Total Proximal Femur Research Articles

EFFECT OF PHYSICAL ACTIVITY ON BONE MINERAL DENSITY OF THE PROXIMAL FEMUR IN CHILDREN WITH CEREBRAL PALSY 139

The effect of an eight month physical activity program on bone mineral density (BMD) of the proximal femur was examined in childen (ages 5-13 yrs) with spastic cerebral palsy. Measures of BMD for total proximal femur (Tot) and femoral neck (FN) regions were obtained from children in control (n=6; age=7.5±2.7 yrs; wt=23.8±8.2 kg; ht=127.3±16.8 cm) and experimental groups (n=7; age=9.6±2.8 yrs; wt=28.6±16.3 kg; ht=128.7±18.2 cm) by DXA (Hologic 2000; array mode) prior to and following the activity program. The experimental group participated in the program which focused on facilitation of normal movement with emphasis on weight bearing activity. The program was conducted for 1 hour 2x/week for 2 months and 3x/week for 6 months. Post intervention height and weight were 129.3±15.1 cm and 25.8±8.7 kg (control) and 129.3±15.1 cm and 25.8±8.7 kg (experimental), respectively. Tot BMD (pre: 0.46±0.08; post: 0.50±0.11 gms/cm2) and FN BMD (pre: 0.43±0.08; post: 0.46±0.17 gms/cm2) increased 9% and 7%, respectively in the experimental group versus a 2% increase in Tot BMD (pre: 0.44±0.08; post: 0.45±0.06 gms/cm2) and no increase in FN BMD (pre: 0.42±0.08; post: 0.42±0.08 gms/cm2) in the control group. However, ANOVA showed no significant differences in BMD between the groups. The results suggest a positive effect on BMD of weight bearing physical activity in children with cerebral palsy.

Long-Term Effects of Calcium Supplementation on Bone Loss and Fractures in Postmenopausal Women

purpose To determine the long-term effects of calcium supplements or placebo on bone density in healthy women at least 3 years postmenopause. patients and methods Eighty-six women from our previously reported 2-year study agreed to continue on their double-blind treatment allocation (1 g elemental calcium or placebo) for a further 2 years, with 78 women (40 on placebo) reaching the 4-year end point. Median (interquartile range) dietary calcium intakes for the whole group were 700 mg (range 540 to 910) per day at baseline, 670 mg (range 480 to 890) per day at 2 years, and 640 mg (range 460 to 880) per day at 4 years. The bone mineral density (BMD) of the total body, lumbar spine, and proximal femur was measured every 6 months by dual-energy, x-ray absorptiometry. results There was a sustained reduction in the rate of loss of total body BMD in the calcium group throughout the 4-year study period ( P = 0.002), and bone toss was significantly less in the calcium-treated subjects in years 2 through 4 also (difference between groups 0.25% ± 0.11% per year, P = 0.02). In the lumbar spine, bone loss was reduced in the calcium group in year 1 ( P = 0.004), but not subsequently. There was, however, a significant treatment effect at this site over the whole 4-year period ( P = 0.03). In the proximal femur, the benefit from calcium treatment also tended to be greater in the first year and was significant over the 4-year study period in the femoral neck ( P = 0.03) and the trochanter ( P = 0.01). Nine symptomatic fractures occurred in 7 subjects in the placebo group and 2 fractures in 2 subjects receiving calcium ( P = 0.037). conclusions Calcium supplementation produces a sustained reduction in the rate of loss of total body BMD in healthy postmenopausal women.

