Differences In Bone Mineral Density Values Research Articles

Evaluation of bone mineral density in adolescent idiopathic scoliosis using a three-dimensional finite element model: a retrospective study

BackgroundAdolescent idiopathic scoliosis (AIS) is often accompanied by osteopenia and osteoporosis, which can cause serious complications. The aim of this study was to determine the specific bone mineral density (BMD) of each vertebral body in patients with AIS using biomechanical finite element modeling based on three-dimensional (3D) reconstruction.MethodsThis retrospective study involved 56 patients with AIS. Computed tomography (CT) and radiography were performed. Spinal vertebrae were segmented from the spinal CT images of patients with AIS to reconstruct 3D vertebral models. The vertebral models were meshed into tetrahedral finite elements to assess the BMD.ResultsThe mean main curve Cobb angle was 88.6 ± 36.7°, and the mean kyphosis angle was 36.8 ± 31.5°. The mean BMD of the global spine was 0.83 ± 0.15 g/cm2. The highest BMD was measured on the concave side of the apex (0.98 ± 0.16 g/cm2). Apical vertebral BMD was negatively correlated with age and height (r = − 0.490, p = 0.009 and r = − 0.478, p = 0.043, respectively). There were no significant differences in BMD values between the concave and convex sides (p > 0.05).ConclusionsThe 3D finite element modeling of BMD in patients with AIS is a reliable and accurate BMD measurement method. Using this method, the overall BMD of patients with AIS was shown to gradually decrease from the top to the bottom of the spine. Our findings provide valuable insights for surgical planning, choice of screw trajectories, and additional biomechanical analyzes using finite element models in the context of scoliosis.

Identification of Bone Mineral Density Deficit Using L1 Trabecular Attenuation by Opportunistic Multidetector CT Scan in Adult Patients

Multidetector computer tomography (CT) has been used to diagnose pathologies such as osteoporosis via opportunistic screening, where the assessment of the bone structure and the measurement of bone mineral density (BMD) are of great relevance. To construct reference BMD values based on the measurement of the attenuation of the L1 vertebral body by multidetector CT scan (in the soft tissue and bone windows) in adult patients and to establish normative ranges by sex and age of BMD values. A retrospective cross-sectional study of 5080 patients who underwent multidetector CT scan between January and December 2021. Adult patients (≥18 years) with non-contrast multidetector CT scan of the abdomen or thorax-abdomen at a voltage 120 kV. The attenuation of the L1 vertebral body in Hounsfield units (HU) in both windows were compared using the Mann-Whitney U-test with α = 0.05. Additionally, the quartiles of the BMD were constructed (in both windows) grouped by sex and age. Only 454 (51.30 ± 15.89 years, 243 women) patients met the inclusion criteria. There is no difference in BMD values between windows (soft tissue: 163.90 ± 57.13, bone: 161.86 ± 55.80, p = 0.625), mean L1 attenuation decreased linearly with age at a rate of 2 HU per year, and the presence of BMD deficit among patients was high; 152 of 454 (33.48%) patients presented BMD values suggestive of osteoporosis, and of these, approximately half 70 of 454 (15.42%) corresponded to patients with BMD values suggestive of a high risk of osteoporotic fracture. From clinical practice, the bone mineral density (BMD) of a patient in either window below the first quartile for age- and sex-matched peers suggests a deficit in BMD that cannot be ignored and requires clinical management that enables identification of the etiology, its evolution, and the consequences of this alteration.

P32. Can CT-based bone mineral density predict proximal junctional fracture?

