Zealand Bone Research Articles

Primary hyperparathyroidism in adults-(Part I) assessment and medical management: Position statement of the endocrine society of Australia, the Australian & New Zealand endocrine surgeons, and the Australian & New Zealand bone and mineral society.

To formulate clinical consensus recommendations on the presentation, assessment, and management of primary hyperparathyroidism (PHPT) in adults. Representatives from relevant Australian and New Zealand Societies used a systematic approach for adaptation of guidelines (ADAPTE) to derive an evidence-informed position statement addressing nine key questions. PHPT is a biochemical diagnosis. Serum calcium should be measured in patients with suggestive symptoms, reduced bone mineral density or minimal trauma fractures, and in those with renal stones. Other indications are detailed in the manuscript. In patients with hypercalcaemia, intact parathyroid hormone, 25-hydroxy vitamin D, phosphate, and renal function should be measured. In established PHPT, assessment of bone mineral density, vertebral fractures, urinary tract calculi/nephrocalcinosis and quantification of urinary calcium excretion is warranted. Parathyroidectomy is the only definitive treatment and is warranted for all symptomatic patients and should be considered for asymptomatic patients without contraindications to surgery and with >10 years life expectancy. In patients who do not undergo surgery, we recommend annual evaluation for disease progression. Where the diagnosis is not clear or the risk-benefit ratio is not obvious, multidisciplinary discussion and formulation of a consensus management plan is appropriate. Genetic testing for familial hyperparathyroidism is recommended in selected patients. These clinical consensus recommendations were developed to provide clinicians with contemporary guidance on the assessment and management of PHPT in adults. It is anticipated that improved health outcomes for individuals and the population will be achieved at a decreased cost to the community.

Primary hyperparathyroidism in adults-(Part II) surgical management and postoperative follow-up: Position statement of the Endocrine Society of Australia, The Australian & New Zealand Endocrine Surgeons, and The Australian & New Zealand Bone and Mineral Society.

To develop evidence-based recommendations to guide the surgical management and postoperative follow-up of adults with primary hyperparathyroidism. Representatives from relevant Australian and New Zealand Societies used a systematic approach for adaptation of guidelines (ADAPTE) to derive an evidence-informed position statement addressing eight key questions. Diagnostic imaging does not determine suitability for surgery but can guide the planning of surgery in suitable candidates. First-line imaging includes ultrasound and either parathyroid 4DCT or scintigraphy, depending on local availability and expertise. Minimally invasive parathyroidectomy is appropriate in most patients with concordant imaging. Bilateral neck exploration should be considered in those with discordant/negative imaging findings, multi-gland disease and genetic/familial risk factors. Parathyroid surgery, especially re-operative surgery, has better outcomes in the hands of higher volume surgeons. Neuromonitoring is generally not required for initial surgery but should be considered for re-operative surgery. Following parathyroidectomy, calcium and parathyroid hormone levels should be re-checked in the first 24 h and repeated early if there are risk factors for hypocalcaemia. Eucalcaemia at 6 months is consistent with surgical cure; parathyroid hormone levels do not need to be re-checked in the absence of other clinical indications. Longer-term surveillance of skeletal health is recommended. This position statement provides up-to-date guidance on evidence-based best practice surgical and postoperative management of adults with primary hyperparathyroidism.

Assessment and management of bone health in women with oestrogen receptor-positive breast cancer receiving endocrine therapy: Position statement of the Endocrine Society of Australia, the Australian and New Zealand Bone & Mineral Society, the Australasian Menopause Society and the Clinical Oncology Society of Australia.

