Femoral Osteoporosis Research Articles

Association of lipid profile with bone mineral density in postmenopausal women in Yazd province

Low bone mass is a major health problem in postmenopausal women. There is no general agreement regarding relationship between serum level of lipids and bone mineral density. This study was carried out to investigate the association between lipid profile and bone mineral density (BMD) in postmenopausal women in Yazd, Iran. This cross-sectional study was performed on 170 women aged between 50 and 70 years old with menopause for at least one year from Yazd, Iran, between March 2013 to September 2013. Association of lipid profile and BMD were measured in all study participants. Among our participants 73 cases had lumbar osteoporosis, 17 cases had femoral osteoporosis and 80 cases did n't have osteoporosis. After controlling for body mass index, there were no correlations between serum level of lipids and bone mineral density of femur and lumbar bones. No significant association between serum level of lipids and BMD of femur and lumbar was found in postmenopausal women.

Proton pump inhibitors use and change in bone mineral density.

Limited data are available reporting the effect of proton pump inhibitor (PPI) use on changes in bone mineral density (BMD). The aim of this study was to investigate the relationship between PPI use and BMD. The current cross-sectional study included 80 patients (31 male and 49 female) aged 20-45 years old without history of hip fracture with a follow-up of at least 2 years. The study was carried out in 40 daily PPI users and 40 PPI non-users. Femur and posterior-anterior spine BMD were quantified by dual-energy X-ray absorptiometry in all participants. The relationship between use of PPI and BMD was tested by multivariate linear regression analysis adjusted for age, sex, BMI and serum vitamin D levels. Our study demonstrated that mean femoral T-scores were significant between PPI and non-user groups (-0.44 ± 1.11 vs. +0.19 ± 0.95, P = 0.007). In addition, the frequency of femoral osteoporosis and osteopenia in the exposed group was significantly more in the control group (P = 0.04). Mean femoral Z-scores, lumbar spine T-score and lumbar spine Z-score were not statistically different between PPI and non-user groups. The linear regression analysis revealed that there was no association between PPI and non-users, and lumbar spine T-score. Overall, the results of this study showed that PPI use in subjects without risk factors of osteoporosis determined by the femoral T-score compared with the control group was associated with increased risk of developing osteoporosis and osteopenia in the femur bones.

Infectious diseases in perspective.

Infectious diseases represent an ever-changing field of practice. Virtually each week brings new information, some with the potential to adjust or reinvent the current clinical practice. It is our task as clinicians to browse through field literature, through reports of randomized controlled trials, excerpts of conference proceedings, and to choose relevant scoops with high applicability in patient management. This supplement brings together four articles relevant to four different areas of medical practice, from HIV infection to Gram-negative bacilli such as Acinetobacter baumannii and Pseudomonas aeruginosa, and interdisciplinary studies on infectious acute maxillary sinusitis. Non-infectious comorbidities are of utmost importance in the management of HIV infection, as occurrence of kidney impairment, or fractures following decrease in bone mineral density, can significantly impact the quality of life and/or even life expectancy. The study presented at the 11th Edition of the Scientific Days of the National Institute for Infectious Diseases “Prof. Dr. Matei Balș” describes the epidemiology of chronic kidney disease and bone demineralization in HIV-positive patients from the Romanian HIV cohort, patients who acquired HIV infection at an early age, in infancy and childhood, in the late ‘80s, and who have since have tried all available therapeutic options. The prevalence of chronic kidney diseases is reported at 29.6 % for stage 2 and 1.4 % for stage 3 chronic kidney disease. The prevalence of lumbar osteopenia and osteoporosis was 33.3 % and 13.7 %, respectively, and that of femoral osteopenia and osteoporosis was 37.3 % and 7.8 %, respectively. An in-depth study of the virulence factors expressed by Pseudomonas aeruginosa revealed that virulence genes are highly prevalent in strains isolated from patients treated in a Dermatology department in Bucharest, Romania, namely ExoT (100 %), AlgD (92.3 %), genes codifying for phospholipases (84.6 % each) and genes coding for protease IV (61.5 %). A study performed by oromaxillofacial and dentoalveolar surgeons revealed an incidence of 4.3 % acute maxillary sinusitis in patients undergoing sinus lift procedures, and identified certain grafting materials which may be correlated with higher incidences. This study can pave the way for new therapeutic guidelines for the interdisciplinary management of acute sinusitis, which is currently treated by dental surgeons, ear-nose-throat practitioners, and infectious diseases specialists, alike. The last study included in the volume evaluated the patterns of antimicrobial susceptibility of Acinetobacter baumannii strains isolated from patients in intensive care, and reported a worrisome prevalence of carbapenem resistance: 94.6 % to imipenem and 86.5 % to meropenem. The authors conclude that there is dire need for new therapeutic options, as carbapenems are considered last-resort antibiotics, and the only antimicrobial to which Acinetobacter strains still displayed satisfactory susceptibility was colistin, with resistance reported in 9/37 strains (24.3 %) in this study.

