OBJECTIVES: A significant number of patients who had a previous surgical treatment in the hip area experience subsequent hip fracture (SHF) on the opposite side. This study aims to analyze the risk factors and the correlation between osteoporosis and SHF on the opposite side by measuring bone mineral density (BMD) and treatment provided by risedronate for the prevention of SHF. MATERIAL & METHODS: We studied 475 patients without treatment who had unilateral hip and included following: death, SHF, alcoholism, living alone, dementia, dizziness, health status, osteoporotic treatment after fracture and BMD from March 1997 to June 2006. We selected 26 patients with SHF and the other 26 patients without SHF who had similar age, sex, BMI, BMD, diagnosis, treatment and follow up. The average follow up was 6.4 years (4~12 years) and 6.2 years (4~12 years).
Alcoholism ; Bone Density ; Dementia ; Dizziness ; Etidronic Acid ; Follow-Up Studies ; Hip ; Humans ; Osteoporosis ; Risk Factors ; Risedronate Sodium

OBJECTIVES: Exercise and physical activity may increase bone mineral density (BMD), especially in premenopausal women. However, previous studies have concentrated on postmenopausal women. This study was conducted to evaluate the independent associations of exercise and physical activity with BMD in premenopauseal women. MATERIAL & METHODS: One hundred premenopausal women were recruited from outpatient clinics and a health promotion center in a university hospital located in Seoul. We measured the BMD of lumbar spine and hip using dual energy X-ray absoptiometry. Data on sociodemographic characteristics and exercise status were obtained from self-reported questionnaires. The Stanford questionnaire was used to assess physical activity. RESULTS: Age and body mass index-adjusted ANCOVA revealed that the mean BMD at the spine and hip was not significantly associated with exercise time. The mean BMD at the spine was significantly higher in women who exercised regularly > or =3 a week than in women who exercised <3 times a week. (P=0.026) Higher BMD at the spine and femur neck was significantly associated with an increase in physical activity (P<0.05). After additional adjustment for exercise frequency, BMD at the femur neck was still significantly associated with total physical activity (P=0.007). CONCLUSION: Premenopausal women who exercised > or =3 times every week had significantly higher spine BMDs. The increase in physical activity was significantly associated with higher BMD at the spine and femur neck.
Ambulatory Care Facilities ; Bone Density ; Female ; Femur Neck ; Health Promotion ; Hip ; Humans ; Motor Activity ; Premenopause ; Surveys and Questionnaires ; Spine

OBJECTIVES: The aim of this study was to evaluate the appropriate position of the forearm for measuring the BMD (Bone Mineral Density). MATERIAL & METHODS: CT scanning was performed in 21 men to determine the appropriate position for the forearm. Twenty one healthy volunteers who were without any history of operations, anomalies or trauma were enrolled. CT scanning was used to evaluate the cross sectional structures and the rotation angle on the horizontal plane of the distal radius. The rotation angle was measured by the m-view program on the PACS monitor. The DXA was used for measuring 20 dried radii of cadaveric specimens in pronation and supination with 3degrees, 5degrees, 7degrees and 10degrees of rotation respectively, including a neutral position (0degrees) to evaluate the changes of BMD according to the rotation. RESULTS: The mean rotation angle of the distal radius on the CT scan was 7degrees of supination (76%, n=16), 3.3degrees of pronation (15%, n=3), and 0degrees at the neutral position (9%, n=2), respectively. The total average rotation angle in the 21 people was 5.2degrees of supination. In the cadaveric study, the BMD of the distal radius was different according to the rotational angles. The lowest BMD was obtained in 1.4degrees of pronation. CONCLUSION: In the case of the measuring of the BMD in the forearm in a neutral position, the rotational angle of the distal radius is close to supination. Therefore, pronation is needed for the constant measurement of BMD in the forearm. We recommend measuring the lowest BMD of the distal radius at about five degrees of pronation.
Cadaver ; Forearm ; Humans ; Male ; Organothiophosphorus Compounds ; Pronation ; Radius ; Supination