To formulate clinical consensus recommendations on bone health assessment and management of women with oestrogen receptor-positive early breast cancer receiving endocrine therapy, representatives appointed by relevant Australian Medical Societies used a systematic approach for adaptation of guidelines (ADAPTE) to derive an evidence-informed position statement addressing 5 key questions. Women receiving adjuvant aromatase inhibitors and the subset of premenopausal woman treated with tamoxifen have accelerated bone loss and increased fracture risk. Both bisphosphonates and denosumab prevent bone loss; additionally, denosumab has proven antifracture benefit. Women considering endocrine therapy need fracture risk assessment, including clinical risk factors, biochemistry and bone mineral density (BMD) measurement, with monitoring based on risk factors. Weight-bearing exercise, vitamin D and calcium sufficiency are recommended routinely. Antiresorptive treatment should be considered in women with prevalent or incident clinical or morphometric fractures, a T-score (or Z-scores in women <50years) of <-2.0 at any site, or if annual bone loss is ≥5%, considering baseline BMD and other fracture risk factors. Duration of antiresorptive treatment can be individualized based on absolute fracture risk. Relative to their skeletal benefits, risks of adverse events with antiresorptive treatments are low. Skeletal health should be considered in the decision-making process regarding choice and duration of endocrine therapy. Before and during endocrine therapy, skeletal health should be assessed regularly, optimized by nonpharmacological intervention and where indicated antiresorptive treatment, in an individualized, multidisciplinary approach. Clinical trials are needed to better delineate long-term fracture risks of adjuvant endocrine therapy and to determine the efficacy of interventions designed to minimize these risks.

Abstracts from the combined 2017 meeting of the Australian and New Zealand Bone and Mineral Society (ANZBMS) and the International Federation of Musculoskeletal Research Societies (IFMRS), in conjunction with the Japanese Society for Bone and Mineral Research (JSBMR)

Abstracts from the combined 2017 meeting of the Australian and New Zealand Bone and Mineral Society (ANZBMS) and the International Federation of Musculoskeletal Research Societies (IFMRS), in conjunction with the Japanese Society for Bone and Mineral Research (JSBMR)

Professor Solomon Posen, MD, FRACP, FRCP: 1924–2016—Physician, Scientist, Mentor

Professor Solomon Posen, MD, FRACP, FRCP: 1924–2016—Physician, Scientist, Mentor

1507P - Correlation between Tumour Necrosis and Overall Survival in Adults with Osteosarcoma Treated with Neoadjuvant Cisplatin and Doxorubicin

ABSTRACT Purpose The degree of tumour necrosis following neoadjuvant chemotherapy has crucial prognostic significance in methotrexate containing regimens. We examined whether a similar relationship exists for a non methotrexate containing regimen in a cohort of adult patients treated at the Auckland Regional Cancer Service between Feb 1996 and Feb 2011. Methods We retrospectively identified 35 patients with high grade osteosarcoma using data recorded prospectively in the New Zealand Bone Tumour registry and regional pathology laboratories. All patients received neoadjuvant cisplatin and doxorubicin, without high dose methotrexate. Reported necrosis rates following surgery clustered into 3 groups: >90%, 30-65% and 90% necrosis) prognostic groups. Analysis was on an intention-to-treat basis. Results Median overall survival was 130.6 months, with a 5-year survival of 52%. Of the 35 patients, 29% were in the “poor”, 46% in the “intermediate” and 26% in the “good” prognostic groups. Median survival was significantly different between the “good”, “intermediate” and “poor” prognostic groups (“not reached” vs 50.1 mo vs 23.7 mo (logrank test, p = 0.05). 5-year overall survival rate for the “poor”, “intermediate” and “good” groups was 23%, 49% and 83% respectively. 16 patients (46%) relapsed; 13 patients relapsed (81%) in the lungs alone, 1 local recurrence, 2 lung and other sites. 8 underwent metastasectomy with a median survival of 50 mo vs 21 mo in those whose disease was not operable (p = 0.0009). Conclusion This study demonstrates a clear trend to better outcomes with greater degrees of tumour necrosis, but challenge the dogma that necrosis of less than 90% confers a uniformly poor prognosis. Those in the “intermediate” and “poor” response groups had lower 10-year survival rates, but there were long-term survivors in both groups. Overall survival in the “poor” response group is similar to that of historical controls treated by surgery alone, despite a change of chemotherapy in 40% of this group Those with relapsed disease have significant benefit from surgery for metastases. Disclosure D. Porter: Previous consulting fro Pfizer. Current consulting for GSK. Previous travel grant from Novartis. All other authors have declared no conflicts of interest.

