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PubMed2006

Effects of femur position on radiographic assessment of completeness of femoral head and neck excision in medium- to large-breed dogs.

OBJECTIVE: To determine the effect of femur positioning on radiographic assessment of completeness of excision after femoral head and neck excision (FHNE) in medium to large breed dogs. SAMPLE POPULATION: 10 femurs from canine cadavers (body weight > 20 kg). PROCEDURE: Complete FHNE was performed on 5 canine femurs. Excision consisting of inadequate removal of the medial distal aspect of the femoral neck was performed on the remaining 5 femurs. Each femur was positioned with predetermined amounts of internal and external rotation about the long axis and radiographed. Investigators evaluated a set of 8 radiographic views of each femur. Sensitivity (SE), specificity (SP), positive predictive value, negative predictive value, and completeness of excision assessment accuracy were estimated for each of the femur positions. RESULTS: Craniocaudal radiographic views of the femur positioned with external rotation of 15 degrees, 30 degrees, and 45 degrees as a group had the highest SE, SP, and completeness of excision assessment accuracy relative to other radiographic views. The SE, SP, and accuracy of assessment were higher when the degree of external rotation was increased from 15 degrees to 30 degrees or 45 degrees. CONCLUSIONS AND CLINICAL RELEVANCE: Craniocaudal radiographic views of the femur positioned in external rotation (15 degrees, 30 degrees, and 45 degrees) improved the ability to detect adequacy of excision relative to standard craniocaudal and lateromedial radiographic views. Evaluation of craniocaudal radiographic views of the femur positioned in external rotation may increase the ability to assess FHNE adequacy in medium- to large-breed dogs.

Animals↗
PubMed2001

Variation in fetal femur length with respect to maternal race.

We sought to evaluate whether the expected fetal femur length, based on biparietal diameter, varies in second-trimester fetuses with respect to maternal race. The study population was composed of all fetuses scanned from 15 to 20 completed weeks' gestation during a 2-month period (June to August 1998). Maternal race was documented at the time of the ultrasonographic examination. Biparietal diameter and femur length were prospectively documented. The variance from the expected femur length, given the biparietal diameter, was calculated, and the mean variations were compared according to maternal race. The study subgroups were composed of the fetuses of 39 Asian mothers, 31 black mothers, and the first 100 white mothers. The mean values of the variance from the expected fetal femur length by biparietal diameter +/- 1 SD for the various racial groups were as follows: fetuses of Asian mothers, -0.66 +/- 1.64 mm; fetuses of black mothers, 0.88 +/- 1.57 mm; and fetuses of white mothers, 0.13 +/- 1.66 mm (P = .0007). To isolate the differences among the 3 racial groups, the mean values of the variance from the expected femur length by biparietal diameter for the fetuses of Asian and black mothers were compared with the mean value for the fetuses of white mothers (Asian versus white mothers, P = .014; black versus white mothers, P = .026). A significant difference in the mean variance from the expected femur length by biparietal diameter was identified among the fetuses of women in the second trimester with respect to racial group. Less-than-expected femur lengths were noted among the fetuses of Asian mothers, and greater-than-expected femur lengths were noted among the fetuses of black mothers, compared with the femurs of fetuses of white mothers. The implications for the use of fetal femur length as a component of the genetic sonogram in patients of various races require further study.

Asian People↗
PubMed2005

Childhood femur fractures, associated injuries, and sociodemographic risk factors: a population-based study.

