Decreased bone mineral density at the distal radius, but not at the lumbar spine or the femoral neck, in Japanese type 2 diabetic patients

The purpose of this study is to assess the association between type 2 diabetes and bone mineral density. This study included 145 Japanese patients (64 men and 81 women) with type 2 diabetes and 95 non-diabetic control subjects (41 men and 54 women) of similar age. We measured bone mineral density (BMD) at the sites with different cortical/cancellous bone ratio (lumbar spine, femoral neck, and distal radius) using dual-energy X-ray absorptiometry. BMD and Z score at the distal radius were significantly lower in type 2 diabetic patients than those in control subjects, and in type 2 diabetic patients, the Z score at the distal radius was lower than that at their own lumbar spine and femoral neck. In type 2 diabetic patients, negative correlation between BMD and the mean HbA1c during the previous 2 years was found significantly at the distal radius in both genders and at the femoral neck in women. These results indicate the selective cortical bone loss in type 2 diabetes and suggest the importance of also determining BMD at the radius and keeping good metabolic control to prevent bone loss in type 2 diabetic patients.     

Relation of axial bone mass to habitual calcium intake and to cortical bone loss in healthy early postmenopausal women

A group of 60 healthy early postmenopausal women participating in an ongoing study on the effect of habitual calcium intake on the rate of cortical bone loss at the radius, were subjected to additional skeletal measurements at the lumbar spine and femoral neck. The women were between 58 and 64 years of age, and 3 to 10 years postmenopausal. No correlations were found between habitual calcium intake (range 560 to 2580 mg/day) and either bone mineral content of the radius, the lumbar spine and the femoral neck, or spine deformity index. Body mass index was found to be positively correlated with bone mass indices of the radius (decrease of BMD and BMD) and femoral neck (BMC), but not with of the lumbar spine (BMC, BMD and SDI), even after adjustments had been made for confounding factors. Although the rate of cortical bone loss at the radius correlated significantly with bone mineral content of lumbar spine and femoral neck, the error in predicting bone mass of the lumbar spine or the femoral neck from longitudinal measurements of cortical bone at the radius was high. The rate of cortical bone loss did not correlate with the spine deformity index. We conclude that in healthy women in early menopause, the bone mineral content of both the appendicular and the axial skeleton are not influenced by habitual calcium intake. A higher body mass index has a protective effect on the appendicular skeleton but appears to be less protective to the axial skeleton. Longitudinal measurements of cortical bone mass are of limited value to predict bone density of the appendicular and axial skeleton.     

体重、身高对成都地区青壮年腰椎、髋部骨量的影响

目的　研究体重、身高对青壮年腰椎、髋部骨量的影响。方法　随机抽取成都地区年龄在 2 0～ 39岁 ,排除心肝肺肾、内分泌等慢性病、骨代谢疾病及脊椎畸形者 2 37名 (其中男性 10 8名 ,女性 12 9名 ) ,采用美国Lunar公司生产DPX L型双能X线骨密度仪测定受试者腰椎和髋部的骨矿含量 (BMC)、面积 (AREA)、骨密度 (BMD)。全部资料输入微机 ,用SPSS软件进行统计学处理。结果　体重、身高、体重指数 (BMI)与腰椎、髋部的BMC、Area、BMD呈正相关 ,其中体重与腰椎、髋部的BMC、Area中等程度相关 (r=0 39～ 0 5 5 ,P <0 0 1) ,身高与腰椎 (L2 - 4)AREA相关性最好 (r=0 75 8,P <0 0 1) ,体重、身高与BMD相关性差 (r=0 15 2～ 0 2 2 5 ,P <0 0 5 )。男性腰椎及髋部的BMC、AREA均明显高于同年龄组女性 (P <0 0 1) ,男、女L2 - 4BMD无显著性差异 (P >0 0 5 ) ,男性略低于女性。L2 - 4BMC与体重比值及L2 - 4AREA与体重比值 ,男、女无显著性差异 (P >0 0 5 )。L2 - 4Area与身高比值男性明显高于女性 (P <0 0 1)。结论　体重对青壮年BMC的影响大于身高 ,身高对L2 - 4AREA影响最大 ,男、女体重、身高的差异决定了峰值骨量的差异。BMC、Area、BMD 3项指标中 ,BMC更能反映体重、身高的差异 ,用BMC诊断骨质疏松     