Professor Philip Sambrook – Obituary

It is with great sadness that I report the passing of my colleague and friend, Philip Sambrook, who died after a fight against ocular melanoma on 31st March 2012. Philip will not only be remembered as the first Editor-in-Chief of this journal, but also for his major clinical and scientific contributions to the field of rheumatology in general and osteoporosis in particular. I first met Philip in the early 1980s when he was working at Northwick Park Hospital in London – we met in Edinburgh and had a wonderful day discussing the effects of glucocorticoids on bone, a meeting we were going to repeat on numerous occasions over the subsequent 30 years. Over those years Philip made enormous contributions, not just in glucocorticoid-induced osteoporosis, but also in the epidemiology and genetics of osteoporosis (via the Dubbo Osteoporosis Epidemiology Study and his work on Australian twins) and transplant osteoporosis. Later in his career he developed a great interest on the causes and prevention of morbidity and mortality in the elderly after fracture. He authored over 300 peer-reviewed publications and continued to contribute to papers in the last few months of his life. His publication record led to a really impressive H-factor of 63. Philip was recognised for his outstanding contributions to osteoporosis research by a large number of awards and prizes, most notably the Parr Prize from the Australian Rheumatology Association in 1988, the Medal of the Order of Australia (OAM) in 2008 and most recently the Distinguished Service award from the Institute of Bone and Joint Research in 2011. He was also recognised by his peers as a leader, for example as the President of the Australia and New Zealand Bone and Mineral Society (2007–2009), and a co-founder and president of the Asia Pacific Osteoporosis Foundation. He was a Board Member and the first Medical Director of Osteoporosis Australia (the Australian Osteoporosis Patient society), member of the Board of Directors of The International Bone and Mineral Society and a member of the Committee of Scientific Advisors of the International Osteoporosis Foundation. All of these awards and positions show the esteem in which Philip was held by his peers. That esteem was not only because of his scientific contributions, his leadership and the exemplary clinical care of his patients, but because he was a thoroughly nice man. He will be sorely missed by so many and a very hard act to follow as Editor-in-Chief of this journal.

Musculoskeletal CPD revision: Cases from the New Zealand bone and soft tissue tumour registry

The following case report was selected from the New Zealand Bone and Soft Tissue Tumour Registry to highlight some key concepts and findings in musculoskeletal imaging with radiological-pathological correlation. The presentation follows a question and answer format followed by clinical information, selected images, diagnosis, discussion and teaching points.

How i handle bone specimens: a case based presentation

This practical talk covers a range of bone specimens handled and reported at Middlemore Hospital, the site of the New Zealand Bone and Soft Tissue Tumour Registry. A variety of techniques and approaches for the gross handling of the specimens and equipment is discussed. This includes dealing with a large limb amputation specimen, to a limb salvage specimen comprising a wide excision of bone and soft tissues, to smaller excision specimens, curettings of bony tissue and finally undecalcified bone specimens for quantitative histomorphometry. The use of band saws, desk top skill saws, and hand saws is illustrated. Principles of decalcifying bone are also discussed. Cases that have been selected to demonstrate this range of techniques include synovial chondrosarcoma, pleomorphic undifferentiated sarcoma, conventional osteosarcoma, post-radiation osteosarcoma, degenerative joint disease, osteomyelitis, and hypophosphatasia concurrent with renal bone disease.

An approach to lucent lesions of bone: a case based presentation with radiological and histopathological correlation

This practical talk covers a range of bony lesions that are often initially characterised on plain radiographs. A discussion of radiological features pertaining to aggressive or non-aggressive properties, thereby allowing generation of a radiological differential diagnosis, is undertaken. This is then correlated with a series of cases managed at Middlemore Hospital, the site of the New Zealand Bone and Soft Tissue Tumour Registry. The disease entities covered range from benign to malignant, and primary to secondary. Cases include examples of fibrous dysplasia, Langer-hans cell histiocytosis, giant cell tumour of bone, non-ossifying fibroma, osteoid osteoma, osteoblastoma, aneurysmal bone cyst, simple bone cyst, osteomyelitis, chondroblastoma, chondromyxoid fibroma and bone metastasis.

