Osteopenia is a well recognized medical complication of anorexia nervosa (AN). The mechanism of bone loss is not fully understood and there is uncertainty about its management. New markers of bone turnover have been developed. C-terminal type 1 propeptide (PICP) is a measure of bone formation and urinary pyridinolines such as deoxypyridinoline (DPYRX) and serum carboxyterminal crosslinked telopeptide (ICTP) are markers of bone resorption. The aim of this study was to examine these bone markers in patients with AN. Twenty female patients with AN and 12 healthy controls were included in the study. Bone mineral density (BMD) of AN patients was measured by dual energy X-ray absorptiometry (DEXA). Lumbar bone density was significantly reduced in the AN group compared to standardised values of thirty year old adults (t-score 83.2%, S.D. 12.1). Femoral neck bone density showed an even greater reduction (t-score 79.4%, S.D. 13.5). We found a significant negative correlation between femoral BMD and the duration of the illness. Femoral BMD correlated significantly with minimal body weight (r(16) = 0.504, p = 0.033). The markers of bone resorption were significantly higher in the patients with AN compared to the values of the control group (ICTP t(30) = -2.15, p = 0.04, DPYRX t(25) = -2.26, p = 0.033), whereas the markers of bone formation did not differ significantly between the groups. AN appears to be a low turn over state associated with increased bone resorption without concomitant bone formation. This pattern differs from osteopenia in menopausal women and should, therefore, lead to the development of specific therapeutic strategies in AN associated osteopenia. Hormone replacement therapy as well as calcium and vitamine D-supplementation are so far discussed controversially. Long-term treatment studies are warranted.

Adult↗

PubMedDate not supplied

Repeat sudden unexpected and unexplained infant deaths: natural or unnatural?

BACKGROUND: There have been suggestions that when two or three unexpected unexplained infant deaths occur within a family they are more likely to be unnatural than natural. We aimed to estimate the probability that a second infant death is natural versus unnatural. METHODS: The Care of Next Infant programme (CONI) supports parents who have previously had an unexpected and apparently unexplained infant death and is currently available in over 90% of health districts in England, Wales, and Northern Ireland. We studied all deaths in 6373 infants who had completed the CONI programme by December, 1999. After a CONI death, we made detailed enquiries into the previous death and the CONI death, including a family interview, a review of autopsies, and case discussion. FINDINGS: 57 (8.9 per 1000) CONI infants died. Nine deaths were inevitable, and 48 were unexpected. 44 families lost one child, and two families lost two children. Of the 46 first CONI deaths, 40 were natural; the other six were probable homicides, five committed by one or both parents (two criminally convicted). The ratio of 40 natural to six unnatural deaths is 6.7 (95% CI 2.8-19.4). Enquiries identified 18 families with two SIDS(sudden infant death syndrome) deaths and two families with probable covert double homicides (ratio 9.0 [2.2 to 80.0]). There were no convictions in 13 incomplete cases. Families with three deaths are reported. INTERPRETATION: Repeat unexpected infant deaths are most probably natural.

Humans↗

PubMedDate not supplied

Anthropometric characteristics and pulsatile growth hormone secretion patterns in premenopausal and postmenopausal women from Austria.

The intercorrelations between 18 anthropometric variables, describing amount and distribution of subcutaneous fat tissue, and 12 growth hormone (GH) levels which had been obtained at intervals of 2 hours over a period of 24 hours, were tested in 25 premenopausal and 23 postmenopausal women from Austria. The 12 GH levels were included in the analyses because the GH shows typical pulsatile secretion patterns with peak values about midnight. Initially, premenopausal and postmenopausal women showed significantly different secretion patterns of GH; furthermore it became evident that the GH constantly correlated positively, however insignificantly, with stature height, but significantly negatively with all those measures describing amount and distribution of subcutaneous fat tissue. Beyond that the present paper indicates that age and menopausal status have a marked influence on GH secretion patterns. It became evident that, independent of menopausal status, typical association patterns between frequency of GH pulses per 24 hours, as well as the amplitude of the individual bursts and the amount of subcutaneous fat tissue, occur.

Adipose Tissue↗