Biomedical subjects

L R Hedlund

Publications and source records attributed to L R Hedlund.

5 recordsLinked to original sources

PubMed1989

Increased incidence of hip fracture in osteoporotic women treated with sodium fluoride.

There has been controversy as to whether fluoride therapy increases the risk of fracture in the appendicular skeleton. In the present study we compared the incidence of hip fracture in four groups of osteoporotic women: 22 treated with placebo, 17 with fluoride and calcium, 18 treated with fluoride and calcitriol, and 21 with calcitriol alone. Four hip fractures occurred in 3 patients on fluoride and calcitriol, and two hip fractures occurred in 2 patients on fluoride and calcium. No hip fractures occurred in patients receiving either calcitriol alone or placebo. The difference in fracture rates for fluoride versus nonfluoride treatment is significant (p = 0.006). Moreover, the six hip fractures occurring in patients receiving fluoride during 72.3 patient years of treatment is 10 times higher than would be expected in normal women of the same age. The probability of observing six fractures in 2 years is extremely small (0.0003). In four of the hip fracture cases, the history suggested a spontaneous fracture. These findings suggest that fluoride treatment can increase the risk of hip fracture in osteoporotic women.

Aged↗

PubMed1989

The effect of age and menopause on bone mineral density of the proximal femur.

Although the menopause has been associated with increased bone loss at several skeletal sites, it has not previously been noted in the hip, yet estrogen therapy has been reported to reduce the incidence of hip fractures. We investigated the effect of age and menopause on bone loss in the proximal femur by measuring bone mineral density (BMD) of the femoral neck, Ward's triangle, and trochanter by dual-photon absorptiometry in 263 normal women aged 20-84. Multiple regression analyses revealed a significant decrease in BMD of the femoral neck and Ward's triangle with age in both pre- and postmenopausal women (p less than 0.001). In the trochanter the decrease with age was significant only in postmenopausal women (p less than 0.001). Further analysis revealed that BMD decreased faster at all sites in the early postmenopausal years. During the first 6 years postmenopause, the decrease in BMD of the femoral neck and trochanter was 3-10 times higher than the change in the decade prior to menopause. About 20% of the lifetime femoral neck loss and 30% of the trochanteric loss occurred in the early postmenopausal period. It is concluded that both age and menopause are major determinants of BMD in the proximal femur. These findings could explain why estrogen therapy has been reported to prevent hip fracture. The rapid early postmenopausal loss in BMD of the proximal femur demonstrates the importance of starting estrogen replacement therapy immediately after menopause for maximum effect.

Adult↗

PubMed1989

Change in vertebral shape in spinal osteoporosis.

The change in vertebral shape with increasing severity of spinal osteoporosis was studied in 139 women with atraumatic spinal fractures. The anterior height was below the normal range in 570 vertebrae, and the posterior height was below normal in 157 vertebrae. All values below the normal range were defined as fractures. Ninety-eight percent of posterior fractures were associated with anterior fractures. The fractures involved both the anterior and posterior vertebral borders in 58/356 (17%) of the fractured vertebrae in patients with 6 or less fractures, compared with 93/217 (45%) of the fractured vertebrae in patients with 7 or more fractures. The distribution of anterior fractures was biphasic with peak frequencies at T7-T8 and T11-T12. Posterior fractures had a more lumbar distribution, perhaps resulting from higher compressive forces on the posterior vertebral border of the lordotic lumbar spine than on the kyphotic thoracic spine. The mean anterior and posterior height of nonfractured vertebrae in osteoporotics was not significantly different from normal, suggesting that osteoporotics do not have smaller vertebrae than normal subjects.

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PubMed1988

Vertebral morphometry in diagnosis of spinal fractures.

Vertebral morphometry was performed on lateral thoracic and lumbar radiographs of 153 women with a preliminary diagnosis of spinal osteoporosis. Measurements included anterior and posterior vertebral height, width, area, wedge angle, percent reduction of anterior to posterior height (PRH) and percent difference in anterior height between adjoining vertebrae (PDAH). A vertebral fracture was identified if any of the measurements which control for interindividual variation in vertebral size (wedge angle, PRH, PDAH) were below the normal range. Among individuals with mild osteoporosis (0-2 fractures) PDAH identified 86% of the fractures and 95% of the individuals with fractures. Other measurements identified less than 71% of the fractures and less than 80% of the individuals with fractures. Although the results reflect a relative rather than a true sensitivity it appears that PDAH is the better diagnostic measurement for fractures in the earlier stages of spinal osteoporosis.

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PubMed1988

Vertebral morphometry: normative data.

Morphometric measurements of the thoracic and lumbar vertebrae were carried out on spinal radiographs of 150 normal women. A normal range was established for each individual vertebra. There was no change in the anterior height of the thoracic or lumbar vertebrae with age but there was a small significant decrease in the posterior height of the lumbar vertebrae with age. This is unlike the pattern seen in osteoporotics in whom a decrease in anterior height of the vertebrae is the first clinical manifestation of spinal osteoporosis. At the present time diagnosis of an osteoporotic spinal fracture is usually based on a subjective decision. Normative data for the vertebral dimensions should help improve the accuracy of diagnosis.

Adult↗