Bone status in primary hyperparathyroidism assessed by regional bone mineral density from the whole body scan and QUS imaging at calcaneus

To assess the bone mineral density status in primary hyperparathyroidism (PHPT), we studied 64 females with PHPT and 17 healthy women. Regional BMD (arms, trunk, legs) from the whole body scan and conventional sites (lumbar spine, femur, radius) were assessed by DXA. Quantitative ultrasound (QUS) imaging measurements were performed at calcaneus. Sixteen women had history of renal lithiasis, 11 had low impact fracture and 37 women had neither renal lithiasis nor fracture. In the entire group, the mean Z-scores were significantly decreased at all sites (lumbar spine, femur, radius). In all clinical subgroups, the mean Z-scores were significantly decreased at radius. The mean Z-scores in premenopausal women were significantly decreased comparatively to postmenopausal women at lumbar spine and femur. In a group of PHPT females matched to controls for age and BMI, only BMD values at radius were lower in PHPT patients than in control (P < 0.03). However, from the whole body scan data, all sites but no trunk were significantly involved in PHPT patients (P < 0.04). Using QUS measurements at calcaneus, the BUA but not SOS in PHPT females was significantly lower (P = 0.03) than in controls. Our results suggest that low BMD at lumbar spine and femur is encountered preferentially in premenopausal women. The BMD decrease predominates at limbs in PHPT with presumably a gradient from proximal to distal part of the limbs. Indeed, the distal part of the limbs are the most affected areas in PHPT whatever the amount of cortical or trabecular bone.     

Bone mass and structure in adolescents with type 1 diabetes compared to healthy peers

Summary  We measured bone mass and structure using pQCT and DXA in adolescents with Type 1 diabetes and compared the results with those of healthy peers. Our results showed that diabetes is associated with reduced bone mass and smaller bones. The diabetes-associated deficits seemed to concern male adolescents more than females. Introduction  The aim of this study was to compare bone mass and structure between adolescents with type 1 diabetes and their healthy peers. Methods  Peripheral quantitative computed tomography (pQCT) at radius and tibia, and dual-energy X-ray absorptiometry (DXA) at lumbar spine and proximal femur were performed for 48 adolescents, 26 girls and 22 boys, with type 1 diabetes, and for healthy peers matched for age, sex, body height and weight, and pubertal maturity. Results  Diabetes was associated with reduced bone mineral content (BMC) and smaller bone cross-sectional size. Diabetic boys seemed to be more affected than diabetic girls. Among the boys, the mean deficit in BMC of all measured skeletal sites was more than 10%, while among the girls it was less than 5%. Conclusion  In conclusion, type 1 diabetes is associated with reduced BMC and appears to affect bone cross-sectional size and cortical rigidity. The diabetes-related skeletal deficits seemed to concern male adolescents more than females. Whether diabetes-related deficits would contribute to an increased risk of fractures in adulthood or later in life remains to be confirmed.     

Peak skeletal mass assessment in young adults with idiopathic scoliosis

In 52 adult women with ages ranging from 20 to 35 years (mean age, 26.5 +/- 4.9 years) with scoliosis of the idiopathic type (mean, 44.7 +/- 17.4 Cobb degrees), bone density was assessed by conventional grading of the relative vertebral density (RVD) and the Singh trabecular index (STI). In vivo determinations of the bone mineral content (BMC) were performed in the radius, femur, and lumbar vertebrae by new noninvasive techniques of single (SPA)- and dual (DPA)-photon absorptiometry. Frequency distributions of scoliosis vs. control subjects with respect to RVD and STI grades showed interdependence to the P less than 0.01 level of significance. The mean BMC determinations of the radius (0.685 +/- 0.061 gm/sq cm) of the femur (0.947 +/- 0.110 gm/BA/sq cm) and of the vertebrae (1.091 +/- 0.105 gm/BA/sq cm) were markedly reduced compared with published control values (P less than 0.001). In comparison with the authors' institutional controls, mean BMC measurements were significantly lower for the radius (P less than 0.05) and for the femur (P less than 0.001). These results conclusively demonstrated that assessment of peak skeletal mass in a population of adult premenopausal women with idiopathic scoliosis showed significant decrease in average BMC measurements compared with control values. Maximal bone accretion was best evaluated at locations unaffected by deformity such as the radial diaphysis and the femoral neck.     

