Femoral Neck Bone Density Research Articles

Double-blind placebo-controlled study to evaluate the effect of pro-juven progesterone cream on atherosclerosis and bone density

To establish whether treatment for three years with pro-juven progesterone cream affects progression of atherosclerotic plaques or bone density in postmenopausal women. Design Randomized double-blind placebo-controlled trial. Sample One hundred and thirty-one healthy postmenopausal women aged between 50 and 75 years with at least one asymptomatic arterial plaque visible on ultrasound of the carotid or femoral bifurcation. Women were randomly allocated to receive pro-juven progesterone cream, 20 mg twice daily, or placebo, for three years. Main outcome measure Rate of change of plaque thickness, intima-media thickness and bone density of lumbar spine and femoral neck. There was no difference between the groups. Pro-juven progesterone cream 20 mg twice daily did not affect progression of asymptomatic atherosclerosis or deterioration in bone density over three years.

The Relationship Between Knowledge And Beliefs Of Osteoporosis And Bone Mineral Density

There are over 20 million individuals that currently have osteoporosis contributing to the 1.5 million fractures in the U.S. each year. It has been previously determined that one's knowledge of a disease or health condition is related to the health behaviors toward preventing that particular illness. However, this concept has not been studied sufficiently with osteoporosis. PURPOSE: Therefore the aim of this proposed project is to determine if specific knowledge of osteoporosis and its prevention are related to bone density. METHODS: Women from the surrounding community volunteered to participate in the present investigation. Each participant completed the previously approved informed consent, health history questionnaire, Osteoporosis Knowledge Test (OKT), and Osteoporosis Health Belief Scale (OHBS). Upon completion of all surveys, the participants had their bone density analyzed via dual-energy x-ray absorptiometry (iDXA, GE Lunar, Madison, WI). A total of three scans were completed; total-body, left hip, and lumbar spine. Multiple regression analyses were used to determine if the results of the surveys predicted bone density (total-body, left femur, and spine). Independent variables used were the OKT and OHBS surveys. Dependent variables were the participant's bone density values for total-body, left femur, and lumbar spine. RESULTS: The sample consisted of 16 women ranging in age from 18 to 65 years (41.44 + 13.69). Analyses revealed that the OHBS and OKT are significant predictors of total-body BMD (F[2,13] = 4.23, p =.04) and left femoral neck BMD (F[2,13] = 6.35, p =.01). However, the two surveys did not significantly predict BMD of the lumbar (F[2,13] = 0.25 p =.78). CONCLUSIONS: It has been previously stated that knowledge and/or health beliefs affect the personal habits of individuals. In the present investigation, this was affirmed with the femoral neck and total-body bone density; however, this was not the case with the lumbar spine. Further research should be implemented to determine if, in fact, beliefs and knowledge are actually related to this specific health outcome. With over 20 million Americans inflicted with this incurable disease, education is the key to prevention.

Relationship of a lifelong physical workload with physical function and low back pain in retired women

The effect of heavy work-related physical loads (WRPL) on low back pain (LBP) and impaired physical function has been studied extensively in active workers but not in pensioners. We compared LBP and physical function in post-menopausal pensioners, divided according to their life-long WRPL into 114 heavy physical workers (HPW), and 391 light physical workers (LPW). LBP and physical function (domains of mobility, home routines) were scored by a questionnaire. Data on age, age at menopause, number of years in retirement, age at menarche, number of pregnancies, body mass index (BMI), femoral neck bone density, WRPL, years spent at work, and smoking were also collected. HPW were older (p=0.004), had worked fewer years (p=0.001), had reduced mobility (p=0.001), worse LBP (p=0.001) and performed home routine activities worse (p=0.001) than LPW. Logistic regression adjusted for confounders (LBP, home routines and mobility dichotomised at the median) showed that heavy WRPL, aging and high BMI were LBP risk factors, whereas heavy WRPL, high BMI and early menopause were mobility risk factors. The area under receiver-operating characteristic curves showed that predicted probabilities, derived from logistic models, predicted mobility (area 0.816, SE 0.020) better than pain (area 0.643, SE 0.024) (Hanley McNeil test p<0.001). Lifelong heavy WRPL and high BMI seem to be risk factors for worse LBP and mobility in retired women. Mobility seems to be especially affected by these risk factors, and should be further investigated for prevention purposes.

