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PubMed1995

Heel ultrasound in women after long-term ERT compared with bone densities in the forearm, spine and hip.

To compare heel ultrasound values with bone densities at different measurement sites as determined by single photon absorptiometry (SPA) and dual-energy X-ray absorptiometry (DXA) in long-term users of estrogen replacement therapy (ERT), we analyzed data from 30 users of estradiol implants (mean duration of treatment 16 years) and 32 non-users, comprising 28 complete age-matched pairs. The precision errors in vivo of ultrasound measurements were 0.18%, 1.3% and 1.5% for speed of sound (SOS), broadband ultrasound attenuation (BUA) and stiffness index, respectively. In the controls, ultrasound parameters correlated well with values from SPA and DXA measurements (r = 0.51-0.63, p < 0.004). In long-term users of ERT, however, measurements with ultrasound did not correlate with DXA in the spine and hip (r = 0.01-0.31, NS) but correlated well with SPA in the forearm (r = 0.47-0.66, p < 0.009). Implant users, compared with non-users, had small and just significantly different values when measured by ultrasound (at most 12%, p = 0.03-0.04) but significantly higher bone mineral densities (18%-25%, p = 0.0001-0.01) in the forearm, spine and hip when measured by SPA or DXA. Data indicated that a substantial proportion of long-term users of estrogen may be non-responders concerning the effect of estrogen on bone qualities expressed in heel ultrasound values. In a multivariate regression analysis the effect of increasing age and increasing treatment duration were both negative for the ultrasound parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗

PubMed1992

Osteoporosis in spinal cord injury: using an index of mobility and its relationship to bone density.

This study was undertaken to improve quantification of the extent of osteoporosis that accompanies spinal cord injuries (SCI) of various types, using single photon densitometry. In this study, we evaluated subjects with complete and incomplete SCI to determine whether there is a correlation between mobility and bone density. We created an index to rank the various levels of mobility among SCI subjects. Mobility index parameters ranged from 1, for complete immobility, to 9, for the full mobility of the uninjured control population. Incomplete SCI subjects (motor and/or sensory) ranked from 2 to 8 on the mobility scale. We also attempted to define clearly the mechanism of osteoporosis in those with predominantly unilateral SCI (Brown-Sequard syndrome). Using single photon absorptiometry (SPA), we found a strong correlation between our mobility index and observed bone density. These observations clearly show that osteoporosis is affected by the subject's level of physical activity. These observations also support the hypothesis that SCI individuals benefit from efforts to maintain a standing posture with some regularity. This effort to improve bone density slows the development of osteoporosis, a process that results in physical impairments in the SCI population.

Absorptiometry, Photon↗

PubMed1998

Cyclical etidronate increases bone density in the spine and hip of postmenopausal women receiving long term corticosteroid treatment. A double blind, randomised placebo controlled study.

OBJECTIVE: To study the effect of cyclic etidronate in secondary prevention of corticosteroid induced osteoporosis. METHODS: A double blind, randomised placebo controlled study comparing cyclic etidronate and placebo during two years in 37 postmenopausal women receiving long term corticosteroid treatment, mainly for polymyalgia rheumatica (40% of the patients) and rheumatoid arthritis (30%). Bone density was measured in the lumbar spine, femoral neck, and femoral trochanter. RESULTS: After two years of treatment there was a significant difference between the groups in mean per cent change from baseline in bone density in the spine in favour of etidronate (p = 0.003). The estimated treatment difference (mean (SD)) was 9.3 (2.1)%. Etidronate increased bone density in the spine (4.9 (2.1)%, p < 0.05) whereas the placebo group lost bone (-2.4 (1.6)%). At the femoral neck there was an estimated difference of 5.3 (2.6)% between the groups (etidronate: 3.6% (1.4)%, p < 0.05, placebo: -2.4 (2.1)%). The estimated difference at the trochanter was 8.2 (3.0) (etidronate: 9.0 (1.5)%, p < 0.0001, placebo: 0.5 (2.3)%). No significant bone loss occurred in the hip in placebo treated patients. CONCLUSIONS: Cyclic etidronate is an effective treatment for postmenopausal women receiving corticosteroid treatment and is well tolerated.

