广西壮、汉族绝经后妇女维生素D 受体基因型与骨密度、骨代谢的关系

目的探讨维生素D受体基因(VDR)型在壮、汉族绝经后妇女中的分布及其与骨密度、骨代谢的关系.方法在广西居住20年以上的绝经后汉族妇女116名,壮族妇女82名.记录年龄、绝经年龄,测量身高、体重.采用双能X线吸收法测定骨密度(BMD);用聚合酶链反应-限制性片段长度多态性(PCR -RFLP)法测定受试者的VDR基因型;测定血清骨钙素(osteocalcin,OC)、尿脱氧吡啶啉(deoxypyridinoline,DPD)和尿肌酐(creatinine,Cr).结果壮、汉族妇女年龄、绝经年限、体重、体重指数、BMD、VDR基因型频率分布无显著性差异(P>0.05);BB、Bb、bb基因型检出率分别为6.57%、66.16%和27.27%;BB基因型组第2腰椎(L2)BMD比bb基因型组低10.03%,第4腰椎(L4)BMD分别较bb、Bb基因型组低9.63%和12.44%(P<0.05);BB基因型组骨质疏松发生率最高(46.15%),Bb基因型组次之(19.85%),bb基因型组最低(14.81%)(P<0.05);BB基因型组OC最低,与Bb、bb 基因型组比较也有显著性差异(P<0.05);三组间尿DPD排泄率(DPD/Cr)差异无统计学意义.结论 VDR基因型可作为预测广西壮、汉族绝经后妇女骨质疏松危险性的遗传学标志.     

糖皮质激素所致骨质疏松与维生素D受体基因型相关性的初步研究

目的　利用聚合酶链反应 限制性片段长度多态性方法 (PCR RFLP)研究长期接受糖皮质激素治疗患者的维生素D受体 (VDR)基因型与骨密度 (BMD)之间的关系。方法　收集 71例长期服用糖皮质激素的风湿性疾病患者的临床资料及静脉血 ,双能X线骨密度仪测定其BMD。提取基因组DNA行PCR扩增出约 185 0bp的VDR基因片段 ,用限制性内切酶BsmI进行酶切 ,根据酶切后片段长度不同判定基因型 ,并统计分析基因型与BMD及Z值之间的关系。结果　 71例患者中检测出的基因型为Bb和bb两种 ,分布频率分别为 11 3%、88 7% ,其等位基因分布频率符合遗传平衡定律 (Hardy Weinberg定律 )。两种基因型间年龄、性别比、体重指数 (BMI)、病程、病种构成比、服用激素时间及激素累积量之间差异无显著性 (P >0 0 5 )。Bb及bb基因型患者的骨质疏松发生率分别为 37 5 %和 33 3% ,差异无显著性 (χ2 =0 0 5 ,P =0 8)。两种基因型患者间腰椎、髋部的BMD和Z值有一定的差异 ,但无统计学意义。结论　①我国汉族人群VDR基因型以bb为主 ,Bb其次 ,BB基因型分布频率最低。②长期接受糖皮质激素治疗的患者中 ,Bb和bb两种基因型间骨密度差异无显著性 ,VDR基因型不能预测糖皮质激素相关性骨质疏松发生的危险性 ,但该结论有待于加大样本量后进一步确证     

维生素D受体基因型与骨密度的关系

目的　了解维生素D受体 (VDR)基因的BsmI多态性在中国人群中的分布 ,并进一步探讨其与骨密度 (BMD)的关系。方法　应用聚合酶链反应 -限制性片断长度多态性解析 (PCR RFLPs)技术检测了 1 86例在长春地区生活 1 0年以上的无亲缘关系的绝经前健康汉族女性VDR基因型 ,用双能X线骨密度仪 (DEXA)测腰椎BMD ,同时考察它们之间的关系。结果　VDR基因型分布频率为Bb:2 3例 (1 2 .4% ) ,bb :1 63例(87.6 % ) ,BB型缺如。b等位基因在本组人群中分布高达 93 .8%。各型的BMD值分别为 :Bb型 (1 .1 87± 0 .0 88) g/cm2 ,bb型 (1 .1 53± 0 .1 1 2 ) g/cm2 ,两组比较差异无统计学意义 (P >0 .0 5)。结论　中国长春地区绝经前汉族女性的VDR基因的BsmI多态性与骨密度间无相关关系。     

