Osteocytes / Mechanical loading
P-50
CALCANEAL BONE MINERAL DENSITY IN ELITE PREADOLESCENT FEMALE SWIMMERS AND
GYMNASTS
B. Durmaz1*, B. Ozcaldiran2, E. Kutlay2
1School of Medicine, University of Ege, Izmir, Turkey
2School of Physical Education and Sport, University of Ege,
Izmir, Turkey
Calcaneal bone mineral density (BMD) was compared between 10-14-yr-old
female swimmers (SWM: N=13) with a history of swimming trainning (min. 12 hour/week for
past 4 years) and gymnasts (GYM: N=12) with a history of high volume impact loading (min.
24 hour/week for past 4 years). Calcaneal BMD measures were determined by ultrasound bone
densitometry (Sahara Clinical Bone Sonometer). BMD was normalized for height and body
weight. GYM were significantly leaner (14.82±1.48 vs 15.85±2.11; means±SD) and had less
body fat (8.92±0.73 vs 10.70±2.20 % body fat) than swimmers. Calcaneal BMD normalized
for body weight was significantly greater in the GYM than SWM.
As would be expected, gymnasts spent significantly more time engaged in
weight bearing activity than swimmers. Our study supports findings that weight-bearing
activity is necessary to produce an increase in bone mass.
In conclusion, high volume impact loading was associated with greater
(compared with swimmers) calcaneal BMD in pre-adolescent female gymnasts.
These results indicate that the effect on bones of participation in
weight-bearing competitive sports begining early in life may be benefical.
[Programme]
P-51
BONE MINERAL DENSITY AND DIETARY INTAKE OF PRE- ADOLESCENT FEMALE
SWIMMERS
B. Ozcaldiran1*, B. Durmaz2
1School of Physical Education and Sport, University of Ege,
Izmir, Turkey
2School of Medicine, University of Ege, Izmir, Turkey
The purpose of this study was to compare the bone mineral density (BMD)of
competitive female swimmers to age-, height- and weight- matched controls; and was to
investigate the relationships between physical activity, dietary calcium and BMD.
23 Swimmers and 29 nonathletic controls aged 9-12 participated in the
study. A 3- d dietary diary was completed by subjects for two weekdays and one weekend
day. Completed diaries were analyzed using the Nutrient Analysis Program. BMD was obtain
by DEXA.
There were statistically significant differences between groups for some
dietary variables. Swimmers consumed much more daily intake of calcium, carbohydrate and
protein than controls. Average total calorie intake was higher in the swimmers. BMD
normalized for height and body weight was significantly greater in the swimmers. Also
there was a positive correlation between calcium intake and BMD.
These results indicate that although the swimmers engaged in
nonweight-bearing training, they have greater BMD. Dietary intake, especially calcium
intake is important for bone mineral density in growing children.
[Programme]
P-52
CARTILAGE AND SUBCHONDRAL BONE INTERACTION IN NORMAL AND OSTEOARTHRITIC
HUMAN KNEE JOINT: A HISTOLOGICAL AND HISTOMORPHOMETRICAL STUDY
J. Spanjol*, D. Bobinac, S. Zoricic, I. Kristofic, B. Vitkovic, I. Maric
Department of Anatomy, School of Medicine, University of Rijeka
The aim of this study was to determine the correlation between the
morphological changes in articular cartilage and underlying subchondral bone in human knee
joint. Tibial condyles were examined: 7 from autopsy specimen (average age 70,height 174
cm,weight 84 kg; equal gender distribution; articular cartilage macroscopically normal in
appearance) and 8 from patients undergoing total endoprothesis surgery due to severe
osteoarthritis (OA) (average age 66,height 170 cm, weight 75 kg, female). Articular
cartilage and correspondent underlying subchondral bone specimens were taken at 8 constant
points from both medial and lateral condyle using bone trephine. Specimens were washed in
saline solution, decalcified in EDTA, embedded in paraffin and cut in serial slices (5
micro m) using Leica RM 2155 microtome. Tissue slices were stained with Safranin O and
Toluidine blue. Human articular cartilage was histologically graded by the method of
Mankin et al. for degenerative changes as well as the thickness of cartilage. Subchondral
bone was studied histomorphometrically by image analysis (Sform, VAMS, Zagreb). The
following static parameters were measured: BV/TV,BS/TV,Tb.Th.,Tb.Sp.,Tb.N.. The results of
histomorphometrical study were divided into 3 groups according to the Mankin score: Mankin
0-6 (minimal changes), 7-9 (moderate changes) and 10-14 (severe changes). Such correlated
results show that the Mankin score corresponds with the higher values of BV/TV and BS/TV.
At the same time Tb.Th. was increased while Tb.Sp. was decreased. The cartilage thickness
did not correspond to degenerative changes graded by the method of Mankin or to the
subchondral bone architecture. Analysis of subchondral bone of the normal tibial condyles
revealed lower values of BV/TV,BS/TV,Tb.Th and higher values of Tb.Sp., and Tb.N. when
compared to the OA tibial condyles. Comparing results of morphometry of both normal
condyles we determined that lateral condyle had greater bone volume of subchondral bone
especially on the central part of the articular surface. In OA tibial condyles, the
results were inversed; medial condyle was changed more strongly.
[Programme]
P-53
CALCANEAL BONE MASS AND MUSCLE STRENGTH IN FEMALE ATHLETES (SWIMMERS AND
GYMNASTS)
B. Ozcaldiran1*, B. Durmaz2
1School of Physical Education and Sport, University of Ege,
Izmir, Turkey
2School of Medicine, University of Ege, Izmir, Turkey
The purpose of this study was 1) to investigate the relationship between
calcaneal bone mass and muscle strength and 2) to compare the effects of two different
physical activity (weight-bearing versus non-weight bearing exercise as gymnastic and
swimming) on calcaneal bone mass and ankle muscle strenth.
19 Swimmers and 21 gymnasts were enrolled the study. The participants
were female Physical Education and Sport School Students, 18-21 years old, who had an
athletic history of at least 10 years. Ultrasound parameters of the right heel was
measured with the Sahara Clinical Bone Sonometer. Ankle muscle strength was evaluated with
the isokinetic dynamometry.
Ankle muscle strength was positively correlated with ultrasound
parameters. No significant difference in muscle strength was noted among the two groups.
Calcaneal ultrasound parameters; BUA, SOS, QUI and BMD were higher (p<0.05)in the
gymnasts than swimmers.
In conclusion;
1) Calcaneal bone mineral density was significantly higher in the
gymnasts that performed weight bearing exercises than swimmers.
2) Although swimming is a non-weight bearing exercise, it can improve the
muscle strength.
3) Swimming exercise had minimal effect on calcaneal bone mineral
density.
[Programme]
Osteoporosis: pathophysiology and epidemiology
P-54
BONE MINERAL DENSITY AND BODY COMPOSITION ASSESSMENT IN CLINICAL PRACTICE
T. O. Chernova
Russian Endocrinology Research Centre, 24-1-387, Kirovogradsksya St,
Moscow, Russia
During the past decades the implementation of bone densitometry in
clinical practice made it possible to assess BMD in health and disease and to monitor the
treatment.
PURPOSES: 1) To assess the clinical value of dual-femur acquisition in
comparison with single-femur acquisition and the clinical value of spine densitometry in
cases of bone deformities; 2) To assess the clinical significance of T- and Z-Scores
in comparing the clinical data of obese and normal patients; 3) To assess
the perspectives of lateral morphometry in clinical practice; 4) To find the new
modalities for clinical usage of body composition data.
METHODS: About 6000 patients were examined over the period of 4 years. We
assessed all parameters of BMD and body composition using DEXA (Lunar Expert XL, USA).
CONCLUSIONS: 1) There were clinically insignificant differences between
dominant and non-dominant proximal femur DEXA results. Dual-femur assessment is very
important in special cases of problems with one femur or spine deformities and in cases of
early diagnostics of osteopenia among risk population. The obtained data show that in
cases of kyphosis, scoliosis, etc the spine acquisition has no clinical significance and
is not acceptable for the therapy monitoring; 2) T-Score is important parameter, but
Z-Score is more important in assessment of obese patients; 3) Lateral Morphometry (LM) is
rather difficult for performance and assessment, it is necessary to assess it
simultaneously with x-ray examinations or CT and LM may be useful for scientific research,
but its usage for clinical practice is limited; 4) Body composition (BC) is a perspective
research in the assessment and therapy monitoring of obesity along with the possible
future implementation in the research of aging, insulin resistance and meno- and
andropause treatment. The implementation of a new fan- beam densitometer (Prodigy) is
promising due to unique possibilities of body composition assessment program.
[Programme]
P-55
FOREARM BONE MINERAL DENSITY AND URINARY CROSS- LINKED N-TELOPEPTIDES OF
TYPE I COLLAGEN LEVELS IN PATIENTS WITH RHEUMATOID ARTHRITIS
J. Iwamoto1*, T. Takeda1, S. Ichimura2
1Keio University, Tokyo, Japan
2National Defense Medical College, Saitama, Japan
The purpose of the present study was to compare the factors that affect
forearm bone mineral density (BMD) and urinary cross-linked N-telopeptides of type I
collagen (NTx) levels in patients with rheumatoid arthritis (RA). One hundred and
eighty-four patients with RA and 185 sex- and age-matched controls were enrolled in the
study: 71 men, 37-68 years of age (RA: 31, controls: 40), 129 premenopausal women, 30-48
years of age (RA: 67, controls: 62), and 169 postmenopausal women, 48-69 years of age (RA:
86, controls: 83). Forearm BMD was measured with a DXA (DTX-200, Osteometer, MediTech, CA,
USA.), and urinary NTx levels were measured with enzyme-linked immunosorbent assay. The
correlations of forearm BMD and urinary NTx levels with anatomic grade of the wrist,
functional class, duration of disease, steroid use, health assessment questionnaire scores
for the upper and lower extremities, the levels of serum c-reactive protein and rheumatoid
factor, and erythrocyte sedimentation rate were examined by multiple regression analysis.
Forearm BMD (g/cm2) was significantly lower and urinary NTx levels (nmol
BCE/mmol Cr) were significantly higher in postmenopausal women with RA than in controls
(BMD: 0.192±0.063 [mean±SD] vs 0.223±0.076, P<0.01; NTx: 76.2±27.3 vs 57.1±28.3,
P<0.001). Urinary NTx levels were significantly higher in premenopausal women with RA
than in controls (57.1±36.6 vs 42.3±21.3, P<0.01), although forearm BMD did not
differ significantly between them. However, both forearm BMD and urinary NTx levels did
not differ significantly between men with RA and controls. Multiple regression analysis
showed that in postmenopausal women with RA, forearm BMD was negatively correlated with
anatomic grade of the wrist (P<0.01), while urinary NTx levels were positively
correlated with functional class and serum rheumatoid factor levels (both P<0.05).
These findings suggest that forearm BMD loss in cases of RA may be apparent in women after
menopause, and that it may be associated with disuse of the wrist, while increased urinary
NTx levels may be associated with decreased general physical activity and increased
disease activity.
