Incidence Of Osteoporosis In Patients Research Articles

The effect of long-term use of pioglitazone on bone mineral density in patients with diabetes mellitus

Aims: This study aimed to explore the incidence of osteoporosis in patients with diabetes mellitus (DM) who have been on a long-term pioglitazone regimen, and to ascertain the link between pioglitazone usage and the onset of osteoporosis.
 Methods: We enrolled patients prospectively and conducted a comparative analysis between two groups of DM patients: those who had been using pioglitazone for a period exceeding two years, and those with no history of pioglitazone use. Bone Mineral Density (BMD) was assessed using dual energy X-ray absorptiometry (DEXA).
 Results: There were no significant differences in age, gender, disease duration, fasting plasma glucose levels, and HbA1c levels between pioglitazone users and non-users. However, a significant variation was found in the BMD measurements. Patients on pioglitazone had an L1-L4 vertebra BMD T-score of -1.3, compared to -0.9 in non-users (p

Impact of tuberculosis on the incidence of osteoporosis and osteoporotic fractures: a nationwide population–based cohort study

ObjectivesDespite the high prevalence of tuberculosis (TB) and the disease burden of osteoporosis and osteoporotic fractures, there is still a lack of well-designed, large-scale studies demonstrating associations among them. We aimed to investigate the effect of TB on the incidence of osteoporosis and osteoporotic fractures. Study designThis was a nationwide population–based cohort study. MethodsThis study was conducted using the National Health Insurance Service Database of South Korea. We included patients with newly diagnosed TB aged >40 years from January 2006 to December 2017. An uninfected control for each TB patient was randomly extracted by frequency matching for sex, age, income level, residence, and registration date at a 2:1 ratio. The primary outcome was the incidence of osteoporosis and osteoporotic fractures between the two groups, adjusted for sex, age, income level, residence, comorbidities, body mass index, blood pressure, laboratory tests, alcohol drinking, and smoking. The risk factors associated with osteoporosis or osteoporotic fractures were also investigated. ResultsA total of 164,389 patients with TB and 328,778 matched controls were included (71.9% males). The mean duration of follow-up was 7.00 ± 3.49 years. The incidence of osteoporosis in patients with TB was 6.1 cases per 1000 person-years, which was significantly higher than that in matched controls (adjusted hazard ratio [aHR] 1.349, 95% confidence interval [CI] 1.302–1.398, P < 0.001). The incidence of osteoporotic fractures was also higher in patients with TB than in controls (aHR 1.392, 95% CI 1.357–1.428, P < 0.001). Among fractures, the risk of hip fracture was the highest (aHR 1.703, 95% CI 1.612–1.798, P < 0.001). ConclusionsTB independently contributes to the incidence of osteoporosis and osteoporotic fractures, particularly hip fractures.

High prevalence of osteoporosis in patients undergoing spine surgery in China

BackgroundWith the increase in life expectancy, a large number of patients with osteoporosis (OP) are undergoing spine surgery, which may adversely affect the surgical success rate. The prevalence of OP varies in different regions, and no data are available that represent the prevalence of OP among Chinese patients over 50 years of age who are undergoing spine surgery. It was the first multicenter study to assess OP in these patients. Aiming to obtain comprehensive data, this study combined bone mineral density (BMD) measurements and visual radiography assessment (VRA) to analyze the prevalence of OP in patients aged > 50 years who underwent spine surgery.MethodsData from 1,856 patients aged over 50 years undergoing spine surgery who resided in northern, central, and southern China were reviewed between 2018 and 2019. Based on the perioperative BMD and X-ray data, we calculated the prevalence of OP in this special population according to sex, age, and spine degenerative disease.ResultsA total of 1,245 patients (678 females and 567 males) were included in the study. The prevalence of OP diagnosed by BMD was 52.8 % in females and 18.7 % in males. When we combined with BMD and VRA, the prevalence of OP increased from 52.8 to 65.9 % in females and from 18.7 to 40.6 % in males. Although OP was more severe in females than in males, a significant difference in the rate of vertebral fracture (VF) was not observed between females and males with a normal BMD and osteopenia (females vs. males: aged 50–59 years, P = 0.977; 60–69 years, P = 0.302; >70 years, P = 0.172). Similarly, no significant difference in the vertebral fracture rate was observed within different age groups of patients with a normal BMD and osteopenia (females: P = 0.210; males, P = 0.895). The incidence of OP in patients with degenerative scoliosis was higher than that in the remaining patients (females: 63.6 % vs. 42.4 %, P = 0.018; males: 38.9 % vs. 13.8 %, P = 0.004).ConclusionsA high prevalence of OP was identified in patients aged > 50 years undergoing spine surgery, especially in patients whose primary diagnosis was degenerative scoliosis. BMD and VRA evaluations should be included in the clinical routine for these patients prior to surgery.

