Comparison of Facial Proportions and Anthropometric Norms Among Turkish Young Adults With Different Face Types

Background This study aimed to determine the prevalence of three different face types among Turkish young adults based on facial indices, to assess and compare the vertical and horizontal dimensions for each type, and to establish anthropometric norms for Turkish adults. Methods A total of 173 healthy young adults (83 females and 90 males) 17 to 25 years of age were examined. Using anthropometric landmarks, 8 horizontal and 10 vertical direct measurements were made with a millimetric compass. Results Using facial indices, 59 of the 173 subjects were classified as euryprosopic, 49 as mesoprosopic, and 65 as leptoproposic. In the total evaluation of both groups, all the parameters were higher in the males except forehead heights 1 and 2. A comparison of face types in females and males separately showed no significant differences between the parameters. Conclusions The data presented in this study may help plastic surgeons and orthodontists objectively determine the relationships between facial structures for different face types. Additionally, the facial anthropometric norms derived from this study may be useful in the treatment of Turkish patients.     

Cephalometrics of Libyan adults

BackgroundCephalometric radiography enables a physician to identify specific areas of craniofacial disproportionality and decide on a treatment plan. Cephalometric analysis is a method for localizeing malocclusion with the facial skeleton and soft tissue structures. This study reports the results from the cephalometric analysis of Libyan adults, as a surrogate for the population of North Africa.MethodsLateral cephalometric radiographs were taken of 100 non-growing Libyan adults: 74 males and 26 females, aged 17–45 years. All subjects had no previous orthodontic treatment. The mean values and standard deviations of 92 parameters were determined.ResultsThe hard tissue cephalometric analysis revealed lower variability in the length of vertical distances compared to those extending more horizontally. In adult Libyans, linear and angular midface measurements (hard tissue and soft tissue) exhibit less variability compared to other measurements taken. Libyans exhibit some of the structural deviations from Bolton's means that were previously found in Americans of African descent. Namely, they are characterized by the greater development of the maxillomandibular complex and by the presence of dentoalveolar protrusion, which must be taken into account when treating patients of this ethnic group.ConclusionThe current study once again confirmed the need to develop cephalometric norms for different ethnic groups, the Arab population in North Africa in particular.     

The Fate of Porous Hydroxyapatite Granules Used in Facial Skeletal Augmentation

Facial appearance is largely determined by the morphology of the underlying skeleton. Hydroxyapatite is one of several materials available to enhance projection of the facial skeleton. This study evaluated the long-term maintenance of augmented bony projection when porous hydroxyapatite granules are used on the facial skeleton. Ten female patients aged 28–58 years were studied following aesthetic augmentation of the facial skeleton at 24 sites using porous hydroxyapatite granules. Postoperative CT scans at 3 months served as the baseline measurement and compared with scans taken at 1 and 2 years, with the thickness of the hydroxyapatite measured in axial and coronal planes. Thickness of original bone plus overlay of hydroxyapatite, thickness of the overlying soft tissue, and the overall projection (bone plus soft tissue) were recorded. It was found that 99.7% of the hydroxyapatite was maintained at 2 years, with no statistical difference (t test) from the baseline measurement. The overall projection (bony and soft tissue) was maintained as there was no evidence of native bone resorption or soft tissue atrophy. Radiographic results confirmed that the use of porous hydroxyapatite granules for enhancement of the facial skeleton is not only a predictable procedure, but maintains full bony projection at 2 years.     

Variation in lumbar spine bone mineral content by age and gender in apparently healthy Indians

The aim of this study was to assess variation in bone mass from childhood through later age and to examine bone health status of Indian males and females. Lumbar spine (LS) bone mineral content (BMC) was measured by dual energy X-ray absorptiometry of lumbar vertebrae (L1–L4) in 683 males and 858 females (5–70 years) from Pune, India and apparent bone mineral density (BMAD) was calculated. A cubic regression model was fitted to describe the change in bone mineral content (BMC) with age in males and females separately. Regression analysis revealed that peak LS BMC was achieved around 26 years (63.6 ± 11.0 g) for males and 30 years (54.1 ± 11.6 g) for females. After 50 years of age, BMC showed an average annual decrease of 2.7% in males and 4.1% in females. Males had 11–15% higher mean BMAD than females after 50 years of age. T scores of 19% males and 28% females above 50 years, were less than −2.5 and T scores of 36% males and 43% females were between −1.0 and −2.5 when compared with the Lunar reference database. Low peak bone mass at a young age and higher bone loss in adults are alarming features of apparently healthy Indians.     

