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Appendicular bone density, biochemical markers of bone turnover and lifestyle factors in female teachers of Southern Italy.
The present study was designed to investigate relationships between urinary free pyridinolines (F-Pyr), serum osteocalcin (OC) and appendicular bone mineral density (BMD). Furthermore, possible correlations between such variables and putative risk factors for low bone density were also analysed. We were not able to find any relationships between biochemical markers of bone turnover and appendicular BMD or putative risk factors for osteoporosis at multivariate analysis. Multivariate analysis showed a significant decrease of BMD when age increases (p < 0.001), with menopause and time since menopause (p < 0.001), while number of pregnancies (p = 0.018) was associated with a higher value of BMD. Age, menopause and time since menopause were significantly associated with urinary excretion of F-Pyr. Indeed age was an inverse effect modifier of the relationship between urinary excretion of F-Pyr and time since menopause.
I-125 photon absorptiometric analysis of bone density in patients with regular dialysis treatment.
The density of bone in the distal third of the radius is measured by I-125 photon absorptiometry in 38 RDT (Regular Dialysis Treatment) patients (19 mean and 19 women, age range from 17 to 65 years). In the majority of patients the bone density (BMC/W) is reduced. The clinical follow-up of dialysis patients demonstrates that the incidence and severity of clinical symtpoms do not always correlate closely with the bone density values, nor with the biochemistry and histopathological findings of bone disease associated with dialysis. Despite control of calcium and phosphorus metabolism, decreased mineralization of the appendicular skeleton persists. The advantages as well as disadvantages of bone density measurements in RDT patients are discussed.
Bone density and markers of bone turnover in predicting fracture risk and how changes in these measures predict fracture risk reduction.
Surrogate markers in clinical medicine provide a useful means to assess therapeutic response to pharmacologic therapy in a wide range of chronic disease states. In the area of osteoporosis, the surrogate markers of change in bone mineral density (BMD) and bone turnover markers (BTM) provide the clinician with a means of assessing the biologic response to osteoporosis-specific pharmacologic agents. Increases in BMD and/or reductions in BTM can independently be correlated to reductions in vertebral and nonvertebral fracture risk. In managing osteoporosis patients, the BTM change at an earlier point of time after initiation of therapy and a change in BTM can provide earlier feed-back to the patient and clinician regarding issues such as compliance and a bone biologic response. An increase in BMD at 12 or 24 months after initiation of therapy is also evidence of an improvement in bone strength though with antiresorptive agents no change in BMD may also be associated with risk reduction within clinical trial sets. In this regard, changes in BMD and BTM are complimentary in their application to patient management.
Photon absorptiometric analysis of bone density in primary hyperparathyroidism.
The density of bone in the distal third of the radius was measured in 13 men and 17 women with primary hyperparathyroidism. The bone density was significantly reduced (as compared to age-matched controls) in 7 of 11 postmenopausal women. However, it was reduced in only 2 of 13 men and in 1 of 6 premenopausal women. Thus, most of the postmenopausal women with primary hyperparathyroidism had low bone density, whereas most men and premenopausal women with this condition had normal bone density. The results support the conclusion that oestrogen deficiency may contribute to the development of bone disease by sensitising bone to the action of parathyroid hormone.
I was prescribed alendronate (Fosamax) for bone loss a year ago, when I was 55. I just got the results of my recent bone density scan and I'm puzzled by the results. Why would it show a good improvement in the spine but no so much on my hip? How long do I have to wait to see results on my bone density?
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Prediction of fracture risk. I: Bone density.
Low bone mass is the most important and individually objective predictor of osteoporotic fragility fracture risk. The challenge to the clinicians who care for patients with low bone mass is to identify those who are asymptomatic and nonfractured by using a bone mass measurement technique to make a diagnosis and decide on the level of intervention. All bone mass measurement techniques have value and limitations, necessitating careful individual clinical interpretation to avoid a misdiagnosis of osteoporosis or an erroneous interpretation of serial changes in bone mass. The inverse relationship between low bone mass and increasing fracture risk needs to be carefully interpreted because this relationship has only been determined in patients with a mean age of 65 years. It is not the same in younger, perimenopausal patients. Increasing age is a strong, independent risk factor for fragility fracture. In patients older than 70 years the curves relating fracture risk to low bone mass density become exponential when more than 3.0 standard deviations below peak adult bone mass. The assessment of this relationship is a professional activity and needs clinical input from appropriately educated physicians.