Detection of prefracture spinal osteoporosis using bone mineral absorptiometry

Bone mineral measurements have been criticized for their inability to clearly distinguish fracture and "nonfracture" populations. However, this failure is not unexpected, since some individuals in the "nonfracture" group have low bone mass and are at increased risk but have not yet experienced fractures. Although standard radiographs are not sensitive indicators of vertebral demineralization, they do identify some of the "prefracture" osteoporotic subpopulation within the nonfracture group. Prospective follow-up of 536 Japanese-American women demonstrated that 14 new spine fractures occurred in the prefracture osteoporosis group, whereas none occurred in the nonosteoporotic group (p less than or equal to 0.03). However, bone mineral content (BMC) measurements using photon absorptiometry were much more accurate than radiographs as indicators of spine fracture risk. BMC values were somewhat higher in the prefracture group than in those with existing fractures, but values for both groups were significantly lower than in nonosteoporotic patients even after adjusting for age, height, and weight (p less than 0.0001). The magnitude of the difference was proportional to the trabecular bone content of the measurement site; the differences were greatest for the os calcis and lumbar spine, smaller for the distal radius, and least for the proximal radius. The prevalence of spinal osteoporosis (including both fracture and prefracture cases) was inversely proportional to BMC (p less than 0.0001). Again, the relations were strongest for the os calcis and lumbar spine. These results indicate that BMC measurements are valid indicators of osteoporosis status, particularly when osteoporosis is defined to include both patients with existing fractures and those at increased risk for fractures. However, dual-photon spine BMC was adversely influenced by the presence of aortic calcification, arthritis, and other disease processes (p less than or equal to 0.0001).     

绝经后骨密度的改变及其临床意义

为指导临床防治绝经后骨质疏松,以单光子吸收法(SPA)测量了435例妇女挠骨皮质骨密度,并以定量计算机层面扫描法(QCT)测其中263例腰椎松质骨密度。435例年龄21～75岁,分5组:正常月经130例,绝经前月经失调81例,自然绝经后172例,人工绝经13例,合并其它疾病39例。挠骨与腰椎单位长度骨矿含量(BMC)峰值分别出现于36～40和31～35岁。月经正常时,从峰值期至50岁,挠骨与腰椎年降率分别为0.94%和0.51%;从峰值期经绝经至75岁,年降率分别为0.89%和1.41%。骨加速丢失从绝经前月经失调时开始。与绝经时间的关系,BMC表现非线性下降,可分为加速丢失、稳定及再次丢失三期。人工绝经与合并疾病者BMC不同程度地提前下降。172例自然绝经后妇女总骨折率为12.8%,骨折组腰椎BMC显著低于未骨折组(P<0.01)。人工绝经组骨折率为15.4%,合并疾病组为25.6%。     

Bone mineral content at three sites in normal perimenopausal women

Bone mineral content (BMC) in 217 healthy white women between the ages of 40 and 55 years was measured using single- and dual-photon absorptiometry. The sites measured included the distal radius, midradius, proximal femur, and lumbar spine. The relationship between BMC and age was constant over the age range studied when the confounding effect of menopause was controlled. Women with low body mass indices (BMIs) had significantly lower BMC than women with average or greater than average BMIs. More active women had higher BMC than less active women at both appendicular and axial sites. A trend suggesting that women with higher calcium intake may have higher BMC was statistically significant only at the midradial site. A trend of postmenopausal women having lower BMC than pre- or perimenopausal women was also statistically significant only at the midradial site. Only modest correlations were found between the various sites. These correlations are too weak to allow accurate clinical predictions of BMC at axial sites from the BMC at an appendicular site in individual patients.     