Bone turnover and mineral density in adult thalassemic patients: relationships with growth hormone secretory status and circulating somatomedins.

Previous evidence supports a role for growth hormone (GH)-insulin-like growth factor (IGF)-I deficiency in the pathophysiology of osteopenia/osteoporosis in adult thalassemia. Moreover, serum IGF-II has never been studied in this clinical condition. Thus, we elected to study the GH secretory status and the levels of circulating somatomedins, correlating these parameters with bone mineral density (BMD) and biochemical markers of bone turnover. A hundred and thirty-nine normal weight adult thalassemic patients (72 men and 67 women) were studied. Lumbar and femoral neck BMD were measured in 106/139 patients. Sixty-eight patients underwent growth hormone releasing hormone plus arginine testing. Measurement of baseline IGF-I and IGF-II was performed in all patients, while osteocalcin, C-terminal telopeptide of type I collagen (CTx), and urinary cross-linked N-telopeptides of type I collagen (NTx) were assayed in 95 of them. Femoral and lumbar osteoporosis/Z score below the expected range for age were documented in 61.3 and in 56.6% of patients, respectively. Severe GH deficiency (GHD) was demonstrated in 27.9% of cases, whereas IGF-I SDS was low in 86.3%. No thalassemic patients displayed circulating levels of IGF-II below the reference range. GH peaks were positively correlated with femoral, but not lumbar, Z score. No correlations were found between GH peaks and osteocalcin, CTx and NTx. GH peaks were positively correlated with IGF-I values, which in their turn displayed a positive correlation with osteocalcin, CTx, and NTx. No correlations emerged between IGF-I values and either femoral or lumbar Z scores. No correlations were found between IGF-II and any of the following parameters: GH peaks, osteocalcin, CTx, NTx, femoral Z score, and lumbar Z score. Our study, besides providing for the first time evidence of a normal IGF-II production in thalassemia, contributes to a better understanding of the involvement of the somatotropin-somatomedin axis in the pathophysiology of bone demineralization in this disease. In particular, the contribution of GHD to femoral osteoporosis appears to be likely mediated by locally produced rather than circulating IGF-I.

The effects of visceral obesity and androgens on bone: trenbolone protects against loss of femoral bone mineral density and structural strength in viscerally obese and testosterone-deficient male rats.

