Single Photon Absorptiometry Research Articles

Predictors of axial and peripheral bone mineral density in healthy children and adolescents, with special attention to the role of puberty

The role of various physical and lifestyle factors in determining axial bone mineral density (BMD) at the lumbar segment of the spine, as measured by dual-photon absorptiometry, and peripheral BMD at the distal third of the radius, as measured by single-photon absorptiometry, was assessed in 299 healthy white children of both sexes, aged 6 to 18 years. The BMD measurements were correlated with age, height, weight, body mass index, and pubertal status. Peripheral and axial BMD were highly correlated with age, height, weight, and pubertal stage, and more weakly with body mass index. Approximately 76% of the observed changes in peripheral BMD were accounted for by age, height, weight, and pubertal stage, with weight being the single strongest predictor. Up to 80% of the variation in axial BMD was explained by weight and pubertal stage, with pubertal stage being the strongest single predictor. After adjustment for weight, the effect of puberty on axial BMD in both sexes was greatest between middle and late puberty. These data indicate that a large amount of the observed changes on BMD is accounted for by standard measures of growth and development, which are largely genetically determined. Peripheral BMD rose steadily with age. Axial BMD increased steadily before puberty, followed by accelerated increases during puberty, beginning at 10 years of age in girls and 13 years of age in boys. A significant positive effect of dietary calcium intake on peripheral BMD and of physical activity on axial BMD indicated a potentially important impact of physical activity and calcium intake on peak bone mass.

Quantification of flowing bed porosity near the outlet of an axially symmetric hopper using single profile photon absorptiometry

A new approach to densitometric quantification is described which uses a single photon transmission profile to provide tomographic data in axially symmetric objects. Using phantom tests, the specially developed computer algorithm is shown to perform data transformation with a high degree of accuracy. The main advantage of the novel application compared to the complete tomographic scanning is in its speed. The single profile absorptiometry technique allows the quantification of voidage variations in particulate flows over time resolutions of the order of a few seconds, thus making it especially suitable for investigation of flowing bed porosity in the immediate vicinity of a hopper outlet where the particles are known to accelerate significantly accompanied by significant dilation of the bed voidage. Application to powder flows in hoppers is discussed and a comparison is drawn with complete tomographic scanning.

Correlation of bone histology with parathyroid hormone, vitamin D3, and radiology in end-stage renal disease

We analyzed transiliac bone biopsy specimens from 30 end-stage renal failure patients, taken at the time of admission for CAPD training. Results were compared with values of iPTH, bone alkaline phosphatase, 1,25-dihydroxyvitamin D3, skeletal survey, quantitative computed tomography (QCT) and single photon absorptiometry (SPA) bone density measurements. Osteitis fibrosa was the most common histological diagnosis, present in 15 of the 30 patients (50%), with eight classified as "severe" and seven as "mild." Eight patients (27%) had adynamic bone lesion, four mixed renal osteodystrophy (13%), and two (7%) osteomalacia. The mean age of the adynamic group was higher than the osteitis fibrosa group (41 +/- 12.1 vs. 56 +/- 10.2 years; P < 0.01), and than the mixed group (39 +/- 7.5 vs. 56 +/- 10.2 years; P < 0.02). Levels of iPTH enabled discrimination between groups, but not between individual patients, and values correlated with bone alkaline phosphatase (r = 0.62; P < 0.001). Erosion of the terminal phalanges was seen on the plain X-rays of 7 of 15 patients with mild or severe OF, and in three patients with another diagnosis. The majority of patients (> 90%) had bone density measurements within the normal range. No significant correlation existed between QCT or SPA scores and any of the histomorphometric parameters, or iPTH. We conclude that iPTH is the most helpful non-invasive investigation in this group of patients. Plain X-ray of the hands is the most useful radiological investigation, but single measurements of bone density are not diagnostic.

Hormone replacement therapy prevents bone loss in patients with inflammatory bowel disease.

