Calcaneal Bone Research Articles

Bone lead levels are associated with measures of memory impairment in older adults

Accumulating evidence suggests a link between lead exposure and memory impairment but assessments based on predictive and validated measures are lacking. We conducted a pilot study of 47 healthy subjects 55–67 years of age to examine associations between bone lead levels and 4 tests sensitive to the natural history of Mild Cognitive Impairment (MCI) and Alzheimer's disease (AD). These include three subtests of the Cambridge Neuropsychological Test Automated Battery (delayed match-to-sample, paired associates learning and spatial recognition memory) and the Montreal Cognitive Assessment Test. Bone lead concentrations were measured at the mid-shaft of the tibia and the calcaneus with K X-ray fluorescence. Higher tibial and calcaneal bone lead values were significantly ( p < 0.05) associated with lower performance levels on delayed match-to-sample and paired associates learning in unadjusted analyses with Spearman rank correlation coefficients of about 0.4. Multiple linear regression analyses (i.e., least-squares means of cognitive test scores across tertiles of lead exposure) adjusted for age, education and smoking status continued to show an association of higher calcaneal lead levels with increasing memory impairments on delayed match-to-sample ( p = 0.07). As might be expected, additional adjustment for history of hypertension reduced the strength of this association ( p = 0.19). Given the demonstrated impact of lead exposure on hypertension and the vascular etiology of certain dementias, we speculate that hypertension could play a mediating role in the association between lead exposure and memory impairment.

Quantitative Ultrasonography of Calcaneal Bone Mass and Its Relationship to Calcium Consumption Among Impoverished Hispanic Women

Perimenopausal Hispanic women need to be able to build and sustain peak bone mass, but this may be affected by their low socioeconomic status. This feasibility research study provided descriptive information on the relationship between calcium consumption and bone mass measured with sonography at the calcaneus. Little research exists to examine bone health with this specific age or ethnic group of women. This research found a strong positive correlation between the amount of self-reported calcium food consumed and the bone stiffness index recorded using quantitative sonography. The translational impact of this project will inform the development of culturally relevant patient education for Hispanic women of low socioeconomic status to encourage the development of peak bone mass.

Determination of consistent patterns of range of motion in the ankle joint with a computed tomography stress-test

Background Measuring the range of motion of the ankle joint can assist in accurate diagnosis of ankle laxity. A computed tomography-based stress-test (3D CT stress-test) was used that determines the three-dimensional position and orientation of tibial, calcaneal and talar bones. The goal was to establish a quantitative database of the normal ranges of motion of the talocrural and subtalar joints. A clinical case on suspected subtalar instability demonstrated the relevance the proposed method. Methods The range of motion was measured for the ankle joints in vivo for 20 subjects using the 3D CT stress-test. Motion of the tibia and calcaneus relative to the talus for eight extreme foot positions were described by helical parameters. Findings High consistency for finite helical axis orientation ( n) and rotation ( θ) was shown for: talocrural extreme dorsiflexion to extreme plantarflexion (root mean square direction deviation ( η) 5.3° and θ: SD 11.0°), talorucral and subtalar extreme combined eversion–dorsiflexion to combined inversion–plantarflexion ( η: 6.7°, θ: SD 9.0° and η:6.3°, θ: SD 5.1°), and subtalar extreme inversion to extreme eversion ( η: 6.4°, θ: SD 5.9°). Nearly all dorsi – and plantarflexion occurs in the talocrural joint ( θ: mean 63.3° (SD 11°)). The inversion and internal rotation components for extreme eversion to inversion were approximately three times larger for the subtalar joint ( θ: mean 22.9° and 29.1°) than for the talocrural joint ( θ: mean 8.8° and 10.7°). Comparison of the ranges of motion of the pathologic ankle joint with the healthy subjects showed an increased inversion and axial rotation in the talocrural joint instead of in the suspected subtalar joint. Interpretation The proposed diagnostic technique and the acquired database of helical parameters of ankle joint ranges of motion are suitable to apply in clinical cases.