In males, visceral obesity and androgen deficiency often present together and result in harmful effects on bone. Our findings show that both factors are independently associated with adverse effects on femoral bone structure and strength, and trenbolone protects rats from diet-induced visceral obesity and consequently normalises femoral bone structural strength. In light of the rapidly increasing incidence of obesity and osteoporosis globally, and recent conjecture regarding the effects of visceral adiposity and testosterone deficiency on bone health, we investigated the effects of increased visceral adipose tissue (VAT) mass on femoral bone mineral density (BMD), structure and strength in normal weight rats with testosterone deficiency. Male Wistar rats (n = 50) were fed either standard rat chow (CTRL, n = 10) or a high-fat/high-sugar diet (HF/HS, n = 40). Following 8 weeks of feeding, rats underwent sham surgery (CTRL, n = 10; HF/HS, n = 10) or orchiectomy (HF/HS + ORX, n = 30). Following a 4-week recovery period, mini-osmotic pumps containing either vehicle (CTRL, n = 10; HF/HS, n = 10; HF/HS + ORX, n = 10), 2.0 mg kg day(-1), testosterone (HF/HS + ORX + TEST, n = 10) or 2.0 mg kg day(-1) trenbolone (HF/HS + ORX + TREN, n = 10) were implanted for 8 weeks of treatment. Dual-energy X-ray absorptiometry and three-point bending tests were used to assess bone mass, structure and strength of femora. Diet-induced visceral obesity resulted in decreased bone mineral area (BMA) and content (BMC) and impaired femoral stiffness and strength. Orchiectomy further impaired BMA, BMC and BMD and reduced energy to failure in viscerally obese animals. Both TEST and TREN treatment restored BMA, BMC, BMD and energy to failure. Only TREN reduced visceral adiposity and improved femoral stiffness and strength. Findings support a role for both visceral adiposity and testosterone deficiency as independent risk factors for femoral osteoporosis, adverse bone geometry and impaired bone strength in male rats. Trenbolone may be a more effective candidate for androgen replacement therapy than testosterone in viscerally obese testosterone-deficient males.

Low Bone Mineral Density in Thalassemia Major: Sanjay Gandhi Post Graduate Institute Experience and a Brief Focus on Underlying Factors behind the Cause

Thalassemia major is a genetic disorder and blood transfusion is critical for survival in these patients. Over the course of the past three decades, hyper transfusion therapy in these patients has shown has dramatically extended life expectancy and improved quality of life. Unfortunately, this type of therapy also increased the incidence of complications due to iron overload. The aim of this study was to assess bone mineral density (BMD) in patients with β-thalassemia major and to determine their biochemical and hormonal profiles that may affect BMD. A cross- sectional study was carried out in Sanjay Gandhi—PGIMS, a tertiary care hospital over period of 3 years on all β-thalassemia major patients above 7 years receiving regular transfusion. Patients with transfusion dependent anaemia other than β thalassemia major were excluded. Physical examination, laboratory tests and bone density measurements were performed. Then, the data were analyzed. The total number of children over 7 years of age with β-thalassemia major receiving regular blood transfusions during the study period was 150. Mean hemoglobin was 7.8 ± 0.6 g/dL and the mean serum ferritin level 5295 ± 2736 ng/mL. Short stature was seen in 54.7% boys and 28.7% of girls. Prevalence of lumbar osteoporosis and osteopenia were 42.5% and 37.5%. Femoral osteoporosis and osteopenia were present in 32.5% and 55% of the patients. Impaired puberty, hypothyroidism, diabetes mellitus, hypoparathyroidism were observed in 26%, 18%, 7%, and 15%, of patients, respectively. Nearly 75% of patients had low bone mineral density. Bone mineral density was significantly associated with short stature (p = 0.002), hypogonadism (p = 0.006), hypoparathyroidism (p = 0.038), hypothyroidism (p = 0.044) and vitamin D deficiency (p < 0.001). High prevalence of complications among our thalassemics signifies the importance of more detailed studies along with therapeutic interventions.