The Effects of Surgery for Primary Hyperparathyroidism

Objective Investigate the effects of parathyroidectomy vs. medical observation for patents with asymptomatic primary hyperparathyroidism (pHP). Methods A meta-analysis of randomized controlled trials was performed. Outcome parameters include biochemistries and bone density of the lumbar spine, femoral neck, and distal radius. Also, health-related quality of life (HRQOL) as measured by validated instruments was analyzed. Results A total of 5 trials involving 345 patients (163 observed, 182 surgery) were analyzed for serum calcium, 24-hour urine calcium, and serum PTH levels. Surgical treatment produced a significant decrease in all of these parameters. Mean serum and 24-hour urine calcium levels decreased from 10.6 mg/dl to 9.4 mg/dl (p&lt;0.001), and 253 mg/d to 148 mg/d (p&lt;0.001) respectively. Similarly, a significant decrease in serum PTH by 58 pg/ml (p&lt;0.001) was observed. After analyzing 7 RCT involving 531 patients, bone density in both the lumbar spine [odds ratio 2.29 (1.37 – 3.85) p&lt;0.01] and femoral neck [odds ratio 1.84 (1.106 – 3.066) p&lt;0.02] demonstrated statistically significant improvement 2 years after parathyroidectomy when compared to observed patients. The difference in bone density of the radius did not reach statistical significance. Narrative interpreted data was available on three RCT regarding HRQOL. Primary data from authors has been requested to allow for complete analysis of this parameter. Conclusions For patients with asymptomatic primary hyperparathyroidism, parathyroidectomy results in a significant improvement in lumbar spine and femoral neck bone density, as well as a normalization of chemistries. HRQOL is similarly expected to be improved, however, qualitative data to support this is pending.

The Effect of a 9-Week Physical Activity Programme on Bone and Body Composition of Children Aged 10 – 11 Years: An Exploratory Trial

A high-impact exercise and a lifestyle intervention were implemented over a 9-week period; changes in bone and body composition were compared to controls. Sixty-one children volunteered from three randomly selected schools. Each school was randomly assigned to either a structured exercise (STEX) intervention, a lifestyle intervention (PASS) or control (CONT). Bone mineral content (BMC) and density (BMD) of total body, femoral neck and lumbar spine were measured as well as fat and lean mass at baseline and post-intervention by dual-energy X-ray absorptiometry. The STEX intervention resulted in an additional mean increase in total body BMC of 63.3 g (p = 0.019) and an additional increase of 0.011 g . cm (-2) (p = 0.018) for BMD over increases observed by controls. Bone mineral increases observed for the PASS intervention were not significant compared to the control group (p > 0.05). Neither intervention produced significant increases in bone mineral at femoral neck or lumbar spine sites (p > 0.05) compared with the controls. No significant changes were found in fat mass index (p > 0.05), lean mass index (p > 0.05) or percent body fat (p = 0.09) in any groups. Structured impact exercise promoted significant and clinically relevant increases in bone measures, without significant changes to body composition. A larger, definitive randomised trial is needed to confirm the present results.

Association Between Alcohol Consumption and Both Osteoporotic Fracture and Bone Density

Objective Alcoholism is a risk factor for osteoporotic fractures and low bone density, but the effects of moderate alcohol consumption on bone are unknown. We performed a systematic review and meta-analysis to assess the associations between alcohol consumption and osteoporotic fractures, bone density and bone density loss over time, bone response to estrogen replacement, and bone remodeling. Methods MEDLINE, Current Contents, PsychINFO, and Cochrane Libraries were searched for studies published before May 14, 2007. We assessed quality using the internal validity criteria of the US Preventive Services Task Force. Results We pooled effect sizes for 2 specific outcomes (hip fracture and bone density) and synthesized data qualitatively for 4 outcomes (non-hip fracture, bone density loss over time, bone response to estrogen replacement, and bone remodeling). Compared with abstainers, persons consuming from more than 0.5 to 1.0 drinks per day had lower hip fracture risk (relative risk = 0.80 [95% confidence interval, 0.71-0.91]), and persons consuming more than 2 drinks per day had higher risk (relative risk = 1.39 [95% confidence interval, 1.08-1.79]). A linear relationship existed between femoral neck bone density and alcohol consumption. Because studies often combined moderate and heavier drinkers in a single category, we could not assess relative associations between alcohol consumption and bone density in moderate compared with heavy drinkers. Conclusion Compared with abstainers and heavier drinkers, persons who consume 0.5 to 1.0 drink per day have a lower risk of hip fracture. Although available evidence suggests a favorable effect of alcohol consumption on bone density, a precise range of beneficial alcohol consumption cannot be determined.