OBJECTIVES: Orphan nuclear receptor small heterodimer partner (SHP) is involved in osteoblastic differentiation. This study was undertaken to demonstrate a role of SHP in in vivo bone development using microcomputed tomographic (microCT) analysis of SHP knockout (KO) mice. MATERIAL & METHODS: Tibia bones were harvested from 1-, 4-, 8- and 20-week-old wild type (WT) and SHP KO mice. The microarchitecture of tibial bone was analyzed using a microCT (Skyscan 1172; Skyscan, Kontich, Belgium). Samples were scanned at a resolution of 17 microm (isotropic). The X-ray was operated with 50 kV, 200 microA of energy, 1.2 sec of exposure time, and a 0.5 mm thick aluminum filter. Projections were acquired over an angular range of 180degrees. For quantification of the bone mineral density (BMD), the microCT was calibrated using 2 standard phantoms with densities of 0.25 and 0.75 g/cm3. The image slices were reconstructed and analyzed using CT analyzer software (CTan, Skyscan). RESULTS: The CT values of tibial trabecular bone were significantly decreased in SHP KO compared to WT at 20-week-old mice determined by microCT; (bone volume / tissue volume [BV/TV, 40%], BMD [80%], and trabecular number [Tb.N, 50%]). However, the CT values were not significantly different between WT and SHP KO in cortical bone. Furthermore, the qualitative indices of trabecular bone such as the structure model index (SMI) and the polar moment inertia (PMI) did not differ between WT and SHP KO mice. CONCLUSION: These microCT results supports that SHP may act as a positive regulator of trabecular bone formation.
Aluminum ; Animals ; Bone Density ; Bone Development ; Child ; Child, Orphaned ; Humans ; Mice ; Mice, Knockout ; Osteoblasts ; Osteogenesis ; Tibia ; X-Ray Microtomography

OBJECTIVES: We evaluated the frequency of osteoporosis diagnosed in Bucheon postmenopausal women who attended our hospital using the World Health Organization (WHO) diagnostic criteria and the 2007 International Society for Clinical Densitometry (ISCD) official positions. And we evaluated a difference of bone fracture rate to have determined in diagnosis standards. MATERIAL & METHODS: From the database maintained in our department, we evaluated approximately 250 postmenopausal women, 45~69 years of age (mean, 56.9 years), between January 2005 and December 2007. We divided the women into 5 groups by age, and each group included 50 postmenopausal women. Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry (DXA). RESULTS: When the WHO threshold for postmenopausal women was applied, the frequency of osteoporosis diagnosed was 22.8% at the lumbar spine, 30.4% at the femoral neck, and 38% in at least one of the evaluated sites. When the ISCD criteria were applied, the frequency of osteoporosis diagnosed was 14%, 2.8%, and 14.8%, respectively. The fracture rate of osteoporosis diagnosed using ISCD criteria and WHO thresholds were 4 patients (1.6%, P-value=0.021), 9 patients (3.6%, P-value=0.057) each. CONCLUSION: The frequency of osteoporosis diagnosed in postmenopausal women using the WHO criteria is much lower than the 2007 ISCD official positions. The WHO criteria are more liberal than the ISCD official positions. We anticipate new criteria that will unify these two methods of diagnosis.
Absorptiometry, Photon ; Bone Density ; Densitometry ; Female ; Femur Neck ; Fractures, Bone ; Humans ; Osteoporosis ; Spine ; World Health Organization

Osteoporosis is a debilitating disease affecting the elderly population, associated with compromised stability and reduced mobility of the bone. Osteoporosis is diagnosed as a condition when the measured bone mineral density (BMD) falls below 2.5 standard deviations of peak mass. However, BMD alone might not be enough to define the osteoporotic condition because it does not accounts on the micro-architectural changes in the bone trabeculae. Thus, this study aimed at studying the micro-architecural changes in trabeculae rich bone metaphysis of ovariectomized rat models in comparison with the conventional BMD measurements and the mechanical parameters. In this study, proximal tibiae of twenty-five female rats from four different groups (SHAM, OVX, IBAN and PTH) were evaluated using micro-CT, pQCT and three point bending tests. The micro-CT analysis showed that the deterioration of trabecular bone was significant during the first 6 weeks after OVX surgery. During the early stage of osteoporosis, the trabecular density decreased more rapidly than the cortical density. Morphological analysis showed that early administration of both ibandronate and parathyroid hormone has a beneficial effect on restoring the trabecular structures. Bone mechanical properties of treatment groups did not show significant difference, but followed the overall trend as morphological indices. The results suggest that early administration of either ibandronate or PTH is effective in restoring the trabecular bone loss caused by osteoporosis. However, larger-scale studies should be conducted to better understand the effect of both anti-resorptive and anabolic treatments in terms of morphological and mechanical properties.
Aged ; Animals ; Bone Density ; Diphosphonates ; Female ; Humans ; Osteoporosis ; Parathyroid Hormone ; Rats ; Tibia

