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Biomedical subjects

D W Purdie

Publications and source records attributed to D W Purdie.

At least 37 records · Page 2Linked to original sources
PubMed1999

Prevention of postmenopausal bone loss at lumbar spine and upper femur with tibolone: a two-year randomised controlled trial.

OBJECTIVE: To examine the effects of tibolone on bone mineral density and its concurrent safety and subject acceptability. DESIGN: Prospective randomised controlled study. SETTING: Centre for Metabolic Bone Disease, Hull. POPULATION: Forty-seven healthy post-menopausal women aged 50-57 years with normal bone mineral density at lumbar spine. METHODS: Bone mineral density was assessed every 24 weeks at lumbar spine and proximal femur using dual energy X-ray absorptiometry. RESULTS: The bone mineral density of the tibolone treated subjects tended to increase while those of the controls tended to fall. The higher densities in the tibolone group were significant at lumbar spine from week 24 (P = 0.002) and at the trochanter from week 72 (P = 0.014). The lower bone densities in the controls were significant at Ward's Triangle and femoral neck at week 96 (P < 0.0001), and at lumbar spine from week 24 onwards (P < 0.05). Between-treatment analysis indicated that, by the 96th week, the bone densities at all sites in the tibolone group were significantly different from those in the control group. At the lumbar spine the differences were highly significant throughout the study (P < 0.0004). Four women receiving tibolone withdrew from the study due to unacceptable adverse events. Two women withdrew from the control group. There was no significant difference between the groups in the number of subjects suffering adverse experiences. Vaginal bleeding occurred in seven women, all from the tibolone treated group, resulting in one withdrawal from the study. CONCLUSION: Tibolone is thus an effective and well-tolerated alternative to oestrogen in the prevention of osteoporosis with its beneficial effects being most apparent at the lumbar spine.

Absorptiometry, Photon↗
PubMed1999

Effects of sex steroids on sleep.

Sex steroid secretions are generally synchronous with the circadian rhythm and sleep, and there is evidence that prolactin secretion is sleep-dependent. Polysomnographically assessed changes in sleep during the menstrual cycle are characterized by increased EEG activity in the 14-15-Hz (sleep spindle) range in the luteal phase accompanying an increase in core temperature. There are no other consistent changes in sleep architecture associated with the menstrual cycle. The hot sweats which disturb sleep in menopausal women are attributable to oestrogen deficiency and are reduced by oestrogen replacement therapy. Although it is often assumed that the psychological changes during the menopause are attributable to chronic sleep disturbance caused by hot sweats, the evidence for this is uncertain. Sex steroids have also been shown to have a role in the aetiology of obstructive sleep apnoea and its treatment. It is clear that the sex steroids are all implicated in sleep and thermoregulatory processes, although we cannot as yet define their precise roles.

Adolescent↗
PubMed1998

Prevalence of osteoporosis and related risk factors in UK women in the seventh decade: osteoporosis case finding by clinical referral criteria or predictive model?

The objectives of the study were: to determine the prevalence of osteoporosis in women in their seventh decade; to determine the number of women who conformed to at least one of the current East Yorkshire Clinical Referral Criteria for Osteoporosis; and to determine the sensitivity and specificity of these referral criteria in the diagnosis of osteoporosis and to compare this with the receiver operating characteristic (ROC) curve of a logistic regression model incorporating variables that were significantly associated with the risk of osteoporosis. An observational study was carried out at the Centre for Metabolic Bone Disease, Hull Royal Infirmary, on women in their seventh decade from three general practices. Densitometric assessment of lumbar spine and femoral neck was carried out using dual-energy X-ray absorptiometry (DXA) and a detailed medical history taken. The main outcome measures were prevalence of osteoporosis in women in their seventh decade and efficacy of agreed clinical referral criteria at osteoporosis case finding. Of 823 Caucasian women who underwent DXA, 24% proved to have osteoporosis at hip, spine or both according to WHO criteria. A further 49% had osteopenia detected at hip, spine or both. At least one of the referral criteria was present in 47% of the women assessed. The sensitivity of the clinical referral criteria for detection of osteoporosis was 58% with a corresponding specificity of 60%. This point lies below the ROC curve (area under fitted curve, Az = 0.73) of a logistic regression model incorporating weight, age at menopause and current use of hormone replacement therapy. In conclusion, osteoporosis according to WHO criteria was found in almost 25% of women in their seventh decade. A simple logistic regression model provided a more sensitive method of osteoporosis case finding than the selective screening component of the clinical referral criteria employed in our practice.

