CiteULike: Tag bmd

Predictors of low bone mineral density in the elderly: the role of dietary intake, nutritional status and sarcopenia

A Coin — 2007-07-18T23:15:07-00:00

European Journal of Clinical Nutrition, Vol. aop, No. current.

The relationship between body composition and bone mineral content: threshold effects in a racially and ethnically diverse group of men.

TG Travison — 2008-06-26T15:30:31-00:00

Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, Vol. 19, No. 1. (January 2008), pp. 29-38.

We examined BMC and body composition in 1,209 black, Hispanic, and white men. Weight, BMI, waist circumference, and fat mass were associated with BMC only up to certain thresholds, whereas lean mass exhibited more consistent associations. The protective influence of increased weight appears to be driven by lean mass. INTRODUCTION: Reduced body size is associated with decreased bone mass and increased fracture risk, but associations in men and racially/ethnically diverse populations remain understudied. We examined bone mineral content (BMC) at the hip, spine, and forearm as a function of body weight, body mass index (BMI), waist circumference, fat mass (FM), and nonbone lean mass (LM). METHODS: The design was cross-sectional; 363 non-Hispanic black, 397 Hispanic, and 449 non-Hispanic white residents of greater Boston participated (N = 1,209, ages 30-79 y). BMC, LM, and FM were measured by DXA. Multiple linear regression was used to describe associations. RESULTS: Weight, BMI, waist circumference, and FM were associated with BMC only up to certain thresholds. LM, by contrast, displayed strong and consistent associations; in multivariate models, femoral neck BMC exhibited a 13% increase per 10 kg cross-sectional increase in LM. In models controlling for LM, positive associations between BMC and other body composition measures were eliminated. Results did not vary by race/ethnicity. CONCLUSIONS: The protective effect of increased body size in maintaining bone mass is likely due to the influence of lean tissue. These results suggest that maintenance of lean mass is the most promising strategy in maintaining bone health with advancing age.

Association of a common polymorphism in the methylenetetrahydrofolate reductase (MTHFR) gene with bone phenotypes depends on plasma folate status.

RR McLean — 2008-06-20T13:39:44-00:00

Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, Vol. 19, No. 3. (March 2004), pp. 410-418.

A study of a polymorphism in the MTHFR gene, plasma folate, and bone phenotypes in 1632 individuals revealed that the genotype effect on BMD and quantitative ultrasound was dependent on the level of folate. Our findings support the hypothesis that the association between an MTHFR polymorphism and bone phenotypes depends on folate status. INTRODUCTION: Genome-wide screens using quantitative ultrasound (QUS) and BMD phenotypes have shown suggestive linkage on chromosome 1pter-1p36.3, a region containing the methylenetetrahydrofolate reductase (MTHFR) gene. Individuals homozygous (TT) for the MTHFR C677T polymorphism who have low plasma folate concentrations exhibit elevated plasma homocysteine (tHcy) concentrations that may compromise bone quality. We hypothesized that folate status might modify an association between the C677T polymorphism and bone, possibly by influencing homocysteine concentrations. MATERIALS AND METHODS: QUS (broadband ultrasound attenuation [BUA], speed of sound, and quantitative ultrasound index) of the heel and BMD of the hip and spine were measured in 1632 male and female members of the Framingham Offspring Study (1996-2001). Participants were assessed for plasma folate concentration and genotyped for the MTHFR C677T polymorphism. TT participants were compared with individuals in the CC + CT group using analysis of covariance. RESULTS: Adjusted mean QUS and BMD measures did not differ between C677T groups. Although all participants with plasma folate concentrations > or =4 ng/ml had approximately 2% higher QUS and BMD than those with folate <4 ng/ml, the association disappeared after controlling for tHcy. Suggestive interactions between folate status and the C677T group (CC + CT versus TT) were found for hip BMD (p < or = 0.05) and BUA (p = 0.11). Compared with CC + CT participants, TT individuals had lower mean BUA (p = 0.06) and Ward's area BMD (p = 0.08) within the folate <4 ng/ml group and significantly higher hip BMD (p < or = 0.05) within the folate > or =4 ng/ml group. For both folate groups, TT participants had higher age-adjusted mean plasma tHcy versus CC + CT participants. Controlling for tHcy in these models did not affect the statistical significance of the interaction effects. CONCLUSIONS: Our findings support the hypothesis that the association between the C677T MTHFR polymorphism and bone phenotypes depends on folate status. The mechanism mediating the association, however, remains unclear, but may be partially caused by homocysteine effects on bone.

B vitamins, homocysteine, and bone disease: epidemiology and pathophysiology.

RR McLean — 2008-06-20T13:31:00-00:00

Current osteoporosis reports, Vol. 5, No. 3. (September 2007), pp. 112-119.

Observational studies indicate that mildly elevated homocysteine is a strong risk factor for osteoporotic fracture, yet there is no clear biologic mechanism for an effect of homocysteine on bone. The association could instead be attributed to B vitamins (folate, vitamin B(12), vitamin B(6)), as low levels of these nutrients are the primary determinants of homocysteine and may be associated with lower bone quality. Discovery of a direct effect of homocysteine or B vitamins on bone would be important in terms of interventions, as these factors can be modified with changes in diet or supplementation. This article reviews the connections of homocysteine and B vitamins to measures of bone quality and osteoporotic fracture. Although the literature suggests that these factors may be associated with bone health, most of the epidemiologic studies are observational, limiting conclusions regarding causality. More controlled -trials are needed to determine whether treatment with B vitamins would reduce fracture rates among community-dwelling cohorts.

Serum 25-Hydroxyvitamin D and Bone Mineral Density in a Racially and Ethnically Diverse Group of Men

Marian Hannan — 2008-01-10T23:20:03-00:00

J Clin Endocrinol Metab, Vol. 93, No. 1. (1 January 2008), pp. 40-46.

Context: Although racial and ethnic differences in vitamin D status and bone mineral density (BMD) are recognized, less is known about how differences in vitamin D status impact BMD, especially among men. Objective: Our objective was to examine the relation between serum 25-hydroxyvitamin D [25(OH)D] and BMD by race and ethnic group. Design: We conducted a population-based, observational survey. Participants: Participants included 1114 Black, Hispanic, and White men, 3079 yr of age. Outcomes: We assessed 25(OH)D by a competitive protein binding assay and BMD by dual-energy x-ray absorptiometry. Results: Mean age +/- SD of the 331 Black, 362 Hispanic, and 421 White men was 48 +/- 12.8 yr. Mean 25(OH)D was lower among Black (25.0 +/- 14.7 ng/ml) and Hispanic (32.9 +/- 13.9 ng/ml) men compared with White men (37.4 +/- 14.0 ng/ml, P < 0.01). A higher percentage of both Black (44%) and Hispanic (23%) men had levels of 25(OH)D in the lowest quartile, compared with 11% of White men (P < 0.001). After adjusting for age, height, and weight, only White men showed significant positive correlation between 25(OH)D and BMD (range of correlations, 0.000.14). Serum 25(OH)D was not associated with BMD in Black or Hispanic men at any bone site. Results were similar when adjusted for age only. Conclusions: Our findings confirm substantial racial and ethnic group differences in BMD and serum 25(OH)D in men. Serum 25(OH)D and BMD are significantly related to one another in White men only. This may have implications for evaluation of bone health and supplementation in men with low levels of 25(OH)D. Further understanding of the biological mechanisms for these differences between race and ethnic groups is needed. 10.1210/jc.2007-1217

Long-Term DHEA Replacement in Primary Adrenal Insufficiency: A Randomized, Controlled Trial

Eleanor Gurnell — 2008-02-09T17:47:52-00:00

J Clin Endocrinol Metab, Vol. 93, No. 2. (1 February 2008), pp. 400-409.

