Young Adult Mean Values Research Articles

Bone Health In Patients With Inflammatory Bowel Disease (IBD)

Metabolic bone disease is prevalent in persons with immune-mediated inflammatory diseases, including inflammatory bowel disease (IBD). Within these conditions the most common are osteoporosis and reduced bone mineral density (BMD), often termed osteopenia in adult patients, and refer to a decreased mineralization of the bone matrix. This decreased mineralization weakens the resistance of the bone to external forces, thus increasing the risk of fractures when external compressive or deforming forces are applied. Osteoporosis is asymptomatic in the absence of a fracture, and diagnosis generally occurs through the use of programmatic screening (most commonly dual energy x-ray absorption [DEXA]) or incidentally following the occurrence of a fracture. Osteoporosis is defined as a DEXA-measured BMD at the lumbar spine or proximal femur which falls more than 2.5 standard deviations below the mean value for healthy young adults (known as a T-score). BMD decreases of a lesser degree (a T-score falling between -1 and -2.5) are referred to as osteopenia. Osteoporosis is a major public health concern, owing to the significant morbidity and mortality that is attributed to fractures. While fractures may represent a time-limited hardship among persons in otherwise good health and function, major osteoporosis-related fractures, especially those of the femur and spine, can lead to permanent disability and premature mortality. In Canada, approximately 150 people per 100,000 suffer a hip fracture per year, which confers a 3-fold higher risk of mortality.

Sarcopenia Severity Based on Computed Tomography Image Analysis in Patients with Cirrhosis.

Standardized sex-specific cut-offs for sarcopenia in cirrhosis are needed to identify the risk of clinical complications and to discriminate the severity of sarcopenia. We aimed to compare clinical characteristics between patients with cirrhosis categorized according to the severity of sarcopenia. Computed tomography images were taken at the 3rd lumbar vertebra from 603 patients with cirrhosis and 129 adult donors for living liver transplantation. Patients with skeletal muscle index (SMI) two standard deviations (SD) below the sex-specific mean value of young donors (18–40 years old) were categorized as having severe sarcopenia whereas patients with SMI between −1 and −2 SD of the sex-specific young adult mean values were categorized as having sarcopenia. In the cirrhosis group, 408 patients (68%) were male with the mean age of 57 ± 0.4 years, and MELD score of 14 ± 0.4. Patients were divided into three groups: severe-sarcopenic (SMI < 30 cm2/m2 in females and <42 cm2/m2 in males), sarcopenic (30 ≤ SMI < 37 cm2/m2 in females and 42 ≤ SMI < 50 cm2/m2 in males) and non-sarcopenic (SMI ≥ 37 cm2/m2 in females and ≥50 cm2/m2 in males). Patients with cirrhosis and severe sarcopenia had lower muscle radiodensity and higher plasma neutrophil as well as neutrophil to lymphocyte ratio levels than both non- and sarcopenic groups. The frequency of alcohol-induced cirrhosis, refractory ascites, hepatic encephalopathy, CRP > 20 mg/mL, and severe malnutrition was also higher in severe-sarcopenic patients. The interval between sarcopenia and severe sarcopenia may reflect a window of opportunity in which to intervene and mitigate muscle wasting to improve patient outcomes.

Growth of cortical bone thickness and trabecular bone density in Japanese children.