Patients with inflammatory bowel disease have an increased prevalence of osteoporosis, and suffer high rates of spinal bone loss. Hormone replacement therapy (HRT) is effective in the treatment and prevention of osteoporosis but has not been studied in patients with inflammatory bowel disease. A two year prospective study of HRT in inflammatory bowel disease was performed in 47 postmenopausal women aged 44 to 67 years with ulcerative colitis (25) or Crohn's disease (22). Patients had radial and spinal bone density measured annually by single photon absorptiometry and quantitative computed tomography respectively. The mean (95% confidence intervals) annual change in radial bone density was +1.42%/yr (+0.58 to +2.26; P < 0.005) and for spinal bone +2.60%/yr (+1.06 to +4.15; p < 0.005). There was no significant correlation between rates of change of bone density at the two sites, or between the rates of change and the initial bone density either in the radius or spine. Twelve patients were given prednisolone during the study, and their rates of change for spinal bone density were lower, but values were not statistically significantly different from those who did not receive corticosteroids. Changes in bone density for patients with ulcerative colitis and Crohn's disease were not significantly different. The change in bone density did not correlate with the patients' age or number of years after the menopause. It is concluded that HRT is effective in prevention of bone loss in postmenopausal women with inflammatory bowel disease.

The aged male rat as a model for human osteoporosis: Evaluation by nondestructive measurements and biomechanical testing

Effects of androgen deficiency and androgen replacement on bone density, as measured with dual-energy X-ray absorptiometry (DXA) and single photon absorptiometry (SPA), cortical ratio (cortical thickness/outside bone diameter x 100), and biomechanical properties were evaluated in 14-month-old (1 month after orchiectomy (orch) or sham-operation) and in 17-month-old (4 months after orch or sham) male rats. Whole femoral bone mineral content (BMC) and density (BMD) measured with DXA were not significantly decreased 1 month after orch. Whole femoral BMC and BMD were 10% and 8% lower in 4 months after orch (P < 0.01 and P < 0.001, respectively). This decrease was prevented by testosterone replacement. There was an excellent correlation (R = 0.99) between whole femoral BMC and femoral ash weight. Selective scanning of cortical and cancellous sites of the femur showed that both cancellous and cortical BMC and BMD were significantly decreased 4 months after orch. SPA of the right tibia confirmed a 7% decrease in cancellous BMC and BMD 4 months after orch (preventable by testosterone) but not in cortical BMD and BMC. Femoral cortical ratio decreased with age (47 +/- 2 in 14-month-old and 40 +/- 2 in 17-month-old sham rats versus 63 +/- 1 in 6-month-old male rats) due to a continuously enlarging femoral shaft. Androgen deficiency resulted in an even greater decrease of the cortical ratio 4 months after orch (36 +/- 2 in 17-month-old orch rats) that was again prevented by testosterone (47 +/- 3).(ABSTRACT TRUNCATED AT 250 WORDS)

Low bone mineral density at axial and appendicular sites in amenorrheic athletes

Amenorrheic athletes have low axial bone-mineral density (BMD, g.cm-2). We compared 12 amenorrheic and 9 eumenorrheic women athletes to determine whether athletes with amenorrhea have lower BMD in other skeletal regions, including weight-bearing lower limbs. BMD was measured by dual energy x-ray and single photon absorptiometry. Both groups had similar age, body mass, and exercise quantity. Women with amenorrhea missed 86.3 +/- 58.3 menstrual periods since menarche. BMD was lower in the amenorrheic vs eumenorrheic subjects for the lumbar spine (0.928 +/- 0.056 vs 1.050 +/- 0.110, P < 0.005), whole body (1.032 +/- 0.05 vs 1.09 +/- 0.06, P < 0.05), most regions of the whole body (P < 0.05-0.001), all areas of the proximal femur (P < 0.005), and at the femoral mid-shaft (1.333 +/- 0.109 vs 1.491 +/- 0.088, P < 0.005). No significant differences were detected at the mid-radius and tibial shaft. The best predictors of BMD were years of regular menstruation for lumbar spine; and years of amenorrhea for hip, femoral mid-shaft, and whole body. We conclude that low BMD in athletes with amenorrhea is not limited to the axial skeleton but is also present in other regions including appendicular weight-bearing bones.

