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Adami G, Arioli G, Bianchi G, Brandi ML, Caffarelli C, Cianferotti L, Gatti D, Girasole G, Gonnelli S, Manfredini M, Muratore M, Quarta E, Quarta L. Radiofrequency echographic multi spectrometry for the prediction of incident fragility fractures: A 5-year follow-up study. Bone 2020; 134:115297. [PMID: 32092480 DOI: 10.1016/j.bone.2020.115297] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/13/2020] [Accepted: 02/20/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE To investigate the effectiveness of the T-score values provided by Radiofrequency Echographic Multi Spectrometry (REMS) in the identification of patients at risk for incident osteoporotic fractures. METHODS A population of Caucasian women (30-90 years), enrolled from 2013 to 2016, underwent dual X-ray absorptiometry (DXA) and REMS scans at axial sites. The incidence of fragility fractures was assessed during a follow-up period up to 5 years. Afterwards, patients with and without incident fractures were stratified in two age-matched groups with a 1: 2 proportion (Group F' and Group NF', respectively). The performance of REMS T-score in discriminating between the two groups was quantitatively assessed and compared with DXA. RESULTS 1516 patients were enrolled and 1370 completed the follow-up (mean ± SD: 3.7 ± 0.8 years; range: 1.9-5.0 years). Fracture incidence was 14.0%. Age-matched groups included 175 fractured patients and 350 non-fractured ones, respectively (median age 70.2 [interquartile range: 61.0-73.3] and 67.3 [65.4-69.8] years, p-value ns). The groups resulted also balanced for height, weight and BMI (p-values ns). As expected, the differences in REMS T-score (for vertebral site, -2.9 [-3.6 to -1.9] in Group F', -2.2 [-2.9 to -1.2] in Group NF') and DXA T-score (-2.8 [-3.3 to -1.9] in Group F', -2.2 [-2.9 to -1.4] in Group NF') were statistically significant (p-value <0.001). Analogous results were obtained for femoral neck. Considering the T-score cut-off of -2.5, REMS identified Group F' patients with a sensitivity of 65.1% and specificity of 57.7% of (OR = 2.6, 95%CI: 1.77-3.76, p < 0.001), whereas DXA showed a sensitivity of 57.1% and a specificity of 56.3% (OR = 1.7, 95%CI: 1.20-2.51, p-value = 0.0032). For femoral neck, REMS sensitivity and specificity were 40.2% and 79.9%, respectively, with an OR of 2.81 (95%CI: 1.80-4.39, p < 0.001). DXA, instead, showed a sensitivity and specificity of 42.3% and 79.3%, respectively, with an OR of 2.68 (95%CI: 1.71-4.21, p < 0.001). CONCLUSIONS REMS T-score resulted an effective predictor for the risk of incident fragility fractures in a population-based sample of female subjects, representing a promising parameter to enhance osteoporosis diagnosis in the clinical routine.
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Affiliation(s)
- Giovanni Adami
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Arioli
- Department of Neurosciences and Rehabilitation, "Carlo Poma" Hospital, ASST-Mantova, Mantova, Italy
| | | | - Maria Luisa Brandi
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Metabolic Bone Diseases Unit, University Hospital of Florence, Florence, Italy
| | - Carla Caffarelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Luisella Cianferotti
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Metabolic Bone Diseases Unit, University Hospital of Florence, Florence, Italy
| | - Davide Gatti
- Rheumatology Unit, Department of Medicine, University of Verona, Verona, Italy
| | | | - Stefano Gonnelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Monica Manfredini
- Department of Neurosciences and Rehabilitation, "Carlo Poma" Hospital, ASST-Mantova, Mantova, Italy
| | - Maurizio Muratore
- O.U. of Rheumatology, "Galateo" Hospital, San Cesario di Lecce ASL-LE, Lecce, Italy.
