Significant Changes In Bone Density Research Articles

A numerical investigation of stress, strain, and bone density changes due to bone remodelling in the talus bone following total ankle arthroplasty

Total ankle arthroplasty is the gold standard surgical treatment for severe ankle arthritis and fracture. However, revision surgeries due to the in vivo failure of the ankle implant are a serious concern. Extreme bone density loss due to bone remodelling is one of the main reasons for in situ implant loosening, with aseptic loosening of the talar component being one of the primary reasons for total ankle arthroplasty revisions. This study is aimed at determining the performance and potential causes of failure of the talar component. Herein, we investigated the stress, strain, and bone density changes that take place in the talus bone during the first 6 months of bone remodelling due to the total ankle arthroplasty procedure. Computed tomography scans were used to generate the 3D geometry used in the finite element (FE) model of the Intact and implanted ankle. The Scandinavian Total Ankle Replacement (STAR™) CAD files were generated, and virtual placement within bone models was done following surgical guidelines. The dorsiflexion physiological loading condition was investigated. The cortical region of the talus bone was found to demonstrate the highest values of stress (5.02 MPa). Next, the adaptive bone remodelling theory was used to predict bone density changes over the initial 6-month post-surgery. A significant change in bone density was observed in the talus bone due to bone remodelling. The observed quantitative changes in talus bone density over 6-month period underscore potential implications for implant stability and fracture susceptibility. These findings emphasise the importance of considering such biomechanical factors in ankle implant design and clinical management.

Phase II Study of ENZAlutamide Combined With Hypofractionated Radiation Therapy (ENZART) for Localized Intermediate Risk Prostate Cancer.

BackgroundIntermediate-risk prostate cancer (PCa) is usually treated by a combination of external beam radiation therapy (EBRT) and a short course of androgen deprivation therapy (ADT). ADT is associated with multiple side effects, including weight gain, loss of libido, and hot flashes. In contrast, anti-androgen monotherapy is generally better tolerated in spite of higher rates of gynecomastia.ObjectiveThis study assessed the effectiveness of enzalutamide monotherapy combined with hypofractionated EBRT (Hypo-EBRT) for treating intermediate risk prostate cancer.MethodThis trial was a multicenter, open-label phase II study of 6 months of enzalutamide monotherapy combined with Hypo-EBRT for intermediate-risk prostate cancer. Hypo-EBRT was initiated 8–12 weeks after initiating enzalutamide. The primary endpoint was PSA decline >80% measured at the 25th week of enzalutamide administration. Secondary end-points included assessment of toxicity, changes in anthropomorphic body measurements, sexual hormones, and metabolic changes.ResultsSixty-two patients were included in the study from January 2018 to February 2020. A PSA decline of >80% was observed in all evaluable patients at the end of enzalutamide treatment and 92% achieved PSA values under 0.1 ngr/ml. All patients remain in PSA response (<80% reduction of the initial values) 6 months after the end of enzalutamide treatment. The most frequent adverse events were hypertension, asthenia, and gynecomastia. There were no significant changes in bone density, body mass index (BMI), or patient-reported outcomes (PROs).ConclusionEnzalutamide monotherapy is very effective along with hEBRT in reducing PSA levels for patients with intermediate-risk prostate cancer. Longer follow-up is needed to confirm the potential use of this combination in future randomized trials.

Preliminary Study on Immediate Postoperative CT Images and Values of the Modular Polyetheretherketone Based Total Knee Arthroplasty: An Observational First-in-Human Trial.