Bone mineral density and circulating biomarkers in the BIG 1-98 trial comparing adjuvant letrozole, tamoxifen and their sequences

The purpose of the study is to determine the effects of the BIG 1-98 treatments on bone mineral density. BIG 1-98 compared 5-year adjuvant hormone therapy in postmenopausal women allocated to four groups: tamoxifen (T); letrozole (L); 2-years T, 3-years L (TL); and 2-years L, 3-years T (LT). Bone mineral density T-score was measured prospectively annually by dual energy X-ray absorption in 424 patients enrolled in a sub-study after 3 (n = 150), 4 (n = 200), and 5 years (n = 74) from randomization, and 1 year after treatment cessation. Prevalence of osteoporosis and the association of C-telopeptide, osteocalcin, and bone alkaline phosphatase with T-scores were assessed. At 3 years, T had the highest and TL the lowest T-score. All arms except for LT showed a decline up to 5 years, with TL exhibiting the greatest. At 5 years, there were significant differences on lumbar T-score only between T and TL, whereas for femur T-score, differences were significant for T versus L or TL, and L versus LT. The 5-year prevalence of spine and femur osteoporosis was the highest on TL (14.5 %, 7.1 %) then L (4.3 %, 5.1 %), LT (4.2 %, 1.4 %) and T (4 %, 0). C-telopeptide and osteocalcin were significantly associated with T-scores. While adjuvant L increases bone mineral density loss compared with T, the sequence LT has an acceptable bone safety profile. C-telopeptide and osteocalcin are useful markers of bone density that may be used to monitor bone health during treatment. The sequence LT may be a valid treatment option in patients with low and intermediate risk of recurrence.

Optimal dietary calcium intake in HIV treated patients: No femoral osteoporosis but higher cardiovascular risk

We performed a cross-sectional study on adult HIV-infected patients, on HAART, without calcium or vitamin D supplementation to evaluate if the cardiovascular risk or the presence of osteoporosis may be predictive factors of an optimal daily calcium intake (DCI>1000 mg/day). Patients underwent a dual-energy X-ray absorptiometry, measured biochemical parameters and compiled a validated questionnaire for the assessment of DCI. Osteoporosis (OP) was defined according to the WHO classification at either the vertebral spine or femoral neck. Cardiovascular risk was assessed by the 10-year Framingham cardiovascular risk score. 200 HIV-infected patients evaluated: 171 (86%) males with a median age of 48.1 (42.3-53.8) years and 10.6 (4.3-13.6) years of HAART exposure. DCI was 889 (589-1308) mg/day and 79 (40%) patients had an optimal DCI. Framingham risk>20% was found in 13 (6.7%) patients and femoral OP was diagnosed in 12 (6%) pts. By multivariate analysis, optimal DCI was more likely in patients with a Framingham risk>20% [OR = 5.547, 95% CI:1.337, p = 0.025] and less likely in patients with femoral osteoporosis [OR = 0.159, 95% CI: 0.018-0.790, p = 0.047]. We found that an optimal dietary calcium intake was more likely in patients with high cardiovascular risk and no femoral osteoporosis.

Relations between alcoholism and osteoporosis or femoral head necrosis

To explore the relationship of alcoholism between osteoporosis or femoral head necrosis. In this case-control study, we selected 95 eligible patients with femoral head necrosis and another 67 cases of osteoporosis as case group, together with 342 patients of fractures from the Second Hospital affiliated to Shanxi Medical College, from February to December 2010, as the control group. Questionnaire was used to collect general information of the patients. Through comparative analysis, related factors of femoral head, osteoporosis were defined. 18 patients with alcoholic femoral head necrosis, 11 patients with alcoholic osteoporosis and 20 patients with fractures were selected from the above said three groups and going through the Alcohol Use Disorders Identification Test (AUDIT) as well as the Alcohol Use Disorders Scale(ADS). Using SPSS 13.0 conducted one-way ANOVA(analysis of variance), chi-square test, categorical logistic regression analysis were used for statistical analysis. Results from logistic regression analysis showed that the adjusted odds ratio of those subjects who liked drinking alcohol had an incidence of femoral head necrosis or osteoporosis as 7.70 (95% CI:1.84, 32.30) and 8.44 (95% CI:1.70, 41.90), respectively. The risks of using hormone for treating femoral head necrosis or osteoporosis were 78.43 (95%CI:11.20, 149.05) and 22.75 (95%CI:2.59, 100.27) times than those without. Data from the AUDIT showed that:over-dose of alcohol drinking habit existed 100% in the femoral head necrosis group while 54.45% in the osteoporosis group, while 75 percent patients in the fractures group had normal alcohol drinking habit. Statistically significant differences appeared in the three groups (P < 0.01). from the ADS showed that there were statistically significant differences between the ADS scores of the three groups(F = 3.68, P = 0.03). Alcohol intake did seem to be highly correlated with the incidence rates of femoral head necrosis or osteoporosis. Alcohol-related necrosis could be viewed as alcohol-dependent diseases while alcohol-related and osteoporosis could partially be recognized as alcohol-dependent disease.