[Programme]
P-56
NORMAL LEVEL OF P1NP IN PATIENTS WITH SUBCLINICAL HYPERTHYROIDISM AS A
MARKER OF NORMAL BONE TURNOVER
S. Mirzaei1,2*, M. Hahn1, P. Knoll1,2,
G. Krotla3, K. Koriska3, H. Koehn1,2
1L. Boltzmann Institute of Nuclear Medicine,
Wilhelminenspital, Vienna, Austria
2Wilhelminenspital, Vienna, Austria
3Kaiserin Elisabethspital, Vienna, Austria
There are differing reports in the literature on behalf of bone turnover
in patients with subclinical Hyperthyroidism (suppressed TSH and peripheral normal thyroid
hormone levels) or suppressed TSH (under treatment with thyroid hormone). The aim of this
study was to compare the level of N-terminal pro-peptide of type 1 collagen (P1NP) in
patients with different levels of thyroid function. 148 patients (119 f , 29 m, median age
57 y, age range : 17-87 y) of our outpatients were enrolled into the study. Patients with
other systemic illnesses or systemic treatment with negative effect on bone metabolism
were excluded. 19 out of 21 (14 f, 7 m) patients with elevated P1NP values had
hyperthyroidism. Only two patients with elevated P1NP level had a subclinical
hyperthyroidism. 60 out of the 127 patients with normal values of P1NP had a subclinical
hyperthyroidism (n=35), suppressed TSH under treatment with thyroxin (n=15) , a slight
hyperthyroid function (n=10) and the rest of the patients had an euthyroid function. In
accordance with other studies it could be demonstrated that a hyperthyroidism is
accompanied by a high bone turnover.
However, our findings suggest that subclinical hyperthyroidism is not
associated with increased bone turnover.
[Programme]
P-57
DIFFERENCES IN LIFESTYLES AND ACTIVITY LEVELS IN AN ELDERLY POPULATION
WITH AND WITHOUT MINIMAL TRAUMA FRACTURES
P. A. Turner1*, G. A. Pryor2
1School of Social Sciences, University of Teesside,
Middlesbrough, UK
2Department of Orthopaedic Surgery, Peterborough Hospitals
Trust, Peterborough, UK
BACKGROUND: Prevention of fragility fractures requires more than
increased physical activity. Recent studies indicate that health benefits derive from
social activities and that clinical depression is a risk factor for fragility fractures.
This survey aimed to evaluate lifestyles, pursuits and barriers to activity in people aged
60-79 years, with and without recent minimal trauma fractures.
METHODS: A questionnaire administered during interview to 207 clients
(26; 12.6% male; 181; 87.4% female), determined lifestyle behaviours in the three months
preceding a fracture or interview. Interviews were conducted in the fracture clinic, the
ward, or by telephone. The fracture group (Fg) comprised120 clients. The non- fracture
group (NFg) (n-87), matched for race, age and gender was obtained from local GP lists.
Exclusions: clients with neurological, severe cardiorespiratory or other disease related
to inactivity or osteoporosis. Levels of activity were ranked using a 5- point scale.
RESULTS & DISCUSSION: TV viewing, shopping and reading emerged as
dominant pursuits for all. As expected, physical activity levels for the Fg were
significantly less than the NFg (p<0.01). However, more than a quarter (26%, 32/120) of
the Fg had high activity levels. Multidimensional scaling differentiated between the Fg
and NFg in social activities, participation in pursuits and reasons for changes in
behaviours. For example, the Fg were more likely to have active, unskilled former
occupations (50% v 75%) but were unlikely to drive (53% v 72%). The Fg were less likely to
visit a library, have meals out or visit a pub (31% v 72%) or watch TV quiz shows (47% v
83%); but were more likely to have a recent bereavement (61% v 25%). Bereavement in this
context included loss of a family pet, friends, children leaving home or loss of a spouse.
The picture that emerged in this study indicates that occupation, certain
skills and recent bereavement may contribute to increased fracture risk. Bereavement can
lead to reactive depression. Depression was recently identified as a predictor of
functional decline in older women. Further research is required to both verify these
findings and determine specific interventions that could best improve bone health and
reduce fracture risk.
[Programme]
P-58
AN IMPROVED DIGITAL IMAGE PROCESSING ALGORITHM FOR VISUAL FRACTURE
ASSESSMENT
C. C. Ruth, T. L. Kelly, E. von Stetton*, K. E. Wilson
Hologic, Inc., Bedford, USA
A new image processing algorithm, Image ProTM (Hologic, Inc.)
has been developed to improve visualization of fractures in single energy spine images
obtained on a bone densitometer. The algorithm has been applied to instant vertebral
assessment (IVA) images obtained on a Hologic Delphi system. The algorithm improves
endplate visualization by enhancing the high frequency component of the image.
Medical images often have a wide dynamic range and contain a vast range
of frequency information not all of which is useful for diagnosis. Image Pro processing
was developed to improve IVA images for fracture diagnosis. The image acquired in an IVA
scan is single energy and covers the full spine. The intensity of x-rays which makes up
the image varies significantly between the abdomen and the thorax. This low frequency
variation masks the useful higher frequency information such as bone edges, and makes it
difficult to view the full vertebrae at a single window and level setting. In radiography
this problem is circumvented by taking two different exposures, one thorax and one
abdomen, for a full spine exam. Image pro allows optimal visualization over the entire
spine by enhancing the high frequencies while preserving the overall appearance of the
image. Examples of IVA images are shown with and without Image Pro.
In conclusion, Image Pro digital image processing improves endplate
visualization which may lead to improved fracture diagnosis.
[Programme]
P-59
ESTIMATED VOLUMETRIC BONE DENSITY IN HEALTHY MEN AND WOMEN IN CROATIA
S. Cvijetic1*, M. Korsic2
1Institute for Medical Research and Occupational Health,
Zagreb, Croatia
2Department of Endocrinology, Clinical Hospital Center Rebro,
Zagreb, Croatia
The aim of this study was to measure bone mineral density (BMD) in
healthy Croatian people and see how age, height, weight and postmenopause associate with
BMD and estimated volumetric bone density (BMAD).
The study included 526 healthy subjects (249 men and 277 women), aged 20
to 79 years. Anthropometric measurements included height, weight and body mass index
(BMI). Bone mineral content (BMC) and areal density (BMD) were measured at the lumbar
spine and proximal femur, using dual energy X-ray absorptiometry (DXA). The calculation of
volumetric density relied on the formula: BMAD = BMD/vBA (BA=bone area). Association
between densitometric parameters and age, height, weight and postmenopause was analyzed
with multiple regression.
BMC and BMD decreased with age, especially in postmenopausal women. Bone
area (BA) slightly increased with age in both sexes, and BMD loss after the age of 50
could be contributed to BA increase. To minimize the effect of bone size on bone density,
volumetric density and areal density were regressed to age, anthropometry and
postmenopause. Age and postmenopause were significantly associated with the spine and
femoral BMD and BMAD. Furthermore, BMD showed a stronger association with height and
weight than BMAD, in both regions.
Weaker association of body height and weight with BMAD than with BMD
suggests that BMD depends on the bone size and body size and that the different BMD could
be the consequence of the difference in that parameters.
|
Spine |
Proximal femur |
|
BMD |
BMAD |
BMD |
BMAD |
|
Men |
Women |
Men |
Women |
Men |
Women |
Men |
Women |
Age |
-0.381a |
-0.231a |
-0.468b |
-0.226a |
-0.517b |
-0.276b |
-0.271d |
-0.201c |
Height |
-0.318d |
-0.090d |
-0.164 |
-0.02 |
-0.288d |
-0.043 |
-0.084 |
-0.064 |
Weight |
0.504b |
0.275b |
0.415a |
0.225c |
0.356c |
0.272b |
0.035 |
0.192b |
PM |
--- |
-0.167c |
--- |
-0.228d |
--- |
-0.151d |
--- |
-0.021 |
BMD=bone mineral density; BMAD=bone mineral
apparent density PM=postmenopause (years) ap<0.001; bp<0.0001; cp<0.01;
dp<0.05 |
[Programme]
P-60
CHANGE IN BONE MINERAL DENSITY IN PATIENTS WITH UROLITHIASIS: A FOLLOW-UP
STUDY
A. Tucak1*, S. Cvijetic2, V. Babic Ivancic3,
H. Milhofer Furedi4, J. Galic1
1Department of Urology, Clinical Hospital Osijek, Osijek,
Croatia
2Institute for Medical Research and Occupational Health,
Zagreb, Croatia
3Institute Rudjer Boskovic, Zagreb, Croatia
4Casali Institute of Applied Chemistry, The Hebrew University,
Jerusalem, Israel
The purpose of this investigation was to assess the bone mineral content
(BMC) and bone mineral density (BMD) over a period of one year in patients with
urolithiasis and to determine the factors that could have influenced the changes in bone
density during that period.
The patient group comprised 34 men, aged 41.2±7.9 years with recurrent
urolithiasis. A wide spectrum of biochemical measurements was performed. Bone mineral
density (g/cm2), bone mineral content (BMC) and bone area (BA) were measured
twice over a period of one year, at the lumbar spine (L2-L4), femoral neck, Ward's
triangle and trochanter, using dual energy absorptiometry. Patients' results were compared
to those obtained from 30 healthy male controls of a comparable age group.
Nine patients were hypercalciuric, while most of other metabolic
parameters were within the reference values. Bone mineral content and bone areas at all
regions were lower in patients comparing to controls, but not significantly. The biggest
annual reduction of BMD was noticed at the Ward's triangle (-5.70% in patients and -2.36%
in controls), following with femoral neck (-4.06% patients, -2.03% controls) and
trochanter (-3.06% patients, -1.39% controls). There was no significant decrease of the
BMD of the spine. Analysing the influence of age, body mass index, metabolic parameters
and dietary calcium intake on the annual reduction of bone density, we found that age,
hyperuricosuria and calcium intake were significantly associated with the bone loss in
that time period.
Bone mass reduction in patients with urolithiasis over a one year period
did not differ significantly from that in controls and was mostly related to age,
hyperuricosuria and calcium dietary restriction, but not to increased calcium excretion.
[Programme]
P-61
OSTEOPOROSIS IN PATIENTS WITH DEPRESSION
J. Menczel*, J. Y. Galfin, B. Shapira
Herzog Memorial Hospital, Herzog Hospital Institute of Osteoporosis and
Department of Depression, Jerusalem, Israel
Osteoporosis is a major health problem affecting a large proportion of
the population. In addition, depressive disorders are a very common health problem with
the rate of incidence reaching between 10-25 percent for women and 5-12 percent for men.
Higher incidence of osteoporosis in patients with depression have been
reported, but not confirmed by others. Twenty-five patients with major depression were
examined and Bone Mineral Density (BMD) with a Lunar Prodigy Dual Photon Absorptionmeter
(DEXA) were performed, BMD of lumbar spines and both hips were measured. Hamilton ratings
were performed in all patients.
Of the 25 patients with major depression, 12 had definite osteoporosis
(48 percent), and their BMD of the neck of femur ranged from t=-1.6 to -4.3, and L{2} to
L{4} from -0.6 to -3.8. Only patients who had a t lower than -2.5, either of the neck of
femur or L{2} to L{4} were included. Seven were females and five were men. Their ages
ranged between 42 to 84 years.
Osteopenia, defined as a BMD measurement with a t of one of the sites
between -1 to -2.5, was found in five patients. All five patients were females and their
ages ranged from 26 to 73 years.
It can be deducted that 68 percent of the patients with major depression
had a loss of bone mass greater than expected. Five who had a t lower than -2.5 were older
75 years. Each patient underwent an interview and risk factors for osteoporosis and
fractures were recorded.
We have not matched a control group of the same age and sex, but the
results were compared to prevalence figures published as well as to age-matched persons. A
higher incidence of osteoporosis was found.