Bone mineral density in patients with endogenous subclinical hyperthyroidism: Is this thyroid status a risk factor for osteoporosis?

The aim of the present study was to elucidate whether endogenous subclinical hyperthyroidism due to a solitary autonomously functioning thyroid nodule affects bone metabolism and is a risk factor for osteoporosis. In a cross-sectional study measurements of bone mineral density were performed in premenopausal and post-menopausal women. Patients were categorized into non-toxic nodular goitre (n = 32), subclinical hyperthyroid (n = 37) and toxic solitary autonomous thyroid nodule (n = 22) subgroups and the results were compared with those of sex and age-matched control reference population (n = 68). Lumbar spine and femoral neck bone mineral densities were measured by dual energy X-ray absorptiometry. Single-photon absorptiometry was applied to the measurement of bone mineral content in the midshaft of the radius. In the non-toxic nodular goitre group, bone densities for all the scanned sites did not differ from the sex and age-matched reference population. At the L2-4 scanning site a significant decrease in the bone mineral density could be observed only in the toxic nodular goitre group and this decrease was more marked in the postmenopausal (P < 0.001) than in the premenopausal females (P < 0.05). At the femoral neck and midshaft radius the mean densitometric values were slightly, but significantly, lower only in the post-menopausal subclinical hyperthyroid group compared with the reference population (P < 0.01). The bone mineral density of the femoral neck, as well as the bone mineral content of the midshaft radius, was significantly decreased in both the premenopausal and post-menopausal patients with a toxic solitary nodule. This study indicates that the bone mineral density of the lumbar spine, femoral neck and the midshaft of the radius are not significantly decreased in premenopausal patients with endogenous subclinical hyperthyroidism resulting from a solitary autonomously functioning thyroid nodule. Conversely, findings hint at the possibility that long-lasting endogenous subclinical hyperthyroidism may be a contributing factor to the development of osteoporosis in some post-menopausal women, mostly at sites where cortical bone preponderates.

Long-term fracture prediction by bone mineral assessed at different skeletal sites.

Bone mineral density (BMD) was measured at the lumbar spine and cervical and intertrochanteric regions of the proximal femur by dual-photon absorptiometry and bone mineral content was assessed at the distal and midradius by single-photon absorptiometry in an age-stratified random sample of 304 Rochester, Minnesota women aged 30-94 years. Over follow-up extending to 10 years (median 8.3 years), 93 women experienced 163 new fractures. After adjusting for age, these bone mineral measurements predicted the likelihood of any incident fracture due to moderate trauma, with relative hazards varying from 1.4 to 1.6 per SD decrease in baseline bone mineral. A 1 SD decrease in lumbar spine BMD increased the risk of a new vertebral fracture comparably to a 17 year increase in age; a 1 SD decrease in femoral BMD was comparable to a 13-14 year increase in age on the risk of a hip fracture. We conclude that bone mineral measurements made at a variety of skeletal sites can predict the occurrence for at least 8-10 years of moderate trauma fractures of the sort that might be related to osteoporosis.

Bone density is not reduced during the short-term administration of levothyroxine to postmenopausal women with subclinical hypothyroidism: A randomized, prospective study

