Femoral Neck Bone Density Research Articles

High prevalence of spine–femur bone mineral density discordance and comparison of vertebral fracture risk assessment using femoral neck and lumbar spine bone density in Korean patients

The aim of this study was to evaluate the prevalence of spine–femur discordance, and to compare the effectiveness of femoral neck (FN) and lumbar spine (LS) bone mineral density (BMD) for estimation of the risk of vertebral fractures. Women who were evaluated with dual energy X-ray absorptiometry between January 2001 and December 2005 were enrolled in this study. Vertebral fracture risk was calculated using initial FN and LS BMD. The follow-up vertebral X-rays from all subjects were reviewed, and the calculated estimated risk using the Fracture Risk Assessment Tool (FRAX(®)) was compared with the actual prevalence of vertebral fractures during the follow-up period. Among a total of 443 women with a mean age of 58.5 years, 130 women (29.3 %) demonstrated femur–spine discordance (i.e., a difference between FN and LS BMD of [1 SD). Most subjects having discordance showed lower LS BMD (73.1 %) compared to FN BMD. During the mean 7-year follow-up period, 12 (2.7 %) vertebral fractures occurred. In cases with high estimated fracture risk ([20 % for estimated fracture risk), using LSBMD significantly reflected the actual vertebral fracture in total subjects [odds ratio (OR) 19.29, 95 % confidence interval (CI) 4.21–88.46], in subjects with spine–femur discordance (OR 16.00, 95 % CI 1.91–134.16), and in subjects with spine–femur discordance having lower LSBMD (OR 20.67, 95 % CI 1.63–262.71). In comparison, the estimated risk using FN BMD did not reflect the actual occurrence of vertebral fractures. In conclusion, a significant number of Korean subjects exhibited spine–femur discordance, and LS BMD might be more appropriate for estimation of vertebral fracture risk.

SAT0377 Evaluation with densitometry of patients with breast cancer and high risk of fractures after 2 years of treatment

ObjectivesEvaluate the differences with densitometry after 2 years of treatment in patients with breast cancer and a high risk fracture.MethodsA 2 year duration longitudinal study was done in patients diagnosed...

Clinical results of alendronate monotherapy and combined therapy with menatetrenone (VitK2) in postmenopausal RA patients

Objectives: We aimed to evaluate the clinical efficacy of monotherapy with alendronate and combined therapy with alendronate and menatetrenone (vitamin K2 [VitK2]) in postmenopausal rheumatoid arthritis (RA) patients with osteoporosis or osteopenia.Methods: Sixty-two postmenopausal RA patients with untreated osteoporosis or osteopenia (lumbar spine bone density ≤80 % of young adult mean [YAM]) were enrolled: 39 had abnormal serum undercarboxylated osteocalcin (ucOC) levels (>4.5 ng/mL) and received combined therapy with alendronate (35 mg/week) and VitK2 (45 mg/day) (ALN + K group); 23 had normal ucOC levels (≤4.5 ng/mL) and received alendronate monotherapy (35 mg/week) (ALN group). The clinical results for the 57 patients in both groups were evaluated after 1-year treatment.Results: The mean baseline/follow-up (FU) lumbar spine bone density (%YAM) values were 73.0/76.8 % (P < 0.01) in the ALN + K group and 77.0/80.3 % (P < 0.01) in the ALN group; a significant increase was shown in both groups. Mean proximal femoral bone density values at baseline/FU were 71.4/73.8 (P < 0.01) in the ALN + K group and 71.4/71.6 % (not significant; NS) in the ALN group; a significant increase was shown in the ALN + K group only. Serum ucOC levels were normalized in the ALN + K group at FU. At FU, bone metabolism markers [bone-specific alkaline phosphatase (BAP) and N-terminal cross-linked telopeptides of type I collagen] were decreased in both groups. One patient in the ALN + K group and three in the ALN group suffered new fractures.Conclusions: Combined therapy with alendronate and VitK2 decreases bone metabolism marker levels and serum ucOC levels, and increases lumbar spine and femoral neck bone density in postmenopausal RA patients with abnormal ucOC levels and osteoporosis or osteopenia.