Well-nourished cystic fibrosis patients have normal mineral density, but reduced cortical thickness at the forearm

Summary  Our goal was to assess mineral density and geometry of the cortex at the level of the forearm in adolescents and young adults with cystic fibrosis, using peripheral quantitative computed tomography. We found that density was normal, but cortical thickness significantly reduced, as well in males as in females. Introduction  Our goal was to measure bone mineral density as a volumetric density, as well as total cross-sectional area, cortical area and cortical thickness, using peripheral quantitative computed tomography (pQCT) at the forearm in adolescents and young adults with cystic fibrosis. We evaluated relationships between forearm bone measurements and body composition assessed using dual energy X-ray absorptiometry (DXA). Methods  An XCT 2000 pQCT (Stratec, Pforzheim, Germany) and a QDR 4500 A-upgraded to Discovery DXA device (Hologic, Waltham, MA, USA) were used. Results  Forty-eight patients (31 males,17 females, mean+/-SD 20+/5 years) were studied. Anthropometric features were: height 169+/- 10 cm, SDS 0.05+/-0.12, body mass index 19.8+/- 2.5 kg/m², SDS -0.56+/-0.14. Bone mineral density and total cross-sectional area of the forearm and body composition were normal, whereas cortical thickness was significantly reduced in males (mean Z-score – 1.22, p < 0.05), and in females (mean Z-score – 1.61, p < 0.05). Total body lean mass correlated more strongly with cortical thickness (r = 0.72, p < 0.001) than with total bone mineral density at the proximal radius (r = 0.39, p < 0.05). Conclusions  Adolescents and young adults with cystic fibrosis, presenting with only a slight degree of underweight, have at the radius a preserved bone mineral density but a reduced cortical thickness.     

Application of VSD technique in adults with chronic osteomyelitis of the extremities combined with soft tissue defects

To investigate the clinical application of vacuum sealing drainage (VSD) in chronic osteomyelitis of the extremities combined with soft tissue defects in adults. This study retrospectively included 32 adult patients with clearly diagnosed chronic osteomyelitis of the extremities combined with local soft tissue defects, and the trauma was covered by VSD after debridement, osteotomy, and vancomycin-laden bone cement filling of the occupancy, and the trauma was covered by selecting a suitable flap transfer repair according to the site and extent of the soft tissue defect after the trauma condition was suitable, and the secondary trauma was taken from the abdominal full-thickness skin free skin slice graft, according to whether the skin graft area was performed. The skin flap hematoma and infection rate, as well as the skin flap survival rate and implant fixation time were compared and analysed between the two groups. The primary outcome is the implant fixation time, and the secondary outcome is the skin fragment survival rate. In 32 patients, VSD was performed on the bone cement surface to cover the trauma, and 33.2 to 39.8 kPa continuous vacuum sealing drainage was set. The average VSD time duration before soft tissue coverage was 47.87 ± 23.14 days, and the average number of VSD use was 7.18 ± 3.23. The use of VSD before soft tissue coverage did not cause complications such as negative pressure could not be maintained, vacuum sealing drainage was not smooth, skin blistering, trauma. Among the 32 patients, 12 cases of soft tissue coverage were followed by trauma free skin grafting with packing + VSD, and 20 cases were fixed with packing alone, and the duration of continuous packing and fixation of free skin pieces in the VSD group was significantly less than that in the control group (P = .006). The survival rate was significantly higher than that of the control group (P = .019). VSD in adult patients with chronic osteomyelitis of the extremities combined with soft tissue defects can effectively improve the trauma condition, provide the possibility of second-stage soft tissue coverage, and significantly shorten the preparation time for soft tissue coverage. In addition, when soft tissue coverage trauma is performed, VSD combined with skin graft packing technique can significantly improve the survival rate of skin pieces, shorten the time of skin graft fixation.     

