Positive effect of parathyroidectomy on bone mineral density in mild asymptomatic primary hyperparathyroidism

OBJECTIVES: Patients with mild primary hyperparathyroidism (pHPT) often appear asymptomatic, and have previously been regarded as not requiring treatment. However, increased cardiovascular morbidity and dyslipidaemia have also been recognized in mild pHPT, which also seem to be normalized after parathyroidectomy. The present study explores whether postmenopausal women with mild pHPT have decreased bone mineral density (BMD) compared with age-matched healthy controls, and the effects on BMD of parathyroidectomy. DESIGN, SUBJECTS AND INTERVENTION: A population-based health screening of 5202 postmenopausal women identified 87 overtly asymptomatic patients with mild pHPT as well as age-matched healthy controls. A 5-year follow-up included 49 cases who had undergone parathyroidectomy. BMD was measured with DXA at the femoral neck, the lumbar spine and the total body. RESULTS: At study entry, BMD was 5-6% lower in the lumbar spine (L2-L4) and femoral neck in cases compared with matched controls. After the 5-year follow-up, BMD increased in L2-L4 by 2.9% (P = 0.002) in the parathyroidectomized cases and remained stable in the femoral neck. However, femoral neck BMD increased 4.1% (P = 0.013) for cases <67 years old (50% of the cohort). CONCLUSION: In accordance with recent NIH guidelines for pHPT treatment, the level of BMD per se in the investigated group of patients justifies parathyroidectomy in almost half of the cases with mild pHPT. Surgery could be expected to increase BMD in L2-L4 to the level of the controls, to increase femoral neck BMD in patients <67 years of age and to preserve femoral neck BMD in the elderly population.     

前臂骨骨密度测定诊断骨质疏松标准的研究

目的探讨女性前臂骨骨量的年龄分布规律,为建立周围骨骨密度的骨质疏松诊断标准积累数据。方法采用美国NORLAND-Stratec周围型双能X线骨矿测量仪(pDXA)测量了452名20～79岁女性健康志愿者非优势侧前臂远端桡骨和尺骨(distal radius+ulna)、近端桡骨和尺骨(proximal radius+ulna)以及近端桡骨(proximal radius)的BMD值,以问卷调查方法收集研究对象的一般情况,分析前臂骨不同测量部位BMD变化的年龄分布规律。结果前臂骨不同测量部位的BMD数据均符合正态分布规律。健康女性峰值骨密度出现在40～44岁年龄段,此后随年龄增加而下降,在50～59岁和70岁以上年龄段出现快速骨丢失,尤其是前臂远端骨丢失速率较快,55～59岁年龄段女性骨累积丢失率达25%,与DXA测定中轴骨的骨量丢失规律一致。前臂远端桡+尺骨的骨质疏松(OP)检出率较高,是围绝经期妇女OP检出的敏感部位。50～54岁年龄段女性低骨量发生率为57.6%,骨质疏松的发生率为25.8%(以低于PBM-2.0s为诊断标准)和12.1%(以低于PBM-2.5s为诊断标准);55～59岁年龄段女性低骨量发生率上升至80.9%,骨质疏松的发生率上升至50.0%和30.9%。60岁以后,低骨量和骨质疏松发生率的增加速度趋缓,但70岁以后低骨量和骨质疏松的发生率再次上升。结论前臂骨骼BMD测定可以作为骨质疏松高危人群筛查的有效工具。将前臂远端桡+尺骨为BMD主要检测部位,以低于PBM-2.0s为骨质疏松诊断标准,是筛查骨质疏松人群和评估干预措施较适宜的标准。     

Quantitative ultrasound is better correlated with bone mineral density and biochemical bone markers in elderly women