OBJECTIVE: The objectives of this study were to determine the incidence of femur fractures in Colorado children, to assess underlying causes, to determine the prevalence and predictors of associated injuries, and to identify potentially modifiable risk factors. METHODS: The study population included all Colorado residents who were aged 0 to 17 years at the time of injury between January 1, 1998, and December 31, 2001. Cases of femur fracture were ascertained using the population-based Colorado Trauma Registry and International Classification of Diseases, Ninth Revision, Clinical Modification codes 820.0 to 821.39. Associated injuries with an Abbreviated Injury Scale of 2 or higher were classified into 5 categories. Poisson regression, small area analysis, and multivariate logistic regression were used to identify predictors of femur fractures and associated injuries, respectively. RESULTS: During the study period, 1139 Colorado children (795 boys, 344 girls) sustained femur fractures, resulting in the incidence of 26.0 per 100000 person-years. Rates were higher in boys than in girls in all age groups (overall risk ratio: 2.19; 95% confidence interval: 1.92-2.47) but did not differ by race/ethnicity. Femur fractures that were caused by nonaccidental trauma showed more distal and combined shaft + distal pattern; their incidence did not differ by gender or race but was higher in census tracts with more single mothers and less crowded households. Associated injuries were present in 28.6% of the cases, more often in older children. Fatalities occurred only among children with associated injuries. Children who were involved in nonaccidental trauma, motor vehicle crashes, or auto-pedestrian accidents were 16 to 20 times more likely to have associated injuries than those with femur fractures as a result of a fall. In small-area analysis, the incidence of femur fractures in infants and toddlers was higher in census tracts characterized by higher proportion of Hispanics, single mothers, and more crowded households. Among children 4 to 12 years of age, the incidence was higher in census tracts with fewer single-family houses and more crowded households. Finally, the incidence of femur fractures among teenagers was higher in rural tracts and those with a higher proportion of Hispanics. CONCLUSIONS: Femur fractures and associated injuries remain a major cause of morbidity in children. Predictors of femur fractures change with age; however, the risk is generally higher among children who live in the areas with lower socioeconomic indicators.

Abbreviated Injury Scale↗
PubMed2001

Osteoporotic fractures of proximal femur: clinical and epidemiological features in a population of the city of São Paulo.

CONTEXT: It is believed that about 25% of menopausal women in the USA will exhibit some kind of fracture as a consequence of osteoporosis. Fractures of the proximal femur are associated with a greater number of deaths and disabilities and higher medical expenses than all the other osteoporotic fractures together. OBJECTIVE: To study the clinical and epidemiological features of patients with proximal femur fracture in hospitals in São Paulo. DESIGN: Transversal and retrospective study. LOCAL: Hospital São Paulo and Hospital Servidor Público Estadual "Francisco Morato Oliveira". PARTICIPANTS: Patients aged sixty-five years or more hospitalized because of proximal femur fracture, from March to November 1996 (N = 73). This group was compared to patients of the same age without fracture of the proximal femur. INTERVENTION: Evaluation of weight, height, body mass index; lifestyle habits (physical activity at home, ingestion of dairy calcium, drinking of coffee, smoking habit), gynecological history (ages at menarche and menopause, number of pregnancies and lactations), previous morbidity, use of medications, history of previous fractures, family history of osteoporosis. MEASUREMENT: The comparison of the different data regarding lifestyle habits between the two groups was made using the chi-squared test. Other data were analyzed using the Mann--Whitney test. P pound 0.05 was considered significant. RESULTS: We noted a predominance of proximal femur fracture among females in relation to males (a female/male ratio of 3.3:1) with a progressive increase in the frequency of proximal femur fracture with age in both sexes. The group with proximal femur fracture, in comparison with the control group, showed a lower body mass index, less physical activity, and a greater number of pregnancies and lactations. Other data were not different. CONCLUSION: In accordance with the literature, we found a predomination of proximal femur fracture in women in relation to men, and a favorable effect of higher body mass index and physical activity for decreasing the frequency of proximal femur fracture. We also discuss the role of pregnancies and lactation on the frequency of proximal femur fracture.

Age Distribution↗
PubMed1996

Measurement and relationship of the inclination angle, Alsberg angle and the angle between the anatomical and mechanical axes of the femur in males.

The present study was undertaken to determine whether there is a constant difference between the angle of inclination and the Alsberg angle and to evaluate statistical relationships between the inclination angle, Alsberg angle and the angle between the anatomical and mechanical axes of the femur. Measurements were taken from 50 male femurs (25 right and 25 left, aged 30-40 years) from the Anatomy Department, Cukurova University: inclination angle was determined between the neck and the shaft of the femur; Alsberg angle, between a line drawn through the base of the epiphyseal plate and shaft of the femur, and the angle between the anatomical and mechanical axes. The results showed that, for the right and left femurs respectively, the average inclination angle was 123.72 degrees and 125.96 degrees; the angle between the anatomical and mechanical axes was 6.24 degrees and 5.96 degrees; and the average Alsberg angle was 39.92 degrees and 40.61 degrees. The difference between the angle of inclination and the Alsberg angle in this study was 83.80 degrees and 85.36 degrees for the right and left femurs respectively. The correlation, coefficient between the angle of inclination and Alsberg angle was 0.96 and 0.93 for the right and left femurs respectively, while those between the angle between the anatomical and mechanical axes and inclination angle were -0.89 and -0.91 for the right and left femurs respectively. Furthermore, the correlation coefficient between the angle between the anatomical and mechanical axes and Alsberg angle were -0.88 and -0.90 for the right and left femurs respectively.