Increased Plasma Osteoprotegerin Concentrations Are Associated with Indices of Bone Strength of the Hip

Osteoprotegerin (OPG) is an important regulator of bone turnover through its effects on osteoclastogenesis, yet findings from previous studies of circulating OPG and commonly measured bone indices in humans have been conflicting. We conducted a cross-sectional study to evaluate the association between plasma OPG and femoral neck (FN) bone density (BMD) and geometry in a large cohort of women and men. Participants included 1379 postmenopausal women and 1165 men, aged 50-89 yr (mean, 64 yr), in the Framingham Offspring Study. Dual x-ray absorptiometry was used to evaluate FN BMD and geometry (bone width, section modulus, and cross-sectional area at the narrow neck region). Plasma OPG concentrations were measured by ELISA. Sex-specific analysis of covariance was used to calculate means and assess linear trend in BMD and geometry values across OPG quartiles, adjusted for confounders. OPG concentrations were greater in women than men, increased with age, and were greater in smokers and those with diabetes and heart disease. Multivariable-adjusted mean FN BMD in women increased from the lowest to the highest OPG quartile (trend, P < 0.01). However, no linear trend between FN BMD and OPG was observed in men (trend, P = 0.34). Section modulus and bone width increased with OPG in men (trend, P < 0.01), whereas no association between hip geometry indices and OPG was observed in women. Higher OPG concentration may indicate greater skeletal strength in women and men, possibly through reducing bone loss in women and increasing periosteal apposition in men.

Physiologic transdermal estradiol replacement therapy restores femoral neck bone density in women with spontaneous 46,XX primary ovarian insufficiency: 3 year randomized controlled clinical trial

We conducted this trial to address two major questions: 1) does a standard regimen of physiologic transdermal estradiol (100 mcg/day) replacement administered to young women with spontaneous 46,XX primary ovarian insufficiency maintain bone density as well as normal ovarian function does in controls? And, 2) does physiologic transdermal testosterone replacement (150 mcg/day) show additional benefit on bone mineral density (BMD)? Here we report our findings regarding the first question. We previously reported that the addition of testosterone showed no further benefit on BMD.

Does weight gain induce cortical and trabecular bone regain in anorexia nervosa? A two-year prospective study

This prospective study examines bone density and structure over a two-year time period in women with anorexia nervosa (AN) under weight gain treatment. Twenty-four women with AN were examined at baseline and at two annual follow-up examinations. In 9 AN patients BMI increased whereas in 15 it remained unchanged or decreased. Dual energy X-ray absorptiometry (DXA) was performed on the lumbar spine, the femoral neck and the whole hip and three-dimensional peripheral quantitative computer tomography (3D-pQCT) was performed on the ultradistal radius. ANOVAs for repeated measures were used to examine change over time in BMI and bone parameters. At baseline, patients with increased BMI had significantly higher bone density of femoral neck and total hip, and higher levels in all 3D-pQCT parameters of the ultradistal radius, compared to the group with unchanged or decreased BMI. The two groups did not differ at baseline in bone density of the spine. ANOVAs showed that bone density of the total hip increased significantly and that overall bone density (D100), the density of the trabecular area (D.Trab.) and the cortical thickness (C.Th.) in the ultradistal radius decreased significantly. Group × time interactions showed that changes over time were different in the two groups with regard to spine density and in the parameters D100, D.Trab. and C.Th. of the ultradistal radius. In the group with increased BMI the spine density dropped at the first follow-up whereas at the second follow-up it rose again to baseline. Patients with unchanged or decreased BMI showed a small but steady increase in spine density. The group changes of D100, D.Trab. and C.Th. of the ultradistal radius all followed the same pattern. Bone mineral density at all locations measured with both technologies (DXA and 3D-pQCT) did not vary according to BMI changes. The course of bone density and structure at different locations was different, and, despite weight increase, bone regain appeared to need different time periods.