Absorptiometry, Photon↗
PubMed1998

A UK Consensus Group on management of glucocorticoid-induced osteoporosis: an update.

In the UK, over 250 000 patients take continuous oral glucocorticoids (GCs), yet no more than 14% receive any therapy to prevent bone loss, a major complication of GC treatment. Bone loss is rapid, particularly in the first year, and fracture risk may double. This review, based wherever possible on clinical evidence, aims to provide easy-to-use guidance with wide applicability. A treatment algorithm is presented for adults receiving GC doses of 7.5 mg day(-1) or more for 6 months or more. General measures, e.g. alternative GCs and routes of administration, and therapeutic interventions, e.g. cyclical etidronate and hormone replacement, are recommended.

Bone Resorption↗
PubMed1998

Management of male osteoporosis: report of the UK Consensus Group.

Although osteoporosis is generally regarded as a disease of women, up to 30% of hip fractures and 20% of vertebral fractures occur in men. Risk factors for osteoporotic fractures in men include low body mass index, smoking, high alcohol consumption, corticosteroid therapy, physical inactivity, diseases that predispose to low bone mass, and conditions increasing the risk of falls. The key drugs and diseases that definitely produce a decrease in bone mineral density (BMD) and/or an increase in fracture rate in men are long-term corticosteroid use, hypogonadism, alcoholism and transplantation. Age-related bone loss may be a result of declining renal function, vitamin D deficiency, increased parathyroid hormone levels, low serum testosterone levels, low calcium intake and absorption. Osteoporosis can be diagnosed on the basis of radiological assessments of bone mass, or clinically when it becomes symptomatic. Various biochemical markers have been related to bone loss in healthy and osteoporotic men. Their use as diagnostic tools, however, needs further investigation. A practical approach would be to consider a bone density more than one SD below the age-matched mean value (Z < -1) as an indication for therapy. The treatment options for men with osteoporosis include agents to influence bone resorption or formation and specific therapy for any underlying pathological condition. Testosterone treatment increases BMD in hypogonadal men, and is most effective in those whose epiphyses have not closed completely. Bisphosphonates are the treatment of choice in idiopathic osteoporosis, with sodium fluoride and anabolic steroids to be used as alternatives.

Adult↗
PubMed1997

The effect of long-term oestradiol implantation on bone mineral density in postmenopausal women who have undergone hysterectomy and bilateral oophorectomy.

Twelve women who had received oestradiol implantation on demand for at least 15 years following hysterectomy with bilateral oophorectomy, underwent bone densitometry of hip and spine. Bone mass of hip and spine was significantly elevated above that of both the age matched mean to a degree hitherto undocumented. This suggests that oestrogen in high doses or over a long period may produce a true anabolic effect on bone mass.

Absorptiometry, Photon↗
PubMed1997

Maximising the cost effectiveness of BMD referral for DXA using ultrasound as a selective population pre-screen.