The acquisition of a high bone density at a young age is a strategy to prevent fractures/falls later in life. We therefore decided to investigate the increases in cortical thickness (CoTh) and trabecular bone density (TBD) of children. Subjects comprised 1314 students (678 boys and 636 girls) aged between 12 and 18years. Lifestyle factors were examined with a self-administered questionnaire (sleep times, exercise habits, and calcium intake). Bone growth was assessed based on CoTh and TBD using an ultrasonic bone densitometer. Height, weight, and body fat percentage were also measured. Increases in CoTh and TBD occurred earlier in girls than in boys. Calcium intake was not sufficient at any of the ages examined, and sleep times were shorter than those recommended by the National Sleep Foundation. Increases in CoTh and TBD occurred subsequent to increases in height. Although increases in CoTh were observed with age in both sexes, TBD increased in boys until the age of 17years and in girls until the age of 15years. At 18years of age, the young adult mean value was greater than 100% for CoTh but lower than 100% for TBD. A multivariate analysis identified age, body mass index (BMI), and exercise as independent positive factors for CoTh, while body fat percentage was an independent negative factor. Age and BMI were independent positive factors for TBD in both sexes, whereas body fat percentage was a positive factor in boys only. The study found that CoTH and TBD varied with age and differed in increase in boys and girls; related factors of bone increase could also be found. The results of this study may contribute to the acquisition of high bone density in children and adolescents.

CLINICAL EPIDEMIOLOGY OF OSTEOPOROSIS AMONG ELDERLY FISHING AND AGRICULTURAL POPULATION IN TAIPEI, TAIWAN

PurposeThis article is aimed to evaluate through quantification the prevalence and related aspects of osteoporosis among the aging people working in the fishing and agricultural areas in Taipei, Taiwan.MethodsThe population (n=4360) aged 65 years and above and who were admitted to a teaching hospital for a physical examination in 2010 were involved in this study. Osteoporosis is defined as bone mineral density (BMD) of 2.5 standard deviation (SD) or more under the young adult mean value (&minus;2.5 SD or inferior).ResultsThe population presented an over-occurrence of osteoporosis, scoring 34.4%, and exposed a statistically important rise with cumulative age (P&lt;0.001). Female population displayed a higher incidence than male population (48.1% vs. 26.4%; P&lt;0.001). The age-specific frequency of osteoporosis in 65&ndash;74 years, 75&ndash;84 years, and &ge;85 years was 27.7, 40.0, and 56.7%, respectively. The multinomial logistic regression showed that age (odds ratio [OR]=1.07, 95% confidence interval [CI]: 1.06&ndash;1.09), body height (OR=0.98, 95% CI: 0.97&ndash;0.99), body weight (OR=0.97, 95% CI: 0.95&ndash;099), waist circumference (OR=1.02, 95% CI: 1.00&ndash;1.03), total cholesterol (OR=1.01, 95% CI: 1.00&ndash;1.02), uric acid (OR=0.90, 95% CI: 0.85&ndash;0.95), and regular habits of meat intake (OR=1.47, 95% CI:1.19&ndash;1.75) were statistically significantly associated with osteoporosis. ConclusionNumerous medical aspects were individualistically specified, relating the occurrence of osteoporosis in the elderly among the population involved in fishing and agriculture.

Vertebral fracture in elderly female patients after posterior fusion with pedicle screw fixation for degenerative lumbar pathology: a retrospective cohort study

BackgroundThere have been only a few reports of subsequent postoperative vertebral fracture following posterior spinal instrumentation fusion, especially in elderly female patients. This study attempted to evaluate the long-term prevalence of subsequent postoperative vertebral fracture in female patients aged 70 years and older who underwent spine decompression and fusion surgery with pedicle screw fixation.MethodsWe retrospectively reviewed prospectively collected data from 125 patients who met our inclusion and exclusion criteria. Patients were divided into 2 groups according to age: patients aged 70 years and older (Group A) and patients aged under 70 years of age (Group B). We evaluated incidence of subsequent postoperative vertebral fractures, type and timing of vertebral fractures, preoperative bone mineral density (BMD), preoperative diagnosis, surgical procedure, number of levels fused, extension of fusion to the lumbosacral junction, and presence of a transverse fixator.ResultsBaseline characteristics excluding patients’ age were not statistically different between the two groups. Preoperative BMD of Group A was an average 81.7% of the young adult mean (YAM) value and that of Group B was an average 85.1% YAM value. Subsequent postoperative vertebral fractures occurred in 22 (41.5%) of 53 in Group A. On the other hand, fracture occurred in 17 (23.6%) of 72 in Group B. There were significant differences between the groups (p = 0.02). The odds ratio for subsequent vertebral fracture was 2.4 (95% confidence interval: 1.1–5.2) in favor of Group A. Survival analysis showed that the rate of subsequent vertebral fracture was significantly higher in Group A (log-rank test, P = 0.007).ConclusionsThe incidence of subsequent vertebral fracture in patients aged 70 years and older was significantly higher than in patients aged under 70 years of age. In the case of pedicle screw fixation in elderly female patients, it is necessary to note the high risk of subsequent vertebral fracture despite short or non-rigid fusion. Vertebral fracture after posterior fusion surgery even for degenerative lumbar pathology could occur in more than one-third of female patients aged 70 years and older.