Acetabulum↗
PubMed1999

Alterations in bone remodeling in the femur after medullary reaming and cemented hip arthroplasty in dogs.

OBJECTIVE: To determine whether medullary reaming alone, or followed by cemented hemiarthroplasty, influenced porosity, vascularity, and new bone formation in the proximal portion of the femur in dogs. ANIMALS: 12 adult mixed-breed dogs. PROCEDURE: Unilateral femoral head and neck excisions were performed, followed by femoral medullary reaming in 6 dogs and femoral medullary reaming and cemented hemiarthroplasty in 6 dogs; the contralateral femur was used as a control. All dogs were euthanatized 28 days after surgery, and femurs were harvested. Vascularity, porosity, and new bone formation were quantified for all femurs of dogs from both groups at 3 proximal-to-distal levels, 3 regions (periosteal, midcortical, and endosteal), and 4 quadrants (cranial, caudal, medial, and lateral) of the femur. RESULTS: Medullary reamed and cemented hemiarthroplasty femurs had significant increases in vascularity and porosity at all levels and in new bone formation at levels 2 and 3. Porosity was increased significantly in the periosteal region of the cemented hemiarthroplasty (9.7+/-0.7%), compared with control (2.3+/-0.2%) and medullary reamed (8.4+/-0.7%) femurs. Porosity was increased in the caudal and medial quadrants in the medullary reamed and cemented hemiarthroplasty femurs; vascularity results were similar. CONCLUSION: Increased porosity, vascularity, and new bone formation in reamed and cemented hemiarthroplasty-treated femurs supports the theory that surgical trauma associated with medullary reaming is an important factor in early cortical bone loss after hip arthroplasty. CLINICAL RELEVANCE: Femoral remodeling associated with reaming and broaching is appreciable but may be only a temporary response, whereas other factors may be responsible for chronic cortical bone loss.

Analgesics, Opioid↗
PubMed2001

Ultrasound study of the motion of the residual femur within a trans-femoral socket during daily living activities other than gait.

This study analyses the residual femur motion of a single amputee within a transfemoral socket during a series of daily living activities. Two simultaneously transmitting, socket mounted transducers were connected to two ultrasound scanners. Displacement measurements of the ultrasound image of the femur were video recorded and measured on "paused" playback. Abduction/adduction and flexion/extension of the residual femur within the socket at any instant during these activities were estimated, knowing the relative positions of the two transducers and the position of the residual femur on the ultrasound image. Consistent motion patterns of the residual femur within the trans-femoral socket were noted throughout each monitored daily living activity of the single amputee studied. Convery and Murray (2000) reported that during level walking, relative to the socket, the residual femur extends 6 degrees and abducts 9 degrees by mid-stance while flexing 6 degrees and adducting 2 degrees by toe-off. Uphill/downhill, turning to the right and stepping up/down altered this reported pattern of femoral motion by approximately 1 degree. During the standing activity from a seated position the femur initially flexed 4 degrees before moving to 7 degrees extension, while simultaneously adducting 6 degrees. During the sitting activity from a standing position the femur moved from 7 degrees extension and 6 degrees adduction to 3 degrees flexion and 1 degree abduction. The activity of single prosthetic support to double support introduced only minor femoral motion whereas during the activity of prosthetic suspension the femur flexed 8 degrees while simultaneously adducting 9 degrees. Additional studies of more amputees are required to validate the motion patterns presented in this investigation.

Accidents, Occupational↗
PubMed1996

Effect of neonatal exposure to diethylstilbestrol and tamoxifen on pelvis and femur in male mice.

