Distinction between initiation and progression of the osteoarthritis process.
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Hip Fractures↗
Biomedical subjects
J Dequeker
Publications and source records attributed to J Dequeker.
Bone tissue composition: biochemical anatomy of bone.
Bone is chemically built up as a mineralized matrix which comprises collagen and a small amount of noncollagenous proteins. This paper points out some useful methods to evaluate the bone composition. Demineralizing extraction of bone powder with EDTA allows the determination of matrix size and degree of extractability. These parameters vary with bone type, anatomical site of the bone, disease, species, and drug treatment. The study of bone particles in situ can be done by separation of bone powder according to their density. A shift of the bone particles to higher density fractions reflects an increased amount of older, more mineralized osteons in the bone with its consequences on the mechanical competence of the bone. Quantity and quality of bone matrix mineralization are related to bone cell activity which can be studied indirectly by further exploration of the composition of the bone matrix. Many noncollagenous proteins are buried in the extracellular bone matrix from where they can be released when bone is resorbed. These proteins can then act on bone cells in an autocrine or paracrine manner. Altered concentrations of noncollagenous proteins in bone matrix are described in three pathological conditions associated with changes in other bone properties: osteoarthritis, osteopenia, and osteogenesis imperfecta. The functional significance and origin of these changes will have to be subjected to further study.
Animals↗
Assessment of quality of bone in osteoporosis--BIOMED I: fundamental study of relevant bone.
Although osteoporosis is the most common bone disease of the Western world, the diagnosis of osteoporosis or risk for osteoporosis remains problematic despite major advances in technology to measure bone mass in recent years. There is a need to perform more fundamental studies on bone in normal and pathological conditions, in order to progress our knowledge and to detect in time patients at risk for osteoporotic fracture. The BIOMED I project "Assessment of Quality of Bone in Osteoporosis" (PL920296) and 116 other projects were chosen out of a total of 1200 proposals by the Commission of the European Communities, Directorate General XII, Science, Research and Development. The present paper outlines the project proposals. European centers with recognised expertise in assessment of bone, micro-macro-structure, biochemistry, geochemistry and biomechanics will concert their findings on ex vivo bone tissue samples, with the aim to discover a new assessment or combination of assessments for the appreciation of bone quality in vivo. The following modalities for assessment of bone in addition to the established techniques as radiogrammetry, photonabsorptiometry, DEXA, QCT and single photonabsorptiometry, will be incorporated: mechanical testing and fracture mechanics, ultrasound, bone biochemistry, three dimensional imaging, NMR spectroscopy and MRI. Special attention will be given to the standardization of ultrasound velocity and attenuation measurements in a working group bringing together the expertise of 10 centers.
Bone and Bones↗
A familial syndrome of dwarfism, bilateral club feet, premature aging and progressive panhypogammaglobulinemia.
We describe a 47-year-old woman with an unusual combination of clinical signs and symptoms: short stature, oldish appearance with distinct craniofacial stigmata, talipes equinovari with adduction position of the forefeet, subluxations of the interphalangeal joints of hands and toes, carpal synostosis and progressive panhypogammaglobulinemia. Partial expression of the syndrome could be documented in different members of this family over 5 generations. Among the different possible differential diagnoses, the possibility of a variant example of Larsen syndrome is discussed.
Abnormalities, Multiple↗
Fluor in the treatment of osteoporosis. An overview of thirty years clinical research.
It has long been known that fluoride "hardens" mineralized tissues. Fluoride ingestion through drinking water in areas naturally rich in fluoride leads to osteosclerosis, known as endemic fluorosis. The first suggestion that fluoride be used in the treatment of osteoporosis was made in 1964. However, despite 30 years of research, the treatment remains controversial. Fluoride has a dual effect on osteoblasts. On the one hand, it increases the birthrate of osteoblasts at tissue level by a mitogenic effect on precursors of osteoblasts, while on the other hand it has a toxic effect on the individual cell with mineralization impairment and reduced apposition rate resembling osteomalacia. Fluoride has a positive effect on axial bone density, but the axial bone gain is not matched by similar changes in cortical bone. Furthermore, approximately one third of patients are non-responders. The effect of the addition of fluoride to the drinking water on fracture rate is not clear. It probably only has a small relative impact on total hip fracture rates. In two controlled fluoride therapy studies the incidence of vertebral fractures decreased, while in two other studies it increased. Experience teaches that denser bones are not necessarily better bones. The major side effects of fluor therapy are skeletal fluorosis, gastrointestinal intolerance, and painful lower extremity syndrome. Fluoride is the single most effective agent for increasing axial bone volume in the osteoporotic skeleton; however, its therapeutic window is narrow. The best candidates for fluoride therapy are patients with axial osteoporosis but with good peripheral bone density. They should have a good renal function and vitamin D status.(ABSTRACT TRUNCATED AT 250 WORDS)
Bone Density↗
Generalized osteoarthritis associated with increased insulin-like growth factor types I and II and transforming growth factor beta in cortical bone from the iliac crest. Possible mechanism of increased bone density and protection against osteoporosis.
