Bone Mineral Density Percentage Research Articles

Protective effect of Sideritis euboea extract on bone mineral density and strength of ovariectomized rats

The aim of this study was to investigate the potential protective effect of Sideritis euboea extract (SID), commonly consumed as "mountain tea," on bone mineral density (BMD) and the strength of the ovariectomized (OVX) rat model of osteoporosis. Thirty-two 10-month-old Wistar rats were separated into controls (sham operated), OVX, and OVX plus SID in their drinking water (dose, 330 mg/kg body weight per day), starting immediately after OVX for 6 months. Tibial BMD at baseline and at 3 and 6 months post-OVX, three-point-bending of the femur, and body and uterine weight at the study end were examined. BMD percentage change from baseline of the whole tibia was similar in control and OVX + SID rats at 3 months (-3.02% vs -4.67%, P = not significant), revealing a strong osteoprotective effect. At 6 months, the corresponding changes were -6.02% versus -14.37%, P < 0.05, indicating a greater bone loss in treated rats, albeit significantly less than the OVX change (-20.46%; OVX vs OVX + SID, P < 0.05). The proximal (metaphyseal) tibial BMD percentage change from baseline to 3 and 6 months between the OVX and OVX + SID groups (-26.47% vs -15.57% and -31.22% vs -16.57%, respectively) was statistically significant, demonstrating that SID preserved the proximal tibial BMD of the OVX + SID group significantly. Three-point-bending showed a significant increase in the treated compared with the OVX groups. Body and uterine weights were similar in the OVX and treated groups. SID significantly protected tibial bone loss and improved femoral biomechanical strength in OVX + SID rats compared with OVX rats.

Oral Contraceptive Use and Bone Density Change in Adolescent and Young Adult Women: A Prospective Study of Age, Hormone Dose, and Discontinuation

Oral contraceptive (OC) use is common, but bone changes associated with use of contemporary OC remain unclear. The objective of the study was to compare bone mineral density (BMD) change in adolescent and young adult OC users and discontinuers of two estrogen doses, relative to nonusers. This was a prospective cohort study, Group Health Cooperative. Participants included 606 women aged 14-30 yr (50% adolescents aged 14-18 yr): 389 OC users [62% 30-35 μg ethinyl estradiol (EE)] and 217 age-similar nonusers; there were 172 OC discontinuers. The 24-month retention was 78%. The main outcome measure was BMD measured at 6-month intervals for 24-36 months. After 24 months, adolescents using 30-35 μg EE OCs, but not those using lower-dose OCs, had significantly smaller adjusted mean percentage BMD gains than nonusers at the spine [group means (95% confidence interval for between group differences) 1.32 vs. 2.26% (-1.89, -0.13%)] and whole body [1.45 vs. 2.03% (-1.29%, -0.13%)]. Adolescents who discontinued 30-35 μg EE OC showed significantly smaller gains than nonusers at the spine after 12 months [0.51 vs. 1.72% (-2.38%, -0.30%)]. Young adult OC users did not differ from nonusers. However, OC discontinuers of both doses differed significantly from nonusers at the spine 12 months after discontinuation [-1.32% < 30 μg EE, -0.92% 30-35 μg EE vs. +0.27% nonusers (-2.48, -0.54, and -1.94%, -0.55%, respectively)]. Results were similar for mean absolute BMD change (grams per square centimeter). Both OC use and discontinuation were associated with BMD losses/smaller gains relative to nonusers (differences < 2% after 12-24 months for all skeletal sites). The clinical significance of these results regarding future fracture risk is unknown. Study of longer-term trends after discontinuation is needed.

The relationship between bone mineral density and mammographic density in Korean women: The Healthy Twin study

Mammographic density is one of the strong risk factors for breast cancer. A potential mechanism for this association is that cumulative exposure to mammographic density may reflect cumulative exposure to hormones that stimulate cell division in breast stroma and epithelium, which may have corresponding effects on breast cancer development. Bone mineral density (BMD), a marker of lifetime estrogen exposure, has been found to be associated with breast cancer. We examined the association between BMD and mammographic density in a Korean population. Study subjects were 730Korean women selected from the Healthy Twin study. BMD (g/cm(2)) was measured with dual-energy X-ray absorptiometry. Mammographic density was measured from digital mammograms using a computer-assisted thresholding method. Linear mixed model considering familial correlations and a wide range of covariates was used for analyses. Quantitative genetic analysis was completed using SOLAR. In premenopausal women, positive associations existed between absolute dense area and BMD at ribs, pelvis, and legs, and between percent dense area and BMD at pelvis and legs. However, in postmenopausal women, there was no association between BMD at any site and mammographic density measures. An evaluation of additive genetic cross-trait correlation showed that absolute dense area had a weak-positive additive genetic cross-trait correlation with BMD at ribs and spines after full adjustment of covariates. This finding suggests that the association between mammographic density and breast cancer could, at least in part, be attributable to an estrogen-related hormonal mechanism.