Bone mineral density and dietary intake of female college gymnasts

The purposes of this study were to determine bone mineral density (BMD) of female college gymnasts (N = 26) and age- (+/- 1.0 yr), height- (+/- 5.1 cm), and weight- (+/- 2.3 kg) matched controls (N = 26) using dual energy x-ray absorptiometry and to examine the relationship of physical activity, diet, menstrual history, and BMD in these athletes. Energy expenditure, dietary intake and menstruation were assessed using standardized questionnaires. The BMD of the gymnasts were significantly (all P < 0.0001) higher than controls for the lumbar spine (L1-4), total proximal femur, femoral neck, Ward's triangle, and whole body. Mean calcium and kcal intakes for both groups were lower than the Recommended Dietary Allowances, and gymnasts had significantly lower kcal intakes than controls (P < 0.05). More gymnasts than controls (59% vs 24%) reported that their menstrual cycle had been interrupted at some point since menarche (P < 0.02). The major finding of this investigation is that the BMD of gymnasts were higher than matched controls despite the fact that gymnasts as a group had inadequate dietary calcium and a higher propensity to have an interruption of their menstrual cycle.

Long-term effects of calcium supplementation on bone loss and fractures in postmenopausal women: A randomized controlled trial

To determine the long-term effects of calcium supplements or placebo on bone density in healthy women at least 3 years postmenopause. Eighty-six women from our previously reported 2-year study agreed to continue on their double-blind treatment allocation (1 g elemental calcium or placebo) for a further 2 years, with 78 women (40 on placebo) reaching the 4-year end point. Median (interquartile range) dietary calcium intakes for the whole group were 700 mg (range 540 to 910) per day at baseline, 670 mg (range 480 to 890) per day at 2 years, and 640 mg (range 460 to 880) per day at 4 years. The bone mineral density (BMD) of the total body, lumbar spine, and proximal femur was measured every 6 months by dual-energy, x-ray absorptiometry. There was a sustained reduction in the rate of loss of total body BMD in the calcium group throughout the 4-year study period (P = 0.002), and bone loss was significantly less in the calcium-treated subjects in years 2 through 4 also (difference between groups 0.25% +/- 0.11% per year, P = 0.02). In the lumbar spine, bone loss was reduced in the calcium group in year 1 (P = 0.004), but not subsequently. There was, however, a significant treatment effect at this site over the whole 4-year period (P = 0.03). In the proximal femur, the benefit from calcium treatment also tended to be greater in the first year and was significant over the 4-year study period in the femoral neck (P = 0.03) and the trochanter (P = 0.01). Nine symptomatic fractures occurred in 7 subjects in the placebo group and 2 fractures in 2 subjects receiving calcium (P = 0.037). Calcium supplementation produces a sustained reduction in the rate of loss of total body BMD in healthy postmenopausal women.

Continuous therapy with pamidronate, a potent bisphosphonate, in postmenopausal osteoporosis.

There is a need for effective and acceptable therapies for postmenopausal osteoporosis. The bisphosphonates show promise in this role, but the effects of the potent bisphosphonates in established osteoporosis have not yet been reported. We performed a 2-yr, randomized, double blind, placebo-controlled trial of pamidronate (150 mg/day) in 48 postmenopausal osteoporotic women. Bone mineral density of the total body, lumbar spine, and proximal femur was measured every 6 months by dual energy x-ray absorptiometry. Bone mineral density increased progressively in the total body (1.9 +/- 0.7%; P < 0.01), lumbar spine (7.0 +/- 1.0%; P < 0.0001), and femoral trochanter (5.4 +/- 1.3%; P < 0.001) in subjects receiving pamidronate, but did not change significantly in those receiving placebo. There were significant decreases in bone density at both the femoral neck (P < 0.02) and Ward's triangle (P < 0.01) in subjects taking placebo, which did not occur in the pamidronate group. The differences between the treatment groups were significant at all sites (0.0001 < P < 0.05) except Ward's triangle. Vertebral fracture rates were 13/100 patient yr in the pamidronate group and 24/100 patient yr in those receiving placebo (P = 0.07), and there was a nonsignificant trend toward height loss being less in those receiving pamidronate (P = 0.16). It is concluded that pamidronate is an effective therapy in postmenopausal osteoporosis.

Changes in bone mineral density associated with dietary-induced loss of body mass in young women.