Patients with major depression suffer from falls and taking into
consideration the higher prevalence of a low bone mass, preventive and therapeutic
measures should be started to avoid fractures, especially of the neck of femur.
[Programme]
P-62
BONE MINERAL DENSITY AND MECHANICAL STRENGTH OF FEMUR IN FEMALE RATS
CHRONICALLY EXPOSED TO CADMIUM
M. M. Brzoska1*, J. Moniuszko-Jakoniuk1, K.
Majewska2, S. Boczon3, R. Zadernowski2
1Department of Toxicology, Medical Academy, Bialystok, Poland
2Chair of Food Plant Chemistry and Processing, University of
Warmia and Mazury, Olsztyn, Poland
3Diagnostic Imaging Department, Provincial Sniadecki Hospital,
Bialystok, Poland
Chronic cadmium exposure leads, among others, to bone lesion. For many
years it has been thought that this heavy metal damages bone only at high exposure. But
recently it has been hypothesized that cadmium may have lesional effect on bone at much
lower levels of exposure than previously anticipated.
The study was designed to examine the effect of chronic (one year)
cadmium treatment, corresponding to human environmental (5mg Cd/l of drinking water) and
occupational (50mg Cd/l) exposure, on bone mineral density (BMD) and mechanical strength
of femur in female rats.
The exposure to both cadmium levels resulted in a significant reduction
in the femur BMD and decreased the bone mechanical strength. Femur mineral status
significantly correlated with some parameters describing its mechanical properties.
Our results show that cadmium promotes demineralization and affects
mechanical strength of bone, even at relatively low exposure. It can result in elevated
fragility and increased risk of bone fractures.
[Programme]
P-63
OSTEOPOROSIS IN PATIENTS WITH ANKYLOSING SPONDYLITIS: COMPARISON OF
SENSITIVITY OF HIP AND LUMBAR SPINE DXA-MEASUREMENTS
H. Franck*, T. Meurer
Center of Rheumatology, Oberammergau, Germany
Introduction: Patients with ankylosing spondylitis are wellknown to have
osteoporosis to a certain degree. However, DXA-measurements are limited in the lumbar
spine area by syndesmophyts.
The aim of our study was to evaluate the sensitivity of DXA-measurements of the hip,
femoral neck (FN) and lumbar spine (LS) in patients with ankylosing spondylitis.
Methods: The lumbar spine and the hip was measured by DXA (Hologic 4500)
in 258 patients with ankylosing spondylitis (mean age 49.7 years). All patients fulfilled
the modified New York criteria of ankylosing spondylitis.
Results: There were far more patients with osteoporosis according to
WHO-criteria measuring the femural neck than measuring lumbar spine (see table 1), only
one patient was diagnosed as having osteoporosis by lumbar spine measurements, when
hip measurements was normal.
However 16 patients demonstrated with osteoporosis of the hip when measurements of the
lumbar spine was normal (table 2).
Discussion: Our data show that DXA-measurements of the femural neck
should be preferred in patients with ankylosing spondylitis in diagnosing osteoporosis.
Table 1 |
N |
LS normal |
LS Osteopenia |
LS Osteoporosis |
FN normal |
82 |
60 |
11 |
1 |
FN Osteopenia |
128 |
65 |
52 |
11 |
FN Osteoporosis |
50 |
16 |
15 |
19 |
Table 2 |
N |
FN normal |
FN Osteopenia |
FN Osteoporosis |
LS normal |
149 |
68 |
61 |
16 |
LS Osteopenia |
78 |
11 |
52 |
15 |
LS Osteoporosis |
31 |
1 |
11 |
19 |
[Programme]
P-64
THE PREDICTIVE VALUE OF BIOCHEMICAL MARKERS OF BONE TURNOVER AS
PREDICTORS OF LOSS OF BONE MINERAL DENSITY IN POSTMENOPAUSAL WOMEN
M. Díaz-Curiel1*, J. Iborra2, J. Farrerons3,
J. Cannata4, A. Díez-Pérez5, J. González- Macias6, R.
Pérez-Cano7, M. Queseda8, M. Sosa9
1Fundación Jimenez Díaz, Madrid, Spain
2Novartis Farmacéutica, Spain
3Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
4Hospital Central de Asturias, Asturias, Spain
5Hospital del Mar, Barcelona, Spain
6Hospital Marques de Valdecilla, Santander, Spain
7Hospital Universitario Virgen de la Macarena, Sevilla, Spain
8Hospital Reina Sofia, Cordoba, Spain
9Hospital Universitario Insular de las Palmas, Gran Canarias,
Spain
Biochemical markers of bone turnover provide a means of evaluating
skeletal dynamics that complements static measurements of bone mineral density (BMD). This
study was designed to examine whether a single baseline bone marker could predict
subsequent loss of BMD.
Patients and methods:Two hundred and eleven postmenopausal women were
recruited from eight clinical research sites located in Spanish major geographical
regions. We measured osteocalcin (OC) and bone alkaline phosphatase (BSAP), as markers of
bone formation, and tartrate-resistant acid phosphatase (TRAP), Urinary collagen type I
cross-linked C-telopeptide (CTx, CrossLaps) as markers of bone resorption. Lumbar spine
and femoral neck BMD were measured at baseline and 6, 12, 18 and 24 months. The variables
used were baseline data for the different markers and the percentage change from baseline
for lumbar spine and femoral neck BMD. The baseline bone markers were categorised in low,
normal, and high. High was defined as a value higher than the upper limit (mean +2SD). The
percent change in BMD at 2 yr. was used to classify subjects as slow bone loss
(<=1.4%), intermediate (between 1.4 and 2.7%) and fast bone loss patients (estimated
annual bone loss >2.7%). A model of multiple regression was used to identify the
clinical and biochemical parameters that allow to predict the fast loss of bone density.
Results:The mean age was 54.3 (±5.5) yr. Except with TRAP, there were no
statistically significant relationships between the baseline values and subsequent bone
loss. The initial bone turnover was balanced during all study period. Factors associated
with higher annual bone loss in the spine were age (p=0.019; CI 95% -4.6 to -0.3), initial
bone density (p<0.03 CI 95% -14.6 to -0.6) and TRAP (p=0.02; CI 95% -3 to -0.2). In the
neck femoral, initial bone density (p=0.014; CI 95% -0.059 to 0.02) was the only factor
associated with higher annual bone loss.
Conclusions:In this study, we have observed that baseline TRAP were
significantly higher in those who lose bone mass faster to the 2 years. We have not
observed any correlation between other bone markers and postmenopausal bone loss.
This study was supported by Novartis.
[Programme]
P-65
CLINICAL BONE DENSITOMETRIC EVALUATION OF THE MANDIBLE IN COMPLETE
DENTURE WEARERS DEPENDENT ON SOME MORPHOMETRIC INDICES
D. Knezovic Zlataric*, A. Celebic
School of Dental Medicine, University of Zagreb, Croatia
The objective of this study was to determine whether the mandibular bone
mineral density (BMD) is correlated with some mandibular morphometric indices on panoramic
radiograph (PR). In a total of 72 dental PRs the following parameters were evaluated: MI =
thickness of the mandibular cortex below the mental foramen, AI = thickness at the
antegonion and GI = thickness at gonion and MCI = mandibular cortical index, based on the
assessment of the 3 categories of cortical appearence due to resorptive changes. The study
was conducted on 28 male patients (mean age 72.7; range 56 to 84 years) and 44 female
patients (mean age 69.7; range 48 to 86 years). Using dental PRs and copper stepwedge, the
mandibular BMD was investigated densitometrically. All the BMD values were expressed in
equivalents of the actual stepwedge thickness. The results revealed significant positive
correlation between AI, MI and GI and all the measured regions of interest (ROI) on the
mandible, which comprised the density of cortical and trabecular bone together
(p<0.05). The thickness of AI, MI and GI was not significantly correlated with the ROIs
which comprised the density of cortical bone alone (p>0.05). MCI was significantly
correlated with cortical bone density alone (p<0.05), while it was not significantly
correlated with cortical and trabecular bone density together (p>0.05).
The use of morphometric indices and clinical bone densitometry on PRs may
be helpful for general dental practitioners in the assessment of local quality of
mandibular bone structure and osteopenia.
[Programme]
P-66
TRACKING SERUM 25 HYDROXY VITAMIN D (25-OHD) AND PARATHYROID HORMONE
(PTH) IN HEALTHY ELDERLY WOMEN OVER A 1-YEAR PERIOD
J. Z. Ilich*, R. A. Brownbill, H. E. Mulrenan, L. Tamborini
School of Allied Health, University of Connecticut, Storrs, CT, USA
Low 25-OHD and elevated PTH, commonly thought to exist in elderly, may
compromise their bone status. The objective of this study was to assess the relationship
between the two, their possible effect on bone mass, and their changes after subjects have
been supplemented with calcium (Ca) and vitamin D for 1 year.
Subjects included 117 healthy, postmenopausal women who were part of a
larger study. Mean±SD for age, weight, and height was 68.8±7.1years, 68.2±11.0kg,
161.7±6.8cm, respectively. Bone mass of the whole body, forearm, spine, and hip was
measured by DXA (Lunar). 25-OHD and PTH were analyzed by Nichols. Dietary intake was
assessed by 3-day records and analyzed with Food Processor (ESHA).
Baseline values for 25-OHD and PTH were 52.8±12.8nmol/L and
61.9±16.3pmol/L, while those for dietary Ca and vitamin D were 871±371mg/day and
187±130 IU/day, respectively. Subjects were stratified into groups according to season
and below and above 70 years. Participants in spring/summer groups were older, had higher
Ca and vitamin D intakes (p<0.05), but there were no statistically significant
differences in their 25-OHD or PTH compared to those in fall/winter groups. There was also
no difference in 25-OHD or PTH levels across the two age groups. There was no relationship
between 25-OHD and PTH and neither of them showed significant relationship with bone mass
of measured skeletal sites. After baseline assessment, each subject was given 630mg/day Ca
and 400 IU/day vitamin D (Citracal+D, Mission Pharmacal) and assessed 6 and 12 months
later. Compliance with supplements was about 90% bringing total Ca and vitamin D intake to
about 1400mg/day and 550 IU/day, respectively. Values for 25-OHD and PTH after 6 and 12
months were similar to their respective values at baseline (no statistical difference),
there was no relationship between the two and no effect on bone mass.
We conclude that healthy elderly women might not necessarily be in danger
of low 25-OHD and elevated PTH, as commonly thought. Although their intake of Ca and
vitamin D was below recommendations at baseline, moderate supplementation did not make
difference in serum values of 25-OHD and PTH after a year of follow-up.
[Programme]
P-67
HISTOLOGIC VARIABILITY IN THE ILIAC CREST BIOPSY OF POSTMENOPAUSAL AND
OSTEOPOROTIC WOMEN
P. Lozo1*, D. Krpan2, I. Brnic2, A.
Krvavica3, V. Kusec4
1Health Centre Lozo, Zadar, Croatia
2General Hospital Sveti Duh, Zagreb, Croatia
3General Hospital Zadar, Zadar, Croatia
4Clinical Institute of Laboratory Diagnosis, Clinical Hospital
Centre, Zagreb, Croatia
Postmenopausal osteoporosis is the commonest type of osteoporosis in
clinical practice. At the cellular level osteoporosis is the consequence of imbalance or
uncoupling of osteoblastic bone deposition and osteoclastic bone resorption.
