Diagnosis of Osteoporosis
01 Jun 2011-The Journal of the Korean Hip Society (The Korean Hip Society)-Vol. 23, Iss: 2, pp 108-115
TL;DR: WHO recently developed FRAX, a novel method the authors can use to more conveniently evaluate osteoporotic fracture risk, and dual energy X-ray absorptiometry (DXA), one of the measurement tools for BMD, is particularly regarded as the appropriate tool applicable to WHO criteria.
Abstract: Osteoporosis is defined as a skeletal disorder characterized by compromised bone strength, predisposing an individual to increased fracture risk. Many factors can lead to the development of osteoporosis. It is usually asymptomatic unless osteoporotic fracture and secondary changes of bone structure occur. Early radiographs show normal findings; however, osteopenic appearance, fracture, cortical bone thinning, and roughening of bone trabeculae can be found according to severity of osteoporosis. These symptoms are most frequently found in the spine and proximal femur. Bone mineral density (BMD) is the standard method used to diagnose osteoporosis, and dual energy X-ray absorptiometry (DXA), one of the measurement tools for BMD, is particularly regarded as the appropriate tool applicable to WHO criteria, which defines osteoporosis as a T-score of less than 2.5 SDs below the mean of young adult women. Peripheral densitometry is less useful in predicting the risk of fractures of the spine and proximal femur, and it is not enough to diagnose and treat osteoporosis. Biochemical bone markers have demonstrated utility in clinical research and trials; however, they cannot replace BMD as a diagnostic tool. WHO recently developed FRAX, a novel method we can use to more conveniently evaluate osteoporotic fracture risk.
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TL;DR: FO was not properly restored in 23% of subjects receiving bipolar hemiarthroplasty due to femoral neck fracture and independently predicted fair MBI after the surgery.
Abstract: Background Restoring preoperative horizontal femoral offset (FO) promised good functional outcome in patients receiving total hip arthroplasty. However, relatively little was known regarding the clinical relevance of restoring the offset in patients with bipolar hemiarthroplasty to treat displaced femoral neck fracture. Therefore, the objective of this study was to evaluate postoperative FO accurately and verify its relation with functional outcome. Methods One hundred elderly patients who received bipolar hemiarthroplasty to treat displaced femoral neck fracture were identified. Preoperative CT scanning of contralateral hip joint and reconstruction of images led to rotation-free FO. By referencing postoperative implant specification and comparing to measured values in Picture Archive and Communication System, rotation-free postoperative FO and the amount of change were acquired. Postoperative Harris Hip Score (HHS) and Modified Barthel Index (MBI) were evaluated to measure functional outcome at 12-month after the surgery. Patients with significant FO change were identified. Multiple regression analysis was conducted to determine if the FO change might independently affect the outcome regardless of confounding factors. Results The mean preoperative offset was 37.4 ± 2.5 increased by 12.7 ± 9.6% after the surgery. Only 25.0% of postoperative offset after hemiarthroplasty was changed within ±5% of preoperative offset. A total of 45.0% of postoperative offset changed within ±10% while 77.0% of postoperative offset changed within ±20%. 23% of patients whose FO changed more than 20% showed significantly worse outcome score than the patients whose FO change remained within ±20% of initial value. Mean MBI and HHS were negatively correlated with FO change. After adjusting for confounding factors, significant correlation remained between modification of FO and MBI, but not between FO change and HHS ( B = 4.576; β = 0.235; 95% confidence interval of B: 0.534 to 8.135). Conclusions FO was not properly restored in 23% of subjects receiving bipolar hemiarthroplasty due to femoral neck fracture. FO restoration independently predicted fair MBI after the surgery. Therefore, surgeons should pay attention to restoring FO with meticulous templating.
12 citations
TL;DR: Engaging in the outdoor exercise program, including aerobic and resistance exercises, for 20 weeks improved bone mineral density and inhibited bone loss in old women and had a positive influence on vitamin D levels, thereby potentially lowering the risk of osteoporosis.
Abstract: The purpose of this study is to investigate the effects of indoor and outdoor exercise environments on bone mineral density and body composition in old women. A total of 26 old women were randomly divided into two groups: an indoor exercise group (IE, n=13) and an outdoor exercise group (OE, n=13). The exercise groups performed moderate exercise (HR max 50~70%; RPE 11-15) three times a week for 60 minutes over 20 weeks. After exercise training, bone mineral density was significantly improved in the OE group as compared with the IE group. Body fat mass was significantly decreased in the IE group. Weight, lean body mass, and body fat mass were significantly decreased in the OE group. Body mass index was significantly decreased in the outdoor exercise group as compared to the IE group. Our findings show that a 20-week program of outdoor exercise training improves bone mineral density and body composition in old women. As mentioned above, it has been found that engaging in an outdoor exercise program for 20 weeks has a positive effect on bone mineral density and body composition in old women. In conclusion, engaging in the outdoor exercise program, including aerobic and resistance exercises, for 20 weeks improved bone mineral density and inhibited bone loss in old women and had a positive influence on vitamin D levels, thereby potentially lowering the risk of osteoporosis.