Hot Flushes, Bone Mineral Density, and Fractures in Older Postmenopausal Women

To assess whether greater severity of hot flushes is associated with bone loss or fracture risk in older postmenopausal women. This study is a secondary analysis of 3,167 postmenopausal women in the Multiple Outcomes of Raloxifene Evaluation trial. Baseline hot flush severity was assessed by self-report. Femoral neck and lumbar spine bone density was assessed by dual-energy X-ray absorptiometry. Vertebral and nonvertebral fractures were determined radiographically and by interview. Baseline bone density, 3-year bone loss, baseline prevalent fractures, and 3-year fracture incidence were examined in women with varying hot flush severity. After adjusting for other characteristics, greater severity of hot flushes was associated with higher, rather than lower, baseline bone density (adjusted mean femoral neck bone density=0.633, 95% confidence interval [CI] 0.614-0.652 g/cm2, versus 0.611, 95% CI 0.608-0.613 g/cm2 for women with "severe" versus "minimal" hot flushes). Women with more severe hot flushes were less likely to have a baseline fracture (odds ratio 0.64, 95% CI 0.48-0.84, for vertebral fracture in women with moderate or severe versus minimal hot flushes). The 3-year annualized change in bone density did not differ among women with varying hot flush severity (P>.40 for all). Hot flush severity was not related to incident vertebral or nonvertebral fracture (P>.05 for all). Among osteoporotic women who are 5 or more years postmenopausal, greater severity of persistent hot flushes is not associated with progressive bone loss or risk of fracture, despite previous research linking hot flushes to bone loss during early menopause. II.

Decreased spinal and femoral neck volumetric bone mineral density (BMD) in men with primary osteoporosis and their first‐degree male relatives: familial effect on BMD in men

Low bone mass may be caused by a reduction in the amount of bone or density of bone or both. The purpose of this study was to examine differences in bone volume and volumetric bone mineral density (vBMD) in men with primary osteoporosis and their first-degree male relatives (FDMR). We used dual-energy X-ray absorptiometry (DXA) to measure areal density, then calculated bone volume and volumetric density in 121 men with primary osteoporosis, 73 FDMR and 66 normal men. We used regression methods adjusting for age, height and weight to determine deficits in bone volume and vBMD at the spine and femoral neck between men with spinal fractures due to primary osteoporosis, FDMR and normal men. Men with osteoporosis had a tendency to smaller bone volume in the spine and femoral neck (P = 0.08 and P = 0.09, respectively) and lower volumetric bone density at the spine (by about 50%) and femoral neck (by about 30%) compared with healthy controls (P < 0.0001). FDMR had no deficit in bone volume but did have lower volumetric density at the spine (by 10.2%) compared with healthy controls (P < 0.0001). A deficit in bone mineral accrual may underlie the pathogenesis of primary osteoporosis in men, resulting in low vBMD. This is likely to be determined by genetic factors, although shared common environmental factors may also be important.

Comparison of the femoral neck bone density, quantitative ultrasound and bone density of the heel between dominant and non-dominant side

Our study was initiated to evaluate whether there are differences between the two sides, depending on hand dominance, in densitometry values and quantitative ultrasound parameters (QUS) of the lower limb. One hundred and six women and 44 men were involved. The hand dominance was determined by interview. The bone mineral density (BMD) of the left and the right femoral necks and the calcanei were measured by dual-energy X-ray absorpiometry (DXA). The QUS examination consisted of measuring the attenuation (BUA), the speed of the ultrasound (SOS) and quantitative ultrasound index (QUI) transversing the left and right calcanei. The density of the neck of femur of the non-dominant side did not differ from that of the dominant side. On the other hand, BMD, BUA and the QUI of the calcaneus were higher on the non-dominant side in both genders ( p < 0.05 for each parameter). No similar differences were seen for the SOS values. Our study has confirmed the side-to-side differences of the calcaneus in both genders, lower values were found on the dominant side. No similar differences were seen on the femur. The AUC values seemed to be higher on the dominant side, however, these differences were not strictly significant. In the case of peripheral site (heel) measurements, the practical significance of our observations is that they raise the possibility of performing peripheral DXA and QUS examinations of the calcaneus on the dominant side of the patient according to handedness.