| | - Eugenio Quarta
- O.U. of Rheumatology, "Galateo" Hospital, San Cesario di Lecce ASL-LE, Lecce, Italy
| | - Laura Quarta
- O.U. of Rheumatology, "Galateo" Hospital, San Cesario di Lecce ASL-LE, Lecce, Italy
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Pezzuti IL, Kakehasi AM, Filgueiras MT, de Guimarães JA, de Lacerda IAC, Silva IN. Imaging methods for bone mass evaluation during childhood and adolescence: an update. J Pediatr Endocrinol Metab 2017; 30:485-497. [PMID: 28328530 DOI: 10.1515/jpem-2016-0252] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 01/31/2017] [Indexed: 11/15/2022]
Abstract
The objective of the work was to prepare an update on imaging methods for bone evaluation during childhood and adolescence. The text was based on original and review articles on imaging methods for clinical evaluation of bone mass in children and adolescents up to 20 years old. They were selected from BIREME and PUBMED by means of the following keywords: bone density; osteoporosis/diagnosis; densitometry; tomography; ultrasonography; magnetic resonance imaging; and radiogrammetry and published in Portuguese or English, in the last 10 years (2006-2016). The article was organized into topics with the description of peculiarities, advantages and disadvantages of each imaging method and their possible clinical applicability. Despite the emergence of new technologies, dual energy X-ray absorptiometry (DXA) remains the gold standard method for low bone mass diagnosis in all age groups. However, interpretation is complex in children and adolescents and demands skilled people. Quantitative computed tomography (QCT) [central QCT, peripheral QCT (pQCT) and high resolution-pQCT (HR-pQCT)] and magnetic resonance imaging (MRI) evaluate real bone density, but are not yet available for routine use. Quantitative bone ultrasound (QUS) shows good perspectives for its use in primary prevention actions. Automated radiogrammetry shows promise as a method able to flag individuals who might benefit from a complete bone assessment, but the clinical value of the measures still needs to be established.
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Affiliation(s)
- Isabela Leite Pezzuti
- Department of Pediatrics, Division of Pediatric Endocrinology, Faculdade de Medicina/Hospital das Clínicas, Universidade Federal de Minas Gerais (UFMG) Av. Alfredo Balena 190, s/267 30130-100, Belo Horizonte, MG
| | - Adriana Maria Kakehasi
- Department of Locomotor System, Faculdade de Medicina/Hospital das Clínicas niversidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG
| | - Maria Tereza Filgueiras
- Pediatric Imaging, Faculdade de Medicina/Hospital das Clínicas Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG
| | - Juliana Albano de Guimarães
- Research initiation student, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG
| | | | - Ivani Novato Silva
- Department of Pediatrics, Head of Division of Pediatric Endocrinology, Faculdade de Medicina/Hospital das Clínicas Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG
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Nalle Junior C, Passador CS, Iannetta O, Oliveira LRD, Passador JL. Considerações sobre custo-benefício nas políticas de saúde: tratamento curativo versus o preventivo da osteoporose. SAUDE E SOCIEDADE 2013. [DOI: 10.1590/s0104-12902013000400015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A partir da década de 1990 vários paradigmas da prática médica foram sendo modificados, o que levou ao desenvolvimento de novas abordagens médicas, mais eficientes e eficazes. O conhecimento da osteoporose passa por modificações: antes correlacionava redução de massa óssea à elevação do risco de fratura e direcionava o diagnóstico somente a indivíduos idosos; posteriormente, baseia-se em um modelo que privilegia a observação simultânea das duas matrizes ósseas: protéica ou verdadeira e a inorgânica ou secundária, desde tenra idade. Os dois modelos se distinguem basicamente por uma abordagem curativa, que diagnostica o quadro de osteoporose já instalado e adota práticas posteriores ao mal e, de outro lado, por uma abordagem preventiva, que visa evitar que o mal se instale. Dessa forma, com o objetivo de avaliar a relação custo-benefício e custo-efetiva do tratamento curativo versus o preventivo da osteoporose nas políticas públicas de saúde, foi realizada uma pesquisa comparativa dos pacientes atendidos no HCFMRP-USP entre 2007-2009. A partir dos dados obtidos foi efetuada a análise dos custos incorridos versus os benefícios auferidos. Os resultados da pesquisa consideram a abordagem preventiva da osteoporose viável economicamente, por meio do rastreamento da microarquitetura óssea. Nesse sentido, além das evidências econômicas, o estudo permitiu analisar a importância da aplicação de um novo paradigma da osteoporose nas políticas públicas de saúde, a fim de alcançar a melhoria das condições de vida e bem-estar da população.