Long‐Term Effects of Dimethandrolone 17β‐Undecanoate and 11β‐Methyl‐19‐Nortestosterone 17β‐Dodecylcarbonate on Body Composition, Bone Mineral Density, Serum Gonadotropins, and Androgenic/Anabolic Activity in Castrated Male Rats

The potent androgens dimethandrolone 17β-undecanoate (DMAU) and 11β-methyl-19-nortestosterone 17β-dodecylcarbonate (11β-MNTDC) are in development for androgen replacement therapy and hormonal contraception in men. They can be delivered either orally or as long-acting injectables. In the current study, their long-term effects on body composition (percentage lean and fat mass); bone mineral density (BMD); serum gonadotropin levels; and weights of the prostate, seminal vesicles, and levator ani muscle were assessed. Four-week-old male rats were sham-operated (intact) or castrated (Cx) and treated subcutaneously for 16 weeks postsurgery with vehicle (Cx, intact), DMAU, or 11β-MNTDC every 4 weeks; testosterone enanthate (TE) every 2 weeks; or a testosterone (T) implant. There were significant differences in body weights over time with a general trend of intact = Cx + T = Cx + TE > Cx + 11β-MNTDC > Cx > Cx + DMAU. At week 18, rats were evaluated by dual-energy x-ray absorptiometry using the whole-body function of the Hologic software. The percentage lean body mass and BMD were lower (P < .05) in Cx rats than intact rats but equivalent in all groups of androgen-treated Cx rats and intact rats (P > .05). The highest percentage body fat was observed in Cx rats. Only DMAU- and 11β-MNTDC-treated rats had lower percentage body fat compared with Cx rats (P < .05). Prostate, seminal vesicles, and levator ani muscle weights, corrected for final body weight, were decreased (P < .05) in Cx compared with intact rats and increased to varying extents in androgen-treated Cx rats compared with Cx rats (P < .05). The most marked increases were observed in the DMAU-treated rats in which prostate and seminal vesicle weights/kg body weight were 2.4 to 2.7 times those of intact rats, and levator ani muscle weights were increased approximately 1.5-fold. Blood was collected from the tail vein at weeks 4, 8, 12, and 16 for measurement of serum levels of androgens and at necropsy at week 18 for measurement of serum gonadotropins. Serum levels of luteinizing hormone and follicle-stimulating hormone were greatly elevated in Cx rats at week 18 and suppressed to levels comparable to those in intact rats by DMAU, 11β-MNTDC, and T implants (P > .05). Collectively, our data indicate that androgen replacement with DMAU or 11β-MNTDC in Cx rats resulted in favorable changes in body composition and maintenance of BMD comparable to those of T.

