Paget's disease--five years follow up after pamidronate therapy.
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Aged↗
Biomedical subjects
I Fogelman
Publications and source records attributed to I Fogelman.
Post-menopausal vertebral osteoporosis: can dual energy X-ray absorptiometry forearm bone density substitute for axial measurements?
This study compared measurements of BMD using dual energy X-ray absorptiometry (DXA) at three sites in the nondominant forearm (ultradistal, distal one-third and a mid-region between these two), the lumbar spine (L1-L4) and the proximal femur (femoral neck, trochanter and Ward's triangle) for the evaluation of vertebral osteoporosis. Studies were performed on 100 normal women aged 29-69 yr (average 52 yr) and 63 osteoporotic women age 48-75 yr (average 66 yr) using the Hologic QDR-1000. Precision values of < 1% were obtained in both normal and osteoporotic women at both forearm and axial sites. Z-scores for the osteoporotics [Z = (mean BMD normal--mean abnormal)/S.D.] were--2.02 lumbar spine, -1.96 femoral neck, -1.79 ultradistal forearm, -1.73 mid region and -1.66 distal one-third forearm. Receiver operating characteristic curves showed that the lumbar spine and femoral neck equally discriminated between normals and osteoporotics with a 95% area under each curve, significantly greater values than those for the forearm which were 87% ultradistal, 89% mid forearm and 86% distal one-third forearm. Fracture thresholds, defined as the 90th centile of BMD for osteoporotic patients, were 1 S.D. below the normal mean for lumbar spine and femoral neck but equal to the mean for ultradistal, 0.6 S.D. below mean for mid region and 0.3 S.D. below mean for distal one-third region. We conclude that for the discrimination of normals and osteoporotic women the three forearm sites are comparable. However, both lumbar spine and proximal femur BMD are superior to all forearm sites.
Absorptiometry, Photon↗
Bone density of normal women in relation to endogenous and exogenous oestrogens.
To evaluate the relationship between duration of hormone replacement therapy (HRT) and forearm bone density, a population-based study has been conducted of 4638 women comparing bone density of 1079 women who had taken HRT for varying times with those who had never taken it. Forearm bone mineral content (BMC) was measured by single photon absorptiometry. Additionally, free oestradiol and sex hormone binding globulin levels were measured in women with high and low bone mineral content. There were no detectable differences in BMC in those who took HRT for up to 24 months compared with those who did not. Thereafter there were significant positive regression coefficients for duration periods of 2 to 5 yr (beta = 0.77, P = 0.04 and beta = 1.76, P = 0.03) and more than 5 yr (beta = 1.66, P < 0.0005 and beta = 1.87, P = 0.009) in post-menopausal and oophorectomized women. The major determinants of BMC were height, and in post-menopausal or oophorectomized women, age. Weight and parity also had additional explanatory power for pre- and post-menopausal women. Those who were in the highest quintile of BMC but had never taken HRT showed significantly elevated percentage free oestradiol compared with those in the lowest quintile. Thus HRT is osteoprotective if taken after the menopause for more than 24 months.
Adult↗
Bone SPECT in osteoid osteoma of the vertebral lamina.
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Child↗
The role of nuclear medicine in orthopaedics.
Patients with a wide variety of orthopaedic disorders can be usefully investigated by nuclear medicine techniques, mostly by bone scintigraphy. Overall this area of nuclear medicine activity is increasing which is a trend that can be expected to continue. The principal conditions that are imaged are fractures and their sequelae, sports medicine injuries and osteomyelitis. However, there are many other orthopaedic problems that are appropriately investigated including biomechanical stress lesions, enthesopathies, avascular necrosis, some bone tumours, arthritidies, metabolic bone disease and nonaccidental injury. Single photon emission computed tomography (SPECT) has provided new indications for bone scintigraphy such as spondylolysis and facet syndrome in the lumbar spine, and meniscal tears in the knee. A role for positron emission tomography (PET) in orthopaedic nuclear medicine has yet to be identified but applications can be expected.
