Lower Lumbar Spine Bone Mineral Density Research Articles

Biochemical Markers and Health Behavior Related with Bone Mineral Density in Adult Men

Background: More than half of the causes of male osteoporosis is due to secondary osteoporosis. Therefore, it is important to detect and modify its related factors. The aim of this study was to fi nd related lifestyle factors and biochemical markers with low bone mineral density (BMD) in Korean men. Methods: A cross-sectional analysis was performed in men aged 40-69 years who visited a hospital for health checkup from January to March 2007. BMD was measured at proximal femur and lumbar spine by dual energy x-ray absorptionmetry. Lifestyle factors were estimated by a self-administered questionnaire and fasting glucose, uric acid, gamma glutamyltransferase, alkaline phosphatase, creatinine, free testosterone, 25-OH vitamin D, urine deoxypyridinoline, osteocalcin were measured. Multivariate logistic regression was used to fi the association to the lowest tertile of BMD. Results: A total of 152 subjects were included. After multivariate analysis adjusted with age, BMI, smoking, alcohol and exercise, different factors were correlated with low bone density in each site of femoral neck and lumbar spine. Factors correlated at both sites were BMI and exercise; lower BMI and doing no exercise increased risks of low bone density. Increasing age and alcohol intake ≥ 14 drinks/week were associated with lower BMD at femoral neck. The factors associated with lower lumbar spine BMD only were lower level of uric acid and higher level of urine deoxypyridinoline. Conclusion: Different factors were associated with low bone density at femoral neck and lumbar spine in men. BMI and exercise were related in both sites; age, alcohol intake, uric acid and deoxypyridinoline were related on either site.

Predictors of Osteopenia/Osteoporosis in Children with Acute Lymphoblastic Leukemia.

Background: Loss of bone mineral is a major problem in children with acute lymphoblastic leukemia (ALL), resulting in acute and chronic morbidity. About 30–40% of children with ALL will develop osteopenia/osteoporosis (OP) and about 10–15% will suffer from fractures. Identifying a population at high risk for OP is important to implementing a preventive strategy (e.g. biphosphonate therapy). So far predictors of OP in association with ALL in children are uncertain. Hence we undertook the following study to evaluate predictors of OP in children with ALL treated according to Dana-Farber Cancer Institute protocols.Aim: To evaluate the relationship between lumbar spine bone mineral density (LS-BMD) Z scores in patients with ALL during maintenance therapy and the variables of age at diagnosis (< 10 vs. ≥ 10-years), risk group [Standard (SR) vs. high-risk (HR)], gender (male vs. female) and LS-BMD at diagnosis.Methods: Children (≤ 18-years) diagnosed with ALL during the period 1995–2006 who were in first clinical remission, were included in the study. LS-BMD was measured using dual-energy X-ray absorptiometry (DEXA) at the time of diagnosis (n=88) and during the maintenance phase of therapy (n=119). The actual values of LS-BMD were expressed as age and gender matched Z-scores based on local population norms. Regression analyses were used to evaluate the risk of osteopenia, defined as LS-BMD Z score < -1.00, and osteoporosis, defined as LS-BMD Z score < -2.00. We evaluated the effect of age at diagnosis, gender, ALL risk category and LS-BMD at diagnosis on the LS-BMD during maintenance phase of therapy.Results: Of the 119 patients, 19 (16%) were ≥ 10-years of age, 46 (39%) were girls and 41 (34.5%) had HR ALL. At diagnosis 29 of 88 (33%) patients had osteopenia and 6 (6.8%) had osteoporosis whereas, during maintenance therapy, 47/119 patients (39.5%) had osteopenia and 10 (8.4%) patients had osteoporosis. LS-BMD at diagnosis had a positive linear relationship with LS-BMD during maintenance therapy (Pearson correlation coefficient 0.721, p<0.001). Older children and children with HR ALL had a significantly higher risk of osteopenia compared to younger children (p=0.01) and children with SR ALL (p=0.019). Age and risk category were confounding variables since all children ≥ 10 years were classified as HR ALL. Gender by itself had no significant effect. However, the effect of age on the LS-BMD during maintenance phase was gender-dependent with older girls having lower LS-BMD compared to older boys.Conclusions: Osteopenia and osteoporosis (OP) are common in children with ALL. Age over 10-years, female gender, HR ALL and lower LS-BMD at diagnosis are predictors of lower LS-BMD during the maintenance phase of therapy. Using these variables it is feasible to develop a predictive model to define the risk of OP during the maintenance phase of therapy. Larger prospective studies will better define this risk.