BACKGROUND CONTEXT Proximal junctional fractures (PJFr) can be a catastrophic complication associated with adult spinal deformity surgery. Presence of osteoporosis has been shown to be one of the risk factors for PJFr. Dural-Energy X-Ray Absorptiometry (DEXA) scans are standard screening tools for diagnosis of osteoporosis. However, spinal DEXA scores have been reported to be flawed with regional sclerosis associated with spinal degeneration representing a possible confounder to the study. Recently, investigators have reported on the use of a computed tomography (CT) scan surrogate in place of spinal DEXA scores. PURPOSE The primary focus of this study is to investigate whether examining CT based assessments of bone mineral density (BMD) preoperatively can predict the possibility of PJFr. STUDY DESIGN/SETTING Retrospective two-center study with review of adult spinal deformity patients (consecutive surgeries between 2012 and 2015) who underwent instrumented fusions to the pelvis encompassing at least 5 fusion levels. PATIENT SAMPLE n=92 patients. OUTCOME MEASURES Using CT scans we calculated the mean sagittal and axial BMD values in order to predict the risk possibility of PJFr. METHODS Reviewed and documented patients´ demographics, and measured preoperative, postoperative, and final follow up radiographic parameters. In CT scans, mean sagittal and axial BMD values were calculated by defining a region of interest within vertebral. Vertebra at most cranial end of final construct defined as upper instrumented level (UIV). Preoperative BMD values were measured at UIV, UIV+1(proximal), and UIV -1(distal). The measured BMD values were reported in Hounsfield units (HU).Patients were categorized into three groups: no proximal junctional deformity (No PJD, control group), proximal junctional kyphosis (PJK), and PJFr groups. BMD values, demographics and radiographic variables of PJK and PJFr were compared with control group, separately. ANOVA tests used for continuous variable and Chi square tests for categorical variables. RESULTS Study sample n= 92, mean age 64 yrs (42 to 81), mean follow up 1.5 yrs (3 months to 4 years), No PJD group (n=59), PJK group (n=22), PJFr group (n=11). Significantly low preoperative BMD values were noticed for fracture group in all sagittal views at UIV+1 (0.007), UIV (0.04) and UIV-1 (0.05) and in all axial views at UIV+1 (0.02), UIV (0.03), except UIV -1 (0.19) UIV+1, compared to control group. No significant differences in BMD values were noticed for PJK group compared to control group. Osteoporosis history was not statistically different between fracture and control groups (9% vs 20%, p=0.41). CONCLUSIONS Adult spinal deformity patients, who undergo fusions to the pelvis with at least 5 fusion levels, without osteoporosis history appear to be at risk for fractures at proximal junctional vertebras with lower BMD measurements. BMD measurements can be helpful for counseling of patients regarding the risk of fractures, they may also be used for planning of the proximal extent of constructs as well as potential preventative surgical methods. FDA DEVICE/DRUG STATUS computed tomography (CT) scans (Approved for this indication), Dural-Energy X-Ray Absorptiometry (DEXA) scans (Approved for this indication)

A Cross-Calibration Study of GE Lunar iDXA and GE Lunar DPX Pro for Body Composition Measurements in Children and Adults

Objective: To cross-calibrate dual energy X-ray absorptiometry machines when replacing GE Lunar DPX-Pro with GE Lunar iDXA. Methods: A cross-sectional study was conducted in 126 children (3–19 years) and 135 adults (20–66 years). Phantom cross calibration was carried out using aluminum phantom provided with each of the machines on both machines. Total body less head (TBLH), lumbar spine (L2–L4) and left femoral neck bone mineral density (BMD), bone mineral content (BMC), and bone area were assessed for each patient on both machines. TBLH lean and fat mass were also measured. Bland-Altman analysis, linear regressions, and independent sample t test were performed to evaluate consistency of measurements and to establish cross-calibration equations. Results: iDXA measured 0.33% lower BMD and 0.64% lower BMC with iDXA phantom as compared to DPX-Pro phantom (p < 0.001). In children, TBLH-BMC, femoral BMC and area were measured 10%–14% lesser, TBLH area was higher by 1%–2% and L2–L4 area by 10%–14% by iDXA as compared to DPX-Pro. iDXA measured higher TBLH fat [15% (girls), 31% (boys)] than DPX-Pro. In adults, TBLH-BMD (1.7%–3.4%), BMC (6.0%–10.9%) and area (4.2%–7.6%) were measured lesser by iDXA than DPX-Pro. L2–L4 BMD was higher [2.7% (men), 1.8% (women)] by iDXA than DPX-Pro. Femoral BMC was 2.11% higher in men and 4.1% lower in women by iDXA as compared to DPX-Pro. In children, R2 of cross-calibration equations, ranged from 0.91 to 0.96; in adults, it ranged from 0.93 to 0.99 (p < 0.01). After the regression equations were applied, differences in BMD values between both machines were negligible. Conclusion: A strong agreement for bone mass and body composition was established between both machines. Cross-calibration equations need to be applied to transform DPX-Pro measurements into iDXA measurements to avoid errors in assessment. This study documents a need for use of cross-calibration equations to transform DPX-Pro body composition data into iDXA values for clinical diagnosis.