Bone Geometry According to Menstrual Function in Female Endurance Athletes

Athletes have higher bone mineral density (BMD) relative to nonathletes. In amenorrheic athletes BMD may be compromised by estrogen deficiency, but it is unknown whether this is accompanied by structural differences. We compared femoral neck bone geometry and density of a-/oligomenorrheic athletes (AAs), eumenorrheic athletes (EAs), and eumenorrheic controls (ECs). We recruited 156 women: (68 endurance athletes and 88 controls). Femoral neck BMD, section modulus (Z), and width were measured using dual-energy X-ray absorptiometry. Menstrual function was assessed by questionnaire and classified as EA (≥10 periods/year) or AA (≤9 periods/year): 24 athletes were AA and 44 EA. Femoral neck BMD was significantly higher in EA than AA (8 %, difference) and EC (11 % difference): mean [SE] 1.118 [0.015], 1.023 [0.020] and 0.999 [0.014] g cm(-2), respectively; p < 0.001. Z was significantly higher in EA than EC (11 % difference): EA 667 [19], AA 625 [21], and EC 592 [10] cm(3); p < 0.001. Femoral neck width did not differ between groups. All differences persisted after adjustment for height, age, and body mass. The higher femoral neck Z and BMD in athletes, despite similar width, may indicate that exercise-related bone gains are endosteal rather than periosteal. Athletes with amenorrhea had smaller increments in bone mass rather than structural adaptation. The maintained femoral neck width in controls may be an adaptive mechanism to conserve bone strength in bending despite inactivity-related bone decrement.

Weight in Infancy and Adult Calcium Absorption as Determinants of Bone Mineral Density in Adult Men: The Hertfordshire Cohort Study

Adult bone mass is modified by early life environmental influences, but the mechanism of this association is uncertain. Data support an inverse relationship between intestinal calcium absorption (αCa) and birth weight in women. However, little is known regarding determinants in men. This study examines the association between weight in infancy and adult αCa in healthy men and whether this could be a mechanism by which the early life environment may influence bone mass. Men were recruited from the MRC Hertfordshire Cohort Study, for whom detailed early life records were available. Areal bone mineral density (aBMD) was measured using a Hologic QDR 4500 at the femoral neck (FN) and lumbar spine. We randomly selected 123 men stratified by birth weight and assessed αCa using the stable strontium absorption test. The mean age was 63.6 (SD 2.5) years. αCa was not associated with birth weight or weight at 1 year. FN aBMD was associated with both weight at 1 year (r = 0.20, p = 0.03) and αCa (r = 0.20, p = 0.03). Both of these associations remained statistically significant in a mutually adjusted, multivariable model but would account for only ~4 % variance in BMD. We demonstrated a positive association between weight at 1 year and aBMD and between αCa and FN BMD, but no association was found between birth weight and αCa. This suggests that in men, although αCa is a contributing factor in FN bone density, it is not the main mechanism whereby the early environment modifies adult BMD.

The effect of proton pump inhibitors on fracture risk: report from the Canadian Multicenter Osteoporosis Study

A large Canadian cohort was studied over 10 years to see if proton pump inhibitor (PPI) use increased the risk of sustaining a fragility fracture. We found an increased risk of fracture in individuals who used PPIs. The risk remained after controlling for other known fracture risk factors. Multiple retrospective studies have linked proton pump inhibitor use with increased risk of fragility fracture. We prospectively studied the association between PPI use and fracture in a large cohort over a 10-year period while controlling for known fracture risk factors. We studied 9,423 participants in the Canadian Multicenter Osteoporosis Study. The cohort was formed in 1995-1997 and followed for 10 years with monitoring for incident nontraumatic fracture and PPI use. Cox regression analyses were used to assess the association between PPI use and incident fracture risk. PPI use, coded as a time-dependent variable, was associated with a shorter time to first nontraumatic fracture, hazard ratio (HR)=1.75 (95% confidence interval (CI) 1.41-2.17, p<0.001). After controlling for multiple risk factors, including femoral neck bone density, the association remained significant, HR=1.40 (95% CI 1.11-1.77, p=0.004). Similar results were obtained after controlling for bisphosphonate use, using PPI "ever" use, or when the outcome was restricted to hip fracture. In this large prospective population-based cohort study, we found an association between PPI use and increased risk of fragility fracture. Although the increased risk found was modest, this finding is important, given the high prevalence of PPI use and the excess morbidity and mortality associated with osteoporosis-related fractures.