Seasonal variation of lumbar spine bone mineral content in normal women

The seasonal influence on lumbar spine bone mineral was evaluated in a prospective study of 26 normal women aged 19-66 years. Bone mineral content of the second, third, and fourth lumbar vertebrae (lumbar BMC) was determined every 3 months during 1 year by using dual-photon (153Gd) absorptiometry. Lumbar BMC was, on an average (mean +/- SE), 0.86 +/- 0.27 arbitrary units or 1.7 +/- 0.5% higher in July to September than in January to March (P less than 0.005), when other sources of variation were eliminated. It is hypothesized that the seasonal variation in lumbar spine bone mineral reflects differences of the mechanical loading on the vertebrae. The interpretation of longitudinal studies of lumbar BMC may be erroneous if the seasonal variations in bone mineral are not considered.     

Monitoring of bone mineral content in patients on regular hemodialysis

Bone mineral content (BMC) was measured at the lumbar spine region by means of dual photon absorptiometry over a 3-year period in 20 patients on regular hemodialysis (RHD). Baseline mean BMC at the start of the monitoring was significantly decreased to 82.64% of predicted value (p less than 0.05). During a 3-year follow-up mean BMC rose significantly to 90.61% (p less than 0.05). Six patients received vitamin D supplements. Analysis of the data showed that rise of BMC was similar whether vitamin D was given or not. Our data suggest that (1) RHD inhibits bone loss at the lumbar spine level that occurred mainly before active uremia treatment and (2) the increment of BMC observed in this study can be attributed to the different site of measurement, the inaccuracy of the measurements by interference with soft tissue calcifications and the dialysis conditions.     

Genetic determinants of bone mineral content at the spine and radius: a twin study

The possible role of genetic and/or environmental factors in determining bone mass has been investigated in 30 pairs of twins (16 monozygotic and 14 dizygotic) divided in two age groups (below and above 25 years of age). Bone mineral content was evaluated by single- and dual photon absorptiometry at the distol third of the radius for peripheral cortical bone and in the lumbar spine for the axial bone. The "within pair" variance has been used as an index of genetic influence. A significant (p less than 0.01) genetic determinant was found for the bone mass of the radius in adults and for the spinal bone mass in the age group younger than 25 years. The heritability index h2 was 0.75 for cortical BMC and 0.88 for axial BMC. Such a genetic determinant could not conclusively be demonstrated in adult twins for the spine and in youngsters for the cortical bone, suggesting that environmental factors may play a more dominant role in growth of cortical bone during adolescence and diminution of axial bone during adult life.     

Statut osseux au cours de l'hyperparathyroïdie primitive mesurée par densité minérale osseuse régionale par densitométrie corps entier et ultrasonographie quantitative au calcanéum

To assess the bone mineral density status in primary hyperparathyroidism (PHPT), we studied 64 females with PHPT and 17 healthy women. Regional BMD (arms, trunk, legs) from the whole body scan and conventional sites (lumbar spine, femur, radius) were assessed by DXA. Quantitative ultrasound (QUS) imaging measurements were performed at calcaneus. Sixteen women had history of renal lithiasis, 11 had low impact fracture and 37 women had neither renal lithiasis nor fracture. In the entire group, the mean Z-scores were significantly decreased at all sites (lumbar spine, femur, radius). In all clinical subgroups, the mean Z-scores were significantly decreased at radius. The mean Z-scores in premenopausal women were significantly decreased comparatively to postmenopausal women at lumbar spine and femur. In a group of PHPT females matched to controls for age and BMI, only BMD values at radius were lower in PHPT patients than in control (P <0.03). However, from the whole body scan data, all sites but no trunk were significantly involved in PHPT patients (P <0.04). Using QUS measurements at calcaneus, the BUA but not SOS in PHPT females was significantly lower (P =0.03) than in controls. Our results suggest that low BMD at lumbar spine and femur is encountered preferentially in premenopausal women. The BMD decrease predominates at limbs in PHPT with presumably a gradient from proximal to distal part of the limbs. Indeed, the distal part of the limbs are the most affected areas in PHPT whatever the amount of cortical or trabecular bone.     