Age estimation using bone mineral density in South Africans

The use of bone mineral density (BMD) to predict age-at-death in skeletal remains provides a usable alternative to other methods because the values obtained are not observer-dependent. The aim of this study was to investigate the usability of BMD to estimate age in South African populations, and to assess inter-population variation and sex-specific differences in BMD values from the proximal end of the femur. In order to estimate age, regression analysis was done for the construction of population dependent formulae. The sample comprised of a total of 123 femora of black and white South Africans. DXA scans were performed using the Hologic Discovery system. Data analysis was done by employing independent-samples t-tests and correlation/regression analyses. The results indicated a statistically significant difference between black and white South Africans. Male groups were also significantly different from one another, but black and white females showed no significant differences. Linear regression analysis revealed a significant correlation between BMD values and age for the white population and the combined sample, but not for the black population. Bootstrapping were employed to confirm validity of the results. In conclusion, this study showed that the use of DXA measurements of the femur for estimating age may be used for the estimation of age-at-death in white South Africans, but more research is needed to better understand the relationship between bone mineral density and age in black South Africans.

Evaluation of vertebral bone mineral density in scoliosis by using quantitative computed tomography.

PurposeScoliosis is described as a lateral curvature of the spine. We aimed to evaluate bone mineral density (BMD) in patients with scoliosis by using quantitative computed tomography (QCT) and compare the BMD of idiopathic and congenital scoliosis patients.Material and methodsForty-three patients aged 1 to 40 years with idiopathic, congenital, or neuromuscular scoliosis and 41 matched controls of the same sex and approximate age were included in the study. Measurements of BMD were performed by QCT analysis for each vertebral body from T12 to L5, and mean BMD was calculated for each case.ResultsTwenty-two of the patients with scoliosis were idiopathic, 15 were congenital, four were neuromuscular, and two were neurofibromatosis. The mean BMD values of patients with scoliosis were significantly lower compared with the control group (106.8 ± 33.4 mg/cm3 vs. 124.9 ± 29.1 mg/cm3, p = 0.009). No significant difference in BMD values was found between idiopathic and congenital scoliosis patients (p > 0.05).ConclusionsThis study illustrated that the vertebral body BMD values of the patients with scoliosis were significantly lower than those seen in the control group.

The Effects of Prolactin-Raising and Prolactin-Sparing Antipsychotics on Prolactin Levels and Bone Mineral Density in Schizophrenic Patients.

We aimed to investigate the effects of antipsychotics on prolactin levels in patients diagnosed with schizophrenia and the effects of hyperprolactinemia on bone mineral density (BMD) in patients on long-term antipsychotics. In this study, we included eighty consecutive patients who were diagnosed with schizophrenia according to DSM-IV, had been using the same antipsychotic for the last ten months, and fulfilled the inclusion criteria. Data on sociodemographic characteristics of the patients were collected through an information sheet. The Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS) were used to rate positive and negative symptoms of the patients. In addition, their body mass indices (BMI) were calculated. Prolactin levels were measured through luminescence immune assay and BMD measurements were made at lumbar and femoral sites using dual-energy x-ray absorbtiometry. Haloperidol (n=20) and risperidone (n=20) were assigned to prolactin-raising antipsychotic group, and olanzapine (n=20) and quetiapine (n=20) were assigned to prolactin-sparing antipsychotic group for this study. The effects of antipsychotics on BMD were compared among these groups. Hyperprolactinemia was determined in 60% of haloperidol using patients, 90% of risperidone using patients, 25% of olanzapine using patients and 10% of quetiapine using patients. Mean prolactin levels were found to be significantly higher in prolactin-raising antipsychotic using group (p<0.001). There were no statistically significant differences in BMD values between the two groups, for the sites where the measurement was done. Lumbar spine and femoral neck T-scores and Z-scores in the prolactin-raising group significantly negatively correlated with the treatment durations and chlorpromazineequivalent doses (p<0.05). BMI and BMD values of both groups also displayed statistically significant positive correlations (p<0.05). The statistically significant differences in mean prolactin levels and numbers of patients with hyperprolactinemia between the treatment groups support the validity of classifying the antipsychotics as prolactin-raising and prolactin-sparing". The relationship of BMD with the treatment duration and doses in the prolactin-raising antipsychotic using group was deemed to be important, since it indicated that a decrease in BMD was to be expected in long-term antipsychotic treatment.