Vantage 088: Vorinostat in Combination with Bortezomib in Patients with Relapsed/Refractory Multiple Myeloma: Results of a Global, Randomized Phase 3 Trial

Abstract 811 Introduction:Vorinostat (VOR), an oral inhibitor of histone deacetylase class I and class II proteins, regulates genes and proteins involved in tumor growth and survival. The synergistic effects of VOR and bortezomib (BTZ) have been shown in preclinical studies and were confirmed in independent phase 1 trials in patients with relapsed/refractory multiple myeloma (MM), producing objective response rates (ORRs) of up to 42% and overall clinical benefit of up to 90%. Materials and methods:Eligible patients were aged ≥ 18 years, had measurable secretory MM, had received 1 to 3 prior systemic anti-myeloma regimens, and had an Eastern Cooperative Oncology Group status ≤ 2. Previous exposure to BTZ and the presence of extracellular plasmacytoma were allowed per protocol, but patients with prior resistance to BTZ were excluded. Patients were randomized 1:1 to receive 21-day cycles of BTZ (1.3 mg/m2 intravenously; days 1, 4, 8, and 11) in combination with oral VOR 400 mg/d, or matching placebo, on days 1 to 14. Additional use of corticosteroids for the treatment of MM was not allowed during the trial. Patients were treated until disease progression, unacceptable toxicities, or withdrawal from the study. The primary endpoint for this trial was progression-free survival (PFS; occurrence of 412 PFS events). Secondary and exploratory endpoints included ORR (≥ partial response), clinical benefit response (ORR + minimal response), overall survival, time to progression, patient-reported outcomes questionnaires (QLQ-C30, QLQ-MY20), and safety/tolerability of this novel drug combination. Responses and progression were determined according to the European Bone and Marrow Transplantation Group criteria and will be confirmed by an Independent Adjudication Committee. Results:Between January 2009 and January 2011, 637 patients were enrolled from 174 centers in 33 countries across the globe making this trial one of the largest studies conducted in patients with relapsed/refractory myeloma. Median age of the study population was 62 years (range, 29–86 years). Of the enrolled patients, 59% were male and 56% were Caucasian. Patients had received a median of 2 prior regimens (range, 1–3). Prior anti-myeloma agents included BTZ (24%), thalidomide (56%), lenalidomide (13%), melphalan (56%), and stem cell transplantation (35%). As of July 2011, 635 patients had received study medication, with a median exposure of 7 cycles (mean: 7.6 cycles; range 1–30 cycles). Reported median exposure to BTZ monotherapy in previous phase 3 trials was approximately 5 cycles. Conclusions:The study passed the protocol-specified futility analyses by the independent data monitoring committee in November 2010. Database lock is anticipated in November 2011, and top-line data on primary and secondary endpoints will be available at the meeting. Disclosures:Dimopoulos:Celgene, Ortho-Biotech: Consultancy, Honoraria. Off Label Use: Vorinostat, an inhibitor of histone deacetylase, is approved in the US for the treatment of cutaneous manifestations in patients with cutaneous T cell lymphoma (CTCL) who have progressive, persistent or recurrent disease on or following two systemic therapies. Vorinostat is currently under investigation for the treatment of relapsed malignant pleural mesothelioma, relapsed/refractory B cell lymphoma (in combination with other chemotherapy agents), and relapsed/refractory multiple myeloma (in combination with bortezomib and other chemotherapy agents). Jagannath:Merck: Membership on an entity’s Board of Directors or advisory committees; Celgene: Membership on an entity’s Board of Directors or advisory committees; Millennium: Membership on an entity’s Board of Directors or advisory committees. Yoon:Celgene: Consultancy; NK Bio: Consultancy. Siegel:Millennium: Honoraria, Research Funding, Speakers Bureau; Merck: Honoraria. Lonial:Millennium: Consultancy; Celgene: Consultancy; Novartis: Consultancy; BMS: Consultancy; Onyx: Consultancy; Merck: Consultancy. Hajek:Celgene: Honoraria; Janssen: Honoraria; Merck: Educational lecture. Facon:Janssen: Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau; Merck: Membership on an entity’s Board of Directors or advisory committees. Rosiñol:Celgene: Honoraria; Janssen-Cilag: Honoraria. Blacklock:New Zealand Bone Marrow Donor Registry: Consultancy, Employment; Mercy Hospital, Auckland New Zealand: Consultancy; Leukaemia and Blood Foundation, New Zealand: Consultancy, Membership on an entity’s Board of Directors or advisory committees; Middlemore Hospital: Employment, Research Funding. Goldschmidt:Amgen, Novartis, Chugai: Research Funding; Janssen-Cilag, Celgene: Membership on an entity’s Board of Directors or advisory committees, Research Funding. Palumbo:Merck: Honoraria; Celgene: Honoraria, Membership on an entity’s Board of Directors or advisory committees; Amgen: Honoraria; Janssen-Cilag: Honoraria, Membership on an entity’s Board of Directors or advisory committees. Reece:Merck: Honoraria, Research Funding; Janssen: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Otsuka: Honoraria, Research Funding. Graef:Merck: Employment. Houp:Merck Research Laboratories: Employment. Sun:Merck & Co., Inc.: Employment. Eid:Merck Research Laboratories: Employment. Anderson:Celgene: Consultancy; Millennium: Consultancy; Novartis: Consultancy; BMS: Consultancy; Onyx: Consultancy; Merck: Consultancy; Acetylon: founder.