Fibroblast growth factor 21 (FGF21) is a sensitive marker of osteoporosis in haemodialysis patients: a cross-sectional observational study

IntroductionOsteoporosis is one of the important bone abnormalities in chronic kidney disease-mineral and bone disorder (CKD-MBD) and still lacks a sensitive biomarker to diagnose. Fibroblast growth factor 21 (FGF21) can stimulate bone loss in patients with diabetes and increase in CKD patients. In this study, we investigated whether FGF21 could serve as a biomarker to predict osteoporosis in a haemodialysis cohort.MethodsWe recorded demographic information, biochemical data, and serum FGF21 and FGF23 levels and measured the CT attenuation values of 339 haemodialysis patients from two large medical centres. We assessed the correlation of CT attenuation values with serum FGF21 and FGF23 levels and tested whether they were independent factors for osteoporosis. ROC curves were constructed to compare the prognostic value of FGF21 and FGF23 for osteoporosis.ResultsBased on the CT attenuation value, serum FGF21 levels were higher in our osteoporosis group (median 640.86 pg/ml vs. 245.46 pg/ml, P ˂ 0.01). Meanwhile, FGF21 (r = -0.136, P < 0.05) and FGF23 (r = -0.151, P < 0.05) were both negatively associated with osteoporosis. Moreover, FGF21 (β = -0.067, P < 0.05) was an independent factor for osteoporosis. Furthermore, FGF21 combined with age yielded a marked specificity (90.5 %) and sensitivity (61.8 %) in predicting osteoporosis of haemodialysis patients with less residual renal function.ConclusionsFGF21 has a positive relationship with the incidence of osteoporosis in patients on haemodialysis. FGF21 combined with age is a good predictive biomarker for osteoporosis in patients on haemodialysis, especially those with less residual renal function.

Association between osteoporosis and hepatitis B cirrhosis: a case-control study.

Hepatitis B virus (HBV)-related cirrhosis is associated with decreased bone mineral density (BMD); however, the mechanism is yet unknown. To assess the incidence of osteoporosis in patients with HBV-associated cirrhosis and relevant mechanisms. A total of 80 hospitalized patients with HBV-associated cirrhosis and 80 healthy controls were enrolled. The levels of serum osteocalcin, total procollagen type 1 amino-terminal propeptide, β-C-terminal telopeptide of type I collagen (β-CTX), and 25-hydroxy vitamin D3 (25(OH)D3) was evaluated in the cirrhosis group. The BMDs of the lumbar spine (P<0.001) and hip joints (P=0.015) in the cirrhosis group were significantly lower than those in the controls. The incidence of osteoporosis in the cirrhosis group was significantly higher than that in the control group (P<0.001). Compared to the patients of the Child-Pugh grade A and B, the BMD of lumbar spine and 25(OH)D3 was significantly decreased in patients of grade C, while β-CTX was elevated. Patients in the cirrhosis group faced a higher risk of osteoporosis as compared to the controls(P<0.001). Enhanced bone resorption accounted for increased risk of osteoporosis in severe cirrhosis. Thus, HBV-associated cirrhosis was a risk factor for osteoporosis.

Osteoporosis and Implant-Related Complications After Anatomic and Reverse Total Shoulder Arthroplasty.