The association between quantitative ultrasound (QUS) and bone turnover in postmenopausal women of different ages is an area of continuous investigation. The aim of this study was to investigate the relationship of ultrasound parameters [broadband ultrasound attenuation (BUA) and speed of sound (SOS)] to bone mineral density (BMD) and biochemical markers of bone turnover in three age groups of postmenopausal women. One hundred and twenty-three postmenopausal Caucasian women were divided into three groups according to their age: group A, range 44–54 years, mean age (±SD) 48.3 ± 2.3; group B, range 55–65 years, mean age 59.4 ± 2.1; and group C, range 66–77 years, mean age 68.2 ± 3.1. Ultrasound parameters were measured by the DTU-one imaging ultrasonometer in the calcaneus. BMD was assessed by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine, femoral neck, and trochanter. Bone turnover was assessed by serum bone-specific alkaline phosphatase (BAP), urinary excretion of free deoxypyridinoline, N-telopeptides (NTX), and C-telopeptide breakdown products of type I collagen (CTX). QUS and BMD were significantly correlated in all sites, except hip BMD in group A. The most significant correlation was observed between BUA and femoral neck BMD in group C (r = 0.626, p < 0.01). BUA correlated significantly with BAP, NTX, and CTX (r = −0.434, −0.511, −0.478, respectively; p < 0.01), and SOS with BAP and NTX (r = −0.351 and −0.356, respectively; p < 0.05) only in group C. In groups A and B, ultrasound parameters did not correlate significantly to biochemical markers. Ultrasound parameters were better correlated to hip BMD and to biochemical markers of bone turnover in elderly postmenopausal women. These ultrasound measurements could be used as a screening test for bone status, either in nonambulatory third aged women or in those living in rural areas where attending medical centers with DEXA equipment and biochemical laboratories is difficult.     

Genetic association between bone mineral density and the fracture of distal radius: A case-control study

Low bone mineral density (BMD) was significantly related to the fracture of distal radius. Serum brain-derived neurotrophic factor (BDNF) level was closely related to BMD in spine and osteoporotic fractures. In this study, we aimed to explore the association of BDNF polymorphisms (rs6265 and rs7124442) with BMD and the fracture of distal radius.This retrospective study included 152 patients with distal radius fractures and 148 healthy controls. BDNF polymorphisms were detected via TaqMan allelic discrimination assay. BMD was evaluated through X-ray. Difference in features between cases and controls were compared adopting Chi-square test or t test. The associations of BDNF polymorphisms with fracture risk of distal radius and BMD were assessed employing χ² test and expressed by odd ratios (ORs) with 95% confidence intervals (95% CIs).BMD was significantly decreased in patients with the fracture of distal radius than in healthy controls. The polymorphism rs6265 significantly increased the risk of distal radius fracture (adjustment: GA: OR = 1.724, 95%CI = 1.003 –2.951, P = .049; GG: OR = 2.415, 95%CI = 1.0219 –3.674, P = .005). Moreover, rs6265 genotypes GA (OR = 4.326, 95%CI = 1.725 –11.896, P = .003) and GG (OR = 13.285, 95%CI = 3.659 –51.072, P = .001) significantly increased BMD reduction. However, BDNF polymorphism rs7124442 had no obvious correlation with BMD or fracture risk.BMD was associated with BDNF rs6265 polymorphism. BDNF polymorphism rs6265 could elevate the risk of osteoporosis and distal radius fracture.     

Secondary hyperparathyroidism due to hypovitaminosis D affects bone mineral density response to alendronate in elderly women with osteoporosis: a randomized controlled trial