Bone mineral density of overweight sedentary women chronically consuming low calcium diets

Previous reports suggest that being overweight helps preserve bone mineral density (BMD) in women. Exercise and ethnicity can also influence bone preservation. The objective of this study was to investigate the relationship between BMD and low calcium diets in overweight sedentary women. Measures of lumbar spine (LS), hip and total body BMD were obtained by DXA in 3 African American and 5 Caucasian females between the ages of 33–43. Two dietary recalls were obtained by a multi‐pass approach using Nutrition Data System software. Mean body mass index was 28.2 ± 0.6 kg/m2. LS BMD was 1.28 ± 0.04 g/cm2 with a T‐Score of 0.7 ± 0.3. Total body BMD was 1.22 ± 0.03 g/cm2 and total hip BMD was 1.04 ± 0.04 g/cm2. Mean BMDs were within normal limits. T‐Scores for total body BMD and total hip BMD were 1.2 ± 0.3 and 0.3 ± 0.3 respectively. Mean calcium intake was 533 ± 50 mg/d. Correlations were examined between calcium intake and LS BMD (r = −0.65; p = 0.08), total hip BMD (r = −0.34; p = 0.41), and total body BMD (r = −0.51; p = 0.20). Until we attain our larger, final sample size, these data suggest a trend toward a relationship between low calcium intake and low LS BMD in a diverse ethnic sample. While these findings are preliminary in nature, they suggest that being overweight may not protect LS BMD when calcium intake is low in sedentary women. Exercise and adequate calcium intake remain prudent strategies for osteoporosis prevention.

Remarkable increase in lumbar spine bone mineral density and amelioration in biochemical markers of bone turnover after parathyroidectomy in elderly patients with primary hyperparathyroidism: a 5-year follow-up study

We evaluated the efficacy of parathyroidectomy (PTX) on bone mineral density (BMD) and hormonal and biochemical markers of bone metabolism in elderly primary hyperparathyroidism (PHPT) patients, and followed these patients for 5 years after PTX. Eleven PHPT patients were enrolled and were followed for 5 years by measuring lumbar spine BMD (LSBMD), femoral BMD (FBMD), radial BMD (RBMD), parathyroid hormone (PTH), 1,25-dihydroxyvitamin D [1,25(OH)(2)D], serum calcium (SCa), inorganic phosphate (iP), bone-specific alkaline phosphatase (BAP), intact osteocalcin (IOC), urinary excretion of type I collagen cross-linked N-telopeptide (NTx), and urinary deoxypyridinoline (DPD). PTX produced significant increases in LSBMD of 12%, 19%, and 29% as compared with pretreatment levels after 1, 3, and 5 years, respectively (P < 0.01, compared to baseline), whereas there was no significant increase in FBMD and a slight decrease in RBMD. SCa and iP levels remained normal over the five years. PTX also resulted in significant decreases in PTH, 1,25(OH)(2)D, BAP, IOC, NTx, and DPD that continued for at least 3 years after PTX. In conclusion, PTX seemed effective to normalize various markers of bone metabolism in elderly PHPT patients and is recommended to patients with low LSBMD to prevent future fractures. On the other hand, the use of PTX for low FBMD or RBMD patients requires further discussion.

Vitamin D Receptor 3′ Haplotypes Are Unequally Expressed in Primary Human Bone Cells and Associated With Increased Fracture Risk: The MrOS Study in Sweden and Hong Kong