Testosterone Use in Men and Its Effects on Bone Health. A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials

Androgen-deficient men are at increased risk of osteoporosis. The extent to which testosterone can prevent and treat osteoporosis in men remains unclear. We performed a systematic review and meta-analysis of randomized placebo-controlled trials in men to estimate the effect of testosterone use on bone health outcomes. The review encompassed librarian-designed search strategies using MEDLINE (1966 to March 2005), EMBASE (1988 to March 2005), and Cochrane CENTRAL (inception to March 2005); a review of reference lists from included studies; and content expert files. Independently and in duplicate, we assessed the methodological quality of the eligible trials and collected data on bone mineral density and bone fractures at the longest point of complete follow-up. We included eight trials enrolling 365 patients. Two trials followed patients for more than 1 yr. Meta-analysis of these trials showed that, compared with placebo, im testosterone was associated with an 8% (95% confidence interval, 4%, 13%) gain in lumbar bone mineral density and transdermal testosterone had no significant impact. Testosterone use was associated with a nonsignificant 4% (95% confidence interval, -2%, 9%) gain in femoral neck bone mineral density with unexplained differences in results across trials (26% of these differences were not explained by chance alone). No trials measured or reported the effect of testosterone on fractures. Intramuscular testosterone moderately increased lumbar bone density in men; the results on femoral neck bone density are inconclusive. Without bone fracture data, the available trials offer weak and indirect inferences about the clinical efficacy of testosterone on osteoporosis prevention and treatment in men.

Bone mineral density in Iranian patients with inflammatory bowel disease

Patients with inflammatory bowel disease (IBD) are at increased risk of developing osteopenia and osteoporosis. The aim of the study was to investigate the prevalence of decreased bone density and related risk factors in Iranian IBD patients. A total of 126 ulcerative colitis (UC) and 39 Crohn's disease (CD) patients were enrolled. Dual-energy x-ray absorptiometry technique was used to measure bone density, and blood samples were obtained to measure biochemical markers. To find predictive variables for bone mineral density (BMD), stepwise regression analysis was carried out. A total of 53 IBD patients (32.1%) had diminished bone mineral density at either lumbar spine (L1-L4) or femoral neck. Of these, 9 (5.4%) had osteoporosis; however, 44 (26.7%) were osteopenic. Femoral neck bone density was significantly decreased among CD patients (p<0.04). There was no significant difference in BMD between men and women. We have found significant differences in BMD T scores at lumbar L1-L4, L2-L4, and femoral neck in corticosteroid ever-users (p<0.002, p<0.001, p<0.003, respectively). There was no significant difference in biochemical markers between UC and CD patients, except that more CD patients were hypocalcemic (p<0.001). Stepwise regression analysis has revealed lumbar spine T score was predicted by age (p<0.0001), corticosteroid use (p<0.002), and body mass index (BMI) (p<0.005); however, femoral neck was predicted by age (p<0.0001), BMI (p<0.0001), smoking (p<0.009), and corticosteroid use (p<0.028). Low bone density in Iranian UC and CD patients is in accordance with Western societies. Treatment with corticosteroid has increased this possibility in both groups. Corticosteroid use, age, smoking, and BMI are predictive factors for low bone density.

Dual energy X-ray absorptiometry analysis of peri-prosthetic stress shielding in the Birmingham resurfacing hip replacement

Numerous reports in the literature refer to the femoral neck fracture rate in hip resurfacing. The aim of this study was to determine the bone mineral density and evidence of stress shielding around the femoral component of the Birmingham resurfacing prosthesis. Twenty-eight patients with primary unilateral osteoarthritis had a Birmingham resurfacing prosthesis. DEXA analysis of the proximal femur and femoral neck was performed and compared with the opposite unaffected side. Total periprosthetic bone mineral density was 0.49% greater than the control, but this did not achieve statistical significance. Although the BMD of the femoral neck was slightly increased on the prosthetic side (1.002 g/cm2) as opposed to the control side, this difference did not reach statistical significance. The Birmingham resurfacing prosthesis does not appear to reduce femoral neck bone mineral density in comparison to the normal femoral neck bone density. We conclude that femoral neck fractures are unlikely to be due to stress shielding related to the prosthesis.