OBJECTIVES: To determine whether secondary hyperparathyroidism (HPTH) due to hypovitaminosis D affects bone mineral density (BMD) response to alendronate (ALN) in elderly women with osteoporosis. DESIGN: Randomized, controlled trial with 1-year follow-up. SETTING: Two osteoporosis centers in northern Italy. PARTICIPANTS: Community-dwelling women aged 60 and older with a BMD T-score below -2.5 and secondary HPTH with vitamin D insufficiency. INTERVENTION: One hundred twenty subjects were randomly assigned to receive ALN 70 mg once a week alone or ALN 70 mg once a week plus calcitriol (1,25D3) 0.5 microg daily. MEASUREMENTS: BMD measured using dual-energy x-ray absorptiometry at the lumbar spine (L1-L4), femoral neck, and total hip and serum levels of intact PTH at baseline and 12 months. RESULTS: After 1 year, BMD of the lumbar spine, femoral neck, and total hip significantly increased from baseline in both groups (P<.001). Patients allocated to ALN plus 1,25D3 demonstrated a significantly higher increase in lumbar spine BMD than those receiving ALN alone (mean percentage+/-standard deviation 6.8+/-4.6 vs 3.7+/-3.2, P<.001). Serum levels of PTH did not change significantly at 1 year in the ALN group (mean percentage, -3.7+/-27.1, P=.13) but decreased significantly in the ALN plus 1,25D3 group (-32.1+/-22.1, P<.001). At 12 months, subjects with normalized PTH independent of therapy allocation had a greater increase in lumbar spine BMD than those with persistent HPTH (6.5+/-4.6% vs 3.7+/-3.4%, P<.001). Lumbar spine BMD changes showed a significant negative correlation with PTH at 1 year (correlation coefficient (rho) =-0.399, P<.001) and a positive correlation with PTH changes (i.e., baseline value - 1 year value; rho=0.295, P=.005). CONCLUSION: Persistence of secondary HPTH reduces BMD response to ALN in older women with osteoporosis.     

Lumbar bone mineral density as the major factor determining increased prevalence of vertebral fractures in monoclonal gammopathy of undetermined significance

The possible relationships between biochemical measurements and both densitometric and radiographic indexes of skeletal fragility were evaluated in 65 postmenopausal women with monoclonal gammopathy of undetermined significance (MGUS). There was a significantly higher prevalence of vertebral fractures in the MGUS group compared with a control population (P < or = 0.001). The MGUS patients were then grouped according to the presence or absence of at least one mild vertebral fracture. Patients with fractures (Fx, n=34) were older (62.8 +/- 6.1 years), with long-standing disease (8.8 +/- 7.1 years) when compared with those without fractures (NFx, n=31; 59.7 +/- 5.0 years, P < or = 0.05 and 5.8 +/- 4.1 years, P < or = 0.05). The receptor activator of nuclear factor kappa-B ligand/osteoprotegerin ratio was higher in Fx compared with NFx (0.092 +/- 0.018 vs. 0.082 +/- 0.020; P < or = 0.05). Lumbar spine (0.811 +/- 0.14 vs. 0.956 +/- 0.12 g/cm2), femoral neck (0.660 +/- 0.09 vs. 0.747 +/- 0.10 g/cm2) and total bone mineral density (BMD) (0.788 +/- 0.11 vs. 0.884 +/- 0.11 g/cm2) were lower (all P < or = 0.001) in FxMGUS compared with Nfx patients. Receiver operating characteristic curves identified lumbar BMD as the variable that best predicted vertebral fractures (area under the curve 0.817; 95% confidence interval, 0.713-0.921). This study provides an indication for the measurement of BMD in MGUS patients, as a means of predicting vertebral fractures, especially in those that are asymptomatic. Patients with prevalent fractures should undergo pharmacological treatment to prevent further fractures.     

男性HIV相关脂肪营养不良综合征患者骨矿含量DXA测量结果浅析

目的分析HIV相关脂肪营养不良综合征患者的骨矿量(BMC)及骨密度(BMD)变化特点。方法 2002年1月至2009年12月在北京协和医院接受抗逆转录病毒治疗(HAART)治疗并行双能X线骨密度测量(DXA)检查的成年男性HIV/AIDS患者41例,年龄20～71岁,平均年龄(43±11)岁。根据患者主诉和医师评估结果,将上述患者分为脂肪营养不良(LD)组与非LD组,分析2组患者骨矿量及骨密度的差异。结果 41例HIV/AIDS患者中,经调整年龄、身高、体重,BMC与脂肪量(FM)间呈正向线性回归关系;LD组患者全身和局部骨BMC均低于非LD组患者,2组患者腰椎BMC差异有统计学意义(P=0.038);LD组患者腰椎和右髋部BMD均低于非LD组患者,2组患者腰椎BMD差异有统计学意义(P=0.028)。结论 DXA对评估HIV-LD患者的骨矿量变化有重要意义,可为骨质疏松的综合预防提供客观依据。     