THU0376 Bone Mineral Density in Patients with Advanced Atherosclerosis

ObjectivesTo evaluate lumbar spine and femoral neck bone mineral density (BMD) and T score at lumbar and femoral neck levels in documented coronary artery disease patients.MethodsWe studied spine and femoral...

Bone Mineral Density Assessment in a Multiple Sclerosis Population (P06.163)

Objective: To evaluate the prevalence of osteoporosis in a population of patients with Multiple Sclerosis (MS), and to assess the correlation of Bone Mineral Density (BMD) with demographic, clinical and treatment parameters. Background Osteoporosis and low BMD are common in MS. Possible explanations are attributed to factors such as lack of mobility, reduced vitamin D levels, chronic inflammatory state, steroidal and immunomodulatory treatments (DMTs). To date, available data do not allow to comprehensively define the profile of risk factors for osteoporosis in patients with MS. Design/Methods: As part of a project of «good clinical practice» in our centre, to all patients with MS aged ≥35 years, was offered the opportunity to carry out a BMD assessment by Dual energy X-ray Absorptiometry (DXA). Then we have retrospectively analyzed DXA reports, especially considering the diagnosis of osteoporosis, as well as evaluating the possible correlation of BMD with demographic, clinical and treatment parameters. Results: 112 agreed to partecipate, 96 with full available data. Sample mean age was 50.8 ± 7.2 y., 79% females, mean disease duration of 15.4 ± 8.8 y., and mean EDSS score of 3.0 ± 2.0. Osteoporosis was found in 16.7% of the patients; mean vertebral and femoral BMD scores were respectively of .93 ± .13,and .82 ± .14. As expected, patients with either vertebral (p =. 02) or femoral (p =. 025) osteoporosis were older, while those with only femoral osteoporosis had a higher EDSS score (p Conclusions: The prevalence of osteoporosis was comparable with previous reports. As in the general population BMD correlated with age, while femoral BMD strongly correlated with disability. No correlation was found with the use of steroid therapy or DMTs. Disclosure: Dr. Haggiag has nothing to disclose. Dr. Mercurio has nothing to disclose. Dr. Bray has nothing to disclose. Dr. Haggiag has nothing to disclose. Dr. Gasperini has received personal compensation for activities with Merck Serono, Bayer Pharmaceuticals Corporation, Biogen Idec, Sanofi-Aventis Pharmaceuticals, Inc. as a speaker. Dr. Galgani has nothing to disclose.

Comparison of mandibular bone mineral density in osteoporotic, osteopenic and normal elderly edentulous subjects measured by the dual‐energy X‐ray absorptiometry technique

The aim of this study was to compare the mandibular body bone mineral density according to bone mineral density status of spine and femur measured by dual-energy X-ray absorptiometry (DXA) technique in elderly edentulous individuals. One of the factors that affect the survival rate of implants is bone mineral density (BMD) of the jaws. Fifty edentulous elderly patients' (27 women and 23 men) spine, femur and the mandibular body BMDs were measured using DXA technique. BMD scans of the AP lumbar spine (L2-L3) and femur were classified using World Health Organisation criteria for bone mass. There was a statistically significant difference between the normal femur group's-osteoporosis group's mandibular body BMD (p = 0.001) and femoral osteopaenia group's-osteoporosis group's mandibular body BMD (p < 0.001). The femoral osteoporosis group's mandibular body BMDs were lower than those of both the normal femoral and the femoral osteopaenia group subjects'. Classification of edentulous mandibles according to low and high bone mineral densities is a problem in implant dentistry. The results of this study demonstrated that femoral bone mineral density status may be used to provide preliminary information about the bone mineral density of the mandibular body region in elderly edentulous subjects.