purpose: Controversy exists as to whether patients with subclinical hypothyroidism benefit from treatment. Two randomized trials reported that hypothyroid symptoms improved following thyroid hormone replacement therapy. However, during the initial treatment of overt hypothyroidism with levothyroxine, three studies have demonstrated short-term (6 to 12 months) 5% to 13% reductions in bone density. The current study measures bone density during the initial treatment of subclinical hypothyroidism. patients: Seventeen postmenopausal women with subclinical hypothyroidism (elevated serum thyrotropin [TSH] and normal serum free thyroxine concentrations) and no prior history of thyroid disease were randomly assigned to levothyroxine treatment or no treatment and followed prospectively. Patients in the treatment group had similar initial serum TSH concentrations (9.8 ± 3.3 versus 8.4 ± 2.7 μU/mL) but were slightly older (68 ± 7 years versus 60 ± 5 years [p <0.02]). The average dose of levothyroxine needed to normalize serum TSH concentration was 0.072 ± 0.027 mg. results: Bone density determinations were not significantly different between the two groups at baseline. After 14 ± 1 months, single-photon absorptiometry of the wrist decreased by 1.8% ± 3.2% in the untreated patients and 0.5% ± 4.1% in the levothyroxine-treated patients (p = NS). Dual-energy X-ray absorptiometry of the lumbar spine decreased by 0.7% ± 2.9% in the untreated patients and rose 0.1% ± 4.75% in the levothyroxine-treated patients (p = NS). conclusions: Unlike the early treatment of overt hypothyroidism, there is no short-term reduction of bone density with levothyroxine treatment of subclinical hypothyroidism in post-menopausal women. These data suggest that potentially symptomatic women with subclinical hypothyroidism should be given a trial of levothyroxine therapy without concern about adverse effects on skeletal integrity.

Reduction of bone density: An effect of gonadotropin releasing hormone analogue treatment in central precocious puberty

Gonadal steroids drive the significant bone mineral increase that occurs at puberty. Oestrogen deprivation in women results in bone loss. We investigated bone mineralization by single photon absorptiometry in girls with central precocious puberty (n = 13, age 3.8-8.5 years) before and during 1 year of treatment with gonadotropin releasing hormone analogue (GnRH-a = long-acting D-Trp6-GnRH, 60 micrograms i.m. every 28 days). Before GnRH-a therapy, bone mineral density (BMD) was significantly higher in patients than in ten control girls matched for chronological age (patients 0.575 +/- 0.097 g/cm2, controls 0.433 +/- 0.049 g/cm2, P < 0.001). Patient BMD was not significantly different from that of ten control girls matched according to patient bone, age (0.550 +/- 0.046 g/cm2, P = NS). During GnRH-a treatment, pituitary-gonadal axis was suppressed and patient BMD significantly decreased (6 months: -6.0%, P < 0.002 vs baseline; 12 months: -8.0%, P < 0.001 vs baseline). We conclude that in girls with precocious puberty the activation of gonadal steroid secretion induces an increase in bone mineralization and that oestrogen deprivation by GnRH-a treatment caused a significant decrease in BMD.

A Multi-Element Isotopic Tracer Assessment of True Fractional Absorption of Minerals from Formula with Additives of Calcium, Phosphorus, Zinc, Copper and Iron in Young Piglets

True fractional absorption of minerals was measured to determine the bioavailability of Zn, Fe, Mn and Se from liquid formulas fortified with stepwise additions of Ca and P (as Ca glycerophosphate and carbonate, Ca*P), and Zn, Cu and Fe (as sulfate salts). Growth, deposition of tracers in organs and bone mineral content of femurs as assessed by single photon absorptiometry were measured. Four-day-old piglets (n = 36) were randomly assigned to groups fed a basal diet or additions of Ca*P (Ca = 25, P = 18 g/kg dry diet), Ca*P+Zn (Zn = 0.04 g/kg), Ca*P+Zn+Cu (Cu = 0.007 g/kg) or Ca*P+Zn+Cu+Fe (Fe = 0.008 g/kg). Oral and intravenous administration of extrinsic isotopes of 59Fe, 54Mn, 65Zn, 75Se and 47Ca was followed by fecal monitoring for 15 d and true absorption calculated after accounting for endogenous excretion. Addition of Ca*P+Zn reduced Zn absorption (P < 0.05) and Ca*P+Zn+Cu reduced Fe absorption (P < 0.01), but Mn and Se absorptions were not altered. Uptake of only Zn tracer into heart was significantly different (P < 0.05) among diet groups. Weight gain and linear growth were similar in all groups. Addition of Ca*P produced higher bone mineral density, but its effect on Zn absorption warrants further investigation.