OBJECTIVE: To investigate whether growth factors stored in bone might explain the increased bone density and resistance to osteoporosis in generalized osteoarthritis. METHODS: Levels of insulin-like growth factor (IGF) types I and II and transforming growth factor beta (TGF beta) were measured in extracts of cortical bone from the iliac crest obtained at necropsy from subjects with or without osteoarthritis of the hands. RESULTS: Concentrations of IGF-I, IGF-II, and TGF beta were significantly higher in extracts of bone powder from subjects in the osteoarthritis group than in extracts from subjects in the control group. CONCLUSION: The results suggest that the increased bone density and resistance to osteoporosis in patients with osteoarthritis may be associated with increased skeletal concentrations of IGF-I, IGF-II, and TGF beta and may reflect a generally increased biosynthetic activity of osteoblasts in these patients.
Aged↗
Mechanical properties, bone mineral content, and bone composition (collagen, osteocalcin, IGF-I) of the rat femur: influence of ovariectomy and nandrolone decanoate (anabolic steroid) treatment.
Nandrolone decanoate (ND) is an anabolic steroid with a positive effect on bone mass in osteoporotic patients. The mechanism of action, (i.e., reduction of bone resorption and/or stimulation of bone formation), the ultimate effect on mechanical properties, and the most effective dosage are not yet clear. To address these issues, dose-related effects of the long-term effect of ND on serum and bone biochemistry, bone mineral content, and bone mechanical properties in ovariectomized (OVX) rats (12 weeks old at the start of the experiment) were studied for 6 months. The results were compared with those obtained in age-matched, intact, and OVX rats. OVX caused in the femur a significant increase in net periosteal bone formation and net endosteal bone resorption of bone collagen content and torsional strength, and of serum alkaline phosphatase, osteocalcin, and insulin-like growth factor-I (IGF-I) levels, whereas cortical bone density and calcium/creatinine and phosphorus/creatinine in 24-hour urine were significantly reduced. Treatment of OVX rats with 1 mg ND/14 days resulted in a significant increase in periosteal bone formation, femur length, cortical and trabecular bone mineral content and density, torsion stiffness and strength, and bone IGF-I content, and a decrease in serum osteocalcin, urinary calcium/creatinine levels, and bone collagen content compared with OVX controls. The higher ND dosage of 2.5 mg/14 days did not improve the results. ND treatment did not reverse all changes induced by OVS to the level of the intact controls. These results indicate that ND acts as an antiresorptive drug and as a home formation stimulating drug.(ABSTRACT TRUNCATED AT 250 WORDS)
Anabolic Agents↗
The relation between resonant frequencies and torsional stiffness of long bones in vitro. Validation of a simple beam model.
The results of vibration analysis experiments and impact torsion tests performed on excised animal long bones were used to validate a simple beam model for the prediction of torsional stiffness from resonant frequencies. Resonant frequency data on two mutually perpendicular bending vibration modes of 142 excised long bones were evaluated. Torsional stiffness of the same bones had been determined by an impact torsion test. Using a simple beam model, a theoretical relation between resonant frequencies and torsional stiffness was derived. If total bone mass and bone length are known, the formula thus derived allows one to calculate torsional stiffness from resonant frequencies. Linear regression analysis shows a strong correlation between the measured and the calculated torsional stiffness for sheep femora (r2 = 0.63, n = 24), dog femora (r2 = 0.94, n = 34), dog tibiae (r2 = 0.79, n = 18) and monkey radii (r2 = 0.77, n = 66). It was found that this linear relation was valid not within one bone type alone. Linear regression analysis on the combined data of all bones demonstrated that all bones obeyed the same global linear relation between measured and the calculated torsional stiffness (r2 = 0.98, n = 142). This implies that one and the same beam model is valid for the different bone types investigated. The calculation of stiffness from resonant frequencies, however, requires total bone mass, m, and length to be known. In view of in vivo applications, the feasibility of using total bone mineral content (TBMC) as a measure for m was investigated.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Osteoarthritis protects against femoral neck fracture: the MEDOS study experience.