BackgroundTotal knee arthroplasty (TKA) is now frequently performed and is highly successful. However, patient satisfaction after TKA is often difficult to achieve. Because of the presence of metallic prosthetic knee joints, there is a lack of imaging tools that can accurately assess the patient's postoperative prosthetic position, soft tissue impingement, and periprosthetic bone density after TKA. We conducted a clinical trial of the world's first totally modular polyetheretherketone (PEEK) TKA and determined the bone density values in the stress concentration area around the prosthesis based on postoperative computed tomography data to reconstruct a three-dimensional model of the PEEK prosthetic knee joint after implantation. Based on the model, the overhang of the prosthesis was measured at various locations on the prosthesis.MethodsAll patients who underwent PEEK-based TKA were postoperatively assessed with radiography and computed tomography (CT). Hounsfield units (HUs) for the different components of the quantitative CT assessment were measured separately.ResultsTen patients (nine female and one male) aged 59–74 (mean 66.9, median 67) years were included. The HU values were as follows: PEEK prosthesis mean 182.95, standard deviation (SD) 4.90, coefficient of variation (CV) 2.68; polyethylene mean −89.41, SD 4.14, CV −4.63; lateral femoral osteochondral mean 192.19, SD 55.05, CV 28.64; lateral tibial osteochondral mean 122.94, SD 62.14, CV 42.86; medial femoral osteophyte mean 180.76, SD 43.48, CV 24.05; and medial tibial osteophyte mean 282.59, SD 69.28, CV 24.52. Analysis of the data at 1, 3, and 6 months showed that the mean PE (p = 0.598) and PEEK (p = 0.916) measurements did not change with the time of measurement. There was a decrease in bone mineral density in the lateral tibia at 3 months (p = 0.044). Otherwise, there was no significant change in bone density in other regions (p = 0.124–0.803). There was no overhang in all femoral prostheses, whereas there were two cases of overhang in tibial prostheses. Overhang measurements do not differ significantly across time points. The overhang measurements were not significantly different at all time points (p = 0.186–0.967).ConclusionPEEK knee joint prosthesis has excellent CT compatibility. The change in periprosthetic bone volume during the follow-up period can be determined using the HU value after CT scan, while the prosthesis position can be assessed. This assessment may potentially guide future improvements in knee prosthesis alignment techniques and artificial knee prosthesis designs.

Elevated Urate Levels Do Not Alter Bone Turnover Markers: Randomized Controlled Trial of Inosine Supplementation in Postmenopausal Women.

Observational studies have consistently demonstrated that serum urate level positively correlates with bone mineral density (BMD). We undertook this study to determine whether moderate hyperuricemia induced by inosine supplements influences bone turnover markers in postmenopausal women over a 6-month period. One hundred twenty postmenopausal women were recruited for a 6-month randomized, double-blind, placebo-controlled trial. Key exclusion criteria were osteoporosis, previous fragility fracture, bisphosphonate therapy, gout, kidney stones, and a urine pH level of ≤5.0. Participants were randomized in a 1:1 ratio to receive placebo or inosine. The coprimary end points were change in levels of N-propeptide of type I procollagen (PINP) and change in levels of β-C-telopeptide of type I collagen (β-CTX). Change in BMD, as measured by dual x-ray absorptiometry, was an exploratory end point. Administration of inosine led to a significant increase in serum urate concentration over the study period (P < 0.0001 for all follow-up time points). At week 26, the mean change in serum urate concentration was +0.13 mmoles/liter (+2.2 mg/dl) in the inosine group and 0.00 mmoles/liter (0 mg/dl) in the placebo group. There was no difference in PINP or β-CTX levels between groups over the 6 months. There were no significant changes in bone density between groups over the 6 months. Adverse events and serious adverse events were similar between the 2 groups. This clinical trial shows that although inosine supplementation leads to sustained increases in serum urate levels over a 6-month period, it does not alter markers of bone turnover in postmenopausal women. These findings do not support the concept that urate has direct biologic effects on bone turnover.

JAK2-IGF1 axis in osteoclasts regulates postnatal growth in mice.