Biochemical markers of bone turnover as predictors of osteoporosis and osteoporotic fractures in men and women: 10-year follow-up of the Taiji cohort

We aimed to assess the capacity of biochemical markers of bone turnover (BTMs) to predict bone loss, osteoporosis (OP), and osteoporotic fractures. We randomly selected 400 individuals (age 40–79 years in 1993; 50 of each gender and age stratum) from a list of registered residents. In the years 1993, 1996, 2000, and 2003, bone mineral density (BMD) of the spine and hip were measured by dual-energy X-ray absorptiometry. The BTMs assessed at baseline were serum intact osteocalcin (OC), total OC, bone-specific alkaline phosphatase, C-terminal propeptide of type I procollagen, N-terminal propeptide of type I procollagen (PINP), C-terminal cross-linking telopeptide of type I collagen generated by matrix metalloproteinase, C-terminal cross-linking telopeptide of type I collagen (beta-CTX), N-terminal cross-linking telopeptide of type I collagen (NTX), urinary pyridinoline, and deoxypyridinoline (DPD). For 307 completers, multivariate analysis after adjusting for confounders revealed that serum PINP levels in men [hazard ratio (HR) 2.80, P < 0.05] and serum PINP (HR 1.65, P < 0.05), beta-CTX (HR 1.80, P < 0.001), NTX (HR 1.96, P < 0.01), and urinary DPD levels (HR 1.40, P < 0.05) in women were significantly related to the occurrence of spinal OP. In addition to adjustment for the baseline status of BMD, i.e., osteopenia or normal range, PINP, beta-CTX, and NTX in women could significantly predict the future occurrence of spinal OP. BTMs were not significant predictors of bone loss, femoral OP, or osteoporotic fractures. In conclusion, various BTMs in women can predict the occurrence of spinal OP.

Regional fat, weight and osteoporosis in elderly women in Egypt

To test the hypothesis that regional fat and not total body weight has a protective effect on bone mineral density (BMD) in postmenopausal women, a cross-sectional study was conducted during the period from March 2008 to June 2009 on 303 healthy postmenopausal women presenting to the osteoporosis unit for screening purposes. BMD of the lumbar spine, L2-L4, and the neck of the left femur were measured by dual energy X-ray absorptiometry. Regional fat percentage was measured using the same scanner. While overweight was an independent protective factor for both spinal and femoral osteoporosis (OR = 0.397, 95% CI: 0.214-0.739; OR = 0.289, 95% CI: 0.151-0.553 respectively), regional fat percentage was not.

Biochemical markers of bone turnover as predictors of osteoporosis and osteoporotic fractures in men and women: 10-year follow-up of the Taiji cohort

We aimed to assess the capacity of biochemical markers of bone turnover (BTMs) to predict bone loss, osteoporosis (OP), and osteoporotic fractures. We randomly selected 400 individuals (age 40-79 years in 1993; 50 of each gender and age stratum) from a list of registered residents. In the years 1993, 1996, 2000, and 2003, bone mineral density (BMD) of the spine and hip were measured by dual-energy X-ray absorptiometry. The BTMs assessed at baseline were serum intact osteocalcin (OC), total OC, bone-specific alkaline phosphatase, C-terminal propeptide of type I procollagen, N-terminal propeptide of type I procollagen (PINP), C-terminal cross-linking telopeptide of type I collagen generated by matrix metalloproteinase, C-terminal cross-linking telopeptide of type I collagen (beta-CTX), N-terminal cross-linking telopeptide of type I collagen (NTX), urinary pyridinoline, and deoxypyridinoline (DPD). For 307 completers, multivariate analysis after adjusting for confounders revealed that serum PINP levels in men [hazard ratio (HR) 2.80, P < 0.05] and serum PINP (HR 1.65, P < 0.05), beta-CTX (HR 1.80, P < 0.001), NTX (HR 1.96, P < 0.01), and urinary DPD levels (HR 1.40, P < 0.05) in women were significantly related to the occurrence of spinal OP. In addition to adjustment for the baseline status of BMD, i.e., osteopenia or normal range, PINP, beta-CTX, and NTX in women could significantly predict the future occurrence of spinal OP. BTMs were not significant predictors of bone loss, femoral OP, or osteoporotic fractures. In conclusion, various BTMs in women can predict the occurrence of spinal OP.