Athletic Injuries↗
The incidence of vaginal bleeding with tibolone treatment.
OBJECTIVE: To determine the incidence of breakthrough bleeding and its significance in recently postmenopausal women who take tibolone (Livial-Organon). DESIGN: A two year comparative nonrandomised prospective study of women taking tibolone (2.5 mg) and control subjects not on medication. SETTING: Teaching hospital menopause and well women clinic. SUBJECTS: One hundred women who were recently menopausal (between 6 and 36 months since last menstrual period). Fifty were commenced on tibolone and 50 received no medication. MAIN OUTCOME MEASURES: Episodes of bleeding throughout the two year study period were recorded. Oestradiol levels were measured at baseline and at six, 12 and 24 months. The age of menopause and time since last menstrual period (LMP) were noted. RESULTS: Twenty percent (12/59) (95% CI 11.0% to 32.8%) of women in the tibolone group had breakthrough bleeding compared with 9.4% (5/23) (95% CI 3.1% to 20.7%) in the control group. Of the women who bled in the tibolone group, 50% had LMP between six and 12 months prior to entering the study, and 83% were younger than the average age of menopause. Sixty-seven percent had detectable oestradiol levels on at least one occasion over the two years (five women had detectable oestradiol levels and did not bleed). None had evidence of endometrial stimulation at dilatation and curettage. Eighty percent of women who bled in the control group were between six and 12 months since LMP on entry into the study, and 80% had detectable oestradiol levels during the study. At dilatation and curettage there was no evidence of endometrial stimulation. CONCLUSIONS: A minority of women will bleed on tibolone therapy. Women who are likely to bleed are younger, are recently menopausal, and may have remaining endogenous oestrogen production.
Anabolic Agents↗
Goserelin (Zoladex) and the skeleton.
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Adult↗
Osteoporotic vertebral fractures: diagnosis with radiography and bone scintigraphy.
PURPOSE: To determine the radiographic appearance of osteoporotic vertebral fracture. MATERIALS AND METHODS: Lateral thoracic and lumbar spine radiographs were examined in 58 patients (812 vertebra) with osteoporosis and evidence of vertebral collapse at bone scintigraphy. Scintigraphic activity was graded as faint, moderate, or intense. Anterior, middle, and posterior heights of the T-4 to L-5 vertebrae were measured. The degree of vertebral deformity was derived by comparing a ratio of heights with the normal mean. RESULTS: At radiography, 378 of the 812 vertebrae (47%) were normal, 434 (53%) had deformities that were more than two standard deviations (SDs) below the normal mean, 304 (37%) had deformities that were more than three SDs below the normal mean, and 222 (27%) had deformities that were more than four SDs below the normal mean. Of 86 vertebrae that showed moderate or intense radionuclide uptake at scintigraphy, all had deformities that were more than two SDs below the normal mean, and 80 (93%) had deformities that were more than three SDs below the normal mean. CONCLUSION: Only in vertebrae with deformities more than three SDs below the normal mean can fractures be confidently diagnosed.
Female↗
Dual X-ray absorptiometry of the lumbar spine: the precision of paired anteroposterior/lateral studies.
Supine lateral dual X-ray absorptiometry (DXA) has the potential to provide a sensitive and precise method of measuring changes in trabecular bone mass in the lumbar vertebral bodies. An important reason for the improvement in precision compared with the earlier decubitus lateral technique is the use of baseline compensation, an algorithm which computes the changes in lateral bone mineral density (BMD) using data from both anteroposterior (AP) and lateral scans. This report examines the precision of supine lateral DXA based on scans of 12 female volunteers (age range 21-56 years). Five AP/lateral scan pairs were performed on each subject and precision expressed by the coefficient of variation (CV). For the AP scan the CV for both L1-L4 and L2-L4 BMD was 0.8%. Precision of the L2-L4 lateral vertebral body, mid-vertebral and volumetric BMD parameters with (without) the baseline compensation correction were 1.2% (2.1%), 2.4% (3.0%) and 1.5% (2.5%), respectively. Two methods of performing baseline compensation, referred to as the multiplicative and additive algorithms, were compared and the former shown to give significantly better precision. The precisions of different combinations of lumbar vertebrae for the measurement of lateral vertebral body BMD were compared and the precision for L2-L4 shown to be significantly better than for L3-L4. When individual vertebrae were examined L3 had the best precision although the differences with L2 and L4 were not significant. The study confirmed that supine lateral measurements of vertebral body BMD with baseline compensation give better precision than the decubitus method. The improvement makes it feasible to follow patients longitudinally and may allow the sensitivity of the lateral scan to supersede that of AP measurements.