Bone Mineral Density in Patients with Nonalcoholic Steatohepatitis among End-Stage Liver Disease Patients Awaiting Liver Transplantation

Several studies have shown that patients with end-stage liver disease (ESLD) have lower bone mineral density (BMD) and a higher prevalence of osteoporosis compared to an age-matched population. Hyperinsulinemia and insulin resistance are typically associated with increased BMD. We hypothesized that patients with nonalcoholic steatohepatitis (NASH) and underlying insulin resistance may have higher BMD than patients with cirrhosis from other causes. We performed a retrospective chart review of patients with ESLD who underwent liver transplant evaluation at Ochsner Clinic Foundation and had a BMD study as part of initial work up and compared BMD values of patients diagnosed with NASH to patients with cirrhosis due to other causes. Patients were categorized into 3 groups based on the etiology of their liver disease as NASH, alcoholic cirrhosis, or viral hepatitis C or B (HCV/HBV). A total of 63 patients met the study inclusion criteria, including 15 with NASH, 17 with alcoholic cirrhosis, and 31 with HCV/HBV. The overall prevalence rates of osteopenia and osteoporosis were 44% and 12%, respectively. BMD values were higher in the NASH group than the HCV/HBV group at lumbar spine, total hip, and femoral neck (P = .01, .03, and .02, respectively). There were no statistical differences in BMD values between NASH and alcoholic cirrhosis groups at any site. We found a high prevalence of low BMD among patients with ESLD awaiting liver transplantation. NASH patients had higher BMDs than HCV/HBV patients. The effects of NASH and insulin resistance on bone are complex and should be examined further.

The association of RANK gene C421T and C575T polymorphisms with bone mineral density in postmenopausal Turkish women

To investigate the association between C421T polymorphism within exon 4, C575T polymorphism within exon 6 of the RANK gene and bone mineral density (BMD) variations in postmenopausal Turkish women. One hundred seventy-eight postmenopausal women (patients=100 and controls=78) who applied to Ege University Faculty of Medicine, Department of Physical Medicine and Rehabilitation, for osteoporosis examination were analyzed. BMDs of the lumbar spine and femoral sites were measured. Patient and control groups were established based on their T-score values being above and/or below -1. After venous blood sampling, C421T and C575T polymorphisms of the RANK gene were assessed through PCR process following DNA extraction. Genotype frequencies for the C421T and C575T polymorphisms were compared between the control group and the patient group. No significant difference was detected between the two groups for both polymorphisms. There was also no significant difference between the control and patient groups in terms of the combined genotype (p=0.752) and the combined haplotype analysis of the C421T and C575T polymorphisms (p=0.723). In the control and patient groups separately, no significant differences in BMD values either at the femoral sites or at the lumbar spine were detected between the combined genotypes of the two polymorphisms. The genotypes, combined genotypes and allele frequencies of C421T and C575T polymorphisms of the RANK gene have not been found to be associated with BMD in Turkish women. Further studies including both sexes and more cases are required.

Association of P2Y2 receptor SNPs with bone mineral density and osteoporosis risk in a cohort of Dutch fracture patients

The P2Y2 receptor is a G-protein-coupled receptor with adenosine 5′-triphosphate (and UTP) as natural ligands. It is thought to be involved in bone physiology in an anti-osteogenic manner. As several non-synonymous single nucleotide polymorphisms (SNPs) have been identified within the P2Y2 receptor gene in humans, we examined associations between genetic variations in the P2Y2 receptor gene and bone mineral density (BMD) (i.e., osteoporosis risk), in a cohort of fracture patients. Six hundred and ninety women and 231 men aged ≥50 years, visiting an osteoporosis outpatient clinic at Maastricht University Medical Centre for standard medical follow-up after a recent fracture, were genotyped for three non-synonymous P2Y2 receptor gene SNPs. BMD was measured at three locations (total hip, lumbar spine, and femoral neck) using dual-energy X-ray absorptiometry. Differences in BMD between different genotypes were tested using analysis of covariance. In women, BMD values at all sites were significantly different between the genotypes for the Leu46Pro polymorphism, with women homozygous for the variant allele showing the highest BMD values (0.05 > p > 0.01). The Arg312Ser and Arg334Cys polymorphisms showed no differences in BMD values between the different genotypes. This is the first report that describes the association between the Leu46Pro polymorphism of the human P2Y2 receptor and the risk of osteoporosis.

