Bone mineral content in patients with Crohn's disease. A longitudinal study in patients with bowel resections

BACKGROUND

Low bone mineral content (BMC) has been reported in patients with inflammatory bowel disease. The aim of the present study was to measure BMC in patients with Crohn's disease.

METHODS

BMC was monitored for a mean period of 5.5 years in 108 patients. The patients were divided into two groups: group A, patients with the colon preserved; group B, patients with a resected colon. The mean length of the resected small intestine was 90 cm.

RESULTS

The BMC of the lumbar spine expressed as Z-score ((actual value-mean)/s) was significantly reduced: mean Z-score for group A, -0.51, P < 0.05; group B, -0.80, P < 0.001. The BMC of the femoral neck was significantly reduced: mean Z-score for group A, -1.24, P < 0.001; group B, -1.23, P < 0.001. A Z-score below -2.0 of spine or femoral neck BMC was found in 10% and 23% of the patients, respectively. The BMC of the femoral neck decreased significantly in both groups during the study period (group A, -2.2%, P < 0.001; group B, -1.21%, P < 0.05). The BMC of the lumbar spine did not change. There was an inverse correlation between the initial Z-score and the rate of change in BMC (P < 0.05). We found no correlation between Z-score or change in BMC and period of prednisolone treatment. Moreover, there was no correlation between the length of the resected small intestine and BMC or annual percentage change in BMC.

CONCLUSION

At inclusion the BMC of the spine and femoral neck was low in patients with Crohn's disease. During the study significant bone loss was only demonstrated in the femoral neck. BMC or rate of change in BMC was not related to treatment with steroids or length of the resected small intestine.

Bone mineral content in patients on home parenteral nutrition

Bone mineral content (BMC) was monitored in 15 patients with short bowel syndrome receiving home parenteral nutrition (HPN). Thirteen patients had Crohn's disease and 2 ulcerative colitis (mean age 36 years, range 23-69 years). During the study the patients received HPN for a mean period of 62 months, range 20-106 months. At the time of inclusion the patients had a significantly reduced BMC of lumbar spine and femoral neck compared to normals (Z-scores = -3.35 +/- 3.49, p < 0.05 and Z-score = -2.23 +/- 2.11, p < 0.05). During HPN the Z-score of lumbar spine BMC decreased in 8 patients and increased slightly or was unchanged in 7 patients. The mean Z-score of BMC of lumbar spine declined by 1.46 +/- 2.48 (p < 0.05) and the Z-score of femoral neck BMC declined by 0.831 +/- 1.14 (p < 0.05). This corresponds to a yearly decrease of lumbar spine BMC of 4%. There was no correlation between the decline in BMC during the study and the period of length the patients were on HPN. We conclude that patients on HPN have a low bone mineral density and that the bone loss continues during prolonged HPN.

Bone mineral distribution of the proximal tibia in gonarthrosis assessed in vivo by photon absorption

Regional bone mineral density (BMD, g/cm2) of the proximal tibia including the subchondral plate was measured in vivo by dual photon absorptiometry (DPA). Twenty-one women and six men with gonarthrosis (GA) were examined. Twenty-four healthy women served as controls for the women. The precision error of the BMD measurements ranged from 1.4-3.7% depending on the region measured. Subchondral BMD correlated significantly to the radiologic stage (P < 0.05). Compared to the controls, BMD of the subchondral plate, BMD of the medial condyle, the medial to lateral distribution ratio of subchondral BMD and the ratio between BMD of the subchondral plate and of the immediately underlying region were significantly increased in patients with predominantly medial GA (P < 0.05-0.0001). The BMD of the lateral condyle was lower in GA patients than in controls (P < 0.05). In patients with unilateral GA, the above-mentioned changes were found in the affected tibia compared to the normal knee in the same individual (P < 0.05). In contrast to any of the patients with varus deformity, the two patients with valgus deformity had higher BMD of the lateral condyle than of the medial. No differences in BMD of the distal forearm or the ultradistal region of the proximal tibia were found between the GA patients and the controls. The study shows that regional bone changes of the proximal tibia in GA can be measured precisely and noninvasively in vivo by DPA.