Calf circumference as a surrogate marker of muscle mass for diagnosing sarcopenia in Japanese men and women.

To examine the relationship between calf circumference and muscle mass, and to evaluate the suitability of calf circumference as a surrogate marker of muscle mass for the diagnosis of sarcopenia among middle-aged and older Japanese men and women. A total of 526 adults aged 40-89 years participated in the present cross-sectional study. The maximum calf circumference was measured in a standing position. Appendicular skeletal muscle mass was measured using dual-energy X-ray absorptiometry, and the skeletal muscle index was calculated as appendicular skeletal muscle mass divided by the square of the height (kg/m(2)). The cut-off values for sarcopenia were defined as a skeletal muscle index of less than -2 standard deviations of the mean value for Japanese young adults, as defined previously. Calf circumference was positively correlated with appendicular skeletal muscle (r = 0.81 in men, r = 0.73 in women) and skeletal muscle index (r = 0.80 in men, r = 0.69 in women). In receiver operating characteristic analysis, the optimal calf circumference cut-off values for predicting sarcopenia were 34 cm (sensitivity 88%, specificity 91%) in men and 33 cm (sensitivity 76%, specificity 73%) in women. Calf circumference was positively correlated with appendicular skeletal muscle mass and skeletal muscle index, and could be used as a surrogate marker of muscle mass for diagnosing sarcopenia. The suggested cut-off values of calf circumference for predicting low muscle mass are <34 cm in men and <33 cm in women.

THU0384 Juxtaarticular Osteoporosis Exists in the Wrist Joint from the Early Stage of Rheumatoid Arthritis

BackgroundJuxtaarticular osteoporosis is considered a unique feature, especially in the finger joints, in patients with rheumatoid arthritis (RA). However, there is little evidence from when it exists, and few reports...

Prevalence of osteopenia and osteoporosis and factors associated with decreased bone mineral density in elderly inpatients with psychiatric disorders in Huzhou, China.

BackgroundLittle is known about the risks of bone fractures in elderly patients with mental disorders in China.AimAssess the bone mineral density (BMD) of elderly patients with mental disorders in China and identify factors that are associated with low BMD, osteopenia and osteoporosis.MethodsOne hundred and two psychiatric inpatients 60 years of age or older (including patients with schizophrenia, depression, bipolar disorder and dementia) were randomly selected from patients in the geriatric wards of the Third People's Hospital of Huzhou. Detailed demographic, clinical and biometric data were obtained and the BMD of the lumbar spine was assessed using standard dual energy X-ray absorptiometry (DXA) procedures. Based on WHO criteria, individuals with BMD 1 to 2.5 standard deviations below the mean value for healthy young adults were diagnosed as osteopenia and those with BMD values 2.5 or more standard deviations below the mean value were diagnosed as osteoporosis.ResultsThe prevalence of osteopenia was 33.3% (95% CI, 24.4%-43.2%) and the prevalence of osteoporosis was 35.3% (26.0%-45.2%) but none of these patients – even the five patients who had had non-traumatic fractures – had ever been treated for these conditions. The prevalence of osteoporosis in females was 10-fold that in males (53% versus 5%). BMD decreased with age and increased with increasing body mass index (a reflection of nutritional status). The prevalence of osteoporosis was much higher in patients with a diagnosis of depression (58%) than in those with schizophrenia (33%), Alzheimer's disease (30%) or bipolar disorder (13%). Regression analyses found that low BMD and the combined category of osteopenia and osteoporosis were both independently associated with female gender, increasing age, decreasing body mass index, and a diagnosis of depression. BMD and osteoporosis were not significantly associated with regular use of antipsychotic medication.ConclusionOsteopenia and osteoporosis are common conditions in elderly patients with mental disorders that can seriously affect their quality of life but they often go undiagnosed and untreated. Long-term prospective studies are needed to clarify the relative importance of nutritional status, activity level, medication usage, and other factors in the causal pathways that connect mental illnesses to BMD.