Osteoclasts are specialized cells of the hematopoietic lineage that are responsible for bone resorption and play a critical role in musculoskeletal disease. JAK2 is a key mediator of cytokine and growth factor signaling; however, its role in osteoclasts in vivo has yet to be investigated. To elucidate the role of JAK2 in osteoclasts, we generated an osteoclast-specific JAK2–KO (Oc-JAK2–KO) mouse using the Cre/Lox-P system. Oc-JAK2–KO mice demonstrated marked postnatal growth restriction; however, this was not associated with significant changes in bone density, microarchitecture, or strength, indicating that the observed phenotype was not due to alterations in canonical osteoclast function. Interestingly, Oc-JAK2–KO mice had reduced osteoclast-specific expression of IGF1, suggesting a role for osteoclast-derived IGF1 in determination of body size. To directly assess the role of osteoclast-derived IGF1, we generated an osteoclast-specific IGF1–KO mouse, which showed a similar growth-restricted phenotype. Lastly, overexpression of circulating IGF1 by human transgene rescued the growth defects in Oc-JAK2–KO mice, in keeping with a causal role of IGF1 in these models. Together, our data show a potentially novel role for Oc-JAK2 and IGF1 in the determination of body size, which is independent of osteoclast resorptive function.

Long Term Changes in Normal Vertebral Bone Density after Radiation Therapy

Bone density is the universal measure of bone strength and integrity. Insufficiency fractures are reported after radiation therapy. The cause is uncertain, but conceptually, radiation alters the integrity of the bone. We measure bone density before and after radiation therapy of normal vertebra to test for significant change. A total of 36 patients were identified who received photon radiation therapy for spinal metastases to a field including an adjacent vertebra without an identifiable lesion with at least a year of follow up. The irradiated normal bone received a mean total dose of 28.14 Gy (range 8 – 45 Gy) and mean BED of 57.4 Gy (range 29-90 Gy). Mean follow-up imaging intervals between pre-treatment and follow-up scans was 14.5 months (range 2.3 – 34 months). Every patient had an untreated vertebra of similar type available as a control. A Hounsfield-density calibration curve was used to measure the vertebral body density before and after treatment. The region of measurement included the trabecular bone and 1/3 of the inner cortical bone to avoid bias while capturing changes in cortical bone. Sample normality was confirmed with the Shapiro-Wilk test, and a paired t-test was used to compare pre-radiation and post-radiation densities. A p < 0.05 was used to establish significance. The density of the irradiated normal bone did not significantly decrease in control or irradiated vertebra. The Shapiro-Wilk test confirmed normality with pre-treatment p = 0.057 and post-treatment p = 0.175. Control vertebra had a mean density change of -0.10% (95% CI = 0.73, p = 0.74). Irradiated bone had a mean density change if -0.94% (95% CI = 1.06, p = 0.09). We found no significant change in bone density after irradiation of normal bone, suggesting that architectural integrity is maintained. Further work is needed to elucidate more complex causes of insufficiency fractures after radiation.

Mechanical Regulation of the Maternal Skeleton during Reproduction and Lactation

This review summarizes recently published data on the effects of pregnancy and lactation on bone structure, mechanical properties, and mechano-responsiveness in an effort to elucidate how the balance between the structural and metabolic functions of the skeleton is achieved during these physiological processes. While pregnancy and lactation induce significant changes in bone density and structure to provide calcium for fetal/infant growth, the maternal physiology also comprises several innate compensatory mechanisms that allow for the maintenance of skeletal mechanical integrity. Both clinical and animal studies suggest that pregnancy and lactation lead to adaptations in cortical bone structure to allow for rapid calcium release from the trabecular compartment while maintaining whole bone stiffness and strength. Moreover, extents of lactation-induced bone loss and weaning-induced recovery are highly dependent on a given bone's load-bearing function, resulting in better protection of the mechanical integrity at critical load-bearing sites. The recent discovery of lactation-induced osteocytic perilacunar/canalicular remodeling (PLR) indicates a new means for osteocytes to modulate mineral homeostasis and tissue-level mechanical properties of the maternal skeleton. Furthermore, lactation-induced PLR may also play an important role in maintaining the maternal skeleton's load-bearing capacity by altering osteocyte's microenvironment and modulating the transmission of anabolic mechanical signals to osteocytes. Both clinical and animal studies show that parity and lactation have no adverse, or a positive effect on bone strength later in life. The skeletal effects during pregnancy and lactation reflect an optimized balance between the mechanical and metabolic functions of the skeleton.