Relationship between quadriceps strength and bone mineral density of the proximal tibia and distal forearm in women

It is well known that there is a relationship between muscle strength and bone density, but it is uncertain whether this relationship is site specific. The aim of this study was to assess the relationship of quadriceps strength to site-specific bone mineral density (BMD) of the tibia and to BMD of the forearm. In 66 healthy women, aged 21-78 years, BMD was measured in the proximal tibia and the distal forearm by dual-photon absorptiometry. Isometric and isokinetic strength of the quadriceps was measured using an isokinetic dynamometer (Cybex II). Highly significant correlations between BMD of the proximal tibia and quadriceps strength were found (RS ranging from 0.79 to 0.84, p < 0.0001). Also, BMD of the distal forearm was correlated with quadriceps strength (RS ranging from 0.59 to 0.62, p < 0.0001). In a stepwise multiple regression analysis, quadriceps strength was a better predictor of tibial BMD than age, body height, or weight. However, age, height, and weight were more predictive of forearm BMD than quadriceps strength. When studying the pre- and postmenopausal women separately, quadriceps strength was correlated with BMD of the proximal tibia but not to forearm BMD. In conclusion, the study provides support for a site-specific relationship between muscle and bone.

Anti-cardiolipin antibodies (IgG and IgA) in women with recurrent fetal loss correlate to clinical and serological characteristics of SLE

AIM OF STUDY

We investigated to which degree IgG, IgA and IgM anti-cardiolipin antibodies (aCL) are associated in recurrent abortion or late fetal death with other signs of autoimmune disease and in particular SLE.

MATERIAL AND METHODS

Serological variables typical of SLE and of the anti-phospholipid antibody syndrome were measured once eight to 16 weeks after the last fetal loss in 158 women with recurrent abortion or late fetal death; women with manifest autoimmune rheumatic disease were excluded.

RESULTS

(1) Positive values, i.e. above the 99th percentile of reference material, of IgG aCL and IgA aCL were observed in 4% and 7%, respectively, whereas 26% had positive values of IgM aCL. (2) IgG aCL and IgA aCL but not IgM aCL correlated to anti-nuclear antibodies and to anti-double stranded DNA. (3) Anti-double stranded DNA, IgG aCL and IgA aCL but not IgM aCL correlated to previous occurrence of thrombosis. (4) ANA correlated to lower blood platelet concentrations and higher erythrocyte sedimentation rates.

CONCLUSIONS

Women with recurrent abortion or late fetal death who have higher but not necessarily abnormally high levels of IgG aCL or IgA aCL constitute a group with increased occurrence of clinical and serological characteristics of SLE. We suggest that these women be kept under surveillance for future development of autoimmune disease especially SLE. The women with high IgM aCL constitute another group without these characteristics.

Calcium absorption and bone mineral content in patients subjected to ileal bypass because of familial hypercholesterolaemia

Calcium absorption and bone mineral content were studied prospectively in 30 patients with familial hypercholesterolaemia subjected to partial ileal bypass surgery. One-third of the patients were followed up for 10 years after the operation. Six months postoperatively calcium absorption decreased significantly, from a median of 16% to 13%. The effect persisted up to 5 years of follow-up study. Ten years after the operation the absorption of calcium (median, 14.5%) was not significantly different from the preoperative calcium absorption (median, 16%). Bone mineral content, measured in 76% of the patients, was retained in all patients studied. A significant correlation was present between calcium absorption and urinary calcium. The reduction in calcium absorption did not correlate with increases in faecal fat. Other long-term side effects were persistent diarrhoea and moderate steatorrhoea. A significant weight loss was slowly regained in most patients. An increase of renal oxalate excretion was only small and transient in most patients. The study shows that bypass of the terminal 200 cm of ileum for familial hypercholesterolaemia causes moderate diarrhoea and steatorrhoea in most patients but only a slight reduction of intestinal calcium absorption and apparently no risk of bone demineralization. A benefit of a postoperative calcium and vitamin D supply cannot be excluded.

