[The prevention of osteoporosis].
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Bone Density↗
Biomedical subjects
R Willvonseder
Publications and source records attributed to R Willvonseder.
Bone turnover markers and sex hormones in men with idiopathic osteoporosis.
BACKGROUND: In contrast to osteoporosis in postmenopausal women, osteoporosis in men has received much less attention. PATIENTS AND METHODS: We determined various biochemical parameters of bone metabolism and sex hormones in 31 men with idiopathic osteoporosis and 35 age matched control subjects. RESULTS: In the men with osteoporosis, a significantly increased urinary excretion of deoxypyridinoline (5.3 +/- 0.2 vs. 4.6 +/- 0.2 nmol mmol-1 creatinine; P = 0.033) in addition to increased serum levels of the c-terminal telopeptide of type I collagen (2677 +/- 230 vs. 2058 +/- 153 pmol; P = 0.037) were found. While parameters of bone formation were not significantly different in the patients and controls, serum bone sialoprotein levels were significantly decreased in the patients (3.7 +/- 0.8 vs. 12.4 +/- 4.0 ng mL-1; P = 0.021). Moreover, in men with idiopathic osteoporosis, lower levels of estradiol (91.3 +/- 5.8 vs. 114.6 +/- 7.8 pmol L-1; P = 0.044), higher levels of sex hormone binding globulin (31.5 +/- 3.1 vs. 24.2 +/- 1.4 nmol L-1; P = 0.034) and a decreased free androgen index (42.6 +/- 5.2 vs. 56.4 +/- 5.9; P = 0.016) were seen. Serum estradiol levels correlated negatively with several parameters of bone resorption. CONCLUSIONS: In men with idiopathic osteoporosis, bone resorption is increased and exceeds bone formation. The excessive bone resorption seen in idiopathic male osteoporosis may be due to decreased estradiol levels and low levels of bioavailable testosterone.
Adult↗
Gender differences in fracture risk and bone mineral density.
We have investigated gender-related differences of bone mineral density and fracture threshold in 136 males (age, 60.7+/-9.3 years) and 337 females (age, 59.7+/-7.8 years) without evidence of secondary osteoporosis. Women and men were examined for total amount of spine fractures and bone mineral density by quantitative computed tomography (QCT) of three non-fractured vertebral bodies L1-L5. Females with lumbar fractures (n=96) when compared with non-fracture women (n=241) were older and had lower bone density at their vertebral sites. Males with vertebral fractures (n=52) were older and had a significantly reduced bone mineral density of the spine when compared with healthy males (n=84). When we compared gender-related vertebral fracture rates, we observed a significantly higher prevalence of vertebral fractures in the male population. After matching males and females for age and bone mineral density to exclude an influence of either variable, we compared the prevalence of vertebral fracture risk in both sexes with logistic regression analysis. Data of estimated fracture risk, differed very significantly for sex and bone density at the vertebral site, indicating that men present fracture at a higher bone density level compared with females; in 10% of study population fractures occurred at a QCT level of 105 mg/cm(3) in women and 120 mg/cm(3) in men. The estimated odds ratio for sex of 3.1 (95% CI) means a three-fold increased risk for vertebral fractures compared to males at a given density level. These results underline that a decreased bone mineral density leads to the occurrence of spine fractures in females and males as well.
Aged↗
[Osteoporosis in the male].
BACKGROUND: Osteoporotic fractures occur frequently also in men. Epidemiologic data from Germany indicate that more than 900,000 men are affected by osteoporotic fractures. Diagnosis and therapy of male osteoporosis are hampered by a lack of clinical studies. DIAGNOSIS: Risk factor analysis, conventional spine X-rays, bone densitometry and a limited number of serum and urine analyses contribute to the diagnosis of osteoporosis and the assessment of future fracture risk. Bone densitometry at the femoral neck is superior to measurements at the lumbar spine because of the high prevalence of degenerative changes at the lumbar spine in elderly men. Major risk factors for osteoporosis are hypogonadism, glucocorticoid therapy, hypercalciuria, gastrointestinal disease, and high alcohol consumption. In individual cases, bone histology or additional biochemical studies are needed to establish the cause of osteoporosis. THERAPY: Calcium and vitamin D deficits should be substituted both in prevention and treatment of male osteoporosis. Testosterone replacement therapy is effective in hypogonadism. In primary osteoporosis and in corticosteroid-induced osteoporosis, bisphosphonates (cyclical etidronate, alendronate) and fluorides are therapeutic options. CONCLUSION: Important principles in the care of men with osteoporosis are the transfer of knowledge established for postmenopausal osteoporosis and the rigorous search for secondary osteoporosis aiming at treatment of the underlying cause. Large prospective randomized trials aiming at the reduction of fracture rate in male osteoporosis are missing. They are urgently needed.
