Lower Spine Bone Mineral Density Research Articles

Quantitative ultrasound of the tibia: A novel approach for assessment of bone status

An ultrasound instrument has recently been developed for the diagnosis and monitoring of osteoporosis (SoundScan 2000, Myriad Ultrasound Systems Ltd., Israel). The instrument measures the speed of propagation of ultrasound waves (SOS, meters per second) along a fixed longitudinal distance of the cortical layer at the tibial shaft. Its in vivo precision is 0.25%. The performance of the SoundScan 2000 was studied in 307 Caucasian women (age range 24–87 years) who also had their bone mineral density (BMD) measured at the spine, femoral neck, and radial shaft by absorptiometric techniques. The SOS ranged from 3471–4226 m/sec (mean 3867). The standardized coefficient of variation (CV), an expression of the effective clinical precision corrected for the spread of measurements (CV/[range/mean]), was 1.6% for the tibial SOS, compared to 1.5%, 3.8%, and 4.4% for spinal, femoral, and radial BMD, respectively. Tibial SOS significantly correlated with age ( r = −0.52), time since menopause ( r = −0.43), height ( r = 0.29), and weight ( r = 0.16), as well as with BMD at the radius ( r = 0.63), spine ( r = 0.50), and femur ( r = 0.47). After classification of bone measurements into textiles, about 60% of the women with low tertile spinal BMD fell within the low textile of either tibial SOS, femoral BMD, or radial BMD. The results show that measurement of tibial SOS is a precise method of assessing bone status without exposing the patient to sources of radiation.

OSTEOPOROSIS : SCREENING USING A DIGITAL IMAGE PROCESSING METHOD

A digital image processing (DIP) method has been developed as a simple and easily available means of assessing the bone mineral density (BMD) of the metacarpals. This study was conducted to examine the usefulness of the DIP method in mass-screening for osteoporosis. BMD of the metacarpals, the lumbar spine and the calcaneus were assessed by a DIP method, dual energy X-ray absorptiometry (DXA) and single X-ray absorptiometry (SXA), respectively, in 231 female residents of rural town. The presence or absence of compression fracture of the spinal column was roentagenographically studied.The BMD of the metacarpals showed a significant correlation with that of the lumbar spine and calcaneus. Coefficients of correlation between DIP values and BMD of the lumbar spine (anterior-posterior view), DIP values and that of the lateral view, and DIP values and the calcaneus BMD were 0.47, 0.39 and 0.60, respectively. A DIP value of 2.18mmAl could detect women with low lumbar spinal BMD <0.897g/cm2, which included 90% of women with compression fracture.The sensitivity and specificity of the DIP value were 65% and 72%, respectively. These results indicate that the DIP method provides an index for assessing spinal or calcaneal BMD and can be used as a criterion in screening for osteoporosis.

Vertebral deformity, bone mineral density, back pain and height loss in unscreened women over 50 years.

Bone mineral density (BMD) was measured in the lumbar spine using dual-energy X-ray absorptiometry in 222 unscreened women (aged 50-82 years), and information on back pain and historic loss of standing height was obtained at interview. Vertebral morphometry was performed on lateral spinal radiographs. The shape of the vertebral body was quantified using appropriate vertebral shape indices (VSIs), and vertebral deformities were identified using thresholds defined in terms of the means (M) and standard deviations (SD) of these VSIs for the whole group. Severity of deformity was defined as either grade 1 (M+2SD < VSI < M+3SD), grade 2 (M+3SD < VSI < M+4SD or grade 3 (VSI > M+4SD). Subjects with grade 1 vertebral deformities were older than subjects without such deformities, but did not have a reduced age-related Z-score of BMD. Grade 2 wedge and concave deformities were associated with a reduced age-related Z-score of BMD, suggesting that the aetiology of such deformities is closest to conventional concepts of 'osteoporotic fracture'. Grade 3 deformities were associated with neither increased age nor decreased BMD. Stature decreased in these subjects with age. Subjects reporting historic height loss had a higher mean number of wedge deformities. Subjects with back pain did not have a higher incidence of vertebral deformity than subjects without, confirming that many deformities were asymptomatic. Neither back pain nor historic loss of height were found to be associated with low spinal BMD.

Bone mineral mass in hip fracture patients

The aims of this study were to measure the bone mineral density (BMD) and some anthropometric variables in patients with hip fracture, to compare these data with those from controls, and to compare the fractured and unfractured hip. Bone mineral measurements with dual energy X-ray absorptiometry (DEXA) were undertaken in 93 consecutive hip fracture patients, 26 men and 67 women, with a mean age of 75 and 78 years, respectively, within 10 days after injury. We found lower BMD in most measurements in both men and women compared with age- and sex-matched controls. The body weight and lean body mass were also significantly lower in the male hip fracture patients; in women only weight was lower. In women there was lower BMD in spine and hip in those who had sustained trochanteric hip fractures compared with those with cervical fracture. No such difference was found in men. There was no difference in BMD in the hip when patients with stable and unstable fractures were compared. In the fractured and nonfractured hips we measured BMD in regions of interest. In women with trochanteric hip fractures the BMD was decreased in the fractured hip compared with the uninjured. No such difference was found for cervical fractures or in men.