Risk categorisation through standard deviations – the challenge of bone density measurements: A focus group study among women attending the Nord-Trøndelag Health Study (HUNT)

Bone density measurements play an important part in the categorisation of osteoporosis as a risk factor in modern medicine. According to the World Health Organization, people are categorised as having osteoporosis when their bone mineral density (BMD) value is 2.5 standard deviation (SD) below the young adult mean value, and as having osteopenia when the value lies between one and 2.5 SDs below the young adult mean value. The categorisation according to SDs makes osteoporosis a rather unique case within the medical world of risk definitions. We invited women who had their bone mass scanned in the Nord-Trøndelag Health Study (HUNT) to participate in focus groups and share their scanning experiences. Nine groups of women met three times for a total of 27 focus group discussions. Our findings illustrate that having their BMD measured contributed to a substantial confusion, related in particular to feedback given as SDs, the choice of reference populations and the body sites chosen for BMD. Some of the women had had their BMD measured at different health institutions using different reference groups, which resulted in women being told that they were osteoporotic at one institution, but not at the other. As the different institutions also scanned various body sites, including the wrist, hip and spine, the women were also confused about what site(s) provides the best information about their bone status. Overall this study shows that osteoporosis presents us with a particularly challenging example of risk categorisation.

Prevalence of osteoporosis and osteopenia in advanced chronic obstructive pulmonary disease patients

Background:Reduction of bone mineral density (BMD) is a known and established phenomenon in chronic obstructive pulmonary disease (COPD). However, there have been no data regarding osteoporosis/osteopenia in COPD patients in India.Aim:To look for the degree and frequency of osteoporosis/osteopenia in our OPD patients being diagnosed as COPD.Materials and Methods:Thirty-seven randomly selected patients with COPD were assessed for BMD with commercially available ultrasound bone densitometer (HOLOGIC SAHARA) in a pulmonary OPD. Some cofactors for reduced BMD were also noted.Results:Out of the 37 COPD (all belonging to the GOLD III/IV category) patients studied, the BMD was found to be normal in 10 (27%) patients, while 27 (73%) patients were found to have osteopenia/osteoporosis [19 (51.35%) and 8 (21.62%) patients having osteopenia and osteoporosis, respectively].Conclusion:Frequency of osteoporosis and osteopenia was found to be very high (73%) in our population of advanced COPD. The data suggest a need for further in-depth study regarding the issue.

Defining Sarcopenia in Terms of Risk of Physical Limitations: A 5‐Year Follow‐Up Study of 3,153 Chinese Men and Women