Aged↗
[Prevention and prophylaxis of osteoporosis: options and limitations].
Osteoporosis is considered a systemic disease involving decreased bone mineral content and increased fracture risk. Therefore, for young people, adults and also the elderly, any measures have to taken which could prevent fractures. In this respect, clinically, femoral neck fractures are most important, however, in vertebral fractures a rise in morbidity and mortality can also be demonstrated. Radius fractures occurring in advanced age lead to increasing care being required and loss of independence. From today's point of view, it is tried to divide preventive measurements into primary and secondary steps, depending on whether healthy subjects or patients suffering from chronic diseases are affected. To evaluate the fracture risk, apart from anamnesis, bone density measurement and, in recent times, biomarker are suitable for the assessment of bone turnover. As primary prevention, basic lifestyle measures are recommended, in case of a concomitant relevant basic disease secondary prophylaxis is instituted to contain bone mineral loss. The following survey is to show the importance of prevention and of prophylaxis in osteoporosis both for healthy people and for patients with various accompanying diseases, and to list present possible preventive measures.
Adult↗
[Lumbar bone density. Risk factor for vertebral fractures in women].
BACKGROUND AND OBJECTIVE: The direct connections between a reduction in bone density and an increase in the incidence of fractures with increasing age is well known. When interpreting bone density measurements the attending physician is confronted with an overlap of false-positive and false-negative parameters, as is also the case with biochemical data. Aim of this study was to determine, in addition to bone density, a fracture threshold, i.e. a value for bone density with maximal sensitivity and specificity, in a representative cohort of women. PATIENTS AND METHODS: 534 healthy women (mean age 60.9 +/- 8.07, range 40-83 years), seen in an out-patient osteological clinic between 1993 and 1996 were included. After full biochemical investigation to exclude a metabolic bone disease, bone density (LBD) of the lumbar vertebrae 1-5 and the number of vertebral body fractures were documented, together with age and menopausal status. LBD was measured by quantitative computed tomography (qCT), results being analysed with the Wilcoxon 2-sample test and logistic regression and assessed by receiver operating characteristics (ROC) analysis. RESULTS: None of the women with a qCT value over 111 mg/cc had evidence of vertebral fractures. Those with values under 60 mg/cc had at least one vertebral fracture (defined as at least 15% reduction in vertebral body height). There was a highly significant negative correlation between age and LBD (r = -0.56; P < 0.0001), as well as between LBD and the number of fractured vertebrae (r = -0.58, P < 0.0001). But there was no longer any correlation between age and number of vertebral body fractures once allowance was made for LBD (r = 0.001, not significant). The least overlap of false-positive and false-negative values was at an LBD with qCT values of 102 mg/cc. CONCLUSIONS: LBD is the determining variable for fracture risk independent of age. Despite an overlap of false-positive and false-negative LBD values, the probability of fractures can be predicted from bone mineral content.
Adult↗
The effect of age on the transendothelial migration of human T lymphocytes.
Since the migration of immunologically active cells into perivascular tissue is an important step in acute and chronic inflammation, the authors studied the possible influence of age on the transendothelial migration of T cells in an in vitro model. After incubation on collagen gels coated with human endothelial cells, three populations of T cells of elderly and young subjects were harvested: non-adherent (NAD), bound (BND) and migrated (MIG) cells. The percentages of the BND and MIG fractions were similar in the young and elderly groups. Phenotypic analysis showed that in the starting population of the elderly subjects T-cell subpopulations that have an increased capacity of transendothelial migration (e.g., CD4+ memory cells, CD8+/CD57+ cells) were enriched: nevertheless ageing was not associated with an increase in the transendothelial migration of T cells.
Adult↗
Differential expression of various T cell surface markers in young and elderly subjects.
The purpose of this study was to investigate the expression of lymphocyte markers in the peripheral blood of aged individuals and of young healthy blood donors. Results showed significant changes in the distribution of various T cell subpopulations. The CD3, CD4 and CD8 surface expression was not different in the elderly patients when compared to the young subjects. The number of CD4+ T cells expressing CD45 RO isoform (memory cells) was increased in aged people; CD45 RA+ CD4+ cells (naive cells) were decreased. The expression of the CD45 RB on the CD4+ cells was significantly lower in the elderly when compared to the young subjects. In contrast, the surface expression of CD45 RO and CD45 RB in the CD8+ cells was not statistically different in the young and aged subjects. The proportion of CD8+ cells coexpressing CD57 was significantly increased in the elderly subjects. These results indicate age-dependent alterations of various surface markers of T cells. These observations may be of importance in the investigation of immunoregulatory mechanisms in geriatric patients with infection, autoimmune disease or cancer.
