Bone Diseases, Metabolic ; diagnosis ; etiology ; therapy ; Chronic Disease ; Humans ; Liver Diseases ; complications ; diagnosis ; therapy

INTRODUCTION: Bone mineral density (BMD) is an important index in diagnosis of osteoporosis and other metabolic bone diseases, prediction of fractures, and monitoring treatment. This study was to find a more feasible technique for prediction of osteoporotic fracture between dual energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT) and to reveal the actual change of bone strength when BMD was changed. METHODS: Ten of these 20 specimens were used as the demineralized group and the other 10 as the control. Each specimen was immersed in HCl solution at for a period of at least 10 minutes, up to 100 minutes, at an interval of 10 minutes for different levels of demineralization. BMD was measured using DXA and QCT. Uniaxial compression tests were conducted to measure biomechanical parameters. Pearson correlation analysis was used respectively between BMD and biomechanical parameters and between DXA and QCT. RESULTS: Elastic modulus (r=0.87) and yield stress (r=0.84) showed a statistically significant correlation with DXA BMD. Through correlation analysis with QCT BMD and elastic modulus, correlation coefficient showed hemi-vertebra (r=0.80) and trabecular (r=0.68). In yield stress, there was a statistically significant correlation in hemi-vertebra (r=0.87) and trabecular bone (r=0.84). CONCLUSION: DXA is a current standard technique not only for diagnosis of osteoporosis but also for prediction of fracture risk compared to QCT. Actual decrease of bone strength was much greater than that of BMD by both DXA and QCT.
Absorptiometry, Photon* ; Biomechanical Phenomena ; Bone Density* ; Bone Diseases, Metabolic ; Diagnosis ; Elastic Modulus ; Osteoporosis ; Osteoporotic Fractures

OBJECTIVES: Abnormalities of bone metabolism could be followed in gastrectomized patients as a late complication. Nowadays, many biochemical and radiologic measurements are applied to detect these abnormalities. The aim of our study is to determine the valuable parameter as an appropriate screening test during long-term follow-up periods and define the usefulness of new biochemical markers for bone metabolism by comparing with traditional markers. METHODS: Fifteen patients who had undergone partial gastrectomy were chosen randomly and fifteen healthy controls were compared. Then, several biochemical and radiologic tests were measured. We excluded subjects who proved to have other causes of bone metabolism abnormalities. Ten patients and 10 controls were finally selected. RESULTS: Comparing the data with those of a corresponding control group, the lumbar bone density measured by quantitative computed tomography (QCT) was statistically significantly lower in the patient group (p +ADw- 0.01). The urinary deoxypyridinoline, a biochemical marker for bone resorption, was statistically higher in the patient group (p +ADw- 0.025). Osteocalcin, Procollagen I C-terminal peptide (PICP) and Type I collagen C-terminal telopeptide (ICTP) were slightly but not significantly higher in the patient group. The serum parathyroid hormone (PTH) and 25-hydroxy vitamin D levels were similar in both groups. CONCLUSION: We could suggest that urinary deoxypyridinoline and QCT are appropriate parameters as screening tests for the detection of bone metabolism abnormalities in gastrectomized patients during long-term follow-up. Urinary deoxypyridinoline may be a simple and rapid test which could replace cumbersome 24-hour urinary hydroxyproline.
Absorptiometry, Photon ; Adult ; Biological Markers/analysis ; Bone Density/physiology+ACo- ; Bone Diseases, Metabolic/etiology+ACo- ; Bone Diseases, Metabolic/diagnosis ; Bone Diseases, Metabolic/blood ; Comparative Study ; Gastrectomy/methods ; Gastrectomy/adverse effects+ACo- ; Human ; Male ; Middle Age ; Reference Values ; Sensitivity and Specificity

Osteoporosis is a metabolic bone disease characterized by decrease of bone matrix, resulting in generally reduced bone mass, and the diagnosis and grading of progression are assessed by many methods. There are Singh Index as a simplest method, for grading the trabecular pattern of the femur in pelvis anteroposterior X-ray, and the recently developed Dual Photon Absorptiometry which measures the bone mineral contents in the lumbar spine(L2-L4), femur neck, Ward's triangle and trochanteric area. Study for correlation between the Singh index and bone mineral contents measurements by Dual Photon Absorptiometry was performed in 36 normal Korean persons and 35 persons with osteoporosis. The results and conclusion were as follows; 1. A significant difference in bone mineral density at each area was noted between the control group and osteoporosis group. 2. A significant difference in Singh Index at each area was noted between the control group and osteoporosis group. 3. Positive correlation was noted between the mineral density and Singh Index. 4. We think Singh Index is a useful method in the diagnosis and grading of progression of osteoporosis.
Absorptiometry, Photon ; Bone Density ; Bone Diseases, Metabolic ; Bone Matrix ; Diagnosis ; Femur ; Femur Neck ; Humans ; Methods ; Miners ; Osteoporosis ; Pelvis

