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1.
Delayed union and non-union are common complications after fracture of the tibial shaft. Response of the surrounding bone
as a fracture heals could be monitored using techniques currently used in the study of osteoporosis. The aims of our study
were to: (1) evaluate the decrement in bone measurements made close to the fracture using dual-energy X-ray absorptiometry
(DXA), quantitative ultrasound (QUS) and peripheral quantitative computed tomography (pQCT); (2) compare values for fractured
versus non-fractured leg to determine the duration of decrement in bone measurements; and (3) calculate short-term precision
in DXA, QUS and pQCT in order to calculate the ratio of decrement to precision (response ratio, RR) to determine the optimal
test for monitoring changes after tibial fracture. The biggest decrement in bone measurements at the ipsilateral limb of 28
patients with tibial shaft fracture was observed at the pQCT tibial trabecular sites (distal = 19%, p<0.0001; proximal 5% = 21%, p<0.001; proximal 10% = 28%, p<0.001) and the ultradistal tibia/fibula measured by DXA (19%, p<0.0001). When comparing Z-scores, the magnitude of decrements at the ipsilateral limb was bigger for variables measured directly at the tibia, both
proximal and distal to the fracture. The magnitude of the decrement in ultradistal tibia/fibula BMD decreased as the time
since fracture increased (r = 0.55). When response ratios are considered, pQCT measurements at the distal tibia (RR 6–8) and proximal 5% and 10% trabecular
sites (RR 5 and 9 respectively) were found to be the most sensitive to change. Therefore, pQCT of the trabecular regions of
either the proximal or distal tibia should prove the most sensitive measurement for monitoring changes in bone adjacent to
a tibial shaft fracture.
Received: 24 January 2002 / Accepted: 23 July 2002 相似文献
2.
Bone loss occurs after distal forearm fracture, but it is unclear if this bone loss is fully recovered. We designed a cross-sectional
study to evaluate the time course of the bone loss from the hand after distal forearm fracture. We identified 40 women who
had a fracture of the distal forearm within the previous 4.5 years. Their ages ranged from 42 to 81 (mean 64 years) and time
since fracture 6 to 54 (mean 28 months). These were compared with 95 women (mean age 67, range 57 to 80 years) from a population-based
cohort. Lumbar spine (LS) and hand bone mineral density (BMD) were measured in all subjects using a Hologic QDR 1000/W densitometer.
Ultrasound of the fingers of both hands was measured in the forearm fracture group using a DBM Sonic 1200 R model. Compared
to controls, LS BMD was decreased by 6.4% (p<0.001), non-fractured hand by 3.2% (p<0.001) and the fractured hand by 6.1% (p<0.001) in the forearm fracture group. The mean differernce in bone density between the fractured and non-fractured hand was
0.0207 g/cm2, the average value for the non-fractured hand being 0.304 g/cm2. The decement in hand BMD was equivalent to 6.2% (p<0.0001). The difference in hand BMD between the fractured and non-fractured side was greatest when the time since fracture
was short; there was no further difference in hand BMD after 2 years. Ultrasound showed a mean difference of 18.7 m/s in amplitude-dependent
speed of sound (AD-SoS) with the average value being 1893 m/s. A 1.0% decrease was observed in the fractured hand AD-SoS (p<0.05). A strong relationship was observed between AD-SoS and BMD in both hands (r= 0.70, p<0.001). We conclude that distal forearm fracture results in a significant decrease in hand BMD that is partially reversible.
The decrease in hand BMD is reflected in the ultrasound properties of the finger phalanx.
Received: 26 July 2000 / Accepted: 5 January 2001 相似文献
3.
N. Barthe B. Basse-Cathalinat P. J. Meunier C. Ribot X. Marchandise J. P. Sabatier P. Braillon J. Thevenot B. Sutter 《Osteoporosis international》1998,8(4):379-384
The relative influence of genetic and environmental determinants on bone mass is still unclear. Using an original multicentric
mode of recruitment, based on absorptiometry current practice, the hypothesis of a familial predisposition to low bone mineral
content was assessed. The study was based on dual-energy X-ray absorptiometry (DXA) measurements of lumbar and femoral neck
bone mineral density (BMD), using daughters of women with a low BMD (case mothers). These BMD values were compared with those
of control daughters of women with a normal BMD. Case mothers (n= 72) aged 54.3 ± 4.8 years were recruited on the basis of a questionnaire and a vertebral Z-score < – 2 SD. Their healthy daughters of more than 20 years (n= 77) aged 28.2 ± 4.9 years had their vertebral and femoral BMD Z-score determined. The control groups were composed of mothers aged 54.1 ± 4.7 years, paired by age ± 2 years to the case
mothers, and of their daughters of more than 20 years old, aged 27.7 ± 5.8 years. For daughters, a significant difference
was found between the mean vertebral Z-scores (–0.82 ± 1.08 for cases and 0.01 ± 1.14 for controls, p < 0.0001). The difference was in the same direction but was not statistically significant for mean femoral Z-scores (–0.58 ± 1.15 for cases and –0.22 ± 1.33 for controls, p <0.073). These findings confirm the hypothesis of a familial predisposition to low BMD.