Prevalence of osteoporosis in Australian men and women: Geelong Osteoporosis Study

To the Editor: Few reports have been published on bone mineral density (BMD) among randomly sampled populations. Organisations such as Osteoporosis Australia and the Australian and New Zealand Bone and Mineral Society rely on research to supply reliable data that are representative of the Australian community. This information informs practitioners, researchers and policymakers of the size of the problem of osteoporosis in Australia. Our study aimed to document the proportion of individuals who have reduced BMD.

Biomedical Titanium Alloy with Ultralow Elastic Modulus and High Strength

Ti2448 (Ti-24Nb-4Zr-8Sn wt.%) is a metastable  type titanium alloy developed recently for biomedical applications. The alloy possesses good biomechanical compatibility with human bone, in terms of high strength and an elastic modulus approaching that of the hard tissue of human body, as well as biochemical compatibility since it contains only nontoxic alloying elements. Bone plates manufactured from the Ti2448 alloy has undergone clinical trials and an application for product permission has been submitted to FDA of China. We review briefly the methodology of alloy design and peculiar properties including pronounced nonlinear elasticity and localized plastic deformation. Variations of mechanical properties with processing scheme will be presented. The positive effects of improved elastic matching between implant and bone on healing fractured bone are demonstrated by new bone formation at intramedullary nails implanted in New Zealand white rabbits and bone plates implanted in Beagle dogs.

