Bilateral Femoral Necks Research Articles

Changes in bone mineral density and clinical parameters after stroke in elderly patients with osteopenia.

We aimed to determine the association between changes in bone mineral density (BMD) of the lumbar spine, bilateral femoral necks and clinical parameters in ambulatory older adult patients with stroke who were diagnosed with osteopenia. This retrospective study included ambulatory patients older than 65 years diagnosed with stroke between January 2019 and June 2021. Osteopenia was diagnosed within 1 month after stroke diagnosis. Subsequently, follow-up BMD was performed within 12 to 14 months. The manual muscle test and modified Barthel index were measured as clinical parameters, and bone turnover markers were measured as biochemical markers. The Wilcoxon signed-rank test was used to compare whether a significant difference in the change in BMD was noted at each site measured at 1-year intervals. The BMD of the paretic and non-paretic femoral necks decreased significantly over time, but no significant change was observed in the BMD of the lumbar spine. Bone turnover markers were significantly changed at follow-up. Patients with modified Barthel index of less than 82 had significant bone loss only on the paretic side of the femoral neck. The BMD of the paretic side of the femoral neck was significantly decreased regardless of the strength of the hip and knee extensors. Although older adult patients with stroke and osteopenia can walk independently, more active osteoporosis treatment is needed to prevent bone loss and fractures, including improvement in daily living function and bilateral lower extremity strength training.

Quantitative evaluation of bone marrow fat content and unsaturated fatty index in young male soccer players using proton magnetic resonance spectroscopy (1H-MRS): a preliminary study.

Marrow fat exists as a distinct adipose tissue and plays a critical role in affecting both the quantity and quality of bone. However, the effect of soccer training on marrow fat has been rarely reported. This study aims to evaluate and characterize the marrow fat content and composition in different bone areas of soccer players and age-matched healthy subjects using proton magnetic resonance spectroscopy (1H-MRS). Between May 2020 and June 2020, 20 professional soccer players (20.7±0.9 years) and 20 age-matched healthy subjects (21.2±0.8 years) were enrolled in this cross-sectional study. The 1H-MRS were acquired from the 3rd lumbar vertebrae, bilateral femoral necks, and distal tibias of all subjects using a single-voxel point-resolved spatially localized spectroscopy (PRESS) sequence. Four soccer players underwent a second magnetic resonance (MR) examination within a 30-minute interval after the initial scan to evaluate test-retest reproducibility. Inter- and intra-observer measurement reliabilities were assessed using 10 randomly selected spectra from the soccer players group. All spectra were processed using the jMRUI software package (http://www.jmrui.eu/). Quantified water and lipid signals were used to calculate fat content (FC) and the unsaturated fatty index (UI). Compared with healthy subjects, we found that soccer players had a lower FC in L3 and bilateral femoral necks and higher UI in the left femoral neck (P<0.05). All FC and UI values of the bilateral distal tibias showed no significant differences between the two groups (P>0.05). The UI values of the right femoral neck or distal tibia were markedly higher than the left side in both inactive subjects and soccer players (P<0.05, except for the femoral neck in players), and there were notable ΔUI differences in the lower limbs between the soccer players and the healthy subjects (P<0.05). Soccer practice can be considered a positive sport that contributes to decreasing FC in lumbar vertebrae and femoral necks and increasing the UI in femoral necks. Quantitative MRS provides an ideal modality to predict marrow fat metabolism caused by mechanical stimulation.

Modified cannulated screw fixation in the treatment of Pauwels type III femoral neck fractures: A biomechanical study

BackgroundAchieving satisfactory internal fixation for patients with Pauwels type III femoral neck fractures has become a critical problem. The purpose of this study was to compare a common standard internal reduction and fixation method for femoral neck fractures to the modified fixation methods. MethodsA computed tomography scan of the femur was performed to make a Three-dimensional (3D) model, and a fracture line was simulated in the femoral neck. 3Dfinite element analysis was carried out for different insertion methods of cannulated tension screws. Six healthy femur specimens were harvested from three formalin-fixed cadavers, and Pauwels type III femoral neck fracture was artificially created in bilateral femurs. The right side was treated with the inverted triangle construct method and the left side by the modified screw fixation method. After fixation, uniaxial compression and maximum load experiments on the bilateral femoral necks were carried out using the non-contact full-field dynamic strain measurement system (VIC-3D) on a pressure testing machine. FindingsBoth 3D finite element analysis and biomechanical study showed that the modified screw fixation method(group D) provided better anti-shearing and anti-rotation properties for Pauwels type III femoral neck fractures, and offered better interfragmentary compression. Therefore, this modified screw fixation method can offer patients a better option for treatment of Pauwels type III femoral neck fractures. InterpretationChanging the placement of the anterosuperior screw in the inverted triangle construct as perpendicular to the fracture line has the advantages in anti-shearing, anti-rotation and increasing interfragmentary compression.