糖尿病维生素D受体基因多态性与骨密度相关性研究

目的　探讨糖尿病 (DM )患者维生素D受体 (VDR)基因多态性与骨密度 (BMD)及骨转化的关系。方法　采用PCR RFLP技术 ,检测 6 8例 2型DM患者、5 4例 1型DM患者和 6 2例健康人的VDR基因型。并采用双能X线吸收法测BMD ,放免法测血清BGP、降钙素和 2 5 (OH)D3 ,免疫放射法测血清完整PTH及Ⅰ型胶原羧基末端前肽。结果　 (1)DM组VDR基因型分布与健康组差异无显著性 ;(2 )健康组AA基因型者腰椎和大转子BMD高于aa型 ,股骨颈和Ward′s三角BMD高于aa和Aa型 (P <0 .0 5 ) ,而 2型DM组Aa基因型者股骨颈和大转子BMD高于aa型 ,1型DM组Aa基因型者仅股骨颈BMD高于aa型 (P <0 .0 5 ) ;(3)VDR基因TaqⅠ位点多态性与BMD无明显相关性。结论　DM患者VDR基因ApaⅠ位点的多态性与BMD存在相关性。     

维生素D受体基因多态性与汉族儿童氟斑牙易感性的关系研究

目的 观察维生素D受体(VDR)基因多态性在汉族儿童中的分布情况,探讨VDR基因多态性与汉族儿童氟斑牙易感性的关系.方法 2008年10月至2009年3月,Dean法检查安徽省凤台县关店乡8～12岁儿童氟斑牙患病情况,选择氟斑牙儿童101例及对照儿童102例,采集外周静脉血提取DNA,采用聚合酶链反应-限制性片段长度多态性(PCR-RFLP)方法测定两组儿童VDR Apa I、Bsm I、Fok I和Taq I的基因型,观察汉族儿童VDR各基因型分布情况,并分析两组间基因型分布的差异.结果 汉族儿童中存在VDR基因多态性.且基因型的分布以Aa、bb、Ff、TT居多,分别占51.7%(105/203)、89.7%(182/203)、52.7%(107/203)、93.1%(189/203);aa、Bb、FF、Tt次之,分别占39.9%(81/203)、7.9%(16/203)、31.5%(64/203)、6.9%(14/203);AA、BB、ff、tt最少,分别占8.4%(17/203)、2.4%(5/203)、15.8%(32/203)、0(0/203).VDR Apa I基因型分布频率为:氟斑牙患者AA占7.9%(8/101),Aa占55.4%(56/101),aa占36.7%(37/101);对照组AA占8.8%(9/102),Aa占48.0%(49/102),aa占43.3%(44/102);两组基因型分布比较,差异无统计学意义(χ2=1.13,P>0.05).VDR Bsm I基因型分布频率为:氟斑牙患者BB占3.0%(3/101),Bb占5.9%(6/101),bb占91.1%(92/101);对照组BB占2.0%(2/102),Bb占9.8%(10/102),bb占88.2%(90/102);两组基因型分布比较,差异无统计学意义(χ2=0.55,P>0.05).VDR Fok I基因型分布频率为:氟斑牙患者FF占28.7%(29/101),Ff占56.4%(57/101),ff占14.9%(15/101);对照组FF占34.3%(35/102),Ff占49.0%(50/102),ff占16.7%(17/102);两组基因型分布比较,差异无统计学意义(χ2=1.14,P>0.05).VDR Taq I基因型分布频率为:氟斑牙患者TT占93.1%(94/101),Tt占6.9%(7/101);对照组Tr占93.1%(95/102),Tt占6.9%(7/102);未发现tt型;两组基因型分布比较,差异无统计学意义(χ2=0.00,P>0.05).结论 汉族儿童中存在VDR基因多态性,但VDR Apa I、Bsm I、Fok I和Taq I 4个酶切位点的多态性与所调查儿童氟斑牙发生无明显关系.     