Female patients with low systemic BMD

Sir—We read with interest the paper of Alm et al. (2009). The authors looked at post- total hip arhtroplasty periprosthetic (THA) bone changes in 39 subjects using DXA to analyse bone mineral density (BMD) in the Gruen zones surrounding the femoral prosthesis component. The purpose of the study was to look for factors such as bone mineral status that might influence femoral periprosthetic bone loss. In Figure 4 of their paper, the authors graphed the change in BMD in Gruen zone 7 at 2 years post-THA expressed as a percentage of baseline BMD at that site (y-axis) against the lowest preoperative T score from lumbar spine, proximal femur or non-dominant distal forearm (x-axis). From the significant positive correlation they obtained between these graphed variables, they concluded that”low preoperative systemic BMD was associated with higher bone loss in Gruen zone 7”. We would like to introduce a note of caution here because we will show that it is possible to demonstrate a significant correlation between the variables as defined by Alm et al when there is absolutely no influence of systemic BMD on postoperative BMD change at Gruen zone 7. In order to do this we need to mimic their experimental data with “mock data” for both x and y variables as per Alm's Figure 4. From inspection of that figure, the x-axis T-scores appear to have a mean of around -1.5 and a standard deviation (SD) of 1. From this information, it is possible to produce a set of 39 random numbers normally distributed with this mean and SD using, for example, the “Data Analysis” toolkit in Microsoft Excel. This gives us our x variable. The y variable is comprised of a numerator showing the BMD difference between Gruen zone 7 BMD at 2 years and that at a preoperative baseline. From Alm et al's data in Table 2, there is an average Gruen zone 7 BMD loss of -0.25 g/cm2 over 2 years. We make the assumption that this is fixed at that value for all patients, i.e. no possibility of variation with systemic bone mineral status. The denominator of the y variable is the baseline Gruen zone 7 BMD expressed in g/cm2. From our own data on 26 adult females scheduled for THA, we obtain a regression equation for the excellent positive correlation of baseline Gruen zone 7 BMD against baseline Total Hip T-score as expressed below: It is reasonable to accept this equation to an estimator for baseline Gruen zone 7 BMD given that Total Hip T-score is accepted as the most relevant indicator of systemic bone loss. Therefore, we have constructed mock data for both the numerator and denominator of the y variable and can therefore combine these to provide “mock data” for the y variable. We now have a y variable incorporating a constant BMD change in Gruen zone 7. If we proceed to look for a “relation” between these “mock” x and y variables, we find that there is a strong positive correlation with the following regression equation: From inspection of Alm et al's Figure 4, the y-intercept is approximately -14 and the gradient is approximately 5.4. Therefore, our mock data gives similar results to the experimental data of Alm et al. This occurs despite our choosing a constant BMD change in Gruen zone 7 at 2 years postoperatively, i.e. a change that was independent of systemic bone mineral status. The reason we get a “false”positive correlation with our data is that the y variable denominator and the x variable, both of which are preoperative assessments, are highly correlated, i.e. a low Total Hip T-score corresponds to a low Gruen Zone 7 baseline BMD and because this appears on the denominator of the y variable, it increases the apparent % bone loss represented by that variable. This analysis suggests that the conclusions made by Alm et al on the basis of their Figure 4 must be viewed with some caution. However, perhaps the most clinically important message from their study is that if you start with poor quality bone at the femoral prosthesis, any further postoperative loss whether related to systemic bone mineral status or not will not improve the situation.

GH in combination with bisphosphonate treatment in osteogenesis imperfecta

To verify the effects of bisphosphonates (Bps) in combination with recombinant human GH (rGH) in pediatric osteogenesis imperfecta (OI) patients; we focused on possible improvement of bone mineral density (BMD), projected bone areas, growth velocity, and fractures risk. A randomized controlled 1-year clinical trial on 30 prepubertal children (M:F=14:16) affected by OI (type I, IV, and III) being treated with neridronate. Following an observational period of 12 months during ongoing neridronate treatment, the patients were randomly divided into two groups: 15 were treated for 12 months with rGH and neridronate (group Bp+rGH) and 15 continued neridronate alone (group Bp). We evaluated auxological parameters, number of fractures, bone age (BA), bone metabolic parameters, and bone mass measurements (at lumbar spine and radius by dual-energy X-ray absorptiometry). The mean variation in percentage of BMD (Delta%BMD)--at lumbar spine (L2-L4), at distal and ultradistal radius--and the projected area of lumbar spine increased significantly in group Bp+rGH (P<0.05). Growth velocity was significantly higher during rGH treatment in group Bp+rGH versus group Bp and versus pretreatment (P<0.05), with no difference in increase in BA or fracture risk rate. Patients with quantitative (-qt) collagen synthesis defects had a higher, although not significant, response to rGH in terms of growth velocity and BMD. In OI patients, the combined rGH-Bp treatment may give better results than Bp treatment alone, in terms of BMD, lumbar spine projected area and growth velocity, particularly in patients with quantitative defects.

Effect of body composition on bone mineral density in males with different glucose tolerance

To investigate the effect of body composition on bone mineral density (BMD) in males with different glucose tolerance. A total of 87 male subjects aged 35~64 years were divided into 2 groups by glucose tolerance test, 57 diagnosed T2DM and 30 with normal glucose tolerance(NGT). BMDs of anteroposterior lumbar vertebrae (AP), left femur neck (FN), total hip (T-hip), and total bone mineral density(TBMD)were measured by dual-energy-X-ray absorptiometry (DEXA). Body composition was also measured by DEXA, while fat tissue mass(FTM), lean tissue mass(LTM), percentage of truncal fat (Tru-fat%) and total fat (Fat%) were computed. The effect of body composition on the BMD of the 2 groups was analyzed. LTM and FN-BMD had a positive correlation in the NGT group, but no correlation in the T2DM group. The percentage of fat showed a negative relationship with the BMD of AP in the T2DM group, but not in the NGT group. The percentage of fat and total BMD had a negative association in both the NGT and the T2DM groups. In the NGT group, LTM was the independent predictor of BMD of AP,FN and hip (b=0.509, 0.411, and 0.585; P<0.01 or 0.05; R2=0.169~0.342). In the T2DM group, LTM was the independent predictor of BMD of AP (b=0.330, P<0.05, R2=0.109) and hip (b=0.462, P<0.01,R2=0.213), but not FN. LTM has an attenuated effect on the BMD in male patients with T2DM compared with patients with NGT. An increased percent of fat percent is harmful to preserve bone mass in male adults, regardless of normal glucose tolerance or T2DM.