The VDR is a prime candidate gene for osteoporosis. Here, we studied three common VDR haplotypes in relation to bone phenotypes in 5014 participants of the global MrOS Study. We also studied the relative expression of the haplotypes in human bone cells. One haplotype was associated with increased fracture risk and differently expressed in primary human bone cells. Vitamin D plays an essential role in skeletal metabolism by binding to its nuclear steroid receptor, the vitamin D receptor (VDR). The heritability of BMD is well established, and the VDR gene is considered a prime candidate suggested to partially account for genetically controlled BMD variance in the population. Here, we reconstructed common haplotypes in the VDR 3' untranslated region (UTR) and studied the association to BMD and risk of vertebral fractures in elderly men from Sweden (n = 3014) and Hong Kong (n = 2000), all participants of the global MrOS Study. To assess any functional implications of the VDR polymorphisms, we studied allele-specific expressions of the different VDR 3' UTR haplotypes in the normal chromosomal context of 70 unrelated human trabecular bone samples. This was performed by quantitative genotyping of coding polymorphisms in RNA samples and in corresponding DNA samples isolated from the bone samples. Three major haplotypes were reconstructed and in agreement with the previously well-defined baT, BAt, and bAT haplotypes, herein denoted Hap1, Hap2, and Hap3. The Hap1 haplotype was independently associated with increased risk of vertebral fractures in Swedish men (OR, 1.655; 95% CI, 1.146-2.391; p < 0.01) and with lower lumbar spine BMD in elderly men from Sweden (p < 0.01) and Hong Kong (p < 0.05). The VDR gene was also shown to exhibit a 3' UTR haplotype dependent allelic imbalance, indicating that the VDR Hap1 allele was overexpressed in human trabecular bone samples. The results indicate that the relatively overexpressed VDR Hap1 haplotype could be considered a risk allele for osteoporosis regardless of ethnicity.

Low lumbar spine bone mineral density in both male and female endurance runners

There have been many reports of low bone mineral density (BMD) in female endurance runners. Although there have been several reports of low BMD in male runners, it is unclear how comparable the problem is to that in females. We compared BMD between male and female endurance runners and with a reference population. One hundred and nine endurance runners (65 females, 44 males) aged 19–50 years participated and had been training regularly for at least 3 years (32–187.2 km week −1) in events from 3 km to the marathon. BMD was measured at the lumbar spine (L2–L4) and hip by DXA. A questionnaire assessed training and menstrual status. Lumbar spine T scores were similar in male and female runners (−0.8 (0.8) versus −0.8 (0.7); f = 0.015; P = 0.904) as were total hip T scores (0.6 (7.9) versus 0.5 (9.2); f = 0.192; P = 0.662). The proportion of male runners with low lumbar spine BMD (<−1.0) ( n = 16 from 44) compared to that of females ( n = 27 from 65) ( P = 0.675). Males had lower spine T scores than eumenorrhoeic females (−0.8 (0.7) versus −0.4 (0.7); f = 5.169; P = 0.03). There were moderate negative correlations between weekly running distance and lumbar spine BMD in males and females ( r 2 = 0.267; 0.189; P < 0.001), independent of menstrual status in females ( r 2 = 0.192; P < 0.001). Lumbar spine but not hip T scores were greater in runners who participated in resistance training at least twice-a-week (male: −0.4 versus −1.1; female: −0.5 versus −1.1; P < 0.01). Using multiple regression, running distance (−) and BMI (+) together best predicted lumbar spine T scores ( r 2 = 0.402; P < 0.01) in females. Although weak, BMI (+) best predicted hip T scores ( r 2 = 0.167; P < 0.05). In males, running distance and training years (−) together best predicted lumbar spine T scores ( r 2 = 0.400; P < 0.01). Training years (−) best predicted hip T scores ( r 2 = 0.361; P < 0.01). To conclude, our findings suggest that male runners face the same bone threat at the spine, as female runners. Further research in male athletes is required. Incorporation of regular resistance training into an athlete's training programme may be a useful preventative strategy.

Guidelines on the diagnosis and management of multiple myeloma 2005

In 2001, guidelines for the diagnosis and management of myeloma were published by the Guidelines Working Group of the UK Myeloma Forum (UKMF) on behalf of the British Committee for Standards in Haematology (BCSH) (UK Myeloma Forum; British Committee for Standards in Haematology, 2001). That same year, the second edition of guidelines prepared by the Nordic Myeloma Study Group (NMSG) in 1995 was issued (in the Scandinavian languages; http:// www.myeloma-nordic.org). As both sets of guidelines were intended to be evidence based, it was reassuring to note that the recommendations were similar. Subsequently, informal contact between members of the two groups led to the decision to prepare these common, updated guidelines. These revised and updated guidelines include new sections on imaging and the management of skeletal disease, cover new developments in disease classification and staging and the use of new therapeutic approaches, such as thalidomide, bortezomib and reduced-intensity allogeneic transplantation. The guidelines are presented in specific sections as follows:

Prevalence of low trauma fractures in long-term kidney transplant patients with preserved renal function

We evaluated the prevalence of low bone mineral density (BMD) and osteoporotic fractures in kidney transplantation (KT) patients and determined risk factors associated with osteoporotic fractures. The study was conducted on 191 patients (94 men and 97 women) with first KT for 3 years or more presenting stable and preserved renal function (serum creatinine levels lower than 2.5 mg/dl). KT patients were on immunosuppressive therapy and the cumulative doses of these drugs were also evaluated. BMD was determined by dual-energy X-ray absorptiometry at multiple sites (spine, femur and total body). Quantitative ultrasound of the calcaneus (broadband ultrasound attenuation, speed of sound, and stiffness index, SI) was also performed. Twenty-four percent (46) of all patients had either vertebral (29/46) or appendicular (17/46) fractures. We found osteoporosis and osteopenia in 8.5-13.4 and 30.9-35.1% of KT patients, respectively. Women had more fractures than men. In women, prevalent fractures were associated with diabetes mellitus [OR = 11.5, 95% CI (2.4-55.7)], time since menopause [OR = 3.7, 95% CI (1.2-11.9)], femoral neck BMD [OR = 1.99, 95% CI (1.4-2.8)], cumulative dose of steroids [OR = 1.1, 95% CI (1.02-1.12)] and low SI [OR = 1.1, 95% CI (1.0-1.2)]. In men, fractures were associated with lower lumbar spine BMD [OR = 1.75, 95% CI (1.1-2.7)], lower SI [OR = 1.1, 95% CI (1.03-1.13)], duration of dialysis [OR = 1.3, 95% CI (1.13-2.7)], and lower body mass index [OR = 1.24, 95% CI (1.1-1.4). Our results demonstrate high prevalence of low BMD and osteoporotic fractures in patients receiving a successful kidney transplant and indicate the need for specific intervention to prevent osteoporosis in this population.

Bone mineral density in men with genetic hemochromatosis and HFE gene mutation

Genetic hemochromatosis (GH) is an iron overload disorder mainly due to the C282Y mutation of the HFE gene. The possibility of bone involvement was only recently recognized. The aims of this study were to assess bone mineral density (BMD) and bone remodeling in men with GH, and to examine the influence of iron overload. Thirty-eight men (mean age 47.2+/-9.4 years) with well-defined HFE-related GH were studied. They had an important iron overload with liver iron concentration to age ratio >2.5, no previous venesection therapy and were C282Y homozygotes (n=37) or compound C282Y/H63D heterozygote (n=1). BMD measured by DXA was 0.925+/-0.15 g/cm2 at the lumbar spine (LS) and 0.778+/-0.13 g/cm2 at the femoral neck (FN). Osteopenia (T-score<-1 SD) was observed in 78.9% of patients and osteoporosis (T-score<-2.5 SD) in 34.2%. Vitamin D levels were normal, and no 1-84 parathyroid hormone dysfunction was found. Hypogonadism was found in only 13.2% of patients. Patients with hypogonadism had lower LS BMD than eugonadal patients (0.788+/-0.16 and 0.954+/-0.14 g/cm2). Bone remodeling and parathyroid hormone levels were lower in patients with cirrhosis, but BMD values were similar to those in patients without cirrhosis. FN BMD appeared to fall with rising hepatic iron concentrations (r=-0.399). We conclude that there is significant bone loss in HFE-related hemochromatosis that cannot solely be explained by hypogonadism or cirrhosis. Further investigations are needed to determine the role of iron overload itself.

Effect of L-000845704, an αVβ3 Integrin Antagonist, on Markers of Bone Turnover and Bone Mineral Density in Postmenopausal Osteoporotic Women