Photogrammetric Facial Analysis of Attractive Korean Entertainers

Background  The authors have developed a new digital photogrammetric method of facial analysis known as balanced angular and proportional analysis (BAPA). Using BAPA, the authors analyzed the faces of attractive Korean entertainers. Methods  The BAPA approach involves 28 landmarks and 14 measurements (10 proportional and 4 angular measures). Standardized mean angular values of famous entertainers are referred to as recommended aesthetic mean angles (RAMA) and the mean proportional values as the recommended aesthetic mean proportions (RAMP). In this study, 30 frontal views of famous Korean entertainers (15 men and 15 women) were collected from Internet Web pages, and the data analyzed using V-ceph. A t test (with the significance level set at a p value of 0.05) was performed to analyze male versus female comparisons. Results  Significant between-group differences (p < 0.05) were found for P-lower face, P-eye height, P-lip, P-interangle, and the mandibular contour in the frontal views. Famous Korean female entertainers differ from famous male entertainers. The women have a shorter lower face, larger eyes, smaller lips, and a more slender and oval shape of the mandibular soft tissue contour. Conclusions  The authors insist that facial analysis should take into consideration racial, ethnic, and gender differences. The BAPA approach is a new practical and simple method for photogrammetric facial analysis. Using the authors’ method, more advanced and automated computer systems for analyzing human faces may be developed.     

Changes in facial shape with age: an analysis with three-dimensional imaging

The appearance of the aged face has traditionally been attributed to soft tissue changes with surgical treatments targeting ptosis of skin, SMAS, and fat. However, true facial aging is recognized as a combination of soft tissue and skeletal changes, which continue to be integrated into a model for facial aging. With a greater understanding of these changes, techniques in facial rejuvenation will continue to evolve. Three-dimensional imaging technology was used in this study. Measurements correlating with mid- and lower-face changes were compared for each three-dimensional facial image of 31 mother–daughter matched controls. Each mother image was superimposed on the corresponding daughter, using registration of the upper face to visualize mid-face differences between pairs. Also, measurements of women in four age groups were compared using a one-way ANOVA. The ratios of Po-A:Po-N were significantly greater in daughters in comparison to their mothers (p = 0.0073), with the majority of mother subjects showing a more acute Po-N-A angle (p < 0.042). An investigation between age groups exhibited significant difference between the youngest (18–29) and oldest (60+) groups for Po-A:Po-N length ratio, Po-B:Po-N length ratio, Po-N-A angle, and Po-N-B angle. Differences between the 30–44 and 60+ age groups were also significant for the Po-A:Po-N and Po-B:Po-N length ratios. The results from this study suggest a posterior movement of the mid and lower face with age. This multi-factorial process makes facial rejuvenation more complex than initially perceived, and recognizing it will facilitate better rejuvenation strategies in the future.     

The relationship between body composition and the urinary excretion of deoxypyridinoline and galactosyl-hydroxylysine in children and adolescents

The study intends to investigate the relationship of body composition (%fat, percent body fat; FM, fat mass; FFM, fat free mass; FA and MA cross-sectional fat and muscle area) to the urinary excretion of deoxypyridinoline (DPD) and galactosyl-hydroxylysine (Gal-Hyl). 231 healthy children and adolescents (age 5–19 years; 112 males) of the DONALD study were analyzed for FM and FFM by measuring 4 skinfold thicknesses, for DPD and Gal-Hyl in urine samples and for bone parameters, FA and MA at the forearm by peripheral quantitative computed tomography. In contrast to adrenarchal females, adrenarchal males with low %fat had low levels of DPD and Gal-Hyl. %fat was correlated with DPD in pre-adrenarchal males (r = 0.290) and females (r = 0.298). Cortical bone mineral density (BMDcort) was correlated with DPD (r = −0.351) in adrenarchal males. Controlled for BMDcort, FM was correlated with DPD in pre-adrenarchal males (r = 0.348), and FA was correlated with DPD in pre-adrenarchal females (r = 0.294). FFM was negatively correlated with Gal-Hyl in adrenarchal males (r = −0.436) and females (r = −0.338). Less than 40% of variance of excreted DPD and Gal-Hyl was explained by regression models based on parameters of body composition. The effect of body composition explains the minor part of variance of the urinary excretion of DPD and Gal-Hyl. The association of body composition to excreted DPD and Gal-Hyl was not explained by the effect of adipose tissue on bone formation and bone resorption.     