雌激素受体α和维生素D受体基因多态性与上海市妇女峰值骨量的关系

目的　探讨上海市妇女雌激素受体α(ER α)基因和维生素D受体 (VDR)基因多态性与峰值骨量的关系。方法　对上海市 5 15例无亲缘关系 19～ 40岁汉族健康妇女进行PCR RFLP测定ER α基因PvuⅡ、XbaⅠ多态性和VDR基因ApaⅠ多态性 ,用双能X线吸收法测定骨密度 (BMD)。 结果　本研究人群PP、Pp及pp基因型频率分别为 13 .2 %、49.3 %、3 7.5 % ;XX、Xx及xx基因型频率各为 4.7%、40 .4%、5 4.9% ;AA、Aa及aa基因型频率分别为 5 .8%、41.9%、5 2 .3 %。以上等位基因频率分布均符合Hardy Weinberg定律。协方差方法分析各基因型与BMD值的关系显示 :仅VDR基因ApaⅠ多态性与妇女L1 4BMD值显著相关 (P <0 .0 5 ) ,AA基因型在L1 4BMD值均低于Aa/aa基因型 ,差异有显著性 (P <0 .0 5 )。结论　ER α基因PvuⅡ和XbaⅠ多态性对上海市妇女峰值骨量无潜在影响 ;VDR基因ApaⅠ多态性与上海市妇女腰椎峰值骨量的达到和维持有关 ,而且独立于ER α基因PvuⅡ和XbaⅠ多态性。     

新疆哈萨克族人群结核病易感基因的病例对照研究

目的研究自然抗性相关巨噬细胞蛋白1(NRAMPl)基因3′端非编码区(3′UTR)和维生素D受体(VDR)基因FokI、TaqI位点多态性与新疆哈萨克族人群结核病易感性的关联;分析NRAMPl基因和VDR基因交互作用对新疆哈萨克族人群结核病易感性的影响。方法采用病例对照研究方法,选取新疆哈萨克族活动性肺结核病患者213例,同地区同种族健康者211例。用聚合酶链反应 限制性片断长度多态性(PCR RFLP)分析方法对NRAMP1基因3′UTR、VDR基因FokI和TaqI多态性位点基因分型,采用χ2检验分析3个位点多态性与新疆哈萨克族结核病易感性的关系,相乘模型分析NRAMPl基因和VDR基因交互作用。结果1. NRAMPl基因3′UTR位点在病例组和对照组中TGTG/TGTG、TGTG/del和TGTGdel/del基因型频率分别为64.8%、29.6%、5.6%和79.1%、19.5%、1.4%。TGTGdel等位基因组间分布差异有统计学意义(χ2=13.737,P<0.01)。2. VDR基因FokI位点在病例组和在对照组中FF、Ff和ff基因型频率分别为33.8%、45.1%、21.1%和47.9%、41.7%、10.4%。f等位基因频率组间分布差异有统计学意义(χ2=13.868,P<0.01);TaqI位点TT、Tt和tt基因型组间分布差异无统计学意义;等位基因T和t组间分布差异无统计学意义(χ2=1.267,P>0.05);D'=0.477,r2=0.01,两位点不存在连锁不平衡。3. NRAMP1基因和VDR基因存在正交互作用,ORint=1.62。结论1. TGTG/del和TGTGdel/del基因型、TGTG缺失等位基因可能是新疆哈萨克族人群结核病易感基因。2. VDR基因中FokI多态性与新疆哈萨克族结核病易感性有关联,等位基因f可能是新疆哈萨克族结核病易感基因。3. NRAMP1和VDR基因间交互作用可能增加新疆哈萨克族人群结核病的发病风险。     