The alphaVbeta3 integrin (vitronectin receptor) plays a pivotal role in bone resorption. We hypothesized that L-000845704, an alphaVbeta3 integrin antagonist, would potently inhibit bone resorption, thereby increasing bone mass as assessed by bone mineral density (BMD) in women with postmenopausal osteoporosis. In a multicenter, randomized, double-blind, placebo-controlled, 12-month study, 227 women (average 63 yr) with low lumbar spine or femoral neck BMD were randomly assigned to receive 100 or 400 mg L-000845704 once daily (qd), 200 mg L-000845704 twice daily (bid), or placebo. L-000845704 increased lumbar spine BMD (2.1, 3.1, and 3.5% for the 100-mg-qd, 400-mg-qd, and 200-mg-bid treatment groups, respectively, vs. -0.1% for placebo; P < 0.01 all treatments vs. placebo). Only 200 mg L-000845704 bid significantly increased BMD at the hip (1.7 vs. 0.3% for placebo; P < 0.03) and femoral neck (2.4 vs. 0.7% for placebo; P < 0.05). No L-000845704 group increased total body BMD. All doses of L-000845704 resulted in a similar approximately 42% decrease from baseline of N-telopeptide cross-links (P < 0.001 vs. placebo). L-000845704 was generally well tolerated; adverse events resulting in discontinuation from the study were relatively infrequent. In conclusion, the antiresorptive effect of the alphaVbeta3 integrin antagonist L-000845704 translated into significant increases in lumbar spine BMD. Furthermore, 200 mg L-000845704 bid provided efficacy at the hip sites. These data suggest that the alphaVbeta3 integrin antagonist L-000845704 could be developed as an effective therapeutic agent for osteoporosis.

Estrogen receptor alpha gene polymorphisms and bone mineral density in healthy children and young adults.

The accretion of peak bone mass is largely under genetic control, and one of the potential candidate genes is the estrogen receptor alpha (ERalpha) gene. The association of ERalpha gene polymorphisms with bone mineral density (BMD) was investigated in a group of 147 healthy caucasian children, adolescents, and young adults (57 boys and 90 girls) in a cross-sectional and longitudinal study. The mean age was 11.3 years (4.3-19.9 years) at baseline and 15.6 years (7.6-25.3 years) at follow-up. Lumbar spine, total body BMD, and body composition were measured by dual energy X-ray absorptiometry and expressed as age- and sex-adjusted standard deviation scores (SDS). We analyzed two restriction fragment length polymorphisms, Pvull and Xbal, and haplotypes thereof. Subjects homozygous for haplotype 1 (px) (33% of the population) had 0.4 SD (standard deviation) lower lumbar spine BMD (P = 0.02) and bone mineral apparent density (BMAD) (P = 0.04) than those heterozygous or noncarriers for haplotype 1 (px) at baseline. Analysis of the follow-up data gave similar results. The association was stronger for the prepubertal than for the postpubertal subjects. Vertebral width SDS, total body BMD SDS, height SDS, body mass index SDS, lean body mass SDS, and percentage fat SDS did not significantly differ between the haplotypes. The age of menarche was not related to any of the haplotypes in girls. The present study shows that Pvull-Xbal ERalpha gene polymorphism is associated with BMD during childhood.

Severe bone disease and low bone mineral density after juvenile renal failure

Little is known about the late effects of juvenile end-stage renal disease (ESRD) on bone integrity. To establish clinical manifestations of metabolic bone disease and bone mineral density (BMD) in young adult patients with juvenile ESRD, we performed a long-term outcome study. A cohort was formed of all Dutch patients with onset of ESRD between 1972 and 1992 at age 0 to 14 years, born before 1979. Data were collected by review of medical charts, current history, physical examination, and performing dual energy x-ray absorptiometry (DEXA) of the lumbar spine and the femoral neck. Clinical information was retrieved in 247 out of 249 patients. Of all of these patients, 61.4% had severe growth retardation (<-2 SD), 36.8% had clinical symptoms of bone disease, and 17.8% were disabled by bone disease. Growth retardation and clinical bone disease were associated with a long duration of dialysis. DEXA was performed in 140 out of 187 living patients. Mean BMD +/- SD corrected for gender and age (Z score) of the lumbar spine was -2.12 +/- 1.4 and of the femoral neck was -1.77 +/- 1.4. A low lean body mass was associated with a low lumbar spine and a low femoral neck BMD; male gender, physical inactivity and aseptic bone necrosis were associated with a low lumbar spine BMD. Bone disease is a major clinical problem in young adults with pediatric ESRD. Further follow-up is needed to establish the impact of the low bone mineral densities found in these patients.

