

Combined cortical thickness and bone density determination by photon absorptiometry.

Bone cortical thickness and density were measured in rat femurs in vitro by a photon absorptiometry technique. A scan perpendicular to the long bone axis using photons from highly collimated 109Cd or 125I sources yielded the bone wall thickness and attenuation at mid-shaft. A second scan after the bone was rotated axially 90 degrees was taken to measure the wall or shaft thickness identically responsible for the mid-shaft attenuation of the first scan. The mid-shaft attenuation of the second scan was due to the bone thickness derived from the first scan; thus two complementary measurements are derived by this technique. The bone density is then directly calculated with an estimated accuracy of 10% (coefficient of variation) using empirically determined mass attenuation coefficients. Measurements of mass attenuation coefficients of ashed and dried samples were compared with calculated coefficients for estimated bone composition. Results indicate that the mass attenuation coefficient for bone in vivo can be well estimated such that bone density can be accurately derived from this technique.

Animals↗

PubMed1992

Axial and appendicular bone density predict fractures in older women.

To determine whether measurement of hip and spine bone mass by dual-energy x-ray absorptiometry (DEXA) predicts fractures in women and to compare the predictive value of DEXA with that of single-photon absorptiometry (SPA) of appendicular sites, we prospectively studied 8134 nonblack women age 65 years and older who had both DEXA and SPA measurements of bone mass. A total of 208 nonspine fractures, including 37 wrist fractures, occurred during the follow-up period, which averaged 0.7 years. The risk of fracture was inversely related to bone density at all measurement sites. After adjusting for age, the relative risks per decrease of 1 standard deviation in bone density for the occurrence of any fracture was 1.40 for measurement at the proximal femur (95% confidence interval 1.20-1.63) and 1.35 (1.15-1.58) for measurement at the spine. Results were similar for all regions of the proximal femur as well as SPA measurements at the calcaneus, distal radius, and proximal radius. None of these measurements was a significantly better predictor of fractures than the others. Furthermore, measurement of the distal radius was not a better predictor of wrist fracture (relative risk 1.64: 95% CI 1.13-2.37) than other sites, such as the lumbar spine (RR 1.56; CI 1.07-2.26), the femoral neck (RR 1.65; CI 1.12-2.41), or the calcaneus (RR 1.83; CI 1.26-2.64). We conclude that the inverse relationship between bone mass and risk of fracture in older women is similar for absorptiometric measurements made at the hip, spine, and appendicular sites.

Absorptiometry, Photon↗

PubMed2004

Adverse effects of antiretroviral therapy: focus on bone density.

Osteopenia and osteoporosis are the most important bone disorders affecting patients with HIV infection. The available data indicate that HIV-infected patients have a high prevalence of low bone mineral density. Reduced bone mass and alterations of bone metabolism have been found in HIV-infected children, adolescents and adults. The variety and complexity of changes in bone metabolism in patients with HIV infection and the different possible mechanisms triggering bone mineral loss, as well as the different stages of disease and cumulative exposure to antiretroviral drugs at the time of clinical evaluation, may contribute to the wide range of mineral loss observed and to the uncertainty of the role of specific antiretroviral medications.

Anti-Retroviral Agents↗

PubMed1997

A 4-year follow-up study of the effects of calcium supplementation on bone density in elderly postmenopausal women.

To determine the long-term effect of calcium supplementation on bone density, 84 elderly women (54-74 years) more than 10 years past the menopause were studied for 4 years as part of a follow-up study of a randomized, double-masked, placebo-controlled trial. The placebo group who did not take calcium supplements at all during the 4-year study (control group, n = 21) served as a comparison with the treated group who took calcium supplements for 4 years (calcium supplement group, n = 14). We also studied subjects who were treated for 2 years with calcium supplements and then ceased taking them (non-compliant group, n = 49). The changes in bone density at the lumbar spine, hip and ankle sites, current calcium intake and activity were monitored. Over the 4 years the calcium supplement group (mean calcium intake 1988 +/- 90 mg/day) did not lose bone at the hip and ankle site. The control group (mean calcium intake 952 +/- 109 mg/day) lost significantly more bone than the calcium supplement group at all sites of the hip and ankle. No overall bone loss was seen at the spine, in either group, over the 4 years of this study. Between years 2 and 4 the non-compliant group (mean calcium intake 981 +/- 75 mg/day) lost significantly more bone at all sites of the ankle than the calcium supplement group. Therefore, calcium supplementation produces a sustained reduction in the rate of loss of bone density at the ankle and hip sites in elderly postmenopausal women. Increasing dietary calcium intake in women should be the aim of a public health campaign.