The effects of long‐term exposure to extremely low‐frequency magnetic fields on bone formation in ovariectomized rats

The effects of long-term extremely low-frequency magnetic field (ELF-MF) exposure on bone formation and biochemical markers were investigated in ovariectomized rats. Sixty mature female Sprague-Dawley rats were randomly divided into four different groups (n = 15): (i) unexposed control (CTL); (ii) ovariectomized only (OVX); (iii) non-ovariectomized, exposed (SHAM + ELF-MF); and (iv) ovariectomized, exposed (OVX + ELF-MF). The third and fourth groups were exposed to 1.5 mT ELF-MF for 4 h a day for 6 months. Bone mineral density (BMD) was determined using dual energy X-ray absorption (DEXA) measurements. The formation and resorption of bone were evaluated using bone-specific alkaline phosphatase (BAP), osteocalcin, osteoprotogerin, and N-telopeptide. After 6 months of ELF-MF therapy, BMD values were significantly lower in the OVX group and higher in the OVX + ELF-MF and SHAM + ELF-MF groups than they were before therapy (P < 0.001). Although there was no significant difference in BMD values among the groups before therapy, the BMD values increased significantly after 6 months in the OVX + ELF-MF and SHAM + ELF-MF groups and were reduced in the OVX group compared to the CTL group (P < 0.001). The concentrations of BAP, osteocalcin, osteoprotogerin, and N-telopeptide in the three experimental groups also changed in a significant way compared to the CTL group. The results of the present study suggest that osteoporosis can be inhibited by ELF-MF stimulation treatments. It was also concluded that ELF-MF may be useful in the prevention of osteoporosis in ovariectomized rats.

Low-Level Laser Therapy and Calcitonin in Bone Repair: Densitometric Analysis

The aim of this work was to evaluate the association of low-level laser therapy (LLLT, 830 nm) and calcitonin in bone repair considering that bone healing remains a challenge to health professionals. Calcitonin has antiosteoclastic action and LLLT is a treatment that uses low-level lasers or light-emitting diodes to alter cellular function. Both are used to improve bone healing. Densitometry is a clinical noninvasive valuable tool used to evaluate bone mineral density (BMD). Sixty male rats were submitted to bone defect with a trephine bur, randomly divided into four groups of 15 animals each: control (C); synthetic salmon calcitonin (Ca); LLLT (La); LLLT combined with calcitonin (LaCa). Animals from Ca and LaCa received 2 UI/Kg synthetic salmon calcitonin intramuscularly on alternate days after surgery. Animals from groups La and LaCa were treated with infrared LLLT (830 nm, 10 mW, 20 J/cm2, 6 s, contact mode). Five animals from each group were euthanized 7, 14, and 21 days after surgery and bone defects were analyzed by densitometry. Statistical analysis showed a significant difference in BMD values in LaCa group at 7 and 21 days (). The results of the densitometric study showed that LLLT (830 nm) combined with calcitonin improved bone repair.

Analysis of Biological Apatite Crystal Orientation in Anterior Cortical Bone of Human Mandible Using Microbeam X-ray Diffractometry

The human jaw is a unique bone that facilitates mastication. The structural properties of the jaw are determined by mechanical stresses transmitted via the teeth. However, it is very difficult to evaluate the impact of these mechanical stresses on bone. In recent years, it has become clear that the orientation of biological apatite (BAp) crystals is closely related to local stress, and is thought to respond more acutely to local stress than bone mineral density (BMD). Few studies have been conducted on BAp crystal alignment in response to mechanical stress in the human jaw, which has a complex masticatory function. The purpose of this study was to quantitatively evaluate BMD and BAp crystal orientation using micro-computed tomography (micro-CT) and microbeam X-ray diffractometry in the anterior cortical bone of human mandible. The intensity and direction of mechanical stresses in both the alveolar area and mandibular base were compared. The mandibular central incisor region in Japanese bone samples was designated as the region of interest and BMD and BAp crystal orientation in the alveolar area and mandibular base measured. Bone samples were imaged by micro-CT and the data obtained converted into BMD values. BAp crystal orientation was determined by both reflection- and transmission-based microbeam X-ray diffractometry. The diffraction intensity ratio was calculated using X-ray diffraction peaks of (002) and (310). The results showed no difference in BMD values among regions. BAp crystals were oriented predominantly in the mesiodistal direction in the mandibular base and along the direction of masticatory force in the alveolar area. These findings suggest that the mandibular base exhibits long bone-like characteristics, with the mandibular condyle acting as the head of the bone, while in the alveolar area alignment takes place in the direction of masticatory force resulting from mechanical stress exerted via the teeth. Qualitative evaluation revealed clear differences between the mandibular base and alveolar area, suggesting that BAp crystal orientation offers a more precise indicator of bone quality than BMD. [doi:10.2320/matertrans.M2011329]