4 citations
TL;DR: Dietary factors, such as higher vegetable intake, seem to affect the changes in bone mineral density in more favorable way, and efforts are needed to enhance the access to nutritional care for rural elderly postmenopausal women.
Abstract: This study was conducted to investigate dietary factors, bone status, and bone loss in postmenopausal women in rural areas. A total of 189 women participated in the follow-up study after two years. Radius, Tibia, and Phalanx SOS (Speed of Sound) was measured on two occasions 2 years apart by ultra-sonic-metry, and % body fat was measured by bioelectrical impedance analysis at the baseline and after 2years. Dietary intake data were collected 4 times at different season by 24-hour recall method, and then calculated as average. Bone density of radius decreased by 4.2% during the two year period. When the subjects were divided into three groups, by bone decline level during two years, the lowest bone loss group had higher potassium and vegetable intake than other groups. Age and calcium intakes showed significant correlation with bone decline rate at tibia. In multiple regressions, the baseline SOS, vitamin A, vegetables and eggs intakes were found to be significant factors for tibia bone decline. In conclusion, dietary factors, such as higher vegetable intake, seem to affect the changes in bone mineral density in more favorable way. Therefore, efforts are needed to enhance the access to nutritional care for rural elderly postmenopausal women. (Korean J Nutr 2012; 45(5): 470 ~ 478)
3 citations
References
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TL;DR: In this article, the authors compared radiographic absorptiometry (RA) of the phalanges for bone mineral density (BMD) measurement with single-energy X-ray absorption (SXA) of distal forearm.
Abstract: We present baseline bone densitometry from the Early Postmenopausal Interventional Cohort study (EPIC, sponsored by Merck, Sharp & Dohme) for the first time, in which 1609 women from England, Oregon, Hawaii and Denmark are participating to investigate the efficacy of daily oral alendronate to prevent early postmenopausal bone loss. We compared radiographic absorptiometry (RA) of the phalanges for bone mineral density (BMD) measurement with single-energy X-ray absorptiometry (SXA) of the distal forearm, and dual-energy X-ray absorptiometry (DXA) of the lumbar spine, proximal femur and distal forearm. In a random subgroup of 308 women, aged 45–60 years, on average 6 years since menopause (YSM), bone densitometry was measured once at baseline by RA of the phalanges besides the mandatory measurements by DXA. Bone densitometry was furthermore measured by SXA at the Danish site (89 women). Sixty-eight of the women had duplicate measurements performed within 1–3 weeks to evaluate the short-term precision error (CV%). One hundred and one healthy premenopausal women, aged 25–48 years, were recruited at the Danish and Hawaiian sites to establish a reference group. The precision error was 1.5% for RA of the phalanges and in the range 1.0–2.2% for SXA and DXA. BMD by RA correlated with BMD measured by SXA and DXA in the range 0.45
33 citations
Journal Article•
TL;DR: The radiographic appearance of bone is the result of two physiologic processes: the resorption of bone and the remodeling of bone in response to the stresses applied to it.
30 citations
Journal Article•
TL;DR: The American College of Obstetricians and Gynecologists (ACOG) recently issued guidelines for the clinical management of osteoporosis in women, including recommendations for screening, prevention, and treatment.
Abstract: The American College of Obstetricians and Gynecologists (ACOG) recently issued guidelines for the clinical management of osteoporosis in women, including recommendations for screening, prevention, and treatment.
18 citations
TL;DR: A more detailed investigation was undertaken to study the detectability of laboratory-produced osteolytic lesions in cadaveric thoracolumbar vertebral bodies using conventional lateral radiographs to show significant increases in lesion detection in spines.
Abstract: Despite few and inconclusive studies, radiography is generally believed to be insensitive for detection of osteolytic lesions of the spine. A more detailed investigation was undertaken to study the detectability of laboratory-produced osteolytic lesions in cadaveric thoracolumbar vertebral bodies using conventional lateral radiographs. The radiographs were presented to four radiologists in two sessions over a two month period. In the first session, the films were arranged in a composite of five vertebral bodies, T11 to L3 all from the same spine, in which one contained a lesion and the other four were normal. In the second session, each vertebral body film was presented individually. Area (Az) under the receiver-operating characteristic (ROC) curve was used to measure the performances of readers. Observer detection was similar in the two formats with Az ranging from 0.67 +/- 0.05 to 0.79 +/- 0.04 for the composite film arrangement and 0.57 +/- 0.08 to 0.85 +/- 0.10 for the films of individual vertebral bodies. Lesions were grouped into three relative size categories: 18% to 25%, 26% to 40%, and 41% to 60% of transverse vertebral body diameter. The mean increase in ROC area between the small and large lesions was 0.29 (P less than 0.04) for the composite films and 0.16 (P less than 0.05) for the individual films. In the composite study, all readers showed significant (P less than 0.05) increases in lesion detection in spines reflecting large increases (P less than 0.01) in bone mineral content.(ABSTRACT TRUNCATED AT 250 WORDS)
17 citations