Analysis of footprint and its parts for stature estimation in Indian population

BackgroundMost often, forensic podiatrists are called upon in crime scene investigations where pedal evidence is encountered at the crime scenes. The main aim of the forensic podiatrist is such case is to contribute towards the establishment of the identity of the suspects on the basis of the evidence. One form of the pedal evidence is footprints that are often recovered at the crime scenes. Estimation of stature from footprints forms a major parameter of personal identification in forensic examinations.ObjectivesThe main aim of the present study is to make stature estimation standards based on detailed analysis of length measurements of footprints in Indian population using statistical considerations.MethodsA sample of 100 young adults (50 males and 50 females) was included in the study conducted at the Department of Forensic Medicine, Kasturba Medical College, Mangalore, India. Footprints were obtained from both the feet of each subject. Besides stature, five length measurements i.e. T1, T2, T3, T4 and T5 were measured on both the footprints of each subject using international standards. Bilateral asymmetry in the measurements on footprints was calculated and tested using paired t-test. Pearson's correlation coefficients were calculated between stature and various footprint length measurements and the stature was estimated using linear and multiple regression analysis.ResultsOur study observes a statistically significant sex difference (p < 0.001) in the footprint length measurements between males and females in both right and left feet. A positive and strong correlation exists between various length measurements of the footprint and stature in both the sexes. Males show relatively higher values of correlation coefficients than females. Bilateral differences (right ? left differences) were also observed in some of the footprint length measurements among males and females. Linear and multiple regression models are derived for estimation of stature from various footprint length measurements in males, females and for the pooled sample.ConclusionsThe footprints can provide a reliable estimate of stature in forensic investigations. Sex specific regression models give a more accurate estimate of stature than the pooled sample.     

Time series spinal radiographs as prognostic factors for scoliosis and progression of spinal deformities

The effectiveness of clinical measures to predict scoliotic progression is unclear. The objective of this study was to identify potential prognostic factors affecting scoliosis progression. Consecutive measurements (181) from 35 non-instrumented adolescent idiopathic scoliosis patients with at least two follow-up assessments were studied. Potential prognostic factors of gender, curve pattern, age, curve magnitude, apex location and lateral deviation and spinal growth were analyzed. Stable and progressed groups were compared (threshold: Cobb angle ≥5° or 10°) with sequential clinical data collected in 6-month intervals. Double curves progressed simultaneously or alternatively on curve regions. Age was not significantly different prior to and at maximal Cobb angle. Maximal Cobb angles were significantly correlated to initial Cobb angles (r = 0.81–0.98). Progressed males had larger initial Cobb angles than progressed females. Apex locations were higher in progressed than stable groups, and at least a half vertebra level higher in females than males. Maximal apex lateral deviations correlated significantly with the initial ones (r = 0.73–0.97) and moderately with maximal Cobb angles (r = 0.33–0.85). In the progressed groups, males had larger apex lateral deviations than females. Spinal growth did not relate to curve progression (r = −0.64 to +0.59) and was not significantly different between groups and genders. Scoliosis may dynamically progress between major and minor curves. Gender, curve magnitude, apex location and lateral deviation have stronger effects on scoliosis progression than age or spinal growth. Females with high apex locations may be expected to progress.     

Photogrammetric Analysis of Soft Tissue Facial Profile in Turkish Rhinoplasty Population

Background  

The aim of this study was to compare the facial photogrammetric analysis results of the Turkish population who are pleased with their facial appearance with the facial analysis data of patients who underwent rhinoplasty in order to find the most prominent objective facial measurements that lead patients to surgical correction of the nose.     