Mineral'naya plotnost' kosti do i posletransplantatsii serdtsa

There were analysed bone mineral density (BMD) and spine roentgenograms in 15 candidates to heart transplantation and 24 recipients of heart transplantation in early (till 1 year) as far as late (till 12 years) period following operation. BMD showed axial osteopenia in terminal heart failure and early period after heart transplantation. There was progressive fail of axial and hip BMD in late period following heart transplantation to the degree of osteoporosis (axial osteoporosis was 3 times more often in late then in early period after operation while femur osteoporosis was only in late period). Femur BMD in neck, trochanter and Ward triangle inverse correlated with cumulated prednisolone dose. Ward triangle BMD inverse correlated with cumulative cyclosporine dose while axial BMD did not correlate any immunosuppressive drug. Vertebra fractures arised in terminal heart failure and did not progress after heart transplantation.

Comparison of two screening tools for osteoporosis to diagnose osteoporosis

predictive value (PPV= ,945). Furthermore, vitamin D deficiency was statistically associated with osteoporosis at femoral neck (p=,024). The predictive negative value of vitamin D sufficiency for excluding femoral osteoporosis was also high (PNV=,953). Conclusion: Our results indicate that vitamin D deficiency and insufficiency is a common problem in patients with osteopenia or osteoporosis and suggest that the optimal serum 25(OH)D level should be more than 75 nmol/l (30 ng/ml), underscoring the need for improved physician and public education regarding optimization of vitamin D status in this population. Although therewas no statistically significant association between calcifediol levels and BMD at the spine or femoral neck, given the high predictive values, the measurement of 25(OH)-D levels may be helpful in evaluating which postmenopausal patients really need a DEXA scan.

Bone demineralization in adult thalassaemic patients: contribution of GH and IGF‐I at different skeletal sites

GH and IGF-I exert an important role in the control of bone formation, as shown by decreased bone mineral density and increased fracture risk in adult hypopituitary patients untreated for GH deficiency (GHD). Different degrees of bone demineralization are frequently reported in patients affected by beta-thalassaemia. Considering the high prevalence of GHD recently observed by our group among adult thalassaemic patients, we elected to study the possible role of GH-IGF-I abnormalities in the pathogenesis of the osteopenia/osteoporosis of this disease. Sixty-four adult thalassaemic patients (49 with thalassaemia major and 15 with thalassaemia intermedia, 23 men and 41 women, aged 31.4 +/- 6.8 years) were studied. Bone mineral density was assessed by dual energy X-ray absorptiometry at lumbar spine in 62 patients and at proximal femur in 58. All patients underwent GHRH (1 microg/kg as an i.v. bolus) plus arginine (0.5 g/kg as a 30-min i.v. infusion) testing. Severe GHD was defined by GH peaks < 9 microg/l, whereas partial GHD was defined by GH peaks ranging from 9 to 16.5 microg/l. Blood samples for IGF-I measurement were collected. Lumbar osteoporosis and osteopenia were demonstrated in 46/62 (74.1%) and 14/62 (22.5%) patients, respectively. Femoral osteoporosis and osteopenia were documented in 22/58 (37.9%) and 32/58 (55.1%) patients, respectively. Severe GHD was demonstrated in 16/64 patients (25%), while 11 additional patients (17.1%) displayed partial GHD. IGF-I standard deviation score (SDS) was low, that is, below -1.88, in the majority (54.6%) of patients. Lumbar T-score values were not correlated with either GH peaks or IGF-I SDS values. Femoral T-score values were positively correlated with GH peaks (r = 0.38, P < 0.005) and IGF-I SDS values (r = 0.39, P < 0.005). Multiple regression analysis pointed to both GH peak and IGF-I SDS as predictors of femoral T-score. Furthermore, mean femoral T-score was significantly lower in patients with severe GHD than in those with normal GH secretion (-2.94 +/- 0.25 vs.-2.15 +/- 0.12, P < 0.01). This study, while confirming the high prevalence of both osteopenia/osteoporosis and somatotropin-somatomedin deficiency in adult thalassaemic patients, indicates that defective GH secretion and diminished serum IGF-I levels may contribute to femoral demineralization in these patients. Further studies are worth carrying out to evaluate the efficacy of biosynthetic GH administration on bone abnormalities of GH-deficient thalassaemic adults.