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Guglielmi G, Rossini M, Nicolosi MG, Ragno A, Lentini G, de Terlizzi F. Three-year prospective study on fracture risk in postmenopausal women by quantitative ultrasound at the phalanges. J Clin Densitom 2013; 16:341-346. [PMID: 22901551 DOI: 10.1016/j.jocd.2012.07.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 07/11/2012] [Accepted: 07/18/2012] [Indexed: 11/22/2022]
Abstract
The purpose of this study was the calculation of fracture risk in a prospective study on postmenopausal women by quantitative ultrasound (QUS) at the phalanges. A total of 2341 postmenopausal women were recruited in 5 centers in Italy during 2006 and 2007 for QUS measurement during a screening program for osteoporosis. Two ultrasound parameters were collected: amplitude-dependent speed of sound (AD-SoS) and ultrasound bone profile index (UBPI). Women were then recontacted in 2010 and were asked about fracture occurrence during the period since previous QUS measurement. Data about new fracture occurred in this period, site and cause of fracture were requested. Two thousand two hundred eleven women were successfully recontacted. Mean age of the recruited women was 60.9 ± 10.0 yr, mean age at menopause was 49.3 ± 4.4 yr, mean body mass index (BMI) was 26.5 ± 4.6 kg/m². A total number of 108 new major osteoporotic fractures occurred during the 3-yr period, of which 23 are hip fractures, 51 are vertebral fractures. Relative risk (RR) per standard deviation (SD) decrease for major fractures was 1.77 (confidence interval [CI]: 1.59-1.97) for AD-SoS and 2.06 (CI: 1.78-2.37) for UBPI. When corrected for age, BMI, age at menopause, the RRs are still significant and equal to 1.44 (CI: 1.26-1.65) for AD-SoS and 1.67 (CI: 1.39-2.00) for UBPI. RR for vertebral fractures was 1.63 (CI: 1.41-1.88) for AD-SoS and 1.73 (CI: 1.44-2.08) for UBPI. RR for hip fractures was 1.92 (CI: 1.55-2.37) for AD-SoS and 2.68 (CI: 1.86-3.86) for UBPI. Ultrasound parameters AD-SoS and UBPI are able to significantly predict future major fractures in a prospective cohort of more than 2000 postmenopausal women.
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Affiliation(s)
- Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Foggia, Italy; Department of Radiology, Scientific Institute "Casa Sollievo della Sofferenza" Hospital, Foggia, Italy.
| | - Maurizio Rossini
- Department of Rheumatology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Mario Guido Nicolosi
- Department of Gynecology and Obstetrics, Divisione Ospedaliera B, S. Anna Hospital, Torino, Italy
| | - Alessandro Ragno
- Department of Internal Medicine, Ospedale "Regina Apostolorum," Albano Laziale, Italy
| | - Giovanni Lentini
- Department of Gynecology and Obstetrics, Buccheri La Ferla FBF Hospital, Palermo, Italy
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Biino G, Casula L, de Terlizzi F, Adamo M, Vaccargiu S, Francavilla M, Loi D, Casti A, Atzori M, Pirastu M. Epidemiology of osteoporosis in an isolated Sardinian population by using quantitative ultrasound. Am J Epidemiol 2011; 174:432-9. [PMID: 21709133 DOI: 10.1093/aje/kwr106] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This study aimed at estimating the prevalence of osteoporosis and osteopenia in a Sardinian isolated population using hand quantitative ultrasound and at investigating the associated factors. The authors utilized a subset of data from a large population-based epidemiologic survey carried out in the Ogliastra region of Sardinia between 2003 and 2008. The sample consists of 6,326 men and women aged ≥30 years, who underwent quantitative ultrasound at the phalanges, bioelectrical impedance, anthropometric measurements, blood tests, and a standardized epidemiologic questionnaire collecting sociodemographic, lifestyle, medical, physiologic, and pharmacologic data. The T-score thresholds for amplitude-dependent speed of sound of -3.2 standard deviations and between -3.2 and -1 standard deviations were used to diagnose osteoporosis and osteopenia, respectively. Prevalence of osteoporosis was 17.0% in women and 5.2% in men. Logistic regression analysis revealed that factors associated with osteoporosis were age, anthropometric and bioimpedance measures, alkaline phosphatase levels, and menopause in women. High education, exercise, and beer consumption seem to be protective factors, whereas a family history of osteoporosis is a risk factor. Results show that osteoporosis in this population is comparable with that found in different countries, suggesting that quantitative ultrasound could be used more widely to detect high-risk individuals for preventing osteoporotic fractures.