BACKGROUND: Permanent abnormalities have been reported in reproductive and non-reproductive organs of mice and humans exposed perinatally to a synthetic estrogen, diethylstilbestrol (DES). Recent studies demonstrated that sex hormones affected the shape of the innominate bone in mice. Therefore, we analyzed the long-term effects of neonatal exposure of DES and tamoxifen, an anti-estrogen, in mouse bones. METHODS: Changes in the pelvis and femur were examined in 1- to 15-month-old C57BL/Tw male mice given 5 daily injections of 3 micrograms DES or of 100 micrograms tamoxifen beginning on the day of birth by measuring contents of calcium (Ca) and phosphorus (P), and the numbers of osteoblasts and osteoclasts. RESULTS: The ash weight of pelvis and femur in neonatally DES- and tamoxifen-treated mice was lower than that in the controls at 2-15 months of age. Contents of Ca and P of pelvis and femur in neonatally tamoxifen-treated mice were lower than in the controls and neonatally DES-treated mice. In neonatally DES-treated mice at 6-12 months, Ca and P contents in the pelvis were lower than in controls, but not different in the femur. The number of osteoblasts per unit length of endocortical surface of the femur in 2- and 3-month-old DES- and tamoxifen-treated mice was lower than that in the controls. The osteoclast number in the femur in DES-treated mice at 2 to 12 months was not different from that in the controls; however, in tamoxifen-treated mice, the number was higher than in the controls. An epiphyseal line was clearly detected in the femur of 12- and 15-month-old DES- and tamoxifen-treated male mice, whereas the line in the controls disappeared after 12 months. CONCLUSIONS: The present results indicate that in male mice, neonatal exposure to DES and tamoxifen induced permanent changes in the pelvis and the femur, and that tamoxifen had a greater effect on bone tissue than did DES.

Age Factors↗
PubMed1998

Structural integrity of implanted WMT infinity hip and Osteonics Omnifit hip in fresh cadaveric femurs.

Five matched pairs of fresh human femurs were used to quantitatively assess the structural integrity of the implanted Wright Medical Technology modular Infinity hip and the Osteonics single-piece Omnifit hip. The results showed that neither bone implant system was able to recreate the femoral anteversion of the intact femur (p < 0.05). Although the micromotion at the bone-implant interface was well within the limits of achieving bone ingrowth, the axial micromotion was greater for the Infinity hip than for the Omnifit hip (p < 0.05), but the rotational micromotion did not show a significant difference between the two bone implant systems (p > 0.5). The anterior proximal femur deformation patterns were similar for both the two bone implant systems and intact femurs. However, the medial proximal femur deformation patterns showed that the Infinity hip-implanted femur was more similar to the intact femur than the Osteonics Omnifit hip-implanted femur.

Cadaver↗
PubMed1993

Strain distribution in the proximal femur with flexible composite and metallic femoral components under axial and torsional loads.

This study investigated strain distribution changes in the proximal femur after implantation of a flexible composite femoral component (carbon composite material, modulus of elasticity = 18.6 GPa), a titanium alloy implant (E = 100 GPa), and a stainless steel implant (E = 200 GPa). Transverse as well as longitudinal strain was measured using bipolar strain gauges at eight locations on the proximal femur under both physiologic axial (1000 N and 2000 N) and physiologic torsional (10 N-m and 20 N-m) loads. Under axial load, longitudinal compressive strain at the calcar region was significantly greater in intact femurs and the carbon composite stem specimens than in the two metal stem specimens. The difference between intact femurs and the carbon composite stem specimens was not significant. Stress shielding in the proximal lateral region of the femur, however, was still apparent even in the carbon composite stem specimens. Without seating of the stem collar on the femoral neck, longitudinal compressive strain was not generated at the calcar region, and transverse tensile strain at this region was increased. With conventional implant design, the stem collar was still necessary even in the flexible composite stem to provide near normal longitudinal compressive strain in the calcar region. Under torsional load, proximal strain in intact femurs was small and the proximal strain levels observed after either carbon composite or titanium alloy stem implantation were greater than strain levels before implantation. It seemed unlikely that torsional stress relief played a significant role in proximal bone loss after total hip arthroplasty. Both longitudinal and transverse strains at the calcar region under torsional load were significantly greater in the carbon composite stem specimens than in both intact femurs and the titanium alloy stem specimens, suggesting that these abnormally high proximal stresses may cause high proximal micromotion of the implant, and even bone fracture. Proximal implant design seems to be of paramount importance with flexible composite femoral components to avoid excessive proximal stress concentration under torsional load and to provide near normal strain distribution in the proximal femur.

Alloys↗
PubMed1987

Limb lengthening by epiphyseal distraction. An experimental study in the caprine femur.

