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Biomedical subjects

I Fogelman

Publications and source records attributed to I Fogelman.

At least 181 records · Page 10Linked to original sources
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to change and, for example, dual photon absorptiometry, which itself was a major advance, has now effectively been superceded by dual energy X-ray absorptiometry.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↗
PubMed1991

Techetium 99m methylene diphosphonate bone scanning in osteoarthritic hands.

In this prospective study, the radiological features characteristic of osteoarthritis of the hand were compared with the radionuclide bone scan images. A total of 32 patients was assessed at 6-monthly intervals for 18 months. Microfocal radiographs were taken at each visit. The high magnification and resolution of this technique permitted direct measurement of joint space width, subchondral sclerosis, osteophyte number and area and juxta-articular radiolucency area for each joint in the hand. Four-hour technetium 99m methylene diphosphonate bone scans were taken at 0 and 12 months and the activity of tracer uptake at each joint scored. The latter was compared with each X-radiographic feature at every visit and the changes between visits analysed. The scan scores did not correlate with any of the X-radiographic features other than osteophyte size. During the study the size of growing and remodelling osteophytes increased significantly at joints with raised or increased isotope uptake.

Female↗
PubMed1991

The effect of positioning on dual energy X-ray bone densitometry of the proximal femur.

The influence of subject repositioning on the precision of bone mineral densitometry of the proximal femur using dual energy X-ray absorptiometry was estimated by determining the variation in the bone mineral density (BMD) of subjects scanned with their foot and leg position varying from that routinely used in clinical scanning. The mean variations in BMD of the femoral neck, Ward's triangle and trochanter were 2.7, 4.1 and 1.7%, respectively, in eight subjects scanned with the foot internally rotated by 0, 13 and 27 degrees. The mean variations in BMD in four subjects scanned with the leg in the customary position and abducted +/- 6 degrees from the conventionally used scanning position were 3.6, 2.8 and 1.6% for the same respective regions of interest. For diagnostic applications, the orientation of the leg and foot during scanning is relatively unimportant since the variations in BMD introduced by the different foot and leg orientations likely to be encountered in routine clinical scanning are small compared to the intrapopulation variation in BMD. However, for monitoring changes in BMD longitudinally, careful repositioning of the foot and leg will be necessary to achieve precision in vivo of less than 1%.

Absorptiometry, Photon↗
PubMed1991

Oestrogen, the prevention of bone loss and osteoporosis.

There is overwhelming evidence that oestrogen can prevent bone loss and there is less good but convincing evidence that oestrogen prevents fractures. Oestrogen use of between 5 and 10 years is associated with a 50% reduction in risk of fracture. There is good evidence that in established osteoporosis, oestrogen prevents further bone loss and reduces the incidence of fractures. Oestrogen use leads to lasting skeletal benefits and will prevent bone loss at whatever age it is started. Prior to fracture there are no symptoms associated with osteoporosis and few patients will be diagnosed at a time when effective treatment could be instigated. It is apparent that the risk of developing osteoporosis cannot be deduced from clinical data alone and bone mineral measurements provide the single best test for future risk. Bone mass can be measured directly and there is no need for guess work. The most important potential application for oestrogen is in preventive therapy, and the efficient use of oestrogen in this situation depends upon the diagnosis of low bone mass. Who to treat remains the issue. For any age group the median value of bone density and a range of percentiles can be generated, thus facilitating therapeutic decisions.

Bone Density↗
PubMed1991

Comparison of clinical, radionuclide, and radiographic features of osteoarthritis of the hands.

Simultaneous clinical, scintigraphic, and macroradiographic assessments were carried out on 32 patients with hand osteoarthritis and the results at entry and one year reported. The presence and growth of osteophyte correlated with symptoms and a positive scan. The scan did not detect the radiographic features of juxta-articular radiolucencies, subchondral sclerosis, or cartilage thinning. Osteophytes, particularly when fast growing, produce pain, a 'hot' scan, and may predict disintegration of joint architecture.

Arthrography↗
PubMed1991

Intersite comparison of the Hologic QDR-1000 dual energy X-ray bone densitometer.

UNLABELLED: We have compared results from 13 Hologic QDR-1000 bone densitometers: (i) by performing spine and hip scans on two normal volunteers; (ii) by acquiring sets of 10 sequential scans on a Hologic anthropomorphic spine phantom. For each QDR-1000 site visited a set of spine phantom scans was also acquired on a QDR-1000 at Guy's Hospital to serve as a control study. All scans were analysed using the Hologic scan comparison software. Radiographers at each site were asked to perform their own independent analysis of the scans of the two volunteers. The precision of the bone mineral density (BMD), bone mineral content (BMC) and projected area (Area) results for a set of 10 phantom scans was 0.11%, 0.14% and 0.12% respectively. The coefficient of variation (CV) between sites for the sets of phantom scans was 0.58% for BMD, 0.71% for BMC and 0.35% for Area. In comparison, CVs for the phantom scans acquired on a single QDR-1000 were 0.23%, 0.23% and 0.09% respectively. The CV for the BMD results on the two volunteers obtained using the scan comparison software averaged 1.4% for the spine and 2.1% for the femoral neck. The CV for the results obtained by site radiographers averaged 2.2% for the spine and 3.7% for the femoral neck. Significant differences in the technique used for hip analysis were found. CONCLUSIONS: (i) differences in calibration between systems were generally less than 1%; (ii) variations in results resulting from differences in analytical technique were more significant than those resulting from differences in calibration.

Absorptiometry, Photon↗
PubMed1991

Osteoporosis: a growing epidemic.

The osteoporosis epidemic will continue unabated unless the issue of prevention of bone loss is seriously addressed. While a continuing programme of education for both the medical profession and the general public is necessary, positive action is required. Women lose bone at an accelerated rate following the menopause and this seems to be the optimal time for intervention. Those women who enter the menopause with the lowest bone density are at greatest risk of subsequent fracture. An individual's bone density can be accurately measured and those women who have the lowest bone density should have hormone replacement therapy (HRT) recommended, but it is important to discuss fully the possible benefits and risks. It is probable that non-hormonal agents for prevention of bone loss will be available in the near future, and cyclical diphosphonate therapy appears particularly promising. However, at the present time, long-term HRT is the mainstay for the prevention of bone loss.

Aged↗