Context: Dehydroepiandrosterone (DHEA) and DHEA sulfate (DHEAS) are the major circulating adrenal steroids and substrates for peripheral sex hormone biosynthesis. In Addison's disease, glucocorticoid and mineralocorticoid deficiencies require lifelong replacement, but the associated near-total failure of DHEA synthesis is not typically corrected. Objective and Design: In a double-blind trial, we randomized 106 subjects (44 males, 62 females) with Addison's disease to receive either 50 mg daily of micronized DHEA or placebo orally for 12 months to evaluate its longer-term effects on bone mineral density, body composition, and cognitive function together with well-being and fatigue. Results: Circulating DHEAS and androstenedione rose significantly in both sexes, with testosterone increasing to low normal levels only in females. DHEA reversed ongoing loss of bone mineral density at the femoral neck (P < 0.05) but not at other sites; DHEA enhanced total body (P = 0.02) and truncal (P = 0.017) lean mass significantly with no change in fat mass. At baseline, subscales of psychological well-being in questionnaires (Short Form-36, General Health Questionnaire-30), were significantly worse in Addison's patients vs. control populations (P < 0.001), and one subscale of SF-36 improved significantly (P = 0.004) after DHEA treatment. There was no significant benefit of DHEA treatment on fatigue or cognitive or sexual function. Supraphysiological DHEAS levels were achieved in some older females who experienced mild androgenic side effects. Conclusion: Although further long-term studies of DHEA therapy, with dosage adjustment, are desirable, our results support some beneficial effects of prolonged DHEA treatment in Addison's disease. 10.1210/jc.2007-1134

SHBG gene promoter polymorphisms in men are associated with serum sex hormone-binding globulin, androgen and androgen metabolite levels, and hip bone mineral density.

AL Eriksson — 2008-01-27T02:17:52-00:00

J Clin Endocrinol Metab, Vol. 91, No. 12. (December 2006), pp. 5029-5037.

CONTEXT: SHBG regulates free sex steroid levels, which in turn regulate skeletal homeostasis. Twin studies have demonstrated that genetic factors largely account for interindividual variation in SHBG levels. Glucuronidated androgen metabolites have been proposed as markers of androgenic activity. OBJECTIVE: Our objective was to investigate whether polymorphisms in the SHBG gene promoter [(TAAAA)(n) microsatellite and rs1799941 single-nucleotide polymorphism] are associated with serum levels of SHBG, sex steroids, or bone mineral density (BMD) in men. DESIGN AND STUDY SUBJECTS: We conducted a population-based study of two cohorts of Swedish men: elderly men (MrOS Sweden; n congruent with 3000; average age, 75.4 yr) and young adult men (GOOD study; n = 1068; average age, 18.9 yr). MAIN OUTCOME MEASURES: We measured serum levels of SHBG, testosterone, estradiol, dihydrotestosterone, 5alpha-androstane-3alpha,17beta-diol glucuronides, androsterone glucuronide, and BMD determined by dual-energy x-ray absorptiometry. RESULTS: In both cohorts, (TAAAA)(n) and rs1799941 genotypes were associated with serum levels of SHBG (P < 0.001), dihydrotestosterone (P < 0.05), and 5alpha-androstane-3alpha,17beta-diol glucuronides (P < 0.05). In the elderly men, they were also associated with testosterone and BMD at all hip bone sites. The genotype associated with high levels of SHBG was also associated with high BMD. Interestingly, male mice overexpressing human SHBG had increased cortical bone mineral content in the femur, suggesting that elevated SHBG levels may cause increased bone mass. CONCLUSIONS: Our findings demonstrate that polymorphisms in the SHBG promoter predict serum levels of SHBG, androgens, and glucuronidated androgen metabolites, and hip BMD in men.

DHEA in elderly women and DHEA or testosterone in elderly men.

KS Nair — 2007-10-21T23:39:35-00:00

N Engl J Med, Vol. 355, No. 16. (19 October 2006), pp. 1647-1659.

BACKGROUND: Dehydroepiandrosterone (DHEA) and testosterone are widely promoted as antiaging supplements, but the long-term benefits, as compared with potential harm, are unknown. METHODS: We performed a 2-year, placebo-controlled, randomized, double-blind study involving 87 elderly men with low levels of the sulfated form of DHEA and bioavailable testosterone and 57 elderly women with low levels of sulfated DHEA. Among the men, 29 received DHEA, 27 received testosterone, and 31 received placebo. Among the women, 27 received DHEA and 30 received placebo. Outcome measures included physical performance, body composition, bone mineral density (BMD), glucose tolerance, and quality of life. RESULTS: As compared with the change from baseline to 24 months in the placebo group, subjects who received DHEA for 2 years had an increase in plasma levels of sulfated DHEA by a median of 3.4 microg per milliliter (9.2 micromol per liter) in men and by 3.8 microg per milliliter (10.3 micromol per liter) in women. Among men who received testosterone, the level of bioavailable testosterone increased by a median of 30.4 ng per deciliter (1.1 nmol per liter), as compared with the change in the placebo group. A separate analysis of men and women showed no significant effect of DHEA on body-composition measurements. Neither hormone altered the peak volume of oxygen consumed per minute, muscle strength, or insulin sensitivity. Men who received testosterone had a slight increase in fat-free mass, and men in both treatment groups had an increase in BMD at the femoral neck. Women who received DHEA had an increase in BMD at the ultradistal radius. Neither treatment improved the quality of life or had major adverse effects. CONCLUSIONS: Neither DHEA nor low-dose testosterone replacement in elderly people has physiologically relevant beneficial effects on body composition, physical performance, insulin sensitivity, or quality of life. (ClinicalTrials.gov number, NCT00254371 [ClinicalTrials.gov].).

Does thoracic or lumbar spine bone architecture predict vertebral failure strength more accurately than density?

EM Lochmüller — 2008-03-24T21:21:13-00:00

Osteoporosis International, Vol. 19, No. 4. (14 April 2008), pp. 537-545.

Abstract Summary Trabecular bone microstructure was studied in 6 mm bone biopsies taken from the 10th thoracic and 2nd lumbar vertebra of 165 human donors and shown to not differ significantly between these sites. Microstructural parameters at the locations examined provided only marginal additional information to quantitative computed tomography in predicting experimental failure strength. Introduction It is unknown whether trabecular microstructure differs between thoracic and lumbar vertebrae and whether it adds significant information in predicting the mechanical strength of vertebrae in combination with QCT-based bone density. Methods Six mm cylindrical biopsies taken at mid-vertebral level, anterior to the center of the thoracic vertebra (T) 10 and the lumbar vertebra (L) 2 were studied with micro-computed tomography (μCT) in 165 donors (age 52 to 99 years). The segment T11-L1 was examined with QCT and tested to failure using a testing machine. Results The correlation of microstructural properties was moderate between T10 and L2 (r ≤ 0.5). No significant differences were observed in the microstructural properties between the thoracic and lumbar spine, nor were sex differences at T10 or L2 observed. Cortical/subcortical density of T12 (r 2 = 48%) was more strongly correlated with vertebral failure stress than trabecular density (r 2 = 32%). BV/TV (of T10) improved the prediction by 52% (adjusted r 2) in a multiple regression model. Conclusion Microstructural properties of trabecular bone biopsies displayed a high degree of heterogeneity between vertebrae but did not differ significantly between the thoracic and lumbar spine. At the locations examined, bone microstructure only marginally improved the prediction of structural vertebral strength beyond QCT-based bone density.