Osteoporosis is a widespread and growing medical condition, with significant orthopaedic implications. However, the effect of osteoporosis on outcomes after total shoulder arthroplasty (TSA) is not well understood. The goal of the present study was to characterize the incidence of osteoporosis in patients undergoing shoulder arthroplasty and to examine whether patients with osteoporosis undergoing anatomic and reverse TSA are at an increased risk of prosthetic-related complications. Complication rates were calculated for patients with osteoporosis who underwent anatomic and reverse TSA as separate cohorts within 2 years of surgery including loosening/osteolysis, periprosthetic fracture, periprosthetic dislocation, and revision shoulder arthroplasty and compared using a multivariable logistic regression analysis to control for patient demographics and comorbidities during comparisons, including the indication for reverse TSA. The prevalence of an osteoporosis diagnosis at the time of surgery was 14.3% for anatomic TSA patients and 26.2% of reverse TSA patients. Anatomic TSA patients with osteoporosis experienced significantly higher rates of periprosthetic fracture (odds ratio [OR], 1.49; P = 0.017) and revision shoulder arthroplasty (OR, 1.21; P = 0.009) within 2 years of surgery compared with matched controls without osteoporosis. Patients in the reverse TSA group with osteoporosis also had significantly higher rates of periprosthetic fracture (OR, 1.86; P = 0.001) and revision shoulder arthroplasty (OR, 1.42; P = 0.005) within 2 years of surgery compared with matched controls. A significant number of patients undergoing both anatomic and reverse TSA have a concurrent diagnosis of osteoporosis. Osteoporosis represents a significant independent risk factor for periprosthetic fracture and revision shoulder arthroplasty within 2 years of surgery, regardless of the type of implant. Patients with osteoporosis should be counseled on their increased risk of complications after shoulder arthroplasty.

The relationship between TNF-α gene polymorphism, pro-inflammatory cytokines and bone turnover markers in COPD patients with osteoporosis

Tumour necrosis factor alpha (TNF-α) is an important regulator of bone metabolism. Polymorphisms in the promoter region of the TNF-α gene at position 308 have been identified. We investigated whether these polymorphisms and circulating TNF-a levels were related to BMD in osteoporosis caused by COPD. We conducted this study to analyse the relationship between genetic polymorphism of tumour necrosis factor (TNF)-a -308 G/A and levels of pro-inflammatory cytokines, bone turnover marker levels, and the incidence of osteoporosis in COPD patients. This study was conducted on 70 COPD patients. BMD and bone area of the femoral neck and lumbar spines were measured using dual energy X-ray absorptiometry (Stratos ®). Blood cytokines (TNF-a, interleukin (IL)-6, IL-17, IL-1b) and Ctelopeptide (CTX), receptor activator of nuclear factor kB (RANKL), and osteoprotegerin (OPG) were analysed using ELISA. Polymorphism of the TNF-α gene -308 G/A was assayed by PCR-RFLP. The levels of cytokines were significantly increased in the osteoporosis group compared to those without. Polymorphism was significantly different between COPD with osteoporosis and COPD without. The frequency of the GA and AA genotypes was significantly increased in patients with osteoporosis. To conclude, there is a relationship between the TNF-a -308 G/A polymorphism and high levels of TNF-a, IL-1β, IL-6, IL-17, CTX, and the incidence of osteoporosis in patients with COPD.

Irritable Bowel Syndrome Is a Risk of Osteoporosis: A Population-Based Nationwide 1 Cohort Study

Background: Previous cohort studies, have reported higher rates of osteoporosis associated with irritable bowel syndrome (IBS). We evaluated the IBS as a risk factor for osteoporosis and osteoporotic fractures in Korea after adequately adjusting for basic confounding factors. Methods: We performed a nationwide population-based retrospective cohort study between January 1, 2002, and December 31, 2010 using National Health Insurance data, including 3,714 newly-diagnosed IBS patients. We matched every IBS case with non-IBS case from the database at a 1:4 frequency ratio (14,856 non-IBS patients). The outcome parameter was newly diagnosed patients with osteoporosis and osteoporotic fractures, defined as per the International Classification of Diseases, 10th Revision (ICD-10) code, and included those assigned the relevant diagnostic codes for osteoporosis, those receiving osteoporosis medications, those with non-traumatic vertebral, hip, pelvic, femur, clavicle, humerus, wrist, and ankle fractures, and those undergoing operative procedures for hip fractures. Findings: We found 3,714 patients (included 2,169 males and 1,545 females) with newly diagnosed IBS, and the number of the final age- and sex-matched study population was 18,570. The median follow-up duration was 85.97 and 87.48 months for males and females, respectively. The incidence of osteoporosis was higher in the IBS cohort. The Cox proportional regression model revealed that the hazard ratio [HR] for osteoporosis in patients with IBS was 1.509 (95% confidence interval [CI], 1.055-2.159) and 1.476 (95% CI, 1.241-1.754) in males and females, respectively. Furthermore, HR for osteoporotic fractures in female patients with IBS was 1.427 (95% CI, 1.086-1.876). Interpretation: Among patients with IBS 1.9% males and 11.4% females developed osteoporosis during the 7-year study period. We found a higher incidence of osteoporosis in patients with IBS than in those without, indicating an association of IBS with osteoporosis. Funding: None. Declaration of Interest: All authors have completed the ICMJE uniform disclosure form and declare: no financial relationships with any organizations that might have an interest in the submitted work i 321 n the previous three years; no other relationships or activities that could appear to have influenced the submitted work. Ethical Approval: This study was approved to be an exemption study by the Research Ethics Board of the Pusan University Hospital (E-2014090, 25th July 2014) because it was dealt with anonymous patient health records presented by HIRA. Therefore, there was no personally identifiable variable in our data and there were no need informed consents of patients in the present study.