Vitamin D, parathyroid hormone, and bone mineral content of lumbar spine and femur in primary biliary cirrhosis

In order to elucidate the pathogenesis and degree of osteopoenia in primary biliary cirrhosis (PBC) we conducted a cross-sectional study of 47 non-selected female patients with biopsy-proven PBC. Bone mineral content (BMC) of the lumbar spine, femoral neck and femoral shaft was determined using dual photon absorptiometry. Compared to healthy females of corresponding decades the PBC patients exhibited significantly decreased mean BMC-values in lumbar spine (88%, P less than 0.05) and femoral neck (92%, P less than 0.05) but not in femoral shaft (96%, NS). Bone mineral content was not significantly associated with duration of liver disease, impairment of liver function (serum concentrations of albumin, clotting factors II + VII + X, bilirubin, alkaline phosphatase galactose elimination capacity or histology), variables reflecting calcium homeostasis (serum concentrations of ionized calcium, parathyroid hormone, vitamin D binding protein, 25-hydroxy vitamin D3 and 1,25-dihydroxy vitamin D3) or previous treatment with glucocorticosteroids. In view of our negative findings we suggest that future studies in this field should focus on physical activity and female sex hormones as determinants for the prevention of osteopoenia in females with primary biliary cirrhosis.

Bone mineral content of the lumbar spine and lower extremities years after spinal cord lesion

Bone mineral content (BMC) was measured by dual photon absorptiometry in the lumbar spine, femoral neck and shaft, and proximal tibia in 26 individuals with spinal cord lesions sustained 2 to 25 years previously. In average BMC of the lumbar spine was within the range of normal values. BMC of the femoral neck and shaft was in average 25% lower than the normal values, and for the proximal tibia more than 50% lower than the normal value. Participants with cervical lesions had lower BMC values in the femoral bones than those with thoracic lesions. Neither presence of spasticity nor daily use of long leg braces influenced the BMC significantly. Participants with previous lower extremity fractures had lower BMC values in the long bones compared with participants without fractures. The preservation of the BMC of the lumbar spine may be due to maintenance of load on the spine while sitting in a wheelchair.

Different trends of age-related diminution of bone mineral content in the lumbar spine, femoral neck, and femoral shaft in women

The bone mineral content (BMC) was measured by dual photon absorptiometry of 153Gd simultaneously in the lumbar spine, femoral neck, and femoral shaft in a cross-sectional study of 113 healthy women aged 20-89 years. The measurements suggest differences in the patterns of bone mineral decrease at the three sites of the skeleton in relation to age. The lumbar spine BMC decreases mainly during the usual time of menopause, whereas BMC decreases linearly in the femoral neck from young adulthood to old age. The femoral shaft BMC is nearly unaltered until the seventh decade, and thereafter BMC declines significantly. In each of the three age groups selected according to the usual time for menopause there was significant correlations between BMC of the scanning sites and nearly identical variance of BMC with age, suggesting homogeneity in the female population with regard to rate of bone diminution.

Mineral content of upper tibia assessed by dual photon densitometry

Bone mineral content (BMC, g/cm) and bone mineral density (BMD, g/cm2) of the proximal tibia were determined by dual photon absorptiometry (DPA). Measurements just distal to the subchondral plates of the tibia condyles, where the bone structure is predominantly trabecular, proved to give the most consistent results. The precision of BMC measurements in this region, expressed as the coefficient of variation, was 1.1 per cent and of BMD measurements 2.5 per cent. In a cross-sectional study on 63 normal women and men, BMC and BMD showed a decrease with age at a rate of about 8 and 9 per cent per decade, respectively, in women, but not in men. In normal women, BMC of proximal tibia was correlated with BMC of lumbar spine, femoral neck, and femoral shaft, as well as with body weight and height. DPA may be useful in the study of bone reactions, such as in patients undergoing arthroplasty of the knee.

Bone mineral content of the femoral neck and shaft: relation between cortical and trabecular bone

Bone mineral content (BMC) of the femoral neck and shaft was determined with dual photon absorptiometry, using 153Gd. Comparison of BMC with the amount of hydroxyapatite (HA) of in vitro specimen showed correlation coefficients of 0.992 and 0.996 for the femoral neck and shaft respectively. In the femoral neck the amount of cortical bone in a bone section varies from 16% ash weight in the proximal part to 71% in the distal part. Corresponding to the site of BMC measurements, the cortical bone constitutes 57% in the femoral neck and 95% in the femoral shaft. The precision error of measurements of BMC in vivo, expressed as the coefficient of variation for repeated determinations, was 1.4% for the femoral neck and 1.3% for the femoral shaft. In the femoral neck it is possible to distinguish between structures consisting mainly of cortical bone and structures containing mostly trabecular bone. While the cortical bone value decreases only slowly with age in normal women, corresponding to BMC of the femoral shaft, the trabecular bone value decreases rapidly even compared with BMC of the femoral neck. Despite the significant correlation between the values for cortical and trabecular bone a distinction seems essential from a clinical point of view.

