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High peripheral and axial bone densities in a postmenopausal woman with untreated hypoparathyroidism.

It has been reported that bone density is increased in patients with treated hypoparathyroidism, though it is unclear whether this increase is attributable to the condition itself or to its treatment. We have recently investigated a 70 year old woman with untreated hypoparathyroidism from the time of thyroid surgery at the age of 29 years. Bone mineral content of the non-dominant distal forearm was 3.7 standard deviations above the mean normal value found in 23 healthy volunteers of comparable menopausal age, and was also above the mean normal value found in premenopausal women. The vertebral mineral density of her lumbar spine (measured by quantitative computed tomography) was 3.0 standard deviations above the mean normal value. These findings suggest that high bone density is a feature of hypoparathyroidism per se and that postmenopausal bone loss may be significantly attenuated in this condition.

Aged↗

Associations of parity, breast-feeding, and birth control pills with lumbar spine and femoral neck bone densities.

The relationships between parity, breast-feeding, and the use of birth control pills and the bone densities of the lumbar spine and the femoral neck, measured by dual-photon densitometry, were studied in normal women. Femoral neck density was found to decrease by 1.1% per live-birth, whereas lumbar spine density showed no significant association with parity. Breast-feeding was found to increase lumbar spine density by 1.5% per breast-fed child, whereas femoral neck density was not significantly correlated. No significant relationships between the use of birth control pills and the bone densities were found.

Adult↗

A prospective study of changes in bone turnover and bone density associated with regaining weight in women with anorexia nervosa.

Anorexia nervosa (AN) is a condition of self-induced weight loss, associated with an intense fear of gaining weight. Previous studies have shown that bone density may increase with regaining and maintaining normal weight; however, relatively little is known about the changes in bone metabolism that occur during weight restoration. We describe the effect of weight restoration and maintenance of weight over 1 year on bone mineral density (BMD) and bone turnover. We recruited women from the eating disorders services at the South West London and St George's Mental Health NHS Trust, and the Priory and Charter Nightingale Hospitals in London, UK. Details of their AN, fracture history, menstrual history and exercise were obtained by interview and case note review. Morning samples of blood and second void urine were taken for biochemical analysis. BMD was measured by DXA at the lumbar spine (LS), femoral neck (FN), distal radius (RD) and total body bone mineral content (BMC). Patients then entered the treatment program, which includes re-feeding, dietary education and psychotherapy. Over a period of 42 months, we recruited 55 women who agreed to participate in this study and underwent baseline investigations. Of these, 15 (27%) subjects achieved and then maintained their target weight for the duration of the study. At baseline for all subjects (n=55) estradiol levels were lower than the normal reference ranges (both follicular and luteal phases) in 91% of the women. Bone specific alkaline phosphatase (BSAP) concentrations were lower than the premenopausal reference range in 55% of women, and urinary deoxypyridinoline (DPD) was above the premenopausal reference range in 78% of women. Baseline lumbar spine BMD was positively related to BMI (Pearson's r=0.29, P=0.04) and inversely related to bone turnover markers: urinary DPD (Pearson's r=-0.39, P=0.01 and serum BSAP (Pearson's r=-0.3, P=0.06). The 15 patients who regained and maintained weight were followed-up for a mean duration of 69 weeks (SD 7.3, range 54 to 84 weeks). Mean BMI increased from 14.2 (1.7) to 20.2 (0.77) kg/m2 and remained stable throughout follow-up. Menstruation resumed in 8 of the 15 women. Total body BMC and LS BMD increased significantly over the duration of follow-up (by 4.3% each), but FN BMD and distal radius remained stable. Lumbar spine bone area also increased significantly, whereas FN and distal radius did not. These changes were associated with a significant increase in BSAP (P=0.01), and a non-significant trend for a decrease in DPD (P=0.10). Our findings suggest that when women are at low body weight they are in a hypo-estrogenic state, which is associated with imbalance of bone turnover (high bone resorption and low bone formation). This is reversed with weight gain and persists as target weight is maintained and is associated with increases in BMC and BMD.