Epiphyseal distraction of the left distal femur was accomplished in 10 goats (aged 3-4.5 months). A modified Hoffmann external fixation device was used as a unilateral distraction frame. A distraction rate of 1.5 mm/day was applied for 5.5 weeks. Epiphysiolysis occurred after 3-7 days of distraction. After the lengthening procedure, the growth plate had reduced in height in eight animals on radiographic examination. In two animals the growth plate was fused. Three animals were killed at 4 (Group 1) and 8 (Group 2) weeks and four animals at 16 (Group 3) weeks after the end of the distraction period. The gain in leg length obtained by distraction was reduced owing to growth retardation in the distal femur of the operated limb. The average final lengthening was 24.9, 19.4, and 13.4% in Groups 1, 2, and 3, respectively. Femur and tibia from both sides were tested mechanically in torsion. Only one femur fractured in the elongation area. All but one elongated femur fractured in the area of the diaphysis subjected to distractional force. The torsional strength of the elongated femur compared with control was reduced to approximately 50% in all groups. The corresponding torsional strength of the tibia on the elongated extremity compared with control was reduced to approximately 75% in all groups. The difference in relative strength of femur compared with that of tibia was statistically significant. This finding can be explained by a stress-protective effect on the femur in the distraction area caused by the external device.

Animals↗
PubMed2004

Femur and humerus length in trisomy 21 fetuses at 11-14 weeks of gestation.

OBJECTIVE: To determine the value of measuring fetal femur and humerus length at 11-14 weeks of gestation in screening for chromosomal defects. METHODS: Femur and humerus lengths were measured using transabdominal ultrasound in 1018 fetuses immediately before chorionic villus sampling for karyotyping at 11-14 weeks of gestation. In the group of chromosomally normal fetuses, regression analysis was used to determine the association between long bone length and crown-rump length (CRL). Femur and humerus lengths in fetuses with trisomy 21 were compared with those of normal fetuses. RESULTS: The median gestation was 12 (range, 11-14) weeks. The karyotype was normal in 920 fetuses and abnormal in 98, including 65 cases of trisomy 21. In the chromosomally normal group the fetal femur and humerus lengths increased significantly with CRL (femur length = - 6.330 + 0.215 x CRL in mm, r = 0.874, P < 0.0001; humerus length = - 6.240 + 0.220 x CRL in mm, r = 0.871, P < 0.0001). In the Bland-Altman plot the mean difference between paired measurements of femur length was 0.21 mm (95% limits of agreement - 0.52 to 0.48 mm) and of humerus length was 0.23 mm (95% limits of agreement - 0.57 to 0.55 mm). In the trisomy 21 fetuses the median femur and humerus lengths were significantly below the appropriate normal mean for CRL by 0.4 and 0.3 mm, respectively (P = 0.002), but they were below the respective 5th centile of the normal range in only six (9.2%) and three (4.6%) of the cases, respectively. CONCLUSION: At 11-14 weeks of gestation the femur and humerus lengths in trisomy 21 fetuses are significantly reduced but the degree of deviation from normal is too small for these measurements to be useful in screening for trisomy 21.

Adolescent↗
PubMed1994

Effects of loading rate on strength of the proximal femur.

Results from previous quasi-static mechanical tests indicate that femurs from elderly subjects fail in vitro at forces 50% below those available in a fall from standing height. However, bone is a rate-dependent material, and it is not known whether this imbalance is present at rates of loading which occur in a fall. Based on recent data on time to peak force and body positions at impact during simulated falls, we designed a high rate test of the femur in a loading configuration meant to represent a fall on the hip. We used elderly (mean age 73.5 +/- 7.4 (SD) years) and younger adult (32.7 +/- 12.8 years) cadaveric femurs to investigate whether (1) the strength, stiffness, and energy absorption capacity of the femur increases under high rate loading conditions; (2) elderly femurs have reduced strength, stiffness, and energy absorption capacity compared with younger adult femurs at this loading rate; and (3) densitometric and geometric measures taken at the hip correlate with the measured fracture loads. Femurs were scanned using dual-energy X-ray absorptiometry (DXA) and then tested to failure in a fall loading configuration at a displacement rate of 100 mm/second. The fracture load in elderly and younger adult femurs increased by about 20% with a 50-fold increase in displacement rate. However, energy absorption did not increase with displacement rate because of a twofold increase in stiffness at the higher loading rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Absorptiometry, Photon↗
PubMed1997

The correlation between dual-energy X-ray absorptiometry measures of bone density in the proximal femur and lumbar spine of children.