Aged↗

PubMed1999

Increase of axial and appendicular trabecular and cortical bone density in established osteoporosis with intermittent nasal salmon calcitonin therapy.

The aim of this study was to examine the effect of intranasal administration of salmon calcitonin to a group of 24 postmenopausal women with severe, established osteoporosis (t score < -2.5 SD) and more than one vertebral fracture. The patients were treated with 200 IU of nasal salmon calcitonin daily for 2 months with a subsequent pause of 2 months (3 cycles) and 500 mg calcium daily over a total of 12 months in an open randomized study. The patients were compared with an age matched control group of 18 women of a similar clinical status who were treated with calcium and vitamin D only. In the nasal calcitonin treatment group an increase in the trabecular axial bone density of 2.8% was achieved, as well as increase in trabecular appendicular (forearm) bone density of 1.6%, together with a cortical bone density increase of 1.8% axial and 1% appendicular. Initially, elevated values of urinary deoxypyridinoline were found in 12 women in the nasal calcitonin treatment group; these levels returned to normal under salmon calcitonin nasal therapy and documented the inhibition of increased osteoclastic activity. Cyclic intermittent calcitonin nasal therapy led to a general increase in trabecular and cortical axial and appendicular bone density, marked alleviation of the subjective sensation of pain, and a reduction in the daily dose of accompanying nonsteroidal anti-inflammatory drugs by 50%.

Administration, Intranasal↗

PubMed2004

Type 2 diabetes mellitus is associated with increased axial bone density in men and women from the Hertfordshire Cohort Study: evidence for an indirect effect of insulin resistance?

AIMS/HYPOTHESIS: Previous studies have suggested that the high bone density often observed in type 2 diabetic patients may be explained by insulin resistance. We explored this hypothesis in the Hertfordshire Cohort Study. METHODS: A total of 465 men and 444 women aged 59 to 71 years and with no prior diagnosis of diabetes attended a clinic where a glucose tolerance test was performed and bone density measured at the femoral neck and lumbar spine. Biochemical markers of bone turnover (serum osteocalcin and urinary mean c-terminal cross-linking telopeptide of type II collagen) were measured in 163 men. RESULTS: According to WHO criteria, 83 men and 134 women were diagnosed with impaired glucose tolerance and a further 33 men and 32 women were diagnosed as having type 2 diabetes. Bone density was higher in newly diagnosed diabetic subjects, with relationships stronger in women (p<0.001) than men (p<0.05) and attenuated by adjustment for body mass index. In both sexes, we observed positive correlations between the total femur and femoral neck bone mineral density with measures of insulin resistance (r=0.17-0.22), with stronger results observed in women. These relationships did not apply after adjustment for body mass index. Glucose status did not lead to differences in osteocalcin level or c-terminal cross-linking telopeptide of type II collagen levels. CONCLUSIONS/INTERPRETATION: Our findings suggest that hyperinsulinaemia may affect bone mineral density through indirect effects, e.g. body weight.

Aged↗

PubMedDate not supplied

Low vertebral cancellous bone density in peripubertal girls with Turner's syndrome and boys with hypogonadism.