Absorptiometry, Photon↗

The influence of cigarette smoke inhalation on bone density. A radiographic study in rats.

The aim of this study was to evaluate the influence of cigarette smoke inhalation (CSI) and its cessation on tibiae bone quality. Forty-one male Wistar rats were randomly assigned to one of the following groups: Group 1--control (n = 14), Group 2--3 months of CSI and 2 months without exposure to CSI (n = 12), and Group 3--5 months of CSI (n = 15). At the end of the experimental period, the animals were sacrificed, the tibiae removed and immediately radiographed for photodensitometric analysis. The results showed that continuous exposure to cigarette smoke promoted a significantly reduced bone density (p < 0.05) (3.22 mm Al eq +/- 0.58; 2.93 mm Al eq +/- 0.45; 1.86 mm Al eq +/- 0.35; for groups 1, 2 and 3, respectively). Similar levels of bone density were observed for the control and cessation groups (groups 1 and 2 - p > 0.05). Thus, within the limits of the present study, it can be concluded that CSI may affect tibiae bone quality, and CSI cessation results in a return towards the level of the control group.

Absorptiometry, Photon↗

Establishing a regional bone density program: lessons from the Manitoba experience.

In 1997, the province of Manitoba, Canada developed a regional bone density program to address concerns related to access, waiting times, and quality assurance. We report our experience with this model of bone density service delivery, which is unique in North America, and confront the challenge of balancing accessibility, clear guidelines, and fiscal responsibility.

Absorptiometry, Photon↗

Elevated parathyroid hormone-related peptide associated with lactation and bone density loss.

OBJECTIVE: To investigate the hypothesis that parathyroid hormone-related peptide (PRHrP) may be involved with bone loss and recovery as a means of providing adequate calcium and phosphate to infants. DESIGN: An 18-month prospective cohort study. SETTING: General community setting with recruitment occurring at birthing education classes. PARTICIPANTS: Volunteer sample of 115 postpartum healthy women aged 20 to 40 years, and 0 or 1 parity prior to parturition with no intent to breast-feed or intent to breast-feed at least 6 months. MAIN OUTCOME MEASURES: Parathyroid hormone-related peptide, prolactin, estradiol, 1,25-dihydroxyvitamin D, 24-hydroxyvitamin D, femoral bone mineral density, and bone turnover markers were measured in 115 postpartum women at 2 weeks, 2 months, 4 months, 6 months, 12 months, and 18 months postpartum. Lumbar bone mineral density was measured at 2 weeks, 6 months, 12 months, and 18 months postpartum. RESULTS: Elevated PTHrP values were significantly associated (P<.001) with breast-feeding status, elevated prolactin levels, and lower serum estradiol levels, conditions occurring during lactation. Furthermore, elevated PTHrP levels were negatively and significantly associated (P<.01) over time with bone mineral density change at both the spine and the femoral neck, even after accounting for prolactin levels, breast-feeding status, return of menstruation, estradiol levels, PTH levels, 1,25-dihydroxyvitamin D levels, dietary calcium intake, physical activity, and body size. CONCLUSION: These data clearly support the hypothesis that PTHrP is an alternative mechanism associated with bone loss and recovery during and subsequent to lactation.

Absorptiometry, Photon↗

Body composition characteristics are associated with the bone density of the proximal femur end in middle- and old-aged women and men.