初治肺结核患者维生素D与其受体基因多态性位点FokI的相关性分析

目的分析初治肺结核患者血清维生素D(VD)与维生素D受体(VDR)基因多态性位点Fok I的相关性。方法对我院随机选取的180位初治肺结核患者和100位正常对照的血清VD水平,VDR基因多态性位点Fok I基因型进行检测,比较和分析2组血清VD水平与VDR基因Fok I多态性差异以及相关性。结果初治肺结核患者血清VD水平明显低于正常对照组(P0.0001);初治肺结核组VD营养缺乏率(70.5%)明显高于正常对照组(47.0%),VDR基因多态性位点Fok I的三种基因型(纯合子FF,纯合子ff和杂合子Ff)在两组内的分布差异具有统计学意义(P=0.033),初治肺结核组纯合子ff及等位基因f比率明显高于正常对照组(P0.05);初治肺结核患者基因型ff组VD水平明显低于基因型FF组和基因型Ff组(P0.05)。结论初治肺结核患者血清VD水平明显下降,VDR基因多态性位点Fok I基因型ff为肺结核易感基因。     

新疆汉族老年人轻度认知功能障碍患者维生素D受体基因多态性与血清25(OH)D水平的相关性

目的研究新疆汉族老年轻度认知功能障碍(MCI)患者维生素D受体(VDR)基因ApaI、BsmI位点的基因多态性与维生素D水平的关联。方法在2010年7月至2014年7月对新疆维、汉两民族老年人进行了MCI流行病学调查的基础上,采用美国精神病学会的精神障碍和统计手册第四修订版(DSM-Ⅳ)的MCI诊断标准,共入选汉族MCI组100例(女57例,男43例),平均年龄(77.22±6.59)岁;选取对照组145例(女70例,男75例),平均年龄(76.72±5.71)岁,应用SNaPshot方法检测VDR基因ApaI、BsmI位点基因型,用酶联免疫吸附试验(ELISA)检测血清25(OH)D的浓度。结果 VDR基因ApaI位点、BsmI位点基因型分布及等位基因频率在MCI组及对照组间分布差异有统计学意义(P<0.05),对ApaI基因型及等位基因患病风险分析后得出:等位基因A增加MCI的患病风险,AA基因型增加MCI患病风险,对BsmI基因型及等位基因患病风险分析得出:T等位基因增加MCI患病风险,CT基因型增加MCI患病风险;MCI组维生素D水平明显低于对照组,差异有统计学意义(t=-2.24,P<0.05);MCI组中,VDR基因ApaI、BsmI位点不同基因型比较血清25(OH)D水平差异均无统计学意义(P均>0.05)。结论①VDR基因ApaI、BsmI两个位点多态性与汉族老年MCI发病相关。②血清25(OH)D水平的下降可能影响MCI的发生发展。③未发现MCI患者中VDR基因ApaI、BsmI两个位点多态性与维生素D水平有关联。     

藏族妇女维生素D受体基因BsmⅠ多态性与骨量无关

测定藏族妇女维生素D受体基因BsmI单核苷酸多态性和跟骨定量超声参数。结果显示不同基因型组对应的定量超声参数差异无统计学意义,年轻妇女和绝经后妇女的基因型分布频率差异也无统计学意义,未发现藏族VDR基因的BsmI多态性与峰值骨量的获得和骨量丢失速率相关。     

Effects of calcium supplementation on bone loss and fractures in congestive heart failure