Correlation of different bone markers with bone density in patients with rheumatic diseases on glucocorticoid therapy

Osteoporosis is a common concomitant disease in patients with rheumatic diseases on glucocorticoid (GC) therapy. Bone status is usually evaluated by determination of bone density in combination with clinical examinations and laboratory tests. However, the strength of individual biochemical bone makers in GC-induced osteoporosis has yet to be fully clarified. For this reason, different bone markers were investigated in correlation with bone density in patients with rheumatic diseases. Approximately 238 patients (212 women, 26 men) with a rheumatic disease and under GC therapy were examined consecutively for the first time with regard to bone density (BMD) and bone markers [osteocalcin, bone-specific alkaline phosphatase (precipitation method/tandem-MP ostase), crosslinks [pyridinoline (PYD), deoxypyridinoline (DPX), N-terminal telopeptide (NTX)]]. The daily glucocorticoid dose was 10 mg prednisone equivalent (median), and the cumulative dose was 12 g prednisone equivalent (median). None of the patients had previously taken medication for osteoporosis. Osteoporosis was demonstrated in 35.3% of the patients, osteopenia in 47.5%, and a normal BMD in 17.2%. The results of tandem-MP ostase correlated with the BMD of the lumbar spine and of the femoral neck. The values for N-terminal telopeptide and pyridinoline correlated only with the bone density of the femoral neck. All results were statistically significant, although the correlation coefficients were low. After classification of the patients according to their BMD values (osteoporosis, osteopenia and normal BMD), there were significantly more patients with bone markers above the norm in the osteoporosis group and in the osteopenia group than in the group with normal bone density. All bone markers recorded behaved similarly in relation to the bone density values. The same analysis was also undertaken for the different disease groups. In these subgroups there was also a correlation between ostase/crosslinks with BMD, but the correlation coefficients were low. A general recommendation for the routine use of a specific bone marker in patients with rheumatic diseases on glucocorticoid therapy cannot be made from a cost-benefit point of view mainly because of limited predictive power (low correlation coefficients, incomplete correlation with different sites of BMD measurement).

Abdominal fat and hip fracture risk in the elderly: The Dubbo Osteoporosis Epidemiology Study

BackgroundFat mass, which is a major component of body weight, is directly related to bone mineral density and reduced fracture risk. It is not known whether abdominal fat is associated with hip fracture. The present study was designed to examine the association between abdominal fat and hip fracture in women and men aged 60+ years.MethodsThis was a nested case-control study with one fracture case being matched with two controls of the same age. In women 63 cases were matched with 126 controls, and in men 26 cases were matched with 52 controls. Hip fracture was confirmed by X-ray and personal interview. Other measurements included weight, height, body mass index (BMI), abdominal fat, and femoral neck bone density (FNBMD). Conditional logistic regression model was used to analyse data.ResultsThe odds ratio of hip fracture risk associated with each 10% lower abdominal fat was 1.5 (95% CI, 1.1 to 2.1) in women and 1.2 (95% CI, 0.7 to 2.0) in men. However after adjusting for FNBMD or body weight, the abdominal fat-fracture association was no longer statistically significant. Similarly, body weight and BMI was each significantly associated with hip fracture risk (in women), but after taking with account the effect of FNBMD, the association become statistically non-significant.ConclusionLower abdominal fat was associated with an increased risk of hip fracture in elderly women, but the association was not independent of FNBMD or weight. The contribution of abdominal fat to hip fracture risk is likely to be modest.