Subcutaneous Fat and Body Fat Mass Have Different Effects on Bone Development at the Forearm in Children and Adolescents

The present study investigated whether subcutaneous fat differs in the impact on bone development from fat mass (FM). We analyzed 295 healthy children and adolescents (age 5–19 years, 139 males) for FM by measuring four skinfold thicknesses and for bone development and body composition at the forearm by peripheral quantitative computed tomography in a cross-sectional investigation. Relative cross-sectional fat area (FA) was a surrogate for relative subcutaneous FM at the forearm and was associated positively with percent fat in prepubertal individuals and pubertal females but negatively in pubertal males. Percent FM was associated with trabecular bone mineral density (BMDtrab) in prepubertal individuals (females r = 0.394, males r = 0.242) and pubertal individuals (females r = 0.215, males r = −0.275). Bone mineral count was correlated with percent FM in pubertal males (r = −0.287). FA was correlated with BMDtrab (r = 0.285) and with cortical bone mineral density (BMDcort, r = −0.296) in pubertal females. The ratio FA/FM was negatively correlated with BMDcort (r = −0.299) in pubertal females. Pubertal females with relatively high subcutaneous fat area (high ratio FA/FM) were characterized by lower bone strength (P = 0.047). FM and the relative amount of subcutaneous fat have effects on bone formation and resorption that depend on gender and puberty. Especially in pubertal females, higher levels of subcutaneous fat may decrease bone strength due to increased cortical remodeling.     

High prevalence of vitamin D deficiency, secondary hyperparathyroidism and generalized bone pain in Turkish immigrants in Germany: identification of risk factors

Introduction The aim of the study was to determine the prevalence of vitamin D deficiency, secondary hyperparathyroidism (sHPT), generalized bone pain and predictors of vitamin D deficiency in a cohort of 994 healthy adult urban residents (589 males, 405 females; age range: 16–69 years) consisting of 101 Germans, 327 Turkish residents of Turkey and 566 Turkish immigrants living in Germany.Methods The mean (± standard deviation) for 25-hydroxyvitamin D [25(OH)D] and biointact parathyroid hormone (BioPTH) for the German men and women was 68.4 nmol/l and 26.7 pg/ml, respectively. Turkish residents of Turkey had a mean 25(OH)D and BioPTH of 40.6 nmol/l and 27.5 pg/ml, respectively, whereas Turkish residents of Germany had a 25(OH)D of 38.1 nmol/l and a BioPTH of 35.6 pg/ml.Results Vitamin D insufficiency was common among Turkish nationals independent of whether they lived in Turkey or Germany; 75% had 25(OH)D levels of <50 nmol/l. Turkish females had a higher prevalence of 25(OH)D deficiency (<25 nmol/l) than Turkish males: 30 and 19% of Turkish females living in Germany and Turkey were severely vitamin D deficient compared to 8% and 6% of Turkish males living in Germany and Turkey, respectively. With respect to BioPTH levels, 31% of Turkish females and 21% of Turkish males had elevated BioPTH levels in contrast to only 15% of females and 4% of males living in Turkey. Unconditional logistic regression analysis identified the most important predictors for low 25(OH)D levels as sex, body mass index, lack of sun exposure and living at a higher latitude. Additionally, wearing a scarf and number of children were found to be an independent risk factor for vitamin D deficiency in Turkish women living in Turkey and Germany. A strong correlation between low 25(OH)D levels and higher rates and longer duration of generalized bone and/or muscle aches and pains (often diagnosed as fibromyalgia) was observed.Conclusion Secondary hyperparathyroidism and vitamin D deficiency was found to be common among Turkish immigrants living in Germany, especially in veiled women. Therefore, the monitoring of vitamin D status – i.e. 25(OH)D and PTH – in Turkish immigrants is warranted and once a deficiency is identified, it should be appropriately treated.     

The contralateral lamina: a reliable guide in subaxial,cervical pedicle screw placement

We have assessed the clinical observation that the angle of the contralateral lamina matches the angle required from the sagital plane for the placement of pedicle screws in the subaxial cervical spine. Fifty-four randomly chosen axial CT scans taken between December 2003 and December 2004 were examined. Subjects were excluded if the scan showed signs of fracture, tumour or gross abnormality. The digitised images were analysed on the Philips PACS system using SECTRA software. One hundred and sixty-eight individual vertebrae were assessed between C3 and C7. The following were measured; the angle of the pedicle relative to the sagital plane, the smallest internal and external diameter of the pedicles and the angle of the lamina. Angular measures had a CV% of 3.9%. The re-measurement error for distance was 0.5 mm. Three hundred and thirty-six pedicles were assessed in 25 females and 29 males. Average age was 48.2 years (range 17–85). Our morphologic data from live subjects was comparable to previous cadaveric data. Mean pedicle external diameter was 4.9 mm at C3 and 6.6 mm at C7. Females were marginally smaller than males. Left and right did not significantly differ. In no case was the pedicle narrower than 3.2 mm. Mean pedicle angle was 130° at C3 and 140° at C7. The contralateral laminar angle correlated well at C3, 4, 5 (R ² = 0.9, C3 P = 0.002, C4 P = 0.06, C5 P = 0.0004) and was within 1° of pedicle angle. At C6, 7 it was within 11°. In all cases a line parallel to the lamina provided a safe corridor of 3 mm for a pedicle implant. The contralateral lamina provides a reliable intraoperative guide to the angle from the sagital plane for subaxial cervical pedicle instrumentation in adults.     

