Management of Bone Health in Postmenopausal Women

Establishing normal ranges for fetal and neonatal small and large intestinal lengths: results from a prospective postmortem study

Objective

To establish reference intervals (RIs) for fetal and neonatal small and large intestinal lengths.

Methods

Linear measurements on small and large intestines were made upon postmortem examination of 131 preterm and term infants with gestational ages between 13 and 41 weeks. All cases were referred from the Eastern Ontario and Western Québec regions to a tertiary care hospital. Age and sex partitions were considered and RI limits were estimated.

Results

Data consisted of 72 male (54.96%) and 59 female (45.04%) fetuses and neonates with mean gestational age of 25.6 weeks. Results showed that small and large intestinal lengths increased linearly with gestational age. RIs for small intestinal length (cm) of fetuses and neonates aged 13–20 weeks were (21.1, 122.4); of those aged 21–28 weeks were (57.7, 203.8); of those aged 29–36 weeks were (83.6, 337.1); and of those aged 37–41 weeks were (132.8, 406.4). RIs for large intestinal length (cm) of fetuses and neonates from the same four age groups were (5.1, 21.4), (12.7, 39.7), (32.4, 62.4), and (29.1, 82.2).

Conclusions

Establishing accurate RIs for premature and term infants has clinical relevance for pathologists performing postmortem analysis and for surgeons planning postoperative management of patients. The results of this study reaffirm that fetal small and large intestinal lengths increase linearly with gestational age irrespective of sex. Future studies should aim to further investigate the role of possible confounders on growth of fetal intestinal length, including maternal factors such as age and substance use during pregnancy.

Spatiotemporal Control Strategies for Bone Formation through Tissue Engineering and Regenerative Medicine Approaches

Global increases in life expectancy drive increasing demands for bone regeneration. The gold standard for surgical bone repair is autografting, which enjoys excellent clinical outcomes; however, it possesses significant drawbacks including donor site morbidity and limited availability. Although collagen sponges delivered with bone morphogenetic protein, type 2 (BMP2) are a common alternative or supplement, they do not efficiently retain BMP2, necessitating extremely high doses to elicit bone formation. Hence, reports of BMP2 complications are rising, including cancer promotion and ectopic bone formation, the latter inducing complications such as breathing difficulties and neurologic impairments. Thus, efforts to exert spatial control over bone formation are increasing. Several tissue engineering approaches have demonstrated the potential for targeted and controlled bone formation. These approaches include biomaterial scaffolds derived from synthetic sources, e.g., calcium phosphates or polymers; natural sources, e.g., bone or seashell; and immobilized biofactors, e.g., BMP2. Although BMP2 is the only protein clinically approved for use in a surgical device, there are several proteins, small molecules, and growth factors that show promise in tissue engineering applications. This review profiles the tissue engineering advances in achieving control over the location and onset of bone formation (spatiotemporal control) toward avoiding the complications associated with BMP2.

Feed intolerance and necrotizing enterocolitis in preterm small-for-gestational age neonates with normal umbilical artery Doppler flow

This was a prospective observational study conducted in a level III neonatal unit in North India to measure the incidence of feed intolerance and necrotizing enterocolitis (NEC) in preterm small for gestational age (SGA) neonates with normal umbilical artery Doppler flow in comparison with gestation matched appropriate for gestational age (AGA) neonates. Fifty consecutive singleton SGA preterms between 28 and 34 weeks gestation with normal Doppler were enrolled and 50 gestation matched AGA served as controls. There was a trend toward more feed intolerance (22% vs. 12%, p = 0.183), NEC (12% vs. 6%, p = 0.295) and mortality (8% vs. 2%, p = 0.362) in SGA group and these babies also had significantly more hypoglycemia (p = 0.000) and polycythemia (p = 0.032) and longer hospital stay (p = 0.017).

Aromatase inhibitors and bone

The decrease in estrogen levels with the use of aromatase inhibitors results in an increase in the rate of bone remodelling. This result in an acceleration of bone loss, and probably to an increase in the risk of fractures. The risk of fracture is particularly high in the older woman and in the woman with a low bone mineral density. We have a number of proven treatments for the treatment of postmenopausal osteoporosis and it is likely that some of these, particularly bisphosphonates, could be effective at preventing bone loss with aromatase inhibitors.