亚临床甲状腺功能减退症与绝经后女性骨代谢指标的相关性分析

目的探讨亚临床甲状腺功能减退症(SCH)与绝经后女性骨密度及骨代谢相关指标的关系。方法选取2015年1月至2018年6月在空军军医大学西京医院老年病科就诊的138例绝经后女性临床资料,根据患者是否患SCH分为SCH组(68例)和正常对照组(70例)。检测并比较2组患者骨密度相关指标[碱性磷酸酶(ALP)、Ca~(2+)、骨化三醇、骨密度T值(T -1.0为骨密度异常)]以及甲状腺功能相关指标[甲状旁腺激素(PTH)、促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、甲状腺过氧化物酶抗体(TPOAb~+)比例]。采用SPSS 18.0统计软件对数据进行分析。相关性采用Spearman相关分析。结果 SCH组及对照组患者骨密度异常率分别为50.0%(34/68)和25.7%(18/70),2组比较差异有统计学意义(P=0.003)。与对照组比较,SCH组患者TSH水平和TPOAb~+比例显著升高(P0.05),但FT3、FT4、PTH及骨代谢相关指标比较,差异无统计学意义(P0.05)。Spearman相关分析显示,TSH、TPOAb~+与ALP、骨化三醇、骨密度T值呈负相关,其中TSH与T值呈高度负相关(r=-0.804,P0.01)。结论 SCH可能引起绝经后女性骨量异常和骨密度测定值降低,这可能与血清TSH水平升高和TPOAb呈阳性有关。     

骨密度测量在职业性氟中毒诊断中的应用

目的　观察骨密度测量在职业性氟中毒诊断中的应用价值。方法　运用 SD- 10 0 0型单光子吸收法定量测定某铝厂接触氟工人 113人 ,并与该厂非接触氟职工 80人的骨密度及 X线平片的资料进行比较。结果　氟作业者骨密度增高、骨皮质增厚及骨髓腔增大的异常率都显著高于正常人群 (P <0 .0 1) ;曾经 X线平片诊断为氟骨症者 ,骨密度检查的异常率基本上是符合的 ,而 X线平片没有诊断骨密度异常者 ,用骨密度测定能发现其中大部分骨密度异常。结论　骨密度测量对早期氟中毒检查的灵敏度高 ,在氟中毒的诊断中有一定的应用价值。     

Severity of liver disease does not predict osteopenia or low bone mineral density in primary sclerosing cholangitis.

BACKGROUND: The association between metabolic bone disease and cholestatic liver disease has been poorly characterized. To date a single institution has published data suggesting that in primary sclerosing cholangitis (PSC), advanced liver disease predicts advanced bone disease. Aim: To determine the association between the severity of liver disease and bone mineral density (BMD) in PSC patients. METHODS: We identified 30 PSC patients who had undergone dual energy X-ray absorptiometry (DXA) scan. We compared lumbar spine DXA scores between patients with more and less advanced liver disease. RESULTS: Nine patients were osteopenic (30%), and one patient was osteoporotic. Five patients were female (17%), and none was postmenopausal. BMD was not different between patients listed and not listed for liver transplantation (P = 0.49) or between patients with and without hepatic decompensation (P = 0.63). Model for end-stage liver disease (MELD) score (P = 0.99) and the modified Mayo risk score (P = 0.25) did not predict BMD. CONCLUSIONS: Our study is the first to suggest that low bone density cannot be predicted by the severity of liver disease in PSC. Perhaps other known risk factors for osteoporosis will be important predictors of abnormal bone density in this patient population.     