Catch up in bone acquisition in young adult men with late normal puberty

The aim of this study was to investigate the development of bone mineral density (BMD) and bone mineral content (BMC) in relation to peak height velocity (PHV), and to investigate whether late normal puberty was associated with remaining low BMD and BMC in early adulthood in men. In total, 501 men (mean ± SD, 18.9 ± 0.5 years of age at baseline) were included in this 5‐year longitudinal study. Areal BMD (aBMD) and BMC, volumetric BMD (vBMD) and cortical bone size were measured using dual‐energy X‐ray absorptiometry (DXA) and pQCT. Detailed growth and weight charts were used to calculate age at PHV, an objective assessment of pubertal timing. Age at PHV was a strong positive predictor of the increase in aBMD and BMC of the total body (R² aBMD 11.7%; BMC 4.3%), radius (R² aBMD 23.5%; BMC 22.3%), and lumbar spine (R² aBMD 11.9%; BMC 10.5%) between 19 and 24 years (p < 0.001). Subjects were divided into three groups according to age at PHV (early, middle, and late). Men with late puberty gained markedly more in aBMD and BMC at the total body, radius, and lumbar spine, and lost less at the femoral neck (p < 0.001) than men with early puberty. At age 24 years, no significant differences in aBMD or BMC of the lumbar spine, femoral neck, or total body were observed, whereas a deficit of 4.2% in radius aBMD, but not in BMC, was seen for men with late versus early puberty (p < 0.001). pQCT measurements of the radius at follow‐up demonstrated no significant differences in bone size, whereas cortical and trabecular vBMD were 0.7% (p < 0.001) and 4.8% (p < 0.05) lower in men with late versus early puberty. In conclusion, our results demonstrate that late puberty in males was associated with a substantial catch up in aBMD and BMC in young adulthood, leaving no deficits of the lumbar spine, femoral neck, or total body at age 24 years. © 2012 American Society for Bone and Mineral Research.     

Tibial ultrasound velocity in women with wrist fracture.

The aim of the study was to determine whether cortical midtibial speed of sound (Soundscan 2000, Myriad Ultrasound Systems, Israel) was able to discriminate women who sustained a fracture of the distal radius from normal women and to compare the performance of tibial speed of sound with dual-energy X-ray absorptiometry (DXA) of the distal radius, hip, and lumbar spine. The study population consisted of 40 women with a wrist fracture and 41 healthy age-matched controls. Tibial ultrasound velocity correlated with bone mineral density of the distal forearm (rS = 0.64, p < 0.001), the hip (rS = 0.46, p < 0.001), and the lumbar spine (rS = 0.51, p < 0.001). The mean speed of sound value at the mid-tibia of the wrist fracture patients (3873 m/s) was lower than that of the controls (3913 m/s), but the difference was not statistically significant (p = 0.12). All DXA values were significantly lower in fracture cases. Receiver operating curve analysis showed that mid-tibial ultrasound velocity was less effective than DXA of the distal forearm to discriminate wrist fracture patients from age-matched controls.     