BACKGROUND: Cross-sectional studies have shown that more than 50% of patients with congestive heart failure (CHF) have decreased bone mineral density (BMD). There is limited knowledge about the longitudinal changes of BMD and how to treat bone loss in patients with CHF. METHODS: The present study was a prospective, longitudinal trial in which 33 male patients with CHF (ejection fraction (EF): 30+/-11%) were assigned to 1000 mg calcium supplementation or no supplementation. BMD was measured at the lumbar spine (LS) and the femoral neck (FN) by dual-energy X-ray absorptiometry at baseline and after 12 months. RESULTS: Osteopenia (LS 33% and FN 36%) and osteoporosis (LS 15% and FN 6%) were frequently seen in these patients; 70% showed impaired renal function, 42% secondary hyperparathyroidism, and 33% hypogonadism. Bone resorption markers were strongly elevated and correlated negatively with the EF. Patients without calcium supplementation revealed a reduction of BMD (LS 1.7% and FN 1.9%) within 12 months. The fracture incidence was 6%. Patients with calcium supplementation also demonstrated a 6% fracture incidence and a decrease in BMD (LS 1.2% and FN 1.6%), which was not significantly different from the untreated group. Loss of BMD at FN was only seen in patients with impaired renal function. CONCLUSIONS: Patients with CHF demonstrate a progressive decrease in BMD when compared with age-matched healthy individuals. Increased bone resorption due to renal insufficiency with consecutive secondary hyperparathyroidism is a main reason for BMD loss in CHF. Calcium supplementation alone cannot sufficiently prevent the decrease in BMD.     

Increased bone mineral content and bone size in the femoral neck of men with hip osteoarthritis.

OBJECTIVES: Even though clinical findings support the idea that hip osteoarthritis (OA) is associated with increased bone mineral density (BMD), the subject remains controversial. This study was therefore initiated to investigate the relation between the severity of hip OA and femoral and calcaneal BMD. METHODS: On the basis of the American College of Rheumatology criteria on classification of OA of the hip, 27 men (aged 47-64 years) with unilateral or bilateral hip OA and 30 age matched randomly selected healthy men were studied. Plain radiographs were graded using Li's scale from 0 (no OA) to 4 (severe OA). According to the side of the highest radiographic score from the patients with clinical hip OA, 29.6% had grade 1, 29.6% grade 2, and 40.8% grade 3 OA. Bone mineral content (BMC), areal BMD (BMD(areal)), and bone dimensions (area and width) were measured by dual x ray absorptiometry at the proximal femur. BMD(areal) of the calcaneus was measured from the central area of the bone. Volumetric measurements from magnetic resonance images of the femoral neck were used to create a BMD measure that was corrected for the femoral neck volume (BMD(mri)). RESULTS: There were no differences in weight, or body mass index between the study groups. There were no significant BMD(areal) differences in any of the subregions of the proximal femur (femoral neck and trochanter) or calcaneus between the OA and control groups. Neither did the BMD(mri) of the femoral neck differ between the groups. However, the BMC of the femoral neck was 18% higher (p<0.01) in patients with OA than in controls. Similarly femoral neck bone width and volume were 9% and 18% respectively higher (p<0.001) in patients with OA. CONCLUSIONS: The results suggest that men with hip OA have larger femoral neck size and consequently higher BMC than healthy controls matched for age and sex. There is no significant difference in femoral neck BMD (BMD(areal) or BMD(mri)) between the groups. Furthermore, increased BMD(areal) was not found in the peripheral skeleton. These findings suggest that hip OA is not associated with an increase in BMD(areal) in the femoral neck. However, the increase in BMC and bone size in patients with hip OA may play a part in the pathogenesis of the disease.     

Inactivity is a risk factor for low bone mineral density among haemophilic children

Reduced bone mineral density (BMD) in childhood is a risk factor for osteoporosis in later life. This case-control study determined the prevalence of low BMD, calcium intake and physical activity in 62 haemophilic children and 62 sex-, race- and age-matched healthy boys as controls. Lumbar spine (L2-L4) BMD was determined by dual-energy X-ray absorptiometry; BMD was considered to be low when Z-score > or =2. Physical activity was assessed using a validated questionnaire and calcium intake with a standardized quantitative food frequency questionnaire. Twenty-four patients (38%) had low BMD, whereas this was found in only 10 (16%) controls [odds ratio (OR) 2.86, 95% confidence interval (CI) 1.17-7.41; P = 0.014]. Lumbar BMD was significantly lower in the haemophilia patients than the controls (-1.6 +/- 1.0 vs. -0.9 +/- 0.9 respectively; P = 0.0004). Sedentary and low-grade exercise predominated in haemophilia (77%) versus control (50%) (OR 3.2, 95% CI 1.36-7.79; P = 0.003). There were no differences between groups with regard to calcium intake. Our results suggest that low-physical activity is a risk factor for reduced lumbar bone mass in the haemophilic group. This factor must be monitored to avoid a significant reduction in BMD that might contribute to further skeletal fragility.     