Adult↗
Risk of vertebral fractures in men: relationship to mineral density of the vertebral body.
OBJECTIVE: Vertebral fracture is the most frequent manifestation of osteoporosis in women. Because there is a lack of information about bone density and the occurrence of fractures in men with osteoporosis, we evaluated the relationship between vertebral fractures and spinal bone mineral density (BMD) to determine if there is a threshold of BMD below which fractures are likely to occur. SUBJECTS AND METHODS: Radiographs of the spine and BMD measurements of the lumbar spine as measured by quantitative CT were obtained in 201 men 21-86 years old (mean age, 68 +/- 4 years) who were referred consecutively for osteoporosis screening. Radiographs were interpreted for the presence or absence of vertebral fractures. The probability of fractures was determined after classifying the patients into subgroups according to their quantitative CT values. The relationship of spinal bone mass to spinal fracture was examined by both logistic regression and receiver operating characteristic (ROC) analysis. RESULTS: Seventy-one patients were classified as having definite vertebral compression fractures. Spinal BMD was 132 +/- 34 mg/ml for the 130 men without vertebral fractures and 75 +/- 22 mg/ml for the 71 men with vertebral fractures (p < .001). The number of fractures per patient and the BMD were negatively correlated (r = -0.71, p < 0.0001). When a BMD of 100 mg/ml was given as a fracture threshold, 15% of the patients without fractures were below this value and 14% of the patients with fractures were above this threshold. Quantifying the overlap between values from patients with and without fractures by ROC analysis, the value of 100 mg/ml gave a sensitivity of 86%. Logistic regression showed 105 mg/ml as the most discriminate value, resulting in a sensitivity of 90%. Logistic regression analysis of the predicted fracture probability also indicated that age does not significantly influence the regression curve. CONCLUSION: We found that direct quantitative CT measurement of the BMD of the vertebral body is a highly efficient approach to distinguish men without vertebral fractures from those with fractures. Thus, a fracture-threshold concept could provide a quantitative criterion to identify men at high risk for vertebral fractures.
Adult↗
[Evidence of fluoride-induced effects on the calcaneus by measurements of broadband ultrasound attenuation (BUA)].
We measured broadband ultrasound attenuation (BUA) of the calcaneus as well as radial (RBD) and spinal bone density (SBD) in normal and osteoporotic females (n = 188) both before treatment and after long-term fluoride therapy. RBD was measured using single photon absorptiometry of the non-dominant distal forearm (SPA) and spinal bone density (SBD) was assessed using quantitative CT (QCT). In untreated osteoporotic patients (n = 62), BUA as well as the other densitometric methods showed significantly lower values (p < 0.05) when compared to age matched controls (n = 75). Females with osteoporosis and long-term treatment with fluoride (n = 51) had both significantly higher BUA values and higher spinal bone density when compared to women with untreated osteoporosis. BUA and SBD were correlated in the entire group (r = 0.5, r < 0.0001) as well as in the subgroups of untreated (r = 0.48, p < 0.001) and fluoride-treated patients with osteoporosis (r = 0.4, p < 0.05). These results suggest that BUA provides further evidence of an osteogenic response to fluoride at peripheral weight-bearing skeletal sites such as the calcaneus.
Absorptiometry, Photon↗
Influence of sex and age on biochemical bone metabolism parameters.
Age-related changes in bone metabolism are of interest in the pathogenesis of postmenopausal and senile osteoporosis; however, data in the literature give conflicting results. Thus, the aim of our study was to measure serum levels of osteocalcin, a specific biochemical parameter of bone formation, as well as serum levels of midregional parathyroid hormone (PTH) and alkaline phosphatase in healthy males and females of various age groups. We studied 155 healthy subjects (91 females, 64 males, mean age: 43 years, age range: 20-81 years). Serum levels of osteocalcin, alkaline phosphatase and PTH increased with age and were significantly higher in the postmenopausal than in the premenopausal females (osteocalcin: 8.7 +/- 0.4 vs. 6.5 +/- 0.3 ng/ml, p < 0.0001; alkaline phosphatase: 126 +/- 7 vs. 89 +/- 5 U/l, p < 0.0003; PTH: 111 +/- 10 vs. 61 +/- 9 pmol/l, p < 0.0001). In contrast, serum levels of osteocalcin, alkaline phosphatase and PTH were similar in the male subjects above or below the age of 50 years (osteocalcin: 6.5 +/- 0.5 vs. 7.2 +/- 0.4 ng/ml, non significant; alkaline phosphatase: 104 +/- 8 vs. 105 +/- 5 U/l, non significant; PTH: 59.6 +/- 6 vs. 61 +/- 5 pmol/l, non significant. Serum calcitonin levels were significantly lower in postmenopausal women and men above 50 years of age. Our data suggest different age-related alterations in bone metabolism in males and females. The increased levels of osteocalcin, alkaline phosphatase and PTH in postmenopausal females give evidence of increased bone turnover in these subjects. In healthy men bone-specific markers remained unchanged, indicating no relationship between bone turnover and age.