Low-dose Oral Contraceptives in Adolescents: How Low Can You Go?

Context The use of combined oral contraception (COC) before the accrual of peak bone mass in adolescents is common. Despite the tendency to prescribe lower ethinyl estradiol concentrations so as to reduce thromboembolic complications, concerns have developed as to whether low-dose COC provides sufficient estrogen supplementation for adequate adolescent bone development. Objective This paper reviews the available literature on bone mineral density (BMD) and low-dose COC in adolescents in an effort to determine whether adult-oriented recommendations for the lowest tolerated estrogen dose should apply to adolescent populations. Design A MEDLINE search of all English-language literature (1966 to January 2008) was performed using the terms “adolescent,” “oral contraception,” and “BMD.” Bibliographies were reviewed to extract additional relevant sources. Articles were selected based on pertinence to BMD changes in association with low-dose (20 μg ethinyl estradiol) hormonal contraception with emphasis on adolescent study groups. Results A limited number of studies examining 20-ug preparations in adolescents have demonstrated a significantly smaller mean percentage BMD acquisition in COC groups vs untreated controls. Bone mineral density decreases appeared to positively correlate with early gynecological age of first COC use and treatment duration. Conclusions Loss of bone mass as a result of hormonal contraceptive use may have serious long-term implications in the adolescent population, who have yet to achieve peak bone density. Both age at first COC use and cumulative estrogen dose appear to be important factors in determining skeletal development in adolescents. Further studies are warranted to inform specific prescribing practices for this population.

Growth Hormone in Combination with Bisphosphonate Treatment in Osteogenesis Imperfecta

Objective: To verify the effects of bisphosphonates (Bps) in combination with recombinant human growth hormone (rGH) in pediatric osteogenesis imperfecta (OI) patients; we focused on possible improvement of bone mineral density (BMD), projected bone areas, growth velocity and fractures risk. Design: A randomized controlled 1-year clinical trial on 30 pre-pubertal children (M:F=14:16) affected by OI (type I, IV, III) being treated with Neridronate (N). Methods: Following an observational period of 12 months during ongoing N treatment, the patients were randomly divided into two groups: 15 were treated for 12 months with rGH and N (Group Bp+rGH) and 15 continued N alone (Group Bp). We evaluated auxological parameters, number of fractures, bone age (BA), bone metabolic parameters and bone mass measurements (at lumbar spine and radius by DXA). Results: The mean variation in percentage of BMD (∆%BMD) at lumbar spine (L2-L4), at distal and ultra distal radiusand the projected area of lumbar spine increased significantly in Group Bp+rGH (p<0.05). Growth velocity was significantly higher during rGH treatment in group Bp+rGH vs group Bp and vs pre-treatment (p< 0.05), with no difference in increase in BA or fracture risk rate. Patients with quantitative collagen synthesis defects had a higher, although not significant, response to rGH in terms of growth velocity and BMD. Conclusions: In OI patients the combined rGH-Bp treatment may give better results than Bp treatment alone, in terms of BMD, lumbar spine projected area and growth velocity, particularly in patients with quantitative defects. Page 2 of 22

Comparison of anatomic coordinate systems with rigid multi-resolution 3D registration for the reproducible positioning of analysis volumes of interest in QCT

In this study we compared two approaches that have recently been used to minimize precision errors in 3D quantitative computed tomography (QCT) images of the hip and the spine in order to optimize the detection of longitudinal changes in bone mineral density (BMD). In 30 subjects we obtained baseline and 1 year follow-up 3D CT scans of the proximal femur and the spine. QCT analysis was applied to a variety of volumes of interest (VOIs) automatically positioned relative to anatomic coordinate systems (ACS). In the first approach (A1) baseline and follow-up scans were analyzed independently. In the second approach (A2) a 3D versor-based rigid intensity registration method was applied to match baseline and follow-up images, and the baseline ACS was mapped on the follow-up image using the registration transformation. Afterwards, the analysis VOIs were again independently calculated for baseline and follow-up images. There were no significant differences of percent BMD changes between baseline and follow-up images between A1 and A2 for any of the VOIs investigated. With advanced image processing methods a time-consuming 3D registration between baseline and follow-up images before the analysis does not improve analysis precision compared to the use of anatomical coordinate systems.