Longitudinal study of changes in hip bone mineral density in Caucasian and African-American women

OBJECTIVES: To determine whether changes in hip bone mineral density (BMD) differ in Caucasian and African American women. DESIGN: Longitudinal study of changes in hip BMD. SETTING: Four U.S. clinical centers. PARTICIPANTS: Six thousand seven Caucasian (mean age 73) and 482 African-American (mean age 75) women enrolled in the Study of Osteoporotic Fractures. MEASUREMENTS: Total hip and femoral neck BMD were measured an average of 3.5 years apart (Caucasian) and 2.0 years apart (African American). Annual absolute and percentage changes in BMD and bone mineral apparent density (BMAD) were calculated. RESULTS: The multivariate adjusted annual percentage change in BMD was greater in Caucasian than African-American women at the total hip (-0.574%/y vs -0.334%/y) and femoral neck (-0.515%/y vs -0.203%/y) (both, P<.001). Similar findings were observed for BMAD. The average annualized rate of BMD loss was twice as high in women aged 75 and older as in women younger than 75 in both ethnic groups. The annual percentage loss in femoral neck BMD in nonusers versus hormone therapy users was (-0.57% vs -0.22%) in Caucasians and (-0.35% vs 0.64%) in African Americans (interaction P=.03). CONCLUSION: The average rate of hip BMD loss is approximately twice as great in Caucasian as African-American women and increases with age in both groups. The hormonal and biochemical factors that contribute to ethnic differences and the increase in bone loss with advancing age need to be identified.     

Bone density reduction in patients with Crohn disease and associations with demographic and disease variables: cross-sectional data from a population-based study.

BACKGROUND: The extent of bone density reduction in patients with Crohn disease is still being debated. The aim of this study was to examine bone mineral density (BMD) and factors associated with reduced BMD in a representative population of patients with Crohn disease aged between 20 and 70 years. METHODS: BMD (using dual energy X-ray absorptiometry) was measured in spine and hip in 55 patients with Crohn disease recruited from the entire Crohn population (n = 96) in a defined area of southern Norway. Demographic and clinical data were also collected. The patients were compared with 52 age- and gender-matched healthy controls. Potential demographic and disease-related factors associated with BMD reduction were statistically tested with bi- and multivariate analyses. RESULTS: The BMD reduction in patients with Crohn disease was 7.1% (P = 0.02) in spine L1-4, 6.1% (P = 0.08) in femoral neck and 8.4% (P = 0.02) in total hip as compared with the controls. In total hip and femoral neck, age, body weight and gender were independently associated with reduced BMD, but in the spine only body weight. Among the disease-related variables, only ever use of prednisolone was independently associated with reduction in BMD but this only in the femoral neck. CONCLUSIONS: The spine and hip BMD reduction of 6%-8% is similar to that found in a comparable population-based study performed in another area in Norway. Among the disease-related variables tested for, only the use of prednisolone was independently associated with BMD reduction. However, the BMD reduction measured in this study indicates that disease-related mechanisms are involved.     

Changes in bone density and turnover explain the reductions in incidence of nonvertebral fractures that occur during treatment with antiresorptive agents