Bone remodelling around the tibia due to total ankle replacement: effects of implant material and implant–bone interfacial conditions

One of the major causes of implant loosening is due to excessive bone resorption surrounding the implant due to bone remodelling. The objective of the study is to investigate the effects of implant material and implant–bone interface conditions on bone remodelling around tibia bone due to total ankle replacement. Finite element models of intact and implanted ankles were developed using CT scan data sets. Bone remodelling algorithm was used in combination with FE analysis to predict the bone density changes around the ankle joint. Dorsiflexion, neutral, and plantar flexion positions were considered, along with muscle force and ligaments. Implant–bone interfacial conditions were assumed as debonded and bonded to represent non-osseointegration and fully osseointegration at the porous coated surface of the implant. To investigate the effect of implant material, three finite element models having different material combinations of the implant were developed. For model 1, tibial and talar components were made of Co–Cr–Mo, and meniscal bearing was made of UHMWPE. For model 2, tibial and talar components were made of ceramic and meniscal bearing was made of UHMWPE. For model 3, tibial and talar components were made of ceramic and meniscal bearing was made of CFR-PEEK. Changes in implant material showed no significant changes in bone density due to bone remodelling. Therefore, ceramic appears to be a viable alternative to metal and CFR-PEEK can be used in place of UHMWPE. This study also indicates that proper bonding between implant and bone is essential for long-term survival of the prosthetic components.

High‐Protein Diet‐Induced Changes in Body Composition and Metabolic Flexibility in Women: Feasibility of a Novel Template‐based Intervention Delivery Method

Current recommended dietary allowance for protein is 0.8 g/kg/d. Recently, research has posited that this value is insufficient for resistance‐trained individuals and inadequate for the retention of lean mass while on a fat loss diet. Studies support an intake of nearly double the RDA, i.e. ~1.4–2.0 g/kg/day, but effective implementation strategies for achieving this higher protein intake have not been identified. Additionally, metabolic flexibility is the ability to adjust substrate oxidation according to nutrient availability and may be reflective of metabolic health. Whether a higher protein, caloric deficit diet improves metabolic flexibility in resistance‐trained women is not known.PURPOSETo determine the effects of a novel high protein diet template on body composition and metabolic flexibility during an 8‐wk intervention in recreationally resistance trained females.METHODSRecreationally resistance‐trained females (n=7, Age=21.7±2.1 yrs) were underwent baseline and post 8‐wk intervention dual‐energy X‐ray absorptiometry scans, anthropometrics and an acute high fat meal challenge. Baseline (T1) fasting glucose, resting energy expenditure (REE), and lipid (LO) and carbohydrate oxidation (CO) were measured. Participants then consumed a high fat meal (1127±132 kcal; 77±9 g fat) and glucose, REE, LO and CO measurements were taken at 60 (T2), 120 (T3) and 180 (T4) minutes postprandial. The meals contained 61% fat/29% carbohydrate/10% protein and were standardized to participants' body surface area (BSA). Participants were instructed how to follow a high‐protein dietary template (1.5–1.6 g/kg/day) and asked to maintain their resistance training volume and intensity throughout the study. The template was a PDF document containing specific instructions on amounts of lean proteins, vegetables, carbohydrates, and fats to be consumed at each meal throughout the day.RESULTSSignificant decreases were observed in % body fat (pre: 30.7±3.9%, post: 28.3±3.0%; p=0.010), waist circumference (pre: 77.0±4.7 cm, post: 74.4±5.2 cm; p=0.030), and waist‐to‐hip ratio (pre: 0.77±0.04, post: 0.76±0.04; p=0.050), with total body weight (pre: 67.5±6.7 kg, post: 65.5±5.3 kg; p = 0.076) and fat mass (pre: 19.7±3.7 kg, post: 18.6±3.0 kg; p=0.062) approaching significance. There were no significant changes in bone density, lean mass, fasting glucose, REE, LO, or CO.CONCLUSIONSA high protein diet leads to favorable improvements in fat mass, while preserving both lean mass and bone density in resistance trained females, without affecting metabolic flexibility. Our study also supports the feasibility of delivering a dietary intervention in a user‐friendly diet template format.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Effect of intravenous administration of zoledronic acid on jaw bone density in cases having skeletal metastasis: A prospective clinical study.