Clinical results of alendronate monotherapy and combined therapy with menatetrenone (VitK2) in postmenopausal RA patients

We aimed to evaluate the clinical efficacy of monotherapy with alendronate and combined therapy with alendronate and menatetrenone (vitamin K2 [VitK2]) in postmenopausal rheumatoid arthritis (RA) patients with osteoporosis or osteopenia. Sixty-two postmenopausal RA patients with untreated osteoporosis or osteopenia (lumbar spine bone density ≤80 % of young adult mean [YAM]) were enrolled: 39 had abnormal serum undercarboxylated osteocalcin (ucOC) levels (>4.5 ng/mL) and received combined therapy with alendronate (35 mg/week) and VitK2 (45 mg/day) (ALN + K group); 23 had normal ucOC levels (≤4.5 ng/mL) and received alendronate monotherapy (35 mg/week) (ALN group). The clinical results for the 57 patients in both groups were evaluated after 1-year treatment. The mean baseline/follow-up (FU) lumbar spine bone density (%YAM) values were 73.0/76.8 % (P < 0.01) in the ALN + K group and 77.0/80.3 % (P < 0.01) in the ALN group; a significant increase was shown in both groups. Mean proximal femoral bone density values at baseline/FU were 71.4/73.8 (P < 0.01) in the ALN + K group and 71.4/71.6 % (not significant; NS) in the ALN group; a significant increase was shown in the ALN + K group only. Serum ucOC levels were normalized in the ALN + K group at FU. At FU, bone metabolism markers [bone-specific alkaline phosphatase (BAP) and N-terminal cross-linked telopeptides of type I collagen] were decreased in both groups. One patient in the ALN + K group and three in the ALN group suffered new fractures. Combined therapy with alendronate and VitK2 decreases bone metabolism marker levels and serum ucOC levels, and increases lumbar spine and femoral neck bone density in postmenopausal RA patients with abnormal ucOC levels and osteoporosis or osteopenia.

Sex-specific associations between soft tissue body composition and bone mineral density among older adults

Aim: This paper examines sex specific associations between soft tissue body composition (lean and fat mass) and bone mineral density among older adults.Subjects and methods: Two hundred and eighty-two subjects (152 females and 130 males) aged 60–92 years ( = 71.9 ± 7.9) were enrolled. Body composition of the whole body and bone density (BMD) of the whole body and the femoral neckwere measured by dual energy x-ray absorptiometry. Body mass index (BMI), relative appendicular skeletal muscle mass (RASM) and relative total muscle mass (RTSM) were calculated. Subjects were categorized based on sarcopenia, i.e. reduced appendicular skeletal muscle mass, osteopenia and osteoporosis. BMD of the femoral neck was used to categorize osteopenia and osteoporosis.Results: Sex-specific correlation patterns between soft tissue body composition and bone density were observed. Lean body mass (RASM and RTSM) correlated significantly with total and femoral neck bone density in men, absolute and relative fat mass were significantly related to whole and femoral neck bone density among women only. Sarcopenic men suffered significantly more frequently from osteopenia and osteoporosis than their non-sarcopenic counterparts. Among females sarcopenia was not related to reduced bone density.Conclusions: The impact of soft tissue body composition on bone density is different among men and women at older ages. A significant relation between muscle mass and bone density is found among elderly males only.

Potential Extensions of the US FRAX Algorithm

To determine if the revised US FRAX can identify those at high risk for fractures at any skeletal site, we studied 250 women and 249 men ≥40 years old from an age-stratified random sample of Rochester, MN residents. At baseline, femoral neck (FN) bone density was assessed, as were the clinical risk factors included in FRAX, along with additional fracture risk factors such as bone turnover markers and fall history. Fracture ascertainment through periodic interviews and comprehensive medical record review was performed over 10 years of followup. In both women and men, a higher FRAX probability at baseline was associated with greater subsequent likelihood of a major osteoporotic fracture. However, a relative 10% increase in the FRAX 10-year fracture probability was also associated with a 1.4-fold increase (95% confidence interval (CI) 1.1–1.7) in other fractures in women and a 1.7-fold increase (95% CI 0.8–3.1) in men. Furthermore, FRAX predicted asymptomatic vertebral fractures and fractures generally in both sexes. The addition of risk factors not currently included in FRAX did not appear to improve the accuracy of fracture risk prediction. FRAX may provide a conservative estimate of risk for major osteoporotic fractures, but it also predicts fractures generally.