Some, but not all, antiresorptive agents have been shown to reduce the risk of nonvertebral fractures. Agents that significantly reduced nonvertebral fracture risk also appear to produce larger mean increases in bone mineral density (BMD) and reductions in biochemical markers (BCM) of bone turnover, compared with other agents. To examine the extent to which increases in BMD and reductions in BCM during antiresorptive therapy are associated with reductions in risk of nonvertebral fractures, we performed a meta-analysis of all randomized, placebo-controlled trials of antiresorptive agents conducted in postmenopausal women with osteoporosis (i.e. prior vertebral fracture or low BMD) with available relevant data. A total of 18 such trials with usable data were identified, including a total of 2,415 women with incident nonvertebral fractures over 69,369 women-years of follow-up. Poisson regression was used to estimate the association between changes in BMD or BCM during the first year and overall reductions in risk of nonvertebral fractures (vs. the placebo group) across all trials. Larger increases in BMD and larger reductions in BCM were significantly associated with greater reductions in nonvertebral fracture risk. For example, each 1% increase in spine BMD at 1 yr was associated with an 8% reduction in nonvertebral fracture risk (P = 0.02). Mean BMD changes at the hip were smaller than at the spine, but the predicted net effect on fracture risk was the same; an agent that increases spine BMD by 6% at 1 yr reduces nonvertebral fracture risk by about 39%, and an agent that increases hip BMD by 3% at 1 yr reduces nonvertebral fracture risk by about 46%. The results also predict that a 70% reduction in resorption BCM would reduce risk by 40%, and a 50% reduction in formation BCM would reduce risk by 44%. It appears that either BMD or BCM changes are able to explain the effect of treatment, because a separate variable for treatment was not independently significant in any models. These data demonstrate that larger increases in BMD at both the spine and hip and larger reductions in both formation and resorption BCM are associated with greater reductions in the risk of nonvertebral fractures. Antiresorptive agents that do not produce large increases in BMD or large reductions in BCM do not appear to and would not be expected to decrease the risk of nonvertebral fractures.     

Bone mineral density of the hand in rheumatoid arthritis

Objective. To determine the reproducibility, accuracy, and linearity of hand bone mineral content (BMC) measurements, and to evaluate the influence of hand posture; to determine the relationship of hand bone mineral density (BMD) to generalized osteopenia in rheumatoid arthritis (RA); and to determine the relationship between hand BMD and disease severity in early RA. Methods. Hand BMD was measured by dual-energy x-ray absorptiometry (DXA). We studied 70 postmenopausal women with steroid-treated RA (established RA), ages 49–79, and 20 age-matched healthy controls to determine the relationship to generalized osteoporosis; we also studied 20 patients ages 23–74 years with early RA to determine the relationship between disease severity and hand BMD. Results. Reproducibility of hand BMD was to within 1%. In established RA, there was a greater decrease in juxtaarticular BMD (23% at the hand) than in generalized BMD (16% at the femoral neck, 11% at the lumbar spine, and 11% total body) compared with that in age-matched controls. Hand BMD correlated with skeletal size and BMD at other skeletal sites. In established RA, there was no effect of disease duration, disability, or steroid therapy. In early RA, hand BMD correlated with age and disease activity. Conclusion. Measurement of hand BMD by DXA is accurate and precise. Hand BMD reflects BMD at other skeletal sites in patients with RA, and is a marker of disease severity in patients with early disease. It may be a sensitive marker of disease progression and response to therapeutic intervention.     

A randomized, placebo-controlled study of the effects of denosumab for the treatment of men with low bone mineral density

Context: Men with low bone mineral density (BMD) were treated with denosumab. Objective: Our objective was to investigate the effects of denosumab compared with placebo in men with low BMD after 1 yr of treatment. Design, Subjects, and Intervention: This was a placebo-controlled, phase 3 study to investigate the efficacy and safety of denosumab 60 mg every 6 months vs. placebo in men with low BMD. Main Outcome Measure: The primary endpoint was the percent change from baseline in lumbar spine (LS) BMD at month 12. Results: Of the 242 randomized subjects (mean age 65 yr), 228 (94.2%) completed 1 yr of denosumab therapy. After 12 months, denosumab resulted in BMD increases of 5.7% at the LS, 2.4% at the total hip, 2.1% at the femoral neck, 3.1% at the trochanter, and 0.6% at the one third radius (adjusted P ≤ 0.0144 for BMD percent differences at all sites compared with placebo). Sensitivity analyses done by controlling for baseline covariates (such as baseline testosterone levels, BMD T-scores, and 10-yr osteoporotic fracture risk) demonstrated that the results of the primary endpoint were robust. Subgroup analyses indicate that treatment with denosumab was effective across a spectrum of clinical situations. Treatment with denosumab significantly reduced serum CTX levels at d 15 (adjusted P < 0.0001). The incidence of adverse events was similar between groups. Conclusions: One year of denosumab therapy in men with low BMD was well tolerated and resulted in a reduction in bone resorption and significant increases in BMD at all skeletal sites assessed.     