The Challenge of Identifying Commingled Skeletal Remains via CT Imaging and Morphometric Analysis

Human skeletal remains were discovered at a construction site in lower Manhattan. Officially determined that the post‐cranial material was not of medicolegal significance, our team undertook an anatomically driven forensic evaluation of the remains. Post‐cranial isolated bony elements were identified (n = 52), digitally photodocumented, morphometrically assessed and CT scanned for graphical examination. Post‐cranial commingled remains consisted mostly of lower limb bones from at least 3 distinct individuals based on three left cuboid bones found. 31 foot bones were measured and classified using bony landmarks. Comparison to homologous bones of known stature individuals was used to approximate the size differences found among the unknown sample. Maximum a‐p lengths of the three left cuboids measured 44.5, 35.8 and 35.6 mm while the two left calcaneal bones measured 89.2 and 77.5 mm. Size difference was used to group the tarsal bones to either the larger or two smaller individuals. CT imaging of adult femurs revealed their intensity of femoral curvature to fall within the Caucasian spectrum while overall rugosity of the larger bones indicated that the larger individual was male. A combination of CT, comparative and morphometric assessment was the key to overcoming the challenge of cataloging and identifying commingled skeletal remains, and may be the ideal approach for similar future forensic investigations.Grant Funding SourceNone

Self-reported frailty is associated with low calcaneal bone mineral density in a multiracial population of community-dwelling elderly

Low bone mineral density (BMD) is associated with frailty assessed using performance-based measures. However, the latter can be cumbersome and difficult to standardize. We examined whether an easily obtained self-reported frailty measure also predicted low BMD. In 230 elderly (82% female, 58% African-American), calcaneal BMD was measured by DXA and frailty evaluated using the VES-13 questionnaire. In addition to the original scoring, we developed a modified scoring system which provided a broader assessment of frailty and excluded age, which is a known independent predictor of BMD. A telephone interview conducted 6 years later ascertained interval fragility fractures and survival status. A higher modified frailty score was associated with lower BMD (p = 0.002), even after adjusting for age, weight, sex, and race and was more predictive of death at 6 years (p = 0.009) than the original score (p = 0.08). Based on our model, a subject with the highest frailty score differed from an otherwise similar subject with the lowest score by a calcaneal BMD of 1.4 T-score units, corresponding to 2-3 times higher fracture risk. Self-reported frailty is associated with low calcaneal BMD and can be used to identify subjects with a greater risk of osteoporosis than expected from traditional risk factors.

An 11-year-old Boy with Ankle Trauma

An 11-year-old Boy with Ankle Trauma

Bone mineral density measured by calcaneal quantitative ultrasound and bone stress fracture in Thai army recruits.

Background: Stress fracture of army recruits usually occur during basic military training. The symptoms of stress fracture are local tenderness and inability to run. Currently, no methods of risk identification are available in spite of many stress fractures. If bone mineral density (BMD), measured by calcaneal quantitative ultrasound (QUS), is related to stress fractures, QUS may be a tool for identifying army recruits at risk. Objectives: To evaluate the relationship between bone mineral density and stress fractures, and to study the incidence of stress fracture and risk factors among Thai army recruits during basic military training. Material and methods: One-thousand two-hundred sixty-three new army recruits were enrolled from different 10 battalions of Thai army in Bangkok. Before the 10-week basic military training, their heels were measured by calcaneal QUS and a risk factor questionnaire was administered. During training, their musculoskeletal injuries were monitored, especially stress fracture. Radiographic examination or a bone scintigraphy was performed in suspect of stress fracture. At the end of the training, they filled-out another questionnaire. Results: The cumulative incidence of stress fracture was 6.57% (95%CI: 5.27, 8.08) and the incidence rate was 1.22 per 1,000 person-days (95%CI: 0.97, 1.51). The Cox proportional hazards model showed that the BMD, measured by calcaneal QUS, had a significant relationship to stress fracture. The lowest quartile (Q 1 ) of speed of sound (SOS) was significantly related to stress fracture (Hazard ratio (HR) = 3.42; 95%CI: 1.74, 6.75; p-value <0.001), history of fracture (HR=2.20; 95%CI: 1.15, 4.21; p-value=0.017), and heavy smoking (HR=2.08; 95%CI: 1.23, 3.50; p-value=0.006). The area under the ROC curve of SOS was 61.1% (95%CI: 54.70, 67.39). Conclusion: The bone mineral density, measured by calcaneal QUS, was significantly related to stress fracture. In the lowest group of SOS measurement, heavy smokers, and recruits with a history of fracture had high risk of stress fracture. The incidence of stress fracture might be some what reduced by the application of adapted basic