Changes in Bone Mineral Density, Body Composition and Adiponectin Levels in Morbidly Obese Patients after Bariatric Surgery

Gastric bypass surgery (GBP) is increasingly used as a treatment option in morbid obesity. Little is known about the effects of this surgery on bone mineral density (BMD) and the underlying mechanisms. To evaluate changes on BMD after GBP and its relation with changes in body composition and serum adiponectin, a longitudinal study in morbid obese subjects was conducted. Forty-two women (BMI 45.0 +/- 4.3 kg/m(2); 37.7 +/- 9.6 years) were studied before surgery and 6 and 12 months after GBP. Percentage of body fat (%BF), fat-free mass (FFM), and BMD were measured by dual-energy X-ray absorptiometry and serum adiponectin levels by RIA. Twelve months after, GBP weight was decreased by 34.4 +/- 6.5% and excess weight loss was 68.2 +/- 12.8%. Significant reduction (p < 0.001) in total BMD (-3.0 +/- 2.1%), spine BMD (-7.4 +/- 6.8%) and hip BMD (-10.5 +/- 5.6%) were observed. Adiponectin concentration increased from 11.4 +/- 0.7 mg/L before surgery to 15.7 +/- 0.7 and 19.8 +/- 1.0 at the sixth and twelfth month after GBP, respectively (p < 0.001). Thirty-seven percent of the variation in total BMD could be explained by baseline weight, initial BMD, BF reduction, and adiponectin at the twelfth month (r (2) = 0.373; p < 0.001). Adiponectin at the twelfth month had a significant and positive correlation with the reduction of BMD, unrelated to baseline and variation in body composition parameters (adjusted correlation coefficient: r = 0.36). GBP induces a significant BMD loss related with changes in body composition, although some metabolic mediators, such as adiponectin increase, may have an independent action on BMD which deserves further study.

Use of monthly oral ibandronate to prevent anastrozole-induced bone loss during adjuvant treatment for breast cancer: Two-year results from the ARIBON study

554 Background: The ARIBON trial is a double-blind, randomized, placebo-controlled study designed to evaluate the impact of bisphosphonate treatment on bone mineral density (BMD) in postmenopausal women taking adjuvant anastrozole for their endocrine responsive breast cancer. Methods: BMD was assessed in 131 patients prior to commencing adjuvant endocrine treatment. 68, 50, and 13 patients were found to be normal (T >-1.0, group 1), osteopenic (T -1.0 to -2.5, group 2), and osteoporotic (T <-2.5, group 3), respectively. All patients were treated with anastrozole 1mg once a day and calcium and vitamin D supplementation. In addition, group 2 patients were randomized on a 1:1 basis to receive either treatment with oral ibandronate 150 mg every month or placebo. Group 3 patients were treated with open label oral ibandronate 150mg every month. BMD and bone marker measurements were repeated at regular intervals for two years. Group 1 patients were followed up on calcium and vitamin D supplements alone. Results: BMD changes in groups 2 and 3 are shown in the table. In group 2 the mean difference in percentage BMD changes between the ibandronate and placebo treated patients after 1 and 2 years was 5.5 and 6.2% (95% CI 2.4–10.0) at the lumbar spine (LS) and 3.2 and 4.5% (95% CI 1.7–7.3) at the hip (TH) (p<0.01, independent samples t test). After 1-year Urinary n-telopeptide (uNTX), serum c-telopeptide (sCTX), and serum bone-specific alkaline phosphatase (sBALP) levels declined in patients receiving ibandronate (21, 26, and 23%, respectively) and increased in those taking placebo (40, 35, and 40%, respectively). Biomarker assessments at 2 years are ongoing. As expected, group 1 patients lost 4.8% (range -13.8, +4.5) at the LS and 3.7% (range -15.9, +1.3) at the TH after 2 years. Conclusions: Ibandronate 150 mg by mouth once a month prevents anastrozole-induced bone loss and results in significant increases in BMD at the LS and TH in osteopenic and osteoporotic patients. Mean Percentage Change in BMD (Ranges) Osteopenia Osteoporosis Ibandronate Placebo Ibandronate 1 yr n=23 2 yr n=21 1 yr n=25 2 yr n=19 1 yr n=12 2 yr n=12 LS +3.11 (-3.8, +15.1) +2.98 (-8.9, +19.9) -2.35 (-10.5, +2.2) -3.22 (-16.0, +4.3) +5.02 (-8.7, +15.2) +3.52 (-4.9, +14.6) TH +0.98 (-4.1, +5.6) +0.60 (-9.0, +6.9) -2.27 (-9.9, +5.2) -3.90 (-12.3, +7.2) +2.90 (-1.0, +8.5) +2.49 (-3.7, +8.1) Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration AstraZeneca Oncology, Roche AstraZeneca Oncology