Adult↗
The influence of partial gastrectomy on biochemical parameters of bone metabolism and bone density.
Since it has been suggested that gastric resections are followed by changes in bone metabolism, the aim of our study was to determine the biochemical parameters of bone metabolism and radial and lumbar bone density in 15 male ulcus patients treated by partial gastrectomy (Billroth II). Comparing the data with those of a corresponding control group, the lumbar bone density measured by quantitative computed tomography was statistically significantly lower (P less than 0.04) in the patient group, whereas the peripheral bone mass of the distal part of the nondominant forearm measured by single-photon absorptiometry showed no statistically significant difference. In addition, a marked increase in alkaline phosphatase (P less than 0.002) and urinary excretion of hydroxyproline (P less than 0.003) was found in gastrectomy group, whereas the 25-hydroxy-vitamin D levels were found to be significantly decreased (P less than 0.04). Osteocalcin, a biochemical marker for osteoblast activity, and the carboxy-terminal propeptide of type I procollagen (PICP), a marker of collagen formation, were slightly but not significantly higher in gastrectomy-treated patients. The serum parathyroid hormone levels were similar in both groups. As none of the patients had any radiologic evidence of osteopenia, the changes in biochemical parameters of bone metabolism and bone mass in patients who had undergone partial gastrectomy could be a marker of latent bone loss.
Absorptiometry, Photon↗
Bone mass and biochemical parameters of bone metabolism in men with spinal osteoporosis.
With advancing age both sexes have an increased incidence of osteoporotic fractures, although fractures are more common in women than in men. Whereas in women several potential risk factors have been identified, less is known about osteoporosis in men. A total of 27 Austrian men (mean age: 65 +/- 2 years) with atraumatic spine fractures were studied. In all patients, medical history gave no evidence of disease or medications causing osteoporosis. Peripheral bone mass was determined by single-photonabsorptiometry on the distal non-dominant forearm; lumbal bone density was measured by quantitative computed tomography. Serum levels of calcium, phosphate, alkaline phosphatase, osteocalcin, testosterone, estrogen, parathyroid hormone and 25-hydroxy-vitamin D as well as 2-h-urinary-OH proline and calcium excretion were measured. All data were compared with those of an age and sex matched control group consisting of 19 healthy males. A significant difference in mean peripheral and axial bone mass (SPA: P less than 0.004; QCT: P less than 0.0001) was observed between osteoporotic men and controls. When compared to controls, serum levels of alkaline phosphatase (P less than 0.012), urinary OH proline (P less than 0.05) and urinary calcium excretion (P less than 0.003) were significantly higher in the osteoporotic males. Additionally, there was a significant positive correlation between serum alkaline phosphatase and urinary OH proline excretion (r = 0.32; P less than 0.04) in the osteoporotics. All other biochemical parameters showed no significant differences. Our results may lead to the assumption that osteopenia in men is related to increased bone turnover.
Aged↗
The spine deformity index in osteoporosis is not related to bone mineral and ultrasound measurements.
In 34 female patients suffering from osteoporotic vertebral compression fractures, the spine deformity index (SDIM) was determined, according to the method of Minne et al (1988), to reflect the radiological severity of established osteoporosis. Peripheral (single-photon absorptiometry (SPA) of the non-dominant distal forearm) and axial (quantitative computed tomography (QCT) of the lumbar spine) bone mineral measurements, as well as the broadband ultrasound attenuation of the os calcis, were performed in the osteoporotic patients and in a control group of 20 age-matched women. No correlation could be found between bone mineral measurements and radiological severity of osteoporosis, expressed as SDIM. All three densitometry methods showed clearly reduced values in patients with vertebral crush fractures. Correlations established in the control group between peripheral and axial bone mass (SPA versus QCT) could no longer be found in the osteoporotic group, thus indicating changes in bone mineral density of the spine after the occurrence of osteoporotic fractures. Our data show that SDIM is an additional parameter of osteoporotic change in the spine, independent from bone mass measurements. In the management of osteoporotic patients, quantitative radiological methods (i.e. SDIM) in addition to densitometry might be of value for grading and monitoring the progress of disease.