The importance of severity of arthrosis for the reliability of bone mineral density measurement in women

The objective of this study is to investigate the effect of the severity of degenerative changes on measurements of A-P lumbar spines BMD values and to determine the reliability of DEXA measurements associated with severity of the disease on A-P lumbar spines BMD values using DEXA. The measurements using DEXA were taken from L2-L4 spines and femoral neck of total 271 female cases. One hundred and ten of them had mild arthrosis (Group 0), and 69 had severe arthrosis (Group 1). Ninety-two cases without arthrosis were chosen as control group (Group 2). The cases with arthrosic changes were grouped according to their degree of severity of arthrosis. The groups were compared two by two and Tukey multiple comparison test was used for the analysis of the difference of the means of the groups. The mean age of cases was 61.79, 61.84, and 60.47, respectively. The average height was 157.26, 155.93, and 15.92 cm while the average weight was 69.21, 70.78, and 71.45 kg, respectively. The mean body mass index (BMI) was 0.00283, 0.00291, and 0.00293, respectively. L2-L4 A-P spinal BMD values were 0.9870, 0.9848, and 1.0836 g/cm(2) while the femoral neck BMD values were 0.7964, 0.8056, and 0.8223 g/cm(2), respectively. There was no statistical significance between study and control groups in terms of age, weight, height, BMI, and BMD values obtained from femoral neck. However, lumbar region BMD values of the cases with severe arthrosis were statistically significantly high when compared with other two groups. The femoral neck measurement is the prominent alternative method in severe arthrosis while taking measurements from lumbar region is still the most appropriate method in cases with mild arthrosis without having giant osteophytes.     

Calcitriol for bone disease in patients with cirrhosis of the liver

BACKGROUND: Osteoporosis is associated with cirrhosis of the liver, but the effects of therapy for osteoporosis associated with cirrhosis are still controversial. METHODS: We evaluated the effects of calcitriol (1alpha,25-dihydroxyvitamin D3) on bone mineral density (BMD) in 76 patients (26 men and 50 women) with cirrhosis who were assigned randomly to receive calcitriol (0.5 mg twice per day) or not. The BMD of the lumbar vertebrae was measured by dual-energy X-ray absorptiometry at least twice, 12-57 months apart. RESULTS: For men, the mean annual change in BMD was 1.1% in the treated group and -0.4% in the control group. The median (25th and 75th percentiles) annual change in BMD was 0.6 (-0.1, 2.1%) in the treated group and -1.4 (-1.9, 1.6%) in the control group. The difference in the median annual change between the two groups was significant (P = 0.013). For women, the mean annual change in BMD was -0.5% in the treated group and -2.3% in the control group. The median (25th and 75th percentiles) annual change in BMD was -0.5 (-1.8, 1.3%) in the treated group and -1.5 (-3.8, -0.7%) in the control group. This difference was significant (P = 0.011). CONCLUSIONS: Our results suggest that calcitriol can prevent bone loss and, therefore, may be useful for the treatment of bone disease in patients with cirrhosis of the liver.     

The frequency of low bone mineral density and its associated risk factors in patients with inflammatory bowel diseases

Objective: To detect the frequency and the predictive factors of low bone mineral density in inflammatory bowel disease (IBD) patients, so as to optimize bone mineral density (BMD) monitoring and treatment for those at risk. Subjects and methods: Thirty Asian patients were included in this study and were divided into 18 patients with ulcerative colitis (UC), and 12 patients with Crohn’s disease (CD). All patients were diagnosed by colonoscopy and histopathological biopsy and were subjected to routine laboratory investigations in addition to 25 hydroxy vitamin D levels as well as serum calcium, phosphorus and alkaline phosphatise. BMD was measured by using dual‐energy X‐ray absorptiometry (DEXA) scan at lumbar spine and femoral neck; predictive factors for BMD were analyzed by group comparison and step‐wise regression analysis. Results: There was increased frequency of osteoporosis and osteopenia involving the lumbar spine in patients with IBD being more common among CD patients than in the UC group. Positive correlations were found between low BMD measurements and vitamin D levels, body mass index (BMI) (P < 0.001) as well as steroid cumulative dose and duration of therapy (P < 0.001); stepwise regression analysis showed that CD and vitamin D deficiency are predictive factors for both osteoporosis and osteopenia (P = 0.024, P = 0.027, respectively). Conclusion: Low BMD was found to be more frequent among patients with CD than UC; in addition CD and vitamin D deficiency act as predictive factors for low BMD. We recommend that calcium and vitamin D should be given to all IBD patients; in addition, bisphosphonate administration should be put into consideration.     