Absorptiometry, Photon↗
The ultrasonic assessment of osteopenia as defined by dual X-ray absorptiometry.
Dual X-ray absorptiometry (DXA) studies of bone mineral density (BMD) of the lumbar spine and femoral neck were compared with measurements of broadband ultrasonic attenuation (BUA) and velocity of ultrasound (VOS) in the calcaneus in 300 pre- and postmenopausal women (mean age 53 years). The women were referred for evaluation of possible osteopenia as defined by DXA. The ability of ultrasound measurements to predict osteopenia in women was compared with the ability of lumbar spine and femoral neck DXA scans to predict osteopenia in the hip and spine. A new ultrasound parameter obtained by combining BUA and VOS (combined attenuation and velocity (CAV)) was also evaluated. Linear regression analysis of the three ultrasound parameters and lumbar spine and femoral neck BMD gave weak but statistically significant correlations (r = 0.45-0.54). The correlation between spine and femoral neck BMD was statistically significantly better (r = 0.72). Receiver-operating characteristic (ROC) analysis was used to investigate the sensitivity and specificity of ultrasound measurements in predicting patients with osteopenia. The areas under the ROC curves ranged from 0.64 to 0.75 and ultrasound parameters were shown to be poor at predicting osteopenia as defined by DXA. The ability of lumbar spine and femoral neck DXA measurement to predict osteopenia in the hip and spine, respectively, was statistically significantly better than any of the ultrasound parameters. Ultrasound measurements in the calcaneus did not appear to identify accurately patients with osteopenia defined by DXA measurements of bone density in the axial and appendicular skeleton.
Absorptiometry, Photon↗
Aortic distensibility in post-menopausal women receiving Tibolone.
Both oestrogen and androgens have been shown to affect the structural composition and biophysical properties of the arterial wall in vitro. A non-invasive Doppler ultrasound technique, based on the measurement of pulse wave velocity along the thoraco-abdominal aortic pathway, was used to assess aortic compliance C in vivo in 49 normotensive, normal, healthy post-menopausal female subjects. 23 of the women had been receiving Tibolone, a synthetic steroid structurally related to norethisterone, for at least 3 years. Since C varies with non-chronic changes in blood pressure, an index of intrinsic aortic distensibility, Cp, normally independent of blood pressure, was also calculated. No significant difference was found between the control group and those subjects receiving Tibolone for age, body mass index, systolic blood pressure, diastolic blood pressure, C or Cp. As one would expect the control group Cp values did not show a significant relationship with blood pressure (r = -0.1, not significant). However, in the Tibolone group some dependence of Cp values on pressure still remained (r = -0.58, p < 0.004), suggesting that oral administration of Tibolone had altered the dynamic relationship between structural and functional biophysical properties of the aortic wall in vivo.
Anabolic Agents↗
Should broadband ultrasonic attenuation be normalized for the width of the calcaneus?
Broadband ultrasonic attenuation (BUA) is a measure of ultrasound transmission through the calcaneus that is dependent on bone thickness as well as the density of scattering centres. This report examines whether the normalization of BUA (units dB MHz-1) for calcaneal width (nBUA: units dB MHz-1mm-1) improves the discrimination of clinical studies. BUA and calcaneal width were measured in 200 women using a contact ultrasound (CUBA-Research) system and nBUA evaluated by dividing BUA by bone width. 150 subjects were early post-menopausal and the remaining 50 were osteoporotic women with confirmed vertebral crush fracture. The ability of BUA and nBUA to differentiate between the two groups of subjects was compared using receiver operating characteristic (ROC) analysis. The areas (and standard errors) under the ROC curves were 0.878 (0.033) for BUA and 0.910 (0.028) for nBUA. The difference (and standard error) between the areas under the ROC curves was 0.033 (0.026) and was not statistically significant.