Plasma B Vitamins, Homocysteine, and Their Relation with Bone Loss and Hip Fracture in Elderly Men and Women

Elevated homocysteine is a strong risk factor for osteoporotic fractures among elders, yet it may be a marker for low B-vitamin status. Our objective was to examine the associations of plasma concentrations of folate, vitamin B12, vitamin B6, and homocysteine with bone loss and hip fracture risk in elderly men and women. This was a longitudinal follow-up study of the Framingham Osteoporosis Study. Community dwelling residents of Framingham, MA, were included in the study. A total of 1002 men and women (mean age 75 yr) was included in the study. Baseline (1987-1989) blood samples were used to categorize participants into plasma B-vitamin (normal, low, deficient) and homocysteine (normal, high) groups. Femoral neck bone mineral density (BMD) measured at baseline and 4-yr follow-up was used to calculate annual percent BMD change. Incident hip fracture was assessed from baseline through 2003. Multivariable-adjusted mean bone loss was inversely associated with vitamin B6 (P for trend 0.01). Vitamins B12 and B6 were inversely associated with hip fracture risk (all P for trend < 0.05), yet associations were somewhat attenuated and not significant after controlling for baseline BMD, serum vitamin D, and homocysteine. Participants with high homocysteine (>14 micromol/liter) had approximately 70% higher hip fracture risk after adjusting for folate and vitamin B6, but this association was attenuated after controlling for vitamin B12 (hazard ratio = 1.49; 95% confidence interval 0.91, 2.46). Low B-vitamin concentration may be a risk factor for decreased bone health, yet does not fully explain the relation between elevated homocysteine and hip fracture. Thus, homocysteine is not merely a marker for low B-vitamin status.

前立腺癌のアンドロゲン除去療法におけるビスフォスフォネートの臨床的意義

Androgen deprivation therapy (ADT) in patients with prostate cancer is associated with bone loss. We investigated the effectiveness of risedronate about a decreasing bone mineral density in patients with prostate cancer on ADT. A prospective study was conducted in Kitasato University Hospital from April 2004 to October 2006. A total of 69 men with prostate cancer were assigned to receive either oral risedronate or none during ADT (hormone naïve). The treatment group was 58 men and taking 2.5 mg risedronate per day. The control group was 11 men. At baseline, we assessed BMD (bone mineral density) by DEXA and urinary NTX, and measured for these changes every 6 months. At baseline, each BMDs had no significant difference at the lumber and total hip. At the first 6-month stage, the change in BMD percentage between the 2 groups was statistically significantly different at lumber (p = 0.002) and total hip (p = 0.038). At the 12-month stage, the change in the BMD percentage between the 2 groups was statistically significantly different at the lumber (p = 0.038). And each difference made out that the risedronate group was preserving BMD. In urinary NTX, bone turn over was statistically significantly decreased with the risedronate group compared with the control group at the 12-month stage (p = 0.017). We assure the beginning of bone loss at an early date (6 months) with ADT. Daily oral risedronate in patients with receiving ADT reduces bone mineral loss and maintain BMD.

Effect of Calcium Sulfate Pellets on Early Bone Mineralization in Distraction Osteogenesis for Craniofacial Microsomia in Adults

The purpose of this project was to study the effect of calcium sulfate pellets on early bony consolidation in distraction osteogenesis. A total of 13 patients (control group: five patients; calcium sulfate group: eight patients) were operated on between April 2001 and December 2004. The age of the patients ranged from 18 to 25 years. In the calcium sulfate group, after completing a mandibular osteotomy, a total of 4 mm was distracted initially. Nine to 10 calcium sulfate (Osteoset) pellets were implanted into the 4-mm distracted gap of mandible. In the control group, a mandibular osteotomy alone was created without the initial 4-mm distraction gap and the implantation of calcium sulfate. Five days after the operation, the distraction of the mandible was performed at a rate of 1 mm per day. The distracted length of the mandible was between 7 and 23 mm. The follow-up period ranged between 10 and 22 months. In the calcium sulfate group, the percentage of bone mineral density in the distracted area, compared with the normal mandible, was much higher than in the control group with a statistical significance of P < 0.05. The external distraction devices of the calcium sulfate group were removed 5 to 7 weeks after distraction. The devices of the control group were removed by 11 or 12 weeks. In conclusion, results of the present study suggested that calcium sulfate is a very active, economic, and biocompatible osteoconductive material, which has a good effect on early consolidation in distraction osteogenesis.