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Affiliation(s)
- Ginevra Biino
- Institute of Population Genetics, National Research Council of Italy, Sassari, Italy.
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Quantitative ultrasound of the phalanges and DXA of the lumbar spine and proximal femur in evaluating the risk of osteoporotic vertebral fracture in postmenopausal women. Radiol Med 2010; 116:92-101. [DOI: 10.1007/s11547-010-0577-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2009] [Accepted: 03/05/2010] [Indexed: 11/25/2022]
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Cipriani C, Romagnoli E, Scarpiello A, Angelozzi M, Montesano T, Minisola S. Phalangeal quantitative ultrasound and bone mineral density in evaluating cortical bone loss: a study in postmenopausal women with primary hyperparathyroidism and subclinical iatrogenic hyperthyroidism. J Clin Densitom 2009; 12:456-60. [PMID: 19815437 DOI: 10.1016/j.jocd.2009.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 07/31/2009] [Accepted: 08/02/2009] [Indexed: 11/16/2022]
Abstract
Twenty-five postmenopausal women with primary hyperparathyroidism (PHPT) and 30 age-matched women with subclinical hyperthyroidism (sHTH) were studied to assess cortical bone loss. One hundred two healthy women were also recruited. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry at lumbar spine (LS), femoral neck (FN) and femoral total (FT), and at one-third of the radius (R). Amplitude-dependent speed of sound (ADSoS) and Ultrasound Bone Profile Index (UBPI) were also evaluated using phalangeal quantitative ultrasound (QUS). A significant correlation was found between QUS and BMD at LS (ADSoS, p < 0.05) and R (ADSoS and UBPI, p < 0.001) in controls. QUS significantly correlated with BMD at LS, FN (p < 0.01), and FT (p < 0.001) in sHTH. No correlations were found in the PHPT group. Mean T-score values of all parameters were significantly lower in patients compared with controls (p < 0.001); however, they did not differ between PHPT and sHTH patients. T-score of R, ADSoS, and UBPI was reduced compared with other sites (p < 0.001) in both diseases. In postmenopausal women with PHPT and sHTH, bone loss is mainly detectable at cortical level. However, qualitative and/or structural changes of bone could account for the lack of correlations between these 2 techniques at cortical sites.
