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Biomedical subjects

I Fogelman

Publications and source records attributed to I Fogelman.

At least 19 recordsLinked to original sources
PubMed1992

Osteoporosis and chronic back pain: a study with single-photon emission computed tomography bone scintigraphy.

A group of 26 patients aged 47-81 years (average 67) with spinal osteoporosis and back pain for more than 6 months were investigated with planar and SPECT bone scintigraphy and anterior and lateral x-rays of the thoracolumbar spine. Abnormal activity on bone scintigraphy was found in all patients, of whom 22 had multiple lesions. A total of 17 (65%) patients had abnormal activity associated with collapsed vertebral bodies, 5 (19%) had degenerative disk disease, and 21 (81%) had facetal joint disease. Of 112 lesions identified by SPECT, 60 (54%) were localized to the apophyseal joints. Facetal lesions were commoner in those patients with more collapsed vertebrae, and 32 facetal lesions (54%) were associated with collapse of the vertebra immediately above or below. Bone scintigraphy findings suggest that in some individuals with osteoporosis and chronic back pain, collapse of the vertebral body or degenerative disk disease are causes of pain. However, the high frequency of increased apophyseal joint activity suggests that the facet joint may also be an important site of origin of pain in these individuals. Bone scintigraphy may identify a subgroup of osteoporotic patients with chronic back pain who would benefit from treatment to the facet joints.

Aged↗
PubMed1992

Measurements of broadband ultrasonic attenuation in the calcaneus in premenopausal and postmenopausal women.

We report a study of broadband ultrasonic attenuation (BUA) in the calcaneus in 248 women. Measurements were performed with a Walker-Sonix UBA-575 ultrasonic bone analyser. The populations studied were 15 healthy young volunteers (group 1, mean age 26 years), 200 healthy pre- and postmenopausal women (group 2, mean age 53 years) and 33 osteoporotic women with vertebral crush fractures (group 3, mean age 66 years). Subjects in group 1 each had 10 repeated measurements of their right heel. Duplicate BUA measurements in the right heel were performed in 96 subjects and bilateral scans in a further 87 women in group 2. The remaining 17 subjects in group 2 and those in group 3 had a single scan of the right heel. All women in groups 2 and 3 had dual X-ray absorptiometry (DXA) scans of the lumbar spine and femoral neck. The precision study on the women in group 1 gave a root mean square (RMS) coefficient of variation (CV) of 4.2%. Individual CV results showed statistically significant differences (range 1.3%-7.6%). Duplicate scans in subjects in group 2 gave a RMS CV of 4.6% while the bilateral measurements showed no significant difference between the two heels. Linear regression analysis gave the following relationship between BUA and age: BUA = 87.1 - 0.76 (Age - 40) dB/MHz (r = -0.31, p less than 0.001, SEE = 14.0 dB/MHz). Multivariate regression analysis showed that, in addition to age, years since the menopause was also a significant factor in predicting BUA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Gonadotropin-releasing hormone agonists and the skeleton.

OBJECTIVE: To review and evaluate published studies that have assessed the effect on the skeleton of treatment with gonadotropin-releasing hormone agonists (GnRH-a). The effects on bone biochemistry and bone density are presented. DATA IDENTIFICATION: Major studies reporting on bone and GnRH-a use were identified through Excerpta Medica and Medline searches. STUDY SELECTION: Those that have reported on GnRH-a treatment in patients where data relating to skeletal metabolism or bone density were obtained. RESULTS: Changes in bone biochemistry during GnRH-a therapy indicate that there is altered skeletal metabolism associated with GnRH-a use. The data on changes in bone density after a 6-month course of GnRH-a therapy generally indicate some bone loss. The magnitude of any detected change in bone density depends on the skeletal site assessed and the method of assessment. No significant bone loss has been documented in cortical bone; any bone loss occurring is usually associated with trabecular bone and is partially or completely reversible on withdrawal of GnRH-a treatment. CONCLUSIONS: A 6-month course of GnRH-a therapy may result in a small reduction in trabecular bone density that is partially or completely reversible on withdrawal of treatment. The magnitude of any persistent residual bone loss is unlikely to be of clinical relevance and the benefits of a single 6-month course of GnRH-a therapy should not be withheld on the basis of a possible effect on bone.

Bone Density↗
PubMed1992

Tamoxifen protects against steroid-induced bone loss.