Diagnostic performance of quantitative ultrasound calcaneus measurement in case finding for osteoporosis in Thai postmenopausal women

Dual-energy X-ray absorptiometry (DXA) is currently considered the gold standard for the diagnosis of osteoporosis. Quantitative ultrasound (QUS) can be an alternative method that is less expensive, portable, and can be used at a primary care level to indicate osteoporosis in women. The present study aimed to assess the diagnostic performance of QUS calcaneus measurement in a case finding for osteoporosis in Thai postmenopausal women using DXA as a gold standard. Three hundred postmenopausal women, who had not menstruated normally for at least 1 year, were included in the study. To determine the accuracy and reliability of QUS of the calcaneus, calcaneus bone density measurement was carried out using the QUS and left femoral neck bone density was measured using DXA. Bone mass density (BMD) was interpreted as osteoporotic or normal using WHO criteria for determining the performance of QUS. Optimal cut-off values were determined using a receiver operating characteristic (ROC) curve for diagnosing the osteoporosis cases. The number of osteoporosis cases in this study was 107 (35.67%). The sensitivity, specificity, positive and negative predictive values were 39.25%, 91.71%, 72.41%, 73.14%, respectively, when using the T-score of the WHO criteria as a reference. The positive and negative likelihood ratios were 4.73 and 0.66. When using the ROC curve to determine the optimal cut-off values, using the stiffness index of the QUS and categorizing age (<65 years and >or=65 years) before conducting the test, sensitivity and specificity were 77.6% and 59.6%, respectively. Bone mass density measurement for predicting osteoporosis using QUS had a very low sensitivity and was not good enough to replace the standard tool (DXA).

Hungry bone syndrome: A case report and review of the literature

A case of hungry bone syndrome (HBS) and changes in bone density is presented. Clinical, laboratory, and radiologic findings of this patient undergoing massive calcium therapy to prevent hypocalcemia are also described. A 31 year-old-man with chronic renal failure underwent parathyroidectomy for parathyroid hyperplasia. His postoperative course was characterized by prolonged hypocalcemia, hypophosphatemia, and risk for tetany due to massive calcium deposition in the bone. Although in most cases HBS is asymptomatic, it may present with severe bone pain and cause death due to tetany. We report a case of severe HBS after parathyroid surgery that demonstrated large increases in hip and lumbar bone density during recovery. Lumbar (L2–L4) bone density increased by 16% (from 1.137 to 1.329 g/cm 2, Z-score 94% to 109%) over an 8-month period. In comparison, left femoral neck bone density increased by 37% (from 0.962 to 1.314 g/cm 2, Z-score 92% to 125%) over the same period. This case reports describes the massive amounts of calcium that are required in the treatment of HBS. A large increase in bone density over a short period of time indicates that endocrine and nutritional conditions allow for rapid bone deposition even in a patient with chronic renal failure. Understanding the bone physiology mechanism(s) responsible for the rapid increase in bone density may advance treatments for osteoporosis.

Hypergonadotropic amenorrhea and bone density: new approach to an old problem.

Amenorrhea can cause bone loss, but not all mechanisms in this process are known. The degree of bone loss in amenorrheic women is determined by the cause of the amenorrhea. The aim of this study was to investigate the influence of secondary amenorrhea on bone density and to compare the bone density between hypogonadotropic amenorrheic women and hypergonadotropic amenorrheic women. Twenty-two amenorrheic and 12 eumenorrheic women under the age of 40 were involved in this study. Every woman underwent measurements of lumbar spine and femoral neck bone density, body mass index (BMI), and serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, progesterone, and prolactin. According to FSH levels, we divided the women with amenorrhea into two groups: hypergonadotropic (n = 7; FSH, >40 IU/l) and hypogonadotropic (n = 15; FSH, < or =40 IU/l) amenorrheic women. Amenorrheic women had a lower lumbar spine bone density than eumenorrheic controls (P = 0.002). Hypergonadotropic amenorrheic women had lower lumbar spine bone density (P = 0.026) than hypogonadotropic ameneorrheic women. In the hypergonadotropic group, only FSH level had a correlation (negative) with lumbar spine bone density (P = 0.05), but in the hypogonadotropic group, there was no correlation between hormonal levels, BMI, age, or duration of amenorrhea. BMI was positively correlated with lumbar spine bone density in amenorrheic women (P < 0.025). Amenorrheic women had lower bone density than eumenorrheic women, but hypergonadotropic amenorrheic women had lower bone density than hypogonadotropic women. The greater bone loss in the hypergonadotropic amenorrheic group could have been caused by a potential direct effect of FSH on bone metabolism.