Bone mineral content of femoral bone and the lumbar spine measured in women with fracture of the femoral neck by dual photon absorptiometry

The bone mineral content (BMC) in the lumbar spine, femoral neck, and femoral shaft in 46 women ranging in age from 60 to 89 years with fractures of the femoral neck was measured by dual photon absorptiometry and compared with that of 38 healthy women in the same age group. For BMC of the lumbar spine and femoral neck there was no significant difference between the fracture group and the control group, whereas BMC of the femoral shaft was significantly reduced in the fracture group. No significant difference was found between BMC values for the 18 transcervical and 28 pertrochanteric fractures. Radiographic evidence of osteoporosis with compression fractures of vertebrae could be demonstrated in ten of the patients with femoral neck fractures. There was a significant correlation between BMC of the axial and peripheral skeleton in the patients with fractures. The Singh Index was significantly correlated with BMC of the lumbar spine but not with that of the femoral neck or shaft. It is concluded that the high incidence of femoral neck fracture with increasing age might be explained in part by a reduction in BMC, primarily cortical bone mineral, but it is likely that other factors that reduce the strength of bone or increase the tendency in older persons to fall are also of importance.

Association between the C3F-gene and essential hypertension

1. The complement 3 (C3) phenotype distribution in 112 patients with essential hypertension was compared with the distribution of 316 normotensive control subjects. 2. A significant increased frequency of the C3F-gene was found among the patients (0.2637 vs 0.1721, P = 0.0031), indicating an association between the C3F-gene and essential hypertension. 3. The relative risk of essential hypertension was calculated to be 1.90 for C3F-positive individuals. 4. The association between the C3F-gene and essential hypertension was stronger among the untreated patients, where a relative risk of 3.89 was found for C3F-positive subjects. 5. A significant negative correlation was found between the C3F-positivity and the severity of the hypertensive disease estimated by eye group changes. This might be in accordance with a negative natural selection of C3F-positive hypertensive patients. 6. The study supports the hypothesis that immunogenetic factors may be of pathogenetic importance in essential hypertension.

Cardio-specific serum enzyme CK--MB following physical exercise in acute myocardial infarction

The possible harmful effect of physical activity on the extent of myocardial damage in patients with fresh myocardial infarction (AMI) has been a matter of debate. In this paper, serial determinations of serum creatine kinase (CK) isoenzymes are presented from 20 unselected patients with AMI, in 14 of them complicated by congestive heart failure or/and significant rhythm disturbances. During the acute phase, the cardiospecific MB-isoenzyme of CK in all patients rose above the upper reference limit of 30 U/l, the peak values ranging from 39 to 741, and returned to normal range within a few days. During the third week a maximal, symptom-limited exercise test was performed, with renewed serial determinations of CK-isoenzymes. Following the exercise an ST-segment deviation in the ECG was noted in 14 patients, anginal pain in 4, and a significant rise in serum CK--MM activity in 9 patients, whereas the CK--MB isoenzyme remained at zero level in all 20 patients. Thus, no evidence was found that even a maximal physical effort during the third week after AMI did cause any myocardial damage.

The degree of bone mineralization in chronic renal failure estimated from phosphorus/hydroxyproline ratio in bone biopsies

The degree of bone mineralization is the proportion between the contents of mineral and collagen in bone. As phosphorus (P) and hydroxyproline (Hypro) constitute a constant fraction of bone mineral and collagen, respectively, the P/Hypro ratio in bone tissue provides an estimate of the degree of mineralization. The P/Hydro ratio has been studied in bone biopsies from 42 patients with severe chronic renal failure. A few of them had a subnormal P/Hypro ratio and these patients corresponded to the diagnosis of classical osteomalacia or probably hyperparathyroidism. However, the mean bone P/Hypro ratio was significantly higher than normal, indicating a general tendency towards a higher degree of bone mineralization in patients with chronic renal failure.