“Physiological osteoporosis” and “osteoblast insufficiency” in old age

Summary To investigate the expectation of general insufficiency of osteoblasts with increasing age, we studied autotopsy material from 105 deceased persons of both sexes who had died between 16 and 91 years and in whom clinically manifest diseases of the bone had been excluded. Quantitative morphometric examination of the structure of the spongy bone of the 3rd–5th lumbar vertebral bodies (LVBs) and of the 5th–7th cervical vertebral bodies (CVBs) was carried out in frontal and saggital planes, the parameters analysed being volumetric density (V_v), surface density (S_v) and specific surface area (S/V), and the results were subjected to statistical evaluation. The results showed that in the three LVBs, V_v, S_v and S/V behave in a similar manner, V_v and S_v decreasing after the age of 50 years by more than one-third while S/V remains constant throughout life. The three lower CVBs had higher values than the LVBs for all three structural parameters. In the 7th CVB somewhat lower V_v and S_v values and higher S/V values were found than in the 5th and 6th. The age-related changes, by contrast, were very small. This differing behavior of the spongy bone in the two regions of the spinal column is an expression of the different characteristic loading forces in each regions: LVB loading is predominantly static, CVB loading mainly dynamic. Thus, from the functional point of view, what is known as physiological osteoporosis due to ageing is nothing more than adaptation by an ageing bone to physical activity, reflecting —like the bone of the young adult — the current loading of the cancellous bone by the actions of the musculoskeletal system. Since such physical activity is often age-related, the performance of the osteoblasts does not depend upon age per se, but merely on the remaining functional adaptive capacities of the ageing organism as whole.Dedicated to Prof. Dr. Heinz Wagner on the occasion of his 60th birthday     

Atherosclerosis and osteoporosis: age-dependent degenerative processes or related entities?

Osteoporosis and atherosclerosis, two multifactorial and degenerative entities, are major public health problems. These diseases accompany the aging process and share common risk factors. Furthermore, several common pathophysiological factors have been suggested. These include similar molecular pathways involving bone and vascular mineralization, estrogen deficiency, parathyroid hormone, homocysteine, lipid oxidation products, inflammatory process, as well as vitamin D and K. Moreover, the use of statins, biphosphonates, beta-blockers and experimental dual-purpose therapies based on the biological linkage of the above entities may simultaneously benefit bone loss and vascular disease. This review considers a potential link between osteoporosis and atherosclerosis beyond aging. These common factors may lead to appropriate treatment strategies.     

Prevalence of osteoporosis and fractures among women prescribed osteoporosis medication in five European countries: the POSSIBLE EU® study

Summary  

European observational 1-year study assessed osteoporosis and fracture patterns in 3,402 postmenopausal women prescribed osteoporosis medication. Almost 40% of patients had a previous fracture, while 25% had neither fracture nor dual energy X-ray absorptiometry (DXA) diagnosis and were prescribed medication, probably due to other risk factors.     

Epidemiology of lumbar osteoporosis and osteoarthritis and their causal relationship—is osteoarthritis a predictor for osteoporosis or vice versa?: The Miyama study

Summary  In a 10-year follow-up of a population-based cohort of Japanese subjects, incidences of and causal relationships between osteoporosis (OP) and osteoarthritis (OA) at the lumbar spine were clarified. OP might reduce the risk of subsequent OA at the spine in women, but not in men. Introduction  The aim of this study is to clarify the contribution of osteoarthritis (OA) to osteoporosis (OP) and vice versa. Methods  A population-based, epidemiological study was conducted in a Japanese rural community. From 1,543 participants aged 40–79 years, 200 men and 200 women were selected and followed up for 10 years. Bone mineral density measurements were repeated after 3, 7, and 10 years, and X-rays were repeated after 10 years. Results  The incidence of lumbar OP per 10,000 person-years for persons in their 40s, 50s, 60s, and 70s was 0, 0, 109.5, and 151.1 for men and 124.2, 384.0, 227.3, and 239.5 for women, respectively. The cumulative incidence of lumbar OA over 10 years aged 40–79 years was 25.8% in men and 45.2% in women. Cox’s proportional hazards model showed no significant relationship between the presence of lumbar OA at the baseline and incidence of lumbar and femoral neck OP in both genders. A significant relationship was demonstrated between the presence of lumbar OP, not femoral neck OP, at the baseline and cumulative incidence of lumbar OA in women (odds ratio, 0.20; 95% confidence interval, 0.05–0.80; P = 0.02). Conclusion  OP in women appears to reduce the future incidence of OA at the lumbar spine.     