Low bone mass and high bone turnover in male long distance runners.

Running is a popular sport, but in some studies long distance running in women has been related to reduced bone mass and a potential risk of osteoporosis. To investigate the impact of running on bone mass in men, 120 healthy, physically active men (19-56 yr old; running 0-160 km/week) were studied. Bone mineral content was measured in the lumbar spine, total body, and proximal femurs by dual energy x-ray absorptiometry and in the forearm by single photon absorptiometry. Bone turnover was assessed by urinary pyridinium cross-links, plasma osteocalcin, and serum alkaline phosphatase. Lumbar bone mineral content was negatively correlated to the weekly distance run (r = -0.37; P < 0.0001), with a difference of 19 +/- 5% (mean +/- SEM) between controls and elite runners. A similar relation was found for all measurement sites. After adjustment for possible confounders, the correlations remained statistically significant in areas with a high proportion of trabecular bone. Bone turnover parameters were 20-30% higher in the elite runners, whereas sex hormone status was unrelated to running activity. We conclude that male long distance runners had reduced bone mass and increased bone turnover compared to controls, which suggests accelerated bone loss. The pathophysiological explanation was not clear, but sex hormones did not seem to play a key role.

Noninvasive Monitoring Techniques for Quantitative Description of Callus Mineral Content and Mechanical Properties

The noninvasive evaluation of fracture healing may allow more precise timing of fixation device removal, quantitative recommendations for weight bearing, and the prediction of abnormal fracture healing patterns. Techniques used for the evaluation of intact bone and of healing fractures include resonance frequency and impedance methods, the measurement of sound speed using ultrasound, computed tomography of ultrasonic energy, roentgenographic photodensitometry, quantitative computed tomography (QCT), single-photon absorptiometry (SPA), and dual-energy x-ray absorptiometry (DEXA). A study comparing QCT, SPA, and DEXA showed that all three techniques had strong correlations with the torsional properties of healing canine tibial osteotomies. Quantitative computed tomography and SPA had stronger correlations with local gap tissue properties than DEXA. The relatively poor performance of DEXA may have been related to the relatively large resolution (2 mm) of the device used in the study. Current DEXA devices have resolutions as low as 0.5 mm, perhaps enhancing its capabilities. Computed tomography of ultrasonic energy, QCT, SPA, and DEXA each appear to have great potential for future use in the evaluation of fracture healing.

Relation between Body Size and Bone Mineral Density in Elderly Men and Women

This cross-sectional study of the Rancho Bernardo, California, cohort examines the relation between bone mineral density and eight measures of body size (total weight, body mass index, waist-hip ratio, lean mass, fat mass, percentage fat mass, and current and maximum adult height) measured between 1988 and 1991 in 1,492 ambulatory white adults aged 55-84 years. Lean mass, fat mass, and percentage fat mass were measured by bioelectric impedance. Bone mineral density was measured at the hip and lumbar spine with dual-energy x-ray absorptiometry and at the midshaft and ultradistal radius with single photon absorptiometry. In multiple linear regression models adjusted for age, smoking, exercise, alcohol, thiazide use, and estrogen use (in women), total weight was the most consistent marker of bone mineral density overall. In this cohort, all measures of body size were associated with bone mineral density in both sexes and were better markers of bone mineral density in the weight-bearing sites than in the non-weight-bearing sites, implying a mechanical effect of weight on bone mineral density.