Bone mineral density in diabetic children and adolescents: a follow-up study

OBJECTIVE: To establish whether T1DM can affect bone mineral density (BMD) in children and adolescents. RESEARCH DESIGN AND METHODS: We performed a cross-sectional and longitudinal study of 57 diabetic children and adolescents and 57 normal controls. Total body and lumbar BMD and bone mineral content (BMC) were assessed by DXA (Lunar DPX) and volumetric transformation was calculated using the Katzman formula for total body BMD (BMAD) and using the Kroger formula for Lumbar BMD (L2L4BMDvol). BMC, BMAD, BMDspine, and L2L4BMDvol were adjusted for confounding factors such as age, gender, BMI, height, weight, and pubertal stage. RESULTS: BMDspine in the control group increased by 0.006 (g/cm(2))/year; while in the 39 diabetic patients longitudinally studied, it dropped by 0.006 (g/cm(2))/year during a follow-up period of 51 +/- 27 months. The average time spent weekly doing physical activity resulted in T1DM group directly correlated to BCM (P < 0.001) and inversely correlated with BMDspine (P < 0.05) and L2L4BMDvol (P < 0.01). L2L4BMDvol resulted significantly correlated with previous BMD spine (R = 0.63; P < 0.0001) and BMC evaluation (R = 0.42; P < 0.01) but not with BMAD. A second lumbar DXA evaluation performed in 38 patients after 1.00 +/- 0.16 years confirmed a small but significant decrease of 1.6% per year in L2L4BMDvol. The percentage of variation of L2L4BMDvol between the two evaluations was not correlated with the level of metabolic control, insulin requirement, and duration of the disease. Patients with complications showed similar L2L4BMDvol to patients without complications. CONCLUSIONS: Diabetic children and adolescents show a slight negative pattern of spine mineralization, which does not depend on metabolic control and microvascular complications.     

Impact of using the ultradistal radius region of interest on diagnostic classification.

World Health Organization (WHO) criteria using T-scores for classifying patients as normal, osteopenic, or osteoporotic are based on bone mineral density (BMD, g/cm2) of the lumbar spine and hip and bone mineral content (BMC) (BMC, g) at the distal and midradius. There is no consensus on whether other forearm regions of interest (ROIs) can be used with the WHO criteria. Because the ultradistal radius region of interest (UDR) has a greater ratio of trabecular to cortical bone than midshaft portions of the radius, it is possible that more patients would be classified as osteoporotic if the UDR is measured. The objective of this study was to determine the prevalence of osteoporosis when using T-scores from the UDR in addition to PA lumbar spine, proximal femur (hip), and the radius 33% ROI. Retrospective data were obtained from three centers with differing patient demographics, thus reducing bias as a result of patient characteristics. Data were used only from patients who had a spine, hip, and forearm scan on the same day. Central dual-energy X-ray absorptiometry (DXA) systems included a GE Lunar DPX-L, DPX IQ, and Prodigy and a Hologic Delphi. Hologic data were for the ultradistal radius + ulna ROI (UDRU). Diagnostic classification (using the WHO T-score criteria) was made excluding and including the UDR and UDRU T-scores, in addition to lumbar spine (L2-L4 or L1-L4), hip (femoral neck, greater trochanter, or total), and the radius 33% ROI. The lowest T-score from any ROI determined the classification. For all GE Lunar patients (n = 409 women; age range: 20-96 yr), the distribution of normal, osteopenic, osteoporotic not using the UDR was 94 (23%), 170 (42%), and 145 (36%), respectively. The distribution when using the UDR was 67 (16%), 137 (33%), and 205 (50%), respectively. The difference in the ratio of normal + osteopenic versus osteoporotic when excluding and including the UDR T-scores was significant (p < 0.0001; two-tailed Fisher's exact test). For all Hologic patients (n = 153 women; age range: 44-93 yr), the distributions were 32 (21%), 66 (43%), and 55 (36%) not using and 31 (20%), 64 (42%), and 58 (38%), respectively, using the UDRU (not statistically significantly different). The group mean T-scores were lowest for the UDR compared to the spine and hip with GE Lunar but not Hologic patients.     