OBJECTIVE: To evaluate the concordance, or discordance, of the osteoporotic diagnosis between femur neck and lumbar spine, using DEXA T-scores and the WHO classification. MATERIALS AND METHODS: The BMD (Define?) on both hips and of the lumbar spine of 718 Korean females were measured. The mean age of the subjects was 55.5 years (31-91). The BMD data were obtained from 3 hip regions and from the lumbar spine, anteroposteriorly, using dual-energy x-ray absorptiometry (Lunar). The BMDs of femur neck and the L2-4 vertebrae were classified into normal (a T-score >-1), osteopenia (-1 < or = T-score < -2.5) and osteoporosis (-2.5< or =T-score) using the WHO definitions. RESULTS: There was significant correlation between the femur neck and lumbar BMDs (r=0.772). However, the discordance rate was 33% for all the cases, but this was 20% in the subjects below 50 of age, 31% in the subjects in their 50's, 47% in their 60's and 42% when 70 or above. The discordance rates of the normal, osteopenic and osteoporotic groups were 21, 54 and 17% respectively, with the highest discordance rate in the osteopenia group. Among the 649 persons in the normal or osteopenia groups, in relation to the femur neck BMD, there were 67 (10.3%) in the osteoporotic group with L2-4 BMD. But the reverse situation was only 12 persons from 594 (2.0%). (Eds note: this whole section makes little sense? What were the BMDs? The last sentence is completely meaningless.) CONCLUSIONS: The discordance rate between the femur neck and lumbar spine was as high as 33%, and was the highest in the osteopenia persons in their 60's. Therefore, in these persons the BMD of both sites should be checked together, but if not, the lumbar BMD should be checked first.
Absorptiometry, Photon ; Bone Diseases, Metabolic ; Classification ; Diagnosis ; Female ; Femur Neck ; Hip* ; Humans ; Osteoporosis ; Spine*

Osteoporosis is one of most common metabolic bone disease that the incidence and related fractures are increasing. Early diagnosis, prevention and treatment are becoming a big issue recently. Diagnosis of osteoporosis previously was from indirect assessment of bone mass by X-ray film of proximal femur, spine or calcaneus lateral, or from histologic grading of iliac bone biopsy. But recently development of dual energy X-ray absorptiometry (DXA) enabled noninvasive and precise assessment of bone mass, and measurement of biochemical bone markers from blood and urine are used as dynamic index of bone metabolism. These diagnostic methods can be used for assessment of fracture risk, and response of medication in osteoporotic patients.
Absorptiometry, Photon ; Biopsy ; Bone Density ; Bone Diseases, Metabolic ; Calcaneus ; Early Diagnosis ; Femur ; Humans ; Incidence ; Osteoporosis ; Spine ; X-Ray Film

Inherited metabolic disease is rare disorders that show symptoms mainly in pediatric age and early treatment is important for preventing complications of the disease. Recent development in molecular and biochemical techniques help clinicians with proper diagnosis of patients, however, many of the disease still remain lack of effective therapeutic strategies. Better understanding on biochemical and molecular basis of pathogenesis of the disease combined with advanced medical care would provide new sight on the disease that can also improve the quality of life and long-term prognosis of patients. Traditionally, there are several modalities in the treatment of metabolic diseases depend on the biochemical basis of the disease such as diet restriction, removing or blocking the production of toxic metabolites, and stimulating residual enzyme activity. The inherited metabolic disease is not familiar for many clinicians because the diagnosis is troublesome, treatment is complicated and prognosis may not as good as expected in other diseases. Recently, new therapeutic regimens have been introduced that can significantly improve the medical care of patients with metabolic disease. Enzyme replacement therapy has showed promising efficacy for lysosomal storage disease, bone marrow transplantation is effective in some disease and gene therapy has been trying for different diseases. The new trials for treatment of the disease will give us promising insight on the disease and most clinicians should have more interest in medical progress of the metabolic disease.
Bone Marrow Transplantation ; Diagnosis ; Diet ; Enzyme Replacement Therapy ; Genetic Therapy ; Humans ; Lysosomal Storage Diseases ; Metabolic Diseases* ; Metabolism ; Prognosis ; Quality of Life