Serum osteocalcin and fracture susceptibility in elderly women

The purpose of this investigation was to evaluate the bone turnover by using bone metabolic markers in relation to previous fracture history and independent of bone mass. Patients and controls were recruited from a population-based study of 193 women, all living in the same city and aged 60, 70, and 80 years. The bone mineral content (BMC) was measured bilaterally in the distal forearm by single-photon absorptiometry (SPA). At the same time, serum samples were obtained for biochemical analysis. Of the 193 women, we identified 26 with at least one major fracture during the past few years. Each of these 26 women with a certified recent previous fracture was individually matched with a woman from the same study group of equal BMC and age but without a fracture history. In the two groups, the serum samples were analyzed for osteocalcin, C-terminal procollagen peptide (P1CP), alkaline phosphatase, bone-specific alkaline phosphatase, calcium, phosphate, and albumin. The serum concentration of osteocalcin was 20% lower in the women with a previous fracture than in the controls (P = 0.03). The other markers of bone formation gave similar values in the two groups. There was a significant correlation between the osteocalcin and P1CP concentrations (P = 0.001). Our findings indicate that the susceptibility to fractures independent of factors such as age and BMC may be related to a decreased bone turnover.

Reproductive correlates of bone mass in elderly women. Study of Osteoporotic Fractures Research Group.

Results from previous studies of reproductive factors and bone density have been conflicting; some demonstrate a beneficial effect, but others show a detrimental effect on bone density. The present study investigates the association of parity, lactation, and menstruation with radial bone density in 2230 white women, 65 years of age and older. Bone density was assessed by single-photon absorptiometry. Linear multiple regression was utilized to determine if reproductive factors were associated with radial bone density. The number of births, duration of menstrual bleeding, age at menarche, and years menstruating were significant independent predictors of postmenopausal bone density of the radius. A 1.4% increase in distal radius bone density was observed with each additional birth. Women who began menstruation at age 9 had 6.3% higher bone density than women who began at age 16. Women who menstruated for 3 days during each menstrual cycle had 2.8% less distal radius bone density than women who bled for 7 days. Each decade of menstruation was associated with a 2% greater distal radius bone density. No difference in bone density was demonstrated for women who breast-fed and women who did not. Length of the menstrual cycle, amount of menstrual flow, and irregularity of the menstrual cycle were not significantly associated with radial bone mineral density. In conclusion, pregnancy and menstruation are associated with postmenopausal bone density of the radius.

Influence of aging and menopause in determining vertebral and distal forearm bone loss in adult healthy women

In order to assess the relative influence of aging and menopause in determining the decrease of bone mass in adult women, two groups of normal subjects were examined in this retrospective, cross-sectional study. In group A, bone mineral density (BMD) was evaluated at spine (L2-L4) by dual X-ray absorptiometry (DXA) (Hologic QDR-1000); in group B, BMD was measured at the distal forearm by single photon absorptiometry (SPA) (Osteometer DT 100). Both groups were further divided into two subgroups: A1 and B1 included women with the same postmenopausal, but different chronological age; A2 and B2 included women with the same chronological, but different postmenopausal age. BMD and BMI-corrected BMD (cBMD) were plotted versus age and years since menopause, respectively. Mathematical analysis of the correlation curves between BMD and chronological age showed that the decrease of BMD is very similar at spine and forearm, and is better fitted by a quadratic function. Age-related fractional bone diminution shows a progressive increase with aging (at spine: -0.38%/year at 45 years, -0.81%/year at 50, -1.3%/year at 55 and -1.9%/year at 60. At forearm: -0.5%/year at 50 years, -1.1%/year at 55 and -1.68%/year at 60). On the other hand, menopause-related BMD decrement is very evident during the first year since menopause (at spine: -8.1%/year; at forearm: -3.4%/year), and progressively decreases, according to a logarithmic function. Ten years later, yearly diminution of BMD is below 1%/year and 0.4%/year at spine and forearm, respectively. At this time, age contributes to determine bone loss for 2/3 and menopause for 1/3.

Effect of weight manipulation on bone loss due to ovariectomy and the protective effects of estrogen in the rat.