Matched‐cohort study of body composition, physical function, and quality of life in men with idiopathic vertebral fracture

To determine the effect of 6 years of routine management on body composition, physical functioning, and quality of life, and their interrelationships, in men with idiopathic vertebral fracture. Twenty men with idiopathic vertebral fracture (patients: mean ± SD age 58 ± 6 years) were age and height matched to 28 healthy controls with no known disease. The primary outcome was skeletal muscle mass (appendicular lean mass by dual x-ray absorptiometry) assessed at 2 visits (0 and 6 years). Physical functioning and quality of life domains were assessed by the Senior Fitness Test and Short Form 36 (SF-36) questionnaire at visit 2 only. Data were analyzed by repeated-measures analysis of variance, independent t-tests, and correlation. At visit 1, appendicular lean mass was 9% lower in patients than controls. Although patients better maintained appendicular lean mass between visits (interaction P = 0.016), at visit 2 appendicular lean mass remained 5% lower in patients than controls. Furthermore, patients' appendicular lean mass change was correlated with femoral neck bone density change (r = 0.507, P = 0.023). Physical function tests were 13-27% lower in patients compared with controls (P = 0.056 to 0.003), as were SF-36 quality of life physical domains (13-26% lower; P = 0.028 to <0.001). Despite an association between changes in muscle mass and bone density, routine management of men with idiopathic vertebral fracture does not address muscle loss. Combined with the observation of reduced physical functioning and quality of life, this study identifies novel targets for intervention in men with idiopathic vertebral fracture.

2011 Marshall Urist Young Investigator Award: When to Release Patients to High-impact Activities after Hip Resurfacing

Surface replacement arthroplasties are commonly performed in young, active patients who desire return to high-impact activities including heavy manual labor and recreational sports. Femoral neck fracture is an arthroplasty-related complication unique to surface replacement arthroplasty. However, it is unclear regarding whether patients are at lower risk for fracture after a certain postoperative time. We therefore raised the following questions: (1) does stress shielding occur after surface replacement arthroplasty, and (2) when does bone mineral density return to normal so patients can return to high-impact activities without excessive risk of fracture? We prospectively enrolled 90 patients (96 hips) with either surface replacement arthroplasty or THA, and performed dual energy x-ray absorptiometry scans at 6weeks, 6months, 1year, and 2years. We analyzed bone density by Gruen zone in both groups, and six femoral neck zones in the patients who had surface replacement arthroplasties. We calculated 6-month, 1-year, and 2-year ratios for the change in bone density compared with baseline. Bone density was greater in patients who had surface replacement arthroplasties than for patients who had THAs at 6months and 1year in Gruen Zones 1, 2, 6, and 7, with the largest increase in femoral neck bone density on the tension side at 6months in Zone L1. We saw no decrease in bone density in patients who had surface replacement arthroplasties in any Gruen zone at any time, and observed no decrease in bone density in female patients. Increased bone density at 6months postoperatively in patients who had surface replacement arthroplasties provides evidence that clinically relevant stress shielding does not occur after surface replacement arthroplasty. Owing to the increased bone mineral density at 6months, we believe patients who underwent surface replacement arthroplasties may to return to high-impact activities at that time without increased risk of fracture.

Vitamin D deficiency and poor bone health are associated with CVD risk in Caucasian and Asian women

Vitamin D deficiency and poor bone health are associated with CVD risk in Caucasian and Asian women

Bone Mineral Density Changes In Patients with Paraproteinemia After Treatment with Bortezomib