To examine the definition of sarcopenia in Chinese subjects by relating the value of appendicular skeletal muscle mass (ASM) divided by height squared to physical functional outcomes after 4 years. Four-year prospective study. A Chinese community in Hong Kong SAR China. Three thousand one hundred fifty-three community-living men and women aged 65 and older. Information collected by questionnaire included demographics, health limitation on activities of daily living (ADLs), self-care, physical activity level, dietary intake, and psychosocial functioning. Measurements included height, weight, grip strength, step length in a 6-minute walk, and body composition. Four-year outcomes for those with ASM in kg per height in meters squared (ASM/ht(2)) less than 2 standard deviations (SDs) and 2 SDs or more below the young adult mean value were compared using analysis of variance and logistic regression, adjusting for potential confounding factors such as age, fat mass, presence or absence of malnutrition, dietary protein and vitamin D intake, comorbidity, and cognitive impairment. Participants with ASM/ht(2) 2 SDs or more below the young adult mean had lower grip strength and greater limitation in climbing stairs and general ADLs after adjusting for confounding factors. A U-shaped relationship was observed between physical limitation and ASM/ht(2), with increasing physical limitation below or above a range of 7.25 to 6.75 kg/m(2) in men and 6.00 to 6.25 kg/m(2) in women. Values of 5.25 to 6.74 kg/m(2) in women were associated with approximately 30% less risk of functional limitation after 5 years. No clear cutoff was found in men. Sarcopenia may be defined in terms of a range of values for ASM/ht(2) associated with the lowest risk of future physical limitations. The importance of establishing a quantitative value for the definition of sarcopenia may facilitate future interventional studies using pharmacological or nonpharmacological strategies.

The geriatric hand: correlation of hand-muscle function and activity restriction in elderly

On the basis of the importance of hand manipulation in activities of daily living (ADL), deterioration of hand function because of various factors reduces quality and independence of life of the geriatric population. The aim of this study was to identify age-induced changes in manual function and to quantify the correlations between hand-muscle function and activity restriction in the geriatric age group, through grip and pinch measurements and a set of questionnaires. Twenty-four geriatric (aged 65-79 years) volunteers participated in the study. Bilateral grip and pinch strengths have been recorded. To document impairment of manual functions, self-estimated hand function, Duruöz and Dreiser hand indices, Geriatrics-Arthritis Impact Measurement Scale (GERI-AIMS) manual dexterity questionnaires have been completed. Activity restriction and quality of life of these patients were inquired with short form (SF)-36 and Instrumental Activities of Daily Living (IADL) scores. Grip and pinch strengths correlated best with Duruöz and Dreiser indices. Similarly, SF-36 and IADL had higher correlation coefficients for Duruöz and Dreiser indices. A very good correlation between IADL and SF-36 was calculated too. Male and female participants revealed statistically significant differences for grip and pinch strengths as well as self-estimated hand function and SF-36. Another result was that none of our parameters, including grip strength and SF-36 had differed significantly between the 65-70 and 70-79 years age subgroups. However, grip strength displayed statistically significant lower values when compared with young adult mean values of a previous study. Our data in this study support the hypothesis that hand-muscle function correlates with functional dependency in the elderly. Manual function can be determined by grip strength in addition to multiple available functional tools. In this study, Dreiser and Duruöz hand function indices were the best to correlate with ADL and quality of life.

Can self-rated health identify us women and men with low bone mineral density? a cross-sectional population study

Despite its simplicity, self-rated health (SRH) is a significant dimension of health assessment, with demonstrated means to identify individuals at increased risk of morbidity and mortality. The aim of the present study was to assess whether SRH, age, and modifiable osteoporosis risk factors in a hypothetical screening situation could identify individuals with low bone mineral density (BMD). Data were analyzed from a multiethnic sample of 4905 women and men aged 50 to 79 years from the Third National Health and Nutrition Examination Survey. Low BMD was assessed according to the World Health Organization definition using gender- and race/ethnicity-specific young adult mean values to calculate T-scores. Multiple linear regression analysis was used to determine whether BMD was lower among those with poorer SRH; multiple logistic regression analysis was used to determine whether poor SRH was associated with low BMD. The study population included 616 and 589 African American; 522 and 564 Mexican American; and 1312 and 1302 white women and men, respectively. The distributions of SRH responses differed for African American and Mexican American women and men compared with the distributions for same-gender whites, with significantly more white women and men reporting excellent or very good health (P < 0.05) and significantly greater proportions of African American and Mexican American women and men reporting poorer health (P < 0.05). Among women and nonwhite men, there was no evidence of an association between BMD and SRH. Linear trends of decreasing BMD with declining SRH were detected for all men with low or normal body mass index (P < 0.001) and overweight men (P < 0.001). When stratified by race/ethnicity, a linear trend of decreasing BMD with declining SRH was found for nonobese white men only (P-trend: <0.001). The likelihood of having low BMD among nonobese white men who reported excellent or very good health was two-thirds that of their male counterparts with poor SRH (P < 0.001). Independent of age and modifiable osteoporosis risk factors, poor SRH may be a relevant risk factor for low BMD among older nonobese white men. Further research is needed to determine whether SRH may be a useful risk assessment tool for low BMD in this group of men.