Histomorphometric studies have demonstrated considerable heterogeneity regarding the
activity of bone cells and bone turnover in osteoporosis. It is well established that
diagnosis for osteoporosis and fracture risk assessment are based on measurement of bone
density. Association of bone histology characteristics and its impact on bone density
remains to be elucidated and was addressed in this study. Forty-five postmenopausal women
have undergone transiliac bone biopsy in the course of diagnostic procedures and the
following static histomorphometric parameters were assessed by an optical grid: bone
volume, osteoblast and osteoid surface, osteoid thickness and osteoclast surface. Bone
mineral density (BMD) was measured by DEXA at the lumbar spine and hip. Published
reference data for histomorphometric indices was used for comparison of the results. Data
was analysed according to normal, osteopenic and osteoporotic BMD results and showed no
difference for any of the histomorphometric parameters. A subgroup of patients with
increased osteoclast and osteoblast/osteoid surface (14/45) was identified, among which
those with reduced bone volume (4/45). BMD and T-scores for the lumbar spine and hip in
these two subgroups were lower but not statistically significant in comparison to patients
with normal histomorphometric parameters for bone volume, osteoclast, osteoblast and
osteoid surfaces (8/45). These results support the existence on great histologic
variability of bone activity in the postmenopause and osteoporosis. Lack
of association between single or several histomorphometric parameters, indicating rate of
turnover, with BMD was probably a consequence of high variance and limited patient sample.
In conclusion, evidence of increased bone cell activity with or without reduced bone
volume might be encountered in postmenopausal women with normal and reduced bone mineral
density.
[Programme]
P-68
AGE RELATED CHANGES IN BONE MINERAL CONTENT, BONE MINERAL DENSITY AND ASH
DENSITY OF THE VERTEBRAL BONE IN RELATION TO THE BONE VOLUME IN WOMEN
S. Zoricic1*, O. Cvijanovic1, I. Kristofic1,
D. Bobinac1, Z. Crncevic-Orlic2, I. Maric1
1Department of Anatomy, School of Medicine, University of
Rijeka, Rijeka, Croatia
2Department for Endocrinology, Clinical Hospital Rijeka,
Rijeka, Croatia
The aim of the present study was to determine the age-related changes in
vertebral bone structure in women assessed by three different methods: dual energy X ray
absorptiometry (DEXA), ash density analysis and bone histomorphometry. Furthermore,
numerical ratios and correlations between measured bone parameters were calculated in
order to establish true relations between them. The lumbar vertebral bodies without
posterior element (L3) from normal female cases were collected during autopsy. The samples
were divided into three age related groups of ages: 50-60, 60-70, and 70-80. The vertebral
bodies without posterior elements, were carefully removed and cleaned from the surrounding
tissue, washed in saline solution and frozen on -20 deg C until performing the
measurement. Each specimen was placed in container filled with demineralized water and
scanned with Hologic QDR 4500 C scanner in a vertical plane under constant conditions. The
density calculations (BMC and BMD) were made with the scanning software in the default
mode. Thereafter, 3 vertical bone cylinders were obtained from each specimen using bone
trephine. Two cylinders were embedded undecalcified in MMA, cut on 5 microm thick slices,
histomorphometrically stained with toluidin blue. Image analysis was performed using
semiautomatic image analyzer (Sform, VAMS, Zagreb) and BV/TV was calculated. The third
cylindrical bone specimen was ashed (580 deg C for 24 h) and weighed. Apparent ash density
(AD) was calculated by dividing ash weight by the volume of the specimen. Calculating
numerical relations between BMC, BMD, ash density and BV/TV showed constant ratios. These
ratios did not significantly differ between different age groups. The results revealed
that histomorphometrically calculated bone volume (BV/TV) was in accordance with the
mineral content and density of the vertebral bone.
[Programme]
P-69
AGE AND GENDER RELATED CHANGES IN BONE HISTOMORPHOMETRY IN FEMALES AND
MALES
S. Zoricic*, I. Kristofic, O. Cvijanovic, D. Bobinac
Department of Anatomy, School of Medicine,University of Rijeka, Croatia
The aim of this study was: 1. to determine age related differences in
vertebral bone structure assessed by histomorphometry in normal adult female and male
population; 2. to evaluate gender related differences between the same parameters that
reflect bone architecture quality. The material for this study comprised human lumbar
vertebral bodies (L3) from normal female (N=20) and male (N=20) cadavers aged from 50 to
80 years. Vertical, 7 mm in diameter, cylinders were drilled in each vertebral specimen
using bone trephine. Undecalcified bone samples were embedded in MMA, cut in 7 microm
thick serial sections and stained with toluidine blue method. Histomorphometric analysis
was performed using semiautomatic image analyzer (Issa, VAMS, Zagreb) and the following
static bone parameters were calculated: trabecular bone volume (BV/ TV), bone surface
density (BS/ TV), trabecular thickness (Tb.Th), number (Tb.N) and separation (Tb.S).
Morphometric parameters were compared between different gender related groups using
Student t test. The results of this study revealed severe alteration of the bone quality
assessed by histomorphometrical parameters in both, female and male groups and in all age
groups. Comparing to the normal values found in the literature, our findings showed 30
percent lower BV/TV in female and 25 percent lower BV/TV in male subjects. Comparing three
correspondent age related groups between female and male, BV/TV, BS/TV, TbTh, TbN were
significantly lower in females up to age 70. These differences were not present after that
age and values of the bone histomorphometry became approximately equal in 70 to 80 years
age group of both female and male subjects. Even though subjects investigated in this
study were with no apparent bone and systemic disease, histomorphometrical study revealed
severely altered bone structure, especially in female group.
[Programme]
P-70
AMENORRHEA IN FEMALE ATHLETES IS A RISK FACTOR FOR OSTEOPOROSIS
T. Dusek*, M. Pecina, M. Loncar-Dusek, I. Bojanic
Department of Orthopaedic Surgery, School of Medicine, University of
Zagreb, Croatia
The aim of this study was to estimate the influence of intensive training
on menstrual cycles in female athletes. The questionnaire was used to determine the time
of menarche, and the prevalence of primary and secondary amenorrhea and dysmenorrhea in 72
active female athletes from Zagreb (10 volleyball players, 18 basketball players, 10
ballet dancers, and 34 runners) aged between 15 and 21. The control group comprised of 96
girls of the same age not engaged in any sports activity. The prevalence of secondary
amenorrhea was three times higher in athletes than in the control group (P=0.037). The
prevalence of the primary amenorrhea was substantially higher in athletes than in the
control group (6 of 72 vs. 0 of 96, p=0.014), whereas the prevalence of dysmenorrhea was
twofold lower in athletes than in the control group (p<0.001). The highest prevalence
of secondary amenorrhea was recorded in runners (14 of 31), particularly long-distance
runners (11 of 17), whereas there was only one case of secondary amenorrhea among
basketball players. Menarche was significantly delayed in athletes who started physical
activities before the onset of menstruation (13.8±1.4 vs. 12.6±1.0 years, p<0.001).
High intensity training before menarche postpones its onset. Type of training may be
related to a significantly higher prevalence of secondary amenorrhea in runners than in
basketball players. This work also presents a case of a female mid-distance runner with a
well known trias of symptoms: anorexia, amenorrhea and osteoporosis which resulted in
stress fracture occurrence on four localizations of the skeleton. Three stress fractures
occurred during sports activities, whereas the fourth stress fracture occurred after
sports activities stopped.
[Programme]
P-71
DETERMINATION OF THE IN VIVO PRECISION OF SUNLIGHT OMNISENSE BONE
SONOMETER IN ITALY
R. Mora*, L. Pedrotti, B. Bertani
Department of Orthopaedics and Traumatology, University of Pavia, Italy
Dual X-ray absorbiometry (DXA) is recognized as the 'gold-standard' for
the diagnosis and treatment monitoring of osteoporosis. Quantitative ultrasound (QUS)
methods are a potential alternative because they are inexpensive and do not expose to
ionizing radiations.
Omnisense bone assessment (Sunlight Ultrasound Technologies, Rehovot,
Israel), based on the measurement of the speed of an ultrasound wave propagating along the
bone, is the first QUS device capable of measuring the SOS at many sites, such as proximal
phalanx of the third digit of the hand, distal radius, fifth metatarsal and others.
Aim of this study was to determine the precision of the device, as
measured by the Coefficient of Variation (CV) at the distal 1/3 Radius, proximal Phalanx
III and Metatarsal V, and to compare the Omnisense CV to the CV obtained from DXA
measurement at the hip joint.
15 females at the age of 45-60 (mean age: 54 years) were enrolled in the
study. Each one was measured at the radius, third phalanx and fifth metatarsal with the
Sunlight Omnisense, and at the hip joint (where the BMD of the neck, trochanter and Ward's
was taken) with a DXA Hologic device (Hologic Inc., Waltham, Mass.).
The in vivo precision of the Omnisense, as measured by the CV, is
extremely high (0.22 % at the radius, 0.36 % at the phalanx, 0.31 % at the metatarsal
bone.
The in vivo precision of the DXA, as measured by the CV, was 1.75 % at
the femoral neck, 1.05 % at the trochanter and 3.10 % at the Ward's.
Obtained results show that the Omnisense bone sonometer may represent a
safe and available method for routinary assessment of skeletal health.
[Programme]
P-72
INTESTINAL CALCIUM ABSORPTION AND BONE TURNOVER IN PRIMARY
HYPERPARATHYROIDISM
V. Zikán*, J. J. Stepan
Department of Internal Medicine 3, Charles University, Faculty of
Medicine, Prague, Czech Republic
Purpose: The purpose of this study was to assess the fractional
intestinal calcium absorption (FCa) in patients with primary hyperparathyroidism (pHPT)
and its relationship to calcium metabolism and bone remodeling.
Methods: The FCa was determined by using a 45Ca, 3 h loading
test. Biochemical markers of bone turnover: plasma type 1 collagen cross-linked
C-telopeptide (betaCTx), plasma aminoterminal propeptide of type I procollagen (PINP), and
plasma N-MID osteocalcin (OC), plasma intact parathormone (PTH), serum ionised calcium
(iCa) and urinary calcium corrected for creatinine (UCa-Cr) were evaluated before and
during 5 hours after the oral administration of calcium. Serum 1,25- dihydroxyvitamin D3
was evaluated at baseline. 15 patients with pHPT (13 postmenopausal women, aged 51-79
years and 2 men, aged 57 and 68 years) were included into the study.
Results: A significant positive correlation was found between FCa and
serum 1,25- dihydroxyvitamin D3 (r2=0.76; p<0.0001) and between FCa and the
change in serum concentration of iCa at 3 h after calcium load (r2=0.48;
p<0.01). A significant negative correlation was found between the FCa and baseline
plasma concentration of the markers of bone remodeling, betaCTx (r2=-0.46;
p=0.01), OC (r2=- 0.40, P=0.01), PINP (r2=- 0.54; P<0.001), and
iCa (r2=- 0.58; p<0.001), and PTH (r2=- 0.31; p<0.05). After
calcium load, a significant correlation was found between the % change in PTH (at 1 h) and
betaCTx (at 3 h) (r2=0.51, p<0.01), and between the % change in PTH (at 1 h)
and UCa-Cr at 2 h (r2=0.53; p<0.01).
Conclusions: The data suggest that the low calcium absorption may
contribute to bone loss in patients with pHPT.