Correlation of plain radiographic indices of the hip with quantitative bone mineral density

Sah — 2007-08-25T18:44:53-00:00

Osteoporosis International, Vol. 18, No. 8. (August 2007), pp. 1119-1126.

The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women

Kanis — 2007-08-25T18:44:54-00:00

Osteoporosis International, Vol. 18, No. 8. (August 2007), pp. 1033-1046.

Osteoporosis in patients with rheumatic diseases

VL Star — 2008-01-10T13:22:56-00:00

RHEUM. DIS. CLIN. NORTH AM., Vol. 20, No. 3. (1994), pp. 561-576.

Arthritis and other musculoskeletal disorders are common causes of disability in the United States. Osteoporosis is the major nonarthritic musculoskeletal condition affecting postmenopausal women. An increased incidence of osteoporosis is seen in some rheumatic diseases resulting in a potential increase in risk of fracture. Patients with rheumatoid arthritis and spondyloarthropathies appear to have decreased bone mineral density whereas patients with osteoarthritis of the hip have increased bone mineral density. In this article studies of bone mass and related fractures in patients with rheumatic disorders are reviewed.

Effects of calcium supplementation on bone and other end-points in normal older women - The Auckland Calcium Study

IR Reid — 2007-12-03T14:03:26-00:00

Int. Congr. Ser., Vol. 1297 (2007), pp. 82-88.

Calcium has been shown to have positive effects on bone mineral density in postmenopausal women. However, because these effects are small, it is unknown whether they are sustained with long-term use, they have not been shown with intention-to-treat analyses, and the evidence for fracture prevention with calcium monotherapy is inconsistent. We have conducted a randomized controlled trial of calcium (1 g/day as the citrate) in 1471 normal postmenopausal women (aged 74 ± 4 years) over 5 years, assessing the effects on bone, blood pressure, body weight and lipid levels. Calcium had a significant beneficial effect on bone density (intention-to-treat analysis), with between-groups differences at 5 years of 1.8% (spine), 1.6% (total hip) and 1.2% (total body). Serum alkaline phosphatase and PINP were lower in the calcium group at 5 years but fracture data were inconclusive. Calcium produced only transient changes in blood pressure, but sustained improvements in HDL/LDL cholesterol ratios. It had no effect on body weight but constipation was more common in the calcium group. We conclude that calcium results in a sustained reduction in bone loss and turnover, but its effect on fracture remains uncertain. Poor long-term compliance limits its effectiveness. © 2006 Elsevier B.V. All rights reserved.

Dual energy X-ray image decomposition by independent component analysis

Y Jiang — 2008-01-17T12:06:02-00:00

Proc SPIE Int Soc Opt Eng, Vol. 4549, pp. 102-107.

The spatial distributions of bone and soft tissue in human body are separated by independent component analysis (ICA) of dual-energy x-ray images. It is because of the dual energy imaging model s conformity to the ICA model that we can apply this method: (1) the absorption in body is mainly caused by photoelectric absorption and Compton scattering; (2) they take place simultaneously but are mutually independent; and (3) for monochromatic x-ray sources the total attenuation is achieved by linear combination of these two absorption. Compared with the conventional method, the proposed one needs no priori information about the accurate x-ray energy magnitude for imaging, while the results of the separation agree well with the conventional one. Conference code: 60037 Sponsors: SPIE; Huazhong University of Science and Technology (China)

Femur strength index predicts hip fracture independent of bone density and hip axis length

Kenneth Faulkner — 2007-10-05T07:55:33-00:00

Osteoporosis International, Vol. 17, No. 4. (April 2006), pp. 593-599.

AbstractIntroduction Proximal femoral bone strength is not only a function of femoral bone mineral density (BMD), but also a function of the spatial distribution of bone mass intrinsic in structural geometric properties such as diameter, area, length, and angle of the femoral neck. Recent advancements in bone density measurement include software that can automatically calculate a variety of femoral structural variables that may be related to hip fracture risk. The purpose of this study was to compare femoral bone density, structure, and strength assessments obtained from dual-energy X-ray absorbtiometry (DXA) measurements in a group of women with and without hip fracture.Methods DXA measurements of the proximal femur were obtained from 2,506 women 50 years of age or older, 365 with prior hip fracture and 2,141 controls. In addition to the conventional densitometry measurements, structural variables were determined using the Hip Strength Analysis program, including hip axis length (HAL), cross-sectional moment of inertia (CSMI), and the femur strength index (FSI) calculated as the ratio of estimated compressive yield strength of the femoral neck to the expected compressive stress of a fall on the greater trochanter.Results Femoral neck BMD was significantly lower and HAL significantly higher in the fracture group compared with controls. Mean CSMI was not significantly different between fracture patients and controls after adjustment for BMD and HAL. FSI, after adjustment for T score and HAL, was significantly lower in the fracture group, consistent with a reduced capacity to withstand a fall without fracturing a hip. Conclusion We conclude that BMD, HAL, and FSI are significant independent predictors of hip fracture.

Association of five quantitative ultrasound devices and bone densitometry with osteoporotic vertebral fractures in a population-based sample: The OPUS Study

CC Gluer — 2007-11-07T13:00:06-00:00

J. Bone Miner. Res., Vol. 19, No. 5. (2004), pp. 782-793.

We compared the performance of five QUS devices with DXA in a population-based sample of 2837 women. All QUS approaches discriminated women with and without osteoporotic vertebral fractures. QUS of the calcaneus performed as well as central DXA. Introduction: Quantitative ultrasound (QUS) methods have found widespread use for the assessment of bone status in osteoporosis, but their optimal use remains to be established. To determine QUS performance for current devices in direct comparison with central DXA, we initiated a large population-based investigation, the Osteoporosis and Ultrasound Study (OPUS). Materials and Methods: A total of 463 women 20-39 years of age and 2374 women 55-79 years of age were measured on five different QUS devices along with DXA of the spine and the proximal femur. Their vertebral fracture status was evaluated radiographically. The association of QUS and DXA with vertebral fracture status was evaluated using logistic regression. Results: All QUS approaches tested discriminated women with and without osteoporotic vertebral fractures (20% height reduction), with age-adjusted standardized odds ratios ranging 1.2-1.3 for amplitude-dependent speed of sound (AD-SOS) at the finger phalanges, 1.2-1.4 for broadband ultrasound attenuation (BUA) at the calcaneus, and 1.4-1.5 for speed of sound (SOS) at the calcaneus, 1.4-1.6 for DXA of the total femur, and 1.5-1.6 for DXA at the spine. For more severe fractures (40% height reduction), age-adjusted standardized odds ratios increased to up to 1.9 for DXA of the spine and 2.3 for SOS of the calcaneus. Conclusions: In conclusion, all five QUS devices tested showed significant age-adjusted differences between subjects with and without vertebral fracture. When selecting the strongest variable, QUS of the calcaneus worked as well as central DXA for identification of women at high risk for prevalent osteoporotic vertebral fractures. QUS-based case-finding strategies would allow halving the number of radiographs in high-risk populations, and this strategy works increasingly well for women with more severe vertebral fractures. It is likely that the good performance of QUS was in part achieved by rigorous quality assurance measures that should also be used in clinical practice. © 2004 American Society for Bone and Mineral Research.