As part of a clinical trial of adjuvant endocrine treatment in postmenopausal women with operable breast cancer serial bone density measurements have been performed by dual photon absorptiometry. Tamoxifen alone was given to 26 women, and 20 received additional prednisolone. By 24 months after entry there was no significant difference between mean bone density of the two groups, nor any significant change from baseline levels. There was a mean gain of 0.46% in the tamoxifen group and 1.95% in those given additional prednisolone. Thus the predicted steroid-induced bone loss was inhibited by tamoxifen. This may be of more general use in prevention of osteoporosis in patients requiring long-term steroid treatment.

Aged↗
PubMed1992

Measurement of bone mass.

The clinical attraction of being able to measure bone density in a precise and accurate manner is clear. With this information, clinicians can identify osteopenic postmenopausal women, assess the effects of disease on the skeleton, and examine the effect of therapy. Significant advances have been made in the last decade in methodology of bone-mass measurements, leading to a number of safe, precise, and accurate techniques. The field continues to change and, for example, dual photon absorptiometry, which itself was a major advance, has now effectively been superceded by dual energy X-ray absorptiometry. It is predicted that such methodology will continue to find an expanding role and will soon be considered part of routine clinical practice. A brief review of the various methodologies that have commonly been used for bone-mass measurements is presented.

Absorptiometry, Photon↗
PubMed1992

Postmenopausal screening for osteopenia.

Dual energy X-ray absorptiometry (DXA) measurements of bone mineral density (BMD) in the lumbar spine and femoral neck have been performed in 1000 consecutive women aged between 40 and 60 years referred for screening for osteopenia. A detailed history was taken from each woman that included relevant lifestyle parameters and known risk factors for osteoporosis. After exclusions, e.g. because of fractures, corticosteroid or prolonged HRT use, 627 women (mean age 53 years) were considered suitable for further analysis. The mean BMD in the lumbar spine (L1-L4) was 0.946 g/cm2 and in the femoral neck was 0.767 g/cm2. Significant correlations were found between BMD and years after the menopause and weight (range r = 0.20-0.24). However, these parameters are not reliable enough predictors of BMD to be of value in clinical practice. If osteopenia is to be the basis for initiating prophylactic measures against bone loss, then a threshold BMD must be chosen below which treatment will be advised. Since the correlation coefficient between spinal and femoral neck BMD measurements was only 0.64, assessment of any individual requires consideration of both sites. There is as yet no consensus as to the number of women who may require to be treated and we have provided BMD values that identify a range of population sizes (the lowest 20, 30, 40 and 50 percentiles). It should be noted that there was a 16% loss of BMD in the spine and 14% in the femoral neck during the first 5 years after the menopause.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1992

Treatment of Paget's disease by weekly infusions of 3-aminohydroxypropylidene-1,1-bisphosphonate (APD).

Thirty patients with symptomatic Paget's disease of bone were treated with weekly infusions of 30 mg APD for 6 weeks and followed for up to 3 years (mean 2 years). Bone pain diminished or disappeared in 83%. Six months following treatment the serum alkaline phosphatase (sAP) had normalized in 53% and had fallen by an average of 68% in the remainder. The average fall in sAP was 65% at 6 months, 59% at 1 year and 51% at 2 years. Urine hydroxyproline/creatinine ratios (OHp/Cr) fell by an average of 72% over the 6 weeks of treatment whilst serum bone gla protein (BGP) showed no significant change. However, there was a significant fall in the mean BGP of 25% by 6 months following treatment. Radionuclide bone scan abnormalities improved in all patients and showed complete resolution in two. The same regimen was used to retreat eight patients with a persistence or recurrence of symptoms after 1 year. At 6 months following retreatment the sAP had fallen to normal in four and in the remainder by an average of 39%. Two patients had a third course after a further year and by 6 months the sAP had fallen by an average of 50%. Normalization of sAP occurred in 86% of patients with a pretreatment sAP less than 900 iu/l (normal less than 300) and 89% of patients with a sAP less than 600 iu/l immediately following the course of treatment. Therefore, knowledge of the pretreatment and post-treatment sAP should enable prediction of the need for further therapy in most cases. We confirm that APD is an effective and well tolerated treatment for the management of Paget's disease, giving long-term suppression.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

The identification of spinal pathology in chronic low back pain using single photon emission computed tomography.