[Programme]
P-73
DIURNAL RHYTHM OF PLASMA 1,25-DIHYDROXYVITAMIN D AND VITAMIN D BINDING
PROTEIN (DBP) IN POSTMENOPAUSAL WOMEN: RELATIONS TO PLASMA PTH AND CALCIUM- PHOSPHATE
METABOLISM
L. Rejnmark1,2*, A. L. Larsen3, P. Vestergaard1,
L. Heickendorff4, F. Andreasen2, L. Mosekilde1
1Department of Endocrinology and Metabolism C, Aarhus
Amtssygehus, Aarhus University Hospital, Denmark
2Department of Clinical Pharmacology, Aarhus University,
Denmark
3Department of Clinical Biochemistry, AKH, Aarhus University
Hospital, Denmark
4Department of Clinical Biochemistry, Aarhus Amtssygehus,
Aarhus University Hospital, Denmark
Objective: diurnal variations in plasma levels of 1,25-dihydroxyvitamin D
(1,25(OH)2D) have previously only been investigated in young individuals, and these
studies have failed to demonstrate a diurnal rhythm. We studied whether plasma levels of
1,25(OH)2D and vitamin D binding protein (DBP) vary in a diurnal rhythm in postmenopausal
women.
Methods: blood and urine were sampled with two- and 4-h intervals in
order to assess diurnal variations in plasma levels of 1,25(OH)2D, DBP, and PTH, as well
as in plasma levels and urinary excretion rates of calcium and phosphate. Additionally,
the free 1,25(OH)2D index was calculated (the molar ratio of 1,25(OH)2D to DBP).
Results: plasma 1,25(OH)2D exhibited a diurnal rhythm (p<0.01) with a
nadir in the morning (99±12pmol/l), followed by a rapid increase to a plateau at daytime
(113±13pmol/l i.e., 14% above nadir level; p=0.005). A similar pattern of variation was
found in plasma levels of DBP; peak levels 15% above nadir levels (p<0.01). The free
1,25(OH)2D index did not vary in a diurnal rhythm. PTH and plasma levels and urinary
excretions of calcium and phosphate exhibited a diurnal pattern of variation.
The diurnal rhythm of DBP correlated to the rhythm of 1,25(OH)2D (r=0.47,
p<0.01) and plasma albumin (r=0.76, p<0.01). Moreover, the rhythm of plasma calcium
and PTH varied inversely (r=-0.36, p=0.02).
Conclusions: By the disclosure of a diurnal rhythm of total plasma
1,25(OH)2D, all major hormones and minerals related to calcium homeostasis now have been
shown to exhibit diurnal variations. In clinical trials the diurnal variations of
1,25(OH)2D and DBP have to be considered i.e., blood sampling must be standardised
according to time of day.
[Programme]
P-74
REDUCED MINERALIZATION OF SV-HFO CELLS BY SERA FROM WOMEN WITH HIGH BONE
MINERAL DENSITY
E. M. Colin*, M. van Driel, H. A. P. Pols, J. P. T. M. van Leeuwen
Erasmus University Medical Center, Rotterdam, The Netherlands
Aim: The risk of osteoporotic fractures is determined by both quantity
and quality of bone. The elasticity of bone and thus its resistance to fracture is related
to its degree of mineralisation. In the present study we analyzed whether there are
differences in effects on osteoblast activity and mineralisation between serum from
postmenopausal women with a very low and high bone mineral density (BMD).
Materials and methods: For this purpose sera of 21 women with a femoral
neck BMD within the lowest quintile (<0.75 gram/cm2), and sera of 29 women
with a femoral neck BMD within the highest quintile (>0.92 g/cm2) were
tested. Serum and urine parameters for bone metabolism were measured. Human fetal
osteoblast (SV- HFO) cells, that proceed through different stages of differentiation in
culture, including extracellular matrix formation and mineralisation, were cultured in
medium supplemented with the sera for 21 days. Mineralisation and alkaline phosphatase
activity were measured at 21 days of differentiation.
Results: In vitro induction of calcium deposition in SV-HFO cells was
significantly increased by sera of the low BMD group compared to sera of the high BMD
group (0.18±0.04 nmol/microgram DNA) vs. 0.15±0.04 nmol/micrgram DNA, P=0.02). Alkaline
phosphatase induction in SV-HFO cells by sera was similar in both groups. There were no
differences in serum 1,25-dihydroxyvitamin D3 and parathyroid hormone levels between the
two groups. Serum 17-beta-estradiol levels were significantly lower in women with a low
BMD compared to women with a high BMD (17.0±4.6 pmol/l vs. 45.4±6.9 pmol/l, P<0.01),
while the serum alkaline phosphatase activity and serum osteocalcin were increased in the
low BMD compared with the high BMD group (55.0±2.5 U/ml vs. 48.6±1.7 U/ml, P<0.05 and
5.8±1.9 microgram/l vs. 4.7±1.8 microgram/l, P<0.05, respectively).
Conclusion: Serum from postmenopausal women with a high BMD and high
estradiol level results in a reduced mineralisation as tested in our in vitro system. The
current data suggest a new role for estradiol in bone homeostasis: i.e. control of the
extent or set point of mineralisation, which potentially contributes to the quality of
bone.
[Programme]
P-75
INTERRELATIONS BETWEEN OSTEOPOROSIS, CARDIOVASCULAR DISEASE AND BREAST
CANCER IN WOMEN: THE ROTTERDAM STUDY
M. van der Klift1,2,3*, H. A. P. Pols2,3, J. J. W.
Coebergh3, J. C. M. Witteman3, A. Hofman3, C. E. D. H. de
Laet1,2
1Institute for Medical Technology Assessment, Erasmus Medical
Centre, Rotterdam, The Netherlands
2Department of Internal Medicine, Erasmus Medical Centre,
Rotterdam, The Netherlands
3Department of Epidemiology & Biostatistics, Erasmus
Medical Centre, Rotterdam, The Netherlands
Osteoporosis, cardiovascular disease and breast cancer are common
diseases in elderly women, and estrogen exposure may be an important etiological factor in
all these diseases. Bone mineral density (BMD) is considered a marker for long term
estrogen exposure. We hypothesised that low BMD, reflecting low estrogen exposure
throughout life would be associated with increased atherosclerosis and myocardial
infarction (MI) risk, whereas a high BMD would be associated with increased breast cancer
risk. As estrogens act more strongly on trabecular bone, results may differ for femoral
neck (FN) and lumbar spine (LS) BMD.
We studied this in 3374 women aged 55 years or over from the Rotterdam
Study, a prospective population-based cohort study with data on BMD available. At
baseline, both LS and FN BMD was measured by DXA (Lunar DPX-L). Z-scores of BMD were
calculated and divided into tertiles. Information on potential confounders was gathered.
The presence of peripheral arterial disease (PAD), defined as an ankle-arm index at or
below 0.9 at baseline was used as a measure of atherosclerosis. All MI cases were reported
by general practitioners in the research area and coded and validated by trained research
physicians. The Rotterdam Cancer Registry provided information on incident cancer.
Logistic regression was used for PAD analyses, and Cox' proportional hazards models were
used for all other analyses.
Follow-up time on average was 6.4 years. Overall, low FN BMD was
associated with increased risk of PAD (OR 1.3 [1.0-1.7]), but also with a decreased risk
of MI, (HR 0.5 [0.2-0.9]). In women with a high FN BMD, also a slight, non-significant
risk reduction for MI was observed (HR 0.7 [0.4-1.3]). No clear association between FN BMD
and breast cancer was observed. In contrast, high LS BMD was associated with increased MI
and breast cancer risk, even though only the latter was statistically significant (HR 2.1
[1.1-3.7]).
The results of this study show that high LS BMD is strongly associated
with increased breast cancer risk. No association between PAD and LS BMD was observed. The
association between BMD, atherosclerosis and MI, however, is unlikely to be explained by
estrogen exposure alone.
[Programme]
P-76
DIETARY CALCIUM INTAKE AND PREVALENCE OF VERTEBRAL DEFORMITY IN SAMPLE OF
ELDERLY URBAN CROATIAN POPULATION
S. Grazio
Department for Rheumatology, Physical Medicine and Rehabilitation
University Hospital 'Sestre Milosrdnice' - Zagreb, Croatia
The aim of the study was to determine the role of calcium intake through
nutritional consumption of milk and other milk products currently and in three time
periods during life (until 25 years, 25-50 years and 50 years and over) and to relate the
results to vertebral deformities in a sample of elderly population of Zagreb. Each of 425
recruited individuals (269 women and 156 men) completed interviewer administered
questionnaire and had lateral thoracolumbar radiography performed according to the
standard protocol. The morphometric measurements of vertebral height were used to
determine the occurrence of vertebral deformity according to the method described by
McCloskey et al. Adding numbers of days in which each subject in the last week eat milk
products we obtained score ranging from 0-28. As the distribution of results was uneven we
arbitrarily divided subjects to groups ( group I = score 0-10 and group II = score 11 and
over). There was no difference between these two groups by age, related to sex, women had
greater current consumption of milk products. There was an increased risk of finding
vertebral deformity in women appertaining to group I (OR = 3,10, 95 percent CI =
1,20-7,97), but not for men (OR = 0,93, 95 percent CI = 0,37-2,35), or for both sexes (OR
= 1,89, 95 percent CI = 0,99- 3,63). There was a statistically significant difference in
frequency of drinking milk in the period of 25-50 years of life (women being again more
frequent consumers), but not during other periods of life. There was no correlation in
frequency of milk
consumption and prevalence of vertebral deformity in any of the periods
of life, separately for men and women and taken together. To estimate milk consumption
throughout the whole life we added the figures for all three periods of life, getting the
score ranging from 3-12. Dividing the subjects into two groups (group I = score 3-7, group
II = score 8-12) we found no increased risk of vertebral deformity in those who have been
drinking less milk (OR = 1,43, 95 percent CI = 0,77-2,66). In conclusion we found that the
relationship between milk consumption and vertebral deformity is inconsistent and
therefore other confounding factors could have influenced the results.
[Programme]
P-77
BONE FORMATION MARKERS IN OSTEOPENIC AND OSTEOPOROTIC POSTMENOPAUSAL
WOMEN
I. Cs Toth, J. C. Dumon, S. DiRomana, N. Kheddoumi, H. Cheblal, J. J.
Body*
Laboratories of Endocrinology, Bone Diseases and Clinical Chemistry, and
Supportive Care Clinic, Inst. J. Bordet, Univ. Libre de Bruxelles, Brussels, Belgium
We have measured in 197 postmenopausal women (median age 59 years, range
40- 82) total Alk Phos, its bone isoenzyme (BAP, Hybritech) and intact osteocalcin (BGP,
Biosource). Of these 197 patients, 95 were osteopenic and 102 osteoporotic. None of them
took HRT nor was treated for osteoporosis. There was a significant correlation between BAP
and BGP levels in osteopenic (rs=0.41; P=0.002) and in osteoporotic women (rs=0.34;
P=0.01). Normal values were determined in 122 healthy premenopausal (PreMP). The
means±SEM values are tabulated below. Values were significantly (P<0.0001) different
in the three groups for all markers, BAP and BGP levels were higher in osteoporotic than
in osteopenic women (P<0.01) but this is not the case for Alk Phos. The upper limit of
normal (=97.5th percentile in PreMP women) was 104 mU/ml for Alk Phos, 14 microg/l for
BAP, and 15 ng/ml for BGP. In osteopenic women, Alk Phos levels were elevated in 23% of
the cases, BAP in 21% and BGP in 40% (P=0.007). In osteoporotic women, Alk Phos levels
were elevated in 17%, BAP in 34% and BGP in 46% (P<0.001). The percentages of increased
values were higher in osteoporotic versus osteopenic patients for BAP (P<0.05) but not
for BGP levels. Along the same line, T scores were higher for BGP (2.3±0.3) than for BAP
(1.7±0.2) and Alk Phos (1.1±0.2) (P<0.0003). In summary, we have shown in osteopenic
and osteoporotic patients that BGP was more sensitive than BAP and Alk Phos, whether in
terms of percentages of increased values or T scores as compared to PreMP women. However,
BAP distinguished better than BGP osteopenic from osteoporotic women.