Relationships Between Bone Mineral Density and Incident Vertebral Fracture Risk With Raloxifene Therapy

Low bone mineral density (BMD) in osteoporotic patients predicts an increased risk of bone fracture, but it is not clear whether increasing BMD in those given antiresorptive drugs predicts a reduced risk. The investigators explored this relationship after 1 or 3 years of treatment with raloxifene or placebo in 7705 postmenopausal women with osteoporosis who participated in the MORE (Multiple Outcomes of Raloxifene Evaluation) trial. Raloxifene was given in a daily dose of 60 or 120 mg. Logistic regression models were used to relate baseline BMD and changes in BMD to the risk of new vertebral fractures (Figs. 1 and 2). All women received supplemental calcium and vitamin D. BMD was estimated by dual-energy x-ray absorptiometry in the femoral neck and lumbar spine at yearly intervals. The risk of a new vertebral fracture was greatest in women having the lowest baseline BMD values at either measurement site. Raloxifene reduced the risk of incident vertebral fractures by 41% compared with the placebo group, regardless of baseline BMD at the femoral neck, but women with relatively low baseline lumbar spine BMD had the most marked reduction in fracture risk from raloxifene. After 3 years, raloxifene therapy was associated with increases of only 2% to 3% in BMD. Raloxifene-treated women had a significantly lower risk of spinal fracture than placebo patients regardless of the change in femoral neck BMD, and they also had a lower fracture risk at any percentage change in lumbar spine BMD. At the 75th percentile of the population, with a 6.1% increase in lumbar spinal BMD, the risk of incident vertebral fracture was reduced 52% by raloxifene therapy. With lesser increases in lumbar spine BMD at the 25th and 50th centiles, raloxifene lowered the risk of incident spinal fracture by 39% and 46%, respectively. These findings indicate that the percentage change in BMD in postmenopausal women treated with raloxifene account for only 4% of the observed reduction in risk of vertebral fracture. Not unexpectedly, changes in BMD during treatment are a poor predictor of risk reduction.

Bone mineral density in adolescent girls with anorexia nervosa--a cross-sectional study.

The total body and lumbar spine bone mineral density (BMD) were measured in order to determine the prevalence and possible risk factors of decreased BMD in anorexia nervosa (AN). Sixty-one in-patient girls with DSM III-R AN: age 14.7+/-2.16 years; duration of AN 12.9+/-15.1 months; percentage of ideal body weight 70+/-8.7%; body mass index score -1.62+/-0.79. Total body (in 61 patients) and lumbar spine BMD (in 43 patients), content of lean and fat tissue mass were measured by DXA during the first month of treatment. Low total body BMD was found in 23.7% and low lumbar spine BMD in 36.6% of patients. There was a negative correlation between BMD and age, age of menarche, degree of undernourishment, duration of AN and amenorrhea. A step-wise linear regression analysis revealed that age of menarche was the most important factor related to BMD in this group.

Bone mineral density and quantitative ultrasound in adults with cystic fibrosis.

With increasing life span osteoporosis becomes a more recognized problem in patients with cystic fibrosis (CF). The aim of this cross-sectional study in 75 adult patients with CF (mean age 25.3 years) was to assess the prevalence of low bone mineral density (BMD) by dual-energy x-ray absorptiometry (DEXA) and, for the first time, by quantitative ultrasound (QUS), and to identify predicting factors. Bone status was assessed at the lumbar spine (L2-L4) and the femoral neck by DEXA, and at the calcaneus by QUS (stiffness index). These data were correlated with a variety of clinical and anthropomorphic variables. Biochemical markers of bone turnover such as osteocalcin, bone-specific alkaline phosphatase, crosslinks in urine, 25-hydroxy vitamin D (25-OH vitamin D), parathyroid hormone, calcium and free testosterone were determined by standard assays. The mean BMD T score (+/-s.e.m.) was -1.4+/-0.17 at the lumbar spine, and -0.54+/-0.16 at the femoral neck. The mean T score of the calcaneal stiffness index was -0.83+/-0.19. Based on a lumbar spine T score <-2.5 by DEXA, 27% of the patients had osteoporosis. Multiple regression analysis showed that the forced expiratory volume in one second (FEV1) and the use of oral glucocorticoids were independent predictors of low lumbar spine BMD, whereas body mass index (BMI) and the use of oral glucocorticoids were independent predictors of low femoral neck BMD. The stiffness index correlated moderately with BMD (0.49-0.62, P<0.0001). QUS had a sensitivity and specificity of only 57% and 89% respectively for diagnosing 'osteoporosis' (based on a femoral neck T score <-2.5 by DEXA). Positive and negative predictive values were 36% and 95% respectively. Low BMD is frequent in adults with CF and is most strongly correlated with disease severity (BMI, FEV1) and the use of glucocorticoids. Calcaneal QUS might help to screen out patients with a normal BMD, but sensitivity and specificity were not sufficiently high to replace DEXA in these patients.