Changes in bone markers after once-weekly low-dose alendronate in postmenopausal women with moderate bone loss

Background High bone turnover, with bone resorption exceeding bone formation, is a major mechanism of postmenopausal osteoporosis. Therefore, inhibition of bone resorption is a rational approach for the prevention of bone loss. The objective of the current study was to determine the short-term efficacy of once-weekly low-dose alendronate in the prevention of bone loss, via bone turnover markers, in early postmenopausal Korean women with moderate bone loss. Methods This study involved a 12-week, randomized, double-blind clinical trial that compared the effects of placebo with alendronate 20 mg once weekly. All subjects received supplemental calcium 600 mg and vitamin D 400 IU daily. We recruited 63 postmenopausal women (ranging from 50 to 65 years of age) with the lowest lumbar spine bone mineral density (BMD) at least 2.0 S.D. below the mean value for young healthy adults. BMD was measured at baseline and serum alkaline phosphatase (ALP), osteocalcin, C-terminal telopeptide of type I collagen (CTX), and osteoprotegerin (OPG) were measured at baseline and 12 weeks after treatment. Results We randomly assigned 63 women to either placebo or alencronate 20 mg once a week for 3 months. Forty-nine women continued and completed all 3 months. After 3 months, bone resorption markers were significantly decreased in the alendronate group than in the placebo group: CTX −47.2% vs. 15% ( p < 0.01), ALP 1.6% vs. 25.9% ( p = 0.01), osteocalcin −29.2% vs. −13.6 ( p = 0.06). Women who received alendronate showed similar results to those who received placebo with regard to adverse events. Conclusion Once-weekly low-dose alendronate may be a cost-effective and safe method of suppressing bone turnover in early postmenopausal women with moderate bone loss.

Increased Cortical Bone Mineralization in Imatinib Treated Patients with Chronic Myelogenous Leukemia.

