Underwent Bone Densitometry Research Articles

Bone mineral density in women with asthma on long-term inhaled corticosteroid therapy.

Inhaled corticosteroids (ICS) have become first line agents in the management of moderate-to-severe asthma. Long-term use of ICS is associated with decreased bone mineral density (BMD). To investigate the prevalence of BMD loss and its severity in women with asthma on long-term ICS. Fifty-six women with asthma on long-term ICS, attending an inner-city allergy clinic were selected to undergo bone densitometry in order to evaluate the association between BMD and the long-term use of ICS at different dose ranges. Women (60.7%) had decreased BMD either at the lumbar spine or hip region. Among postmenopausal women, 17.1% of those <65 years and 42.9% of those > or =65 years had osteoporosis compared with 5.7% (95% CI-3.9% to 8.5%) of those <65 and 29.3% (95% CI-25.7%-33.5%) of those > or =65 years reported in the NHANES III survey. The prevalence of low BMD increased as ICS dose increased from 5% in the low dose group to 50% in the high dose group (P < .002). There were significant linear trends of decline by dose in mean BMD for the hip (P < .001) and the lumbar spine (P < .002). Women who received medium or high doses of ICS had significantly greater bone loss than those receiving low doses. The findings of increasing BMD loss with increasing ICS dose reinforce the necessity to monitor BMD periodically in women on ICS, particularly in the high risk postmenopausal group and those on medium to high doses. There should be a concurrent continual attempt to lower the dose by supplemental nonsteroidal controller medications and providing nutritional and pharmacologic treatment of identified BMD loss in these patients.

Bone density and antiepileptic drugs: a case-controlled study

This case-controlled study explored the relationship between bone mineral density (BMD) and long-term treatment with antiepileptic drugs (AEDs) in older adults with epilepsy. Seventy-eight patients (47 post-menopausal females, 31 males, aged 47–76 years) with epilepsy participated in the study. Each had only ever received treatment with either enzyme-inducing (n= 52) or non-inducing (n= 26) AEDs. Individuals were matched for age, sex, height and weight with a drug-naive control. All patients underwent bone densitometry at the lumbar spine and femoral neck and had blood sampling and urine collected for a range of bone markers. Male patients had lower BMD than controls at the lumbar spine (P< 0.01) and neck of the femur (P< 0.005). Female patients had significantly reduced bone density at the femoral neck (P< 0.05) only. AED usage was independently associated with an overall reduction in bone density at femoral sites and contributed to just over 5% of the variance at the femoral neck. Duration of treatment and type of AED were not independent factors for reduction in BMD. This case-controlled study supports the hypothesis that long-term AED therapy is an independent risk factor for reduced BMD in epileptic patients. Adults receiving treatment for epilepsy are at higher risk of osteoporosis and should be offered bone densitometry.

Technetium-99m Sestamibi Scintigraphy and Bone Densitometry in Primary Hyperparathyroidism

To review our recent experience with technetium-99m sestamibi scintigraphy in identification and localization of parathyroid adenomas and to determine bone mineral loss associated with primary hyperparathyroidism. Thirty-two double-phase technetium-99m sestamibi scans were obtained in 26 patients (22 female and 4 male patients; age range, 14 to 78 years). Serum calcium and intact parathyroid hormone concentrations were measured before scintigraphy. Histopathologic correlation was obtained in all patients who underwent a surgical procedure. Seventeen patients underwent bone densitometry studies of the lumbar spine and hip with use of dual-energy x-ray absorptiometry. Of the 32 scans, 17 (53%) were suggestive of a parathyroid adenoma ("positive"). In these patients, the mean serum calcium concentration was 2.68 mmol/L and the mean serum parathyroid hormone concentration was 669 pg/mL. Overall, one false-negative scan and one false-positive scan were encountered. The overall sensitivity for surgically proven detection and localization of parathyroid adenoma was 90%. The bone density measurements in patients with positive scans were substantially lower in the lumbar spine (mean T score, 2.9) and in the hip (mean T score, 2.1) in comparison with normal control subjects and significantly lower than in those with a negative scan (spine, P = 0.011; hip, P = 0.015). Double-phase technetium-99m sestamibi scintigraphy is highly sensitive and useful in detection and localization of parathyroid adenomas. Patients with primary hyperparathyroidism lose bone mineral from both cortical and cancellous bone sites.

Prognostic value of vertebral lesions detected by magnetic resonance imaging in patients with stage I multiple myeloma.