Received: 18 June 1997 / Accepted: 16 January 1998 相似文献
4.
W. A. Bauman A. M. Spungen J. Wang R. N. Pierson Jr E. Schwartz 《Osteoporosis international》1999,10(2):123-127
Acute immobilization is associated with rapid loss of bone. Prevailing opinion, based on population cross-sectional data,
assumes that bone mass stabilizes thereafter. In order to address whole-body and regional skeletal mass in long-term immobilization,
monozygotic twins were studied, one of each twin pair having chronic spinal cord injury (SCI) of a duration ranging from 3
to 26 years. The research design consisted of the co-twin control method using 8 pairs of identical male twins (mean ± SD
age, 40 ± 10 years; range 25–58 years), one of each set with SCI. The twins were compared by paired t-tests for total and regional bone mineral content (BMC) and bone mineral density (BMD) measured by dual-energy X-ray absorptiometry.
Linear regression analyses were performed to determine the associations of age or duration of injury with the differences
between twin pairs for total and regional skeletal bone values. In the SCI twins, total-body BMC was significantly reduced
(22%± 9%, p<0.001), with the predominant sites of reduction for BMC and BMD being the legs (42%± 14% 35%± 10%, p<0.0001), and pelvis (50%± 10% and 29%± 9%, p<0.0001). Duration of SCI, not age, was found to be linearly related to the degree of leg bone loss in SCI twins (BMC: r
2= 0.60, p<0.05; BMD: r
2= 0.70, p<0.01). Our findings suggest that pelvic and leg bone mass continues to decline throughout the chronic phase of immobilization
in the individual with SCI, and this bone loss appears to be independent of age.
Received: 28 September 1998 / Accepted: 28 December 1998 相似文献
5.
Changes in Bone Mass and Bone Turnover Following Ankle Fracture 总被引:6,自引:0,他引:6
Bone loss and increased bone turnover are recognized local changes after a fracture, but the exact patterns of these changes
after different fractures are unclear. We aimed to investigate the changes in bone density and biochemical markers following
ankle fracture. Fourteen subjects (7 postmenopausal women and 7 men, mean age 63 years) were recruited following fracture
of the distal tibia and fibula. Bone mineral density (BMD) of the ankle and proximal femur were measured by dual-energy X-ray
absorptiometry (DXA) and quantitative ultrasound (QUS) of the calcaneus at 0, 6, 12, 26 and 52 weeks after fracture. Serum
and urine samples were collected at 0, 3 and 7 days and at 2, 4, 6, 12, 26 and 52 weeks after fracture to measure markers
of bone turnover. For bone formation we measured: bone alkaline phosphatase (iBAP), osteocalcin (Oc), procollagen type I N-terminal
propeptide (PINP); and for bone resorption: tartrate-resistant acid phosphatase (TRAcP), deoxypyridinoline (iFDpd), N-telopeptides
of type I collagen (NTx). We used the nonfractured limb to calculate values for baseline BMD and QUS. There was a significant
decrease in BMD at the ultradistal ankle (p<0.001), the trochanteric region of the hip (p<0.01) and QUS of the heel after ankle fracture. This bone loss was maximal for ultradistal ankle BMD by 6 weeks at 13% (p<0.001) and for the trochanter by 26 weeks at 3% (p<0.01). The ankle BMD returned to baseline at 52 weeks but the trochanter BMD did not. Velocity of sound (VOS) decreased at
6 weeks by 2% (p<0.01) and broadband ultrasound attenuation (BUA) by 15% (p<0.01). VOS recovered completely by 52 weeks, but BUA did not return to baseline. Bone formation markers increased significantly
between 1 and 4 weeks by 11–78% (p<0.01), and iBAP returned to baseline at 52 weeks but PINP and Oc remained elevated. Bone resorption markers did not increase
and NTx was decreased at 52 weeks. We conclude that BMD decreased distal and immediately proximal to the fracture line when
measured with DXA and QUS. Ankle BMD and heel VOS recovered at 52 weeks (trochanteric BMD and heel BUA did not) and the bone
turnover markers returned toward baseline.
Received: 27 January 1999 / Accepted: 19 April 1999 相似文献
6.