The relationship between osteoarthritis and osteoporosis (hip fracture) was studied using the data from the MEDOS study, a large prospective epidemiological study of femoral neck fracture patients and age-matched controls in the Mediterranean area. Osteoarthritis was found to be protective against hip fracture in both men and women, with a significant reduction of the relative risk factor for osteoporosis (relative risk = 0.48 and 0.68, respectively, p < 0.001). The age-adjusted relative risk factor for osteoporosis remains even after adjustment for body mass index, indicating that body mass index and osteoarthritis are independent relative risk factors for hip fracture. The mean age of the group with co-existent osteoarthritis and hip fracture was significantly higher for both men and women, compared to the group with osteoporosis alone. This indicates that if osteoarthritic subjects develop osteoporotic fracture, they do so at a later age. The osteoarthritic cases compared to controls and hip fracture cases were significantly smaller in stature in both sexes, and women had a significantly higher body weight and body mass index. Extra-capsular hip fracture was significantly more frequent in cases with concomitant osteoarthritis. These findings confirm earlier observations that osteoarthritis and osteoporosis are two distinct diseases and not phenomena related solely to aging.
Aged↗
Risk factors for falls as a cause of hip fracture in the elderly.
Almost all epidemiologic studies have shown that the age-adjusted incidence of osteoporotic hip fracture has been increasing during the last decades. Although the age-related bone loss is considered to be a crucial determinant of the incidence of hip fracture, spontaneous fractures appear to be uncommon: about 90% of hip fractures in the elderly result from a fall. This article focuses on the different risk factors for falls. Poor health status (especially chronic illness), impaired mobility and postural instability, and a history of prior falls have been associated with the risk of falling. Balance can also be impaired by disease (such as a broad spectrum of ophthalmologic and neurologic disorders) or age-related changes in number of anatomical structures, by medications which reduce their efficient functioning (such as some psychotropic or antihypertensive drugs) and by environmental hazards. The identification of elderly patients at risk for falling and intervention to minimize risk without compromising functional independence should receive a high priority in the health care of elderly persons.
Accidental Falls↗
Bone mineral density and osteoarthritis.
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Aged↗
Fractures, physical activity, and growth velocity in adolescent Belgian boys.
The relationship of fractures to physical activity and growth velocity in stature and metacarpal II bone dimensions was investigated in adolescent Belgian boys. Peak fracture incidence occurred between 12 and 14 yr of age and preceded the age at peak height velocity. The peak fracture rate occurred during mid adolescence (+/- 2 SD of the age at peak height velocity) and was twice as high as the rates before and after this period. The majority of fractures occurred during active participation in sports and general physical activities. The age at peak growth velocity for metacarpal cortical thickness, an indirect measure of bone mineral content, was about 6 months later than the ages at peak height velocity and peak growth velocity for metacarpal length. Peak fracture incidence occurred during a period when the amount of time spent in sports physical activity was low compared with later years. A lag in cortical bone thickness and mineralization, relative to linear skeletal growth, and unknown factors associated with active participation in sports, rather than an increase in the amount of physical activity, appear to be the predominant factors associated with the increased fracture incidence in Belgian boys during the growth spurt.
Adolescent↗
Rheumatoid arthritis-like deformities in an early 16th-century painting of the Flemish-Dutch school.
Hand deformities resembling those of rheumatoid arthritis have been depicted in a painting by an anonymous artist of the Flemish-Dutch School, mid-15th to early 16th century. The painting is presently in the Escorial Museum near Madrid, Spain. This observation, like other earlier observations of rheumatoid deformities in paintings of the Middle Ages, suggests that rheumatoid arthritis is not a modern disease; it had, indeed, appeared several centuries before Landré-Beauvais' description in 1800.
Arthritis, Rheumatoid↗
[Prevention and treatment of osteoporosis].