Relationship between senile osteoporosis and cardiovascular and cerebrovascular diseases

The relationship between senile osteoporosis and cardiovascular hypertension, coronary heart disease and cerebral infarction was investigated. A retrospective study on 428 elderly patients hospitalized in Harrison International Peace Hospital from June 2014 to January 2017 was conducted. There were 207 cases of coronary heart disease, 102 cases of hypertension and 119 cases of cerebral infarction. According to bone density measurement results, the subjects were divided into the osteoporosis group and the non-osteoporosis group. Risk factors for osteoporosis were analyzed, and the incidence of osteoporosis in hypertension, coronary heart disease, and cerebral infarction populations of different severity was analyzed. Hypertension, coronary heart disease and cerebral infarction were the main risk factors for osteoporosis in the elderly. Incidence of osteoporosis in the double-vessel disease group and the three-vessel disease group was significantly higher than that in the single-vessel disease group. Incidence of osteoporosis was significantly higher in the three-vessel disease group than that in the double-vessel disease group (P<0.05). Incidence of osteoporosis was significantly higher in the moderate hypertension and severe hypertension groups than that in the mild hypertension group. Incidence of osteoporosis was significantly higher in patients with severe hypertension than that in the moderate hypertension group (P<0.05). Incidence of osteoporosis in patients with moderate cerebral infarction and severe cerebral infarction was significantly higher than that in the mild cerebral infarction group (P<0.05). Incidence of osteoporosis in patients with severe cerebral infarction was significantly higher than that in the moderate cerebral infarction group (P<0.05). The results indicated that there is a close correlation between senile osteoporosis and hypertension, coronary heart disease and cerebral infarction. Osteoporosis can be used as a predictor of early screening for hypertension, coronary heart disease and cerebral infarction in the elderly population.

Study of the incidence of osteoporosis in patients with Sjögren's syndrome (pSS) and investigation of activation of the RANKL /RANK and osteoprotegerin (OPG) system.