Bone loss occurs close to a fracture and is associated with increased bone turnover. Fracture healing itself results in increased
markers of bone turnover. But the exact patterns of these changes after different fractures are unclear. We aimed to investigate
the changes in bone density and biochemical markers following distal forearm fracture. Twenty women (mean age 63 years) were
recruited following fracture of the distal radius and ulna. Bone mineral density (BMD) of the hand and forearm were measured
by dual-energy X-ray absorptiometry (DXA) and quantitative ultrasound (QUS) of the fingers was measured at 0, 6, 12, 26 and
52 weeks after fracture. Serum and urine samples were collected at 0, 3 and 7 days and at 2, 4, 6, 12, 26 and 52 weeks after
fracture to measure markers of bone turnover. For bone formation we measured: bone alkaline phosphatase (iBAP), osteocalcin
(Oc), procollagen type I N-terminal propeptide (PINP); and for bone resorption: tartrate-resistant acid phosphatase (TRAcP),
free deoxypyridinoline (iFDpd), N-telopeptides of type I collagen (NTx). We used the nonfractured limb to calculate values
for baseline BMD and amplitude-dependent speed of sound (AD-SoS). There was a decrease in BMD at the hand and in AD-SoS of
the fingers after forearm fracture (p<0.001). This bone loss was maximal for BMD by 6 weeks at 9% (p<0.001) and remained decreased at 52 weeks. AD-SoS decreased at 12 weeks by 3% (p<0.01) and recovered completely by 52 weeks. Bone formation markers increased between 2 and 4 weeks by 13–52% (p<0.001), and were still elevated at 52 weeks. Bone resorption markers increased between 2 and 6 weeks by 18–35% and returned
to baseline at 52 weeks (TRAcP remained elevated). We conclude that BMD decreased distal and immediately proximal to the fracture
line when measured with DXA and QUS. Bone loss after distal forearm fracture did not recover by 52 weeks and most bone turnover
markers did not return to baseline.
Received: 27 January 1999 / Accepted: 19 April 1999 相似文献
7.
Regional migratory osteoporosis (RMO) is a migrating arthralgia of the weight-bearing joints of the lower limb associated
with focal osteoporosis. Little information is available on a quantitative assessment of systemic or local osteoporosis. In
this study, we report three cases of RMO in which spine, hip and whole body serial assessments of bone mass have been evaluated
to outline their extent and time course of changes. Systemic osteoporosis, with a prevalent involvement of the mainly trabecular
skeletal sites, was present in all the patients, with T-scores below −2.5 at both the lumbar spine and femoral neck. Bone loss in acute episodes ranged from −75.5% to −14.7% and
appeared related to the severity of the episode. In acute episodes the demineralizing process affected the whole limb from
the hemipelvis to the foot: the bone loss ranged from −33.6% to −3.5% at sites with prevalent trabecular composition and from
−19.1% to −1.1% at sites with prevalent cortical composition. Bone recovery was complete in one episode out of six. In the
other five cases, the average residual bone loss was 26% (range 13.9–32.7%). Our observations suggest that RMO occurs in subjects
with systemic osteoporosis and densitometric assessment may aid in the clinical management.
Received: 12 February 2002 / Accepted: 17 June 2002
Correspondence and offprint requests to: Carlo Trevisan, MD, Clinica Ortopedica, Università degli Studi di Milano Bicocca, Azienda Osp.S.Gerardo, Via Donizetti, 106-20052
Monza (MI), Italy. Tel: +39 039 2332322. Fax +39 039 2302905. e-mail: trevisan@progetto3000.it 相似文献
8.
Prevention of Bone Loss by Clodronate in Early Postmenopausal Women with Vertebral Osteopenia: A Dose-Finding Study 总被引:1,自引:0,他引:1
M. J. V?lim?ki K. Laitinen K. Laitinen A. Patronen H. Puolijoki H. Puolijoki J. Sepp?nen L. Pylkk?nenand the Probone Study Group 《Osteoporosis international》2002,13(12):937-947
This double-masked, placebo-controlled study was undertaken to determine the efficacy and safety of oral clodronate in the
prevention of bone loss in early postmenopausal women with vertebral osteopenia. Altogether 610 women with a mean age of 53
years were recruited for the study. They were 1–5 years postmenopausal and their lumbar spine bone mineral density (BMD) was
at least 1 standard deviation below the mean of premenopausal women (T-score ≤−1). The subjects were randomized into five study groups to receive either placebo, clodronate 65 mg, 400 mg or 800
mg daily, or intermittent clodronate in 3 month cycles with 400 mg daily for 15 days followed with no treatment for 75 days
for 3 years. One hundred and eighty-seven of 509 women who completed the primary study continued in the extension study of
2 years in which previous placebo users were switched to clodronate 800 mg daily, while previous users of 400 mg or 800 mg
of clodronate used either placebo or 800 mg of clodronate daily. In the primary study clodronate was administered in the evening,
and in the extension 1 h before breakfast on an empty stomach. In the primary study mean changes in lumbar spine BMD were
−3.4% in the placebo group and +0.4% in 800 mg clodronate group [difference between groups at 3 years 3.8% (95% CI 2.7% to
4.9%, p<0.0001)], and in the trochanter area BMD −1.1% in the placebo group, and + 0.4% in the 800 mg clodronate group [difference
between groups at 3 years 1.5% (95% CI 0.05% to 2.9%)]. During the extension study mean changes in lumbar spine BMD were +1.5%
in the clodronate group and −0.2 % in the placebo group [difference between groups 1.7% (CI 0.4% to 3.0%, p = 0.010)] and in trochanter BMD were +2.5% in the clodronate group and no change in the placebo group [difference between
groups 2.1% (CI 0.3% to 3.9%, p = 0.007)]. No statistically significant differences between the placebo and 800 mg clodronate groups were found in the femoral
neck BMD. In the primary study the urinary excretion of type I collagen aminoterminal telopeptide (NTX) decreased by 44% (p<0.0001 compared with placebo) and that of deoxypyridinoline by 18% (p<0.0001) in the clodronate 800 mg group. In the extension study urinary NTX decreased by 51% (p<0.0001) in those who were switched to 800 mg of clodronate and increased by 67% (p<0.0001) in those who stopped using that dose. There was no difference in the frequency of gastrointestinal complaints between
clodronate- and placebo-treated patients in the primary study, but they were more common among women who received clodronate
in the extension phase. Clodronate in daily doses of 400–800 mg caused a slight elevation of aminotransferase levels, usually
within the reference range. In bone biopsies no defect in mineralization was found. In conclusion, clodronate in a daily dose
of 800 mg prevents early postmenopausal bone loss at the sites of the skeleton in which cancellous bone predominates. It effectively
reduces bone resorption and bone turnover rate. Antifracture efficacy of clodronate remains to be established by prospective,
placebo-controlled trials.