Urethral narrowing and its treatment: A possible solution for the problems of recurrent urinary infection and the “irritable bladder”

A surgical treatment for longstanding urinary and pelvic complaints of women is described and evaluated. The procedure includes urethral dilatation to 40 F and snowplowing (dull curettage) of urethral, bladder neck, and trigonal mucosa with the heel of the cystoscope, removing granulated tissue, polyps, and villous fronds, and unroofing infected periurethral glands Vigorous urethral massage is performed, and the patient is hospitalized overnight with large-catheter drainage to continue dilatation. Follow-up dilatations in the office are essential. The procedure was evalutated by comparing presenting and post-treatment symptoms for each patient and byasking each patient to rate the effectiveness of the treatment. Results suggest that treatment is very effective, with 80 per cent of respendents rating it either excellent or good.     

What’s in a name revisited: should osteoporosis and sarcopenia be considered components of “dysmobility syndrome?”

Sarcopenia and osteoporosis are age-related declines in the quantity and quality of muscle and bone respectively, with shared pathogeneses and adverse health consequences. Both absolute and relative fat excess, i.e., obesity and sarcopenic obesity, contribute to disability, falls, and fractures. Rather than focusing on a single component, i.e., osteoporosis, sarcopenia, or obesity, we realized that an opportunity exists to combine clinical factors, thereby potentially allowing improved identification of older adults at risk for disability, falls, and fractures. Such a combination could be termed dysmobility syndrome, analogous to the approach taken with metabolic syndrome. An arbitrary score-based approach to dysmobility syndrome diagnosis is proposed and explored in a small cohort of older adults. Further evaluation of such an approach in large population-based and prospective studies seems warranted.     

Dementia and osteoporosis in a geriatric population: Is there a common link?

AIM To determine the existence of a common pathological link between dementia and osteoporosis through reviewing the current evidence base. METHODS This paper reviews the current literature on osteoporosis and dementia in order to ascertain evidence of a common predisposing aetiology. A literature search of Ovid MEDLINE(1950 to June 2016) was conducted. The keywords osteoporosis, osteoporotic fracture, dementia and Alzheimer's disease(AD) were used to determine the theoretical links with the most significant evidence base behind them. The key links were found to be vitamins D and K, calcium, thyroid disease, statins, alcohol and sex steroids. These subjects were then searched in combination with the previous terms and the resulting papers manually examined. Theoretical, in vitro and in vivo research were all used to inform this review which focuses on the most well developed theoretical common causes for dementia(predominantly Alzheimer's type) and osteoporosis.RESULTS Dementia and osteoporosis are multifaceted disease processes with similar epidemiology and a marked increase in prevalence in elderly populations. The existence of a common link between the two has been suggested despite a lack of clear pathological overlap in our current understanding. Research to date has tended to be fragmented and relatively weak in nature with multiple confounding factors reflecting the difficulties of in vivo experimentation in the population of interest. Despite exploration of various possible mechanisms in search for a link between the two pathologies, this paper found that it is possible that these associations are coincidental due to the nature of the evidence available. One finding in this review is that prior investigation into common aetiologies has found raised amyloid beta peptide levels in osteoporotic bone tissue, with a hypothesis that amyloid beta disorders are systemic disorders resulting in differing tissue manifestations. However, our findings were that the most compelling evidence of a common yet independent aetiology lies in the APOE4 allele, which is a well-established risk for AD but also carries an independent association with fracture risk. The mechanism behind this is thought to be the reduced plasma vitamin K levels in individuals exhibiting the APOE4 allele which may be amplified by the nutritional deficiencies associated with dementia, which are known to include vitamins K and D. The vitamin theory postulates that malnutrition and reduced exposure to sunlight in patients with AD leads to vitamin deficiencies. CONCLUSION Robust evidence remains to be produced regarding potential links and regarding the exact aetiology of these diseases and remains relevant given the burden of dementia and osteoporosis in our ageing population. Future research into amyloid beta, APOE4 and vitamins K and D as the most promising aetiological links should be welcomed.     