AbstractAbstract 4989 Background:Bone disease is present at diagnosis in almost all patients with multiple myeloma (MM) and can impact substantially on patient morbidity and quality of life. Decreased bone mineral density is also observed not only in MM but also in patients with monoclonal gammopathy of undetermined significance (MGUS). The pathogenesis of bone disease in MM is complex. The activity of proteasome inhibitor bortezomib has been linked to increased bone formation and osteoblastic activation. Evidence from the available clinical data indicates that bortezomib has a positive impact on bone health in MM and demonstrates a bone anabolic effect. Methods:We analyzed retrospectively 53 patients with MM and 16 with MGUS who have completed bone density at least at diagnosis. 21 patients have completed two bone density (3 MGUS and 18 MM). The bone density was obtained in all patients at baseline and in 16 patients repeated after bortezomib treatement with a median time of bortezomib exposure of 6 months. We analyzed T-score values at lumbar spine and at femoral neck. Results:With a median age of 66 years, 41 male and 28 female were analyzed. At baseline the mean lumbar spine T-score of all subjects and of 16 MM treated with bortezomib was -0.50 and -0.76 respectively. At baseline the mean femoral neck T-score for all subjects and for 16 MM treated with Bortezomib was -1.56 and -1.31 respectively. The baseline mean lumbar spine T-score for MGUS and MM was -0.71 and -0.43 respectively. The baseline mean femoral neck T-score of MGUS and MM was -1.61 and -1.54 respectively. In the group of 16 patients treated with Bortezomib we observed from baseline a change in lumbar bone mineral density T-score of 0.36 and at femoral neck bone density T-score of 0.25. Conclusion:These data show that patients treated with proteasome inhibitor showed moderate increment in bone mineral density at lumbar spine and at femoral neck. [Display omitted] [Display omitted] Disclosures:No relevant conflicts of interest to declare.

Absolute fracture risk assessment using lumbar spine and femoral neck bone density measurements: Derivation and validation of a hybrid system

The World Health Organization (WHO) Fracture Risk Assessment Tool (FRAX) computes 10-year probability of major osteoporotic fracture from multiple risk factors, including femoral neck (FN) T-scores. Lumbar spine (LS) measurements are not currently part of the FRAX formulation but are used widely in clinical practice, and this creates confusion when there is spine-hip discordance. Our objective was to develop a hybrid 10-year absolute fracture risk assessment system in which nonvertebral (NV) fracture risk was assessed from the FN and clinical vertebral (V) fracture risk was assessed from the LS. We identified 37,032 women age 45 years and older undergoing baseline FN and LS dual-energy X-ray absorptiometry (DXA; 1990-2005) from a population database that contains all clinical DXA results for the Province of Manitoba, Canada. Results were linked to longitudinal health service records for physician billings and hospitalizations to identify nontrauma vertebral and nonvertebral fracture codes after bone mineral density (BMD) testing. The population was randomly divided into equal-sized derivation and validation cohorts. Using the derivation cohort, three fracture risk prediction systems were created from Cox proportional hazards models (adjusted for age and multiple FRAX risk factors): FN to predict combined all fractures, FN to predict nonvertebral fractures, and LS to predict vertebral (without nonvertebral) fractures. The hybrid system was the sum of nonvertebral risk from the FN model and vertebral risk from the LS model. The FN and hybrid systems were both strongly predictive of overall fracture risk (p < .001). In the validation cohort, ROC analysis showed marginally better performance of the hybrid system versus the FN system for overall fracture prediction (p = .24) and significantly better performance for vertebral fracture prediction (p < .001). In a discordance subgroup with FN and LS T-score differences greater than 1 SD, there was a significant improvement in overall fracture prediction with the hybrid method (p = .025). Risk reclassification under the hybrid system showed better alignment with observed fracture risk, with 6.4% of the women reclassified to a different risk category. In conclusion, a hybrid 10-year absolute fracture risk assessment system based on combining FN and LS information is feasible. The improvement in fracture risk prediction is small but supports clinical interest in a system that integrates LS in fracture risk assessment.