Bone mass after long-term euthyroidism in former hyperthyroid women treated with (131)I influence of menopausal status.

The objective of this study was to assess bone mineral density (BMD) and bone markers in former hyperthyroid females after long-term euthyroidism (>4 yr) following (131)I therapy, as well as the potential influence of the timing of menopause. Twenty-six females ages 57 +/- 8 yr previously diagnosed with hyperthyroidism and treated with (131)I who were euthyroid for a minimum of the last 4 yr (10 +/- 5 yr) were studied. Eighteen patients (69%) were on levothyroxine (LT(4)) replacement therapy for 9 +/- 4 yr. BMD (g/cm(2) and Z-score) was measured by dual X-ray absorptiometry in the lumbar spine, femoral neck, and Ward's triangle. BMD (Z-score) was lower than the normal reference values for the Spanish population in all sites (lumbar spine: -0.65 +/- 1.13; femoral neck: -0.47 +/- 0.95; Ward's triangle: -0.37 +/- 0.88). No differences were found between BMD values according to the etiology of the hyperthyroidism or current LT(4) therapy. Current postmenopausal patients (n = 21) showed lower BMD than current premenopausal patients in the lumbar spine and femoral neck (p < 0.05). Those women who were postmenopausal at the time of the (131)I therapy (n = 15) also had lower lumbar spine BMD than premenopausal patients (p = 0.01), while no significant difference in BMD was seen according to the menopausal status when hyperthyroidism was diagnosed. Former hyperthyroid patients after long-term euthyroidism following (131)I therapy showed reduced BMD at the lumbar spine and proximal femur. Menopausal women showed a greater reduction in bone density. The menopausal status at the time of diagnosis did not seem to have long-term effects in bone density; nevertheless, an early therapeutic intervention in premenopause is suggested to reduce bone loss.

Bone mineral density in children with acute lymphoblastic leukaemia

Bone mineral density (BMD) may be negatively affected by the disease or its treatment in patients with acute lymphoblastic leukaemia (ALL). Therefore, we evaluated lumbar spine and total body BMD and bone metabolism in children with ALL at diagnosis, during treatment with chemotherapy and 1 year after completion of treatment. 32 children (21 boys and 11 girls) participated in the study. 14 children started the study at diagnosis and 18 during or after the treatment period. Lumbar spine and total body BMD were measured with dual energy X-ray absorptiometry, and expressed as standard deviation scores (SDS). Blood samples were obtained to assess bone metabolism. 3 of 14 children had low lumbar spine BMD (<−2 S.D.) at diagnosis. All children had normal total body BMD. Markers of bone turnover were depressed. Total body BMD SDS decreased significantly during the first year of treatment ( P<0.001). Lumbar spine BMD SDS did not change significantly. Parameters of bone turnover increased to normal during the treatment period. Parathyroid hormone had increased significantly after 1 year ( P<0.05). Mineral homeostasis was disturbed in some patients during treatment. 4 of 9 patients had low total body BMD and 1 patient low lumbar spine BMD one year after completion of treatment. All patients had normal biochemical results at that time. In conclusion, lumbar spine BMD and bone turnover were decreased in some patients at diagnosis. Total body BMD decreased significantly during treatment and was low in 4 of the 9 patients 1 year after completion of the treatment.

Risk factors for vertebral fractures in renal osteodystrophy.