Severe osteoporosis: does structural monitoring help?

Vertebral fractures, the most common osteoporotic fractures, are associated with excess mortality even in the absence of symptoms. Presence of at least one radiological or clinical prevalent vertebral fracture increases the risk of incident vertebral fractures not only in untreated patients, but also in treated patients, as established by studies involving routine radiological monitoring. Therefore, whether structural monitoring is indicated on a routine basis deserves discussion. Height measurement is a basic monitoring tool for detecting new vertebral fractures. However, loss of height is nonspecific. Radiography involves radiation exposure levels and financial costs that are not consistent with use for routine monitoring. Vertebral fracture assessment based on dual-energy X-ray absorptiometry (VFA), in contrast, is an inexpensive method that delivers only low radiation levels. VFA used in conjunction with absorptiometry may be well suited to the monitoring of women with severe osteoporosis.     

Does the Combination of Quantitative Ultrasound and Dual-Energy X-Ray Absorptiometry Improve Fracture Discrimination?

The widespread availability of quantitative ultrasound (QUS) and X-ray absorptiometry densitometers raises the question of whether a combination of QUS and bone mineral density (BMD) measurements could provide a clinically useful method of enhancing the prediction of fracture risk. The aim of this study was to examine whether a combination of axial BMD and calcaneal QUS measurements can enhance fracture discrimination compared with either method alone. The study population consisted of 154 postmenopausal women with a history of atraumatic fracture at the spine, hip or forearm and 221 healthy postmenopausal women with no clinical risk factors for osteoporosis. Subjects had dual-energy X-ray absorptiometry (DXA) measurements of the lumbar spine (LS), femoral neck (FN) and total hip (THIP) and calcaneal broadband ultrasound attenuation (BUA) and speed of sound (SOS) measurements on the Hologic Sahara (SAH) and Osteometer DTUone (DTU). Z-scores were calculated using the mean and SD obtained from the healthy postmenopausal group. Logistic regression analysis yielded odds ratios for BMD measurements at the LS, FN and THIP of 2.2, 2.2 and 2.3, respectively. The odds ratios obtained for QUS measurements ranged from 2.5 for DTU BUA to 3.3 for SAH SOS. While these odds ratios for QUS measurements were higher than those obtained for BMD measurements, the differences were not statistically significant. When the odds ratios for QUS were adjusted for BMD at the spine and hip, the odds ratios remained significant in all cases indicating that QUS and BMD variables contribute independently to fracture discrimination. When the BMD-adjusted odds ratios were compared with those for QUS alone, they were slightly lower but not significantly so. When the QUS measurements were adjusted for THIP BMD, the odds ratios for QUS tended to be lower than when adjusted for LS and FN BMD. The Z-scores for each of the QUS measurement variables were combined with spine or hip Z-scores. Logistic regression analysis of the QUS and BMD combined Z-scores yielded slightly higher odds ratios of approximately 3.1 (compared with 2.9 obtained for QUS alone) and increases in the area under the curve of approximately 2%. However, these increases were not clinically significant. In conclusion, the combination of axial BMD and calcaneal QUS measurements did not significantly improve fracture discrimination compared with either method alone. Received: 29 June 2000 / Accepted: 18 December 2000     

Incontinence and psychological problems in children: a common central nervous pathway?

Nocturnal enuresis is caused by a mismatch between the nocturnal bladder capacity and the nocturnal diuresis rate, in the presence of a deficient arousability in the majority of patients, according to the pediatric and urologic literature. Psychiatric and psychologic literature are still concentrating on the potential role of psychological factors and central nervous mechanisms in the pathogenesis, as is reflected in the DMS-5 criteria. However, research has clearly shown several important comorbidities between neuropsychological dysfunctions and nocturnal enuresis. Due to the increased comorbidity of (neuro)psychological problems, sleep problems, circadian rhythms, and enuresis, the question arises as to whether there is a possible common central pathway in the pathogenesis. It is likely that the coexistence of these problems can be attributed to a common central nervous system involvement. The specific role of the central nervous system remains unclear, but several pathways are possible. The high comorbidity between enuresis, sleep, and (neuro)psychological functioning is probably attributable to a common pathogenetic pathway, emphasizing the importance of a multidisciplinary focus in screening and treatment in children with nocturnal enuresis.