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PubMed1989

Clinical induction of bone repair with demineralized bone matrix or a bone morphogenetic protein.

Treatment of orthopaedic lesions through induction of bone regeneration has produced promising results in laboratory animals and preliminary human trials. Both demineralized bone powder and bone morphogenetic protein (BMP) are being used clinically to treat bony defects without the need for an autogenous bone harvesting procedure. The historical perspective and laboratory rationale for osteoinduction is presented, as well as current and future clinical applications of demineralized bone powder and BMP.

Animals↗
PubMed1991

Bone-cell changes in estrogen-induced bone-mass increase in mice: dissociation of osteoclasts from bone surfaces.

Early studies in certain avian and mammalian species have described estrogen-associated bone-cell changes, which were based on bone cells that were neither quantified nor identified histochemically (osteoclasts). In the experiments described here, weanling female mice were given a pharmacological dose of 17 beta-estradiol benzoate (1 mg/week) for 1 and 4 weeks, and changes in osteoclasts and osteoblasts were assessed in tibial metaphyses and diaphyses. In the proximal metaphysis, the number of osteoclasts/mm surface length was significantly reduced by estrogen at 1 week (43%) and 4 weeks (64%), which was accompanied by significant increases in the number of osteoclasts in the marrow space not in contact with bone surfaces (no./mm2: 382% and 999%, respectively). These increases, along with observations of decreased osteoclast size (19%), of changes in osteoclast morphology, and of numerous acid-phosphatase-positive fragments in the marrow space, suggest that estrogen treatment causes the dissociation and disintegration, and thus decreased activity, of osteoclasts. The above changes were accompanied by more than 48% increases in the number of trabecular osteoblasts. In the diaphysis, the number of endosteal osteoclasts was significantly decreased by estrogen at 1 week (32%), but was not significantly changed at 4 weeks. These changes were attended by significant increases in the number of osteoclasts in the marrow space not in contact with bone surfaces (no./mm2: 393% at 1 week and 342% at 4 weeks). The number of endosteal osteoblasts was also increased by estrogen at 1 week (132%), and so was the size of endosteal osteoblasts (39% at 1 week and 81% at 4 weeks). Comparable results were obtained when a lower dose of 17 beta-estradiol benzoate (20 micrograms/week) was given to ovariectomized mice. The increase in bone mass and its associated cell changes following estrogen treatment were also found in athymic nude mice, suggesting that these bone/bone cell changes are independent of the thymus.

Animals↗
PubMed2003

Tibial fixation comparison of semitendinosus-bone composite allografts fixed with bioabsorbable screws and bone-patella tendon-bone grafts fixed with titanium screws.

Tibial fixation remains the weak link of ACL reconstruction over the first 8-12 weeks postoperatively. This study compared the biomechanical properties of tibial fixation for a bone-patellar tendon-bone (BPTB) graft and a novel semitendinosus-bone composite (SBC) allograft with mixed cortical-cancellous bone dowels at each end. Seven paired, fresh frozen cadaveric knees (20-45 years) were stripped of all soft tissue attachments and randomly assigned to receive either the BPTB graft or SBC allograft. Grafts were placed into tibial tunnels via a standard protocol and secured with either a 10 mmx28 mm bioabsorbable (SBC) or titanium (BPTB) screw. Grafts were cycled ten times in a servo hydraulic device from 10-50 N prior to pull to failure testing at a rate of 20 mm/min with the force vector aligned with the tibial tunnel ("worst case scenario"). Wilcoxon Signed Rank Tests were used to evaluate biomechanical differences between graft types ( p<0.05). Tibial bone mineral density and interference screw insertion torque were statistically equivalent between graft types. The mode of failure for all constructs was direct screw and graft construct pullout from the tibial tunnel. Significant differences were not observed between graft types for maximum load at failure strength (BPTB=620.8+/-209 N vs. SBC=601.2+/-140 N, p=0.74) or stiffness (BPTB=69.8 N/mm+/-29 N/mm vs SBC=47.1+/-31.6 N/mm, p=0.24). The SBC allograft yielded significantly more displacement prior to failure than the BPTB graft (15.1+/-4.9 mm vs 9.2+/-1.3 mm, p=0.04). Increased construct displacement appeared to be due to fixation failure, with some evidence of graft tissue tearing around the sutures: Bioabsorbable screw (10 x 28 mm) fixation of the SBC allograft produced unacceptable displacement levels during testing. Further study is recommended using a titanium interference screw or a longer bioabsorbable screw for SBC graft fixation under cyclic loading conditions.