Bone mineral density (BMD) referral for dual energy X-ray absorptiometry (DXA) is generally based upon agreed clinical referral criteria (CRC). The aim of this study was to determine whether ultrasound measurements of Broadband UI-trasound Attenuation (BUA) and velocity (VOS) provide a superior selective pre-screen referral method for BMD assessment by DXA. 107 women aged 60-69 years (64.2 +/- 2.8) had BMD measurements at lumbar spine and right femoral neck along with ultrasound BUA and VOS measurements of the left calcaneus. Each subject completed an extensive clinical and social questionnaire to ascertain those who would have met one or more of the five general clinical referral criteria adopted by our Centre. Each subject was classified by DXA using the WHO criteria as normal, osteopenic or osteoporotic at lumbar spine or femoral neck. The cost per osteoporotic subject correctly identified was calculated. As a reference, based upon DXA measurements alone on all 107 subjects, the cost per osteoporotic subject identified would be Ponds 185. If subjects had been referred using the clinical referral criteria the cost is Ponds 171. For assessment of referral by BUA or VOS, an additional charge for ultrasound measurement of all subjects was incorporated. At a BUA of 60 dB MHz-1 the cost per osteoporotic subject is Ponds 107. Ultrasound velocity or a combination of BUA or VOS with clinical referral criteria did not provide a significantly reduced cost than the current clinical referral criteria alone. This study has demonstrated that BUA provides an improved referral procedure to that currently achieved with clinical referral criteria and supports the concept of BUA being used as a selective pre-screen for DXA in 7th decade subjects.

Absorptiometry, Photon↗
PubMed1995

Hormone replacement therapy, sleep quality and psychological wellbeing.

OBJECTIVE: To examine the effect of hormone replacement therapy upon sleep quality and duration in postmenopausal women. DESIGN: Randomised, single-blind, placebo-controlled trial. SETTING: Sleep research laboratory. SUBJECTS: Thirty-three healthy postmenopausal women. INTERVENTIONS: Continuous 0.625 mg conjugated equine oestrogens with 0.15 mg cyclic norgestrel taken for 12 days per 28 day cycle. MAIN OUTCOME MEASURES: Occurrence of vasomotor symptoms, polysomnographic sleep stage measures, Stanford sleepiness questionnaire, Crown-Crisp experiential index and the cognitive failures questionnaire. RESULTS: Hormone replacement therapy results in an improvement in menopausal symptoms but not in parameters of sleep quality. Despite this, certain measures of psychological wellbeing showed significant improvement in the hormone replacement therapy group. CONCLUSION: Hormone replacement therapy results in a measurable improvement in physical and psychological welfare, the latter being independent of improvement in sleep quality.

Adult↗
PubMed1995

Coeliac disease and bone mineral density in adult female patients.

A cross sectional study was undertaken to examine the relationship between coeliac disease and bone mineral density. The 135 female coeliac patients registered on the database of the Department of Gastroenterology at Hull Royal Infirmary were approached by letter, advising them of a potential risk of osteoporosis and inviting them to undergo bone densitometry. A total of 81 registered women (60%) attended the Osteoporosis Laboratory, Princess Royal Hospital and underwent dual energy x ray absorptiometry at the lumbar spine (L2-L4) and femoral neck. Historical data relating to the time of diagnosis and adherence to a gluten free diet were obtained. A control group was selected from the local normal population and was first matched for height, weight, and menopausal status. Postmenopausal patients were then further matched to controls of equivalent menopausal age. In coeliac patients, bone mineral density expressed in g/cm2 as mean (SD) was significantly lower at the lumbar spine (1.076 (0.186)) than in the control group (1.155 (0.143), p < 0.001). This was also the case at the femoral neck (0.887 (0.142) versus 0.965 (0.127), p < 0.001). When the coeliac patients were stratified by menopausal status, it was found that femoral neck bone mineral density was significantly below control values in both premenopausal and postmenopausal women. Spinal bone mineral density exhibited a significant decrement only in the postmenopausal group. The age at diagnosis of coeliac disease and adherence to a gluten free diet did not influence bone mineral density at either hip or spine. These results confirm coeliac patients' higher risk of osteopenia. Coeliac disease should be added to the list of medical conditions which constitute an indication for bone densitometry in order that the individual risk of osteoporosis related fracture may be determined.

Adult↗