Aim:The objective is to evaluate the effect of intravenous (i.v.) administration of bisphosphonate (zoledronic acid) therapy on the jaw bone density and incidence of any other bony patholog.Settings and Design:Observational – prospective study.Materials and Methods:A total of 57 patients having a history of bony metastasis (excluding the jaw bone) were enrolled following the inclusion/exclusion criteria. Each patient received six doses of 4 mg i.v. bisphosphonate once a month. Multidetector computed tomography (MDCT) of jawbones for each patient was performed before the start of therapy (baseline) and subsequently at 6 and 12 months. Bone density was assessed at 24 predetermined sites (8 sites in maxilla and 16 sites in mandible) and any pathological change in either of the jaw bones was noted.Statistical Analysis Used:Shapiro–Wilk test ,Pearson's Chisquare test and repeated measures analysis of variance.Results:The result showed no statistically significant increase in mean bone density over a period of 1 year in maxilla and mandible. However, a significant increase in bone density was observed from 6 months to 1 year in mandibular anterior cancellous bone. The detailed observation of each MDCT scan showed no pathological change in either of the jaw bones during the study period.Conclusion:The administration (i.v.) of six doses of 4 mg bisphosphonate did not lead to a significant change in bone density over a period of 1 year.

Bone density assessment following stem cells therapy /corticotomy in the treatment of mild dentoskeletal class III malocclusion; cone beam tomographic study

Objectives: Assessment of bone density following stem cells therapy /corticotomy in the treatment of mild dentoskeletal class III malocclusion through cone beam tomographic analysis. Patient and methods: CBCT scan was done at T1in the beginning of the study and T2 after 6 months. Two groups of randomly selected patient, group I(6males and 4 females with age average of (20years 10months) in which patients were treated using corticotomy facilitated orthodontics with incorporation of stem cells, while in group II(5 males and 5 females with age average of (19 years 8months) the patients were treated using corticotomy facilitated orthodontics. Results: In both groups; there was no statistically significant change in bone density after treatment.

BIOMECHANICAL RATIONALE FOR CHOICE OF CEMENT MANTLE THICKNESS AROUND A FEMORAL STEM

The change in mechanical properties of the femoral bone tissue surrounding hip endoprosthesis stems during the post-operative period is one of the causes of implant instability, and the mathematical description of this phenomenon is the subject of much research. In the present study, a model of bone adaptation, based on isotropic Stanford theory, is created for further computer investigation. The results of implementation of such a mathematical model are presented regarding the choice of cement mantle rational thickness in cemented hip arthroplasties. The results show that for cement mantle thicknesses ranging from 1–1.5[Formula: see text]mm, a peak stress value in the proximal part of the mantle exceeds the limit of durability of bone cement. Moreover, results show that high reduction in the bone density of distal and proximal regions was observed in cases of cement mantle thicknesses varying from 1–3[Formula: see text]mm. No significant changes in bone density of the abovementioned regions were obtained for 4[Formula: see text]mm and 5[Formula: see text]mm. The outcome of numerical investigations can be treated as valuable and will lead to the improvement of cemented hip replacement surgery results.