Aged↗

PubMed2002

The relationship between bone density and incident vertebral fracture in men and women.

Bone mineral density (BMD) is an important predictor of future fracture risk in women; however, there are few prospective data in men. The aim of this analysis was to determine whether there are differences in the relationship between BMD and incident vertebral fracture in men and women. Men and women were recruited from population-based registers in 21 European centers. Those recruited were interviewed and had spinal radiographs performed. The radiographs were assessed morphometrically and prevalent vertebral deformity was defined using the McCloskey-Kanis method. Repeat spinal radiographs were performed at a mean of 3.8 years after the baseline radiographs. Incident fractures were defined using a combination of the point prevalence and 20% reduction in vertebral height (plus a 4-mm reduction in absolute height) criteria. BMD measurements were made in a subsample of those recruited. Poisson regression was used to explore the influence of gender, age, prevalent deformity, and BMD on the incidence of vertebral fracture. Thirty-four hundred sixty-one men and women had both paired spinal radiographs and bone density measurements performed. BMD at the spine and femoral neck was higher in men than in women. After adjusting for age, the risk of incident vertebral fracture was greater in women than in men (relative risk [RR] = 2.3; 95% CI, 1.5-3.6) and increased by a factor of 1.4 (95% CI, 1.2-1.8), 1.5 (95% CI, 1.2-1.8), and 1.6 (95% CI, 1.3-1.9) per decrease of 0.1 g/cm2 in BMD at the spine, femoral neck, and trochanter, respectively. After adjusting for BMD at the spine or trochanter, the gender difference in the predicted age-specific incidence of vertebral fracture was no longer significant (RR = 1.1 and 95% CI, 0.6-1.9 at the spine; RR = 1.5 and 95% CI, 0.8-2.7 at the trochanter), although it persisted after adjusting for femoral neck BMD (RR = 1.9; 95% CI, 1.1-3.3). The presence of a prevalent vertebral deformity was a strong risk factor for future vertebral fracture, although the strength of the association was reduced after adjustment for age, sex, and spine BMD. However, adjustment for the presence of a baseline vertebral deformity did not alter the main findings. In conclusion, at a given age and spine (although not femoral neck) bone density, the risk of incident vertebral fracture is similar in men and women. Incident vertebral fractures are more common in women than men because at any age their spine BMD is lower.

Aged↗

PubMed1990

[Lumbar bone density and serum osteocalcin in pre- and postmenopausal women].

The bone mineral density of the lumbar spine (L3) and serum osteocalcin (OC) were measured in 31 pre- and 25 postmenopausal women. Bone density was measured by single energy quantitative computed tomography (QCT value). A significant inverse correlation between the QCT value and age was demonstrated in postmenopausal women but no correlation was found in premenopausal women. Mean QCT value was significantly lower in postmenopausal women than in premenopausal women. Serum OC increases with advancing age and mean serum OC was significantly higher in postmenopausal women than in premenopausal women. A significant inverse correlation between the QCT value and serum OC was demonstrated. These data suggest that there is an association between menopause and accelerated loss of lumbar bone density and that the serum OC level may be useful in evaluating the bone mass.

Adolescent↗

PubMed1988

Femoral bone density measurements by single energy computed tomography related to hip fractures.

We measured bone density in various parts of the femur by using single energy quantitative computed tomography. In the cadaver studies we found significant correlations between the trabecular and cortical bone density and the structural strength of the femur in bending and rotational loading. This was observed in parts of the femur distant from the fracture site in the femoral neck. Good reproducibility of the density measurements was obtained at the condylar level, a site easily accessible for clinical measurements. In a clinical study, we could record post-traumatic osteoporotic changes at 5% precision level.

Absorptiometry, Photon↗

PubMed1987

Bone density, histomorphometry and biochemistry in patients with fractures of the hip or spine.