OBJECTIVE: To assess the correlation between a pediatric patient's proximal femur and lumbar spine bone mineral density (BMD) Z-scores, and the side-to-side difference between proximal femurs. DESIGN: Three hundred and thirty-nine patients aged 2.2-17.0 years with an assortment of underlying conditions underwent dual-energy X-ray absorptiometry (DXA) measures of BMD in both proximal femurs and the lumbar spine. RESULTS: Z-scores in the proximal femur and lumbar spine correlated highly (r = 0.73, P = 0.0001), but for individual patients the difference was often significant, and increased as BMD deviated further from normal. For patients with proximal femur Z-scores of 1 to -1 the mean difference between proximal femur and lumbar spine Z-scores was 0.5; with proximal femur Z-scores of less than -3 the mean difference was increased to 1.7. In conditions which symmetrically involve the lower extremities, the right and left proximal femur Z-scores differed on average by only 0.2. CONCLUSION: BMD measurements for pediatric patients are most easily interpreted by clinicians if converted to Z-scores, yet these are usually available only for the lumbar spine. Age-normalized BMD assessment at more than one site is necessary to provide a more reliable, complete assessment of bone mineral status in pediatric patients.

Absorptiometry, Photon↗
PubMed1996

Mechanical validation of whole bone composite femur models.

Composite synthetic models of the human femur have recently become commercially available as substitutes for cadaveric specimens. Their quick diffusion was justified by the advantages they offer as a substitute for real femurs. The present investigation concentrated on an extensive experimental validation of the mechanical behaviour of the whole bone composite model, compared to human fresh-frozen and dried-rehydrated specimens for different loading conditions. First, the viscoelastic behaviour of the models was investigated under simulated single leg stance loading, showing that the little time dependent phenomena observed tend to extinguish within a few minutes of the load application. The behaviour under axial loading was then studied by comparing the vertical displacement of the head as well as the axial strains, by application of a parametric descriptive model of the strain distribution. Finally, a four point bending test and a torsional test were performed to characterize the whole bone stiffness of the femur. In all these tests, the composite femurs were shown to fall well within the range for cadaveric specimens, with no significant differences being detected between the synthetic femurs and the two groups of cadaveric femurs. Moreover, the interfemur variability for the composite femurs was 20-200 times lower than that for the cadaveric specimens, thus allowing smaller differences to be characterized as significant using the same simple size, if the composite femurs are employed.

Biomechanical Phenomena↗
PubMed1994

The influence of ultrasound scanner beam width on femur length measurements.

Systematic differences have been found in measurements of femur lengths made with (1) a Hitachi EUB 25, representative of older machines in use when most of the femur length-gestation curves were produced; and (2) a modern high resolution machine (Acuson 128). It is proposed that these differences may be accounted for by the different beam widths of the two systems. Six operators measured the femur lengths of several normal fetuses using both machines. Analysis of the results revealed a highly significant (p < 0.005) difference between machines, that did not correlate with femur length (r = -0.022). The mean difference was 1.02 +/- 0.33 mm (Hitachi larger). The mean femur length was 46.44 mm (n = 57). Pulse-echo beam plots showed that, for the probes used, the Hitachi 6 dB beam width is greater than the Acuson beam width by typically 2 mm, depending on the range and Acuson focus setting. This beam width difference can account for the difference in femur length measurements, if allowance is made for the variable angle between femurs and ultrasound beams. The results suggest that femur length-gestation curves for use with modern machines should be based on measurements made with modern machines.

Analysis of Variance↗
PubMed1995

Cyclical etidronate reverses bone loss of the spine and proximal femur in patients with established corticosteroid-induced osteoporosis.