Received: 4 March 2002 / Accepted: 9 July 2002 相似文献
9.
J. Fiter J. M. Nolla C. Gómez-Vaquero D. Martínez-Aguilá J. Valverde D. Roig-Escofet 《Osteoporosis international》2001,12(7):565-569
The aim of the study was to evaluate whether computed digital absorptiometry (CDA) of the hand might be a useful screening
technique for identifying patients with postmenopausal osteoporosis and to compare the results of CDA with those of dual-energy
X-ray absorptiometry (DXA) of the lumbar spine and femoral neck. We studied 230 postmenopausal women (mean age 58.4 ± 7.9
years). For CDA, bone mineral density (BMD) was measured with an AccuDEXA Schick densitometer in the third middle phalanx
of the nondominant hand. For DXA, BMD of the lumbar spine and upper femur was assessed using a DXA Hologic QDR-1000 densitometer.
We did a comparative analysis (ANOVA) and linear correlation tests. Sensitivity and specificity of CDA and receiver operating
characteristic (ROC) curves for the diagnosis of osteoporosis were calculated. The mean BMD with CDA was 0.445 ± 0.084 (T-score: −1.27 ± 1.29). The mean BMD (g/cm2) with DXA at the lumbar spine was 0.877 ± 0.166 (T-score: −1.52 ± 1.59) and 0.708 ± 0.127 at the femoral neck (T-score: −1.12 ± 1.25). BMD at the lumbar spine and femoral neck correlated positively with CDA of the hand (r= 0.66 and r= 0.65 respectively, p<0.001). When using as cut-off a T-score of −2.5, according to WHO criteria, 76 women (33%) had osteoporosis of the lumbar spine and/or femoral neck with DXA
and 42 (18%) with CDA (p<0.001). The kappa score for osteoporosis was 0.33 for CDA versus spinal DXA and 0.35 for CDA versus femoral DXA. With the
cut-off level used, sensitivity and specificity of CDA in detecting osteoporosis at the lumbar spine were 0.39 and 0.90, respectively;
sensitivity and specificity of CDA in identifying osteoporosis at the femoral neck were 0.58 and 0.87, respectively. The positive
predictive value of CDA for osteoporosis was 69% and the negative predictive value was 75%. The area under the ROC curve for
osteoporosis was 0.822 ± 0.028. We conclude that: (a) CDA assessment has a moderate correlation with BMD measured by DXA at
the lumbar spine and femoral neck; (b) CDA has a low sensitivity for the diagnosis of osteoporosis compared with spinal and
femoral DXA; and (c) predictive values for osteoporosis at both the lumbar spine and femoral neck are acceptable.
Received: September 2000 / Accepted: January 2001 相似文献
10.
Inappropriate Reference Range for Peak Bone Mineral Density in Dual-energy X-ray Absorptiometry: Implications for the Interpretation of T-scores 总被引:1,自引:0,他引:1
An inappropriate reference range for peak bone mineral density (BMD) may result in identification of an incorrect proportion
of subjects with osteopenia and osteoporosis at dual-energy X-ray absorptiometry (DXA). In this study, we assessed the prevalence
of low BMD in Turkish young adults with respect to local population reference range T-scores and the US reference range T-scores. The BMD values of lumbar spine (L1–L4) and proximal femur (femoral neck, intertrochanter, trochanter, Ward”s triangle
and total) were measured by DXA in 323 healthy young adults (171 women, 152 men) aged 19–25 years. The World Health Organization
criteria for the diagnosis of osteopenia (−2.5 <T-score <−1) and osteoporosis (T-score ≤−2.5) were applied. In women, the means of the US reference range T-scores were significantly lower than zero at the spine and proximal femoral sites (p<0.0001). In men, the means of the US reference range T-scores were significantly lower than zero at the spine, femoral neck, intertrochanter, total femur (p<0.0001) and trochanter (p<0.05), but not at Ward”s triangle (p=0.92). When the diagnoses were based on local population reference range T-scores instead of the US reference range T-scores, the prevalence of low BMD (T-score <−1) in women fell from 50.3% to 14.0% at the lumbar spine and from 60.8% to 14.6% at the femoral neck, and in men
from 42.8% to 15.8% at the lumbar spine and from 30.9% to 17.1% at the femoral neck. Our data suggest that individual populations
should use their own reference range T-scores to avoid misdiagnoses of osteopenia and osteoporosis by DXA.