Bone density in the lumbar spine and distal radius, histomorphometric values of iliac crest biopsies and biochemical parameters, including vitamin D metabolites, were determined in 30 women with recent hip fractures and in 19 women with spinal fragility fractures. In both groups, as compared with age- and sex-matched controls, bone density in the spine and peripheral skeleton was reduced. In the peripheral skeleton the degree of osteopenia in the two groups was equal, but loss of trabecular bone in the spine was disproportionate and more extensive in the group with spinal fragility fractures. In the patients with hip fractures the percentage of trabecular bone occupied by osteoid in the iliac crest biopsies was increased in 11 of the 25 patients. Osteomalacia was further suggested by the lower mean levels of serum calcium and phosphate and lower mean urinary excretion of calcium in this group. In the patients with spinal fractures histomorphometry showed that the osteoid and trabecular resorption surfaces were increased and the relative thickness of the osteoid seams was decreased, indicating increased bone turnover. This evidence was further reinforced by the increased mean serum concentration of 1,25(OH)2D and increased urinary excretion of calcium. The results support the view that these two groups of patients suffer from different forms of osteoporosis.

Adult↗

PubMed1995

Oestrogen and bone density: a comparison of tamoxifen and hypo-oestrogenaemia.

The effect of the anti-oestrogen tamoxifen on bone density in post-menopausal women with stage II breast cancer (n = 35) was compared with two untreated hypo-oestrogenaemic groups (premature ovarian failure, n = 20; prolactinoma, n = 19) and a group of women with prolactinomas and normal oestrogen levels (n = 12). Bone densities were normal in the euoestrogenaemic groups, but significantly reduced in both hypo-oestrogenaemic groups. Repeat measurements were available for 31 of the 35 tamoxifen-treated subjects after an interval of 33.9 +/- 14.7 months. The anti-oestrogen action of tamoxifen was not associated with accelerated bone loss of the spine or hip, an outcome that was clearly demonstrable in hypo-oestrogenaemic disorders.

Adult↗

PubMed2004

Radial bone density and breast cancer risk in white and African-American women.

A number of different models for assessing individual risk of breast cancer use known risk factors such as age, age at menarche, age at first live birth, previous breast biopsies, and family history. High bone mass in white women is also associated with an increased breast cancer risk; however, bone mass as a risk factor has not been studied in African-American women. We conducted a case-control study to evaluate bone mineral density as a risk factor for breast cancer in white and African-American women. We recruited 221 women with newly diagnosed breast cancer from a comprehensive breast cancer center at a large university hospital, and 197 control women who were frequency matched for ethnicity and age. Odds ratios were based on proximal and distal radial bone density measured by peripheral bone densitometry (Norland pDEXA) and expressed as a standardized "Z-score" (age and ethnicity specific). Logistic regression models were fitted controlling for body mass index, menopausal status, age, and HRT use (ever/never and duration). With proximal bone density Z-score included in the model as a continuous variable, a one-unit increase in radial shaft bone density increased the risk of breast cancer by 25% (p=0.02). When proximal bone density Z-score was analyzed as a dichotomous variable (< or = 0, > 0) the odds ratio was 1.98 (95% CI, 1.32 to 2.97); that is, having an above average proximal bone density (age-specific) doubles the risk of breast cancer. There were no significant interactions with, and no appreciable confounding effects by, other covariates. An above-average radial shaft Z-score is a significant risk factor for breast cancer in both white and African-American women. The present study extends the association between bone mass and breast cancer risk to African-Americans, and suggests another potential application for bone density testing.

Black or African American↗

PubMed2000

Evaluation of bone height and bone density by computed tomography and panoramic radiography for implant recipient sites.

The objective was to compare the bone height and bone density measurements of implant recipient sites by panoramic radiography and computed tomography. Thirty-seven sites of 21 patients were evaluated using both panoramic radiography and computed tomography. The bone height was measured as the vertical distance from the alveolar crest to the closest anatomical landmark. Density was compared by means of densitometric measurements. Data was evaluated using paired t-test and Pearson's correlation coefficient analysis. Although bone heights measured with the two imaging modalities differed significantly (p < 0.05), there was a significant correlation between bone density measurements (r = 0.93, p = 0.0). Measurements of bone height as well as bone density was found to be comparable using either radiographic method.