Parameters |
PreMP |
Osteopenia |
Osteoporosis |
Alk Phos, mU/ml |
61±2 |
78±3 |
83±3 |
BAP, microg/l |
6.7±0.4 |
10.8±0.5 |
12.4±0.5 |
BGP, ng/ml |
8.3±0.4 |
13.2±0.7 |
16.1±1.0 |
[Programme]
P-78
SERUM ACTIVITY OF TYPE 5B ACP AND BIOCHEMICAL MARKERS OF TYPE I COLLAGEN
DEGRADATION IN OSTEOPOROTIC MEN WITH KLINEFELTER'S SYNDROME TREATED WITH AN INTRAVENOUS
IBANDRONATE
J. J. Stepan1*, P. Burckhardt2
1Dept. of Internal Medicine 3, Charles University Faculty of
Medicine, Prague, Czech Republic
2Département de Médecine Interne, University, Lausanne,
Switzerland
Effects of treatment and withdrawal of ibandronate was studied in 13
patients with Klinefelter's syndrome. The diagnosis of Klinefelter's syndrome was
confirmed by cytogenetical analysis. The average age of the patients was 55.8 yr. (50-64
yr.), height 178.2±5.3 cm, and weight 86.1±14.1 kg. Median serum testosterone
concentration (1.1; 0.6-3.2 ng/ml) was significantly (p<0.01) decreased compared to
normal values. Mean BMD T-score at the lumbar spine, femoral neck and total body (DPX-L
bone densitometer, Lunar, WI) was -2.60±1.08, -1.40±0.94, and -1.70±1.06. The patients
were treated for 2 years with intravenous ibandronate (2 mg every three months) and
followed again when untreated for 1 year. After 6 month of treatment, serum type 5b ACP
(solid immunofixed enzyme activity assay, SBA, Finland) decreased by 44% and serum CTX
(Osteometer, Denmark) by 44%; urinary free DPD, NTX and CTX decreased by 35%, 42%, and
65%, respectively (all p<0.05). Treatment for 2 years with iv ibandronate increased
significantly BMD at the spine, hip, and total body (p<0.01); patients had gained
10.06±4.29%, at the lumbar spine, 6.71±5.46% at the femoral neck, and 5.00±2.35% at the
total body (mean±SD). One year after withdrawal of the treatment, the rate of bone loss
(2.06±3.17% at the lumbar spine; 4.31±3.83% at the femoral neck, and 0.12±2.40% at the
total body) resumed above the pretreatment rate (1.34±0.77% at the lumbar spine,
0.90±0.32% at the femoral neck and 0.64±0.32% at the total body). One year after
withdrawal of the treatment, activity of serum type 5b ACP returned to pretreatment levels
while serum CTX doubled as compared with values on the second year of treatment.
Conclusion: The results indicate that type 5b ACP in the serum reflects number of
osteoclasts rather their activity. The enzyme can be used as a valuable adjunct to markers
of degradation of type I collagen in assessment of mechanism of action of drugs and for
monitoring treatments.
[Programme]
P-79
EFFECT OF CALCIUM SUPPLEMENTATION IN SUCKLINGS ON BONE MINERAL DENSITY IN
ADOLESCENT RATS
M. Saric*, V. M. Varnai, M. Piasek, M. Blanusa, D. Juresa, M. M. Saric,
S. Cvijetic Avdagic, K. Kostial
Institute for Medical Research and Occupational Health, Zagreb, Croatia
Importance of adequate calcium intake on formation of bone mass has been
proved for children and teenagers, but the effect of calcium supplementation during
infancy is yet to be established. An increase in peak bone mass by calcium supplementation
during skeletal formation may contribute to osteoporosis prevention.
We evaluated the effect of calcium supplementation in suckling rats on
bone calcium content and essential element concentrations immediately after
supplementation period and on bone mineral density (BMD) at the age of 2 months.
Forty-eight female suckling rats (Wistar) were artificially fed on cow's milk or on cow's
milk supplemented with 6% calcium (as Ca-hydrogen phosphate) to increase the daily calcium
intake about 3 times above control values. Treatment lasted 7 hr a day for nine
consecutive days, from day 6 through 14 after birth. At the end of supplementation period,
18 sucklings (9 non-supplemented and 9 calcium- supplemented) were killed and calcium
concentration in the carcass (whole body after removal of the organs, total
gastrointestinal tract, and skin) was analysed by atomic absorption spectrometry. Calcium
supplementation was associated with an increase in carcass calcium concentration by about
17% compared to non-supplemented pups. Growth and concentrations of trace essential
elements in carcass and organs were not affected. Other 30 suckling rats (15
non-supplemented and 15 calcium-supplemented) weaned on feed with marginal calcium (0.33%)
and were fed on the same test diet during 7 weeks. At the end of this period, total body
BMD was measured in 2-month- old rats by densitometry using dual energy X-ray
absorptiometry (Lunar DPX, Madison, WI, USA) in ketamine and xylazine anesthesia. No
difference was found between groups in relation to calcium supplementation during the
suckling period.
These results confirm findings from our previous investigation in which
calcium supplementation during the suckling period had no effect on BMD in 3-month-old
female rats fed on either 1% or 0.45% calcium diet. It is concluded that calcium
supplementation during the suckling period increases the calcium concentration in bones,
but it has no influence on bone mineral density in adolescence, even under condition of
marginal calcium intake.
[Programme]
P-80
A MULTICENTER STUDY FOR THE EVALUATION OF PHALANGEAL QUANTITATIVE
ULTRASOUND TECHNIQUE IN HUNGARY
V. Ferencz1*, S. Meszaros1, E. Toth1, E.
Csupor1, F. Terlizzi3, E. V. McCloskey2, C. Horvath1
11st Department of Medicine, Faculty of Medicine, Semmelweis
University, Budapest, Hungary
2WHO Collaborating Centre for Metabolic Bone Diseases,
University of Sheffield, Sheffield, UK
3IGEA, Carpi, Italy
Introduction: The suitability of quantitative bone ultrasound has been
addressed in many studies over the past some years. It is particularly important in
multicenter trials establishing stability of instruments and determining differences that
can occur among devices.
Methods: 17 DBM Sonic Bone Profiler devices (IGEA, Carpi, Italy) had been
calibrated by same operator using a composite phantom developed by IGEA. The phantom was
measured 12 times on each instrument and the precision error (CV%) was calculated for
separate devices and for the whole group. Some more tests checking the zero position, the
span and the amplitude were also done.
Results: The mean CV% and the range for the amplitude-dependent speed of
sound (AD-SoS) was found as 0.2% (0.12-0.28) in the whole group with an inter-instrument
CV% of 0.35%. Calibration of 14 devices was within the acceptable range (2580±25.8 m/s)
for AD-SoS. The excluded 3 devices need recalibration followed by a re-evaluation of
performance tests.
Conclusion: The results confirm the usefulness of the cross-calibration
as a basic process in multicenter work using quantitative ultrasound of the bone. DBM
Sonic Bone Profiler devices show a very low precision error. However, cross-calibration
can reveal the need of service and recalibration if a number of devices are used. We
suggest to repeat this process in regular time during multicenter trials.
[Programme]
P-81
URGENT NEED FOR AN ACTION AGAINST OSTEOPOROSIS IN AFRICA
M. R. D. Zebaze1*, L. M. Ebah2, C. W. Djeumen2,
T. J. B. Echouffo3
1Mfou District Hospital, Yaoundé, Cameroon
2University Teaching Hospital, Yaoundé, Cameroon
3Bafang District Hospital, Bafang, Cameroon
Osteoporosis is a well recognised public health problem in developed
countries and efforts are currently made to reduce its economical and social impact. In
Africa, there is a perpetuation of a certain myth of its scarcity or even absence. Because
of this,no preventive or curative measures are currently taken. However, we reported in a
previous study that osteoporosis is the third cause of admission for fractures in Cameroon
and that fractures incidence are substantials and much higher than previously thought and
may be increasing dramatically. It also appears following recent studies that lack of
awareness of osteoporosis among African physicians might be contributing to the
under-estimation of the disease. Thus osteoporosis is a growing public health problem in
Africa. We therefore call for an urgent need to tackle the upcoming osteoporosis problem
in this part of the world.
[Programme]
P-82
COLLAGEN AND BONE CHARACTERISTICS IN ADULT PATIENTS WITH CONGENITAL HIP
DYSPLASIA
C. M. Bonelli1, D. Walter1, A. Fahrleitner1,
J. C. Piswanger-Sölkner1, H. Dobnig1, W. Linhart2, T.
Reitinger2, R. Windhager3, G. Leb1, B. Obermayer-Pietsch1*
1Dept. of Internal Medicine, Karl-Franzens-University Graz,
Austria
2Dept. of Pediatric Surgery, Karl-Franzens-University Graz,
Austria
3Dept. of Orthopedic Surgery, Karl-Franzens-University Graz,
Austria
BACKGROUND: Congenital hip dysplasia (CHD) is one of the most frequent
congenital malformations of the skeleton. In Austria, every 10th women may be affected.
Recently, we reported on significantly decreased BMD at the hip in adult patients with
conservatively treated CHD (JBMR 15, 2000). In the present study, we investigated bone
mineral density (BMD), parameters of connective tissue, bone and collagen metabolism and
joint laxity in a large group of adult female CHD patients.
METHODS: Using medical records, 150 premenopausal women with a history of
conservatively treated CHD were identified and invited to a clinical examination including
connective tissue and joint laxity parameters, past medical history, DEXA measurements at
the spine and both hips (Hologic 4000 plus) and bone ultrasound measurements at the
radius, proximal phalanx and calcaneus (Sunlight, Lunar) and compared to 249 age matched
controls. Biochemical characteristics included osteocalcin (OC), crosslaps (sCTX),
25(OH)vitamin D3, calcium, phosphate, alkaline phosphatase, aminoterminal propeptide of
type III procollagen (PIIINP), carboxyterminal propeptide of type I procollagen (PICP) and
carboxyterminal cross- linked telopeptide of type I collagen (ICTP). Patients with
secondary causes of osteoporosis were excluded.
RESULTS: In CHD patients, BMD at the hip (neck, ward) was again
significantly decreased as compared to controls (p=0.01, p=0.04, respectively) despite a
normal lumbar BMD. OC, sCTX and PINP levels were significantly elevated in CHD patients
(p=0.0001, p=0.03, and p=0.03 respectively). Furthermore, the incidence of hernias, joint
laxity and peripheral bone fractures was significantly increased in CHD patients
(p=0.0009, p=0.02, p=0.03, respectively) as compared to controls.
DISCUSSION: Decreased femoral BMD may increase the risk for hip fractures
in adult women with conservatively treated CHD. However, disturbances of collagen and bone
metabolism in these patients suggest a more general disorder of bone and connective tissue
affecting a large part of the (female) population. Therefore, characterisation of CHD
pathophysiology and a careful follow-up of CHD patients may contribute to further insights
in causes and prevention of bone disease in these patients.