The bone mass is known to be decreased in patients with type 1 diabetes, and this is primarily due to osteoblastic dysfunction. A number of epidemiologic studies have consistently shown a significantly higher risk of fractures in type 1 diabetic patients as compared to that of healthy subjects. The data on bone mineral density (BMD) in patients with type 2 diabetes has been inconsistent. However, many recent epidemiologic studies have shown that the osteoporotic fracture risk, and especially at the hip, is also increased in patients with type 2 diabetes, and even in patients with normal or higher BMD. Meanwhile, several studies have shown higher bone mass and a lower fracture risk in subjects with recent onset type 2 diabetes or impaired glucose tolerance with hyperinsulinemia. Poor bone quality and an increased risk of falling are thought to be important contributing factors for the higher fracture risk in patients with type 2 diabetes. Collagen overglycosylation by accumulation of advanced glycation end products (AGE) is thought to be one of the possible mechanisms underlying poor bone quality. The risk of falling in patients with diabetes is increased due to hypoglycemia, visual impairment from retinopathy and cataracts, altered balance, gait problems due to neuropathy and foot ulcers, associated cardiovascular diseases and medication use. Insulin-sensitizing agents, such as thiazolidinediones, are also associated with a higher fracture risk through an increase in bone marrow adiposity and a decrease in osteoblastogenesis. Because diabetes and osteoporosis are highly prevalent chronic diseases in the aging population and the incidences are increasing worldwide, understanding the risk factors that predispose patients to such conditions is very important. On considering the potential mechanisms associated with bone metabolism, adequate glycemic control while minimizing the episodes of hypoglycemia is the most important first step in the medical management to prevent osteoporotic fractures in patients with diabetes.
Adiposity ; Aging ; Bone Density ; Bone Marrow ; Cardiovascular Diseases ; Cataract ; Chronic Disease ; Collagen ; Diabetes Mellitus ; Foot Ulcer ; Gait ; Glucose ; Glycosylation End Products, Advanced ; Hip ; Humans ; Hyperinsulinism ; Hypoglycemia ; Incidence ; Osteoblasts ; Osteoporosis ; Osteoporotic Fractures ; Resin Cements ; Risk Factors ; Thiazolidinediones ; Vision Disorders

Osteoporosis, the most common bone disease, is a silent condition resulting in increased fracture risk. Preventive methods for adulthood, early recognition of osteoporosis followed by timely and effective management can reduce fracture risk. Several pharmacologic therapies are currently available, and when choosing from the available options, clinicians should consider the efficacy and safety profiles of each therapy as well as the individual patient's needs and overall health. Ideally, therapy should satisfy multiple criteria: fracture protection across multiple skeletal sites; rapid onset of action to maximize the timing of fracture protection; and minimal side effects with proven long-term safety.
Bone Diseases ; Mass Screening ; Osteoporosis ; Skeleton

OBJECTIVES: To evaluate the effect of postmenopausal hormone therapy alone or in combination with bisphosphonate on bone mineral density (BMD) in postmenopausal women. METHODS: One hundred three women diagnosed with low BMD in postmenopausal women were included in this study. All patients were classified into two groups; oarl hormone therpy alone (Group I) or with alendronate (Group II), given for 12 months. Dual energy X-ray absorptiometry was used to measure BMD before and after 12 months of treatment. RESULTS: In all groups, significant increase in bone density measurements were seen at 12 months of treatment. The BMD of lumbar spine more increased significantly in Group II than Group I. CONCLUSIONS: Postmenopausal hormone therapy is effective in osteopenic and osteoporotic women. However, the combined treatment with hormone therapy and bisphophonate is more effective in postmenopausal women with low BMD.
Absorptiometry, Photon ; Alendronate ; Bone Density ; Female ; Humans ; Menopause ; Spine

OBJECTIVES: To investigate the incidence of non-responder to hormone therapy (HT) and to evaluate the bone response to HT according to basal bone mineral density(BMD) in postmenopausal women. METHODS: A total of 167 postmenopausal women received either continuous combined estrogenprogestogen replacement (n=102) or estrogen replacement (n=65) for 1 years. BMD at the lumbar spine and femoral neck was measured by dual energy X-ray absorptiometry (DXA) before and 1 year after HT. RESULTS: The incidence of non-responder (women with >3% bone loss per year) to HT was 8.3% in the lumbar spine, and 22.1% in femoral neck. non-responder group had a higher basal BMD at the lumbar spine than responder group, and showed bone loss rate of 7.7% per year. After 1 year of HT, postmenopausal women with osteoporosis showed a higher rate of increase in BMD at the lumbar spine and femoral neck than women with normal BMD or osteopenia. CONCLUSIONS: The non-responders to HT have a higher basal lumbar BMD, compared with responders. The higher basal BMD at the lumbar spine is, the less bone conservation effect of HT is.
Absorptiometry, Photon ; Estrogen Replacement Therapy ; Female ; Femur Neck ; Humans ; Incidence ; Osteoporosis ; Spine