Bone scintigraphy with single photon emission computed tomography (SPECT) offers improved lesion detection and localization when compared to conventional planar imaging. The SPECT findings were investigated in 80 consecutive patients (aged 18-70 years, median 44) referred to a rheumatology outpatient clinic with low back pain persisting for more than 3 months. Lesions of the lumbar spine were demonstrated in 60% of patients using SPECT but in only 35% with planar imaging. Fifty-one per cent of all lesions were only detected by SPECT, and lesions visualized on SPECT could be precisely localized to the vertebral body, or different parts of the posterior elements. Fifty per cent of lesions involved the facetal joints of which almost 60% were identified on SPECT alone. X-rays of the lumbar spine, with posterior oblique views, failed to demonstrate abnormalities corresponding to almost all SPECT posterior element lesions although it identified abnormalities corresponding to over 60% of anterior SPECT lesions. Computed tomography (CT) was performed in 30 patients with a SPECT lesion and sites of facetal joint activity corresponded to facetal osteoarthritis in 82%. It is concluded that bone scintigraphy with SPECT in patients with chronic low back pain demonstrates many lesions not seen with either X-ray or conventional planar imaging. In addition anatomical localization is greatly enhanced with bone SPECT. The technique offers improved diagnosis in a group of patients often difficult to evaluate, and in particular a means of detecting apophyseal joint pathology which may be responsive to treatment.

Adult↗
PubMed1992

Compliance with hormone replacement therapy (HRT) after screening for post menopausal osteoporosis.

OBJECTIVE: To assess compliance with recommendations for hormone replacement therapy (HRT) in postmenopausal women following screening for osteoporosis. DESIGN: A postal questionnaire sent to women an average of 8 months (range 6-12) following measurement of their bone mineral density (BMD), and recommendations regarding HRT given to the referring general practitioner. SETTING: Referrals from local general practitioners. Mixed social class. SUBJECTS: 400 postmenopausal women aged 40-69 years (average age 52). MAIN OUTCOME MEASURES: Compliance with advice and if failing to comply, reasons for not doing so. RESULTS: Replies were received from 352 women (88%) and 74% of respondents followed advice to start, continue, or refrain from starting or continuing HRT with regard to protecting their skeleton. Those who rejected advice to take HRT mostly had concern over side effects or the efficacy or safety of treatment. Of the women who started HRT 28% subsequently stopped, the principal reasons being withdrawal bleeding and weight gain. Of the women recommended to take HRT, 39% were not taking treatment by 8 months after referral, either because they ignored advice given (22%) or because of side effects (17%). CONCLUSIONS: Screening leads to increased usage of HRT among women at most risk for osteoporosis. However, almost 40% of women with low bone mineral density were not taking HRT 8 months after referral, and therefore until improved compliance has been demonstrated screening cannot be widely recommended.

Aged↗
PubMed1992

Increase in bone mass after one year of percutaneous oestradiol and testosterone implants in post-menopausal women who have previously received long-term oral oestrogens.

OBJECTIVE: To determine the effect on the bone density of the skeleton after changing from oral oestrogen to subcutaneous oestradiol and testosterone replacement. DESIGN: Prospective non-randomized single centre study. SUBJECTS: Twenty women who were receiving long-term oral oestrogen replacement. Ten changed to oestradiol and testosterone implants; the remaining ten continued with oral oestrogens. MAIN OUTCOME MEASURES: Bone density was measured using dual photon absorptiometry at the lumbar spine and neck of femur at the start of the study and after one year. RESULTS: The bone density increased significantly by 5.7% at the spine and by 5.2% at the neck of femur in those women who changed to implant therapy but remained unchanged in those women who continued with oral therapy. CONCLUSION: Subcutaneous oestradiol and testosterone implants will result in an increase in bone mass even after many years of oral oestrogen replacement therapy.

Administration, Cutaneous↗
PubMed1992

Fracture thresholds in osteoporosis: implications for hormone replacement treatment.

The bone mineral densities of the lumbar spine and femoral neck were determined by dual energy chi ray absorptiometry in 110 women aged 40-82 years (average 65 years) with spinal osteoporosis who had had at least one atraumatic vertebral compression fracture and in 1026 normal women aged 40-79 years (average 52 years). The women with osteoporosis showed a significant decrease in bone mineral density (BMD) at the lumbar spine and femoral neck compared with age matched normal women (sixth decade of life -26% spine, -23% femoral neck; seventh decade -26% spine, -16% femoral neck). The fracture threshold, defined as the 90th centile of spinal BMD for women with osteoporosis, was 0.81 g/cm2 at the lumbar spine and 0.656 g/cm2 at the femoral neck. Five per cent of normal women aged 40-49 years, 20% aged 50-59 years, and 45% aged 60-69 years had a BMD below this threshold. To maintain the bones of women above the fracture threshold until the age of 70 years about 50% of postmenopausal women need hormone replacement therapy. However, if the BMD is to be kept above the fracture threshold for a women's lifetime, e.g. until the age of 80-90 years, then most women will need treatment, though for various lengths of time depending on their initial BMD. Measurements of BMD in postmenopausal women currently help in identifying the risk of osteoporotic fractures but in the lifetime assessment of risk in a single subject they may have a more important role in deciding the duration of hormone replacement therapy.