Alveolar Bone Loss↗

PubMed2002

Association of klotho gene polymorphism with bone density and spondylosis of the lumbar spine in postmenopausal women.

Based on the fact that the klotho-deficient mouse exhibits multiple aging phenotypes, including osteopenia and subchondral sclerosis of joints, we explored the possibility of whether human klotho gene polymorphism is associated with two major age-related skeletal disorders: osteoporosis and spondylosis. Analysis of the CA repeat sequence downstream of the final exon of the klotho gene identified ten types of alleles in Japanese postmenopausal women (n = 377). We investigated the association of this microsatellite polymorphism with bone density and spondylosis score of the lumbar spine. None of the genotypes was associated with bone density in the overall population (n = 377; 754 alleles) nor in the subpopulation at not more than 10 years after menopause ( 20 years after menopause (n = 102; 204 alleles, p = 0.024). The type 7 allele was associated with high bone density in women more than 20 years after menopause (p = 0.042). The association study with spondylosis of postmenopausal women (n = 221) revealed that another distinct allele, type 8, was significantly associated with low spondylosis score at L-4/5 (p = 0.019) and L-5/S-1 (p = 0.048) levels in the subpopulation equal to or younger than the average age (<or=63 years old, n = 119; 238 alleles), but not in the older subpopulation. These findings indicate that the klotho gene may be a candidate for the genetic regulation of common age-related diseases like osteoporosis and spondylosis, and we provide the first evidence suggesting that this gene may be involved in the etiology of human diseases.

Adult↗

PubMed1997

Gymnastic training and bone density in pre-adolescent females.

Bone mineral density (BMD) was compared between 7-11-yr-old female gymnasts (GYM: N = 16) with a history of high volume impact loading (minimum of 15 h.wk-1 for past 2 yr) and healthy nonathletic controls (CON: N = 16). Whole body (WB) and regional areal BMD measures were determined by dual energy x-ray absorptiometry (DXA) normalized for height and body mass and also converted to bone mineral apparent density (BMAD). Volumetric BMD and bone cross-sectional areas were also measured by peripheral QCT (pQCT) at the left distal radius. GYM were significantly (P < 0.01) shorter (129.3 +/- 5.7 vs 136.7 +/- 4.4 cm; means +/- SD) and leaner (15.1 +/- 1.9 vs 19.6 +/- 4.3% body fat from DXA), and had significantly (P < 0.05) greater femoral neck (0.698 +/- 0.058 vs 0.648 +/- 0.064 g.cm-2) and trochanter (0.616 +/- 0.060 vs 0.530 +/- 0.084 g.cm-2) areal BMD than CON. GYM also had significantly higher whole body (0.101 +/- 0.009 vs 0.094 +/- 0.007 g.cm-3), femoral neck (0.245 +/- 0.060 vs 0.205 +/- 0.049 g.cm-3) and lumbar spine (0.227 +/- 0.014 vs 0.210 +/- 0.026 g.cm-3) BMAD compared with CON. Height normalized areal BMD measures were also significantly higher at all sites in GYM. Radial total (367.7 +/- 51.6 vs 307.4 +/- 27.6 mg.cm-3), trabecular (207.9 +/- 45.3 vs 163.8 +/- 31.4 mg.cm-3), and cortical (496.9 +/- 67.5 vs 429.8 +/- 33.8 mg.cm-3) BMD were also significantly greater in the GYM compared with the CON. In conclusion, high volume impact loading was associated with greater (compared with controls) whole body and regional bone mineral density in pre-adolescent female gymnasts.

Biomechanical Phenomena↗

PubMed2000

Dual X-ray absorptiometry detects disease- and treatment-related alterations of bone density in prostate cancer patients.