Primary Sjogren’s syndrome (pSS) is a common chronic autoimmune disease affecting 0.5–4.8% of the population. It is characterized by lymphocytic infiltration of exocrine glands - mainly salivary and lacrimal - resulting in oral and ocular dryness, although any organ system can virtually be affected. Among all autoimmune diseases, pSS has the highest risk for development of non-Hodgkin’s lymphoma (NHL) and approximately 10% of patients with SS associated with increased risk for B-cell lymphoma development and high mortality rates. In pSS there are various systemic manifestations; such as arthritis, rashes, Raynaud’s phenomenon, peripheral neuropathy and glomerulonephritis.1,2 While over the past few years, the importance of coexistence in the context of systemic autoimmune diseases such as subclinical atherosclerosis and osteoporosis has been extensively studied in pSS, data on the incidence and underlying pathophysiological mechanisms of osteopenia/osteoporosis are limited. In particular, osteopenia and osteoporosis levels appear to be elevated in patients with systemic autoimmune disorders, such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and systemic sclerosis.3–5 Patients with pSS display a set of clinical and serological features that could possibly lead to reduced bone remodelling and reduced bone mineral density (BMD); such as low vitamin D levels, hypercalciuria associated with underlying interstitial nephritis, steroid use, as well as coexistence with other autoimmune disorders associated with an increased risk of osteoporosis such as primary biliary cirrhosis, celiac disease and distal renal tubular acidosis (dRTA). A strong relationship between the Wingless-type signalling pathway (Wnt) and pathophysiology of osteoporosis has been recognized, as mutations in that pathway lead to reduced bone density.(6) 77 with rheumatoid arthritis (RA A recent study found reduced bone density in pSS patients compared to reduced levels of DKK1 (Dickkopf-related protein 1) in the Wnt pathway, where it may be due to inhibition of bone formation.7 Another equally important signalling pathway crucial for bone homeostasis is the molecular pathway of RANKL and osteoprotegerin (OPG).7,8 Nf-κB receptor activating factor (RANK), its ligand (RANKL) and osteoprotegerin (OPG) - all members of the cytokine tumour necrosis factor (TNF) superfamily - play an important role in bone homeostasis as principal osteoclastogenic factors.8 RANKL is expressed by syno-vial cells, bone marrow stromal cells and osteocytes, and is secreted by osteoblasts and immune cells; such as activated T cells, including Tregs and activated B cells and lymphoid tissue cells.(9–13) The expression of RANKL is modulated by various cytokines upon stimulation by memory B cells, including interleukin-1 (IL-1), IL-6, IL-11, IL-12, IL-15 and TNF-α, glucocorticoids and parathyroid hormone.12–16 Osteoprotegerin acts as a competitive antagonist receptor, which binds membrane protein RANK and soluble RANKL molecule, plays an osteoprotective role.17 RANKL prevents bone reconstruction while OPG inhibits this action, effectively promoting bone reconstruction. The RANKL / OPG ratio appears to be the key to maintaining bone homeostasis. The RANKL / RANK / OPG signalling pathway has been shown to be activated in many autoimmune disorders, such as RA and systemic lupus erythematosus (SLE), with a role in the development of bone erosions and osteoporosis.14,18,19

Prevalence of osteoporosis and osteopenia in a population of patients with inflammatory bowel diseases from the Wielkopolska Region

Introduction The incidence of osteoporosis in patients with inflammatory bowel disease (IBD) varies across different populations. Objectives The aim of this study was to evaluate the prevalence of osteoporosis in Polish patients with IBD, as well as the effect of the body mass index (BMI), disease duration, the number of hospital stays, and the use of glucocorticoids on bone mineral density (BMD). Patients and methods BMD of 208 patients with IBD (103 with Crohn disease [CD] and 105 with ulcerative colitis [UC]) and 41 healthy controls was measured using dual‑energy X‑ray absorptiometry. The association of BMD with the other parameters was analyzed using statistical methods. Results Osteoporosis of the lumbar (L2-L4) spine (T‑score) was observed in 11.7% of patients with CD and in 3.8% of those with UC, whereas that of the femoral neck (FN), in 5.8% and 2.9% of the patients with CD and UC, respectively. Osteopenia occurred in 35.9% (FN) and 36.9% (L2-L4) of CD patients, and in 25.7% (FN) and 29.5% (L2-L4) of UC patients. In CD patients, BMI was associated with lumbar and femoral BMD and with L2-L4 T‑score, whereas FN T‑score correlated with BMI. In UC patients, the cumulative glucocorticoid dose correlated with L2-L4 T‑score, FN BMD, FN T‑score, and FN Z‑score; the disease duration correlated with FN BMD, while the FN T‑score, with the number of hospital stays and FN BMD. Conclusions Osteoporosis and osteopenia are frequent in Polish patients with IBD. BMD correlated with BMI in all patients. In UC patients, BMD was associated with the cumulative glucocorticoid dose, disease duration, and number of hospital stays.

Inhaled corticosteroids can reduce osteoporosis in female patients with COPD.