ORIGINAL ARTICLE: Effects of rosiglitazone on bone mineral density and remodelling parameters in Postmenopausal diabetic women: a 2‐year follow‐up study

SummaryObjective To evaluate the effect of rosiglitazone on bone metabolism and bone density.Design An open‐label, randomized, controlled trial of 24‐month duration.Patients and measurements Obese, postmenopausal women with newly diagnosed diabetes were studied. Before and after the intervention, metabolic bone markers and bone density were assessed.Results Twenty‐six patients received rosiglitazone (4 mg/day), and 23 remained on diet alone. Serum bone‐specific alkaline phosphatase and osteocalcin levels decreased by 17% (P &lt; 0·001 vs control group) and 26% (P &lt; 0·01 vs control group), respectively, in the rosiglitazone group. There were no significant changes in the deoxypyridinoline levels between the two groups. Annual bone loss at the trochanter and at the lumbar spine associated with each year of rosiglitazone use was 2·56% (P = 0·01 vs control group) and 2·18% (P &lt; 0·01 vs control group), respectively. Femoral neck and total hip bone density declined significantly in both groups (P &lt; 0·01, and P = 0·01, respectively) but was not significantly different between the two groups.Conclusions Rosiglitazone treatment adversely affects bone formation over a 2‐year period. It increases bone loss at the lumbar spine and trochanter in postmenopausal, type 2 diabetic women. However, bone loss at the total hip did not differ with use of this agent.

Relation of body fat distribution to femoral neck bone density and endometrial thickness in postmenopausal women

Objective. Menopause is associated with accelerated bone loss, a decrease in lean mass, an increase and redistribution of fat mass in the trunk region. Trunk obesity has been considered as a risk factor for endometrial cancer. We aimed to determine if body composition and fat distribution are determinants of femoral neck bone mineral density (BMD) and endometrial thickness in healthy postmenopausal women.Study design. Subjects were 40 healthy postmenopausal women with biopsy proven atrophic endometrium. Anthropometrical variables (total fat mass, trunk and leg fat masses, lean body mass and femoral neck BMD) were measured by dual energy X-ray absorptiometry.Results. Femoral neck BMD was positively correlated with body mass index, total fat mass, trunk fat mass, leg fat mass and endometrial thickness, and negatively correlated with age, years since menopause and FSH levels. Trunk fat and age remained significant determinants of femoral neck BMD (R2 = 32.9 %, p < 0.001) and endometrial thickness was significantly associated with femoral neck BMD and oestradiol levels (R2 = 46.5%, p < 0.0001) on regression analysis.Conclusion. Truncal adiposity rather than overall adiposity or lean mass are more closely associated with femoral neck BMD and there is no relationship between subcutaneous fat mass and endometrial thickness in postmenopausal women.

Discordance in Femoral Neck Bone Density in Subjects With Unilateral Hip Osteoarthritis

Osteoarthritis (OA) is a common disease that increases in incidence with age and currently affects an estimated 27 million Americans. To determine whether site-specific hip bone mineral density (BMD) measures are confounded by the presence of OA, we measured bilateral hip BMD by dual X-ray absorptiometry in 34 subjects (19 women and 15 men) scheduled for hip replacement for confirmed advanced unilateral hip OA. The femoral neck (FN) BMD (p=0.035) and T-score (p=0.017) for the hip with OA was higher than those of the contralateral hip. There was a difference in osteoporosis classification depending on which hip was considered: for 11 of the 34 subjects (32%), the FN T-score was normal for OA hip, but the contralateral hip was classified as osteopenic (T-score between −1.0 and −2.5). For 1 subject, the FN T-score was normal for OA hip, but the contralateral hip was classified as osteoporotic (T-score below −2.5). Discordance was also present for trochanter values and not for total hip values. These data indicate that advanced hip OA can be associated with a higher bone density at the FN and trochanter but not at total hip and that the discrepancy between hips at the FN may have an impact on patient treatment decisions.

Optimum frequency of exercise for bone health: Randomised controlled trial of a high-impact unilateral intervention