OBJECTIVE: To characterize the changes of vertebral cancellous bone density in children with hypogonadism. STUDY DESIGN: Quantitative computed tomography (QCT) values of vertebral cancellous bone in 21 girls with Turner's syndrome, 12 boys with hypogonadism, and 46 age-matched controls (24 boys, 22 girls) were studied. The subjects were divided into the following subgroups by the age (year) at the time of the measurement: A. 4-6.9; B. 7-9.9; C. 10-12.9. RESULTS: QCT values for Turner's syndrome vs control girls in the same age groups (A, B, and C) were (mean +/- SD) 226 +/- 36 vs 216 +/- 31 (NS), 193 +/- 29 vs 220 +/- 33 (NS), and 177 +/- 32 vs 217 +/- 17 (p < 0.01) mg/cm3, respectively. Those for boys with hypogonadism vs control boys (A, B, and C) were 236 +/- 15 vs 240 +/- 12 (NS), 187 +/- 21 vs 225 +/- 28 (p < 0.05), and 172 +/- 11 vs 216 +/- 26 (p < 0.0001) mg/cm, respectively. The cross-sectional data for Turner's syndrome and boys with hypogonadism had significant negative correlation with chronological age (r = 0.59; p < 0.001). CONCLUSION: These results showed that vertebral cancellous bone density in children with hypogonadism began to decrease during the peripubertal period in contrast to the constant values in controls, suggesting that a small amount of gonadal steroid in healthy children has an important role in maintaining normal bone density.

Bone Density↗

PubMed1997

Women with past history of bone fracture have low spinal bone density before menopause.

AIMS: Recent work from our laboratory has demonstrated that young girls with bone fractures have low spinal bone density more often than girls who have never fractured. This study was undertaken to determine whether adult women approaching menopause who have any past history of fracture have lower spinal density than women who have never fractured. METHODS: A lifetime fracture history was taken from all premenopausal women (n = 59) enrolled in a clinical trial examining the effect of menopause on cardiac risk. Bone mineral density of the lumbar spine was measured at study entry by dual energy x-ray absorptiometry (Lunar DPX-L) and results from patients with and without fracture were compared. RESULTS: Women with a previous history of fracture (n = 23) had significantly lower bone density (6% less) than the women who had never broken a bone (n = 36). CONCLUSIONS: We conclude that women who report a previous history of fracture, either as young adults or in childhood, should be targeted for perimenopausal screening for osteoporosis since they are likely to have lower bone density and a greater risk of future fracture than women with no past history of fracture.

Absorptiometry, Photon↗

PubMed1992

Bone density, mineral content, and cortical index in patients with thalassemia major and the correlation to their bone fractures, blood transfusions, and treatment with desferrioxamine.

In an attempt to explain the increased frequency of pathological fractures found in thalassemia major patients, we examined noninvasively several properties of bones in 17 patients. We found a significant decrease in the bone mineral content (BMC) and the bone density (BD) of both trabecular (34% and 4% diminution, respectively) and cortical bone (24% and 3% diminution, respectively), as compared with normal controls. We also found that metacarpal cortical indices (CI) were significantly lower in thalassemic patients as compared with normal controls (36% diminution). As expected, upper limb fractures were more frequent in those patients with greater bone diminution. Furthermore, the degree of bone diminution was greater in patients receiving fewer blood transfusions and shorter courses of desferrioxamine. Bone densitometry should probably be included in the comprehensive evaluation of thalassemia patients in order to help guide overall treatment.

Adolescent↗

PubMed2002

Effects of recombinant human IGF-I and oral contraceptive administration on bone density in anorexia nervosa.