While characterizing the effects of estrogen on an ovariectomized (OVX) rat model of bone loss, we examined several weight-matching regimens [e.g., ad libitum (feed bins continually full), weight matched (rate of weight gain for OVX and Sham-OVX groups was equalized), and weight restricted (weight gain rates for all groups were equalized to that of estrogen-treated OVX rats)] for possible effects. Bone loss following ovariectomy is primarily the result of an increase in bone resorption and is extremely sensitive to the effects of estrogens. Thus, in all of our analyses, treatment with 17 beta-estradiol served as a positive control for the prevention of bone loss. Each weight-matching study had three groups: control (Sham-OVX), OVX, and OVX + 17 beta-estradiol (0.1 mg/kg/day), and lasted for either 2, 4, or 6 weeks. Throughout the study, each Sprague Dawley rat was weighed every other day, and following sacrifice, a femur was removed for bone mineral density (BMD) analysis at the distal metaphysis by single photon absorptiometry. Following 2 weeks of dietary modifications, no significant differences were detected in BMD among the ad lib or weight matched groups. However, an estradiol-preventable reduction in BMD in restricted OVX rats was detected at 2 weeks postovariectomy. Additionally, OVX rats in all three dietary regimens displayed an estrogen-preventable reduction in proximal femur BMD at 4 and 6 weeks postovariectomy. These results indicate that a 4-week rat ovariectomized model of bone loss, under conditions of ad libitum feeding, shows great potential for pharmacologic manipulation.

Association between low bone density and stroke in elderly women. The study of osteoporotic fractures.

To determine whether women with low bone mineral density are at increased risk of stroke, the present study was conducted. We studied 4024 ambulatory women aged 65 years or older participating in the prospective Study of Osteoporotic Fractures. Bone mineral density was measured at baseline using single photon absorptiometry; strokes were ascertained using a computerized Medicare data base and death certificates. During a mean of 1.98 years of follow-up, 83 women suffered first strokes (five fatal). Osteopenia was associated with an increased stroke risk: Each SD decrease in bone mineral density at the calcaneus (0.09 g/cm2) was associated with a 1.31-fold increase in stroke (95% confidence interval, 1.03-1.65), adjusted for age, follow-up time, and several potential confounders, including diabetes, systolic blood pressure, use of alcohol, cigarettes or postmenopausal estrogens, cognitive ability, grip strength, and functional ability. The observed relation between bone density and stroke was strongest for intracerebral hemorrhages and occlusions. Most likely, low bone density does not cause stroke; some other process probably results in both osteopenia and cerebrovascular disease.

Is alcohol an osteoporosis-inducing agent for young and middle-aged women?

The effects of alcohol abuse on the bone of women have scarcely been investigated, although women are more prone than men to osteoporosis. We studied 19 noncirrhotic female alcoholics (aged 24 to 48 years) hospitalized for 2 weeks for withdrawal and three groups of control women (n = 182). Sixteen patients and all control subjects had regular menstrual cycles. Forearm bone mineral content (BMC) and axial bone mineral density (BMD) were measured by single-photon absorptiometry and dual-energy x-ray absorptiometry, respectively. Parameters of bone metabolism were analyzed at the beginning and end of the withdrawal period. BMC and BMD did not differ between patients and controls at any of the five measurement sites. On admission, bone formation of the alcoholics was depressed as reflected by osteocalcin levels (−48%, P < .01); it normalized during abstention ( P < .01). Urinary hydroxyproline, a parameter of bone resorption, and serum intact parathyroid hormone were at the control level throughout the observation period. Serum ionized calcium level increased by 4% ( P < .0001), and serum free fatty acid (FFA) levels decreased by 30% ( P < .05) during withdrawal; there was an inverse correlation between changes in these two parameters ( r = −.49, P < .05). On admission, serum concentrations of 25-hydroxyvitamin D 3 [25-OH-D 3] and 1,25-dihydroxyvitamin D 3 [1,25-(OH) 2-D 3] were reduced by 46% ( P < .001) and 16% ( P = .16); these did not normalize during abstention. In conclusion, provided that liver cirrhosis and gonadal dysfunction are not contributing, even heavy drinking does not seem to decrease bone mass in young and middle-aged women. Alcohol-induced suppression of bone formation is quickly reversed during abstention, which is not the case for decreased vitamin D metabolites.