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Affiliation(s)
- Cristiana Cipriani
- Department of Clinical Sciences, University of Rome Sapienza, Rome, Italy
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Albanese CV, Cepollaro C, de Terlizzi F, Brandi ML, Passariello R. Performance of five phalangeal QUS parameters in the evaluation of gonadal-status, age and vertebral fracture risk compared with DXA. ULTRASOUND IN MEDICINE & BIOLOGY 2009; 35:537-544. [PMID: 19097682 DOI: 10.1016/j.ultrasmedbio.2008.09.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 09/08/2008] [Accepted: 09/29/2008] [Indexed: 05/27/2023]
Abstract
The aim of this cross-sectional study was to study the value of five different quantified ultrasound (QUS) parameters-amplitude-dependent speed of sound (AD-SoS), Ultrasound Bone Profile Index (UBPI), fast-wave amplitude (FWA), bone transmission time (BTT) and signal dynamic (SDY)-measured at the phalanges of the hand in discriminating women with vertebral fracture and their relationship with some determinants of bone mass, in particular age and gonadal status compared with lumbar spine and hip dual-energy x-ray absorptiometry (DXA). We included 791 women aged 35-84 y, divided into pre-menopause, early menopause and late postmenopause groups on the basis of gonadal status and years since menopause (YSM). The presence of vertebral fracture was evaluated radiographically. All QUS parameters were very sensitive to changes in early postmenopause, with a doubled decrease in early postmenopausal with respect to late postmenopause. In particular AD-SoS and BTT decreases were markedly high in the early postmenopause group. In the late menopause group, similar decreases were observed for AD-SoS, UBPI and hip bone mineral density (BMD). In the multiple logistic model, DXA and QUS significantly discriminate women with and without fractures (p < 0.0001); odds ratio (OR) was higher at lumbar spine BMD (OR 4.01), FWA (OR 3.88), AD-SoS (OR 3.81) and total hip BMD (OR 3.77). Even adjusting the logistic model for age, height, weight, lumbar spine and total hip BMD, all QUS parameters remained significantly predictive of vertebral fracture. AD-SoS showed the best performances both in terms of OR and ROC analysis. QUS parameters show a different behavior in evaluating the effect on bone mass of the time since menopause; AD-SoS and BTT showed a high sensitivity to first changes in bone tissue after menopause. After correction for potential confounders, AD-SoS showed the same ability of lumbar spine BMD in discriminating women with or without vertebral fractures and in the prediction of fracture risk.
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Affiliation(s)
- Carlina V Albanese
- Service of Bone Densitometry and Ultrasound, Department of Radiological Sciences, University of Rome Sapienza School of Medicine, Viale R. Elena 324, Rome, Italy.
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Constant D, Rosenberg L, Zhang Y, Cooper D, Kalla AA, Micklesfield L, Hoffman M. Quantitative ultrasound in relation to risk factors for low bone mineral density in South African pre-menopausal women. Arch Osteoporos 2009; 4:55-65. [PMID: 20234859 PMCID: PMC2836751 DOI: 10.1007/s11657-009-0029-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2009] [Accepted: 09/02/2009] [Indexed: 02/03/2023]
Abstract
SUMMARY: The study describes the association between risk factors and quantitative ultrasound bone measures in black and mixed-race pre-menopausal South African women. Despite some differences between the two study groups, the findings generally lend support to the use of ultrasound for epidemiological studies of bone mass in resource-limited settings. INTRODUCTION: Quantitative ultrasound at the calcaneus is a convenient and inexpensive method of estimating bone strength well suited to community-based research in countries with limited resources. This study determines, in a large sample of pre-menopausal South African women, whether characteristics associated with quantitative ultrasound measures are similar to those shown to be associated with bone mineral density as measured by dual X-ray absorptiometry. METHODS: This cross-sectional study included 3,493 women (1,598 black and 1,895 mixed race), aged 18-44 living in Cape Town. Study nurses administered structured interviews on reproductive history, lifestyle factors, and measured height and weight. Calcaneus quantitative ultrasound measurements were obtained using the Sahara device. Adjusted means of ultrasound measures according to categories of risk factors were obtained using multivariable regression analysis. RESULTS: Associations between quantitative ultrasound measures and age, body mass index, age at menarche, parity, and primary school physical activity were similar to those known for bone mineral density as measured by dual X-ray absorptiometry. There were no clear associations between quantitative ultrasound measures and educational level, alcohol use, cigarette smoking, and current calcium intake. CONCLUSION: The data give qualified support to the use of quantitative ultrasound as an epidemiological tool in large studies of bone strength in pre-menopausal women.