Effect of low-dose or standard-dose conjugated equine estrogen combined with different progesterone on bone density in menopause syndrome women

Objective: To explore the effect of low-dose or standard-dose conjugated equine estrogen (CEE) combined with natural progesterone or dydrogesterone on bone density in menopause syndrome women. Methods: Totally 123 patients with menopause syndrome were recruited and randomly assigned to 3 treatment groups: group A (low-dose CEE+progesterone) , group B (standard-dose CEE+progesterone) , group C (standard-dose CEE+dydrogesterone) . Using continuous sequential regimen, the duration of intervention was 12 cycles. The bone mineral density of lumbar 2-4 and neck of femur, the bone metabolic markers, the level of FSH and estradiol were examined just before the drug administration and 12 months after the beginning of experiment. Results: There were 107 cases completed the one year trial. (1) Bone density: after 12 cycles of treatment, there was no significant change in bone density in group A (P>0.05) ; lumbar vertebrae of group B and C increased significantly, at 3.0% and 2.1%respectively (all P<0.05) . The bone density of left femoral neck of group C significantly increased by 2.9% (P=0.029) . There was no significant difference among the treatment groups at the beginning of experiment (P>0.05) . (2) Bone metabolic markers: after 12 cycles of treatment, the levels of calcium, phosphorus, alkaline phosphatase, Ca/Cr decreased significantly, the difference were statistically significant (all P<0.05) . There was no significant difference among the treatment groups at the beginning of experiment (P>0.05) . (3) Levels of FSH and estradiol: after 12 cycles of treatment, the levels of FSH in three groups were decreased significantly (all P<0.01) . The levels of estradiol in three groups were increased significantly (all P<0.01) . There was no significant difference among the treatment groups at the beginning of experiment (P>0.05) . Conclusions: Both low-dose and standard-dose menopause hormone therapy (MHT) could elevate the level of estradiol, reduce bone turnover, prevent bone loss of postmenopausal women effectively. The standard dose of MHT could also increase the density of vertebrae and femoral neck, and generate more clinical benefits.

Mineral Density Levels in Male and Female Collegiate Cross Country Runners: Is there Reason for Concern?

Introduction: The results of several recent studies have questioned the consequences of high levels of running on bone mineral density (BMD). Elite endurance athletes experience high physiological stress which may negatively impact bone health. Thus, the purpose of this study was to examine the change in BMD in male and female Division I collegiate runners during a competitive Cross Country (CC) season. Methods: T wenty-three (1 1 male and 12 female) Division I collegiate CC runners (ages 18-22 year) were recruited for this study. Total/regional BMD and body composition was determined using dual x-ray absorptiometry. Caloric intake and running mileage was obtained from self-reported diet and training logs. All measures were performed prior to the start (pre) and immediately following (post) a three month collegiate CC season. Results: Males did not demonstrate any significant changes in body composition from pre-post CC whereas females had a significant increase (2.7 ± 1.7 lbs or 2.1%) in total mass, with non-significant increases in fat free and fat mass. From pre- post CC, males did not have any significant changes in bone density whereas females had a statistically significant decrease in bone density of lumbar vertebrae. While no other changes in total or regional BMD were observed, ~ 50% of the both male and female athletes tested in this study had total BMD lower than the age-based reference value. Conclusion: The results of this study suggest that a single competitive CC season can result in a decrease in the lumbar spine BMD in female collegiate distance runners. Moreover, this study revealed that a large percentage (~ 50%) of both male and female distance runners had lower than age-adjusted normal BMD level, raising concerns about long-term bone health in these athletes. Verification of these findings in a larger more diverse population of young athletes is warranted to determine the long term consequences of distance running on bone health.