Absorbable Implants↗
PubMed1996

Trabecular bone cell proliferation ex vivo increases with donor age in the rat: it is correlated with the extent of bone loss and not with histomorphometric indices of bone formation.

Morphometric parameters of bone formation are markedly depressed in senescent, 21-month old rats and even in middle-aged, 12-month-old animals when compared with mature, 4-month old adults. However, osteoblast-like cells obtained from the metaphyseal trabeculae of the distal femur of 21-month-old female and male rats proliferate more rapidly in primary and secondary cultures than cells from 4-month-old donors. In females the increase in proliferation is significant for donor ages from 4 to 12 months and from 12 to 21 months. Ex vivo cell proliferation is inversely correlated with trabecular bone volume and bone surface in females and with bone surface in males. The relationships are being maintained in females (not tested in males) when cells are grown in serum-free medium. We interpret age and bone loss-dependent stimulated cell proliferation as the in vitro response to an in vivo signal to proliferate resulting from higher strains on less trabeculae. The absence of response in vivo could result from the local deficiency of factors brought back to the cells by the serum-enriched culture medium, or from proliferation inhibitors developing with age.

Aging↗
PubMed2002

Natural variation in the extent of phosphorylation of bone phosphoproteins as a function of in vivo new bone formation induced by demineralized bone matrix in soft tissue and bony environments.

Implants of allogenic demineralized bone matrix were placed in distinct in vivo environments, i.e. calvarial (bony) and subcutaneous (soft tissue) sites. Detailed analyses of the biochemical components were performed. Quantitative levels of osteopontin (OPN), bone sialoprotein (BSP) and calcium phosphate (Ca-P) deposition within each implant environment varied as a function of new bone formation, and were substantially different in samples from calvarial and subcutaneous sites. Quantification of the extent of phosphorylation of affinity-purified OPN and BSP from such implants indicated that: (i) the number of mols of phosphoserine (P-Ser)/mol of affinity-purified OPN or BSP varied as a function of implant time and bone formation within both implant sites, and (ii) the 'effective P-Ser concentration' provided by the total OPN and BSP within each implant site varied and increased as a function of time, being approx. 5-fold higher for BSP in calvarial compared with subcutaneous implants. Peak levels of mols of P-Ser/mol of BSP coincided with maximum rates of Ca-P deposition in calvarial implants. Levels of OPN phosphorylation from both calvarial and subcutaneous implants also indicated fluctuations as a function of bone formation. Hence the present study, for the first time, provides direct evidence of natural variation in the extent of phosphorylation of both OPN and BSP as a function of time of mineralized tissue formation. Further evaluation of the data provides the first evidence of a direct and linear relationship between the rate of Ca-P deposition and the ratio of P-Ser-BSP/P-Ser-OPN for calvarial implants. Data for subcutaneous implants failed to provide such correlation. Overall, the present work demonstrates that the natural biological progression of the process of biomineralization follows strict criteria consistent with the anatomical location. Biomineralization fails to proceed in the same way in a soft tissue environment.

Animals↗
PubMed2001

A bone replaceable artificial bone substitute: osteoinduction by combining with bone inducing agent.

Bone inducing agent (BIA) isolated from Saos-2 human osteosarcoma cells was added to an artificial bone substitute composed of 980 degrees C-heated carbonate apatite (CAp) and Type I atelocollagen (AtCol) extracted from bovine tail skins (88/12 in wt/wt %), and a CAp-AtCol-BIA substitute was prepared as an osteoinductive bone substitute. Rat calvaria osteoblasts treated by the isolated BIA demonstrated significantly increased alkaline phosphatase (ALP) activity after 3 days (p < 0.05). In vitro cell attachment and proliferation and ALP activity were investigated for the bone substitute combined with BIA. Osteoblasts cultured onto the surface of the CAp-AtCol-BIA substitute demonstrated remarkable morphological changes such as radial spreading, flattening, and projecting filopodia after 5 days. In comparison with the substitute without BIA, osteoblasts grown in the BIA-combined CAp-AtCol substitute expressed significantly increased proliferation and ALP activity, respectively (p < 0.05). Both the substitutes combined with and without BIA were implanted into artificial defects created in rabbit radii. After 4 weeks, the CAp-AtCol-BIA substitute implanted lesion was completely replaced by regenerated host bone in radiological observation whereas the substitute without BIA was partially resorbed. No histologic abnormalities appeared in the substitute either with or without BIA.