PURPOSES: Radiologic findings of hands in Turner syndrome(TS) which have been reported were metacarpal sign(MS), carpal sign(CS), phalangeal sign(PS), osteopenia, and delayed bone maturation. The aim of this study is to evaluate the difference of radiologic findings in TS, idiopathic short stature(ISS), and growth hormone deficiency(GHD). METHODS: Sixty girls with short stature were studied for chromosome analysis, and growth hormone provocation test. Simple radiography of hands was also used in this study. They were divided into three groups; 25 cases of TS(45, XO, 13 cases; variants, 12 cases), 24 cases of ISS, and 11 cases of GHD. MS was the distance between the line drawn tangential to the heads of the fourth and fifth metacarpal bones and the distal end of the third metacarpal head. CS was the angle between the line tangential to scaphoid and lunate and the line tangential to lunate and triquetrum. PS was the difference between the sum of the length of distal and proximal phalanges of the fourth finger and the length of the fourth metacarpus. Frequency of osteopenia and the shortening of the fifth middle phalanx among three groups were compared. RESULTS: MS was 0.06+/-4.66 mm in TS, -1.96+/-1.83 mm in ISS, and -2.63+/-30 mm in GHD. CS was 116.54+/-11.52degreein TS, 129.42+/-5.52degreein ISS, and 125.54+/-7.22degreein GHD. PS was 0.52+/-0.34 mm in TS, 0.38+/-0.20 mm in ISS, and 0.33+/-0.20 mm in GHD. There were statistically significant differences between TS and ISS, between TS and GHD, respectively in MS, CS, and PS(P<0.05). There were no significant differences in MS, CS, and PS between 45, XO and variants of TS. Osteopenia was observed in 92.3% of TS, and 54.2% of ISS, and 81.8% of GHD. Shortening of the fifth middle phalanx was observed in 56.0% of TS, 25.0% of ISS, and 45.5% of GHD. CONCLUSION: Simple radiologic findings of hands are helpful in differential diagnosis of TS and other short stature children.
Bone Diseases, Metabolic ; Child ; Diagnosis, Differential ; Female ; Fingers ; Growth Hormone ; Hand* ; Head ; Humans ; Metacarpal Bones ; Metacarpus ; Radiography ; Turner Syndrome*

BACKGROUND: Osteoporosis is an important health concern among the postmenopausal women. Therefore, it is necessary to find out acceptable screening tools for osteoporotic patients. The purpose of this study was to evaluate the Risk Index by OSTA as a screening test for osteoporosis. METHODS: The study population was 322 naturally caused menopausal women in Korea. Their was of femoral neck and lumbar spine BMD measured by DEXA. Risk Index by OSTA, based on weight and age, was calculated and the sensitivity and specificity for osteoporosis and osteopenia were evaluated. To find out the proper cut-off point for osteoporosis and osteopenia among the postmenopausal women in Korea, we also compared the sensitivity and specificity of each Risk Index value. RESULTS: The mean age and ages at menopause were 59.1(+/-6.2) and 50.7 (+/-2.7) years, respectively. The prevalence of osteoporosis was 9.6% with femoral neck BMD. For oeteoporosis, using a cut-off point of -1 yielded a sensitivity of 74.3% and a specificity of 52.2% with femoral neck BMD. Using a cut-off of -2 yielded a sensitivity of 87.3% and a specificity of 70.9%. The ROC curve showed an AUROC 0.88 for Risk Index in identifying osteoporosis. CONCLUSION: The Risk Index is an acceptable, simple and useful method in the diagnosis of osteoporosis with a Risk Index of -2 in Korean postmenopausal women.
Bone Diseases, Metabolic* ; Diagnosis ; Female ; Femur Neck ; Humans ; Korea ; Mass Screening* ; Menopause ; Osteoporosis* ; Prevalence ; ROC Curve ; Sensitivity and Specificity ; Spine

PURPOSE: To determine the incidence of avascular necrosis (AVN) of the femoral head after renal transplantation, evaluate plain radiographic and MR findings, and compare known predisposing factors between the AVN group and the control group. MATERIALS AND METHODS: Between August 1990 and June 1998, 256 renal transplantations were carried out at the Maryknoll hospital. The incidence of AVN was determined clinically, and in the AVN group, plain radiographic and MR findings were evaluated. A control group of 29 cases was randomly selected from among the remaining 241 patients, and acute rejection, mean daily steroid dose and osteopenia were compared between the AVN group and the control group. RESULTS: The incidence of AVN of the femoral head was 5.9 %(15/256). Involvement was bilateral in nine cases and unilateral in six and 24 femoral heads were thus affected. The mean period required for diagnosis of this condition was 10.7 months(within 6 months: 2 hips, between 6 -12 months: 10, between 12 -24 months: 9, over 24 months: 3). Plain radiographs showed that three cases were Ficat stage I, five were stage II, seven were stage III, and nine were stage IV. MRI indicated that 15 cases were Mitchell class A, one was class C, and three were class D. Correlation between Ficat stage and the period required for diagnosis showed that the longer the latter, the higher the Ficat stage. A comparison of risk factors between the AVN group and the control group showed that the incidence of acute rejection and osteopenia, and the mean daily steroid dose, were higher in the AVN group than in the rejection group and that the difference was statistically significant. CONCLUSION: The incidence of AVN of the femoral head after renal transplantation was 5.9 %. The longer the period required for diagnosis of AVN, the higher the Ficat stage. A comparison of risk factors between the AVN group and the rejection group showed that the incidence of acute rejection and osteopenia as well as the mean daily steroid dose, were higher in the AVN group than in the rejection group, and these may thus be pre-disposing factors for AVN. In patients with these risk factors, even though plain radiographic findings are normal, MRI is necessary if AVN is to be diagnosed during its early stages.
Bone Diseases, Metabolic ; Causality ; Diagnosis ; Head* ; Hip ; Humans ; Incidence ; Kidney Transplantation* ; Magnetic Resonance Imaging ; Necrosis* ; Risk Factors