Effects of monthly minodronate with or without eldecalcitol addition in osteoporosis patients with rheumatoid arthritis: An 18-month prospective study

ObjectivesIncreasing bone mineral density (BMD) to reduce fracture risk is a primary goal of osteoporosis treatment. This prospective, observational study evaluates the effects of monthly minodronate (MIN; 50 mg) with or without eldecalcitol (ELD) addition in osteoporosis patients with rheumatoid arthritis (RA) during 18 months. MethodsThe cohort was prospectively and randomly split into the MIN monotherapy group (14 cases) and MIN plus ELD group (combination group; 14 cases) due to no reports on the effectiveness and safety of MIN therapy in relation to ELD addition for comparisons of serum tartrate-resistant acid phosphatase (TRACP)-5b, bone alkaline phosphatase (BAP), and BMD of the lumbar 1–4 vertebrae (L-BMD), bilateral total hips (H-BMD; the mean value of the right and left hips), and bilateral femoral necks (FN-BMD) at baseline and at 6, 12, and 18 months of treatment. ResultsBaseline values were comparable between the groups apart from a tendency for higher TRACP-5b in the combination group. Seven of 14 patients in the combination group had received previous bisphosphonate treatment. BAP was significantly more reduced in the monotherapy group at 6 months, with no other remarkable differences for TRACP5b, L-BMD, H-BMD, or FN-BMD during the observation period. ConclusionsThe above findings suggest that regardless of ELD addition, MIN potentially improves BMD during 18 months in osteoporosis patients with RA.

Significance of Detecting Serum Complement C3 and C4 in Patients with Multiple Myeloma

To investigate the significance of detecting serum complement C3 and C4 in patients with multiple myeloma (MM) and to explore its correlation with myeloma bone disease (MBD). The levels of serum complement C3 and C4 in 69 MM patients and 30 healthy people were examined by scatter nephelometry. The bone density of L1-4 vertebral body, bilateral femoral neck and bilateral hip joints were measured by dual energy bone density meter (DXA). The levels of serum complement C3 and C4 in MM patients significantly increased in comparison with that in healthy people (P＜0.01). The patients in advanced clinical stage exhibited a higher levels of C3 and C4 than those in stable stage (P＜0.01). In addition, the patients with grade C of MBD had a higher levels of serum complement C3 and C4 than those in patients with grade A and B of MBD (P＜0.01). The levels of serum complement C3 and C4 in MM patients negatively correlated with bone density in L1-4 vertebral body, bilateral femoral necks and hip joints. The correlation coefficients were r=-0.938, r=-0.659, r=-0.745, r=-0.748, r=-0.596 in complement C3 and r=-0.908, r=-0.623, r=-0.710, r=-0.714, r=-0.595 in complement C4, respectively. The levels of complement C3 and C4 positively correlate with the severity of bone disease and bone density in MM patients, which suggests that complement C3 and C4 plays important roles in the development of MBD. The levels of serum C3 and C4 may be the sensitive biomarkers of MBD.

Prevalence of vitamin D insufficiency among adolescents and its correlation with bone parameters using high-resolution peripheral quantitative computed tomography.