Height reduction, determined using knee height measurement as a risk factor or predictive sign for osteoporosis in elderly women

Objective We assessed the value of height reduction, calculated using knee height measurement, as a risk factor or predictive sign for osteoporosis in healthy elderly women. Methods In 181 healthy women 76 ± 5 y of age, height, weight, and knee height were evaluated. Femoral and spine bone mineral densities and body compositions were measured using dual-energy X-ray absorptiometry. In 76 young women 27 ± 4 y of age, a regression equation to predict height, based on knee height, was derived. Using this equation, maximum attained height and height loss were calculated in elderly women, which was correlated to bone mineral density. Results The equation to predict height was height (cm) = knee height (cm) × 2.22 + 50.54. The calculated height loss in elderly women was −6.1 ± 3.8 cm or −0.08 ± 0.05 cm/y of age. Height loss and hip circumference were significant predictors of spine bone mineral density. In the case of femoral bone mineral density, to the same predictors, a negative effect of waist circumference was added. Women in the highest quintile of height reduction (>0.199 cm/y) had an odds ratio of 4.5 (95% confidence interval 1.56–13.3, P < 0.02) for femoral osteoporosis. Conclusion Knee height can be used as an accurate measurement of height loss in the elderly, which is a significant predictor of femur and spine bone mineral densities, in addition to hip circumference.

Effect of proximal femoral osteoporosis on cementless hip arthroplasty: A short-term clinical analysis

The aim of this retrospective investigation was to explore the influence of femoral osteoporosis on short-term curative effects of cementless hip arthroplasty and to evaluate the femoral metaphyseal bone mineral density (BMD) for femoral osteoporosis in order to guide prosthesis choice and rehabilitation. We performed 127 total arthroplasty operations between June 1999 to February 2003 and investigated 49 cementless hip replacements with the Metalcancellous cementless Lubeck II system being used in all hips. There were twenty men and twenty-nine women whose mean age at the time of the operation was 60 years (range, 52~81 years). The patients were divided into osteoporosis or normal groups according to the femoral metaphyseal BMD measured preoperatively. The average duration of follow-up was 30 months (range, 8~52 months). We evaluated all of the patients from a clinical standpoint with use of a standard-terminology questionnaire with respect to the short-term curative effects and patients' satisfaction. Hip pain status and functional ability were important indicators of treatment efficacy. Harris hip score and patients' satisfaction in femoral osteoporosis patients who underwent noncemented hip arthroplasty were lower (P=0.004, P=0.03) while the incidence of thigh pain was higher (P=0.03) than the patients with non-osteoporosis. The higher incidence of pain, as well as the decrease in function experienced by the patients in osteoporosis group, supports the case that cementless arthroplasty is not a better choice for those patients and that we had better select prosthesis based on the femoral metaphyseal BMD.