Does body size account for gender differences in femur bone density and geometry?

AC Looker — 2007-10-05T07:50:32-00:00

J. Bone Miner. Res., Vol. 16, No. 7. (2001), pp. 1291-1299.

The extent to which greater bone strength in men is caused by proportionately greater bone mass versus bigger bone size is not clear, primarily because the larger overall body size of men has made direct comparisons of skeletal measures difficult. We examined gender differences in femur neck (FN) areal bone mineral density (BMD) values collected from 5623 non-Hispanic whites aged 20 + years in the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) before and after correction for measured height and weight. We supplemented the conventional areal BMD data (Hologic QDR 1000) with measurements of areal BMD and geometric properties (subperiosteal width, section modulus, and cortical thickness) made at narrow "cross-sectional" regions traversing the FN and the proximal shaft using a structural analysis program. Before body size adjustment, men had significantly higher values than women for all variables at the three measurement sites (p < 0.0001). Adjustment for body size reduced the differences between the sexes for all variables but had a greater effect on BMD (1-8% higher in men) than on geometry (5-17% higher in men). When examined by age, the sex discrepancy was significantly greater in the older group for all variables except subperiosteal widths. We conclude that although body size difference may account for most of the areal BMD difference between men and women, male bones are still bigger in ways that suggest greater bone strength. These differences may contribute importantly to lower fracture risk in men.

Precision bone and muscle loss measurements by advanced, multiple projection DEXA (AMPDXA) techniques for spaceflight applications

Charles — 2007-10-05T07:46:54-00:00

Acta Astronaut, Vol. 49, No. 3-10. (2001), pp. 447-450.

An advanced, multiple projection, dual energy x-ray absorptiometry (AMPDXA) scanner system is under development. The AMPDXA is designed to make precision bone and muscle loss measurements necessary to determine the deleterious effects of microgravity on astronauts as well as develop countermeasures to stem their bone and muscle loss. To date, a full size test system has been developed to verify principles and the results of computer simulations. Results indicate that accurate predictions of bone mechanical properties can be determined from as few as three projections, while more projections are needed for a complete, three-dimensional reconstruction. © 2001 Elsevier Science Ltd. All rights reserved.

Effect of the proportion of organic material in bone on thermal decomposition of bone mineral: An investigation of a variety of bones from different species using thermogravimetric analysis coupled to mass spectrometry, high-temperature X-ray diffraction, and fourier transform infrared spectroscopy

LD Mkukuma — 2007-09-21T06:37:13-00:00

Calcif. Tissue Int., Vol. 75, No. 4. (2004), pp. 321-328.

Thermogravimetric analysis linked to mass spectrometry (TGA-MS) shows changes in mass and identifies gases evolved when a material is heated. Heating to 600°C enabled samples of bone to be classified as having a high (cod clythrum, deer antler, and whale periotic fin bone) or a low (porpoise ear bone, whale tympanic bulla, and whale ear bone) proportion of organic material. At higher temperatures, the mineral phase of the bone decomposed. High temperature X-ray diffraction (HTXRD) showed that the main solids produced by decomposition of mineral (in air or argon at 800°C to 1000°C) were ?-tricalcium phosphate (TCP) and hydroxyapatite (HAP), in deer antler, and CaO and HAP, in whale tympanic bulla. In carbon dioxide, the decomposition was retarded, indicating that the changes observed in air and argon were a result of the loss of carbonate ions from the mineral. Fourier transform infrared (FTIR) spectroscopy of bones heated to different temperatures, showed that loss of carbon dioxide (as a result of decomposition of carbonate ions) was accompanied by the appearance of hydroxide ions. These results can be explained if the structure of bone mineral is represented by Ca10-xVx(Ca)[(PO4)6-x-y(HPO4) x(CO3)y] [(OH)2-x-y(CO 3)yVx(OH)] where V(Ca) and V(OH) correspond to vacancies on the calcium and hydroxide sites, respectively, and 2-x-y = 0.4. This general formula is consistent in describing both mature bone mineral (i.e., whale bone), with a high Ca/P molar ratio, lower HPO42- content, and higher CO32- content, and immature bone mineral (i.e., deer antler), with a low Ca/P ratio, higher HPO42-, and lower CO32- content.

The relationship between spinal and peripheral osteoarthritis and bone density measurements

MA Belmonte-Serrano — 2008-01-10T12:55:02-00:00

J. RHEUMATOL., Vol. 20, No. 6. (1993), pp. 1005-1013.

Objective. To determine the influence of osteoarthritis (OA) on bone density measurements and whether OA at one site is associated with OA at other sites. Methods. Nonrandomized, cross sectional observational study; secondary analysis of a general population database. Sixty-four subjects derived from a longitudinal study of long distance runners and community controls had a complete peripheral radiographic evaluation for osteoarthritic changes in hands, knees, and lumbar spine. Forty-four of these were studied in 1984 with quantitative computed tomography (QCT) of LI, and 54 were studied in 1988 with 153-Gd dual photon absorptiometry (DPA) in the spine and total body. Thirty-four subjects had all measurements done. Results. Total body and lumbar spine DPA were positively correlated with radiological scores of OA in the spine and knees, with coefficients ranging between 0.467 to 0.530 (p < 0.001 in all cases). This correlation was principally associated with spinal spurs and knee sclerosis. Results of stepwise multiple linear regression modeling for QCT included age, spine sclerosis, knee sclerosis and knee spurs as the main predictors of bone mineral density (BMD). For DPA measurements, spine spur score was a useful regressor for all the models. Altogether, the percentage of variance accounted for by individual radiological OA variables was 27.4% for lumbar QCT, 27.3% for lumbar BMD, 7.3% for total spine BMD, and 45.2% for total body BMD. OA scores at different sites were not correlated, although repeated assessment at the same site showed very close correlation. Conclusions. All methods used to determine BMD showed a highly significant positive correlation between lumbar and knee radiological OA and bone mineral content both in the spine and the total body. Thus, our results support the hypothesis that OA is negatively correlated with osteopenia. OA, as seen in this population, was not a generalized condition, but rather, was site specific.

Bone shape, structure, and density as determinants of osteoporotic hip fracture: A pilot study investigating the combination of risk factors

JS Gregory — 2007-09-21T06:33:07-00:00

Invest. Radiol., Vol. 40, No. 9. (2005), pp. 591-597.