Analysis of bone in POMC knockout mice

Abstracts for 2nd Joint Meeting of the International Bone and Mineral Society and The Australian & New Zealand Bone & Mineral Societys for 2nd Joint Meeting of the International Bone and Mineral Society and The Australian & New Zealand Bone & Mineral Society Category 1. Systemic and Local Regulation of Skeletal Metabolism Analysis of bone in POMC knockout mice J.L. Costa, M. Watson, K.E. Callon, U. Hochgeschwender, J. Cornish Department of Medicine, University of Auckland, Auckland, New Zealand Neurobiology, Duke University, Durham, North Carolina, USA The proopiomelanocortin (POMC) gene encodes numerous peptide hormones secreted by the CNS, the pituitary, and other tissues in the periphery. These hormones include α-, βand γ-melanocyte stimulating hormones (MSH), adrenocorticotropin (ACTH), β-lipotrophin, and β-endorphin. Roles for these hormones have been demonstrated in pigmentation, body weight and metabolism regulation, steroid hormone production, and pain modulation. In the hypothalamus and in the peripheral circulation, α-MSH is secreted in response to elevated leptin levels. Several types of bone cells express subsets of the melanocortin receptors as well as the ACTH receptor. In vitro, α-MSH has been shown to increase bone turnover, increasing both osteoblast proliferation and osteoclastogenesis, while systemic administration of α-MSH reduces bone volume in vivo. There are few recent studies of the direct effects of ACTH on bone cells, and its activities in vivo are often confounded by the numerous steroid hormones it stimulates. βendorphin is one of several endogenous opioids and this family has generally been shown to be anabolic to bone. POMC knockout mice have non-functional adrenal glands with reduction or loss of all adrenal hormones, show increased linear growth, are morbidly obese and develop pituitary tumors with age. In this pilot study, we examined tibia from POMC null mutants for changes in their bone characteristics before the onset of obesity (aged 810 weeks, 3 females per group) using computer assisted microtomography. Cortical thickness was significantly increased in POMC null mice (0.18mm±0.009SEM vs. 0.13±0.003, p=0.0139) versus controls. Changes in trabecular bone in POMC null mice did not reach significance in several measurements: trabecular thickness (0.046mm±0.002 vs. 0.044mm±0.001), trabecular separation (0.20mm±0.006 vs. 0.23mm±0.03) or bone surface (12.1mm2± 2.1 vs. 10.83mm2±0.37). Average femur length (13.9mm±0.15 vs. 13.4mm±0.23) and growth plate thickness also did not reach significance in this small number of animals, although interesting trends were again seen in the POMC null animals. This preliminary study shows that ablation of POMC signaling results in changes in bone morphology consistent with some but not all of the constituent POMC hormones. We suggest that the combined loss of α-MSH and reduction of steroid hormone signaling may be responsible for increasing the rate of osteoblast proliferation and/or reducing the rate of osteoclast formation or function in bones, potentially leading to increased linear length. Changes in POMC hormone signaling impact bone formation during mammalian development and warrant further investigation for possible links to central control of bone metabolism. doi:10.1016/j.bone.2009.12.012 Category 4. Clinical Disorders other than Osteoporosis, Mechanisms of erosive gout: Monosodium urate monohydrate crystals reduce osteoblast viability A. Chhana, K.E. Callon, B. Pool, J. Cornish, N. Dalbeth Medicine, University of Auckland, Auckland, New Zealand Gout is an inflammatory arthritis that is triggered by monosodium urate monohydrate (MSU) crystals within the joint. MSU crystals interact with surrounding cells and tissue within the joint causing inflammation. Bone erosion is a frequent manifestation of chronic gout, and leads to joint damage and deformity, with subsequent disability. We have recently shown that patients with erosive gout have disordered osteoclastogenesis and that MSU crystals indirectly promote osteoclast formation through interactions with stromal cells. Bone 46 (2010) 1465–1466

Musculoskeletal CPD revision: Cases from the New Zealand Bone &amp; Soft Tissue Tumour Registry

This case report has been selected from the New Zealand Bone & Soft Tissue Tumour Registry to highlight some key concepts and findings in musculoskeletal imaging with radiological-pathological correlation. The case is presented in a question and answer format, with clinical information and selected images in one section, followed by the diagnosis, discussion and teaching points.

Calcium and bone health: position statement for the Australian and New Zealand Bone and Mineral Society, Osteoporosis Australia and the Endocrine Society of Australia

This position statement was prepared by the Working Group of the Australian and New Zealand Bone and Mineral Society and Osteoporosis Australia. The final statement was endorsed by the Endocrine Society of Australia. Currently, the balance of evidence remains in favour of fracture prevention from combined calcium and vitamin D supplementation in elderly men and women. Adequate vitamin D status is essential for active calcium absorption in the gut and for bone development and remodelling. In adults with a baseline calcium intake of 500-900 mg/day, increasing or supplementing this intake by a further 500-1000 mg/day has a beneficial effect on bone mineral density. Calcium intake significantly above the recommended level is unlikely to achieve additional benefit for bone health.