We determined the prevalence of vertebral fractures in hemodialysis (HD) patients, investigated whether low bone mineral density (BMD) is predictive of vertebral fracture, and evaluated the effect of serum intact parathyroid hormone (iPTH) and alkaline phosphatase (ALP) levels on vertebral fracture. One hundred eighty-seven male HD patients were assessed for vertebral fractures, and lumbar-spine and total-body BMD were measured by dual-energy x-ray absorptiometory. Thirty-nine patients (20.9%) had vertebral fractures. Each standard deviation (SD) decrease in lumbar-spine BMD increased the age-adjusted odds ratio of vertebral fracture 2.0 times (95% confidence interval [CI], 1.4 to 2.0) and 1.6 times (95% CI, 1.1 to 1.6) for total-body BMD. The area under the receiver operating characteristic curve for lumbar-spine BMD was significantly greater than that for total-body BMD (P < 0.05). Patients with serum iPTH levels in the lowest tertile had a 2.4-fold greater risk for vertebral fracture than those in the middle tertile and a 1.6-fold greater risk than those in the highest tertile (P < 0.05). When the two criteria of lowest tertile of serum iPTH level and highest tertile of serum ALP level were combined, the prevalence of vertebral fractures was the greatest. Similarly, when the lowest tertile of serum iPTH level and lowest tertile of serum ALP level were combined, the prevalence was the second greatest among the combined groups according to tertiles of serum iPTH and ALP levels. We conclude that low lumbar-spine BMD might be a sensitive predictor of vertebral fracture in HD patients, and patients with relatively low iPTH levels would have a greater risk for vertebral fracture than those with hyperparathyroidism.

Risk factors for decreased bone density in premenopausal women.

Osteoporosis is a major health problem. Little is known about the risk factors in premenopause. Sixty 40-50-year old patients with regular menses were studied cross-sectionally. None of the patients were on drugs known to interfere with bone mass. Patients answered a dietary inquiry and had their bone mineral density (BMD) measured. The Z scores were used for the comparisons. A blood sample was taken for the determination of FSH, SHBG, estradiol, testosterone, calcium and alkaline phosphatase. Calcium and creatinine were measured in 24-h urine. A Z score less than -1 was observed for the lumbar spine of 14 patients (23.3%), and for the femur of 24 patients (40%). Patients with a Z score less than -1 for the lumbar spine were older than patients with a Z score > or = -1 (45.7 vs 43.8 years) and presented higher values of alkaline phosphatase (71.1 +/- 18.2 vs 57.1 +/- 14.3 IU/l). Multiple regression analysis showed that a lower lumbar spine BMD was associated with higher values of alkaline phosphatase, lower calcium ingestion, a smaller body mass index (BMI), less frequent exercising, and older age. The patients with a Z score less than -1 for the femur were shorter than patients with a Z score > or = -1 (158.2 vs 161.3 cm). Multiple regression analysis showed that a lower femoral BMD was associated with lower BMI, higher alkaline phosphatase and caffeine intake, and less frequent exercising. A lower than expected BMD was observed in a significant proportion of premenopausal women and was associated with lower calcium intake, relatively lower physical activity and lower BMI. We conclude that the classical risk factors for osteoporosis may be present before ovarian failure, and their effect may be partly independent of estrogen levels.

Bone mineral density in mature, premenopausal ultramarathon runners

We measured bone mineral density (BMD) in 25 premenopausal ultramarathon (56 km) runners aged 29-39 yr and related risk factors for decreased BMD with actual BMD. Fifteen runners who had never had oligo/amenorrhea (R) were compared with 10 runners (OA): 4 oligomenorrheic, 2 amenorrheic, and 4 with prior oligo/amenorrhea. Menstrual, dietary and training data were obtained. BMD of the lumbar spine (LS) and proximal femur (F) were measured by dual energy x-ray densitometry. Both groups had similar body mass (58 +/- 8 vs 57 +/- 8 kg), running and dietary histories. F BMD was not different (P = 0.07) and correlated only with BMI (P < 0.05; r = 0.43). LS BMD was lower in OA (0.946 +/- 0.098 g.cm-2) than R (1.088 +/- 0.069 g.cm-2; P < 0.001). Menstrual History Index (MHI), (estimated periods.yr-1 since age 13), was higher in R (11.6 +/- 0.6) than OA (9.4 +/- 2.1; P < 0.01). LS BMD correlated with MHI (P < 0.0005; r = 0.67) and years oligomenorrheic (P < 0.01; r = -0.58) but not years amenorrheic, parity, breastfeeding, diet, or training. In conclusion, in mature women distance runners low LS BMD is related to a history of oligo/amenorrhea regardless of resumption of regular menstrual cycles in some subjects. Not only amenorrhea, but also prolonged oligomenorrhea may negatively influence peak adult bone mass.