Spinal Deformity in Aged Zebrafish Is Accompanied by Degenerative Changes to Their Vertebrae that Resemble Osteoarthritis

Age-related degenerative changes within the vertebral column are a significant cause of morbidity with considerable socio-economic impact worldwide. An improved understanding of these changes through the development of experimental models may lead to improvements in existing clinical treatment options. The zebrafish is a well-established model for the study of skeletogenesis with significant potential in gerontological research. With advancing age, zebrafish frequently develop gross deformities of their vertebral column, previously ascribed to reduced trunk muscle tone. In this study, we assess degenerative changes specifically within the bone and cartilage of the vertebral column of zebrafish at 1, 2 and 3-years of age. We show increased frequency and severity of spinal deformities/curvatures with age. Underlying the most severe phenotypes are partial or complete vertebral dislocations and focal thickening of the vertebral bone at the joint margins. MicroCT examination demonstrates small defects, fractures and morphological evidence suggestive of bone erosion and remodeling (i.e. osteophytes) within the vertebrae during aging, but no significant change in bone density. Light and electron microscopic examination reveal striking age-related changes in cell morphology, suggestive of chondroptosis, and tissue remodelling of the vertebral cartilage, particularly within the pericellular micro-environment. Glycosaminoglycan analysis of the vertebral column by HPLC demonstrates a consistent, age-related increase in the yield of total chondroitin sulfate disaccharide, but no change in sulfation pattern, supported by immunohistochemical analysis. Immunohistochemistry strongly identifies all three chondroitin/dermatan sulphate isoforms (C-0-S, C-4-S/DS and C-6-S) within the vertebral cartilage, particularly within the pericellular micro-environment. In contrast, keratan sulfate immunolocalises specifically with the notochordal tissue of the intervertebral disc, and its labelling diminishes with age. In summary, these observations raise the prospect that zebrafish, in addition to modelling skeletal development, may have utility in modelling age-related degenerative changes that affect the skeleton during senescence.

Assessment of Maxillary and Mandibular Bone Density in Controlled Type II Diabetes: A Computed Tomography Study

This study was undertaken to compare the bone density in nondiabetic and controlled type II diabetes patients using spiral computed tomography. A group of 40 edentulous men, comprising of 20 nondiabetics and 20 controlled type II diabetics between the ages of 50-65 years, were enrolled in the study. Glycemic control of the diabetic patients was assessed by glycosylated hemoglobin level. The controlled diabetic group had an HbA1c level between 6.1-8%. A radiographic stent was prepared by using chemically cured resin. Bone densities at trabecular, buccal, and lingual cortical regions of maxillary and mandibular edentulous arches were measured by a tomography machine. Mean bone density measurements were recorded in Hounsfield units. The data thus obtained from 10 sites of maxillary and mandibular arches were tabulated and analyzed using SPSS statistical software. This study showed no significant changes in bone density between the controlled diabetic and nondiabetic subjects. Within the limitation of this study, it can be concluded that bone density does not seem to be affected in controlled type II diabetics.

Osteodensitometry measurements of periprosthetic bone using dual energy X-ray absorptiometry following total knee arthroplasty

The present study investigates the reaction of bone density as well as the possible factors influencing this reaction following a cement-free total knee arthroplasty (TKA). Osteodensitometry scan data from 50 prospective patients with TKA was evaluated. The patients were split into two groups according to the number of follow-up investigations undertaken. No patient included in the study had received medication to increase bone density. To identify the changes in periprosthetic bone density, dual energy X-ray absorptiometry (DXA) bone density measurements in defined regions of interest (ROI) were performed over a period of 24 months postoperative. The test parameters included gender, severity of arthrosis, as well as the metric parameters T-score, body mass index, cortical bone marrow index, and the varus alignment for the respective patient. The most significant changes in bone density were recorded within the first 3 months postoperative, in particular, the highest bone density loss was found in the region of the proximal medial tibia. Moreover, significant gender-specific associations regarding changes in bone density were established. Finally, results achieved in the present study demonstrate that the fundamental classification in defined ROI proved to be functional and effective.