Alkaline Phosphatase↗
PubMed2004

Enhancement of bone volume in guided bone augmentation by cell transplants derived from periosteum: an experimental study in rabbit calvarium bone.

Bone morphology is genetically encoded and it is usually difficult to change its structure without invasive surgery. We have tried to stimulate bone augmentation by a combination of guided bone regeneration techniques and cell transplants with collagen scaffolds for the suitable skeletal framework. In vitro-expanded tibia periosteum cells were used to promote osteogenesis with collagen scaffolds and titanium (Ti) or poly-L-lactic acid (PLLA) caps as barriers to create a space facing connective tissue under calvarium skin. This approach was assessed in the defective skull bone of a rabbit model. After a 12-week healing period, histomorphometric analyses were performed to determine the percentage of newly formed mineralized tissue in the cap. The mean percentage of newly formed mineralized tissue within the cap was 15.4%+/-3.99 for the Ti cap group, 15.5%+/-4 for the PLLA cap group, 6.19%+/-4.94 for the PLLA cap+collagen carrier group and 23.1%+/-23.1 for the PLLA+collagen carrier+cell transplants group. The cell transplant group showed a significantly higher value than other groups (P<0.05, Wilcoxon signed rank test, Mann-Whitney U-test). This approach of guided bone augmentation and cultured cell transplants with collagen carrier exhibited significantly greater morphogenesis of mineralized tissue than the control over a 12-week experimental period.

Alkaline Phosphatase↗
PubMed1992

Resistant nonunions and partial or complete segmental defects of long bones. Treatment with implants of a composite of human bone morphogenetic protein (BMP) and autolyzed, antigen-extracted, allogeneic (AAA) bone.

Twenty-five patients with resistant nonunions including partial or complete segmental defects were treated with a composite alloimplant of human bone morphogenetic protein (h-BMP) and autolyzed, antigen-free, allogeneic bone (AAA). The series consisted of 16 females and nine males; average age was 45 years. Preoperative symptoms averaged 30 months (range, five to 83 months); 22 of 25 patients had failed multiple attempts at electrical stimulation. Twenty-three of 25 patients had an average of three prior failed surgical attempts at union (range, one to ten). There were ten segmental defects with an average length of 4 cm (range, 2-9 cm). The composite implant was incorporated as an onlay in 15 extremities and as an inlay graft supported by internal fixation in ten extremities. Seven patients received supplementary autogeneic cancellous bone grafting. Average healing time was six months (range, three to 14 months). Average follow-up time was 21 months (range, five to 82 months). Functional results were rated as excellent, 14; good, five; and fair, five. One failed to unite because of a recurrent infection. Union was obtained in 24 of 25 patients. There were five failures of the original operation that required reoperations; union eventually occurred in four of five extremities by repeat composite grafting and replacement of the failed internal fixation. Bony union between host bone and the composite implant began at an average of eight weeks postoperatively. Present results indicate that h-BMP/AAA composite implants represent adjunctive treatment of difficult nonunions. The h-BMP/AAA composite implants may be implanted in either partial or complete segmental defects of long bones.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Quantitative evaluation of the relation between bone mass of the metacarpal bone and bone mineral content of the forearm in normal persons and patients with chronic renal failure before and after kidney transplantation].

Twenty-seven healthy normal subjects, 30 non-dialyzed patients with chronic renal failure, 25 hemodialyzed patients on chronic hemodialysis, and 54 renal transplant recipients were evaluated simultaneously with regard to a correlation between the bone mineral content of the forearm and the total cortical thickness and area of the second left metacarpal bone. A significant correlation was found between bone mineral content of the forearm and the cortical bone mass of the metacarpal bone in normal subjects and in the patient groups.

Adult↗
PubMed2006

Intraoperative fracture of patellar bone plug during anterior cruciate ligament reconstruction with bone-patellar tendon-bone: clinical case.