Bony metastasis of gastric adenocarcinoma

Sir, A 50-year-old male presented with history of abdominal pain, anorexia, early satiety, significant weight loss, and features of gastric outlet obstruction for 3 months. There was a history of maelena and hemetemesis. There was a history of dull aching pain in the right thigh for the last 2 weeks. Examination revealed marked pallor and a huge intra abdominal lump in the epigastric region extending to right hypochondrium and umbilical region. There was a hard swelling of size 5 × 4 cm on the medial aspect of right mid thigh. Upper gastrointestinal endoscopy revealed a large polypoidal mass in body of stomach extending to fundus at least 5 cm distal to gastroesophageal junction. Computed tomography abdomen showed a heterogenous density exophytic mass arising from medial wall of body of stomach. X-ray of right thigh showed an osteolytic lesion in the midshaft region of femur [Figure 1]. Biopsies obtained during endoscopy and fine needle aspiration cytology of soft tissue swelling of the right thigh revealed moderately differentiated adenocarcinoma. Figure 1 Pathological fracture femur Patient was explored and feeding jejunostomy done as growth was unresectable. On 10th postoperative day, patient developed fracture of the shaft of the femur for which internal fixation was done. Patient was given single fraction radiotherapy along with chemotherapy (5-FU and leucoverin) and discharged. Gastric carcinoma is a frequent tumor, especially in some parts of the world like Japan. Metastasis to the bone from gastric tumors is rare and has been estimated to appear in 13.4% of the autopsy cases of gastric carcinoma in a Japenese study.[1] It mainly affects patients with poorly differentiated tumors and widespread disease along with metastasis to other sites. However, there have been reports of bony metastasis from early gastric cancer. Metastasis to the bone can occasionally be the first manifestation of gastric tumor,[2] but have only rarely been described as a sole manifestation of tumor recurrence.[3] Skeletal metastatic lesions arising from gastric cancer are uncommon and usually of osteolytic type. The thoracic and lumbar vertebrae are the most frequent sites[2] although there have been occasional reports of metastasis to the calcaneal bone,[3] pelvis, and even the skull base. Metastasis to femur is very rare.[2,3] Radioisotope bone imaging is generally accepted as being the initial procedure of choice in search for bone metastasis. Roentgenographic evaluation for bone metastasis has limited value because symptoms from bone metastasis frequently occur before any radiological abnormality becomes evident. Prognosis of patients with osseous metastasis from gastric cancer seem to be dismal (median survival time 5 months) and 3.5 years has been the longest survival period reported in the literature. Radiotherapy has been advocated as the best therapeutic alternative for pain control with a response rate of 75%.[4] However, recent reports have employed chemotherapy with 5-FU with no adverse side effects. Nevertheless, prognosis remains poor and therapy is mainly aimed at relieving pain and discomfort.