Aromatase inhibitors in recurrent ovarian endometriomas: report of five cases with literature review

To determine the role of the aromatase inhibitor letrozole in the treatment of recurrent ovarian endometrioma cases. Nonrandomized proof of concept study. Outpatient tertiary-care center. Five premenopausal patients with documented ovarian endometriomas and chronic pelvic pain, all of whom were previously treated with surgery and medicine with unsatisfactory results. Ovarian endometriomas were diagnosed by biopsy after laparoscopic ovarian cystectomy and subsequently treated with hormones. After a 6-month washout of endometriosis hormone therapies, women took letrozole (2.5 mg), one tablet of 0.15 mg of desogestrel, and 0.03 mg of ethinyl estradiol, calcium (1,200 mg), and vitamin D3 (800 IU) daily for 6 months. Size of endometriomas (monitored by ultrasound), assessment of pelvic pain (by visual analog scale), and bone density (DEXA scan). Disappearance of ovarian endometrioma and reduction in pelvic pain in all cases at the end of 6 months. The size of ovarian endometriomas was reduced after 3 months. Pain scores decreased only after 1 month of treatment and continued decreasing in each treatment month. Overall, no significant change in bone density was detected. Letrozole given with combined pills achieved complete regression of recurrent endometriotic cysts and pain relief in all cases.

12주간의 유산소성 운동이 고령 여성노인의 건강체력과 골밀도에 미치는 영향

The purpose of this study was to investigate the effects of 12 weeks aerobic exercise program to old women`s Health-related Physical Fitness and Bone density. The subjects of this study were an aerobic exercise group composing 13 women whose average age was 70.14 and a control group composing 15 women whose average age was 69.12. Aerobic exercise group were joined this exercise program performing for one hour per day, 3 times a week over a period of 12 weeks in 60~80% HRR. The results were analysed by paired t-test and independent t-test at the .05 level of significance. The results of this study were as follows; First, Aerobic exercise group did significant statistical differences at p.05 level in % fat, Cardiorespiratory endurance, Muscular endurance, Flexibility, Balance, Reaction time. Muscular strength was no significant statistical differences in between aerobic exercise group and control group, but had significant statistical differences in aerobic exercise group. Second, Bone density were not significant statistical differences in between aerobic exercise group and control group, and within two group. In conclusion, there has been a substantial improvement in 12 weeks by aerobic exercise program, Exercise Program is recommended to olders in aspect of increasing Health-related Physical Fitness, Balance, and reaction time significantly. To see the significant change in bone density that the researcher thought, we must do more research considering age, exercise type and intensity.

Treatment of endometriosis and chronic pelvic pain with letrozole and norethindrone acetate: a pilot study

Objective To determine the role of an aromatase inhibitor, letrozole, in the treatment of reproductive-age women with endometriosis and associated chronic pelvic pain. Design Phase 2, open-label, nonrandomized proof-of-concept study. Setting Outpatient tertiary-care center. Patient(s) Ten patients with endometriosis, all previously treated both medically and surgically, with unsatisfactory results. Intervention(s) Endometriosis was diagnosed by biopsy and scored from an initial diagnostic laparoscopy performed within 1 month before treatment was begun. Oral administration of letrozole (2.5 mg), the progestin norethindrone acetate (2.5 mg), calcium citrate (1,250 mg), and vitamin D (800 IU) was done daily for 6 months. Within 1–2 months after completion of the treatment, a second-look laparoscopy was performed to score and biopsy endometriosis. Main outcome measure(s) Changes in American Society for Reproductive Medicine (ASRM) scores for endometriosis, pelvic pain assessed by visual analog scale, serum hormone levels (FSH, LH, E 2, and estrone [E 1]), and bone density (DEXA scan). Result(s) No histologically demonstrable endometriosis was present in any patient during the second-look laparoscopy. ASRM and pelvic pain scores decreased significantly in response to treatment. Overall, no significant change in bone density was detected. Gonadotropin levels were not significantly altered by treatment, and although circulating E 2 and E 1 levels were reduced, the decrease was not statistically significant. Conclusion(s) The combination of letrozole and norethindrone acetate achieved marked reduction of laparoscopically visible and histologically confirmed endometriosis in all 10 patients and significant pain relief in nine out of 10 patients who had not responded previously to currently available treatments. On this basis, letrozole should be a candidate for the medical management of endometriosis.