The authors report the case of intraoperative fracture of the patellar bone plug during an operation to reconstruct an anterior cruciate ligament using bone-patellar tendon-bone. This complication, known among the problems of reconstructing the anterior cruciate ligament, is usually reported when using interference screws to block the plug at the femoral level. In the case, we describe the fracture event occurred using cross-pins. The post-operative 3D radiographic reconstruction permitted precise localisation of the position of the detached bone fragment.

Adult↗
PubMed2003

The value of bone marrow scintigraphy using 99mTc monoclonal antigranulocyte antibodies in complement to bone scintigraphy in detecting bone metastases from primary breast cancer.

This prospective study evaluates bone marrow scintigraphy (BMS) in detecting bone metastases from primary breast cancer when performed in complement to conventional bone scan (BS). Sixty women predominantly with low-stage disease underwent BS followed by BMS within 1-35 days using BW250/183 antigranulocyte antibodies. A receiver operating characteristic (ROC) analysis was performed to compare BS to BS+BMS on a patient-by-patient basis using a 'gold standard' composed of subsequent computed tomography, magnetic resonance imaging, X-ray or BS examinations and at least a 12 month follow-up. Metastases were present in eight out of 60 patients (13%). Specificity was improved by BS+BMS compared to BS alone (90%, 65%) as well as positive predictive value (62%, 27%), accuracy (87%, 72%), positive (10.4, 2.4) and negative (0.20, 0.00) likelihood ratios. Sensitivity (100%, 88%) and negative predictive value (100%, 97%) were similar for BMS+BS and BS alone. As a result of BMS, clinical management was modified in 15 patients (25%). In conclusion, BMS supplements BS by improving specificity, positive predictive value and accuracy in detecting breast cancer bone metastases. The ROC curves show improved specificity for BS+BMS at the same sensitivity compared to BS alone. Consequently, BMS may be useful in low-stage subjects with positive or equivocal BS for metastases.

Adult↗
PubMed2006

An in vitro biomechanical comparison between prototype tapered shaft cortical bone screws and AO cortical bone screws for an equine metacarpal dynamic compression plate fixation of osteotomized equine third metacarpal bones.

OBJECTIVES: To compare biomechanical properties of a prototype 5.5 mm tapered shaft cortical screw (TSS) and 5.5 mm AO cortical screw for an equine third metacarpal dynamic compression plate (EM-DCP) fixation to repair osteotomized equine third metacarpal (MC3) bones. STUDY DESIGN: Paired in vitro biomechanical testing of cadaveric equine MC3 with a mid-diaphyseal osteotomy, stabilized by 1 of 2 methods for fracture fixation. ANIMAL POPULATION: Adult equine cadaveric MC3 bones (n=12 pairs). METHODS: Twelve pairs of equine MC3 were divided into 3 groups (4 pairs each) for (1) 4-point bending single cycle to failure testing, (2) 4-point bending cyclic fatigue testing, and (3) torsional single cycle to failure testing. An EM-DCP (10-hole, 4.5 mm) was applied to the dorsal surface of each, mid-diaphyseal osteotomized, MC3 pair. For each MC3 bone pair, 1 was randomly chosen to have the EM-DCP secured with four 5.5 mm TSS (2 screws proximal and distal to the osteotomy; TSS construct), two 5.5 mm AO cortical screws (most proximal and distal holes in the plate) and four 4.5 mm AO cortical screws in the remaining holes. The control construct (AO construct) had four 5.5 mm AO cortical screws to secure the EM-DCP in the 2 holes proximal and distal to the osteotomy in the contralateral bone from each pair. The remaining holes of the EM-DCP were filled with two 5.5 mm AO cortical screws (most proximal and distal holes in the plate) and four 4.5 mm AO cortical screws. All plates and screws were applied using standard AO/ASIF techniques. Mean test variable values for each method were compared using a paired t-test within each group. Significance was set at P<.05. RESULTS: Mean 4-point bending yield load, yield bending moment, bending composite rigidity, failure load and failure bending moment of the TSS construct were significantly greater (P<.00004 for yield and P<.00001 for failure loads) than those of the AO construct. Mean cycles to failure in 4-point bending of the TSS construct was significantly greater (P<.0002) than that of the AO construct. The mean yield load and composite rigidity in torsion of the TSS construct were significantly greater (P<.0039 and P<.00003, respectively) than that of the AO construct. CONCLUSION: The TSS construct provides increased stability in both static overload testing and cyclic fatigue testing. CLINICAL RELEVANCE: The results of this in vitro study support the conclusion that the EM-DCP fixation using the prototype 5.5 mm TSS is biomechanically superior to the EM-DCP fixation using 5.5 mm AO cortical screws for the stabilization of osteotomized equine MC3.