The Biomechanical Performance of Bone Block and Soft-Tissue Posterior Cruciate Ligament Graft Fixation With Interference Screw and Cross-Pin Techniques

The purpose of this study was to evaluate the biomechanical properties of 4 different graft fixation constructs on the tibial side of the posterior cruciate ligament with reconstruction by use of an Achilles tendon graft. Biomechanical testing of 4 different fixation techniques was performed on 20 human cadaveric tibias and Achilles tendons. Cross-pin fixation with bone blocks (group A), interference screw fixation with bone blocks (group B), cross-pin fixation of soft tissue with backup fixation (group C), and interference screw fixation of soft tissue with backup fixation (group D) were tested. The tibia-graft fixation complex was cyclically loaded between 50 N and 250 N at 1 Hz for 1,000 cycles. After cycling, the amount of graft displacement was determined by measuring the change in grip-to-grip distance. The complex was then loaded to failure at 1 mm/s, and maximum failure load, stiffness, and mode of failure were determined. Group C had a higher maximum failure load and stiffness than groups A and B (P < .05 and P < .001, respectively) but poor results for displacement (P < .05 and P < .05, respectively). The failure modes were bone block fracture, graft laceration, or cross-pin fracture in the cross-pin groups and graft pullout in the interference screw groups. Our study suggests that maximum failure load and stiffness of hybrid fixation for Achilles tendon graft are comparable to those of both single calcaneal bone plug fixation methods that we studied. However, tendon graft displacement was significantly greater regardless of fixation method when compared with bone plug fixation. Hybrid fixation for soft-tissue graft on the tibial fixation site provides comparable biomechanical properties of bone-to-bone fixation.

Our clinical experience on calcaneal bone cysts: 36 cysts in 33 patients

Solitary bone cysts are lesions of benign nature with fluid content. The frequent locations for these cysts are the proximal femur or humerus. Rarely, they may occur in locations such as the calcaneus, mostly in adults. We have reported the second largest case series of calcaneal bone cysts. Thirty-six calcaneal cysts in 33 patients, 3 of which showed bilateral involvement, diagnosed, and followed between 1995 and 2008 in our clinic were retrospectively evaluated. The third most common location was the calcaneus, with cysts in 36 (14%) patients. The age range of the patients was 13-74 years (mean, 37.9 years). The complaints of the patients upon presentation to the hospital were heel pain in 16 patients (44.4%). Eighteen patients (50%) underwent surgical treatment, of these ten patients (27.7%) were treated with curettage and autogenous iliac wing grafting. Simple bone cysts with the location of calcaneus are not a rare entity. According to our series, simple bone cysts have been shown to be typically located in the calcaneus bone in middle-aged patients in particular. Furthermore, in such patients, heel pain is considerably severe, which is a symptom to be kept in mind in differential diagnosis. Curettage and autogenous grafting is the successful method of treatment and it provides good results.

A New Peroneal Tendon Rerouting Method to Treat Recurrent Dislocation of Peroneal Tendons

Background The surgical treatment methods for recurrent dislocation of peroneal tendons are controversial. A simpler and more effective treatment method is valuable for these patients. Hypothesis A new rerouting operation designed by the authors will have satisfactory results and avoid disadvantages of the old rerouting methods. Study Design Case series; Level of evidence, 4. Methods Seventeen consecutive male patients with unilateral recurrent peroneal tendon dislocations were treated by transposition of the calcaneofibular ligament from the tubercle of calcaneofibular ligament with a 1 × 1 × 1 cm3 bone block and elevation of this tubercle with another 1 × 1 × 1 cm3 calcaneal bone block, which were fixed by a 3.5-mm cancellous screw with a washer. All patients received clinical and radiographic follow-up for at least 2 years. The preoperative and postoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scales were used for functional results assessment. Results All bone transposition sites healed radiographically at 6 weeks after surgery. Four patients had transient numbness over the lateral aspect of the injured foot, and 3 patients had swelling and pain involving the operative sites. All complications resolved by 3 to 5 months after the operation. No recurrent dislocation of the peroneal tendons was noted. The mean AOFAS ankle-hindfoot scale improved significantly, from 73.4 ± 5.5 preoperatively to 100 at 2- to 5-year follow-up (P <. 001). Normal ankle stability and no tightening of the lateral side of the injured ankles in the inversion position were noted. Conclusion This method is a simple, reliable, and reproducible operation to treat recurrent dislocation of the peroneal tendons. It allows early return to daily, working, and sports activities with satisfactory results.