Paget's osteosarcoma and post-radiation osteosarcoma: secondary osteosarcoma at Middlemore Hospital, New Zealand

To review the clinical and histological features of our cases of Paget's osteosarcoma and post-radiation osteosarcoma. A search through the files of the New Zealand Bone and Soft Tissue Tumour Registry was performed, patients were identified and the relevant details were collated. Thirty-one cases of Paget's osteosarcoma and eight cases of post-radiation osteosarcoma were identified. Patients with Paget's osteosarcoma were aged between 48 and 67 years, predominantly female, and axial and appendicular skeleton were equally affected. The outcome was known in 29 cases, with a median survival of 7.25 months and 5 year overall survival of 10%. Patients with post-radiation osteosarcoma were aged between 17 and 68 years, equally male or female, and axial and appendicular skeleton were equally affected. Index lesions included benign or malignant osseous and non-osseous conditions. The average age at diagnosis of the index lesion was 30.1 years and the average latent period was 13.5 years. The outcome was known in all eight cases, with a median survival of 33 months and 5 year overall survival of 38%. Paget's osteosarcoma and post-radiation osteosarcoma are examples of secondary osteosarcoma. The former affects elderly patients, and has a poor prognosis and response to treatment. The later affects a wide age group, and has a prognosis and response to treatment comparable with primary osteosarcoma.

Sun protection messages, vitamin D and skin cancer: out of the frying pan and into the fire?

Sun protection messages, vitamin D and skin cancer: out of the frying pan and into the fire?

Class II HLA allele polymorphism: DRB1, DQB1 and DPB1 alleles and haplotypes in the New Zealand Maori population

Class II alleles of interest to transplantation comprise the DRB1, DQB1 and DPB1 loci. Sequence-based typing was used to determine the class II allelic variability present in New Zealand Maori, a population with close genetic ties to Polynesia and known anthropological and linguistic connections to mainland Asia. The most common DRB1 alleles identified were DRB1*1201, DRB1*110101, DRB1*0403 and DRB1*080302, with frequencies of 21.5%, 14%, 11.25% and 9.25%, respectively. Standard linkages between the DRB1 locus and the DRB3, 4 and 5 loci were maintained, with no novel patterns identified. The most common DQB1 alleles identified were DQB1*030101, DQB1*060101, DQB1*020101, DQB1*0602 and DQB1*050201, with frequencies of 29.5%, 8%, 7.8%, 6.4% and 6.2%, respectively. The most common DPB1 alleles identified were DPB1*0501, DPB1*040101 and DPB1*020102, with frequencies of 40.2%, 28.89% and 15.83%, respectively. A total of 80 estimated DRB1-DQB1 two-locus haplotypes were detected. DRB1*1201-DQB1*030101 was the most frequent (15.40%) haplotype, followed by DRB1*110101-DQB1*030101 (9.97%), DRB1*0403-DQB1*030201 (7.37%) and DRB1*080302-DQB1*060101 (5.96%). The allelic variation determined is being used in further analysis of the requirement for bone marrow transplantation in the New Zealand Maori population and has implications for optimal ethnic donor distribution on the New Zealand Bone Marrow Donor Registry, anthropological studies and disease association.

Reference ranges for bone densitometers adopted Australia‐wide: Geelong osteoporosis study

Bone densitometry reports a measure of fracture risk in comparison with young adults (T-scores) and age-matched peers (Z-scores). To date, each manufacturer has provided its own reference range resulting in lack of uniformity. The Australia and New Zealand Bone and Mineral Society and Osteoporosis Australia have recognized the need to standardize the reference range and have recommended that data generated by the Geelong Osteoporosis Study (GOS) be used Australia-wide. The GOS recruited a random, population-based sample of adult women and measured bone mineral density (BMD) at the proximal femur and spine using a Lunar DPX-L. These data were used to establish reference ranges for Lunar machines and, using conversion equations, for Norland and Hologic machines. The new standardized Australian reference ranges for BMD will enable consistent diagnosis of osteoporosis and categorization of fracture risk across different types of densitometers.