Received: 4 November 1999 / Accepted: 29 March 2000 相似文献
11.
Exercise May Induce Reversible Low Bone Mass in Unloaded and High Bone Mass in Weight-Loaded Skeletal Regions 总被引:2,自引:0,他引:2
H. Magnusson C. Lindén C. Karlsson K. J. Obrant M. K. Karlsson 《Osteoporosis international》2001,12(11):950-955
Exercise during growth and adolescence increases bone mineral density (BMD) in weight-loaded skeletal regions. The development
of BMD in unloaded or minimally loaded regions during activity is unclear. We measured BMD in one unloaded, one partly loaded
and one highly loaded skeletal region in 67 active soccer players, mean age 22.7 years (range 17–35 years), 128 former soccer
players, mean age 54.0 years (range 19–85 years) and 138 controls, mean age 50.6 years (range 19–80 years). The active soccer
players played at three different levels: premier league, 3rd league or 6th league. Duration of exercise in these three groups
was 12, 8 and 6 h/week, respectively. BMD (g/cm2) was measured by dual-energy X-ray absorptiometry (DXA) in the upper part of the skull (the unloaded skeletal region), the
arms (the partly loaded region) and the femoral neck (the maximal loaded region). Data are presented as mean ± SD. Active
soccer players had 10.3 ± 10.4% lower BMD in the upper part of the skull (p<0.001), 1.4 ± 6.3% higher BMD in the arm (NS) and 12.7 ± 9.8% higher BMD in the femoral neck (p<0.001) compared with age- and gender-matched controls. All three levels of soccer players demonstrated, independent of activity
level, the same discrepancies in BMD compared with controls. Former soccer players had lower BMD in the upper part of the
skull until age 70 years and higher BMD in the femoral neck until age 50 years compared with controls. The BMD of the arm
was not different in former soccer players compared with controls. In summary, active soccer players had lower BMD in the
unloaded skeletal region, no difference in BMD in the partly loaded region and higher BMD in the weight-loaded region compared
with controls. The discrepancies compared with controls diminished with age so that no differences were found in BMD after
age 70 years. In conclusion, unloaded and weight-loaded skeletal regions may respond differently to increased and decreased
physical activity.
Received: 15 January 2001 / Accepted: 31 May 2001 相似文献
12.
Quantitative Ultrasound Assessment of Acute Bone Loss Following Spinal Cord Injury: A Longitudinal Pilot Study 总被引:11,自引:3,他引:11
S. J. Warden K. L. Bennell B. Matthews D. J. Brown J. M. McMeeken J. D. Wark J. D. Wark 《Osteoporosis international》2002,13(7):586-592
Spinal cord injury (SCI) results in substantial and rapid osteoporosis. Given its rapid onset, assessment of bone changes
in the early stages (first 6 months) following SCI is important. This is particularly pertinent if intervention is to be implemented.
Quantitative ultrasound (QUS) represents a potential assessment tool for the evaluation of skeletal changes in the early stages
following SCI. This longitudinal pilot study assessed changes in QUS measures of calcaneal broadband ultrasound attenuation
(BUA) and speed of sound (SOS) in 15 male subjects (age 23.9 ± 7.3 years) over a 6-week period. Their mean time since SCI
was 110.3 ± 34.5 days. Also assessed were bone mineral density of the calcaneus (BMDc) and proximal tibia (BMDt) using dual-energy
X-ray absorptiometry (DXA). Confirming the rapid onset of bone loss following SCI, BMDc and BMDt decreased by 7.5 ± 3.0% (p<0.001) and 5.3 ± 4.2% (p<0.001), respectively. QUS was sensitive to these changes. BUA decreased by 8.5 ± 6.9% (p<0.001), whilst SOS decreased by 1.5 ± 1.3% (p<0.001). Suggesting an influence of the material properties of bone on BUA, BUA was correlated with BMDc at both the initial
(r= 0.68, p<0.01) and final (r = 0.62, p<0.01) assessments. There were no significant correlations in the magnitude of change over the 6-week assessment period between
any of the skeletal measures (all p>0.05). This suggests that skeletal qualities other than material properties also influence QUS measures. Overall, this study
confirmed the rapid onset of bone loss following SCI and showed QUS to be a useful portable measure of acute bone changes.
This may allow assessment of bone loss and the efficacy of intervention on this loss in the early stages following injury,
a period where traditional axial DXA assessment is limited by practical constraints.
Received: 14 February 2001 / Accepted: 18 January 2002 相似文献
13.
Site-Specific Bone Measurements in Patients with Ankle Fracture 总被引:1,自引:1,他引:1
Ankle fracture is one of the most common fractures in adults, particularly postmenopausal women. Few studies have examined
the bone mineral density (BMD) and ultrasound properties of bone close to the site of fracture in patients with ankle fracture.