Cross-sectional study on bone density-related sonographic parameters in children with asthma: correlation to therapy with inhaled corticosteroids and disease severity

The aim of this study was to screen asthmatic children for bone density-related sonographic parameters on the calcaneal bone. Findings were correlated to therapy with inhaled corticosteroids (ICS) as well as with asthma severity (AS), concomitance and severity of atopic dermatitis (AD), and rhinitis (AR). We enrolled 173 children with AS1-3 consecutively; 44% (AS1) had not received any ICS medication; 56% (AS2 and -3) received ICS therapy for > or =6 months (medium daily dose, 286 microg fluticasone-proprionate-equivalent/maximum 500 microg); and in addition 38% (n = 65) presented with AD and 66% (n = 115) with AR. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) results were compared to regional normative values of 3299 children obtained with the identical system. ICS-treated children showed a tendency toward reduced age-, weight-, and height-adjusted standard deviation scores (SDS) for SOS compared to children without ICS treatment, which tendency did not reach statistical significance and was not as consistent for BUA (mean of ICS-treated children compared to our controls: SOS-SDS, -0.29/-0.31/-0.30; BUA-SDS, -0.23/-0.17/-0.05). For ICS-treated children, the proportion of patients with BUA and SOS values below -1 SDS was statistically significant higher for age-adjusted BUA and SOS than for children without ICS medication (BUA 15.00% vs. 5.41%; SOS 32.98% vs. 17.56%). However, we cannot differentiate possible negative effects of ICS from influences of the underlying inflammatory disease because higher asthma severity was associated with greater use of ICS medication. Additionally, the higher physical activity of children with less severe asthma can have influenced quantitative ultrasound (QUS) parameters positively, compared to patients with a higher degree of exercise-induced symptoms. For differentiation of possible negative effect of ICS on ultrasonic bone quality and for evaluation of the potentials of the method, further longitudinal QUS assessment of asthmatics receiving a new ICS treatment is needed.

Impact of Cola Consumption on Quantitative Ultrasound Parameters in College Age Females

Text: Cola consumption may be a modifiable risk factor for poor bone quality. Young women may be at greater risk for poor bone health because this population consumes the most cola beverages among all women and peak bone mass is established during young adulthood. Research Outcome: To assess the relationship between cola consumption and calcaneal bone outcomes in college-aged women. Methods: Estimated Bone Mineral Density (BMD), Quantitative Ultrasound Index (QUI), Broadband Ultrasound Attenuation (BUA) and Speed of Sound (SOS) were measured in 18-20 year old Caucasian females (n 37) using calcaneal quantitative ultrasound sonography. Weekly cola consumption was assessed by self-report using a 10-item questionnaire. Results: No difference was seen in estimated BMD (M SD: 0.693 0.148g/cm, 0.672 0.204g/cm; respectively), QUI (121.7 23.4, 114.6 31.6), BUA (91.4 21.0db/MHz, 89.1 29.7db/MHz) or SOS (1598 38m/s, 1592 50m/s) measures between women who consumed 1 cola beverage per week (n 26) and women who did not consume colas (n 11). There were also no differences in estimated BMD (0.741 0.180g/cm, 0.672 0.132g/cm, 0.672 0.204g/cm; respectively), QUI (129.3 28.4, 118.4 20.9, 114.6 31.6), BUA (97.7 24.0db/MHz, 88.7 19.6db/MHz, 89.1 29.7db/ MHz) or SOS (1610 47m/s, 1593 33 m/s, 1592 50 m/s) between high cola consumers ( 7 colas/week; n 8), low cola consumers (1-6 colas/week; n 18) and those who did not consume cola beverages (n 11). BMI was significantly and positively associated with all bone measures in non-cola consumers but did not exhibit the same relationship among cola consumers. Conclusions: Cola consuming and non-cola consuming young Caucasian females did not differ in calcaneal quantitative ultrasound bone measures regardless of level of consumption; however, weight status may influence this association.