FRⅢ矫治功能性Ⅲ类错畸形的颌面分析

目的:探讨FrankelⅢ功能矫治器(Frankel functional regulator Ⅲ appliance,FRⅢ)矫治功能性Ⅲ类错畸形前后颌骨软组织侧貌头影测量值的变化。方法:选择乳牙期、替牙期功能性Ⅲ类错患者20例(男9例,女11例),年龄6～11岁,平均9.8岁,面型为直面型或轻度凹面型,前牙反,第一磨牙为近中关系,下颌可后退至切对切,上下前牙排列整齐,应用FRⅢ矫治,治疗前后拍X线头颅侧位定位片并测量数据,采用配对t检验统计学分析。结果:功能性Ⅲ类错畸形经FRⅢ矫治6个月左右,临床上患儿反矫正、侧貌发生改变,SNB减小、ANB增加、前下面高增加、IMPA减小、面凸度增加、覆盖增加有显著性差异。唇形改变:上唇突度增大、下唇突度减小,上唇倾斜度减小、下唇倾斜度减小有显著性统计学意义。结论:表明FRⅢ矫治功能性Ⅲ类错畸形能引起颌骨及软组织侧貌的改变,FRⅢ是治疗功能性Ⅲ类错畸形的有效方法。     

Gender-related differences in concomitant articular injuries after acute lateral patellar dislocation

ObjectivesTo explore the gender differences in the concomitant articular injuries after acute lateral patellar dislocation (LPD).MethodsMagnetic resonance images were prospectively analyzed in 166 patients after an acute LPD. Concomitant articular injuries included bone contusion, medial patellofemoral ligament (MPFL) injury, articular cartilage lesion, and vastus medialis obliquus (VMO) lesion. Statistical analyses were performed between the patient's gender and the incidence of concomitant articular injuries in adolescent and adult subgroups.ResultsThe incidence of partial and complete MPFL tear in adolescent males and females were (45%, 50%) and (63.2%, 29.8%), respectively. Compared with adolescent females, adolescent males showed higher incidence of complete MPFL tear (P = 0.049). The incidence of articular cartilage lesion of patella in adolescent males and females were 40% and 21.1%, respectively. Compared with adolescent females, adolescent males showed higher incidence of articular cartilage lesion of the patella (P = 0.043). No correlations were identified in other injuries in the adolescent group. The incidence of partial and complete MPFL tear in adult males and females were (34.4%, 65.6%) and (56.8%, 37.8%), respectively. Compared with adult females, adult males showed higher incidence of complete MPFL tear (P = 0.036). The incidence of articular cartilage lesion of patella in adult males and females were 56.3% and 32.4%, respectively. Compared with adult females, adult males showed higher incidence of articular cartilage lesion of patella (P = 0.047). The incidence of VMO injury in adult males and females were 59.4% and 35.1%, respectively. Compared with adult females, adult males showed higher incidence of VMO injury (P = 0.044). No correlations were identified in other injuries in the adult group.ConclusionsCompared with females, males predispose to complete MPFL tear and articular cartilage lesion of patella after acute LPD. Compared with female adults, male adults predispose to VMO injury.     