Objectives: This article compares and combines methods for examining the external shape and the internal structure of the proximal femur with bone mineral density (BMD) to provide a classifier for hip fracture. Materials and Methods: Fifty standard pelvic radiographs were available from age-matched fracture and control groups of postmenopausal women. Femoral shape was measured using an active shape model, the trabecular structure by means of a Fourier transform. Results: Both the shape and various structure measures were independent of BMD (P = 0.16 and >0.50, respectively). Calculating the area under the receiver operator characteristic (ROC) curve (Az), each of shape (Az = 0.81), the best structure measure (Az = 0.79-0.93), and BMD (Az = 0.79), could partially classify the fracture and control groups. However, the combination achieved almost perfect separation (Az = 0.99). Conclusions: This pilot study shows how bone shape and structure can complement BMD measurements for investigations of fracture risk. Copyright © 2005 by Lippincott Williams & Wilkins.

Axial and hip bone mineral density and radiographic changes of osteoarthritis of the knee: Data from the Baltimore Longitudinal Study of Aging

M Lethbridge-C?ejku — 2008-01-10T12:53:11-00:00

J. RHEUMATOL., Vol. 23, No. 11. (1996), pp. 1943-1947.

Objective. To examine the relationship between axial and hip bone mineral density (BMD) and radiographic changes of knee osteoarthritis (OA). Methods. BMD of the lumbar spine and/or right hip was measured, using dual photon absorptiometry, in 402 men and 247 women in the Baltimore Longitudinal Study of Aging who had bilateral standing knee radiographs taken between 1984 and 1991. Radiographs were read for features of OA using Kellgren-Lawrence and reliable individual feature scales. The relationship between BMD and radiographic changes of OA was examined using multiple linear regression adjusting for age, body mass index, and smoking. Additional analyses with adjustment for menopausal status and estrogen replacement therapy were performed in a subset of women. Results. Adjusted mean lumbar spine BMD was higher in subjects with knee osteophytes in both sexes: 1.23 ± 0.02 vs 1.18 ± 0.01 g/cm2 (p = 0.02) in men, and 1.12 ± 0.02 vs 1.08 ± 0.01 g/cm2 (p = 0.07) in women. There were no differences in levels of adjusted hip BMD by presence of any radiographic features of OA in either men or women. Conclusion. These results show that both men and women with radiographic changes of knee OA, specifically osteophytosis, have higher levels of adjusted spine but not hip BMD.

Predicting femoral neck strength from bone mineral data: A structural approach

TJ Beck — 2007-10-05T07:40:34-00:00

INVEST. RADIOL., Vol. 25, No. 1. (1990), pp. 6-18.

An interactive computer program was developed to derive femoral neck geometry from raw bone mineral image data for an estimate of hip strength using single plane engineering stress analysis. The program, which we will call Hip Strength Analysis (HSA), was developed as an attempt to improve the predictive value of hip bone mineral data for osteoporosis fracture risk assessment. We report a series of experiments with an aluminum phantom and with cadaver femora, designed to test the accuracy of derived geometric measurements and strength estimates. Using data acquired with bone Lunar DP3 (DPA) and Hologic QDR-1000 (x-ray) scanners, HSA computed femoral neck cross-sectional areas (CSA) and cross-sectional moments of inertia (CSMI) on an aluminum phantom were in excellent agreement with actual values (r > .99). Using Lunar DP3 data, CSA and CSMI measurements at mid-femoral necks of 22 cadaver specimens were in good general agreement with literature values. HSA computed cross-sectional properties of three of these specimens were compared with measurements derived from sequential CT cross-sectional images. Discrepancy between the two methods averaged less than 10% along the length of the femoral neck. Finally, breaking strengths of 20 of the femora were measured with a materials testing system, showing better agreement with HSA predicted strength (r = .89, percent standard of the estimate (%SEE) = 21) than femoral neck bone mineral density (r = .79, %SEE = 28%).

Osteoarticular manifestations of Gaucher disease in adults: pathophysiology and treatment

RM Javier — 2008-01-07T08:44:01-00:00

Presse Med., Vol. 36, No. 12 III. (2007), pp. 1971-1984.

Gaucher disease frequently has severe osteoarticular manifestations that may be disabling. Ischemic phenomena cause the most serious complications and lead to irreversible lesions. Aseptic osteonecrosis of the hip is the most disabling complication; it causes intense early bone pain and often joint collapse and secondary osteoarthritis in young adults. Localized or systemic bone fragility explains osteopenia, osteoporosis, and fractures (vertebral collapse with irreversible kyphosis causing chronic morbidity). Although no double-blind randomized studies have assessed the bone effects of enzyme replacement therapy, it has been shown effective in reducing bone pain in about half of all treatment-naive patients within 1 to 2 years and in improving bone mineral density after 3 years. In open-label trials, substrate reduction therapy (miglustat) reduced both bone pain and bone marrow infiltration. Specific treatment for bone fragility, with bisphosphonates for example, should be considered after rigorous individualized evaluation and assessment of other risk factors. © 2007 Elsevier Masson SAS. All rights reserved.

Bone mineral density and vertebral fracture history are associated with incident and progressive radiographic knee osteoarthritis in elderly men and women: The Rotterdam Study

AP Bergink — 2007-09-24T13:09:41-00:00

Bone, Vol. 37, No. 4. (2005), pp. 446-456.

Objective: To study the association between baseline femoral neck and lumbar spine bone mineral density (BMD), prevalent fractures and incident and progressive radiographic osteoarthritis (ROA) of the knee in men and women. Methods: A sample of 1403 subjects (829 women and 574 men) was drawn from the Rotterdam Study, a prospective population-based cohort study of the elderly. Incidence and progression of ROA in quartiles of femoral neck (FN) and lumbar spine (LS) BMD were determined using the Kellgren score, and separate analyses were made for men and women. Furthermore, incidence and progression of ROA were compared in subjects with and without a prevalent vertebral or non-vertebral fracture at baseline. Results: The incidence of knee ROA of subject in the highest FN BMD (10.5%) and LS BMD (14.3%) was significantly higher than of those in the lowest quartiles (3.4% and 3.3% respectively), with corresponding adjusted odds ratios (95% confidence interval) of 2.8 (1.2-6.8) and 4.7 (2.1-10.7). The same trend was seen in the association between LS BMD and the progression of knee ROA, but no association was found between FN BMD and progression of ROA. Separate analyses for men and women both showed significant increased risks in the presence of high baseline BMD, with higher odds ratios in men than in women but larger confidence limits due to lower number of cases in men. Combined incidence and progression of knee ROA in subjects with a prevalent vertebral but not with a prevalent non-vertebral fracture at baseline was 8 times lower than subject without a fracture, independent of baseline BMD. Conclusions: High systemic BMD at baseline is associated with increased incidence and progression of knee ROA in both men and women, while a prevalent vertebral fracture has a protective effect. © 2005 Elsevier Inc. All rights reserved.

The associations of bone mineral density and bone turnover markers with osteoarthritis of the hand and knee in pre- and perimenopausal women

M Sowers — 2008-01-10T12:50:43-00:00

Arthritis Rheum., Vol. 42, No. 3. (1999), pp. 483-489.