Over 90% of women with anorexia nervosa demonstrate osteopenia, and almost 40% demonstrate osteoporosis at one or more skeletal sites. In addition to estrogen deficiency causing an increase in bone resorption, nutritional effects on the GH-IGI-I axis may contribute to the severe bone loss in this population by decreasing bone formation. We tested the hypothesis that recombinant human IGF-I (rhIGF-I) would increase bone density in women with anorexia nervosa and furthermore assessed the effects of combined rhIGF-I and oral contraceptive administration (OCP) in this population. Sixty osteopenic women with Diagnosis and Statistical Manual of Mental Disorders IV Revised confirmed anorexia nervosa [age (25.2 +/- 0.7 yr, range 18-38 yr), body mass index (17.8 +/- 0.3 kg/m(2) ), spinal bone mineral density T score (-2.1 +/- 0.1 SD) were randomized to one of four treatment groups [rhIGF-I (30 microg/kg sc twice daily) and a daily oral contraceptive (Ovcon 35, 35 microg ethinyl estradiol and 0.4 mg norethindrone], rhIGF-I alone (30 microg/kg sc twice daily), oral contraceptive alone, or neither treatment for 9 months. All subjects received calcium 1500 mg/d and a standard multivitamin containing 400 IU of vitamin D. Administration of rhIGF-I was placebo controlled and blinded to subjects. The rhIGF-I was titrated to maintain IGF-I levels within the age-adjusted normal range for each patient and was well tolerated. The effects of rhIGF-I and OCP were analyzed simultaneously among all subjects in a factorial analysis and in an analysis of the four individual treatment groups. Anteroposterior spinal bone density increased significantly in response to rhIGF-I (1.1% +/- 0.5% vs. -0.6% +/- 0.8%, P = 0.05, all rhIGF-I vs. all placebo treated, respectively, by analysis of covariance). In contrast, OCP did not result in increased bone density (0.8% +/- 0.6% vs. -0.4% +/- 0.8%, P = 0.21, all OCP vs. all non-OCP treated, respectively, by analysis of covariance). However, bone density increased to the greatest extent in the combined treatment group (rhIGF-I and OCP), compared with control patients receiving no active therapy (1.8% +/- 0.8% vs. 0.3% +/- 0.6% vs. -0.2% +/- 0.8% vs. -1.0% +/- 1.3%, rhIGF-I and OCP vs. rhIGF-I alone vs. OCP alone vs. no active therapy, P < 0.05 for rhIGF-I and OCP vs. no active therapy). These data demonstrate that osteopenic women with anorexia nervosa treated with rhIGF-I showed more beneficial changes in bone density, compared with patients not treated with rhIGF-I. Antiresorptive therapy with OCP is not sufficient to improve bone density in undernourished patients, but such therapy may augment the effects of rhIGF-I in a combined treatment strategy. Further long-term studies are needed to investigate the effects of rhIGF-I and combined anabolic/antiresorptive strategies on bone in women with anorexia nervosa.

Adult↗

PubMed2003

Impact of disordered puberty on bone density in beta-thalassaemia major.

Reduction of bone density and its associated morbidity is recognized in young adults with beta-thalassaemia major, but the aetiology is not clear. This study used dual X-ray absorptiometry (DXA) to look at bone mineral apparent density (BMAD) in children and young adults with thalassaemia in a predominantly Asian population, in the context of sexual maturation. Fifty-five patients were scanned (mean age 13.8 years, range 5.9-37.5) and BMAD z-scores were calculated using normal data from locally recruited control subjects. Eighteen patients had undergone bone marrow transplantation (BMT) and the remainder were on a transfusion/chelation regimen. BMAD z-scores ranged from -3.3-1.6 with a mean of -0.92. No difference in BMAD was found between those patients treated conventionally and those who had undergone BMT. When comparing mean BMAD z-score according to sexual maturation, there was a highly significant difference (P < 0.0001) between those whose pubertal maturation was age appropriate (mean z-score -0.22), when compared with those who had disordered puberty (mean z-score -1.82). We have shown that failure to progress normally through puberty is highly significant in the failure of adequate bone mineralization and achievement of peak bone mass in thalassaemic patients. The management of these patients should therefore be pro-active to anticipate problems and facilitate normal sexual maturation.

Absorptiometry, Photon↗

PubMed2001

Effects of low-dose continuous combined conjugated estrogens and medroxyprogesterone acetate on menopausal symptoms, body weight, bone density, and metabolism in postmenopausal women.