女性糖尿病患者の骨塩量 ＤＥＸＡ法による評価

To investigate the frequency and etiology of diabetic osteopenia, we measured spinal bone mineral density (SBMD), total body bone mineral density (TBBMD), total body fat and lean body mass in 69 female diabetic patients (14 IDDMs and 55 NIDDMs). SBMD decreased with age in both IDDM and NIDDM, but when expressed as a percentage of age-matched normal Japanese females, some had lower SEMD, but others had normal or increased SBMD. Postmenopausal IDDM patients had lower SBMD than postmenopausal NIDDM patients. Thirteen out of 69 (18.8%) had an SBMD lower than 90% of age-matched controls. SBMD correlated positively with TBBMD. Those with lower SBMD had poor glycemic control, but there was no relation between SBMD and either duration of diabetes or presence of retinopathy and/or nephropathy. IDDM patients had lower 1.25 (OH)2D, osteocalcin than NIDDMs. SBMD correlated negatively with urinary pyridinoline and deoxypyridinoline excretion. SBMD correlated positively with body weight, and those with lower SBMD had significantly lower body mass index, body weight, fat weight and lean body mass than those with normal or increased SBMD. These results suggest that IDDM patients may be at higher risk of losing bone postmenopausally, and diabetic patients with lower SBMD have characteristics of poor diabetic control, lean habitus, low serum 1.25 (OH)2D.

Bone loss after liver transplantation

We studied 35 adult patients (mean age = 43 yr) referred for orthotopic liver transplantation. Spinal bone mineral density was measured by quantitative computed tomography scanning before transplantation (n = 35) and at 3 mo (n = 21) and 12 mo (n = 11) after orthotopic liver transplantation. The readings were corrected to age 50 yr, using the regression equations derived from normal control subjects. Quantitative bone histological studies were performed in 17 patients before orthotopic liver transplantation and 3 mo after orthotopic liver transplantation. Before orthotopic liver transplantation, the corrected spinal bone mineral density in men was 108 ± 20 mg/cm3, less than in male control subjects (129 ± 22 mg/cm3, p &lt; 0.005). In women patients the value was 117 ± 27 mg/cm3, and in female control subjects 126 ± 19 mg/cm3 (NS). However, women patients with primary biliary cirrhosis had lower spinal bone mineral density (106.5 ± 14.8) than female control subjects (p &lt; 0.005). Histologically, the resorbing surface was near the normal mean, whereas the osteoblast surface, tetracycline surface and bone formation rate was lower in men (p &lt; 0.05) but not women. Spinal bone mineral density decreased by 24% in the first 3 mo after orthotopic liver transplantation with no further decrease at 12 mo. Five patients had vertebral fractures within 6 mo of orthotopic liver transplantation. One patient fractured a wrist and three had osteonecrosis of the hip or knee. Bone histological studies 3 mo after orthotopic liver transplantation showed no change in resorbing surface but an increase in osteoblast surface from 2.1% ± 3.0% to 6.0% ± 7.0% (p &lt; 0.05), increased bone formation in men (21 ± 31 to 80 ± 96 μm2/mm2 p &lt; 0.05) and serum osteocalcin increased from 2.3 ± 0.3 pg/ml before transplantation to 5.9 ± 1.8 pg/ml (p &lt;0.05). Bone loss was related to the number of hospital days after orthotopic liver transplantation (r = 0.79, p &lt; 0.001) but not to any other factor, including prednisone and cyclosporin dose. The study shows that bone mass is reduced in men with end-stage liver failure and that considerable bone loss occurs in the first 3 mo after orthotopic liver transplantation, frequently resulting in vertebral fractures. The exact cause of the bone loss is not clear, although immobilization appears to be important, probably in combination with corticosteroid therapy. The cellular changes causing this bone loss must occur very early after orthotopic liver transplantation because by 3 mo after transplantation, increased bone formation had begun to occur. (Hepatology 1991;14:613-619.)

Bone loss after liver transplantation

We studied 35 adult patients (mean age = 43 yr) referred for orthotopic liver transplantation. Spinal bone mineral density was measured by quantitative computed tomography scanning before transplantation (n = 35) and at 3 mo (n = 21) and 12 mo (n = 11) after orthotopic liver transplantation. The readings were corrected to age 50 yr, using the regression equations derived from normal control subjects. Quantitative bone histological studies were performed in 17 patients before orthotopic liver transplantation and 3 mo after orthotopic liver transplantation. Before orthotopic liver transplantation, the corrected spinal bone mineral density in men was 108 +/- 20 mg/cm3, less than in male control subjects (129 +/- 22 mg/cm3, p less than 0.005). In women patients the value was 117 +/- 27 mg/cm3, and in female control subjects 126 +/- 19 mg/cm3 (NS). However, women patients with primary biliary cirrhosis had lower spinal bone mineral density (106.5 +/- 14.8) than female control subjects (p less than 0.005). Histologically, the resorbing surface was near the normal mean, whereas the osteoblast surface, tetracycline surface and bone formation rate was lower in men (p less than 0.05) but not women. Spinal bone mineral density decreased by 24% in the first 3 mo after orthotopic liver transplantation with no further decrease at 12 mo. Five patients had vertebral fractures within 6 mo of orthotopic liver transplantation. One patient fractured a wrist and three had osteonecrosis of the hip or knee.(ABSTRACT TRUNCATED AT 250 WORDS)