Animals↗
PubMedDate not supplied

[Bone mass, bone metabolism, and prevalence of spinal fractures in recipients of allogenic bone marrow transplantation for leukemia].

The aim of this study was to evaluate in 65 patients, who had previously undergone allogenic bone marrow transplantation (ABMT), the bone mineral density (BMD), the skeletal turnover and the prevalence of vertebral fractures. At the moment of recruiting, 10 of 65 transplanted subjects (15.3%) presented with signs of rejection of the transplanted tissue, thus they were excluded. The remaining 55 patients (21 males, 34 females, mean age 30.8 +/- 6.4 years), with a follow-up of 60 +/- 9 months after the transplant and without any treatment inducing osteopenia, underwent ABMT respectively for: chronic myeloid leukemia (n = 24); acute myeloid leukemia (n = 18); acute lymphatic leukemia (n = 13). One hundred and ten healthy control subjects (42 males and 68 females, mean age 31.0 +/- 3.7 years) matching with the patients for age, weight and height, were successively enrolled. All the participants were submitted to a densitometric evaluation (DEXA) of lumbar spine (L1-L4), of femoral neck and total femur; besides some skeletal metabolism parameters were dosed, such as: total alkaline phosphatase, bone alkaline phosphatase and urinary excretion of C-terminal telopeptide fragments normalized to creatinine. On the contrary, the morphometric evaluation, performed through a lateral dorsolumbar radiography, was actually carried out only in patients who had already undergone ABMT. The L1-L4 BMD study showed: 10/55 osteoporotic (18.1%), 19/55 osteopenic (34.5%) and 26/55 normal patients (47.4%). In transplanted patients BMD values, obtained at the three considered sites, resulted significantly reduced (p < 0.01) in comparison to controls. Moreover, in patients who underwent ABMT, a statistically significant increase was observed, in comparison to healthy subjects, in total alkaline phosphatase (p < 0.01), in bone alkaline phosphatase (p < 0.01) and in urinary excretion of C-terminal telopeptide fragments normalized to creatinine levels (p < 0.001). Seven of the 55 transplanted patients (12.7%) presented at the moment of Rx morphometric evaluation at least one vertebral fracture: 6 of whom were affected by osteoporosis and 1 by osteopenia. In conclusion, the subjects who had previously undergone ABMT maintain, even at a certain time after the transplant and without any rejection, an increased skeletal turnover and BMD values meanly lower than normal, leading to an increased risk for vertebral fracture.

Adolescent↗
PubMed1999

Centrifugal isolation of bone marrow from bone: an improved method for the recovery and quantitation of bone marrow osteoprogenitor cells from rat tibiae and femurae.

SUMMARY. The high variation often observed in the ex vivo fibroblastic-colony forming unit (CFU-f) assay is likely to be due to both biological and experimental variation. To determine whether we could improve experimental methods we developed an alternative method of bone marrow cell (BMC) isolation employing a centrifugation step. The osteogenic capacity of centrifugally isolated BMC was compared to that of BMC that were isolated using the standard "flushing" technique using the CFU-f assay. The centrifugation method was found to be both quick and simple to perform and allowed simultaneous preparation of all samples. Centrifugally isolated BMC gave rise to approximately 100% more cfu-ap and cfu-f in cultures from both tibiae and femurae. The proportion of alkaline phosphatase positive colonies remained the same and colony morphologies were similar for both isolation methods. Histological comparison of the flushed and spun bones showed that after the flushing procedure many cells remained in the marrow cavity especially in the trabecular area. In contrast, centrifugation completely emptied the marrow space of all cells except bone lining cells and osteoblasts. Thus the osteogenic capacity of the bone marrow can be expressed as the number of CFU-f per bone instead of the frequency as is the norm. Using these methods to isolate BMC for ex vivo investigations should lead to a reduction in CFU-f number variation due to the isolation method. http://link.springer-ny. com/link/service/journals/00223/bibs/65n5p411.html</++ +hea

Animals↗
PubMed2003

Local 3D scaling properties for the analysis of trabecular bone extracted from high-resolution magnetic resonance imaging of human trabecular bone: comparison with bone mineral density in the prediction of biomechanical strength in vitro.