Unbiased estimation of the calcaneus volume using the Cavalieri principle on computed tomography images

The size and shape of tarsal bones are especially relevant when considering some orthopedic diseases such as clubfoot. For this reason, the measurements of the tarsal bones have been the subject of many studies, none of which has used stereological methods to estimate the volume. In the present stereological study, we estimated the volume of calcaneal bone of normal feet and dry bones. We used a combination of the Cavalieri principle and computer tomographic scans taken from eight males and nine dry calcanei to estimate the volumes of calcaneal bones. The mean volume of dry calcaneal bones was estimated, producing mean results using the point-counting method and Archimedes principle being 49.11+/-10.7 or 48.22+/-11.92 cm(3), respectively. A positive correlation was found between anthropometric measurements and the volume of calcaneal bones. The findings of the present study using the stereological methods could provide data for the evaluation of normal and pathological volumes of calcaneal bones.

Revisiting metatropic dysplasia: Presentation of a series of 19 novel patients and review of the literature

Metatropic dysplasia (MD-OMIM: 156530 and 250600) is a rare chondrodysplasia characterized by short limbs with limitation and enlargement of joints and usually severe kyphoscoliosis, first described in 1893. Up until now, 81 other patients have been reported. The phenotypic variability of MD has led to a classification based on radiological anomalies dividing into three different types: a lethal autosomal recessive form, an autosomal recessive non-lethal form and a non-lethal autosomal dominant form with less severe radiographs manifestations and a better clinical outcome. Here, we report on clinical and radiological features of 19 novel MD patients. We describe new radiological features, including precocious calcification of hyoid and cricoid cartilage, irregular and squared-off calcaneal bones and severe hypoplasia of the anterior portion of first cervical vertebrae. In addition, the observation of an overlap between the autosomal recessive non-lethal form and the non-lethal autosomal dominant form, the rarity of sibship recurrences and the observation of vertical transmissions of MD in the literature argue in favor of an autosomal dominant mode of inheritance for all MD types. This hypothesis is reinforced by the use of the statistical single ascertainment method that rejects the hypothesis of an autosomal recessive mode of inheritance responsible for MD. Therefore, we propose that recurrence in sibs is due to gonadal mosaicism.

Posterior ankle impingement syndrome caused by malunion of joint depressed type calcaneal fracture

Late complications after calcaneal fracture usually resulted in lateral heel pain. Malunion of joint depressed type calcaneal fracture can result in posterior ankle impingement pain. This is caused by the posterior calcaneal bone spike formed just behind the posterior calcaneal facet. We describe a technique to resect the offending posterior calcaneal bone spike to relieve the posterior ankle impingement pain.

A Study of 23 Unicameral Bone Cysts of the Calcaneus: Open Chip Allogeneic Bone Graft versus Percutaneous Injection of Bone Powder with Autogenous Bone Marrow

The treatment of unicameral bone cyst varies from percutaneous needle biopsy, aspiration and local injection of steroid, autologous bone marrow, or demineralized bone matrix to curettage and open bone-grafting. The purpose of this study was to compare the results of open chip allogeneic bone graft versus percutaneous injection of demineralized bone powder with autogenous bone marrow in management of calcaneal cysts. Twenty-three calcaneal unicameral cysts in 20 patients were treated. Lyophilized irradiated chip allogeneic bone (CAB) and autogenous bone marrow were used for treatment of 13 cysts in 11 patients, and 10 cysts in 9 patients were treated with percutaneous injection of irradiated allogeneic demineralized bone powder (DBP) and autogenous bone marrow. There were 11 males and 9 female patients with mean age of 17 years. The patients were followed for an average of 49.4 months. Complete healing was achieved in 9 cysts treated with chip allogeneic bone and in 5 cysts treated with powdered bone. Four cysts treated with CAB and 3 cysts treated with DBP healed with a defect. Two cysts treated with powdered bone and autogenous bone marrow were classified as persistent. No infections or pathological fractures were observed during the followup period. Percutaneous injection of a mixture of allogeneic bone powder with autogenous bone marrow is a minimal invasive method and could be an effective alternative in the treatment of unicameral calcaneal bone cysts. The postoperative morbidity was low, the hospital stay was brief, and patient's comfort for unrestricted activity was enhanced.