Increased trabecular bone density due to bone-loading exercises in postmenopausal osteoporotic women.
A program of diverse and dynamic loading exercises of the distal forearm, a common site of osteoporotic fractures, was applied three times a week for 5 months to 14 postmenopausal osteoporotic women. Two parameters were used to assess the effect of the exercises on bone mass. The mass density of bone (g/cm3) was measured by the Compton scattering technique. The bone mineral content (g/cm2) was measured by single photon absorptiometry. Both measurements were taken at the same location in the distal radius 1 year prior to the exercise period, at its beginning, and at its end, in both the exercised group and a matched control group of 26 osteoporotic women. During the exercise period the mean bone density decreased by 1.9% in the control group whereas it increased by 3.8% in the exercise group. The bone mineral content results did not demonstrate any significant trend over the whole period of the study. It is concluded that the trabecular bone tissue in the distal radius of postmenopausal osteoporotic women responds favorably to dynamic and diverse bone stressing exercises even in the seventh decade of life.
Bone density and dietary findings of 409 Tennessee subjects. 1. Bone density considerations.
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[Cross sectional study of the relationship between bone density to diet and life style using ultrasound bone densitometry].
The relationship between bone density to diet and life style was investigated in pre- and postmenopausal women in Kyoto Prefecture in 1994 by a cross-sectional study. Bone densities of 453 women aged 30-86 years were measured by ultrasound bone densitometry. History of pregnancy and delivery, menstruation, medical history, bone and arthral symptoms, life style, food intake frequency, current and past intake of dairy products, and physical activity were examined by self-administered questionnaire. Analysis of covariance and multiple-regression analysis were performed to determine the relation between bone density and life style adjusted for age and obesity index among 151 premenopausal women (PRE), 244 postmenopausal but not sedentary (under 65 years of age) women (POST), and 58 sedentary (older than 65 years of age) women (SED). The results were as follows; 1) A marked age-related decline in bone density was observed at 45-55 years of age. The correlation coefficient between age and bone density was significant at -0.65 (p < 0.01). 2) Obesity index and bone density were positively correlated in each group. 3) Among the PRE group women, there was no relation between life style and bone density. Those who experienced bone fractures tended toward low bone density. Among the POST group, time since menopause, exercise, and current milk intake were significantly correlated with bone density. In the SED group, women with arthralgia showed significantly lower densities. 4) From multiple-regression analysis, age, obesity index, and milk intake during childhood were shown to be related to bone density in each group.
Targeted disruption of cadherin-11 leads to a reduction in bone density in calvaria and long bone metaphyses.
The migration and adhesion of osteoblasts requires several classical cadherins. Cadherin-11, one of the classical cadherins, was expressed in mouse osteoblasts in skull bone and femur, revealed by immunohistochemistry. To elucidate the function of cadherin-11 in osteoblastogenesis, cadherin-11 null mutant mice were investigated. Although apparently normal at birth, Alizarin red staining of null mutant mice showed a reduced calcified area at the frontal suture that caused a round-shaped calvaria with increasing animal age to 3 months. Consequently, there was a reduction in bone density at the femoral metaphyses and the diploë of calvaria in null mutant mice. In the in vitro culture of newborn calvarial cells, the calcified area of mutant cells was smaller than those derived from wild-type littermates. These results show that absence of cadherin-11 leads to reduced bone density in some parts of skeletons including calvaria and long bone metaphyses, and thus suggest that cadherin-11 plays roles in the regulation of osteoblast differentiation and in the mineralization of the osteoid matrix.
[Vertebral bone density and its correlation with various factors related to bone metabolism in alcoholics: a quantitative study by computed tomography].