BackgroundWhether the use of inhaled corticosteroids (ICSs) in patients with COPD can protect from osteoporosis remains undetermined. The aim of this study is to assess the incidence of osteoporosis in patients with COPD with ICS use and without.Patients and methodsThis is a retrospective cohort and population-based study in which we extracted newly diagnosed female patients with COPD between 1997 and 2009 from Taiwan’s National Health Insurance (TNHI) database between 1996 and 2011 (International Classification of Diseases, Ninth Revision – Clinical Modification [ICD-9-CM] 491, 492, 496). The patients with COPD were defined by the presence of two or more diagnostic codes for COPD within 12 months on either inpatient or outpatient service claims submitted to TNHI. Patients were excluded if they were younger than 40 years or if osteoporosis had been diagnosed prior to the diagnosis of COPD and cases of asthma (ICD-9 CM code 493.X) before the index date. These enrolled patients were followed up till 2011, and the incidence of osteoporosis was determined. The Cox proportional hazards regression model was also used to estimate hazard ratios (HRs) for incidences of lung cancer.ResultsTotally, 10,723 patients with COPD, including ICS users (n=812) and nonusers (n=9,911), were enrolled. The incidence rate of osteoporosis per 100,000 person years is 4,395 in nonusers and 2,709 in ICS users (HR: 0.73, 95% confidence interval [CI]: 0.63–084). The higher ICS dose is associated with lower risk of osteoporosis (0 mg to ≤20 mg, HR: 0.84, 95% CI: 0.69–1.04; >20 mg to ≤60 mg, HR: 0.78, 95% CI: 0.59–1.04; and >60 mg, HR: 0.72, 95% CI: 0.55–0.96; P for trend =0.0023) after adjusting for age, income, and medications. The cumulative osteoporosis probability significantly decreased among the ICS users when compared with the nonusers (P<0.001).ConclusionFemale patients with COPD using ICS have a dose–response protective effect for osteoporosis.

Risk Factors and Cumulative Incidence of Osteoporosis in Patients With Ulcerative Colitis: A Population-Based Study

Risk Factors and Cumulative Incidence of Osteoporosis in Patients With Ulcerative Colitis: A Population-Based Study

Su1265 Risk Factors and Cumulative Incidence of Osteoporosis in Patients With Crohn's Disease: A Population-Based Study

Su1265 Risk Factors and Cumulative Incidence of Osteoporosis in Patients With Crohn's Disease: A Population-Based Study

Bone mineral density evaluation among patients with neuromuscular scoliosis secondary to cerebral palsy

ObjectiveTo evaluate bone mineral density among patients with neuromuscular scoliosis secondary to quadriplegic cerebral palsy. MethodsThis was a descriptive prospective study in which both bone densitometric and anthropometric data were evaluated. The inclusion criteria used were that the patients should present quadriplegic cerebral palsy, be confined to a wheelchair, be between 10 and 20 years of age and present neuromuscular scoliosis. ResultsWe evaluated 31 patients (20 females) with a mean age of 14.2 years. Their mean biceps circumference, calf circumference and body mass index were 19.4cm, 18.6cm and 16.9kg/m2, respectively. The mean standard deviation from bone densitometry was −3.2 (z-score), which characterizes osteoporosis. ConclusionThere is high incidence of osteoporosis in patients with neuromuscular scoliosis secondary to quadriplegic cerebral palsy.

Predictors of iatrogenic lateral wall fractures while treating intertrochanteric fracture femur with the dynamic hip screw system in Indian patients.

The integrity of the lateral wall has been reported to be an important factor determining fracture stability in an intertrochanteric fracture. Iatrogenic the lateral wall fracture (ILWF) has been reported while reaming for the lag screw and the barrel of the dynamic hip screw (DHS). This study aimed to identify the predictors of iatrogenic lateral wall fractures (ILWF) while using the DHS, which will help to improve the pre-operative planning and avoid their incidence. A total of 120 adult patients with intertrochanteric fracture femur treated with the DHS were included in this prospective series. Pre-operatively, the parameters noted were the demographic data, quality of bone using Singh's index, fracture classification using AO/OTA and modified Evan's system. The incidence of ILWF was recorded immediately after the fixation with the DHS. The two groups, i.e. one with ILWF and other without ILWF, were compared. The mean age of 46 females and 74 men in the study was 61years. Among 120 patients, 87 (72.5%) patients had a posterior sag that had to be corrected while passing the guide wire and while reaming the neck of femur. The incidence of ILWF was 23.33%. The incidence of osteoporosis in patients with unstable fracture was 66.67%. 1.7% patients with a stable AO/OTA A1 fracture had ILWF, as compared to 50% of patients with type A2.2 and type A2.3 who sustained an ILWF (p<0.0001). None of the patients with a 2-part fracture on modified Evan's classification had ILWF, while 53.84% with a 4-part fracture had ILWF (p<0.01). There is a high risk of ILWF using the DHS in unstable intertrochanteric fractures (AO type A2.2 and A2.3 or 4-part fracture patterns). IV (case series).