Absorptiometry, Photon↗
PubMed1992

Chronic low back pain: comparison of bone SPECT with radiography and CT.

In patients with chronic low back pain, bone scintigraphy with single photon emission computed tomography (SPECT) of the lumbar spine allows identification of lesions not seen with planar imaging. In this study, findings from radiography, computed tomography (CT), and bone scintigraphy with SPECT in 34 patients with chronic back pain were examined to determine the nature and clinical relevance of the lesions. Twenty-seven patients had lesions at SPECT, of whom 24 (89%) had abnormalities at CT and 18 (67%) had abnormalities at radiography. SPECT allowed identification of 54 lesions, of which only 20 (37%) were detected with planar imaging. Forty-three (80%) SPECT lesions were located at the site of an abnormality also seen at CT and 20 (37%) at the site of an abnormality also seen at radiography. It was concluded that bone SPECT provides diagnostic information in chronic low back pain that is not available with radiography or planar imaging. The majority of lesions seen at SPECT corresponded to identifiable disease at CT.

Adult↗
PubMed1992

Measurement of forearm bone mineral density in normal women by dual-energy X-ray absorptiometry.

We report the results of forearm measurements, without the use of a water bath, using dual-energy X-ray absorptiometry (DEXA) in 100 normal women aged 29-69 years (average age, 52 years). Studies were performed using the Hologic QDR-1000, with bone mineral density (BMD) measured at three sites in the non-dominant forearm: ultradistal, distal one-third and a region between these two. The precision of the technique was 0.74%, 0.55% and 0.58%, respectively. The normal range for forearm BMD and variation with age was established. BMD was also measured in the lumbar spine (L1-L4) and femoral neck. Linear regression analysis gave a range of correlation coefficients between forearm and axial sites of r = 0.49-0.67. Standard errors of the estimate (SEE) in predicting axial from peripheral measurements gave average values from the three forearm sites of 0.085 g/cm2 for the femoral neck and 0.118 g/cm2 for the spine. Forearm measurements using DEXA can now be reliably performed in air. DEXA produces a high-resolution image, is fast and simple to perform, and enables both cortical and trabecular sites to be examined in one measurement. Forearm and axial measurements can be performed using the same equipment, where centres possess a suitable DEXA system.

Absorptiometry, Photon↗
PubMed1992

Bone scintigraphy following intravenous pamidronate for Paget's disease of bone.

Pamidronate is one of several powerful bisphosphonates able to produce prolonged remissions of Paget's disease. This study examined to what extent bone scan changes parallel the clinical response and whether there is variability in the behavior of individual lesions. Twenty-five patients with pagetic bone pain for more than 2 yr were examined with bone scintigraphy before and on average 8 mo after six 30-mg infusions of pamidronate given weekly. Serum alkaline phosphatase and urinary hydroxyproline-to-creatinine ratios were measured before and 6 mo after treatment. A second course of pamidronate was given to 13 patients who had clinical or biochemical relapse. Of 136 pagetic lesions, 13 (10%) completely resolved, 90 (65%) improved and 33 (24%) remained unchanged. There was no significant difference in response between bony sites, although less active lesions were more likely to resolve completely. In conclusion pamidronate has a powerful effect on bone scan appearances in Paget's disease. Most lesions improve but complete resolution is uncommon. Less active lesions are more likely to resolve and are less likely to require further therapy.

Alkaline Phosphatase↗
PubMed1979

Semi-quantitative interpretation of the bone scan in metabolic bone disease: definition and validation of the metabolic index.

Certain easily recognisable features are commonly seen in the bone scans of patients with metabolic bone disorders. Seven such features have been numerically graded by three independent observers in the scans of 100 patients with metabolic bone disease and of 50 control subjects. The total score for each patient is defined as the metabolic index. The mean metabolic index for each group of patients with metabolic bone disease is significantly greater than that for the control group (P less than 0.001).

Bone Diseases↗
PubMed1979

Autoparathyroidectomy: a case report.

This report describes a patient with primary hyperparathyroidism who became spontaneously normocalcaemic preoperatively. This was due to infarction in a parathyroid adenoma. Plasma parathormone (PTH) levels were monitored pre- and postoperatively.

Adenoma↗