Objective. To determine whether Caucasian women ages 28-48 years with newly defined osteoarthritis (OA) would have greater bone mineral density (BMD) and less bone turnover over time than would women without OA. Methods. Data were derived from the longitudinal Michigan Bone Health Study. Period prevalence and 3-year incidence of OA were based on radiographs of the dominant hand and both knees, scored with the Kellgren/Lawrence (K/L) scale. OA scores were related to BMD, which was measured by dual-energy x-ray absorptiometry, and to serum osteocalcin levels, which were measured by radioimmunoassay. Results. The period prevalence of OA (K/L grade ?2 in the knees or the dominant hand) was 15.3% (92 of 601), with 8.7% for the knees and 6.7% for the hand. The 3-year incidence of knee OA was 1.9% (9 of 482) and of hand OA was 3.3% (16 of 482). Women with incident knee OA had greater average BMD (z-scores 0.3-0.8 higher for the 3 BMD sites) than women without knee OA (P < 0.04 at the femoral neck). Women with incident knee OA had less change in their average BMD z-scores over the 3-year study period. Average BMD z-scores for women with prevalent knee OA were greater (0.4-0.7 higher) than for women without knee OA (P < 0.002 at all sites). There was no difference in average BMD z-scores or their change in women with and without hand OA. Average serum osteocalcin levels were lower in incident cases of hand OA (>60%; P = 0.02) or knee OA (20%; P not significant). The average change in absolute serum osteocalcin levels was not as great in women with incident hand OA or knee OA as in women without OA (P < 0.02 and P < 0.05, respectively). Conclusion. Women with radiographically defined knee OA have greater BMD than do women without knee OA and are less likely to lose that higher level of BMD. There was less bone turnover among women with hand OA and/or knee OA. These findings suggest that bone-forming cells might show a differential response in OA of the hand and knee, and may suggest a different pathogenesis of hand OA and knee OA.

Effect of osteoarthritis in the lumbar spine and hip on bone mineral density and diagnosis of osteoporosis in elderly men and women

G Liu — 2008-01-10T12:49:09-00:00

Osteoporosis Int., Vol. 7, No. 6. (1997), pp. 564-569.

To determine in the elderly the effect of osteoarthritis on bone mineral density (BMD) and on diagnosis of osteoporosis, lumbar spine and hip were radiographed and BMD measured by dual-energy X-ray absorptiometry (DXA) in 120 men and 314 women, aged 60-99 years. Prevalence and severity of osteoarthritis were scored on osteophytes, joint space narrowing and bone sclerosis. Ultrasound measurements were also made at the heel to examine whether osteoarthritis at hip or lumbar spine influence bone at this remote site. Osteophytes were the commonest feature, with men having a higher prevalence than women, and lumbar spine having more disease than hip. Lumbar spine osteophytes affected 75% of men and 61.1% of women, and hip osteophytes affected 31.7% of men and 27.4% of women. Stepwise multiple regression analysis using age, weight, height, osteophytes, sclerosis and joint space narrowing indicated that lumbar osteophytes explained 16.6% of variation in lumbar spine BMD in women, and 22.4% in men. Hip osteophytes had a minimal effect on hip BMD, accounting for only 2.2% of variation in women, and none in men. Sclerosis and joint narrowing had little effect on BMD at lumbar spine or hip. Indirect effects of osteoarthritis on BMD were small and inconsistent across genders. Lumbar spine osteophytes in men explained 3.1% of hip BMD variation and 6% of variation in speed of sound at the heel, whereas hip osteophytes in women explained 2.2% of lumbar spine BMD variation. Osteoporosis at the hip, defined as BMD < 2.5 SD of the young normal mean, was present in 33.1% of women and 25.8% of men, whereas, at the lumbar spine it was present in only 24.2% of women and 4.2% of men. However, in women and men free of spinal osteoarthritis, 37.7% of women and 10% of men had osteoporosis. We conclude that lumbar spine ostoephytes affect most subjects over the age of 60 years, and contribute substantially to lumbar spine BMD measured in the anteroposterior position by DXA. The effect is largely direct by virtue of osteophytes being included in the BMD measurement. However, a small indirect effect on remote skeletal sites is also present. Diagnosis of osteoporosis and assessment of osteoporotic fracture risk in the elderly should be based on hip BMD and not on anteroposterior lumbar spine, unless spinal osteoarthritis has been excluded.

Hip structural geometry in old and old-old age: Similarities and differences between men and women

Laurel Yates — 2007-11-05T07:29:35-00:00

Bone, Vol. 41, No. 4. (October 2007), pp. 722-732.

Introduction Changes in hip structure and geometry during aging contribute to decreased bone strength. Little is known, however, about these characteristics at advanced age, when fragility fractures are common. We examined hip structural geometry in men and women of old age (72-84 years) and old-old age (85-96 years) to determine (1) gender differences; (2) whether or not these differences are consistent with the increased occurrence of hip fracture in elderly women, compared to men; and (3) whether or not gender-specific changes are consistent with the increased occurrence of fragility fractures after age 80 in both men and women.Methods We used Hip Structure Analysis (HSA) software to analyze bone densitometry scans from 916 community-dwelling men and women aged 72-96 years. We examined gender differences in hip geometry by age group (72-74, 75-79, 80-84, and >= 85 years) and between gender-specific age groups using multivariable linear regression.Results At the femoral narrow neck, there was no gender difference at age 72-74 in bone mineral density (BMD), cortical thickness (CT), and buckling ratio (BR). In contrast, at age 85 or older women had 13% less BMD and CT than men and 8% higher BR. At the intertrochanteric region, women >= 85 years had 25-31% less BMD, cross-sectional bone area (CSA), and CT than men of comparable age, and 38% higher BR. These gender differences were approximately 10-20% greater than those between men and women in their 70s. In gender-specific comparisons, women showed increasing change in structural geometry with increasing age. At both narrow neck and trochanteric regions, women >= 85 years had nearly 35% higher BR, 15% less BMD and CT, and 10% less CSA than women aged 72-74 years. At the narrow neck, they also had 6% greater outer diameter than the youngest women and 8% lower section modulus (Z), an index of bending strength. In contrast, men showed significant age differences only at the narrow neck region, and only at 85 years or older, including 22% higher BR, 10% less BMD and CT, and 5% greater outer diameter, compared to men in their early 70s. Unlike women, men showed no age-associated decline in section modulus.Conclusions Gender differences in hip geometry consistent with increased fragility and fracture risk in elderly women, compared to men, continue into old-old age. Both men and women 85 or older show the most unfavorable features, suggesting a structural basis for the increased occurrence of hip fracture in both sexes at advanced age.

Differentiation between post-menopausal women with and without hip fractures: enhanced evaluation of clinical DXA by topological analysis of the mineral distribution in the scan images

Boehm — 2007-07-01T11:31:27-00:00

Osteoporosis International, Vol. 18, No. 6. (June 2007), pp. 779-787.