The aim of this study was to evaluate these measurements in women with ankle fractures compared with controls. We studied
31 healthy post-menopausal women ages 50–79 years (mean age 63.2 ± 3.3 years) from a population-based group and 31 postmenopausal
women ages 52–76 years (mean age 61.2 ± 2.2 years) with an ankle fracture. Distal tibia and fibula BMD were measured by dual-energy
X-ray absorptiometry using the Hologic QDR 1000/W densitometer. In addition to total distal and tibia BMD, three subregions
were automatically selected: ultradistal, middle and one-quarter regions. Speed of sound (SOS) and broadband ultrasound attenuation
(BUA) of the calcaneus were measured using the Lunar Achilles+ (LA+) and CUBA Clinical (CC). In addition to SOS and BUA, LA+
Stiffness Index (SI) was also measured. The nondominant limb was measured in the population group and the contralateral limb
in the ankle group. Differences between the groups were determined using t-tests. The ankle fracture group was heavier than the control group by an average of 10 kg. BMD measurements were therefore
adjusted for weight. There were no significant differences between the ankle fracture and control groups in lumbar spine BMD,
total or regional ankle BMD or calcaneal BUA. However, calcaneal SOS was decreased in the ankle fracture group when measured
on the LA+ and CC by 50 m/s (–2.0 SD units, p<0.001) and 19 m/s (–0.5 SD units, p<0.01) respectively. LA+ SI was decreased in the ankle fracture group by 14 units (–1.1 SD units, p<0.001). In conclusion, ankle fracture is not a typical osteoporotic fracture. However, there may be structural changes in
the bone (unrelated to bone density) which result in increased fragility and susceptibility to fracture.
Received: 7 May 2001 / Accepted: 29 August 2001 相似文献
14.
The aim of this project was to compare three phantoms used for cross-calibration of dual-energy X-ray absorptiometers with
an in vivo cross-calibration. The phantoms used were the Bona Fide Phantom (BFP), the European Spine Phantom (ESP) and the
GE Lunar Aluminum Spine Phantom (ASP). The cross calibration was for L2–L4 lumbar spine bone mineral density (BMD) on a GE
Lunar DPX-L and Hologic QDR 2000. The in vivo cross-calibration was obtained using 72 subjects (61 female, 11 male; mean age
49 years, range 14–84 years). The phantoms were measured 10 times without repositioning on both instruments. A further, long-term
cross-calibration was obtained with the BFP over a 9 month period. The true linear relationship between the two instruments
was calculated used a standardized principal components method. The mean residuals were calculated between each phantom cross-calibration
line and the in vivo data to obtain a measure of the goodness of fit between the phantom cross-calibration and the in vivo
data. There was no significant difference between the in vitro and in vivo cross-calibrations. The long-term BFP cross-calibration
gave an in vitro cross-calibration that is closest to the in vivo cross-calibration in this group of subjects. When calculating
Hologic QDR BMD from results on the GE Lunar DPX-L, the ASP underestimates Hologic QDR 2000 BMD by 4% at high BMD and overestimates
by 4% at low BMD. The ESP cross-calibration overestimates Hologic QDR2000 BMD by 1% at high BMD and 4% at low BMD. The BFP
performs best, overestimating Hologic QDR2000 BMD by between 1.2% and 1.8%, whilst the difference between the long-term BFP
cross-calibration and the in vivo data is less than 1% over the range of BMD covered.
Received: 19 October 2001 / Accepted: 9 July 2002 相似文献
15.
An Investigation of the Diagnostic Value of Bilateral Femoral Neck Bone Mineral Density Measurements 总被引:1,自引:0,他引:1
G. W. Petley P. A. Taylor A. J. Murrills E. Dennison G. Pearson C. Cooper 《Osteoporosis international》2000,11(8):675-679
This paper describes a study to assess the clinical value of bilateral femoral neck bone mineral density (BMD) measurements.
Although a range of factors will determine clinical decisions, the classification of the site with the lowest T-score is likely to have significant bearing on the management of a patient. While it is common practice to measure BMD at
the lumbar spine and a single neck of femur, knowledge of the BMD of the second femur may also be of diagnostic value. Using
dual-energy X-ray absorptiometry, BMD of the lumbar spine and right and left femoral neck was measured in a group of 2372
white, Caucasian women (mean age ± SD, 56.6 ±13.9 years) routinely referred for bone densitometry. Analysis of the measurements
showed a significant (p= 0.02) but small difference between the mean BMD of the right (0.840 ± 0.152 g/cm2) and left (0.837 ± 0.150 g/cm2) femoral neck. Further investigation of femur scans revealed 79 (3.3%) patients in whom one side was osteoporotic while the
other side and spine were normal or osteopenic using the World Health Organization diagnostic criteria in combination with
manufacturer”s reference data. Patients in whom the femoral neck BMD measurements differed by less than the precision error
of the system were then excluded. This left only 51 (2.2%) patients, that is 29 (1.2%) for right femur and spine scan and
22 (0.9%) for left femur and spine scan, in whom knowledge of both femoral neck BMD measurements could have altered the classification
of the lowest site assessed to osteoporotic. These data suggest that there is only a small benefit from performing bilateral
femoral neck BMD measurements. Since BMD measurements are only one of a range of factors considered as part of a patient”s
management, it is suggested that the extra time, cost and radiation dose associated with measurement of the second femur may
not be justified.