Introduction Exercise can increase bone strength, but to be effective in reducing fracture risk, exercise must be feasible enough to be adopted into daily life and influence potentially vulnerable skeletal sites such as the superolateral cortex of the femoral neck, where thinning is associated with increased fracture risk. Brief, high-impact exercise increases femoral neck bone density but the optimal frequency of such exercise and the location of bone accrual is unknown. This study thus examined (1) the effectiveness of different weekly frequencies of exercise on femoral neck BMD and (2) whether BMD change differed between hip sites using a high-impact, unilateral intervention. Methods Healthy premenopausal women were randomly assigned to exercise 0, 2, 4, or 7 days/week for 6 months. The exercise intervention incorporated 50 multidirectional hops on one randomly selected leg. BMD was measured by DXA at baseline and after 6 months of exercise. Changes in the exercise leg were compared between groups using ANCOVA, with change in the control leg and baseline BMD as covariates. RM-MANOVA was conducted to determine whether bone changes from exercise differed between hip sites. Results 61 women (age 33.6 ± 11.1 years) completed the intervention. Compliance amongst exercisers was 86.7 ± 10.6%. Peak ground reaction forces during exercise increased from 2.5 to 2.8 times body weight. The change in femoral neck BMD in the exercise limb (adjusted for change in the control limb and baseline BMD) differed between groups ( p = 0.015), being − 0.3% (− 1.2 to 0.6), 0.0% (− 1.0 to 1.0), 0.9% (− 0.1 to 2.0) and 1.8% (0.8 to 2.8) in those exercising 0, 2, 4 and 7 days per week, respectively. When BMD changes at upper neck, lower neck and trochanter were compared using RM-MANOVA, a significant exercise effect was observed ( p = 0.048), but this did not differ significantly between sites ( p = 0.439) despite greatest mean increases at the upper femoral neck. Conclusions Brief, daily hopping exercises increased femoral neck BMD in premenopausal women but less frequent exercise was not effective. Brief high-impact exercise may have a role in reducing hip fragility, but may need to be performed frequently for optimal response.

Proteinase-activated receptor (PAR1) polymorphic variant correlates with thrombocytopenia in Gaucher disease

Background Enzyme replacement therapy (ERT) for Gaucher disease is safe and effectively corrects hepatosplenomegaly and hypersplenism; however, thrombocytopenia, may not normalize. Platelet proteinase-activated receptors (PARs) are signaling effectors in response to inflammation; PAR1 expression is down-regulated during inflammation and may be associated with thrombocytopenia. Accumulation of undegraded lipids in macrophages in Gaucher disease induces a chronic state of inflammation. The purpose of this study was to describe PAR1 polymorphic genotypes in patients with Gaucher disease and ascertain whether these are correlated with platelet counts. Methods Helsinki Committee approval was received for this study. Blood samples were taken from 80 patients with non-neuronopathic disease, some on ERT, and from 44 healthy Jewish controls. PAR1 polymorphisms IVS[−14(A/T)], and [−506(I/D)] and [−1426(C/T)] were analyzed. Patient data were collected from the files. Associations between PAR1 and categorical variables were analyzed by chi-square and Fisher's exact tests; assessment of associations with quantitative variables used ANOVA and Scheffe post-hoc for multiple pair-wise comparisons. Non-parametric Kruskal–Wallis ANOVA was used when one category was small. All tests were 2-tailed; p values ≤ 0.05 were considered statistically significant. Results There was a statistically significant difference ( p = 0.015) between patients and controls for [−1426(C/T)] TT genotype. There was no significant correlation for [−1426(C/T)] with disease severity, need for ERT, splenectomy, or presence of bone disease; rather, there was a significant correlation between lower platelet counts ( p = 0.0003) and the [−1426(C/T)] TT genotype and a trend for correlation with inflammation markers ( p = 0.079). There was a statistically significant correlation for [−506(I/D)] II genotype with femoral neck bone density ( p = 0.034). All patients carried the wild type for IVS[−14(A/T)]. Conclusion The [−1426(C/T)] polymorphic variant of PAR1 is associated with thrombocytopenia in Gaucher disease.

Bone density of the femoral neck following Birmingham hip resurfacing

Background Resurfacing is a popular alternative to a standard hip replacement in young arthritic patients. Despite bone preservation around the femoral component, there is little information regarding the bone quality.Patients and methods 32 patients underwent consecutive Birmingham hip resurfacing. The bone density of the femoral neck was measured preoperatively and then at 6 weeks, 3 months, 1 year, and 2 years. The femoral neck was divided into regions of interest. Results were available for 27 hips in 26 patients.Results The overall femoral neck bone density showed a trend towards a decrease at 6 weeks and 3 months but returned to the preoperative level at 1 year, and was maintained at 2 years. The combined superior regions of the neck showed a statistically significant decrease in bone density at 6 weeks and 3 months. This returned to preoperative levels at 1 year and was maintained at 2 years.Interpretation Bone density appears to decrease at 6 weeks and 3 months, suggesting that care is necessary until bone density begins to recover.