[Programme]
P-83
DIFFERENTIAL DIAGNOSTICS OF INHERITED CONNECTIVE TISSUE DISEASES
V. Vyskocil1,2*, J. Varvarovska2, K. Koudela3,
B. Kreuzberg4
1Department of Bone Disease, Department of Medicine II,
Charles University Hospital, Plzen, Czech Republic
2Department of Pediatric, Charles University Hospital, Plzen,
Czech Republic
3Department of Orthopaedic Surgery, Charles University
Hospital, Plzen, Czech Republic
4Department of Radiology, Charles University Hospital, Plzen,
Czech Republic
The authors followed 350 patients with connective tissue diseases from
1996 to 2000. The reason for that choice is genetic relationship of collagen defect.
Complete clinical, radiological and biochemical examinations (including
50 items) were finished in 200 patients from initial number of 350 patients. The studied
groups consisted of 45 patients with osteogenesis imperfecta (OI), 30 children with Ehlers
Danlos syndrome (ED) and 45 patients with Marfan syndrome (MS) and 35 with familiar joint
hyperelasticity. 21 cases were concluded as other diagnosis and in 24 cases no diagnosis
was found due to different obstacles. Authors tried to apply the criteria combination for
OI, MS and ED so that the validity of particular criteria could be evaluated and then used
in diagnostic difficulties among the studied diseases.
The patients were examined physically first with stress to the single
criteria in OI besides blue sclerae, number of fractures, time of the first fracture,
classification according to Sillence, dentinogenesis imperfecta including some specific
radiograph symptoms. In Marfan syndrome the authors followed not only MCP index but also
the trunk deformity, echocardiography, ophthalmological examination and the index between
arms span and body height, eventually the ratio between trunk and limbs.
In ED the authors followed joint hyperelasticity, especially of knee and
elbow and vascular eventually organ complications such as pneumothorax and intestinal
perforation.
Conclusions:
1. Patients with MF have significantly higher height, arms span and ratio
between trunk and limbs.
2. Patients with ED have significantly lower incidence of scoliosis than
patients with OI or MF.
3. Patients with OI have the lowest bone mineral density BMD, age of the
first fracture and even level of PICP related to age.
4. Combination of densitometry, markers of bone metabolism and
anthropometry can differentiate distinct groups of inherited connective tissue diseases.
5. Response to antiresorptive therapy can be used in differential
diagnosis of those diseases.
[Programme]
P-84
HIERARCHIAL INTEGRATION OF THE SKELETAL SYSTEM: A PLURALISTIC APPROACH TO
A MULTI-FACTORIAL DISEASE - OSTEOPOROSIS
L. Klein
School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
Hierarchial integration of the musculoskeletal system (Cells &
Materials 7: 245, 247-57, 1997) has produced new insights into the sensing, communication,
and signaling that occurs within and between systems, organs, tissues, cells and nuclei.
Additional integration of the nervous and vascular systems permits complex sensing and
communications of mechanical, metabolic, and nutritional stresses of bones and connective
tissues within and among the various joints and bones of the body. The recent focus of
research activities is on fundamental and applied aspects of bone mass, structure,
metabolic turnover, and biological conservation in complex multi-systems. New insights for
the significance of absolute bone mass (a "gold standard"), metabolic turnover,
conservation and redistribution of mass are leading to absolute measurements of bone mass,
hormonal mechanisms of metabolic turnover in bone from young mature and old species.
Estrogen appears to be a biological integrator with its receptors interacting at both
cellular and nuclear membranes from various cells.
New experimental designs and methods yield new quantitative approaches
for analysis and unambiguous interpretation of complex biological systems that interact in
situ. The skeletal system is very complex because it interacts with many other systems and
organs such as muscle, nerve, vascular, renal, gastrointestinal, respiratory and brain. In
addition, bones of the skeletal system are heterogeneous in structure and activity at all
levels of organization, i.e. species, system, organs (bone), regions, tissues, and cells.
The presence of efficient conservation in situ of bone mineral mass
(calcium and phosphorus) in whole animals (man including) requires specific experimental
methods for observing and measuring quantitatively absolute bone mass and metabolic
turnover. Current experimental methods usually observe and measure small parts of bone for
concentraion and density of bone mass and turnover. This latter approach often leads to
incomplete data and misinterpretation. Pluralistically all levels of data are important
because all data are important.
[Programme]
P-85
ABSOLUTE BONE WEIGHT OF WHOLE BONES: A "GOLD STANDARD" FOR BONE
MASS
L. Klein*, C. L. Nash
School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
A distinction needs to be made between absolute data and relative
data in biology and medicine (Table 3, L. Klein, Cells & Materials 7: 245-57, 1997).
Absolute bone mass is the "gold standard" because mass comes directly from
physical weighing of each whole bone which represents a single intact anatomic unit. The
weight of a dry, defatted bone is the absolute bone mass for a given bone and is the sum
of mineral, matrix, and a small amout of cartilage.
In contrast, most radiological measurements are a relative index of bone
mass such as bone mineral density which are presented as gm/cm2, gm/cm3
or ash weight/unit volume. Physically, there is a distinct conceptual difference between absolute
mass and relative mass. Biologically, changes in primary and secondary
mineralization occur over time which complicate the accuracy of measuring bone mineral
density.
The bones are from Hamann-Todd collection of the Cleveland Museum of
Natural History and were obtained from human skeletons devoid of skeletal disease and/or
generalized wasting. Eight appendicular bones (cranium, humerus, radius, ulna, clavicle,
femur, tibia, fibula) and eight axial bones (scapula, pelvis, innominate, sacrum, ribs,
cervical vertebra, thoracic vertebra, and lumbar vertebra) were studied at each decade
from 10 to 93 years of age. Prior to accurate weighing, the bones were defatted, dried,
and then compared as a function of age. The peak bone mass for females was at 20-29 years
old and for males at 30-39 years old which are designated as the baseline (100%).
Our results demonstrated that the female bones from 20 to 90 years of age
showed larger losses of mass by 90 years ranging from 23% in cervical vertebra to 49% in
fibula. In comparison, the males showed much smaller losses of bone mass by 90 years
ranging from 6% in cervical vertebra to 16% in humerus. Starting from the fourth decade,
male bones showed small significant losses of bone (2-3%). In contrast, the female bones
showed larger linear losses (11-12%) starting in the third decade. These data showed a
surprising heterogeneity in the rates of bone loss for both male and female bones.
[Programme]
P-86
ASSOCIATIONS BETWEEN QUANTITATIVE ULTRASOUND OF FINGER PHALANGES AND
FAILURE LOADS OF SPINE AND FEMUR IN VITRO
R. Barkmann1*, E-M. Lochmueller2, F. Eckstein3,
V. Kuhn3, C-C. Glueer1
1Medizinische Physik, Klinik für Diagnostische Radiologie,
UK-Kiel, Germany
2Universitätsfrauenklinik, LMU München, Germany
3Musculoskeletal Research Group, Institute of Anatomy, LMU
München, Germany
Although site matched bone density measurements of spine and femur are
best suited to predict fracture risk on these sites, peripheral measurements offer some
advantages in terms of costs, portability and radiation dose. We determined in an in vitro
study correlations between Quantitative Ultrasound (QUS) measurements on finger phalanges
and failure loads of spine and femur, in comparison with DXA on spine, femur and radius.
QUS measurements were performed on the third phalanx with excised soft
tissue in medio-lateral and superio-inferior direction using a DBMSonic 1200 (Igea,
Italy). Standard parameters are AD-SoS, UBPI and BTT. The performance of AD-SoS and UBPI
depends on the value of a fixed trigger level, which is optimised for in vivo measurements
but cannot be applied on measurements on formalin-fixed bones in vitro. Instead, we used a
recently developed parameter (cAD-SoS) which strongly correlates (R=0.95) with the
standard parameter AD-SoS, but does not depend on a fixed trigger level. nSOS is a new
velocity parameter which strongly correlates with the cortical cross-sectional area of the
phalanx. DXA measurements of LS 3, femur neck and distal radius were performed using a
DPX-L (GE-Lunar, WI).
Significant correlations at p<0.01 could be found between all QUS and
DXA parameters and all failure loads. Site matched DXA yielded the highest correlations
(R=0.74 - 0.82). Lower correlations could be observed for DXA of the radius (R=0.53 to
0.62) and QUS of the phalanges (R=0.4 - 0.66). Best non site matched correlation was
between nSOS and failure load of the femur (R=0.66, vertical loading).
QUS of finger phalanges is associated with failure loads of spine and
femur with correlations somewhat lower than site matched DXA but similar to DXA of the
radius. New QUS parameters might improve these correlations.
[Programme]
P-87
EFFECTS OF THE BODY MASS INDEX AND AMENORRHOEA ON BONE MINERAL DENSITY
C. M. Francucci*, T. Mancini, A. Camilletti, L. Riccialdelli, B. Cola, F.
Massi, M. Boscaro
Division of Endocrinology, Department of Internal Medicine, University of
Ancona, Italy
The pathogenesis of osteoporosis is complex and many risk factors are
involved. In order to select the patients at higher risk of osteoporosis, different
questionnaires have been used. The questionnaire we have been using aims especially to
look for conditions such as amenorrhoea, hyperthyroidism and hypercortisolism, which are
well known risk factors for the osteoporosis.
In this study we have evaluated the effects of these risk factors and of
the body mass (BMI) on bone mineral density (BMD) in 766 women who were referred to our
centre to perform a Dual-Energy X-rays Absorptiometry (DPX Lunar V 3.61, Madison,
Wisconsin).
These women presented a mean age ±SD of 46.2±2.5 (range 40-49 years), a
mean BMI±SD of 25±4.4 and didn't present any other risk factors.
A positive correlation between BMI and BMD was observed (r=0.4 and
P<0.001).
The patients were subsequently divided in four categories depending on
risk factors (amenorrhoea, hypercortisolism, hyperthyroidism and controls). All groups did
not differ for age and BMI.
We observed that amenorrhoic patients presented BMD significantly lower
versus both hyperthyroid and controls (** p<0.001).
In conclusion our data show that underweight and amenorrhoic women have
the lowest BMD. Amenorrhea is an important osteoporosis risk factor, independently of the
weight.
[Programme]
P-88
EFFECTS OF RISK FACTORS ON THE VERTEBRAL MINERAL DENSITY
T. Mancini, A. Camilletti, E. Biondi, P. Rutigliano, F. Massi, C. M.
Francucci*, M. Boscaro
Division of Endocrinology, Department of Internal Medicine, University of
Ancona, Italy
Many risk factors contribute to the pathogenesis of osteoporosis. Typical
examples include lifestyle and constitutional factors, low body mass, low levels of
physical activity, prolonged immobility, alcohol abuse, estradiol deficiency, long term
corticosteroid use and hyperthyroidism. Many studies have shown that these factors predict
low bone mass at any skeletal site.