OBJECTIVE: The purpose of this study was to determine the effects of a low dose of conjugated equine estrogens and medroxyprogesterone acetate plus calcium supplementation on bone density, metabolism, body weight, and symptoms in young postmenopausal women. STUDY DESIGN: Sixty postmenopausal women, aged 45 to 56 years, were randomized in an open-label, 2-year trial that compared treatment with low-dose continuous combined hormone replacement therapy that contained 0.3 mg of conjugated equine estrogens and 2.5 mg of medroxyprogesterone acetate plus 1000 mg of calcium per day or treatment with 1000 mg of calcium per day alone. Menopausal symptoms were evaluated for the first 12 weeks of the study; bleeding profiles, bone mineral density, bone turnover, and body weight were assessed for 24 months. RESULTS: After 24 months, we evaluated 15 subjects in the control group (with a 50% drop-out rate) and 23 patients (with a 23% drop-out rate) in the low-dose continuous combined hormone replacement therapy group. Low-dose continuous combined hormone replacement therapy was effective in reducing menopausal clinical symptoms and provided a favorable bleeding profile and minimal side effects. In comparison with basal values, bone mineral density significantly (P <.05) increased by 2.72% +/- 0.3% in the low-dose continuous combined hormone replacement therapy group and decreased by 7.9% +/- 0.8% (P <.05) in the control group after 24 months, with parallel changes in bone metabolism marker action. In the control group, body mass index significantly (P <.05) increased from baseline value with a weight gain of 3%; in the low-dose continuous combined hormone replacement therapy group, the body mass index did not change after 24 months of treatment, and the 1.3% gain in body weight was not significant. CONCLUSION: Low-dose continuous combined hormone replacement therapy can alleviate subjective symptoms and minimize body transformations that are associated with early menopause and provide an effective protection against the activation of bone turnover and osteoporosis.

Body Weight↗

PubMed1995

Fractures and low axial bone density in perimenopausal women.

The relationship between past fractures and current bone density (BMD) was analyzed in a population sample of 3222 women aged 48-58. BMD was determined with dual X-ray absorptiometry (DXA) at the spine and femoral neck. 702 women reported fractures. Wrist and ankle were the most common fracture sites. Fracture history increased the risk [OR (95% CI)] of low spinal BMD (of more than 1 SD below the study population mean) by 1.75 (1.41; 2.18). The sensitivity and specificity of fracture history to detect a low spinal BMD were 31 and 80%, respectively. One SD decreases of spinal and femoral BMD equalled to respective overall fracture risks (adjusted ORs) of 1.36 (1.24; 1.50) and 1.38 (1.25; 1.51). Both BMDs related more strongly to wrist fracture [1.73 (1.47; 2.05)/1.69 (1.43; 1.99)] than to all nonwrist fractures combined [1.24 (1.11; 1.37)/1.27 (1.14; 1.42)]. Ankle and rib fractures related only to spinal [1.21 (1.00; 1.46)/1.45 (1.12; 1.87)] but tibia and foot bone fractures only to femoral [2.04 (1.37; 3.04)/2.20 (1.42; 3.41)] BMD. Spinal BMD related more strongly to fractures due to falls on same level than to fractures due to all other trauma combined. Fracture history poorly screens out low perimenopausal BMD. The results suggest that pre- and perimenopausal fractures relate to low axial bone density and that the magnitude of this relation depends on the sites of fracture and densitometry as well as on the type of trauma.

Absorptiometry, Photon↗

PubMed2003

Efficacy of alendronate in adults with cystic fibrosis with low bone density.

As adults with cystic fibrosis (CF) have enjoyed incremental increases in longevity over the last few decades, they have also been suffering from low bone density and its clinical manifestations, fractures and kyphosis. We conducted a placebo-controlled, randomized, double-blinded trial of alendronate (10 mg/day orally) (n = 24) compared with placebo (n = 24) for 1 year in 48 patients to improve bone mineral density at the spine as the primary endpoint. All patients received 800 IU of cholecalciferol and 1,000 mg of calcium carbonate. Both groups were similar in age, sex, CF mutations, bone density T scores, renal function, and body mass index at study onset. The alendronate-treated patients gained (mean +/- SD) 4.9 +/- 3.0% and 2.8 +/- 3.2% bone density after 1 year versus placebo, which lost (mean +/- SD) 1.8 +/- 4.0% and 0.7 +/- 4.7%, in spine and femur bone density, respectively (p < or = 0.001 for the spine; p = 0.003 for the femur). Urine N-telopeptide, a bone resorption marker, levels declined in the treatment group more than in the control group (p = 0.002), consistent with the known antiresorptive effects of bisphosphonates. Alendronate was more effective than placebo in improving spine and femur bone mineral density and is a promising agent for the long-term prevention and management of bone disease in patients with CF.

Administration, Oral↗

PubMed2003

Statin use, clinical fracture, and bone density in postmenopausal women: results from the Women's Health Initiative Observational Study.