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Affiliation(s)
- Deborah Constant
- Women’s Health Research Unit, Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, 7925 Cape Town, Western Cape South Africa
| | - Lynn Rosenberg
- Slone Epidemiology Center, Boston University, Boston, MA USA
| | - Yuqing Zhang
- Slone Epidemiology Center, Boston University, Boston, MA USA
| | - Diane Cooper
- Women’s Health Research Unit, Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, 7925 Cape Town, Western Cape South Africa
| | - Asgar A. Kalla
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, 7925 Cape Town, Western Cape, South Africa
| | - Lisa Micklesfield
- Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Observatory, 7925 Cape Town, Western Cape, South Africa
| | - Margaret Hoffman
- Women’s Health Research Unit, Department of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, 7925 Cape Town, Western Cape South Africa
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Musumeci M, Vadalà G, Tringali G, Insirello E, Roccazzello AM, Simpore J, Musumeci S. Genetic and environmental factors in human osteoporosis from Sub-Saharan to Mediterranean areas. J Bone Miner Metab 2009; 27:424-34. [PMID: 19255718 DOI: 10.1007/s00774-009-0041-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2007] [Accepted: 07/31/2008] [Indexed: 01/03/2023]
Abstract
The aim of this study was to determine the prevalence of known gene polymorphisms associated with osteoporosis in postmenopausal normal women from Burkina Faso and Sicily, compared to postmenopausal Sicilian women with osteoporosis, and to establish the weight of environmental factors in the mechanism of osteoporosis. Bone mass density (BMD) was measured by phalangeal quantitative ultrasound (QUS) in Burkinabe woman and by the dual X-ray absorptiometry at the femoral neck in Sicilian women. The polymorphisms of the vitamin D receptor (VDR) gene, estrogen receptor (ESR) gene, calcitonin receptor (CTR) gene and COL1A1 collagen gene were characterized by PCR. The social characteristics of studied women were evaluated by a specific questionnaire. The observed percentages of single specific polymorphisms did not differ from that expected with exception of VDR B allele and ESR X and P allele in Burkinabe and Sicilian women, respectively. Association analyses and multivariate two-step regression model of social and molecular parameters, demonstrated that in comparison to the VDR, ESR, CTR polymorphisms, physical activities and healthy diet, associated with outdoor work are the best favourable prognostic factors for osteoporosis. A diet rich in calcium, other minerals and vitamin D in association with physical activity represents the most effective way to maintain not only a healthy bone structure but also an acceptable BMD. This is particularly true for Sub-Saharan women.
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Affiliation(s)
- Maria Musumeci
- Department of Hematology, Oncology and Molecular Medicine, National Institute of Health, Rome, Italy
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Omodei U, Benussi C, Ramazzotto F, Feller M, Gambacciani M. Risk identification of osteoporosis in postmenopausal women by a simple algorithm based on ultrasound densitometry and body mass index. J Clin Densitom 2008; 11:412-6. [PMID: 18375162 DOI: 10.1016/j.jocd.2008.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Revised: 01/14/2008] [Accepted: 01/14/2008] [Indexed: 11/24/2022]
Abstract
Dual-energy X-ray absorptiometry (DXA) method is the main device for diagnosing osteoporosis; this method, however, involves the use of expensive equipment. Ultrasound method, being portable, noninvasive, and cost-effective, seems to be an appropriate screening device to identify subjects at risk of osteoporosis. Two hundred and twenty-four postmenopausal women (mean age: 57.9+/-6.2yr) were recruited at 2 Menopause Centers. All subjects were assessed by phalangeal Quantitative Ultrasound (QUS) and by DXA at femur and rachis. Applying the first-level screening strategy, the following risk factors were considered: (1) Amplitude Dependent Speed-of-Sound T-score<-1.8 standard deviation (SD) or Ultrasound Bone Profile Index T-score<-1.8SD; (2) body mass index (BMI)<20kg/m(2). BMI identified 25 subjects (11%) of the total population as at risk, the QUS parameters 100 subjects (45%), and the combination of the 2 showed 118 subjects (53%). The percentage of osteoporotics identified by BMI was 17%, by QUS 78%, and by the combination of the two 90%. The sensitivity of this algorithm was 90%; 53% of the subjects would undergo a further densitometric evaluation, the remaining 47% were correctly identified as not at risk. The diagnostic work up proposed appears effective to be indicated for extensive clinical employment, thanks also to its simplicity.