Bone mineral density and risk of incident and progressive radiographic knee osteoarthritis in women: The Framingham Study

Y Zhang — 2008-01-10T12:48:23-00:00

J. Rheumatol., Vol. 27, No. 4. (2000), pp. 1032-1037.

Objective. To examine the relations of bone mineral density (BMD) and change in BMD to risk of incident and progressive radiographic knee osteoarthritis (OA) in a longitudinal cohort study. Methods. Female participants aged 63 to 91 years (mean age 71) in the Framingham Study received anteroposterior weight bearing knee radiographs at biennial examinations 18 (1983-85) and 22 (1992-93). Knee radiographs were given scores for global severity of OA (Kellgren-Lawrence scale: range 0 to 4) and for the presence of osteophytes and joint space narrowing (range 0 to 3). Femoral neck BMD was assessed using dual photon absorptiometry at examination 20 and dual x-ray absorptiometry at examination 22. We examined the relations of BMD at examination 20 and its change between examination 20 and examination 22 to incident and progressive knee OA, as well as to worsening of individual radiographic features adjusting for age, body mass index, and other potential confounding factors. Results. In total, 473 women (ages 63 to 91 yrs) had complete assessments. Over 8 years of followup, risk of incident radiographic knee OA increased from 5.6% among women in the lowest age- specific quartile of BMD to 14.2, 10.3, and 11.8% among women in the 2nd, 3rd, and highest quartiles, respectively. Multivariate adjusted OR of incident OA for each increase quartile of BMD were 1.0, 2.5, 2.0, and 2.3, respectively (p for trend = 0.222). This was mainly reflected in an increased risk of osteophyte development. However, risk of progressive OA decreased from 34.4 to 22.0, 20.3, and 18.9% as BMD increased. Compared to those in the lowest quartile of BMD, adjusted OR for progressive disease were 0.3, 0.2, and 0.1 among women in the 2nd, 3rd, and highest quartiles (p for trend < 0.001), respectively, mainly due to its effect on lowering the risk of joint space loss. Compared to those who lost BMD > 0.04 g/cm2 over the followup period, women who gained BMD were at increased risk of incident but at a significantly decreased risk of progressive knee OA. BMD change was not associated with osteophyte development, but gain in BMD lowered the risk of joint space loss. Conclusion. High BMD and BMD gain decreased the risk of progression of radiographic knee OA, but may be associated with an increased risk of incident knee OA. The protective effect was mainly through its influence on reducing the risk of joint space loss. Our results offer insights into how bone may affect the course of the most common joint disease, and thus may have potential therapeutic implications.

Appendicular bone mass and osteoarthritis of the hands in women: Data from the Baltimore longitudinal study of aging

MC Hochberg — 2008-01-10T14:26:03-00:00

J. RHEUMATOL., Vol. 21, No. 8. (1994), pp. 1532-1536.

Objective. The association of appendicular bone mass with hand osteoarthritis (OA) was studied in 238 Caucasian female participants aged 40 and above in the Baltimore Longitudinal Study of Aging. Methods. Bilateral hand radiographs taken between 1978 and 1991 were read for grade of OA using Kellgren-Lawrence scales. Two measures of appendicular bone mass, percent cortical area of the second metacarpal and bone mineral density of the distal radius measured with single photon absorptiometry, were assessed at the same visit. Results. Bivariate analyses showed that increasing grade of hand OA was associated with increasing age and decreasing bone mass as measured by both techniques. After adjustment for age and body mass index, however, neither of these measures of appendicular bone mass remained significantly associated with grade of hand OA. Conclusion. Our data fail to support the hypothesis that increased appendicular bone mass is associated with hand OA in women.

Association of radiographically evident osteoarthritis with higher bone mineral density and increased bone loss with age

H Burger — 2008-01-10T12:47:22-00:00

Arthritis Rheum., Vol. 39, No. 1. (1996), pp. 81-86.

Objective. To investigate the relationship of osteoarthritis (OA) to bone mineral density (BMD) and rate of bone loss. Methods. The study group consisted of 2,745 persons (1,624 women) from the general elderly population. Disability was assessed by the Health Assessment Questionnaire. Femoral neck BMD was measured at baseline and, in 1,723 subjects, after 2 years of followup. Knee and hip radiographic OA was assessed on anteroposterior radiographs. Results. With the exception of knee radiographic OA in men, radiographic OA was associated with significantly increased BMD (3-8%). BMD increased significantly according to the number of affected sites and the Kellgren score. Radiographic OA was also associated with significantly elevated bone loss with age (in men, only for radiographic OA of the hip). A significant increase in relation to the number of affected sites and the Kellgren score (except with regard to knee OA in men) was found, independent of disability. Conclusion. Radiographic OA is associated with higher BMD and increased rate of bone loss. This suggests a more pronounced difference in BMD earlier in life.

A cotwin control study of the relationship between hip osteoarthritis and bone mineral density

L Antoniades — 2008-01-10T14:25:00-00:00

Arthritis Rheum., Vol. 43, No. 7. (2000), pp. 1450-1455.

Objective. Previous case-control studies have shown various degrees of inverse relationship between osteoarthritis (OA) and osteoporosis (OP). The aim of this study was to examine the relationship between radiographic hip OA and bone mineral density (BMD) at the affected and contralateral hips, as well as at more distal sites. We also explored the possibility that this association might be confounded by genetic factors. Methods. Using the discordant twin model to reduce selection bias and adjust for genetic factors, plain pelvic radiographs of white female twins aged >40 years, from the St. Thomas' UK Adult Twin Register, were assessed for radiographic features of hip OA. overall OA was classified using a 6-point global grading system (Croft). Osteophytes (OPH) and joint space narrowing (JSN) were also examined separately. BMD was measured by dual x-ray absorptiometry at the left hip, lumbar spine, and total body. The association of OA with BMD was assessed using conditional logistic regression. Adjustments were made-for body mass index, lifetime physical activity, menopausal status, use of estrogen, and smoking. Results. The analysis included a total of 1,148 women comprising 160 monozygotic and 414 dizygotic twin pairs. The median age of the twins was 53 years (range 40-70). The crude and adjusted odds ratios and 95% confidence intervals for having radiographic features of hip OA were 1.63 (1.06, 2.50) and 1.80 (1.05, 3.12), respectively, per unit difference in standardized BMD of the ipsilateral femoral neck. The presence of OPH, but not JSN, was associated with higher BMD. Twins with hip OPH had 3.5% higher femoral neck BMD than their unaffected cotwins. No clear association was found between hip OA and BMD at the contralateral site, lumbar spine, or total body. Conclusion. This twin study confirms the existence of an inverse relationship between OA and OP at the hip. However, the relationship was localized to the OA-affected hip. The generalized and greater increase in BMD in osteoarthritic subjects seen in previous studies of unrelated populations is therefore likely to be due, in part, to genetic factors shared by hip OA and high bone mass. It also suggests that local changes in bone density may be a component of the disease process in hip OA.

Epidemiology of fractures in England and Wales

Van Staa — 2008-03-12T10:05:36-00:00

Bone, Vol. 29, No. 6. (2001), pp. 517-522.

Records from the General Practice Research Database were used to derive age- and gender-specific fracture incidence rates for England and Wales during the period 1988-1998. In total, 103,052 men and 119,317 women in the sample of 5 million adults sustained a fracture over 10.4 million and 11.2 million person-years (py) of follow-up. Among women, the most frequent fracture sites were the radius/ulna (30.2 cases per 10,000 py) and femur/hip (17.0 per 10,000 py). In men, the most common fracture was that of the carpal bones (26.2 per 10,000 py); the incidence of femur/hip fracture was 5.3 per 10,000 py. Varying patterns of fracture incidence were observed with increasing age; whereas some fractures became more common in later life (vertebral, distal forearm, hip, proximal humerus, rib, clavicle, pelvis), others were more frequent in childhood and young adulthood (tibia, fibula, carpus, foot, ankle). The lifetime risk of any fracture was 53.2% at age 50 years among women, and 20.7% at the same age among men. Whereas fractures of the proximal femur and vertebral body were associated with excess mortality over a 5 year period following fracture diagnosis among both men and women, fractures of the distal forearm were associated with only slight excess mortality in men. This study provides robust estimates of fracture incidence that will assist health-care planning and delivery. © 2001 by Elsevier Science Inc. All rights reserved.