Chronic idiopathic neutropenia of adults is associated with decreased bone mineral density and alterations in bone turnover biochemical markers.

The aim of this study was to assess bone mineral density (BMD) and biochemical indices of bone metabolism in patients with chronic idiopathic neutropenia of adults (CINA) and define the relationships, if any, between these parameters and serum levels of interleukin-1beta (IL-1beta) and tumour necrosis factor-alpha (TNF-alpha), two cytokines normally involved in bone metabolism. Femoral neck BMD, serum osteocalcin (OC), bone-specific alkaline phosphatase (BAP) and type I procollagen carboxy-terminal propeptide (PICP), as well as urine-free deoxypyridoline (Dpd) cross-links, N-telopeptide (NTx) and C-telopeptide (CTx) cross-links of type I of collagen were measured in 45 CINA patients and 36 normal subjects. Patients were arbitrarily classified in two groups, A and B, as having mild (neutrophils 1700-2500/microl) or 'pronounced' (neutrophils<1700/microl) neutropenia, respectively. BMD values were found significantly reduced in both groups of patients, compared to controls, and they strongly correlated with the number of circulating neutrophils. Serum OC and urinary NTx were significantly increased in patients of group B. Both serum OC and urinary NTx correlated inversely with the number of circulating neutrophils. Serum BAP and PICP and urine Dpd and CTx were within normal range. Serum IL-1beta and TNF-alpha were elevated in both groups of patients and correlated inversely with the number of circulating neutrophils and the values of BMD. In addition, TNF-alpha, but not IL-1beta, inversely correlated with OC and NTx. These findings indicate that CINA patients have biochemical evidence of increased bone turnover which leads to decreased BMD. The elevated serum IL-1beta and TNF-alpha concentrations, suggestive of an underlying chronic inflammatory process in these patients, may be part of a mechanism accelerating bone turnover which, if prolonged, causes lowering of BMD.     

Prevalence and predictive factors of undernutrition and low bone mineral density in children with chronic pancreatitis

BackgroundMalnutrition and bone disease are common in adults with chronic pancreatitis (CP). We studied the nutritional status and bone mineral density (BMD) of children with CP and the factors predicting them.MethodsCP children were prospectively evaluated with a detailed questionnaire, anthropometry, 25-hydroxy vitamin D, fecal elastase and BMD [total body less head (TBLH), spine and hip] by dual energy x-ray absorptiometry. Body mass index (BMI) Z score of ?1 to ?1.9, ?2 to ?2.9 and <-3 was taken as mild, moderate and severe malnutrition respectively. Low BMD and osteoporosis were defined as per International Society for Clinical Densitometry.Results83 children (46 boys, 14[4.3–21]years) with CP were enrolled. Majority had Cambridge IV (51,62.2%) or III (15,18.3%) changes. 34(41%) had undernutrition (mild-37.3%, moderate-2.4%, severe-1.2%). Overweight and obesity were present in 3.6% and 1.2% cases. BMI had a significant correlation with haemoglobin, serum albumin, percentage body fat and BMD. A majority had low fecal elastase (69 [84.1%], <100 μg/g) and vitamin D deficiency (70[84.3%],<20 ng/ml). 9 cases had a history of fractures. 14/75(18.6%) cases had low TBLH-BMD and this group had a lower BMI (?1.3[-1.9 to 0.34] vs 0.8 [-2.1 to 5.50; p = 0.03) than patients with normal BMD. There was no difference in age, disease duration, vitamin D, fecal elastase and Cambridge grade between normal and low BMD.Conclusions41% CP children have undernutrition with a majority having mild undernutrition. Nearly 20% have low BMD, with osteoporosis in none. Subjects with low BMI have lower BMD and percentage body fat.