BACKGROUND: 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) have been shown to stimulate bone formation in laboratory studies, both in vitro and in vivo. While early epidemiologic studies showed lower risk for hip fracture among statin users than nonusers, subsequent studies have produced mixed results. OBJECTIVE: To examine the association of statin use with incidence of hip, lower arm or wrist, and other clinical fractures and with baseline levels of bone density. DESIGN: Prospective study. SETTING: Women's Health Initiative Observational Study conducted in 40 clinical centers in the United States. PARTICIPANTS: 93 716 postmenopausal women ages 50 to 79 years. MEASUREMENTS: Rates of hip, lower arm or wrist, and other clinical fractures were compared among 7846 statin users and 85 870 nonusers over a median follow-up of 3.9 years. In 6442 women enrolled at three clinical centers, baseline levels of total hip, posterior-anterior spine, and total-body bone density measured by using dual-energy x-ray absorptiometry were compared according to statin use. RESULTS: Age-adjusted rates of hip, lower arm or wrist, and other clinical fractures were similar between statin users and nonusers regardless of duration of statin use. The multivariate-adjusted hazard ratios for current statin use were 1.22 (95% CI, 0.83 to 1.81) for hip fracture, 1.04 (CI, 0.85 to 1.27) for lower arm or wrist fracture, and 1.11 (CI, 1.00 to 1.22) for other clinical fracture. Bone density levels did not statistically differ between statin users and nonusers at any skeletal site after adjustment for age, ethnicity, body mass index, and other factors. CONCLUSION: Statin use did not improve fracture risk or bone density in the Women's Health Initiative Observational Study. The cumulative evidence does not warrant use of statins to prevent or treat osteoporosis.

Aged↗

PubMed2003

Effect of distraction rate and consolidation period on bone density following mandibular osteodistraction in rats.

The high cost of large animal protocols has limited the study of distraction osteogenesis (DO) in the craniofacial region. This study was designed to characterise a rat model for DO with regard to distraction rate and consolidation period. Unilateral mandibular distraction was performed on 129 male Sprague-Dawley rats using an osteotomy from the sigmoid notch to the inferior border of mandible. After a 3-day latency, 12 groups of 8-9 rats underwent distraction for 5 days at four different rates (0, 0.2, 0.4, 0.6mm per day), with three different post-osteotomy sacrifice times (10, 24, and 38 days) and four final predicted distraction lengths (0, 1, 2, and 3mm). Another four groups of rats (N=8 per group) were sacrificed 6 days post-osteotomy, resulting in distraction for 3 days with a predicted distraction length of 0, 0.6, 1.2, 1.8mm. Changes in mandibular morphology were measured from radiographs of disarticluated hemimandibles. The bone density of the regenerate and control sites was measured using microdensitometry calibrated with an epoxy stepwedge. Distraction linearly increased mandibular length, distraction gap width and the area of the distraction gap (P<0.00005). Mandibular length increased by 0.394 mm per distraction rate. Gap width and area increased by 0.67 and 5.8mm(2) per distraction rate, respectively. The increase in length represents only 39.4% of what was predicted, suggesting that compensatory alteration in condylar or mandibular morphology may have occurred. This speculation was further supported by the finding that mandibular length, measured without the condylar landmark, was 53.8% of predicted. During DO and early consolidation, the measures of bone density in the regenerates decreased compared to control for all groups. Thereafter, bone density in the regenerates generally increased in all groups until day 24 (P<0.01), obtaining levels that were comparable to the unoperated side. At both rostral and caudal sites adjacent to the osteotomies, measures of bone density were enhanced over control in all groups, with the rostral site also showing significant increases over time in the sham and the highest distraction groups (P<0.008 and P<0.014). We conclude that this rat model for mandibular distraction osteogenesis provides bone density changes that are consistent with those reported using larger animal protocols.

Analysis of Variance↗

PubMed1997

Regional variation in vertebral bone density and trabecular architecture are influenced by osteoarthritic change and osteoporosis.