Metastatic bone disease is an important clinical problem which has proven difficult to study because of a lack of noninvasive investigative modalities. Here we show that dual-energy X-ray absorptiometry (DXA) scanning provides clinically useful information about the status of metastatic bone lesions in cancer patients undergoing palliative treatment. In the study group of 21 patients, a significant increase in metastatic bone mineral density (BMD) was confirmed in prostate (n = 14) relative to breast (n = 7) cancer patients. With respect to the prostate cancer cohort, further increases in lesional BMD were evident in all evaluable patients in whom biochemical progression occurred; conversely, lesional BMD declined in patients who had a partial response to therapy. BMD of uninvolved bone decreased with all types of androgen-deprivation therapy regardless of whether patients responded or relapsed. We conclude that BMD changes in both lesional and uninvolved bone are readily detectable in metastatic prostate cancer, and propose that DXA scanning represents a promising new approach to monitoring the natural history and therapeutic course of this disease.

Absorptiometry, Photon↗

PubMed1999

Estrogen receptor gene polymorphism, but not estradiol levels, is related to bone density in healthy adolescent boys: a cross-sectional and longitudinal study.

The purpose of the present study was to investigate the influence of estrogen receptor alpha gene polymorphism and estradiol on height and bone density during and after puberty in males. Using the restriction enzymes XbaI and PvuII, the allelic variants XX, Xx, xx, PP, Pp, and pp were identified in 90 Caucasian boys 16.9+/-0.3 yr of age (mean +/- SD). Bone mineral density (BMD; g/cm2) of the total body, head, femoral neck, and lumbar spine was measured using dual-energy x-ray absorptiometry. Volumetric BMD (vBMD; mg/cm3) was estimated for the spine. The XbaI or PvuII genotypes were not related to the levels of estradiol, and the levels of estradiol were not related to BMD (P > 0.05). The xx allelic variant was associated with a higher spine vBMD than the Xx allelic variant (361 vs. 340 mg/cm3, P = 0.04). In a multivariate analysis including pubertal development, physical activity, and body weight, the XbaI genotype independently predicted total body BMD, head BMD, and spine vBMD (P < 0.05). The PvuII genotype independently predicted spine vBMD (pp > PP, P = 0.01). The 20 boys with the PP allelic variant were found to have a greater body height than the other 70 boys (182 cm vs. 179 cm, P = 0.03). At a 2-yr follow-up the XbaI genotype was still independently related to total body BMD, head BMD, and spine vBMD. In conclusion, estrogen receptor gene polymorphism is related to bone density and height during late puberty and at attainment of peak bone density in young men.

Absorptiometry, Photon↗

PubMed1989

Measurements of bone mass and bone density.

X-ray-based procedures are available to measure bone mineral density in vitro at almost any skeletal site. These bone density measurements are not useful in the diagnosis of the cause of bone loss but at present are the only tests available for assessing bone mass prior to the occurrence of irreversible changes such as fractures or vertebral compression, which are easily recognizable on x-rays. When fractures are present, the severity of the bone loss and the risk for future fractures can be assessed. Repeated measurements permit estimation of the rate of bone loss, which gives useful information for monitoring treatment effect or course of the disease. Measurement of total body calcium is of less clinical importance because of the predominantly trabecular bone loss that generally occurs in metabolic bone disease. Dual-energy x-ray absorptiometry (DEXA) and quantitative computed tomography (QCT) of the spine are of about equal clinical value in the first approach to the patient with metabolic bone disease, although DEXA allows greater variety in sampling sites. For repeated measurements, DEXA provides better precision at significantly lower radiation burden. For bone mineral measurements, the lumbar spine appears to be the most sensitive skeletal site.

Bone Density↗

PubMed1988

Craniomandibular bone density in the primate as assessed by computed tomography.

