Footedness related differences in femoral bone mineral density in elderly women with osteoporosis

Purpose: The presumed link between lateralized habitual motor activity and bilateral skeletal asymmetry, as result of bone functional adaptation, is the basis for inferences about bone mineral distribution; consequently, bone loss and osteoporosis. As there is no research connecting directly footedness with osteoporosis, the present study was designed to investigate their relation, in elderly women with osteoporosis.Methods: A sample of 420 white, Caucasian race women, older than 65 years, with previous diagnosis of osteoporosis, was recruited for the study. Finally, 164 women met the inclusion criteria and participated. The femoral neck and total hip bone mineral density (BMD) differences between right and left hips of 105 right-footed and 59 non-right-footed women, and the between footedness groups differences of the above right-left BMD differences, were measured with Dual-energy X-ray Absorptiometry (DXA).Results: In right-footers, total hip right-left BMD differences were statistically significant, favoring left femur [t(104) = -2.79, p < .01, two tailed]. In non-right-footers, femoral neck right-left BMD differences were statistically significant, favoring right femur [t(58) =2.025, p < .05, two tailed]. Femoral neck and total hip right-left BMD differences of right- versus non-right-footed women were statistically insignificant.Conclusion: The dominance of the right lower limb had an asymmetric effect on left total hip BMD, while non-right-footedness favored right femoral neck BMD. The findings highlighted the influence of load bearing effects of the body weight and muscle contractions on femoral BMD. We noted a possible association between footedness and BMD, as a result of bone functional adaptation.

John Thomas sign--a memorable but misleading sign in hip fractures

OBJECTIVE

The John Thomas sign is a favourite of medical students and theorizes that in femoral neck fractures, the male member will lie to the side of the fracture on the plain radiograph. The aim of this study was to evaluate the accuracy, and examine the phenomenon of eponymous signs. We sought to answer the following questions: (1) How accurate is the sign in the context of a consecutive series of male patients with hip fractures? (2) Is there a relationship between side and size of penile lie and the side of fracture?

HYPOTHESIS

That the accuracy of the John Thomas sign is, like many eponymous signs, spurious.

MATERIALS AND METHODS

Two hundred male AP pelvis radiographs were examined, of which 100 had a hip fracture and compared these against 100 control films that did not. Age at presentation, and the side, length and angle of penile lie were measured.

RESULTS

The results show two findings: that the accuracy of the supposed "sign" is less accurate than the toss of a coin; and that left lie and left-sided fractures are more common. We fail to show a relationship between side of fracture, John Thomas size or degree of angulation.

CONCLUSION

John Thomas sign is no better than the toss of a coin in relation to hip fractures, and is not related to side of fracture, or penile attitude. We propose that the side of lie observed in male fractures may be as a result of handedness or natural underlying body asymmetry rather than as a result of the fracture.

LEVEL OF EVIDENCE

Level III Case control study.

Discrepancy in improvement of hearing loss between left and right ears after postmenopausal hormone therapy

Physiological levels of estrogen would seem to have a possible protective effect on hearing function and estrogen replacement therapy may delay hearing loss in menopausal women. Treatment of healthy menopausal women with Tibolone for 6 months resulted in improvement in audiometry results at low frequencies which was more prominent on the right side. The reason of better improvement on the right side is not known. There might be some other factors modifying the condition or effect of the drug such as laterality. There might be hearing lateralization in menopausal women. Especially significant improvement on right ear might be explained by differences in distribution of estrogen receptor (ER) in the ear, in another words lateralization of ER concentration. ER-α and -β might be more dense in the right ear, so give better response to estrogen treatment. Another reason might be difference in bone mineral density of sides of body which is lower on the right side. Similarly lower bone mineral density right ear bones would cause better response to estrogen therapy and better improvement in audiometry results on that side.