A cross-sectional study of the forearm bone mineral density in long-term current users of the injectable contraceptive depot medroxyprogesterone acetate

Background One of the well-established effects of the use of depot medroxyprogesterone acetate (DMPA) contraception is on bone mineral density (BMD). However, little evidence assesses the skeletal impact of long-term DMPA use. The objective of this study was to assess BMD on a cohort of women who used DMPA uninterruptedly between 1 and 15 years. Study Design A cross-sectional study with 232 users of DMPA matched to a group of 232 copper intrauterine device (IUD) users by age (±1) (range 20–53 and 20–51 years for DMPA and IUD group, respectively), body mass index (BMI; kg/m 2) (±1) (range 17.4–44.5 and 18.5–40.2 for DMPA and IUD group, respectively) and years of use (1–15 years) was performed. The women underwent forearm BMD evaluation using dual-energy X-ray absorptiometry. The women were divided into five groups (1–5) according to the length of DMPA use: 1–3, 4–6, 7–9, 10–12 and 13–15 years of use. Results The mean (±SEM) age was 38.3±0.5 and 38.1±0.57 years and the mean (±SEM) BMI (kg/m 2) was 26.4±0.3 and 26.3±0.3 for the entire group of women in the DMPA and IUD group, respectively. Women who used DMPA or IUD for a short time were younger and had lower BMI (kg/m 2) than the women who used either contraceptive method long term. White women were significantly more frequent among IUD users (p<.040) than DMPA users. In addition, parity (p<.053) and physical activity (p<.012) were significantly greater among IUD users, whereas the prevalence of washing clothes by hand (p<.025) was significantly greater among DMPA users. There was no significant difference in BMD measurements between the current users of DMPA and those who had used the IUD either at the distal or ultra-distal sections of the forearm. However, women who had used DMPA for 13–15 years showed significantly lower BMD at the distal and ultra-distal radius when compared to IUD users (p<.041 and .042, respectively). Otherwise, all other differences in BMD values between DMPA and IUD users were nonsignificant at the distal and ultra-distal radius. For both DMPA and IUD users, we noted a direct correlation between higher BMD and BMI (kg/m 2) and an inverse correlation between BMD and age for distal and ultra-distal radius. Conclusions Our study did not detect a deleterious effect on measurements of forearm BMD among long-term DMPA users with less than 13 years of use; however, a significantly lower BMD was observed at 13–15 years of use in DMPA users when compared to IUD users. Bone mineral density was inversely correlated to older age and directly correlated to BMI (kg/m 2).

Bone mineral density in diabetes mellitus patients with and without a Charcot foot

To measure bone mineral density in patients with diabetes mellitus and the complication Charcot osteoarthropathy (CA). A total of 49 patients with diabetes were investigated. The population consisted of patients with an acute CA (n = 17) or chronic CA (n = 7). Control groups consisted of diabetes patients with (n = 9) and without neuropathy (n = 11) and who had an amputation of the first toe (n = 5). Values measured were bone mineral density (BMD) in lumbar spine, hip and calcaneus, using lunar DEXA scanner. The bone turnover markers CTX-1 and N-MID were measured. There were no differences in BMD measured in the spine and hip. There was an increase in the markers of bone turnover in the patients with acute CA. The BMD of the calcaneus was statistically lower in the affected foot in patients with chronic Charcot (P < 0.01), than in the unaffected foot, but there were no statistically significant differences between the BMD of the calcaneus in the feet in the other groups. From this study, we can conclude that there were no differences in BMD values in the spine and hip between groups. There were no differences between BMD of the calcaneus between groups, except that patients with chronic Charcot had a significantly lower calcaneal BMD in the affected foot than in the healthy foot. Furthermore, there was an increased bone turnover in the group with acute CA, which was not found in the other patients groups. This suggests that the Charcot foot is a rather local phenomenon, with little effect on the skeleton in general.