Changes in bone mineral density in premenopausal women with rheumatoid arthritis during a two-year follow-up

Objective To ascertain changes in axial bone mineral in premenopausal women with severe rheumatoid arthritis (RA) treated with and without prednisolone (PRED), we conducted a two-year follow-up study of axial bone mineral density (BMD) and bone mineral content (BMC). Methods Premenopausal RA women ( n = 74) attending wards in the Rheumatism Foundation Hospital, Heinola, Finland were consecutively recruited for a follow-up study of BMD. BMD measurements in the lumbar spine and left proximal femur (femoral neck) were performed using dual X-ray absorptiometry at baseline and after two years. BMD is expressed as BMC per projectional area g/cm 2. The Larsen score of 0–100 was assessed at the check-ups. Two RA groups were analyzed: patients receiving prednisolone ( n = 48), RA with PRED group and without prednisolone ( n = 26), RA without PRED group. The control group ( n = 43) comprised age-matched, premenopausal healthy women. Results The patients in the RA with PRED group had lower BMD values than those in the RA without PRED group at commencement of follow-up. The mean weight-adjusted BMD percentage change in the lumbar spine to two years was −1.5% in the RA with PRED group, +0.6% in the RA without PRED group and −0.6% among the controls; a significant difference ( P = 0.030) was found between the RA groups. The mean BMC percentage change to two years in the lumbar spine was −2.2% in the RA with PRED-group ( P = 0.003), +0.0 in the RA without PRED-group and −0.6% in the control group. Accordingly, the mean weight-adjusted BMD percentage change in the femoral neck to two years was −2.6% in the RA with PRED group, +0.4% in the RA without PRED group and −0.9% among the controls; the difference between the RA groups being again significant ( P = 0.049). The mean BMC percentage change to two years in the femoral neck was −1.9% ( P = 0.006), −0.4% and −0.8%, respectively. Mean BMD decreased significantly in both lumbar spine ( P = 0.002) and femoral neck ( P < 0.001) only in the RA with PRED group. However, in spite of statistical findings above, when BMD is expressed as BMC per projectional area there was no statistically significant difference between the three groups in the change in BMC or projectional area in the lumbar spine or femoral neck. There was no significant correlation between the change in BMD in lumbar spine or femoral neck and the change in Larsen score among the RA groups. Conclusions We conclude that according to BMC, premenopausal RA women both with and without prednisolone treatment and controls lost bone statistically similarly. It seems that the role of RA itself in the multifactorial development of axial bone mass during the first decade of severe RA is not the most essential issue. We assume that this role will be less important with better treatment of RA than our patients received. The amount of bone loss during treatment with low-grade prednisolone remains controversial.

The Effect of Zoledronic Acid on Bone Mineral Density in Patients Undergoing Androgen Deprivation Therapy

Purpose The aim of this study was to evaluate the efficacy and safety of zoledronic acid compared with placebo in preventing bone mineral density (BMD) loss and suppressing bone markers when initiated during the first year of androgen deprivation therapy in patients with locally advanced prostate cancer. Patients and Methods Patients were randomized to receive zoledronic acid 4 mg or placebo intravenously every 3 months. Lumbar spine (LS) and total hip BMD was measured using dual-energy x-ray absorptiometry at baseline and at week 52. N-telopeptide (NTX) and bone-specific alkaline phosphatase (BSAP) were evaluated at baseline and every 12 weeks. Safety assessments were performed throughout the study. Results Efficacy analyses included 106 patients and 109 patients in the zoledronic acid and placebo groups, respectively. At week 52, the least squares mean BMD percentage differences were 6.7% for LS and 3.7% for total hip ( P < 0.0001 for both). In the zoledronic acid group, decreases in NTX (−14% to −28%) and BSAP (−31% to −37%) levels were significant and sustained; changes in NTX levels and LS BMD ( r = −0.25; P = 0.04) and in BSAP levels and hip BMD ( r = −0.28; P = 0.02) were significantly correlated. Only traumatic fractures were reported for 2 and 3 patients receiving zoledronic acid and placebo, respectively. One patient in each group experienced acute renal failure. Osteonecrosis of the jaw was not reported. Conclusion Zoledronic acid (4 mg intravenously every 3 months) was safe and effective in preventing bone loss and reducing bone turnover in patients with prostate cancer when initiated during the first year of androgen deprivation therapy; patients with low baseline BMD experienced the greatest benefit.