Geometry of thoracolumbar vertebral endplates of the human spine

Novel and better vertebral body replacement constructs are always desired by surgeons. Endplate geometry is crucial for the design of those implants, but current literature on that topic is very scarce. The authors present a morphometric study of thoracolumbar vertebral endplates, the goal of which was to analyze the geometry of endplates from T10 inferior to L3 superior by employing data from CT scans, as well as to verify the reliability of data derived from the CT measurement. Reformatted CT scans of 83 individuals were analyzed and sagittal concave angle, location of concave region, sagittal diameter of endplate, coronal concave angle, as well as transverse diameter of endplate were measured in midsagittal plane and specified coronal plane. The data of CT and cadaveric measurements of ten cadaveric specimens were also compared. Age and gender did not influence sagittal concave angle, location of concave region, and coronal concave angle significantly (P > 0.05). No significant difference has been revealed among each endplate for sagittal concave angle (range 162.5°–163.9°) and location of concave region (range 42.5–44.2%), either. Ranging between 170.9° and 175.7°, coronal concave angle was constantly larger in superior endplate than in inferior one. The sagittal and transverse endplate diameters of females were significantly smaller than those of males (P < 0.05), being about 88% of the latter one. The mean difference between CT and cadaveric measurements was small (Cronbach alpha > 0.8). Those morphologic parameters, especially the concavity of endplates, should be taken into consideration when designing novel vertebral body replacement constructs. CT measurement data could be used to calculate most suitable geometric parameters of those implants.     

Changes in soft tissue composition are the primary predictors of 4-year bone mineral density changes in postmenopausal women

Summary  Changes in body weight influence bone mineral density, but the role of body composition is not clear in postmenopausal women. Body weight and soft tissue composition predicted bone changes independent of calcium supplementation and exercise frequency, indicating that soft tissue composition should be measured in clinical trials. Introduction  The purpose of this study was to examine the relationship between changes in body weight and composition and changes in 4-year bone mineral density (BMD) after accounting for age, 4-year exercise frequency (EX), and 4-year calcium supplement intake (CA) in postmenopausal women with and without hormone therapy (HT). Methods  Postmenopausal women (aged 40–65 years) either using HT (for 1–3.9 years) or not using HT (for ≥1 year) were recruited to the study. EX and CA was monitored throughout the study and 167 women completed 4 years. BMD and soft tissue composition measurements were made using dual-energy X-ray absorptiometry. Regression was used to predict 4-year BMD changes from EX, CA, age, baseline and 4-year changes in body weight and composition. HT users (n = 115, 55.3 ± 4.3 years) and non-users (n = 52, 57.5 ± 4.7 years) were analyzed separately. Results  The models predicting regional BMD changes that included soft tissue composition changes explained the most variation compared with those with body weight or EX and CA alone. Larger amounts of variation in BMD changes were explained in the no HT group. Conclusion  Body composition changes are important positive predictors of BMD changes independent of EX and CA supplementation, but their contribution varies according to bone site and with HT use.     

The impact of accurate positioning on measurements made by peripheral QCT in the distal radius

Summary  Data from pQCT sections at the forearm were examined to assess the impact of positioning on measurements. Two thousand five hundred fifty one scans were analysed. The results showed 25% of scans were not performed in the same anatomical location at follow-up when one section was scanned. These results have implications for accurate follow-up BMD measurements. Introduction  pQCT of the distal radius is routinely performed using a single section of 2 mm thickness. Accurate positioning is essential to maximise long-term repeatability. We perform two adjacent sections which, permits us to select sections at baseline and follow-up that are in the most similar anatomical site for calculating longitudinal change. This study aimed to assess baseline and follow-up pQCT forearm data to examine variability and determine whether performing two sections, as opposed to one section, improved accuracy when monitoring long-term change in BMD. Methods  Two adjacent 1.2 mm pQCT radial sections were performed at: baseline n = 2,551 (1,896F:655M) and follow-up n = 335F. Results  Baseline: difference between adjacent 1.2 mm forearm sections: total BMD 19.3 mg/cm³ (females) and 16.7 mg/cm³ (males); trabecular BMD 3.1 mg/cm³ (females) and 2.35 mg/cm³ (males); CSA 16.2 mm² (females) and 17.7 mm² (males) (all significant). Follow-up: percentage of scans at baseline and follow-up performed in the same anatomical location: one section performed—75%, two sections performed—95%. Conclusion  When performing a single section at the distal radius it is difficult to perform scans in the same anatomical location at visits. Performing two or more sections can overcome this problem in some individuals and provide more accurate BMD measurements.