PURPOSE: To compare the bone-mass effects of calcium supplementation and intermittent cyclic etidronate in patients with established corticosteroid-induced osteoporosis. PATIENTS AND METHODS: Eighteen male and 21 female patients who had established corticosteroid-induced osteoporosis and were receiving chronic prednisone therapy (> or = 10 mg/d) were enrolled in a prospective 12-month, open-label study. In addition to continuing prednisone therapy, patients received continuous calcium supplementation 500 mg/d (n = 20) or four cycles of intermittent cyclic etidronate therapy consisting of etidronate 400 mg/d for 14 days followed by calcium 500 mg/d for 76 days (n = 19). Bone mineral density (BMD) of the spine (L1 through L4) and proximal femur (total hip, femoral neck, trochanter, Ward's triangle) was measured by dual-energy x-ray absorptiometry at baseline, 6 months, and 12 months by staff blinded to the treatment. Serum calcium, phosphorus, and alkaline phosphatase were also measured at these times. RESULTS: Treatment with intermittent cyclic etidronate for 12 months resulted in significant increases of 5.7% and 6.8% in BMD of the spine and proximal femur (total hip), respectively (P < 0.02 versus baseline; P < 0.001 versus calcium group). Calcium supplementation alone did not prevent significant losses of 3.4% and 4.1% in BMD at the respective sites (P < 0.02 versus baseline). At the end of the study Z scores reflected significant increases in BMD of the spine and proximal femur (all regions) in the etidronate group (P < 0.01), and significant decreases at the spine, proximal femur, and trochanter in the calcium group (P < 0.01). After 12 months, the difference between the groups was 9.1% (P < 0.01; 95% CI 6.3% to 11.9%) at the spine and 10.9% (P < 0.01; 95% CI 7.8% to 14.1%) at the proximal femur (total hip). Seventeen (89%) of the etidronate-treated patients had increases in BMD of both skeletal sites, whereas only 2 (10%) and 3 (15%) of the calcium-treated patients had positive changes in BMD of the spine and proximal femur (total hip), respectively (P < 0.01). Serum calcium, phosphorus, and alkaline phosphatase levels did not change significantly during the study in either treatment group. Both treatment regimens were well tolerated, with no interactions between prednisone therapy and the study medications. Analyses of response by subgroups (female/male, pulmonary/nonpulmonary indication for prednisone) showed no significant attribute-dependent changes during the 12-month study. At baseline, women had significantly lower BMD of the spine and proximal femur (total hip) (P < 0.01), and patients with pulmonary disease had significantly longer duration of prednisone therapy and cumulative prednisone dose (P < 0.03). CONCLUSIONS: Intermittent cyclic etidronate reversed the progressive loss of bone mineral density of the spine and proximal femur in female and male patients with established osteoporosis secondary to chronic corticosteroid (prednisone) therapy for pulmonary and nonpulmonary diseases. Calcium supplementation alone did not prevent or attenuate corticosteroid-induced losses.

Absorptiometry, Photon↗
PubMed2003

Reductions in bone turnover, mineral, and structure associated with mechanical properties of lumbar vertebra and femur in glucocorticoid-treated growing minipigs.

The present study was designed to determine the effects of glucocorticoid (GC) on bone turnover, minerals, structure, and bone mechanical properties in minipigs. Six 8-month-old Göttingen minipigs were subcutaneously injected with prednisolone (PN, 0.5 mg/kg body wt (BW)/day, 5 days/week for 26 weeks (Group GC)), 6 were treated with vehicle alone (Group VC), and 4 were sacrificed at start of the study for baseline controls (Group BC). The increase in BW was similar in all groups. PN significantly reduced serum osteocalcin and urinary type-1 collagen N-telopeptide levels at 13 weeks and thereafter, compared with baseline and control, and also reduced serum bone specific alkaline phosphatase levels relative to baseline. At 26 weeks, the longitudinal axis of the lumbar bone and length of femur were smaller in Group GC than Group VC. The total cross-sectional area of femur, but not the lumbar bone, in Group GC was significantly different from Group VC. BMD of the femur, but not L2, measured by DXA, was lower in Group GC than in Groups BC and VC. The cortical shell structure measured by 2D-micro-CT deteriorated and age-dependent increases in trabecular bone structure 3D micro-CT were reduced by PN. PN also caused deterioration of the cortical structure of the mid-femur. In L2 and femur, PN significantly reduced the ultimate load and maximum absorption energy of the femur and L2 compared with Group VC. The structural modulus in Group GC was lower than in Group BC. Regression analyses revealed that bone minerals, bone structure, and chemical markers correlated with mechanical properties of L2 and mid-femur. Our results indicate that PN reduced systemic bone formation and resorption and suppressed the age-dependent increases in bone minerals, structure, and mechanical properties of L2 and mid-femur. Reduced bone turnover seemed to be associated with a reduction in mechanical properties. The growing minipig could be a suitable model of GCs-induced osteoporosis in humans.

Animals↗