Bone Health in Immigrant Hispanic Women Living in Texas

Osteoporosis is a serious national public health problem, and is expected to increase significantly over the next few decades, especially in women. A limitation of bone health research exists since few studies have involved Hispanic women, and even fewer, Hispanic immigrant women. For this study we examined the effects of anthropometric, behavioral, and health history variables on bone mineral density (BMD) in 84 immigrant Hispanic women, age 40 and above. BMD was assessed at the spine, femur, and forearm using dual energy x-ray absorptiometry (DXA). Demographic information, health histories, and behavioral risk factors were obtained from a questionnaire. In the younger group (mean age = 44.1 years) 61% had spinal osteopenia, and in the postmenopausal group (mean age = 53.0 years) 59% had osteopenia and 13% had osteoporosis. Femur sites were free of osteoporosis. Mean body mass index (BMI) was 31.8 ± 6.1 and mean waist girth was 95.6 ± 12.5 cm, indicating overall and abdominal obesity. Partial correlations indicated a significant positive relationship between body fat variables and total femur BMD values. ANOVAs revealed no differences in BMD values at any bone site across tertile levels for calcium intake or for physical activity. However, supplemental and dietary calcium intakes were very low and few participants engaged in regular physical activity outside of work and activities of daily living (ADL). In light of the expected increase in osteoporosis in this population and the prevalence of spinal osteopenia in the younger participants, education about the health risks of osteoporosis should be made available to this group.

Use of co-registered high-resolution computed tomography scans before and after screw insertion as a novel technique for bone mineral density determination along screw trajectory

Introduction Bone mineral density (BMD) is an important factor in the examination of the performance of bone instrumentation both in and ex vivo, and until now, there has not existed a reliable technique for determining BMD at the precise location of such hardware. This paper describes such a technique, using cadaveric human sacra as a model. Methods Nine fresh-frozen sacra had solid and hollow titanium screws placed into the S1 pedicles from a posterior approach. High-resolution micro-computed tomography (CT) was performed on each specimen before and after screw placement. All images were reconstructed with an isotropic spatial resolution of 308 μm, reoriented, and the pre-screw and post-screw scans were registered and transformed using a six-degree rigid-body transformation matrix. Once registered, two points, corresponding to the center of the screw at the cortex and at the screw tip, were determined in each scan. These points were used to generate cylindrical regions of interest (ROI) with the same trajectory and dimensions as the screw. BMD measurements were obtained within each of the ROI in the pre-screw scan. To examine the effect of artefact on BMD measurements around the titanium screws, annular ROI of 1 mm thickness were created expanding from the surface of the screws, and BMD was measured within each in both the pre- and post-screw scans. Results The registration process was accurate to 190 μm, with a precision of 189 μm and error in BMD measurement of ± 2% in repeated scans. BMD values in the cylindrical ROI corresponding to screw trajectories were not statistically different from side to side of each specimen ( p = 0.23). Metal artefact created significant differences in BMD values ( p = 0.001) and followed an exponential decay curve as distance from the screws increased, approaching a low value of approximately 20 mg HA cm − 3 , but not disappearing completely. Summary CT in the presence of metal creates artefact, making measured BMD values near implants unreliable. This technique is accurate for determination of BMD, non-destructive, and eliminates the problem of this metal artefact through the use of co-registered scans. This technique has applications both in vitro and in vivo.

IS LONG-TERM USE OF HORMONAL CONTRACEPTIVES A RISK FACTOR FOR OSTEOPOROSIS ?