STUDY DESIGN: The effects of age-related osteoarthritic disease and bone loss on cortical and trabecular bone density in the human spine were analyzed. Changes were quantified by a new method of computed quantitative radiography. Using this method, the relative losses of bone mineral from specific areas and the specific redistribution of bone within vertebrae as a function of age-related bone loss and osteoarthritic change were determined. OBJECTIVES: To quantify the effects of age-related bone loss and osteoarthritic disease on cortical and trabecular density in the human spine by the use of a new method of computed quantitative radiography. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, osteoarthritic and age-related changes resulting in the relative loss of bone mineral from specific areas within vertebrae have never been quantitatively studied. METHODS: Seventy-four vertebrae were obtained from 23 normal, human subjects at autopsy. Vertebral bodies were measured by dual-energy x-ray absorption, and then sectioned for analysis by computerized quantitative radiography. Attention was focused on overall bone density, regional cancellous bone density, and cortical bone density (anterior cortex, superior, and inferior endplates) for both mid-sagittal and para-sagittal sections. One hundred forty sections were so analyzed. RESULTS: Quantitative radiography demonstrated previously undescribed, well defined patterns of cortical and trabecular architecture and bone density within vertebral bodies that were uniform among vertebrae, but strongly influenced by osteoarthritic change and bone loss. These changes were neither detected nor documented by dual-energy x-ray absorption. CONCLUSIONS: Understanding the patterns of bone lose, and knowing how osteoarthritic change affects normal bone loss yields insight into the pathophysiology of the aging process and osteoarthritic disorders. Knowledge of the variations in density and microanatomy within vertebrae may improve techniques of internal fixation and designs of spinal implants, and may help to clarify the pathogenesis of clinical problems such as fractures.

Absorptiometry, Photon↗

PubMed1996

Effects of physiologic growth hormone therapy on bone density and body composition in patients with adult-onset growth hormone deficiency. A randomized, placebo-controlled trial.

BACKGROUND: Patients with adult-onset growth hormone deficiency have reduced bone density and increased fat mass. Growth hormone at high doses may decrease body fat in these patients, but the effects of growth hormone at more physiologic doses on bone density and body composition have not been convincingly shown. OBJECTIVE: To determine whether long-term growth hormone therapy at a dose adjusted to maintain normal insulin-like growth factor 1 (IGF-1) levels has clinical effects in patients with adult-onset growth hormone deficiency. DESIGN: Randomized, placebo-controlled study. SETTING: Tertiary referral center. PATIENTS: 32 men with adult-onset growth hormone deficiency. INTERVENTION: Growth hormone (initial daily dose, 10 micrograms/kg of body weight) or placebo for 18 months. The growth hormone dose was reduced by 25% if IGF-1 levels were elevated. MEASUREMENTS: Body composition and bone mineral density of the lumbar spine, femoral neck, and proximal radius were measured by dual energy x-ray absorptiometry at 6-month intervals. Markers of bone turnover were also measured during the first 12 months of the study. RESULTS: Growth hormone therapy increased bone mineral density in the lumbar spine by a mean (+/- SD) of 5.1% +/- 4.1% and bone mineral density in the femoral neck by 2.4% +/- 3.5%. In the growth hormone group, significant increases were seen in the following markers of bone turnover: osteocalcin (4.4 +/- 3.6 mg/L to 7.2 +/- 4.6 mg/L) and urinary pyridinoline (39.0 +/- 19.8 nmol/mmol of creatinine to 55.7 +/- 25.5 nmol/mmol of creatinine) and deoxypyridinoline (8.4 +/- 7.1 nmol/mmol of creatinine to 14.9 +/- 9.4 nmol/mmol of creatinine). Percentage of body fat in the growth hormone group decreased (from 31.9% +/- 6.5% to 28.3% +/- 7.0%), and lean body mass increased (from 59.0 +/- 8.5 kg to 61.5 +/- 6.9 kg). These changes were significant compared with corresponding changes in the placebo group (P < 0.01 for all comparisons). CONCLUSIONS: Growth hormone administered to men with adult-onset growth hormone deficiency at a dose adjusted according to serum IGF-1 levels increases bone density and stimulates bone turnover, decreases body fat and increases lean mass, and is associated with a low incidence of side effects.

Adult↗