Absorptiometry, Photon↗
Peripheral and axial bone mass in Austrian free climbers.
The present investigation was carried out in healthy white adult males to determine the effects of exercise, in the form of free climbing, on peripheral and axial bone mass. 13 men who have been regularly engaging in alpine free climbing for a mean period of nine years and, for training purposes, have been performing additional muscle building exercises (4.5 h +/- 1 SEM per week) and 12 age matched controls were included in the study. Bone mineral content of the non-dominant distal forearm was measured by single-photon absorptiometry, and bone mineral density of the lumbar spine was determined by quantitative computed tomography. It was found that consistent exercise in the form of alpine free climbing was associated with increased bone mass of the lumbar spine (162.4 +/- 4.4 vs 184.8 +/- 7.9 mg/ml, p less than 0.025). Peripheral bone mineral content of the distal forearm was slightly but not significantly increased in the free climbers (55.4 +/- 9.0 vs 61.1 +/- 7.4 Units, p less than 0.09 N.S.). The study provides additional evidence that exercise in the form of alpine climbing, is associated with increased lumbar bone mass.
Absorptiometry, Photon↗
Decreased peripheral bone mineral content in patients under anticoagulant therapy with phenprocoumon.
In experimental and clinical studies, conflicting results regarding the effect of oral anticoagulant therapy on bone metabolism have been reported. To measure a possible influence of long-term anticoagulant therapy with phenprocoumon on peripheral bone mass, measurements of peripheral bone mineral content (BMC) and serum osteocalcin levels were performed with single photon absorptiometry in a total of 78 patients on anticoagulant treatment. We studied 43 women (mean age 66 years +/- 2 SEM) and 35 men (mean age 65 years +/- 2 SEM) with a median duration of phenprocoumon therapy of 1 year (1-9 years). In all patients, the medical history gave no symptoms of metabolic bone disease, or diseases or medications causing osteoporosis. Both in the male and female groups, mean peripheral BMC was significantly decreased (male: P less than 0.01, female: P less than 0.003) when compared with corresponding controls. Serum OC-levels measured in 16 patients were also significantly lower than those of the controls (P less than 0.02). Our data of decreased BMC and low serum OC-levels indicate reduced bone mass in patients on long-term anticoagulant therapy with phenprocoumon. This may imply an influence of anticoagulants on bone metabolism resulting in decreased bone formation.
Aged↗
Decreased serum osteocalcin levels in patients with postmenopausal osteoporosis.
Osteocalcin is a 49 amino acid non collagenous bone matrix protein which is synthesized by the osteoblasts. The serum levels of osteocalcin have been found to be a specific biochemical parameter of bone formation. We determined the serum levels of osteocalcin, parathyroid hormone, calcitonin and alkaline phosphatase as well as the 2 hour fasting hydroxyproline excretion in 26 patients with postmenopausal osteoporosis and in 24 postmenopausal control subjects. Serum levels of osteocalcin were significantly lower in the patients with postmenopausal osteoporosis than in the control subjects (p less than 0.002). In contrast, serum levels of parathyroid hormone, calcitonin, alkaline phosphatase and the 2 hour hydroxyproline excretion in the patients with postmenopausal osteoporosis and the control subjects were not statistically different. Our data give evidence of a decreased bone formation in patients with postmenopausal osteoporosis.
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Bone mass and bone diminution of the axial and peripheral skeleton in normal and osteoporotic Austrian females.
Measurements of bone mass were performed in 133 healthy Austrian women using the quantitative computed tomography technique of the lumbar spine and single photon absorptiometry of the distal forearm. The data were compared with those of 110 Austrian females with osteoporotic spine fractures. A significant difference in mean bone density of the lumbar spine was observed between normal and osteoporotic patients in every decade, whereas forearm measurements showed statistical differences in the seventh and eighth decade but not in the sixth decade. Compared to age matched controls, bone mass of osteoporotic women showed the following diminution: sixth decade: distal forearm: -12.7%, spine: -46.8%; seventh decade: distal forearm: -19.0%, spine: -36.7%, eighth decade: distal forearm: -15.4%, spine: -33.7%. It appears that postmenopausal osteoporosis involves greater loss of bone in the spine in the first decade after menopause and slows down after this period, whereas loss of forearm bone mineral density (BMD) increases with advancing age.
Absorptiometry, Photon↗