Between 4.040 women (mean age±SD 55.2±10.1, BMI 25.8±5.1 and BMD
1.070±0.1g/cm2) arrived at our center, at the first time from 1996 to 2000, to
effect a Dual-Energy X-ray Absorptiometry (DXA) for bone mineral density evaluation, we
have selected 775 women with a middle age of 46.2±2.5 that are the whole group of
patients with an age range of 40 to 49 years. Since these women had a significant
reduction of spinal BMD at lumbar spine (L2-L4) vs 715 healthy women with the same range
of age of DPX Lunar V 3.61 (mean BMD±SD 1.149±0.15g/cm2 vs 1.170±0.12g/cm2;
p=<0.001), we have excluded 283 women that had a history of amenorrhea (n. 217),
hypercortisolism (n.30), hyperthyroidism (n.25), renal illnesses (n.9) and
hyperparathyroidism (n.2). The others 492 women (without no other osteoporosis risk
factors referred to us) had a bone mass like controls of DPX Lunar V 3.61 (mean BMD±SD
1.170±0.1g/cm2 vs 1.170±0.12g/cm2; p=0.8). Even if the women with
hypercortisolism had a bone mass reduced vs controls, only the patients with amenorrhea
had a significantly lower BMD vs 492 healthy women and vs controls of DPX Lunar V 3.61
(mean BMD±SD 1.099±0.14g/cm2 vs 1.170±0.1g/cm2 vs 1.170±0.12;
p=<0.001).
Our data show that amenorrhea is an osteoporosis risk factor more
important than endogenous or iatrogenic hypercortisolism, that hyperthyroidism don't give
rise to significant reduction of bone mass at vertebral level and that healthy women of
middle Italy (Adriatic coast) and controls of DPX Lunar V 3.61 have the same BMD at lumbar
spine.
[Programme]
P-89
AXIAL AND LOCAL TIBIAL BONE MINERAL DENSITY IN MENOPAUSAL WOMEN WITH
OSTEARTHRITIS
E. Jodar1*, J. M. Padrino2, G. Martinez1,
S. Azriel1, F. Hawkins1
1Dept of Endocrinology, University Hospital 12 de Octubre,
Madrid, Spain
2Dept of Rheumatology, University Hospital 12 de Octubre,
Madrid, Spain
A negative association between osteoporosis (OP) and osteoarthritis (OA)
has been described. OA has been related to an increased subcondral bone mineral density
(BMD). Our aim was to assess axial (lumbar spine [LS] and fenoral neck [FN]) and local
tibial (tibial spine [TS] and internal condylus [IC]) BMD in menopausal women with spinal
or knee OA.
Patients & methods: 90 consecutive menopausal women, aged 50-70
years, were studied. 12 women did not show OA and were used to calculate local tibial
z-scores (TS and IC). 78 patients showed mild to moderate spinal and/or knee OA. BMD was
measured by DXA (Hologic QDR1000w). Bone turnover markers (BGP, total and bone ALP, NTx
& Pyr) and calciotrophic hormones were also measured (PTHi, 25(OH)D, IGF-I and
estradiol).
Results: Control and OA groups were comparable in age, weight, years
since menopause, calciotrophic hormones and bone markers except for BGP, lower in OA
patients (p=0.003). Local tibial BMD was increased in OA patients (z-score): IC:
0.711±1.789; TS: 0.722±0.946 (p<0.003 vs 0). Local tibial and axial BMD correlated
closely, and local tibial BMD correlated with radiographic rating scale of OA (RxSc). 40
women (51.3%) showed densitometric OP. In the multivariate analysis, IC BMD was related to
FN BMD, RxSc, estradiol and PTH (R: 0.872; adjusted R2: 0.693); TS BMD was, in turn,
related to FN BMD and estradiol (R: 0.629; adjusted R2: 0.335).
Conclusions: Local tibial BMD is increased in menopausal women with
mild-to- moderate spinal and/or knee OA and is related to radiographic rating scale. The
prevalence of OP in these women is very high. Local tibial BMD and femoral neck BMD are
closely related.
[Programme]
P-90
PRECISION OF BONE MINERAL MEASUREMENT BY DUAL ENERGY X-RAY ABSORPTIOMETRY
M. R. Salamat
Department of Medical Physics and Medical Engineering, Isfahan University
of Medical Sciences, Isfahan, Iran
There are several methodologies available for bone mineral measurement.
Dual energy x-ray absorptiometry (DXA) has an overall advantage in terms such as precision
and radiation exposure. It is a well-established method and has the potential of
multi-site measurement. Although DXA is widely used to assess bone mineral of the spine
and hip, little use of the technique has been made to investigate other sites of the body.
Therefore, appropriate methods were developed to measure the hand, os calcis and tibia.
Precisions of the methods were assessed. A Hologic QDR-1000W DXA system was used for the
investigations.
Hand bone mineral measurement is of particular interest in rheumatoid
arthritis patients (RA). A hand phantom which provided a convenient means of evaluating
various protocols and assessing long term precision was developed and used for the
investigations. The conventional protocols differ in factors such as scan speed,
linearity, tissue depth dependence and precision. Therefore, a new protocol was evaluated
for the precision.
A technique was developed for the assessment of os calcis. An os calcis
phantom was constructed and used to assess precision and the effect of size of region of
interest (ROI) on precision. In-vitro precise (CV=0.4%) and linear measurements were
achieved independent of the size of ROI and soft tissue. Two different ways of subject
positioning and two ROIs for the measurements were established, using a group of subjects.
In-vivo precise measurements (CV<1.1%) were achieved for both ROIs.
A method was developed for the assessment of the various sections of the
lower leg (tibia/fibula). Measurements were linear and soft tissue independent. Precise
measurements (CV<1.4%) were achieved for the proximal and total lower leg. The rotation
of the legs showed the least effect on BMD measurement of the proximal lower leg.
[Programme]
P-91
ULTRASOUND DETERMINATION OF OSTEOPOROSIS PREVENTION
Z. C. Orlic1*, K. D. Bozic2
1Internal Clinic, University of Rijeka, Croatia
2Health Center Pula, Croatia
People who live in the sunshine part of Croatia, in Istria, were
characterised as a low milk intake population forty years ago. Today there is no heavy
industry, and the standard of living is much higher than in those days. Milk as the major
calcium source was thought to be the main reason of low bone mass.
Clinicians can identify accurately, non-invasively and inexpensively,
patients with low bone mass nowadays. So, we have done ultrasound examination of calcaneus
to evaluate bone mass in l0% of the Istrian population.
Our investigation shows that the prevalence of osteoporosis is 27% in the
whole population, 35% in women past menopause, but also 20% in men and l0% in
premenopausal women. Osteopenia was detected 35% in the whole population and 37% in
postmenopausal women, as well as 30% in men and in 30% premenopausal women. In 35% of
whole population, and in 37% postmenopausal women, as well as in 30% of man and in 33% of
premenopausal women.
Our findings of such low bone mass in people in Istria indicate urgent
need for better evaluation of skeletal status in that population.
It will be interesting to correlate nutrition habits, genetic and
physical factors in those people, which all can point out ethiological priorities in
pathogenesis of primary osteoporosis.
[Programme]
P-92
SECONDARY OSTEOPOROSIS IN PATIENT WITH ADULT CELIAC DISEASE
B. M. Sincic B.1, Z. C. Orlic1*, D. Krpan2,
D. J. Erzen1
1Internal Clinic, University of Rijeka
2Internal Clinic, Clinical Hospital 'Sveti Duh' Zagreb,Croatia
Bowel diseases are frequently associated with bone loss.
We have analyzed a fifty two year old woman who came to the clinic with
the illness history of diarrhea, loss of weight and old fracture of fourth left metacarpal
bone.
Routine laboratory test indicated malapsorption problems. Results of
D-xylosa test, lipid absorption test, endomisial antibodies and jejunal biopsy confirmed
the diagnosis of celiac disease.
After the specific diet treatment she slowly gained weight, but body mass
index (BMI) did not rise more than 20 kg/m2.
After she was complaining of back pain, X-ray examination and bone
densitometry were done.
Low bone mineral density (BMD) values indicated osteoporosis.
Biochemical markers of bone resorption confirmed an active resorption
phase of bone remodeling. Parathyroid hormone (PTH) was twice the normal values. Bone
biopsy and hystomorphometry established the diagnosis of hyperparathyroidism.
After three months of treatment with biosposphonates (alendronate),
vitamin D and calcium supplementation, bone markers were elevated and the patient
complained less of back pain.
The findings of the present case report suggest that patients with
malapsorption syndrome are at high risk for bone loss. Further studies are needed to
evaluate the efficacy of specific antiresorptive therapies and clinical utility of
biochemical markers of bone turnover in predicting therapeutic response in these patients.
[Programme]
P-93
EVALUATION OF BONE MASS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE
B. M. Sincic, Z. C. Orlic*, D. Stimac, B. Radakovic, D. J. Erzen
Internal Clinic, University of Rijeka, Croatia
A low bone mineral density (BMD) has been reported in patients with
inflammatory bowel diseases (IBD). The prevalence of osteoporosis seems to be higher in
patients with Crohn's disease (CD) than in those with ulcerative colitis (UC), whereas the
prevalence of osteopenia was found to be similar by most studies. Factors associated with
bone loss in IBD are the inflammatory activity, corticosteroid use, duration of disease,
male sex, low body-mass index, inactivity, hypogonadism, and in CD smoking and surgical
resection.
The purpose of the present study was to determine the prevalence of
osteopenia and osteoporosis in IBD patients, and to test the influence of clinical
variables (age, sex, disease duration, corticosteroid use) on the bone mineral density
(BMD).
Fifty eight patients with IBD entered the study. BMD was measured by
dual- energy X-ray absorptiometry (DEXA). Overall prevalence of osteopenia and
osteoporosis was 42% and 30%, respectively. We found no difference between CD and UC
patients. There was also no significant difference regarding clinical variables between
patients with normal and low BMD. When patients with CD were analyzed separately, we found
statistically significant negative correlation (with correction for age, sex body mass
index and corticosteroid use) between BMD and the duration of disease (r=0.58, p=0.002).
We conclude that the IBD patients have well defined osteopenia and
osteoporosis, the degree of which is not different in CD and UC. Duration of the disease
seems to be the only phenomenon related to the low bone mass.
[Programme]
P-94
CONTRIBUTION TO THE PREVENTION OF OSTEOPOROSIS IN POSTMENOPAUSAL WOMAN IN
REGION OF THE REPUBLIC OF CROATIA - CROATIAN LITTORAL
D. J. Erzen, Z. C. Orlic*
Internal Clinic, University of Rijeka, Croatia
The aim of the study was to evaluate the effects of hormonal replacement
therapy, calcitonin and bisphosphonates on bone mass of postmenopausal women in region of
the Republic of Croatia - Croatian Littoral. We have analysed 122 women of control group
(the postmenopausal women who did not receive the therapy for osteoporosis) and 79 women
who received therapy for osteoporosis during the period of 12 month (33 women hormonal
replacement therapy, 32 women calcitonin and 14 women bisphosphonates).
In these women we measured bone mass density (BMD) of lumbal spine using
densitometer MBC-lab 23 wich works on the principle of dual photon absorbtiometry
utilizing gamma rays of the element gadolinium Gd 153. Laboratory measurements include
routine tests and electrolite values in serum and urine and OH proline in urine specimens.
Hormonal replacement therapy prevents futher rapid loss of bone density
that occurs in the first five years of menopause, during the period of 12 months and
significantly increases bone mass of spine - about 2% Salmoncalcitonin 100 IU given
intranasaly prevents bone loss in the spine in established osteoporosis and increases bone
mass in a small percentage - about 1%. Cyclical etidronate therapy did not change BMD
values. All of the patients have the calcium supplementation of 1000 mg daily and 600 UI
vitamin D.
Hormonal replacement therapy and calcitonin have expected effect on
increase of the bone mass. In the group treated with cyclic etidronate, we have poor
results because it was a small group with small initial bone mass. For the better
evaluation of these results in this group, it is necessary to have more patients and a
longer period for the therapy.
To be more effective, all treatments should be started early, before
serious bone loss has occurred.
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