Comparison of anteroposterior and lateral lumbar spine DEXA measurements in postmenopausal women

The purpose of this study was to evaluate diagnostic sensitivity of lateral (LAT) spine bone mineral density (BMD) measurements which were performed by DEXA (Dual Energy X-ray Absorbsiometry) and compare to anterior-posterior (AP) spine BMD in postmenopausal women. One hundred and three postmenopausal women were studied. Osteoporosis was diagnosed by standard AP position (T&lt; - 2.5) and then BMD was measured by LAT position. Subjects are divided into two groups according to their ages ( between 50-60 age and over 70). BMD percentage difference between the two groups found 11.69 % for AP L2-L3, 29.84% for LAT L2-L3. There was a significant difference between mean values of the two groups (p &lt; 0.05). Decrease in BMD related to age is more prominent in LAT position compared to AP position. Diagnostic sensitivity is measured by the Z score method. When AP and LAT measurements are compared for both groups, LAT measurements showed lower diagnostic sensitivity (AP mean Z score : -2,5 ± 0,852 ve LAT mean Z score: -1,9± 0,822 ). As a result of this study, LAT spine position had lower diagnostic sensitivity according to AP position. We think that LAT spine position should be used as a complementary procedure in the evaluation of BMD.

Novel, high-frequency, low-strain mechanical loading for premenopausal women with low bone mass: early findings

Universally safe and effective methods of mechanically loading the skeleton to improve strength and prevent fracture have yet to be identified. To be osteogenic, mechanical strains must either be of substantial magnitude or applied at high frequency (>15 Hz). High-magnitude loads place frail bones at risk of fracture. Active loading can rarely be achieved at a frequency faster than 2-3 Hz. A 12-month, uncontrolled, prospective, pilot intervention trial was conducted with five premenopausal Caucasian women with low bone mass. Subjects stood on a vibrating platform (Optimass model 1000 Mechanical Strain Device) and received a 0.2-g stimulus at 30 Hz, 2 x 10 min/day, for 12 months. Bone mineral density (BMD) was measured at the whole body, lumbar spine, proximal femora (PF), and distal radius at baseline and 6 and 12 months by DXA (Hologic QDR-1000/W). Blood and urine were collected at baseline and 3, 6, 9 and 12 months for markers of bone resorption and formation. A mean percent BMD increase of 2.03% +/- 0.33% (P < 0.02) was detected at the non-dominant PF after 12 months. Trends for increases were observed at all other sites with the exception of the dominant PF. No uniform trends were observed in bone resorption and formation markers. One subject, on Fosamax, increased BMD by 6% at the lumbar spine and 4.4% at the distal radius. Preliminary findings provide evidence of a possible positive response of regions of low bone mass to brief daily bouts of in-home, passive, noninvasive, low-strain, high-frequency, mechanical loading.

Soy protein and bone mineral density in older men and women: A randomized trial

Objective Test the hypothesis that soy isoflavone supplementation preserves bone mineral density (BMD) in men and women. Methods We conducted a controlled, parallel-arm, double-blinded trial with 145 participants, 50–80 years, with random assignment to soy beverage daily for 12 months. Active treatment (+ISO) received soy protein containing 83 mg isoflavones (45.6 mg genistein, 31.7 mg daidzein), aglycone units; the comparison group (−ISO) received soy protein containing 3 mg isoflavones. We measured BMD using dual-energy X-ray absorptiometry at the total hip and posterior–anterior spine (L1–L4) at baseline in 22 women and 123 men, and at 12 months in 13 women and 98 men. We used linear mixed models to test for an isoflavone effect on percentage BMD change from baseline in spine and hip. Results Among all participants, mean percent change in spine BMD (±S.E.) was 0.16 ± 0.44 in −ISO ( P = 0.10) at 12 months. Treatment effects on spine BMD were significantly greater in women than men ( P = 0.01). At 12 months, in women, mean percent change was 0.58 ± 0.70 in +ISO and −1.84 ± 0.86 in −ISO ( P = 0.05); among men it was 1.32 ± 0.53 in +ISO and 0.31 ± 0.48 in −ISO ( P = 0.16). By comparison, percent change in hip BMD was similar in the treatment groups, and was not different between men and women. Mean percent change in hip BMD from baseline to 12 months was 0.54 ± 0.38 in +ISO and −0.13 ± 0.36 in −ISO ( P = 0.20) among all participants. Conclusions Soy protein containing isoflavones showed a modest benefit in preserving spine, but not hip BMD in older women.