Received: 28 October 1999 / Accepted: 2 February 2000 相似文献
16.
Bone Mineral Density of 704 Amateur Sportsmen Involved in Different Physical Activities 总被引:12,自引:0,他引:12
The aim of the study was to analyze the relation between sports and bone mass. Seven hundred and four men with no history
of chronic disease were questioned on their adolescent and adult sporting activities. Their total body (TB) and regional (head,
spine, arms and legs) bone mineral density (BMD) were measured by dual-energy X-ray absorptiometry. BMD measurements and ratios
of regional BMD to TB BMD were compared using a multiple regression analysis. Probands (mean age 30 years) were engaged in
14 sports activities: rugby, soccer, other team sports, endurance running, fighting sports, bodybuilding, multiple weightbearing
activities, swimming, swimming with flippers, biking, rowing, climbing, triathlon and multiple mixed activities. They stated
that they were practising a physical activity at the amateur level: 7.1 h/week between the ages of 11 and 18 years and 9 h/week
between age 18 years and the day of the interview (no significant difference between physical activities). Rowers and swimmers
had low TB BMD (1.22 and 1.17 g/cm2) and low leg BMD (1.37 and 1.31 g/cm2). Participants in rugby, soccer, other team sports and fighting sports had a high TB BMD (1.27–1.35 g/cm2) and high leg BMD (1.41–1.5 g/cm2). For head BMD, there was no stastistical difference among the different groups. Constructed ratios pointed out the site-specific
adaptation of the skeleton: soccer player and runners had a higher leg ratio; bodybuilders, fighters, climbers and swimmers
had a higher arm ratio; rugby players had a higher spine ratio. Head ratio was higher in non-weightbearing sports (rowing,
swimming) than in weightbearing sports (rugby, team sports, soccer, fighting sports and bodybuilding). Thus the BMD and ratio
differences among the 14 disciplines seem to be site-specific and related to the supposedly high and unusual strains created
at certain sites during sport training by muscle stress and gravitational forces. Head ratio is closely related to the type
of practice; its value could predict whether sport participants have developed the maximal peak bone mass they could achieve.
Received: November 1999 / Accepted: 12 September 2000 相似文献
17.
Decreased Bone Mineral Density in Neurofibromatosis-1 Patients with Spinal Deformities 总被引:3,自引:0,他引:3
A cross-sectional study was carried out to obtain data on the bone mineral density status of a group of neurofibromatosis-1
patients with spinal deformities, and to search for possible accompanying changes in the bone mineral turnover. Neurofibromatosis-1
is a heredofamiliar disorder that is associated with a variety of skeletal anomalies (mostly spinal deformities) in 10–50%
of patients. Intraoperatively, a poor vertebral bone quality has been observed. Efforts have been made to identify factors
preventing curve progression, to optimize operational planning and to explain the pathomechanism. As part of the preoperative
evaluation, dual-energy X-ray absorptiometry was used to assess the bone mineral density of the lumbar spine in 12 patients
with neurofibromatosis-1, supplemented by laboratory blood/urine investigations. A significant decrease in bone mineral density
of the lumbar spine was measured. An inverse relation was suggested between the severity of scoliosis and the lumbar spine
Z-scores. No pivotal alterations were identified in the laboratory measurements. The bony tissue abnormality observed intraoperatively
in neurofibromatosis-1 patients may be described as a diminution of the axial bone mineral density. The biochemical parameters
do not support the presence of hyperparathyroidism, renal disorders or other associated diseases influencing the bone mineral
turnover. The evaluation of bone mineral density in the course of the preoperative planning is proposed in neurofibromatosis-1;
the exact background and the role of a possible osteoporosis in the prognosis remain to be elucidated.
Received: 12 January 2001 / Accepted: 21 March 2001 相似文献
18.