Despite the fact that osteoporosis is a common disease and an important cause of morbidity and mortality, that screening tests are available which are safe and acceptable to patients, and that effective therapy is possible, osteoporosis remains a controversial subject. The Dutch Health Advisory Board (Gezondheidsraad) recently submitted to the Ministry of Health a balanced and comprehensive report to remedy this controversial situation. As often in a consensus report made by a variety of experts, completeness is assured but the necessary relevance of the statements and the feasibility of the therapeutic recommendations are not always clear. Based on personal experience, clinical practice and research in osteoporosis, the author formulates a number of messages which complement the report. The following messages are elaborated: osteoporosis is a silent thief; backache during the menopause is not always osteoporosis; detection of the patient at risk for osteoporotic fractures is possible; primary osteoarthrosis protects against osteoporosis; bone densitometry has given osteoporosis a scientific cachet; bones are not stones, effective prevention and treatment are possible, there are alternatives to calcium and hormone replacement therapies. There is still much to learn about osteoporosis and its treatment. Nevertheless, there is a great deal that is known and we need to give the best advice we can in the light of this knowledge.
Bone Density↗
Alterations of the mineralization profile and osteocalcin concentrations in osteoarthritic cortical iliac crest bone.
The relation between bone mineralization and osteocalcin content was investigated in iliac crest cortical bone obtained at necropsy in young females and in two groups of elderly women with and without osteoarthritis of the hands evaluated by X-ray. Using density fractionation technique, the bone was separated into fractions of increasing density from 1.72 to 2.30 g/ml. The mineralization profile revealed a significant shift to higher densities in the osteoarthritis cases compared with young adults (P less than 0.005) and age-sex-matched controls (P less than 0.001). The ash, calcium, and phosphorus content of the bone increased with increasing density of the fractions whereas collagen content, measured as hydroxyproline, decreased. The osteocalcin concentration of each fraction was determined in the supernatants obtained after EDTA-extraction in the presence of protease inhibitors. In the young control and osteoarthritis group, the osteocalcin content in the lowest density fractions was higher compared with the older non-osteoarthritic group. Osteocalcin content of the high density fractions, representing highly mineralized osteons, was the same in the three groups studied. These findings support the hypothesis that quality differences in bone may explain the inverse relationship between osteoarthritis and osteoporosis.
Adult↗
Radiographic findings of spontaneous subluxation of the sternoclavicular joint.
Eight middle-aged women with spontaneous atraumatic subluxation of the sternoclavicular joint were evaluated with radiography and computed tomography. All patients were employed in occupations involving moderate to heavy physical labour, and no patients could recall a specific traumatic incident associated with onset of symptoms. In seven of the eight patients, the displacement of the medial clavicle was in a cranial direction; in four of the eight patients, there was an associated anterior subluxation, and in one patient, the subluxation was purely anterior. All five patients with an anterior component to the sternoclavicular subluxation had associated condensing osteitis of the clavicle. The sclerosis of the medial clavicle is possibly the result of chronic abrasion on the sternum and first costal cartilage in association with normal respiration and with upper extremity motion.
Adult↗
Siebrandus Sixtius: evidence of rheumatoid arthritis of the robust reaction type in a seventeenth century Dutch priest.
Rheumatoid arthritis of the robust reaction type has been diagnosed in a seventeenth century Dutch priest, Siebrandus Sixtius, based on pictorial evidence of typical hand deformities and historical evidence affirming that he had chronic nodular rheumatism for many years. This case report, in conjunction with other pictorial depictions of probable rheumatoid arthritis, questions the view that rheumatoid arthritis is a modern disease which prevailed in the New World and was found in the Old World only after the discovery of America.
Arthritis, Rheumatoid↗
Intranasal calcitonin for the prevention of bone erosion and bone loss in rheumatoid arthritis.
The effect of intranasal salmon calcitonin on pain, erosion progression, and bone loss in 40 women with rheumatoid arthritis was investigated. The study design was double blind, placebo controlled for the first four months and open for the next 36 months, allowing for cross over to active drug treatment or to the control group. Morning stiffness was reduced in the group treated with salmon calcitonin after two and four months. After an average follow up of 28 months no significant effect on erosion progression was observed using the Larsen score. The mean (SD) monthly progressions in the Larsen score in the calcitonin and control groups were 0.21 (0.22) and 0.23 (0.28) respectively. The bone mineral density was evaluated in the forearm and spine. During the 12 months of follow up the control group lost bone at a rate of 2%/year at the spine and 4.8%/year at the radius distal third. In contrast, the group receiving nasal calcitonin gained 1% in bone mineral density at the lumbar spine and no loss at the radius distal third. The increase in bone density at the spine in the calcitonin group was not sustained and a loss of 1.8%/year was observed in the second year. The difference with the placebo group remained significant.
Administration, Intranasal↗