We measured vertebral bone density of 59 male alcoholics (ALC) using quantitative computed tomography (QCT). Bone density of ALC was decreased measured on admission compared with age-matched healthy male controls (ALC: 144 +/- 42, CONTROLS: 173 +/- 34 mg/cm3, p less than 0.05). The bone density was not correlated with serum ALP, Ca, and Pi. Serum parathyroid hormone and calcitonin were also not correlated with the bone density in ALC. Serum 25-(OH)-D showed significant positive correlation with the bone density (p less than 0.01) and 1,25-(OH)2-D showed trend of positive correlation with the bone density (p less than 0.01) in ALC. Severity of liver diseases did not have any relation to the bone density in ALC. Although the decreased bone density was not improved at the second QCT examined about 10 weeks after first QCT without medication, patients administered 1 microgram of 1 alpha-(OH)-D3 daily showed a significant increase in the bone density (on admission: 152 +/- 37, 10 weeks later: 162 +/- 35 mg/cm3, p less than 0.02). Combination therapy of 1 alpha-(OH)-D3 and calcitonin did not increase the bone density. These results indicate that bone density was decreased in ALC and a decrease in serum vitamin D metabolites may cause a decrease in the bone density, although liver dysfunction does not have a role in it. These data also suggest that 1 alpha-(OH)-D3 is effective in an increase in the bone density in ALC with osteoporosis after abstinence.
Comparison of the radiographic vertebral trabecular pattern with the vertebral fracture prevalence and spinal bone density.
Spinal bone densitometry allows accurate and precise measurement of the severity of bone loss. Where densitometry is not yet available medical practitioners have to continue to rely on clinical radiography. Since the grey levels of the radiographic image are highly inaccurate we studied the radiographic vertebral trabecular pattern for its suitability as a semiquantitative assessment of vertebral bone loss. We defined four vertebral trabecular pattern indices (VTPI 4 = normal, VTPI 1 = severe bone loss) and tested these for correlations with the prevalence of vertebral fractures, and with spinal and hip bone mineral density measured by dual-energy X-ray absorptiometry (DXA). We found negative correlations between VTPI and the percentage of patients with vertebral fractures (p = 0.0001), between VTPI and the number of vertebral fractures per patient (r = 0.606, p = 0.001) and between VTPI and the severity of vertebral fractures, and a positive correlation between VTPI and spinal (r2 = 0.556, p = 0.0001) and hip DXA values (r2 = 0.315, p = 0.0001). We conclude that the vertebral trabecular pattern index can be used to assess the severity of spinal bone loss when a bone densitometer is not available.
The impact of degenerative spinal changes on the correlation of peripheral and axial bone density.
Results of bone density measurements by quantitative computed tomography of the peripheral skeleton (pQCT) were compared with those of measurements at the axial skeleton with a view to study the effects of degenerative spinal changes on the validity of bone densitometry of the lumbar spine. 556 consecutive patients were examined by dual-energy x-ray absorptiometry (DXA) of the spine and by peripheral quantitative computed tomography (pQCT) of the distal radius. There were significant differences between the bone mineral values at the distal radius and those at the spine, depending on the degree of spinal degeneration. As expected, spinal degenerations showed a highly significant age dependence. With increasing degeneration the correlations between the radius total bone mineral concentration and the bone density of the lumbar spine decreased from r = 0.45 to 0.23 in women and from r = 0.64 to 0.28 in men. We conclude that the value of spinal DXA is reduced in patients with degenerative spinal disease, compared to the pQCT at the peripheral skeleton.
Bone density and markers of bone remodeling in type 1 male diabetic patients.