Background: Imatinib mesylate (Gleevec™) is the drug of choice for most patients with chronic phase CML. It was recently suggested that hypophosphatemia develops in imatinib treated patients as a consequence of suppression of bone turnover and renal phosphate wasting.Aim: To study the mineral metabolism, and areal and volumetric bone mineral density in chronic phase CML patients treated with imatinib.Material and methods: Seventeen imatinib treated CML patients (11 males/6 females; mean age 60±11 (SD) years) and 17 healthy volunteers (11 males/6 females; mean age 59±11 (SD) years) were included. All CML patients were treated in first chronic phase, targeting an imatinib dose of 400 mg q.d. At time of study, all patients were in complete cytogenetic remission and the mean imatinib treatment duration was 50±19 (SD) months. Serum levels of total and ionized calcium, phosphate, magnesium, parathyroid hormone (PTH), and markers of bone formation (osteocalcin and bone specific alkaline phosphatase) and bone resorption (carboxyterminal cross-linked telopeptide of type I collagen) were analyzed. Twenty-four hours urine collections, for determination of calcium and phosphate excretion, were also obtained from all patients and controls. Areal and volumetric bone mineral density (aBMD and vBMD) were evaluated by dual energy x-ray absorptiometry (DXA) and peripheral quantitative computerized tomography (pQCT), respectively.Results: Imatinib treated patients had significantly lower serum levels of ionized calcium, phosphate, magnesium, osteocalcin and bone specific alkaline phosphatase. Serum PTH was higher in the patients compared the controls (p=0.06). The patients also excreted less calcium in the urine. aBMD were increased in hip and lumbar spine compared to controls.The results of the DXA measurements. T-score is the difference of BMD from young adult (20–40 years; same sex) mean value normalised to the population SD. Z-score is the difference of BMD from age-matched (same sex) mean value normalised to the population SD.vBMD was increased in cortical but not trabecular bone of tibia and radius.The results of pQCT-measurements. vBMD and cross sectional area were measured at *4% and **25% bone length in the proximal direction.Conclusion: Our data show that imatinib increases cortical bone mineral density and clearly rules out the previous concern of “imatinib induced osteomalacia”. It can be speculated that tyrosine kinase inhibitors could be novel antiosteolytic agents in skeletal disorders such as osteoporosis, myelomatosis and bone marrow metastatic diseases. Indeed, previous animal studies have shown that imatinib decreases osteoclastogenesis and osteoclast activity.DXACML (n=17)Controls (n=17)P-valueHip bone (total)aBMD (g/cm2)1.08±0.20.95±0.10.025T-score0.07±1.42−0.82±0.83Z-score0.46±1.37−0.26±0.85Lumbar spineaBMD (g/cm2)1.27±0.221.12±0.150.029T-score0.38±1.77−0.82±1.23Z-score0.57±1.72−0.36±1.29pQCTCML (=17)Controls (n=17)P-valueRadiusTrabecular vBMD* (mg/cm3)190.9±34.2193.9±28.8nsCortical vBMD** (mg/cm3)1211.3±23.81181.1±38.70.01Cortical area** (mm2)95.1±16.388.6±18.7nsTibiaTrabecular vBMD* (mg/cm3)240.2±47.3226.2±23.9nsCortical vBMD* (mg/cm3)1185.6±23.51159.4±36.20.017Cortical area** (mm2)262.6±50.7261.3±44.4ns

Knochendichtemessung: Quantitativer Ultraschall am Kalkaneus und distalen Radius

Quantitative ultrasound (QUS) has been successfully used for more than a decade in predicting the risk of osteoporotic fractures. However, the "gold standard" in the diagnosis of osteoporosis is dual-energy X-ray absorptiometry (DXA). The aim of this study was to perform QUS at the calcaneus and distal radius, as well as DXA over the lumbar spine and proximal femur in women and to compare both QUS results with the DXA ones. 230 postmenopausal Bulgarian women, aged between 42 and 80 years, took part in this study. QUS was performed ar the calcaneus and the radius. At the calcaneus the "quantitative ultrasound index" (QUI) was used, but at the radius the speed of sound (SOS) T-scores (SD's under the mean value for young healthy adults) were calculated. The highest accuracy was observed at the radius (coefficient of variance 0.59 %), followed by that for the total hip (0.95 %). The lowest mean T-scores were found at the lumbar spine (-1.94), followed by the calcaneus (-1.85) und radius (-1.74). The correlation coefficients between calcaneal QUI and BMD of the lumbar spine and proximal femur were 0,285 and 0.442 (p=0.059 and 0.001, respectively); the corresponding values for radial SOS were 0.201 and 0.061 (p=0.019 and 0.513, respectively: no significant difference). T-scores of -1.0 for the Sahara device and of -0.5 for the Sunlight device identified women without spinal osteoporosis with a 90% probability. Women with normal bone density of the proximal femur were better identified using transverse QUS at the calcaneus. Both QUS techniques (transverse and axial) are well suited for identifying women without osteoporosis of the lumbar spine.

Bone Mineral Density Assessment in Premenopausal Women

In the absence of fragility fractures, low bone mineral density may reflect attainment of a lower peak bone mass in comparison with the young adult mean value. It is necessary to distinguish between low peak bone mass and a systemic disorder resulting in low bone mineral density and skeletal fragility. Low peak bone mass in the absence of fragility fracture or progressive bone loss may not require pharmacological intervention. However, systemic disorders contributing to bone loss do require diagnosis and intervention. Common causes of low bone density in premenopausal women include ovulatory disturbances and low body weight. Other diseases, conditions or medications may also contribute to bone loss and these should be identified and treated if present. Fracture risk is reduced by lifestyle changes and pharmacological intervention in those with glucocorticoid-induced bone loss. Discontinuing depo medroxyprogesterone acetate use has been associated with improvements in bone mineral density. Bone mineral density alone is insufficient for the diagnosis of osteoporosis in premenopausal women in the absence of fragility fractures. Bone mineral density testing should only be performed in premenopausal women in the presence of approved indications.