Assessment of bone density in patients with scoliosis neuromuscular secondary to cerebral palsy

OBJECTIVE: To evaluate bone mineral density in patients with neuromuscular scoliosis secondary to spastic quadriplegic cerebral palsy. METHODS: A prospective descriptive study in which, in addition to bone densitometry, the anthropometric data of the patients were assessed. As inclusion criterion we adopted patients with spastic quadriplegic cerebral palsy, wheelchair users, aged between 10 and 20 years and with neuromuscular scoliosis. RESULTS: We evaluated 31 patients, 20 female, whose average age was 14.2 years. The mean bone density was -3.2 standard deviation (Z-score), with mean biceps circumference of 19.4 cm, calf circumference 18.6 cm and BMI of 13.6 kg/m². CONCLUSION: There is a high incidence of osteoporosis in patients with neuromuscular scoliosis secondary to spastic quadriplegic cerebral palsy.

Avaliação da densidade mineral óssea em pacientes portadores de escoliose neuromuscular secundária a paralisia cerebral

Objectiveto evaluate bone mineral density among patients with neuromuscular scoliosis secondary to quadriplegic cerebral palsy. Methodsthis was a descriptive prospective study in which both bone densitometric and anthropometric data were evaluated. The inclusion criteria used were that the patients should present quadriplegic cerebral palsy, be confined to a wheelchair, be between 10 and 20 years of age and present neuromuscular scoliosis. Resultswe evaluated 31 patients (20 females) with a mean age of 14.2 years. Their mean biceps circumference, calf circumference and body mass index were 19.4cm, 18.6cm and 16.9kg/m2, respectively. The mean standard deviation from bone densitometry was –3.2 (z‐score), which characterizes osteoporosis. Conclusionthere is high incidence of osteoporosis in patients with neuromuscular scoliosis secondary to quadriplegic cerebral palsy.

Osteoporosis as a risk factor for the recurrence of benign paroxysmal positional vertigo

Benign paroxysmal positional vertigo (BPPV) frequently occurs in females over 50 years old, suggesting that a postmenopausal decrease in estrogen secretion might be involved in its onset. An estrogen deficiency is generally known to cause osteoporosis through a reduction in bone mass. This study was designed to investigate a clinical association between idiopathic BPPV and osteoporosis. Case-control study. We measured the bone mineral density (BMD) at the lumbar vertebrae in 61 patients with idiopathic BPPV who were postmenopausal women over 50 years old using dual-energy x-ray absorptiometry. After being treated with the canalith repositioning maneuver, the patients were followed up for at least 1 year. Our results showed that the incidence of osteoporosis in patients with BPPV was 26.2%, which was similar to those observed in epidemiological surveys conducted in Japan. However, we found that in BPPV patients with osteoporosis, the incidence of recurrence was 56.3%, which was significantly higher than that observed in patients with normal bone mineral density (16.1%). Furthermore, the frequency of BPPV recurrence increased as BMD decreased. These results suggest that osteoporosis is a risk factor for BPPV recurrence. The prognosis of BPPV might be clinically predicted by BMD reduction.

Bone tissue metabolism in men with ankylosing spondylitis

The aim of the study was the composite estimation of bone tissue metabolism in ankylosing spondylitis (AS) after having taken into account such factors as a high risk of incidence of osteoporosis in patients with AS and potential danger of permanent immobility. Sixty-six patients with established diagnosis of AS and 63 healthy individuals in the control group were included into the study. To measure bone mineral density (BMD) the dual energy X-ray absorptiometry (DEXA) method was used. Additionally, biochemical markers of osteoporosis such as bone fraction of an alkaline phosphatase (BALP), osteocalcin (BGP) and deoxypyridinoline (Dpd) as well as many inflammatory markers of disease activity have been determined. In our study with AS had significantly diminished bone mineral density, as compared with health controls. The presence of osteopenia/osteoporosis was associated with longer duration of the disease and with higher age. In the overall group of AS patients bone degradation marker, Dpd, correlated with serum concentration of interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha) and C-reactive protein (CRP), and inversely with BMD measured in the forearm. However, no direct association could be revealed between lower bone density and markers of inflammation or inflammatory cytokines, except of IL-6 witch was significantly higher in AS patients with osteoporosis/osteopenia than those without. Our results indicate that disease duration and higher age are risk factors for osteoporosis in patients with AS. Inflammation might contribute to the accelerated bone loss in AS through stimulation of bone degradation.