Vitamin D deficiency and insufficiency are highly prevalent among adolescents in Hong Kong, which is a sub-tropical city with ample sunshine. Vitamin D level is significantly correlated with key bone density and bone quality parameters. Further interventional studies are warranted to define the role of vitamin D supplementation for improvement of bone health among adolescents. The relationship between bone quality parameters and vitamin D (Vit-D) status remains undefined among adolescents. The aims of this study were to evaluate Vit-D status and its association with both bone density and bone quality parameters among adolescents. Three hundred thirty-three girls and 230 boys (12-16years old) with normal health were recruited in summer and winter separately from local schools. Serum 25(OH) Vit-D level, bone density and quality parameters by Dual Energy X-ray Absorptiometry (DXA) and High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT), dietary calcium intake, and physical activity level were assessed. Sixty-four point seven percent and 11.4% of subjects were insufficient [25 ≤ 25(OH)Vit-D ≤ 50nmol/L] and deficient [25(OH)Vit-D < 25nmol/L] in Vit-D, respectively. The mean level of serum 25(OH)Vit-D in summer was significantly higher than that in winter (44.7 ± 13.6 and 35.9 ± 12.6nmol/L, respectively) without obvious gender difference. In girls, areal bone mineral density (aBMD) and bone mineral content (BMC) of bilateral femoral necks, cortical area, cortical thickness, total volumetric bone mineral density (vBMD), and trabecular thickness were significantly correlated with 25(OH)Vit-D levels. In boys, aBMD of bilateral femoral necks, BMC of the dominant femoral neck, cortical area, cortical thickness, total vBMD, trabecular vBMD, BV/TV, and trabecular separation were significantly correlated with 25(OH)Vit-D levels. Vit-D insufficiency was highly prevalent among adolescents in Hong Kong with significant correlation between Vit-D levels and key bone density and bone quality parameters being detected in this study. Given that this is a cross-sectional study and causality relationship cannot be inferred, further interventional studies investigating the role of Vit-D supplementation on improving bone health among adolescents are warranted.

Abnormal Bone Mechanical and Structural Properties in Adolescent Idiopathic Scoliosis: A Study with Finite Element Analysis and Structural Model Index.

Previous studies found adolescent idiopathic scoliosis (AIS) is associated with low bone mineral density (BMD) and abnormal bone quality, whilst the association between AIS and their bone strength is unknown. From high-resolution peripheral quantitative computed tomography-generated images, bone mechanical properties can be evaluated with finite element analysis (FEA), and trabecular rod-plate configuration related to trabecular bone strength can be quantified by structure model index (SMI). This study aimed to compare trabecular configuration and bone mechanical properties between AIS and the controls. 95 AIS girls aged 12-14 years and 97 age- and gender-matched normal controls were recruited. Bilateral femoral necks and non-dominant distal radius were scanned by dual-energy X-ray absorptiometry for areal BMD and HR-pQCT for SMI and FEA, respectively. Subjects were further classified into osteopenic and non-osteopenic group based on their areal BMD. Bone mechanical properties (stiffness, failure load and apparent modulus) were calculated using FEA. Linear regression model was used for controlling age, physical activity and calcium intake. AIS was associated with lower failure load and apparent modulus after adjusting for age, whereas AIS was associated with lower apparent modulus after adjusting for all confounders. Osteopenic AIS was associated with more rod-like trabeculae when compared with non-osteopenic AIS, whereas no difference was detected between osteopenic and non-osteopenic controls. This might be the result of abnormal regulation and modulation of bone metabolism and bone modelling and remodelling in AIS which will warrant future studies with a longitudinal design to determine the significance of micro-architectural abnormalities in AIS.

MRI-based morphological evidence of spinal cord tethering predicts curve progression in adolescent idiopathic scoliosis