1. Moderately overweight, premenopausal women were assessed for bone mineral density of the total body, lumbar spine and proximal femur before and after 6 months of modest dietary restriction (minimum 4800 kJ/day). The aim was to evaluate the effect of loss of body mass on bone mineral density. 2. Dietary assessment included two analyses of 3 day weighed food intakes, one before and the other after 4 months of dietary restriction. Energy and calcium intakes were significantly reduced by 27% and 5%, respectively. The change in calcium intake was negatively and significantly related to initial levels of calcium intake. 3. A significant mean loss of 3.4 +/- 3.1 kg in body mass was achieved mainly in the first 3 months of the study; it was accompanied by significant losses at 6 months in bone mineral density in the total body of 0.7% and in the lumbar spine of 0.5%. There were no changes in the femur. 4. The change in bone mineral density in the total body was significantly related to the reduced absolute calcium intake, initial bone mineral density and loss of body mass. The change in bone mineral density in the spine was significantly related to the change in calcium intake. 5. These modest losses could be a threat in women with lower bone mineral density, and indicate the importance of maintaining a high intake of calcium during dietary restriction.

Bone density and body composition on the pacific rim: A comparison between japan-born and u.s.-born japanese-American women

Bone mineral density (BMD) of total body, spine, and proximal femur and the percentage of body fat in 151 U.S.-born Japanese-American women and 137 Japan-born immigrant Japanese-American women living in San Diego, California were measured using dual-energy x-ray absorptiometry. These data were compared with unpublished data from Japanese women obtained in previous studies in Hamamatsu, Japan. The age-adjusted BMD for the spinal level, femoral neck, Ward's triangle, trochanter, and total body, respectively, of U.S.-born Japanese-American women were 10.2, 9.8, 9.9, 9.2, and 2.7% higher than those of native Japanese women. The U.S.-born Japanese-American women had significantly higher body fat than immigrant Japanese-American women. Furthermore, the immigrant women had higher BMD and higher body fat than their native Japanese counterparts; however, no significant total-body BMD differences were found among the three groups after age, height, and weight were adjusted. The U.S.-born Japanese-American women had BMD values equivalent to those of white normals at the spine and femur. Significant life-style differences between U.S.-born and immigrant Japanese-American women were noted. Weight, exercise, early menarche, and years of lifetime estrogen exposure correlated positively with BMD. The significant negative correlates of BMD were age, smoking, and percentage of body fat. Our study presents data suggesting that immigration to the United States has produced a higher BMD in Japanese-American women that is attributable to changes in life-style and diet.

Effect of Calcium Supplementation on Bone Loss in Postmenopausal Women

The use of calcium supplements slows bone loss in the forearm and has a beneficial effect on the axial bone density of women in late menopause whose calcium intake is less than 400 mg per day. However, the effect of a calcium supplement of 1000 mg per day on the axial bone density of postmenopausal women with higher calcium intakes is not known. We studied 122 normal women at least three years after they had reached menopause who had a mean dietary calcium intake of 750 mg per day. The women were randomly assigned to treatment with either calcium (1000 mg per day) or placebo for two years. The bone mineral density of the total body, lumbar spine, and proximal femur was measured every six months by dual-energy x-ray absorptiometry. Serum and urine indexes of calcium metabolism were measured at base line and after 3, 12, and 24 months. The mean (+/- SE) rate of loss of total-body bone mineral density was reduced by 43 percent in the calcium group (-0.0055 +/- 0.0010 g per square centimeter per year) as compared with the placebo group (-0.0097 +/- 0.0010 g per square centimeter per year, P = 0.005). The rate of loss of bone mineral density was reduced by 35 percent in the legs (P = 0.02), and loss was eliminated in the trunk (P = 0.04). Calcium use was of significant benefit in the lumbar spine (P = 0.04), and in Ward's triangle the rate of loss was reduced by 67 percent (P = 0.04). Calcium supplementation had a similar effect whether dietary calcium intake was above or below the mean value for the group. Serum parathyroid hormone concentrations tended to be lower in the calcium group, as were urinary hydroxyproline excretion and serum alkaline phosphatase concentrations. Calcium supplementation significantly slowed axial and appendicular bone loss in normal post-menopausal women.