Bearing surface modeling of the talus and calcaneus

Precise talar in vivo motion is difficult to measure due to its inaccessibility to surface based measures. Thus, most measures of talar motion have been limited to cadaver based measures, typically under static conditions. Quantitative measures of the talar bearing surfaces and their ability to mesh with the calcaneal and malleolar bearing surfaces would provide an understanding of the envelope of movements available in both in healthy and pathological joints. Such measures could exploit the availability of 3D non-invasive imaging methodologies, making it available for large-scale healthy and pathological studies. Thus, the purpose of this work is to mathematically model the bearing surfaces of the talar and calcaneal bones in order to determine the allowable motions of a healthy joint.

Lower calcaneal bone mineral density and broadband ultrasonic attenuation, but not speed of sound, in South Asian than white European women

Background: Quantitative ultrasound (QUS) measures of bone predict fracture risk in older white women. South Asian women have low bone mineral density (BMD), perhaps related to smaller body size or vitamin D insufficiency, but it is unknown whether this is accompanied by lower QUS.Aim: The study compared QUS, BMD and vitamin D status between South Asian and white European women.Subjects and methods: Participants were 47 postmenopausal women (23 white European, 24 South Asian) aged 55–65 years. BMD was measured at the calcaneus and radius by dual X-ray absorptiometry. The QUS measurements were broadband ultrasound attenuation (BUA) at the calcaneus and speed of sound (SOS) at the calcaneus, radius and tibia. Serum 25-hydroxy vitamin D was determined in late summer.Results: South Asian women had significantly lower serum 25-hydroxyvitamin D than white Europeans (13.0 ± 5.1 versus 30.3 ± 7.1 ng mL–1; p < 0.001). Calcaneal BMD and BUA were 14% and 10% lower (p = 0.016 and 0.045), respectively, in South Asian women. Radial BMD, and SOS at all sites, did not differ significantly between groups.Conclusion: In this study, postmenopausal South Asian women living in the UK had a high prevalence of vitamin D insufficiency and lower calcaneal BMD than white European women, consistent with previous findings. Differences were detected in calcaneal BUA but not SOS. Further research is needed to evaluate fracture risk and its detection in South Asian women.

A cross-sectional study of 130 Brazilian patients with Crohn’s disease and ulcerative colitis: analysis of articular and ophthalmologic manifestations

This is a cross-sectional study that analyzed the pattern and frequency of articular and ophthalmologic manifestations in patients with Crohn's disease (CD) and ulcerative colitis (UC), with or without signs of active bowel inflammation. One hundred and thirty consecutive patients with CD (n = 71) and UC (n = 59) were examined. Simple X-rays of lumbar spine, sacroiliac joints, and calcaneal bone were performed and human leukocyte antigen (HLA)-B27 was typed. Joint manifestations occurred in 41 (31.5%) patients, 27 (38%) with CD and 14 (23.7%) with UC. Peripheral involvement occurred in 22 patients, axial involvement in five, and mixed involvement in 14. The most frequently involved joints were knees (56.1%), ankles (29.3%), and hips (29.3%), while the predominant pattern was oligoarticular (84.6%) and asymmetrical (65.6%). Enthesitis was identified in seven (5.4%) patients and inflammatory lumbar pain in 13 (10%). Eight of these patients fulfilled the diagnostic criteria for ankylosing spondylitis (6.2%). Radiographic sacroiliitis occurred in 12 patients (9.2%). Ocular abnormalities were present in six patients (6.2%), and HLA-B27 was positive in five (5.8%). In conclusion, the articular manifestations in the present study were predominantly oligoarticular and asymmetric, with a low frequency of ophthalmologic involvement and positive HLA-B27.