RATIONALE AND OBJECTIVES: A novel, nonlinear morphologic measure [DeltaP(alpha)] based on local 3D scaling properties was applied to high-resolution magnetic resonance images (HR-MRI) of human trabecular bone to predict biomechanical strength in vitro. METHODS: We extracted DeltaP(alpha) and traditional morphologic parameters (apparent trabecular volume fraction, apparent trabecular separation) from HR-MR images of 32 femoral and 13 spinal bone specimens. Furthermore, bone mineral density (BMD) and maximum compressive strength (MCS) were determined. The morphologic measures were compared with BMD in predicting the biomechanical strength. RESULTS: In the vertebral (femoral) specimens, R2 for MCS versus DeltaP(alpha) was 0.87 (0.61) (P < 0.001). Correlation between BMD and MCS was 0.53 (P = 0.05) (0.79 [P < 0.001]) for the vertebral (femoral) specimens. For the femoral specimens, prediction of MCS could be improved further by combining BMD and morphologic parameters by multiple regression (R2 = 0.88). CONCLUSIONS: Morphologic measures extracted from HR-MRI considering local 3D-scaling properties can be used to predict biomechanical properties of bone in vitro. They are superior to 2-dimensional standard linear morphometric measures and, depending on the anatomic location, more reliably predict bone strength as measured by MCS than does BMD.

Adult↗
PubMed1982

Bone formation of transplanted autologous bone matrix in rabbit evaluated by technetium radionuclide bone imaging.

In adult rabbits a 12 mm piece of the radius was bilaterally resected and subsequently decalcified. One piece was placed in one of the radial defects and the other in a skin tube on the back. The other radial defect served as a control. The bone formation process was evaluated by roentgenographic examination and quantified radionuclide bone imaging by technetium diphosphonate scintigraphy at 3 and 6 months postoperatively. Reliability of the scintigraphy method was assessed by means of testing interexamination variability where the same sample was measured twice and where no significant difference was found. In the defect restituted with decalcified bone matrix there was a significantly (p less than 0.01) higher bone formation rate at 3 months postoperatively, with a mean increase of 47% compared to the control side. In the skin tube the implanted matrix showed mineral formation both at 3 and 6 months postoperatively and increased radionuclide uptake compared to the adjacent tissues. Technitium radionuclide imaging was found to be a suitable method for evaluation of the bone formation in these small defects.

Animals↗
PubMed2002

Vitamin D receptor gene polymorphisms, bone mineral density and bone turnover: FokI genotype is related to postmenopausal bone mass.

The relationship between vitamin D receptor (VDR) intragenic polymorphisms FokI, BsmI, ApaI and TaqI and bone mineral density (BMD) or biochemical markers of bone remodeling were investigated in 114 Czech postmenopausal women, on the average 62.5+/-8.9 years of age. Restriction fragment length polymorphisms in the VDR gene were assessed by PCR amplification and digestion with restriction enzymes FokI, BsmI, ApaI, and TaqI recognizing polymorphic sites in the VDR locus. Bone mineral density was measured at the lumbar spine and at the hip by dual-energy X-ray absorptiometry (DEXA, g/cm2). After adjusting for age and the body mass index (BMI), subjects with the ff genotype had 9.4% lower BMD at the hip than those with the Ff genotype (p=0.0459, Tukey's test). FF individuals had an intermediate BMD at the hip. A similar pattern of lower lumbar spine BMD was also found in ff individuals, but it did not reach statistical significance. There was no relationship between BsmI, ApaI and TaqI VDR polymorphisms and BMD at any skeletal site. Subjects with Aa (ApaI) genotypes had higher levels of propeptide of type I collagen (PICP) than homozygous AA (p=0.0459, Tukey's test). In FokI, BsmI and TaqI restriction sites the biochemical markers of bone remodeling did not differ by genotype. In addition, no significant difference was observed in VDR genotypic distribution between osteoporotic women and non-osteoporotic controls in the study group. To conclude, the FokI genotype of the vitamin D receptor gene is related to bone mass at the hip in Czech postmenopausal women, whereas the importance of remaining VDR genotypes was not evident.

Aged↗