Forearm bone mineral density in an unselected population of 2,779 men and women--the HUNT Study, Norway.

The fracture incidence in Norway is among the highest in Europe, presumably due to osteoporosis. As part of a multipurpose health study in the county of Nord-Trondelag, Norway (the HUNT study), a 5% randomly selected sample (n=4,646) of the population >19 years of age was invited to undergo single X-ray absorptiometry (SXA) of the forearm. A total of 1,274 men (50.5 years) and 1,505 women (49.9 years) participated (60%). The aim of the study was to describe the variation in bone mineral density (BMD) and the prevalence of forearm BMD 2.5 standard deviations (SD) below the mean value for young adults in an unselected population sample. In women the BMD remained stable until the age of 50 years, whereupon a strong decline in BMD was observed. In men, a BMD increase was observed until about the age of 40 years; the decline after the age of 65 was, however, similar to that in women. Based on age and gender-specific reference values, the age-adjusted prevalence of T-scores <-2.5 SD in women and men aged 50-69 years was 16.0% and 5.6%, respectively. In the age group of 70 years or older the prevalence was 65.8% and 30.6% for women and men, respectively. The accelerated BMD reduction in women aged 50-65 explains the higher prevalence of T-score <-2.5 SD in elderly women than in men. Further studies on bone loss and falls are required to explain the high fracture incidence in Norway.

Risk assessment and screening for low bone mineral density in a multi-ethnic population of women and men: does one approach fit all?

Screening for osteoporosis is currently recommended for all women aged 65 years and older in the USA. How to address screening of non-white women and all men is unclear. Osteoporosis risk assessment questionnaires have been designed and tested mostly among postmenopausal white women, and there is a lack of consensus on appropriate bone mineral density (BMD) cut-off values for defining osteoporosis in non-white persons. The objectives of the present study were to identify a set of risk factors from published population-based studies in white women and men and determine the ability of these risk factors to predict osteoporosis and low BMD in African-American (AA), Mexican-American (MA), and white women and men, and to assess the diagnostic accuracy of this set of risk factors for identifying osteoporosis separately in AA, MA, and white women and men by the use of data for 2,590 women and 2,391 men 50-79 years of age from the third National Health and Nutrition Examination Survey (NHANES III). We employed the World Health Organisation (WHO) definition of osteoporosis, using race/ethnic and gender-specific young adult mean values when calculating the T scores. Low body-mass index, low calcium intake, current cigarette smoking, and physical inactivity were independent risk factors identified from population-based studies. The presence of one or more risk factors was associated with having osteoporosis and low BMD in all groups. The strength of these associations was greater when two or more risk factors were present but varied with race/ethnicity, gender, and age. We conclude that this set of osteoporosis risk factors predicts osteoporosis in non-white women and men. Furthermore, as a risk assessment tool, this set of risk factors might be useful for reducing the number of unnecessary BMD tests performed in older women as well as identifying non-white men who do not require BMD testing.

Diagnosis with bone mass

In diagnostic criteria of osteoporosis proposed by WHO, the severe osteoporosis is defined as a patient with a value for BMD or BMC more than 2.5SD below the young adult mean value in the presence of one or more fragility fractures. When severe fragility fracture occurs from the second to forth lumbar vertebra, the lumbar BMD could be over-estimated. On the other hand, when the lumbar BMD is markedly low, the demarcation of bone contour is incomplete, and the precision of the BMD measurement decreases. Thus, in the severe osteoporosis it is necessary to be careful in the diagnosis with bone mass using DXA.