AIMS: To assess the prevalence and severity of bone disease in type 1 diabetic patients and to determine serum markers of bone remodeling as well as their relationship with bone mineral density (BMD). METHODS: BMD [by dual energy x-ray absorptiometry (DXA)] and serum markers of bone remodeling [osteocalcin, c-terminal telopeptide of type I collagen (CTX)], leptin and osteoprotegerin (OPG) were measured in 42 adult males with type 1 diabetes. Twenty-four non-diabetic subjects served as controls. RESULTS: In 40% of the patients, osteopenia at the lumbar spine (L1-L4) and/or at the left hip was found, and 7% met criteria for osteoporosis. L1-L4 BMD z-score was correlated with age (r=0.365, P=0.018) and a similar trend was observed at left hip. L1-L4 BMD z-score was negatively correlated with CTX and osteocalcin (r=-0.343, P=0.028; r=-0.376, P=0.024, respectively). A significant correlation was evidenced between BMD z-score at both lumbar spine and left hip and leptin values (r=0.343, P=0.03; r=0.395, P=0.012, respectively) but after adjustment for weight this correlation was no longer significant. Osteocalcin, CTX and leptin concentrations were comparable between patients and controls, while OPG concentrations tend to be higher in diabetic subjects (P=0.08). CTX was negatively correlated with age (r=-0.390, P=0.012) and positively correlated with osteocalcin (r=0.696, P<0.001). OPG was positively correlated with age (r=0.507, P=0.001). CONCLUSION: Our results suggest that in diabetic subjects osteopenia is a relatively frequent complication but bone loss is attenuated with age progression. Whether this is also mediated by OPG and/or leptin remains to be confirmed.
Bone density comparison of selected carpal and tarsal bones: validation for their use in compression fracture fixation studies of scaphoid screws.
INTRODUCTION: To determine if trabecular, total and cortical bone densities of the capitate, navicular, cuboid, and first cuneiform were equivalent to those of the scaphoid, such that these bones could be used in place of the scaphoid in evaluating new headless scaphoid compression screws. METHODS: Fifty scaphoids, capitates, naviculars, cuboids, and first cuneiforms were harvested from fresh frozen cadavers. The trabecular, total and cortical bone densities were measured using pQCT technology and statistically compared. RESULTS: A paired t comparison between paired scaphoids and capitates showed no difference between the trabecular bone densities. However, their total bone and cortical densities were found to be different. An independent measures ANOVA comparison of the five bones, showed no significant difference in mean trabecular density between the capitates, naviculars and first cuneiforms when compared to the scaphoids. However, the mean total and cortical densities of the first cuneiforms were less than the scaphoids and the mean trabecular, total and cortical bone densities of the cuboids were all less than the scaphoids. DISCUSSION: Compression fracture fixation studies of headless compression screws could be conducted using the capitate, navicular, and first cuneiform as models of the scaphoid when the supply of scaphoids is limited.
Sequential changes in bone density before and after parathyroidectomy in primary hyperparathyroidism.
Bone density (bone mineral content/bone width) was determined by iodine-125 (125I)-photon absorptiometry in the distal third of the radius before and after successful parathyroidectomy in 37 patients with primary hyperparathyroidism. Bone density progressively declined during the two years immediately preceding surgery. It rose by 6.4% during the first year following surgery but remained stable thereafter. The results suggest that photon absorptiometry analysis of bone density may disclose continuing bone loss before surgery and may show a partial recovery of bone loss that may ensue after successful parathyroidectomy.
[Bone density of spongiosa and cortical bone of the lumbar spine. Relations to sex, age and spinal deformities in a regional collective of the European Study of Vertebral Osteoporosis (EVOS)].
BACKGROUND AND METHOD: In an additional bone density measurement protocol to the European Vertebral Osteoporosis Study (EVOS) separate spongious and cortical density measurements (sQCT) were carried out at the first 3 lumbar vertebrae in 293 volunteers (92 men and 201 women) in 3 Berlin regional centers. RESULTS: The spongious mineral density decreases from proximal to distal (L1 to L3), the cortical density increases from proximal to distal, mainly in men. Men showed no significant decrease of cortical density and a lower decrease of spongious density with age compared to women. A comparison of bone mineral density with vertebral height indices of McCloskey/Kanis, Eastell/Melton and Felsenberg showed significant differences of spongious density between a group with normal vertebral height and a group with at least one pathologically degraded vertebra. Individuals with osteoporosis according to the WHO-definition showed a higher prevalence of vertebral deformities. No significant loss of cortical density was observed in these people.