Visual Assessment of Vertebral Deformity by X-ray Absorptiometry: A Highly Predictive Method to Exclude Vertebral Deformity 总被引:6,自引:6,他引:0
J. A. Rea J. Li G. M. Blake P. Steiger H. K. Genant I. Fogelman 《Osteoporosis international》2000,11(8):660-668
The accurate identification of prevalent vertebral fractures is important in both the clinical and research setting as they
are associated with increased risk of further fracture and irreversible clinical consequences. This study reports a direct
comparison of prevalent vertebral deformity identification using X-ray absorptiometry (XA) scans, acquired on a dual-energy
X-ray absorptiometry (DXA) machine, and conventional radiographs in a diverse group of 161 postmenopausal women, ranging from
healthy subjects with normal bone mineral density (BMD) to osteoporotic subjects with multiple vertebral deformities. Deformities
were identified by a trained operator by visual assessment of the XA scans (VXA) and semiquantitatively by an experienced
radiologist on the conventional radiographs (XSQ). Subjects were recruited prospectively and were triaged according to their
VXA results into normal, equivocal and definite deformity groups. VXA and XSQ demonstrated good agreement (96.3%, κ= 0.79)
in classifying vertebrae as normal or deformed in the 1978 of 2093 vertebrae deemed analyzable on both the XA scans and conventional
radiographs. VXA showed good sensitivity (91.9%) in the identification of moderate/severe XSQ deformities and an excellent
negative predictive value (98.0%) was produced when VXA was used to distinguish subjects without vertebral deformities from
those with possible or definite deformities on a per subject basis. The majority of disagreement between the two methods resulted
from different classification of mild wedge and endplate deformities and the poor visualization of upper thoracic vertebrae
on the XA scans. Agreement improved, particularly on a per subject basis, when analysis was restricted to the vertebral levels
from L4 to T7. Visual triage of XA scans by a trained operator would seem to be swift, convenient and cost-effective method,
with excellent negative predictive value, to distinguish subjects with very low risk of vertebral deformities from those with
possible deformities. These ‘normal’ subjects can then be excluded prior to performing conventional radiographs and further
time-consuming and costly methods of vertebral deformity assessment such as XSQ by an experienced radiologist and/or quantitative
morphometry. VXA may prove useful in the clinical evaluation of patients at risk of osteoporosis as an adjunct to BMD scans
or in the selection of subjects for osteoporosis-related clinical trials.
Received: 27 July 1999 / Accepted: 4 February 2000 相似文献
19.
Longitudinal Study of Bone Loss in Pre- and Perimenopausal Women: Evidence for Bone Loss in Perimenopausal Women 总被引:3,自引:0,他引:3
R. D. Chapurlat P. Garnero E. Sornay-Rendu M. E. Arlot B. Claustrat P. D. Delmas 《Osteoporosis international》2000,11(6):493-498
Bone loss before and around the time of menopause is not well characterized by longitudinal studies. We measured bone mineral
density at various skeletal sites – total body, femoral neck, trochanter, anteroposterior (AP) and lateral spine, and forearm
– with dual-energy X-ray absorptiometry in a large prospective cohort of 272 untreated pre- and perimenopausal women aged
31–59 years, at 1 year intervals for 3 years. Sex steroids and the following markers of bone remodeling were measured: serum
osteocalcin (OC), procollagen I carboxyterminal extension peptide, bone alkaline phosphatase (BAP) and urinary crosslinks
(CTX and NTX). Seventy-six women were classified as perimenopausal and 196 as premenopausal. Over the 3 years, premenopausal
women had no significant bone loss at any site and a small but significant increase in bone mineral density at the trochanter,
total hip, AP spine and radius. Perimenopausal women significantly lost bone from cancellous and cortical sites, i.e., the
femoral neck, trochanter and lumbar spine. In perimenopausal women with increased follicle stimulating hormone, the rate of
bone loss at the femoral neck correlated negatively with OC and BAP. In perimenopausal women, serum estradiol levels decreased
during the 3 years of follow-up and bone loss from the trochanter and the AP spine was correlated with serum estradiol after
3 years. In conclusion, among premenopausal women there is no bone loss. In contrast, there is a rapid and diffuse bone loss
in perimenopausal women, related to decreased estrogen secretion. Bone markers may be useful to identify these women losing
bone.
Received: 13 October 1997 / Accepted: 19 October 1998 相似文献
20.
M. Lötborn L.-E. Bratteby G. Samuelson S. Ljunghall L. Sjöström 《Osteoporosis international》1999,9(2):106-114
Bone mineral area (BA), total bone mineral content (TBMC) and total bone mineral density (TBMD) were assessed by dual-energy
X-ray absorptiometry (DXA) in 396 randomly selected, healthy 15-year-old Swedish boys and girls. The influence of body size,
pubertal development, physical activity level (PAL), total energy expenditure (TEE), dietary intake of energy, calcium and
vitamin D, and alcohol and smoking habits on TBMC and TBMD were examined in bi- and multivariate analyses. In bivariate analyses
BA, TBMC and TBMD showed strong correlations with weight, height and TEE in both sexes. In boys but not in girls these bone
variables were significantly correlated with dietary intakes of energy, calcium and vitamin D. No significant correlations
were found between PAL and the three bone variables. In multivariate analyses with TBMC as dependent variable BA, height,
weight and Tanner stages explained 88% and 87% of the variance in boys and girls respectively. In similar analyses with TBMD
as dependent variable the corresponding figures were 50% and 54%. The major part of the variance in all these models was explained
by BA, and only a few percent by all the other independent variables. No significant reduction was found when TEE or daily
intakes of calcium or vitamin D were introduced into the models. These results illustrate the importance of including BA,
weight and height as independent variables in regression models of TBMC to avoid spurious associations with other variables
in the analyses. The results may also indicate that in normal Swedish adolescents environmental factors such as dietary intake
of nutrients play a minor role as determinants of bone mineralization. High levels of physical activity and bone mineral measures
possibly explain the lack of significant correlations between these variables and do not imply a lack of association.
Received: 16 December 1997 / Accepted: 19 May 1998 相似文献