Background contextExisting prognostic factors for adolescent idiopathic scoliosis (AIS) patients have focused mainly on curve, maturity, and bone-related factors. Previous studies have shown significant associations between curve severity and morphological evidences of relative shorter spinal cord tethering in AIS, and increased prevalence of abnormal somatosensory cortical–evoked potentials and low-lying cerebellar tonsil in severe AIS. Earlier evidence suggests that there might be neural morphological predictors for curve progression. PurposeThe purpose of this study was to identify any morphological predictors associated with cord tethering, as measured by magnetic resonance imaging (MRI), for curve progression in AIS patients. Study design/settingThis is a prospective cohort study. Patient sampleA total of 81 female AIS subjects between 10 and 14 years were included, without surgical intervention during the follow-up period. Outcome measuresMagnetic resonance imaging scans of hindbrain and whole spine and areal bone mineral density (BMD) at bilateral femoral necks were performed. MethodsAll AIS patients were longitudinally followed up starting from initiation of bracing beyond skeletal maturity in 6-month intervals. Clinical and radiographic data were recorded at each clinic visit. Bone mineral density and MRI measurements including ratio of spinal cord to vertebral column length, ratio of anteroposterior (AP) and transverse (TS) diameter of cord, lateral cord space (LCS) ratio, cerebellar tonsil level, and conus medullaris position were obtained at baseline. Only compliant patients with a minimum 2-year follow-up were analyzed. Adolescent idiopathic scoliosis girls were assigned into three groups according to bracing outcome: Group A, nonprogression (curvature increase of less than or equal to 5°); Group B, progression (curvature increase of greater than or equal to 6°); Group C, progression with surgery indication (Cobb angle of greater than or equal to 50° after skeletal maturity despite bracing). The predictors for curve progression were evaluated using univariate analysis and multivariate ordinal regression model. ResultsThe average duration of follow-up was 3.4 (range, 2.0–5.6) years. There were 46 girls (57%) in Group A, 19 (23%) in Group B, and 16 (20%) in Group C. No significant intergroup differences were found in spinal cord length, tonsil level, and conus position. Group C had significantly longer vertebral column length, smaller cord-vertebral length ratio, and higher AP/TS cord ratio compared with Group A, whereas LCS ratio in Group C was significantly increased compared with both Group A and Group B. In regression model, five significant independent predictors including cord-vertebral length ratio (odds ratio [OR]: 1.993 [95% confidence interval {CI}: 1.053–3.771], p=.034), LCS ratio (OR: 2.639 [95% CI: 1.128–6.174], p=.025), initial Cobb angle (OR: 1.156 [95% CI: 1.043–1.281], p=.006), menarche age (OR: 1.688 [95% CI: 1.010–2.823], p=.046), and BMD (OR: 2.960 [95% CI: 1.301–6.731], p=.010) and a marginally significant predictor namely AP/TS cord ratio (OR: 1.463 [95% CI: 0.791–2.706], p=.096) were obtained. ConclusionsOn baseline MRI measurement, cord-vertebral length ratio and LCS ratio are identified as new significant independent predictors for curve progression in AIS, whereas AP/TS cord ratio is suggested as a potential predictor requiring further validations. The earlier MRI parameters can be taken into accounts for prognostication of bracing outcome.

Bone mineral density as a prognostic factor for curve progression in adolescent idiopathic scoliosis: a longitudinal validation study

Methods A cohort of 60 patients with a mean age of 12.6 years old (SD=0.8) and an average Cobb angle of 21.4 (SD=6.3) degrees were followed from their first visit till skeletal maturity defined as Risser 4 or above and greater than 1.5 years postmenarchal. Progressive curves were defined as a cumulative increase of 6 degrees or more in the Cobb angle, or the magnitude of any curve exceeding 45 degrees or the patients receiving surgery recommendation before or at skeletal maturity. BMD was measured with Dual Energy X-ray Absorptiometry of bilateral femoral necks at the first visit. Other anthropometric measurements such as body weight, body height and Tanner staging were also recorded at baseline.

Abnormal bone quality versus low bone mineral density in adolescent idiopathic scoliosis: a case-control study with in vivo high-resolution peripheral quantitative computed tomography

Background contextAdolescent idiopathic scoliosis (AIS) is associated with low bone mass that could persist into early adulthood and is an important prognostic factor for curve progression. Previous studies were confined to areal bone mineral density measurement that was a two-dimensional investigation for a three-dimensional structure. Evaluation of volumetric BMD (vBMD) and other bone quality parameters are important for gaining in-depth understanding of the etiopathogenesis of AIS. PurposeThe objective of this study was to carry out direct in vivo measurement of bone quality in AIS using high-resolution peripheral quantitative computed tomography (HR-pQCT) and compare the correlation of bone quality with osteopenia between AIS and control subjects. Study design/settingA case-control study. Patient sampleNewly diagnosed AIS girls (n=112) and non-AIS girls (n=115) between 11 and 13 years. Outcome measuresAreal bone mineral density of bilateral femoral necks and HR-pQCT of the nondominant distal radius were performed. MethodsAreal bone mineral density of femoral necks was measured by dual-energy X-ray absorptiometry. Subjects were classified into the osteopenic (Z score less than or equal to −1) and nonosteopenic (Z score more than −1) groups. Bone quality parameters, including bone morphometry, trabecular bone microarchitecture, and vBMD, were measured by HR-pQCT (XtremeCT; Scanco Medical, Zurich, Switzerland). ResultsIn AIS, the osteopenic group had lower measurements in cortical area, cortical thickness, average vBMD, compact bone vBMD, trabecular vBMD, trabecular bone volume to tissue volume ratio, and trabecular thickness compared with nonosteopenic AIS subjects. In contrast, among the non-AIS controls, the osteopenic group had lower measurements only in bone morphometry, average vBMD, and compact bone vBMD but not in trabecular vBMD and all other trabecular bone microarchitecture parameters. ConclusionsThis is the first study using HR-pQCT to compare the correlation of bone quality with osteopenia in AIS and non-AIS subjects. It provides new insights and highlights the unique bone quality profile with predominant changes in the trabecular compartment in association with osteopenia being notably only detected in the AIS subjects. Further studies in this area are warranted for defining the metabolic nature and biomechanical sequelae of derangement in bone mass and bone quality and their roles in the etiopathogenesis of AIS.