Objective : To study the effect of long-term use of different forms of hormonal contraceptives on bone mineral density (BMD)Design : A prospective studySetting: Fertility Care Unit, Mansoura University Hospitals.Subjects and Methods: One hundred healthy women aged 25-49 years who chose long term hormonal contraceptives were recruited in the study. Women had to fulfill a set of inclusion and exclusion criteria. Tlio.sc women were categorized into five groups, each comprised twenty women. All groups were well balanced with respect (o age, height, weight and body mass index. Those who used combined oral contraceptives (group l), Norplanl subdcrmal implants (group 2), Implanon subdermal implants (group 3), injectablc Dcpo-Provera (group 4) and Control group used non-hormonal intrauterine contraceptive device Tcu 380A (group 5). After 3 years of contraceptive use, bone mineral density (BMD) of lumber spine (L2-L4) was measured for all women using dual energy X-ray absorpliomclry (DEXA). BMD measurements (g/cm2) were expressed as Z-scores to assist in the interpretation of BMD results. BMD and Z-scores in different groups were compared using Annova Test with Post Hoc Test (Turkey HSD) for multiple comparisons between groups.Results: Of 100 women, 9 women were excluded from analysis and a total of 91 women made up the final sample; 18 used combined oral contraceptives (group 1), 19 used Norplant (group 2), 19 used Implanon (group 3), 18 used Depo-Provera (group 4) and 17 used non-hormonal IUD Tcu 380A (group 5). Age, height and body mass index were not significantly different among the groups. Mean BMD at lumbar spine (L2-L4) was 1.205 (group 1), 1.182 (group 2), 1.11 (group 3) 0.842 (group 4) and 1.113 (group 5). There were significant differences in BMD values at lumber spine between different groups. Depo-Provera group was associated with a lower BMD than the other groups whereas the combined oral contraceptive group was associated with a higher BMD. Mean /.-scores were -0.34 (group 1), -0.37 (group 2), -0.5 (group 3), -2.26 (group 4) and -0.5 (group 5). Multiple comparisons by using Post Hoc Tests (turkey HSD) demonstrated that BMD and Z-scores in Depo-Provera users were significantly lower than that of other groups. All women using Depo-Provera experienced osteoporotic changes with a Z-score ranging from -2.02 to -2.4. Conclusion: Depo-Provera was associated with a significantly lower BMD; hence its long term use is a potential risk factor for osteoporosis. Combined oral contraceptives and Norplant were associated with increased BMD while Implanon had no effect. These results have a great importance in cases of medico-legal examination of women who used Depo-Provera for a long duration as a simple trauma may lead to fractures.

No Alteration in Bone Mineral Density in Patients with Periodontitis

Alveolar bone destruction can be magnified in the presence of generalized skeletal disorders. We questioned whether severe generalized periodontitis patients display signs of bone metabolism disturbances. Our objective was to assess skeletal bone mineral density (BMD) and biochemical bone parameters in premenopausal women with periodontitis. Forty-five patients and 40 control individuals were included in the study. We measured BMD by dual-energy x-ray absorptiometry. The results showed no difference in BMD values between the periodontitis and control groups (p > 0.05). A positive relationship between the clinical attachment level and Body Mass Index (BMI) scores was observed (p = 0.03). Increased serum creatinine levels were noted in the periodontitis group (p = 0.04). Analysis of the data suggests that there is no evidence for an association between skeletal BMD and severe periodontitis in premenopausal women. There may be a link between elevated creatinine levels and periodontitis. The persons with high BMI scores seemed to be at risk for periodontitis.

Serum Pentosidine Levels Are Positively Associated with the Presence of Vertebral Fractures in Postmenopausal Women with Type 2 Diabetes

Although type 2 diabetic patients are at increased risk of fractures, bone mineral density (BMD) may not be useful for assessing the risk. Recent studies have reported that increased bone content of pentosidine (PEN) is associated with its plasma concentration and bone fragility. To examine the association between serum PEN levels and vertebral fractures (VFs) in Japanese type 2 diabetic patients (77 males older than 50 yr and 76 postmenopausal females), we compared parameters including BMD, PEN, serum bone-specific alkaline phosphatase, and urinary levels of N-telopeptide between those with and without VFs. Comparison of diabetic subjects with and without VFs revealed no significant differences in BMD values or bone metabolic markers in either gender. In contrast, PEN levels in women with VFs were significantly higher than in those without VFs (0.0440+/-0.0136 vs. 0.0321+/-0.0118 microg/ml; P<0.001). Multivariate logistic regression analysis adjusted for age, height, weight, hemoglobin A1c, estimated glomerular filtration rate, the presence of diabetic complications, histories of taking insulin or pioglitazone, risk factors for osteoporosis, and lumbar BMD identified PEN levels as a factor associated with the presence of VFs in postmenopausal diabetic women independent of BMD, risk factors for osteoporosis, diabetic status, and renal function (odds ratio 2.50, 95% confidential interval 1.09-5.73 per sd increase; P=0.0302). PEN levels, but not BMD, may be useful for assessing the risk of prevalent VFs in postmenopausal diabetic women and may reflect bone quality in this group.