Aged↗
Prevalence and patterns of use of concomitant medications among participants in three multicenter human immunodeficiency virus type I clinical trials. AIDS Clinical Trials Group (ACTG).
Data on the prevalence and patterns of use of concomitant medications among participants in three large phase III clinical trials of zidovudine (ZDV) in human immunodeficiency virus type 1 (HIV-1) infection were analyzed. Overall, 2,801 patients reported 43,331 uses of concomitant medications. Over 85% of clinical trial participants used one or more concomitant medications at some point during the study. Patients with acquired immune deficiency syndrome (AIDS) used an average of 7.1 drugs per month. Patients with AIDS-related complex (ARC) or who were asymptomatic used relatively fewer drugs: 3.1 and 2.7 per month, respectively. Fourteen percent of patients with AIDS used more than 10 concomitant medications per month. The three most commonly utilized classes of drugs were antiinfectives (57%), analgesics or antipyretics (55%), and vitamins (47%). A total of 17% of patients overall and 30% of AIDS patients used acyclovir while on trial. Consumption of prescription drugs was greater, and "over-the-counter" drugs less, among AIDS patients. Reported use of agents not approved by the Food and Drug Administration or approved drugs used for off-label indications was infrequent. Overall use of concomitant medications did not differ across demographic subgroups when corrected for disease stage at the time of enrollment. White, non-Hispanic, homosexual and bisexual men consumed significantly more antivirals and vitamins than other trial participants. Women in all three protocols took more analgesics or antipyretics than did men.(ABSTRACT TRUNCATED AT 250 WORDS)
AIDS-Related Complex↗
Analysis of IL-2, IL-4, and IFN-gamma-producing cells in situ during immune responses to protein antigens.
Immunohistochemistry has been used to define the patterns and kinetics of IL-2, IL-4, and IFN-gamma production at the sites of Ag exposure and in the lymphoid tissues of immunized mice, and to examine the anatomic relationships between cytokine-producing T cells and various APC or Ag-stimulated B cells. The earliest detectable cytokine response to administration of a protein Ag in adjuvant was the appearance of IFN-gamma-producing NK cells at the site of immunization by day 3. T lymphocytes producing IL-2, IL-4, and IFN-gamma were initially detected in draining lymph nodes and spleen within 7 days after immunization, and IL-2-producing cells were present at the immunization site several weeks later. Thus, T cell activation is initiated within lymphoid tissues, and these cells migrate back to depots of Ag. The IFN-gamma produced by NK cells early after immunization may regulate the phenotype of the subsequent Ag-specific T cell response. Using a hapten to which the antibody response is oligoclonal and dominated by a single idiotype, Ag-stimulated (idiotype-producing) B cells could also be detected by immunohistochemistry. These B cells were present in the same areas of lymphoid tissues as cytokine-producing T lymphocytes. Two-color staining showed that idiotype-producing B cells were in close proximity to both IL-2- and IL-4-producing T cells, suggesting that T cells producing either of these cytokines could provide helper function for the B cells. Finally, after subcutaneous immunization with adjuvant, IL-2+ T cells were found adjacent to F4/80+ macrophages, suggesting that macrophages function as important APC in this response.
Animals↗
Comparison of simultaneous 99mTc-HMPAO and 111In oxine labelled white cell scans in the assessment of inflammatory bowel disease.