Bone density of the radius,spine, and hip in relation to percent of ideal body weight in postmenopausal women

Summary Bone mineral content (BMC) and bone mineral density (BMD) of the spine (L2–L4) and hip (at femoral neck, Ward's triangle, and greater trochanter sites) were determined by dual-photon absorptiometry (DPA), and of the radius by single-photon absorptiometry (SPA) in healthy postmenopausal women aged 40–70 years. The relationships of BMC and BMD to years since menopause were examined separately in 97 women who were above 115% of ideal body weight (IBW) and in 128 women below. The heavier women had significantly greater mean BMC and BMD at each site than did the normal-weight women. In the normal-weight women, there was a significant negative correlation between BMD and years since menopause at each measurement site except the greater trochanter. In the obese women, BMD decreased with increasing years since menopause at the radius site only and BMC declined with increasing years after menopause at the hip (femoral neck and Ward's triangle region) as well as the radius. Thus, body size is a significant determinant of BMD in this population. The pattern of loss of BMD from Ward's triangle and femoral neck regions of hip are similar to that of the spine. The BMC and BMD findings in the hip suggest that remodeling occurs at this weight-bearing site which has a favorable effect on bone strength.     

Mechanical strength of the thoracolumbar spine in the elderly: prediction from in situ dual-energy X-ray absorptiometry,quantitative computed tomography (QCT), upper and lower limb peripheral QCT,and quantitative ultrasound

The objective of this study was to compare the ability of clinically available densitometric measurement techniques for evaluating vertebral strength in elderly individuals. Measurements were related to experimentally determined failure strength in the thoracic and lumbar spine. In 127 specimens (82 women and 45 men, age 80 +/- 10 years), dual-energy X-ray absorptiometry (DXA) was performed at the lumbar spine, femur, radius, and total body, and peripheral-quantitative computed tomography (pQCT) at the distal radius, tibia, and femur under in situ conditions with intact soft tissues. Spinal QCT and calcaneal ultrasound parameters were performed ex situ in degassed specimens. Mechanical failure loads of thoracic vertebrae 6 and 10 (T-6 and -10), and lumbar vertebra 3 (L-3) were determined in axial compression on functional three-segment units. In situ anteroposterior DXA and QCT of the lumbar spine explained approximately 65% of the variability of thoracolumbar failure. A combination of cortical and trabecular density (QCT) provided the best prediction in the lumbar spine. However, this was not the case in the thoracic spine, for which lumbar cortical density (QCT) and DXA provided significantly better estimates than trabecular density (QCT). pQCT was significantly less correlated with the strength of lumbar and thoracic vertebrae (r(2) = 40%), but was equivalent to femoral or radial DXA. pQCT measurements in the lower limb showed no advantage over those at the distal radius. Ultrasound explained approximately 25% of the variability of vertebral failure strength and added independent information to spinal QCT, but not to spinal DXA. These experimental results advocate site-specific assessment of vertebral strength by either spinal DXA or QCT.     

Negative correlation between bone mineral density and TSH receptor antibodies in male patients with untreated Graves’ disease

Introduction Although it has been established that hyperthyroidism leads to reduced bone mineral density (BMD), with accelerated bone turnover promoting bone resorption in female patients, there is a dearth of data for male patients with hyperthyroidism. This study evaluated BMD and bone metabolism in male patients with Graves’ disease. Methods The study included 56 Japanese male patients with newly diagnosed Graves’ disease and 34 normal Japanese male control subjects of similar age and body mass index. We used dual energy x-ray absorptiometry to measure BMD at sites with different cortical/cancellous bone ratios (lumbar spine, femoral neck, and distal radius). Results At the lumbar spine and the distal radius, BMD and T-scores were significantly lower for patients than for controls. At the femoral neck, on the other hand, the same values were relatively, but not significantly, lower in patients than in controls. However, Z-scores at all three sites were significantly lower for patients than for controls. The Z -score at the distal radius of patients was significantly lower than that at their lumbar spine and femoral neck. In addition, Z-score at the distal radius correlated negatively with age, free thyroxine, thyroid stimulating hormone receptor antibodies, thyroid stimulating antibody, and urinary N-terminal telopeptide of type I collagen normalized by creatinine. Conclusions These results indicate a high prevalence of cortical bone loss in male patients with Graves’ disease, especially elderly patients. We conclude that BMD measurement is crucial in all Graves’ disease patients regardless of their gender and that the radial BMD as well as BMD at the lumbar spine and femoral neck should be monitored to effectively prevent bone loss and subsequent fracture.