Exercise and lumbar spine bone mineral density in postmenopausal women: a meta-analysis of individual patient data

BACKGROUND: Low bone mineral density (BMD) at the lumbar spine is a major public health problem among postmenopausal women. We conducted a meta-analysis of individual patient data (IPD) to examine the effects of exercise on lumbar spine BMD in postmenopausal women. METHODS: IPD were requested from a previously developed database of summary means from randomized and nonrandomized trials dealing with the effects of exercise on BMD. Two-way analysis of variance tests with pairwise comparisons (p < or =.05) and 95% confidence intervals (CIs) were used to determine the statistical significance for changes in lumbar spine BMD. RESULTS: Across 13 trials that included 699 subjects (355 exercise, 344 control), a statistically significant interaction was found between test and group (F = 15.232, p =.000). Pairwise comparisons (Bonferroni t tests) revealed a statistically significant increase in final minus initial BMD for the exercise group ( +/- SD = 0.005 +/- 0.043 g/cm(2), t = 2.46, p =.014, 95% CI = 0.001-0.009) and a statistically significant decrease in final minus initial BMD for the control group ( +/- SD = -0.007 +/- 0.045 g/cm(2), t = -3.051, p =.002, 95% CI = -0.012--0.002). Changes were equivalent to an approximate 2% benefit in lumbar spine BMD (exercise, +1%, control, -1%). CONCLUSIONS: The results of this IPD meta-analysis suggest that exercise helps to improve and maintain lumbar spine BMD in postmenopausal women.     

Evaluation of changes in bone density and biochemical parameters after parathyroidectomy in primary hyperparathyroidism

We examined the relationships between serum levels of intact parathyroid hormone (PTH) and alkaline phosphatase (ALP) versus bone mineral density (BMD) at the lumbar spine and radius in terms of their preoperative values and of their annual percentage and net changes after parathyroidectomy (PTX) in 44 Japanese patients (14 men and 30 women) with primary hyperparathyroidism (pHPT). Lumbar and radial BMD values were measured by dual energy X-ray absorptiometry and single photon absorptiometry and were used for evaluating the cancellous and cortical bone mass, respectively. Age- and sex-adjusted value (Z-score) of the radial BMD was significantly lower than that of the lumbar BMD before and after PTX (P < 0.05). In preoperative patients, serum levels of both intact PTH and ALP were significantly and negatively correlated with Z-score of the radial BMD (P < 0.05 and P < 0.001, respectively), but not with that of the lumbar BMD. After PTX, serum levels of calcium, phosphorus, ALP, and PTH became normal, and both lumbar and radial BMD values markedly increased over 1 year, with percentage changes of 12.2+/-1.4% and 11.6+/-1.6%, respectively, which were larger than those in any other Caucasian study previously documented. Even in patients without osteopenia (Z-score of BMD 20), lumbar and radial BMD values increased considerably after the operation (9.6+/-1.9% and 6.7+/-1.4%, respectively). Annual percentage and net changes in lumbar BMD were significantly and negatively correlated with those in ALP with high correlation coefficients, but those in radial BMD were correlated only with the annual net change in ALP but not with the percentage change. No significant correlations were observed between annual changes in either lumbar or radial BMD and those in intact PTH. Taken together, this study shows that PTX causes dramatic improvements in both the cancellous and cortical bone mass in Japanese pHPT patients regardless of the severity of their osteopenia, and suggests that the cancellous and cortical bones react differently to a preoperative endogenous PTH excess and a high bone turnover rate as well as to the postoperative normalization of a bone turnover rate in the patients.