An anatomical subject-specific FE-model for hip fracture load prediction

L Duchemin — 2008-02-25T08:28:34-00:00

Computer Methods in Biomechanics and Biomedical Engineering, Vol. 11, No. 2. (2008), pp. 105-111.

In order to reduce the socio-economic burden induced by osteoporotic hip fractures, finite element models have been evaluated as an additional diagnostic tool for fracture prediction. For a future clinical application, the challenge is to reach the best compromise between model relevance and computing time. Based on this consideration, the current study focused on the development and validation of a subject-specific FE-model using an original parameterised generic model and a specific personalization method. A total of 39 human femurs were tested to failure under a quasi-static compression in stance configuration. The corresponding FE-models were generated and for each specimen the numerical fracture load (FFEM) was compared with the experimental value (FEXP), resulting in a significant correlation (FEXP = 1.006 FFEM with r2 = 0.87 and SEE = 1220 N, p < 0.05) obtained with a reasonable computing time (30 mn). Further in vivo study should confirm the ability of this FE-model to improve the fracture risk prediction.

Osteoarthritis and bone mass

NE Lane — 2008-01-10T14:24:36-00:00

J. RHEUMATOL., Vol. 21, No. 8. (1994), pp. 1393-1396.

The relationship between osteoarthritis of the hands, bone mineral density, and osteoporotic fractures in elderly women

C Marcelli — 2008-01-10T14:23:26-00:00

OSTEOPOROSIS INT., Vol. 5, No. 5. (1995), pp. 382-388.

To study the relationship between osteoarthritis (OA) and osteoporosis (OF), radiographic osteoarthritis lesions of the hands (HOA) were quantified in 300 healthy women, aged 75 years or more, as a subgroup of a cohort originally recruited for a multicentre study of risk factors for femoral neck fracture. The HOA combined score (i.e. the sum of the grades of joint-space narrowing, osteophytes, erosions and joint misalignment), the osteophytosis score and the joint-space narrowing score were calculated on a radiograph of both hands. Bone mineral density (BMD) was measured using dual-energy X-ray absortiometry (Lunar DPX) at the femoral neck, Ward's triangle and the total body. BMDs of the total spine, lumbar spine, and the upper and lower limbs were derived from the regional analyses of the total body measurement. Correlations between bone mass, HOA scores and other variables were explored by multiple linear regression and stepwise logistic regression analysis. The HOA combined score was positively correlated with increasing age but not with body mass index. In the multiple regression analyses the HOA combined score positively correlated with BMD at all sites, except the femoral neck and Ward's triangle; the osteophytosis score correlated with BMD at all sites; and no correlation was found between BMD and the joint-space narrowing score. According to stepwise logistic regression and after adjustment of BMD for age, women with an HOA combined score higher than 20 had significantly higher BMD values at all skeletal sites. Sixty-nine women (23%) reported a history of osteoporotic fracture; among them, 20 (6.6%) reported a history of vertebral fracture. The OA score of both subgroups was significantly lower than that of women with no history of fracture. These data suggest that in elderly women the severity of HOA is positively correlated with bone mass and that women with a high score of HOA more rarely report a history of osteoporotic fracture.

Noninvasive measurements of bone mass, structure, and strength: current methods and experimental techniques

KG Faulkner — 2007-12-12T12:04:44-00:00

Am. J. Roentgenol., Vol. 157, No. 6. (1 December 1991), pp. 1229-1237.

Difference in femoral head and neck material properties between osteoarthritis and osteoporosis

Shih-Sheng Sun — 2008-01-16T13:03:13-00:00

Clinical Biomechanics, Vol. In Press, Corrected Proof

Background Osteoarthritis and osteoporosis are the two most common musculoskeletal diseases found in the aged population. It is of interest to measure and study the material properties of the femoral head and neck of these two groups, and hopefully to offer explanation of the observed phenomenon that most patients suffer from one of the two disorders, not both.Methods Seven osteoarthritic and seven osteoporotic femoral heads were used for this study. The principal compressive region of the femoral heads were cut to determine the Young's modulus and yielding stress by a material testing machine. Comparisons between these two groups were conducted by using material properties and the properties normalized by individual patient physical parameters, including body weight, body height and femoral head diameter, respectively. The finite element model of femoral neck cuboid in OA and OP were obtained based on the micro-CT-scan cross-section. The intrinsic material properties were calculated from the solid FE models.Findings The results showed significant differences in density, modulus and strength between the osteoarthritic and osteoporotic femoral heads as measured, with the former having 2-3 times the values of the latter. Femoral head diameter has stronger influence in mechanical properties than patient's body weight and body height. Regarding to bone volume (BV), bone surface (BS), bone volume fraction (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), and true trabecular elastic modulus, the intrinsic material properties of femoral neck with OA were higher than OP.Interpretation It is still unknown why patients do not suffer from both osteoporosis and osteoarthritis at the same time. Many studies aimed to investigate the mechanical property of two groups. However, individual difference of the femoral head and neck is too difficult to obtain a reasonable comparison between these two groups. This study investigated the two groups more quantitatively and further estimated the factors which influence mechanical properties from a biomechanical point of view.

Effects of teriparatide [recombinant human parathyroid hormone (1-34)] on cortical bone in postmenopausal women with osteoporosis

JR Zanchetta — 2008-06-10T09:31:45-00:00

Journal of Bone and Mineral Research, Vol. 18, No. 3. (2003), pp. 539-543.

Treatment with teriparatide (rDNA origin) injection teriparatide, recombinant human parathyroid hormone (1-34) [rhPTH(1-34)]reduces the risk of vertebral and nonvertebral fragility fractures and increases cancellous bone mineral density in postmenopausal women with osteoporosis, but its effects on cortical bone are less well established. This cross-sectional study assessed parameters of cortical bone quality by peripheral quantitative computed tomography (pQCT) in the nondominant distal radius of 101 postmenopausal women with osteoporosis who were randomly allocated to once-daily, self-administered subcutaneous injections of placebo (n = 35) or teriparatide 20 ?g (n = 38) or 40 ?g (n = 28). We obtained measurements of moments of inertia, bone circumferences, bone mineral content, and bone area after a median of 18 months of treatment. The results were adjusted for age, height, and weight. Compared with placebo, patients treated with teriparatide 40 ?g had significantly higher total bone mineral content, total and cortical bone areas, periosteal and endocortical circumferences, and axial and polar cross-sectional moments of inertia. Total bone mineral content, total and cortical bone areas, periosteal circumference, and polar cross-sectional moment of inertia were also significantly higher in the patients treated with teriparatide 20 ?g compared with placebo. There were no differences in total bone mineral density, cortical thickness, cortical bone mineral density, or cortical bone mineral content among groups. In summary, once-daily administration of teriparatide induced beneficial changes in the structural architecture of the distal radial diaphysis consistent with increased mechanical strength without adverse effects on total bone mineral density or cortical bone mineral content.