We assessed the role of spinal magnetic resonance imaging (MRI) and bone densitometry as prognostic factors in patients with asymptomatic stage I multiple myeloma (MM) and negative skeletal survey. 55 consecutive patients underwent spinal MRI and 41 of them underwent bone densitometry by dual-energy X-ray absorptiometry (DEXA). Spinal MRI studies showed evidence of bone marrow involvement in 17/55 patients (31%). A diffuse pattern was present in three patients and a focal pattern in 14 patients, nine of them with only one nodular lesion. During a median follow-up of 25 months, 10 patients had disease progression, 8/17 patients with abnormal MRI and 2/38 patients with normal MRI. Median time to disease progression was not reached in both groups but was significantly different for patients with normal and those with abnormal patterns on MRI (P < 0.0001). Lumbar BMD was only slightly decreased compared with normal people (median lumbar Z score -0.43) and was not of prognostic value. Using a multivariate analysis the only two independent significant prognostic parameters were abnormal MRI (P<0.001, HR 30.4, 95% CI 4.3-213) and bone marrow plasmacytosis >20% (P=0.004, HR 16.4, 95% Cl 2.6-104). Thus, spinal MRI but not bone densitometry, appeared to be justified in patients with stage I asymptomatic MM and negative skeletal survey.

Association of BsmI vitamin-D receptor gene polymorphism with combined bone mass in spine and proximal femur in Icelandic women.

To evaluate whether there is an association between BsmI-vitamin-D receptor (VDR) gene polymorphism and combined bone mass in the spine and proximal femur in a group of adult Icelandic women with high and low bone mineral density (BMD). Comparison of distribution of VDR genotypes (BB, Bb and bb) and allele frequency (B and b) in two groups of women: a group with 'strong bones' with high BMD in both the spine and proximal femur (> 1 standard deviation [SD]) above the age-matched mean (n = 35) and a group with 'weak bones' with BMD > 1.5 SD below the age-matched mean at both sites using dual energy X-ray absorptiometry. Iceland, a population with a mean calcium intake > 1000 mg day-1. The calcium intake in the study group was however not evaluated. Eighty-three Icelandic women, aged 22-65, free of diseases affecting bone and not taking drugs affecting calcium or bone metabolism, recruited from women undergoing bone densitometry at the Reykjavik Hospital. Frequency of VDR genotypes and alleles in the two groups. The distribution of VDR genotypes was significantly different in the two groups (P < 0.01); the b allele frequency was 70% in the group with high BMD compared to 48.5% in the group with low BMD. In this selected group of adult Icelandic women the b allele in the vitamin-D receptor gene seems to be associated with high bone mass in the spine and proximal femur.

Beta 2 adrenergic receptor gene restriction fragment length polymorphism and bronchial asthma.

Beta 2 adrenergic dysfunction may be one of the underlying mechanisms responsible for atopy and bronchial asthma. The gene encoding the human beta 2 adrenergic receptor (beta 2ADR) has recently been isolated and sequenced. In addition, a two allele polymorphism of this receptor gene has been identified in white people. A study was carried out to determine whether this polymorphism is functionally important and has any relation to airways responsiveness, atopy, or asthma. The subjects studied were 58 family members of four patients with atopic asthma. Restriction fragment length polymorphism (RFLP) with Ban-I digestion of the beta 2ADR gene was detected by a specific DNA probe with Southern blot analysis. Airways responses to inhaled methacholine and the beta 2 agonist salbutamol, the skin prick test, and serum IgE levels were also examined and correlated to the beta 2ADR gene RFLP. In addition, measurements of cAMP responses to isoproterenol in peripheral mononuclear cells were performed in 22 healthy subjects whose genotype for beta 2ADR was known. A two allele polymorphism (2.3 kb and 2.1 kb) of the beta 2ADR gene was detected in the Japanese population. Family members without allele 2.3 kb (homozygote of allele 2.1 kb) had lower airways responses to inhaled salbutamol than those with allele 2.3 kb. The incidence of asthma was higher in those without allele 2.3 kb than in those with allele 2.3 kb. The beta 2ADR gene RFLP had no relation to airways responses to methacholine and atopic status. cAMP responses in peripheral mononuclear cells of the subjects without allele 2.3 kb tended to be lower than those of the subjects with allele 2.3 kb. These results suggest that Ban-I RFLP of the beta 2ADR gene may have some association with the airways responses to beta 2 agonists and the incidence of bronchial asthma.

Total and regional bone mineral content in normal premenopausal women

In the present, cross-section study, a total of 185 normal premenopausal females--aged 15 through 19 years (n = 40), 20 to 29 years (n = 60), 30 through 39 years (n = 40) and 40 to 49 years (n = 45)--were assessed in order to observe and evaluate the total body bone mineral content and the regional body mineral content of different anatomical regions (head, trunk, arms and legs), when the bone mass peak is established in women and its course during premenopause. All subjects underwent bone densitometry with dual energy X-ray absorptiometry with a Norland XR-26 bone densitometer. No differences between groups were found in total body bone mineral and regional bone mineral content values. Total body bone mineral values (mean +/- SD) were 2546 +/- 461 g and 2691 +/- 499 g in the 15-19 year-old group and 40-49 year-old group respectively. The regional bone mineral content values for the same age group were 495 +/- 75 g and 499 +/- 89 g for the head, 1007 +/- 254 g and 1043 +/- 212 g for the trunk, 327 +/- 74 g and 336 +/- 81 for the arms, and 860 +/- 167 g and 811 +/- 146 g for the legs. The results of this study indicate that the peak bone mass is reached at the age of 20 years and that it remains stable in the premenopausal eugonadal females.