OBJECTIVES: In the present study the associations between bone density of the proximal femur end and weight status, fat distribution patterns (FDI) and body composition parameters i.e. amount of body fat and lean body mass were tested in a sample of old aged women and men. METHODS: In 77 healthy women ranging in age from 60 to 92 years (x=71.8 years) and 62 healthy men ranging in age from 60 to 86 years (x=71.5 years) the bone mineral density (BMD of the proximal femur end and the body composition parameters absolute fat mass, relative fat mass, lean body mass and bone mineral content were estimated by dual energy X-ray absorptiometry. Additionally, the weight status (body mass index, BMI) and the FDI were calculated. The bone density of the proximal femur end was correlated with the absolute fat mass and the lean body mass as well as with the BMI and the FDI. RESULTS: BMD correlated in females significantly positively with parameters of body composition, in males no significant correlations between fat mass (absolute and relative) and BMD as well as BMD/stature was found. Furthermore, it was shown that the weight status (BMI; r(2)=0.13, P<0.0003 in males and r(2)=0.27, P<0.000 in females), and the lean body mass (r(2)=0.21, P<0.001 in males, r(2)=0.36, P<0.004 in females) were associated significantly positively with the BMD of the proximal femur end in both sexes. The absolute fat mass had a significant impact on BMD in the female subsample only (r(2)=0.24, P<0.000). CONCLUSIONS: A lower weight status and a low amount of lean body mass, indicating not only lack of biomechanical forces of the proximal femur end, but also a lack of physical activity can be assumed to be associated increased bone loss and the development of osteoporosis in both sexes. An association between low amount of fat tissue and decreased BMD was especially found in women and may be due to the reduced conversion rates from androgens to estrogens in a low amount of fat tissue.

Absorptiometry, Photon↗

Peripheral and axial measurements of trabecular bone density in patients suspected of idiopathic vertebral osteoporosis.

In 18 patients with idiopathic crush fracture syndrome, iliac trabecular bone volume measured in 8 mm trephine biopsies correlated well with trabecular bone density as estimated in low thoracic or high lumbar vertebrae by computed tomography (CT). The CT of trabecular bone in the radius correlated poorly with the other two measurements, but it discriminated fairly well between patients and age-matched controls. These results suggest that abnormally low trabecular bone density values in the radius may be useful in predicting some patients at risk for crush fractures, but ranking patients in order of severity of axial bone loss after they have acquired a fracture requires measurements on the spine or iliac crest.

Aged↗

[The value of the Kapandji-Sauvé procedure with considering clinical results and measurement of bone density. A clinical study].

Between 1989 and 1995, 33 patients were treated with a Kapandji-Sauvé procedure for malunited fracture of the distal radius and instabilities of the distal radioulnar joint. Thirty patients were followed up with a mean follow-up time of 91 months. Fourteen patients underwent a measurement of bone density of the distal forearm. Twenty-eight patients showed good ossification of the distal radioulnar arthrodesis. Forearm rotation improved by 17.3 %. Mean grip strength was 72 % of that of the contralateral hand. Evaluation by the Cooney score resulted in 10 % very good, in 65 % good, 22 % fair and in 3 % poor results. The measurement of bone density of the distal radius showed an increase of rotation and flexure firmness. The cortical density remained constant. In the subcortical bone of the distal radius, we found a decrease of the trabecular density in the radial part.

Adult↗

Lack of effect of gallium nitrate on bone density in a rat model of simulated microgravity.

The effect of gallium (Ga) nitrate upon bone density was studied in 24 male Sprague-Dawley rats (275-335 g) in an established model of simulated microgravity. Rats, tail-suspended for 14 d from a system of double pulleys, were allowed free mobility with their hind limbs unloaded. Animals were randomized into four groups of six: 1) unsuspended, saline; 2) suspended, saline; 3) unsuspended, Ga; and 4) suspended, Ga. On day 0, 1 d prior to suspension, rats received equal volumes of a single subcutaneous injection of either saline or 30 mg/kg of elemental Ga in the form of Ga nitrate. On day 15, all animals were euthanized under anesthesia, and their hind limbs analyzed in vitro using single-photon absorptiometry. Although we previously demonstrated that Ga inhibits bone resorption in patients with Paget's disease of bone, and although Ga exhibits many apparent similarities in efficacy to diphosphonates, which prevent bone loss in ovariectomized, paralyzed, and single-limb immobilized rats, Ga failed to prevent bone loss in the tail-suspended rats.

Animals↗