Forty-seven patients, 29 with chronic inflammatory bowel disease (IBD) and 18 with presumed irritable bowel syndrome, including one with uncomplicated diverticular disease, were studied with simultaneous technetium-99m hexamethylpropylene amine oxime and indium-111 oxine labelled leucocyte scans performed at 1, 3 and 24 h. Twenty-seven patients with IBD had active disease as judged by clinical and laboratory criteria and all of these had positive scans with both agents. No false positive studies were obtained. The 1-h 99mTc-HMPAO WBC scans showed the same distribution to disease as the 3-h 111-In WBC scans, with no difference in intensity (P < 0.92); they showed more extensive disease (P < 0.02) and more intense uptake (P < 0.001) than did the 1-h 111-In scans. The 3-h 99mTc-HMPAO WBC scans showed more extensive disease (P < 0.002), with greater intensity (P < 0.0005), than did the 3-h 111In WBC scans. Physiological bowel activity on 3-h 99mTc-HMPAO WBC scans was present in 12 patients but was faint and did not interfere with assessment of disease extent and activity. It is concluded that in terms of isotope availability, radiation dosimetry and image quality, 99mTc-HMPAO is the agent of choice in detecting active IBD, with localization of disease possible at 1-h after re-injection and optimal resolution and definition of disease extent at 3 h. A negative scan reliably excludes active disease.
Adult↗
Recent advances in bone densitometry.
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Absorptiometry, Photon↗
Bone single-photon emission tomography in recent meniscal tears: an assessment of diagnostic criteria.
Bone single-photon emission tomography (SPET) was performed in 40 patients within 6 months of acute knee injury where internal derangement of the knee was suspected, and the results related to the arthroscopy findings. Scan features with high sensitivity, specificity, and predictive accuracy for a meniscal tear could not be obtained on planar imaging. However, a half-crescent or more of increased tibial plateau activity on transaxial SPET gave a sensitivity of 89%, a specificity of 76%, a positive predictive accuracy of 77% and a negative predictive value of 89%. For longitudinal (bucket handle) tears alone the optimum scan pattern was a full crescent of increased tibial plateau activity with adjacent femoral activity and increased blood pool activity which gave corresponding values of 78%, 94%, 78% and 93%. It is concluded that the inclusion of tibial plateau activity of less than a full crescent and the presence of femoral condyle and blood pool activity in the diagnostic criteria improves the ability of bone SPET to detect meniscal tears. The value of bone SPET in the diagnosis of meniscal tears suggests that it could have a significant role to play in the management of knee injuries.
Adolescent↗
Spine and femur BMD by DXA in patients with varying severity spinal osteoporosis.
Bone mineral density (BMD) at the lumbar spine, femoral neck, trochanteric region, and Ward's triangle was measured using dual-energy X-ray absorptiometry (DXA) in 118 women with osteoporotic vertebral collapse (average age 65 years), divided into four groups according to numbers and SD of vertebral deformation below norms: group 1: -3SD deformations only; group 2: one -4SD deformation; group 3: two-four -4SD deformations; and group 4: 5 or more -4SD deformations. There were no significant differences between the groups. Results were compared with those from 80 premenopausal (average age 32 years, range 20-40 years) and 109 postmenopausal normal women (average age 64, range 60-70 years). Mean BMD in osteoporotic group 1 was lower than premenopausal normal women by 32% at the lumbar spine, 31% femoral neck, 30% trochanteric region, and 44% at Ward's triangle, and postmenopausal controls by 17% lumbar spine, 16% femoral neck, 17% trochanter, and 14% Ward's triangle. There was a clear trend to reduction in mean BMD between osteoporotic groups 1 and 4 at all four measured sites with significant differences at the spine of 0.102 g/cm2 (P < 0.01) and Ward's triangle 0.059 g/cm2 (P < 0.01). When compared with premenopausal controls, there was a reduction in mean BMD between osteoporotic groups 1 and 4 of 10% at the lumbar spine, 7% femoral neck, 8% trochanteric region, and 13% Ward's triangle. Receiver operating characteristic analysis showed no significant differences in diagnostic sensitivities among the four measured sites for vertebral fractures. We conclude from this cross-sectional data that the majority of bone loss in spinal osteoporosis occurs before the onset of fractures.
Absorptiometry, Photon↗