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Affiliation(s)
- Umberto Omodei
- Obstetric and Gynaecologic Clinic, University of Brescia, Brescia, Italy.
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Calcium metabolism and vitamin D in the extreme longevity. Exp Gerontol 2007; 43:79-87. [PMID: 17698310 DOI: 10.1016/j.exger.2007.06.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2006] [Revised: 04/06/2007] [Accepted: 06/26/2007] [Indexed: 12/31/2022]
Abstract
Skeletal remodelling is a continuous process during life and is still active also in extreme senescence. In the elderly, bone resorption often prevails over bone formation, causing bone loss and fragility. Elderly subjects are exposed to the risk of fractures, and loss of self-sufficiency, if considering that the proximal femur is the most frequently involved site. Bone remodelling can maintain circulating calcium within physiological ranges, at the expense of a substantial loss of this ion from the skeleton, particularly during senescence. Calcium metabolism is regulated at cellular/molecular level by a network of cytokines, growth factors, systemic hormones that act on bone in paracrine/autocrine/systemic fashion. Among the molecules involved in bone metabolism, parathyroid hormone (PTH) and vitamin D present some peculiar aspects during senescence. The osteometabolic features in a consistent group of centenarians have been evaluated. It results that a severe hypovitaminosis D was present in 99 out of 104 centenarians (25-OH vitamin D below 5 nmol/L), and that it plays an important role as a factor inducing a vicious circle involving hypocalcemia, secondary hyperparathyroidism, together with biochemical features indicating a consistent bone loss. Serum C-terminal cross-linking telopeptide, a specific marker of bone resorption was elevated in 92% of these subjects. Moreover, it has been found that several femoral fractures had occurred after 90 years of age. These data offer a rational for the possible prevention of elevated bone turnover, bone loss and consequently the reduction of osteoporotic fractures and fractures-induced disability, in the oldest olds, through the simple supplementation with calcium and vitamin D.
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Rossini M, Viapiana O, Del Marco A, de Terlizzi F, Gatti D, Adami S. Quantitative ultrasound in adults with cystic fibrosis: correlation with bone mineral density and risk of vertebral fractures. Calcif Tissue Int 2007; 80:44-9. [PMID: 17205331 DOI: 10.1007/s00223-006-0117-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Accepted: 09/05/2006] [Indexed: 10/23/2022]
Abstract
In several conditions, including cystic fibrosis (CF) and corticosteroid-induced osteoporosis, bone mineral density (BMD) measurements provide a modest prediction of fracture risk. We investigated in adult CF patients whether quantitative ultrasound (QUS) parameters were able to discriminate between patients with and without prevalent vertebral fractures. One hundred seventy-two adults with CF, 91 men and 81 women, often on chronic oral or inhaled corticosteroid therapy, were studied. BMD at the lumbar spine, proximal femur, and total body were measured by dual-energy X-ray absorptiometry (DXA). QUS parameters were assessed by Achilles Express at the calcaneus and by the DBM Sonic 1200 at the phalanges. All bone measurements by DXA and QUS were significantly correlated with each other, with the exception of phalangeal amplitude-dependent speed of sound versus spine BMD. The mean T-score values in CF patients with and without prevalent vertebral fractures were similar for all DXA measurements and for stiffness index. A significant difference between the two groups was observed only for phalangeal ultrasound bone profile index (UBPI) values (relative risk = 1.25, 95% confidence interval 1.05-1.49 for each decrease in T score), and this difference was maintained after adjusting the values for age, body weight, forced expiratory volume in 1 second, gender, and corticosteroid use. In conclusion, only a phalangeal QUS parameter (UBPI), in contrast with calcaneus QUS or DXA measurements, was able to discriminate CF patients with from those without vertebral fractures, possibly as a result of qualitative alterations of bone tissue independent of BMD.
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Affiliation(s)
- M Rossini
- Rheumatology Unit, University of Verona, Azienda Ospedalieta, Verona, Italy.
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