Low Bone Mineral Density is Associated with Poor Clinical Outcome in Acute Ischemic Stroke

Chronic low bone mineral density is associated with an increased risk of stroke. However, little is known about the influence of bone mineral density at the time of stroke on clinical outcome. We investigated the association between bone mineral density and functional disability at three-months in patients with acute ischemic stroke. We retrospectively examined consecutive acute ischemic stroke patients who underwent bone densitometry tests within seven-days of stroke symptom onset. Patient demographics, risk factors, and initial National Institute of Health Stroke Scale scores were assessed. Bone mineral density was measured at the lumbar spine and bilateral femoral necks. Osteoporosis was defined as bone mineral density ≤-2·5 T-scores at each site. The primary outcome was modified Rankin Scale at 90 days poststroke. A favorable outcome was defined as modified Rankin Scale 0-1 and poor outcome as modified Rankin Scale 2-6. Of the 191 patients included, 61 (31·9%) were men. Mean age (±standard deviation) was 69·8 ± 11·1 years. Patients with osteoporosis of the right femoral neck were more likely to have poor outcome (25/82; 30·5%) than those without (12/109; 11·0%, P = 0·001). After adjustment for age, sex, and initial National Institute of Health Stroke Scale score, osteoporosis of the right femoral neck was significantly associated with poor outcome (odds ratio, 2·97; 95% confidence interval 1·21 to 7·32, P = 0·018). Low bone mineral density of the right femur in the acute poststroke period is associated with poor outcome at three-months. Assessment of bone mineral density in acute stroke patients may be a useful prognosticator and facilitate early intervention.

Normocalcemic primary hyperparathyroidism with fractures

Normocalcemic primary hyperparathyroidism is an uncommon condition usually found among patients with urinary stones. To the best of our knowledge, this is the first case of a patient with normocalcemic primary hyperparathyroidism presenting with bilateral femoral neck fracture. A 45-year-old man had pain both hip joints and limping in for several months. Vertical fractures of bilateral femoral necks were found by radiographs. Laboratory findings showed a normal value of total serum calcium but elevated serum ionized calcium. Serum parathyroid hormone and alkaline phosphatase levels were elevated. The patient was treated with subtrochanteric valgus osteotomy fixed with a dynamic hip screw and total parathyroidectomy. Histopathologic examination showed hyperplasia of the parathyroid glands. At 1-year follow-up, the patient was doing well clinically. Copyright 2002, Elsevier Science (USA). All rights reserved.

尿細管性アシドーシスに合併した骨軟化症の治療経験

A 41-year-old female with renal tubular acidosis showed osteomalacia and pseudo-fracture of bilateral femoral necks. She had been treated with Shohl's fluid or NaHCO3, and acidosis was almost corrected, but hypophosphathemia and hypokalemia continued. So instead of these drugs, Uralyt-U was administered. As a result, acidosis was corrected and serum levels of P and K became normal. Uralyt-U was effective for this patient with renal tubular acidosis.

A case report of Gaucher's disease with the pathologic fractures of the bilateral femoral necks

A girl aged three years was admitted because of the pathologic fractures of the bilateral femoral necks. She had splenomegaly, sequint, mild generalized lymphadenopathy and anaemia. There was a past history of splenectomy two years ago. Laboratory test revealed a marked increase of acid phosphatase and decrease of blood cholesterol, and Gaucher's cells were observed in the bone marrow taken at the osteosynthesis of the femoral neck.