Ten normal rhesus monkeys, five juvenile and five adult animals, were analyzed for symmetry in bone density across the cranioskeleton with computed tomography (CT). Fifty contiguous axial CT scans were done using 1.5-mm thick scans between the lower mandibular border and inferior orbital ridge, and 3-mm thick scans from the inferior orbital ridge to the rostral level of insertion of the temporalis muscle. Eleven regions comprising areas of the lower mandibular border, lower ramus, upper ramus with condyle, the coronoid process, the zygomatic arch, and cranial bone were analyzed for symmetry using small regions of interest. Only one region, the condyle, demonstrated a statistically significant difference between the two sides with all other measured sites demonstrating the same bone mineral density bilaterally. Large area analysis of five regions--the lower mandibular border, upper ramus with condyle, the coronoid process, the zygomatic arch, and upper cranium--demonstrated no significant difference in the distribution of CT numbers. This analysis of bilateral distribution of bone density in the primate craniofacial skeleton demonstrates a basic symmetry that can be used to study altered patterns of neuromuscular function and their effects on bone density.

Aging↗

PubMed1993

The effect of rheumatoid arthritis and steroid therapy on bone density in postmenopausal women.

OBJECTIVE: To assess bone mineral density (BMD) in postmenopausal women with rheumatoid arthritis (RA) and the relative effects of disease activity, disability, and past and current use of corticosteroids. METHODS: One hundred ninety-five postmenopausal patients with RA were compared with 597 post-menopausal control subjects. Bone density was measured at the lumbar spine and the proximal femur using dual x-ray absorptiometry. Patients were divided into 3 groups according to corticosteroid use, i.e., never users (61%), current users (21%), and ex-users (18%). RESULTS: Compared with controls, the never users had no difference in BMD at the lumbar spine, but a 6.9% reduction at the femur (95% confidence interval [95% CI] 3.4-10.3%). In current users (mean daily prednisolone dosage 6.9 mg), BMD was reduced by 6.5% at the spine (95% CI 0-13.0%) and by 7.4% at the hip (95% CI 1.2-13.6%) compared with never users, after adjustment for age, weight, duration of menopause, and functional disability. Mean BMD was similar in the ex-user and never user groups. Results were confirmed in 54 patients who had whole-body BMD measurements. There were inverse correlations between BMD and Health Assessment Questionnaire scores (femoral BMD r = -0.23, P < 0.01; whole-body BMD r = -0.40, P < 0.01) and between BMD and cumulative steroid dose (femoral BMD r = -0.32, P < 0.01; whole-body BMD r = -0.72, P < 0.01). CONCLUSION: Osteoporosis in postmenopausal women with RA is more evident at the hip than the spine, and the most important determinants of bone loss are disability and cumulative corticosteroid dose. Low-dose steroids cannot be used with complacency, but recovery after discontinuation of use may be possible.

Absorptiometry, Photon↗

PubMed1987

Subclinical hyperthyroidism and reduced bone density as a possible result of prolonged suppression of the pituitary-thyroid axis with L-thyroxine.

Spontaneous hyperthyroidism and that due to excessive administration of thyroid hormone result in osteopenia. Bone density was measured in 28 white premenopausal female patients who were taking commonly prescribed suppressive doses of L-thyroxine (mean dose 0.171 +/- 0.035 g) for five or more years. The thyroxine level was 13.5 +/- 2.6 micrograms/dl (normal 8.0 +/- 2.4 micrograms/dl), the free thyroxine index was 4.4 +/- 1.0 (normal 2.4 +/- 0.8), and the triiodothyronine value was 154 +/- 26 ng/dl (normal 132 +/- 32 ng/dl). Basal thyrotropin was undetectable (less than 0.08 microIU/ml) in 23 patients, and thyrotropin measured 20 minutes after thyrotropin-releasing hormone administration was not demonstrable in 13 patients and subnormal in 10 patients. Women who had taken L-thyroxine for 10 or more years (n = 12, age 37 +/- 4 years) had a 9 percent reduction in bone density (0.667 +/- 0.044 g/cm2, p less than 0.01) compared with normal premenopausal age-matched control subjects (n = 56, age 35 +/- 6 years, bone density 0.733 +/- 0.055 g/cm2). It is concluded that prolonged suppressive L-thyroxine treatment may result in mild subclinical hyperthyroidism with adverse effects on bone. Patients requiring suppression of the pituitary-thyroid axis should be given the smallest dose of L-thyroxine necessary to achieve a satisfactory clinical response.

Adult↗