OBJECTIVES: Abnormal bone turnover and mineralization is the characteristic of the end-stage renal disease (ESRD) patients receiving dialysis treatment. Reduced bone mineral density (BMD) has been reported in ESRD patients in many recent studies. Recent study has demonstrated hypoxia increases the loss of bone mass whereas the use of erythropoietin (EPO) increases bone marrow mesenchymal stem cell in vitro, which is the commonly found in ESRD patients. The objective of the present study is to analyze the relationship between erythropoiesis and calcium, phosphorus, parathyroid hormone (PTH) status in ESRD patients. METHODS: This study was a cross-sectional analysis of 183 ESRD patients (78 males, 105 females) on dialysis with mean age of 52 +/- 13 years and mean dialysis duration of 3.4 +/- 3.0 years. Duration and dose of EPO administration, hemoglobin, serum ferritin, and iron were checked in all subjects. BMD was evaluated by DXA. RESULTS: Age was negatively, and body weight and c-calcium positively associated with spine and femur neck and total hip BMD. Hemoglobin was positively correlated with femur neck and total hip BMD. Total dose of EPO, iPTH, and alkaline phosphatase had no significant association with BMD. However, according to tertile of serum PTH concentration, BMD were worst in third tertile group. In multivariate linear regression analysis, age, weight, and serum PTH affect BMD. CONCLUSIONS: BMD was independently related with age and weight. Hemoglobin correlated positively with femur neck and total hip BMD. However, treatment with EPO had no association with BMD. Increased PTH was related with reduced BMD.
Alkaline Phosphatase ; Anoxia ; Body Weight ; Bone Density ; Bone Marrow ; Calcium ; Cross-Sectional Studies ; Dialysis ; Erythropoiesis ; Erythropoietin ; Femur Neck ; Ferritins ; Hemoglobins ; Hip ; Humans ; Iron ; Kidney Failure, Chronic ; Linear Models ; Male ; Mesenchymal Stromal Cells ; Parathyroid Hormone ; Phosphorus ; Spine

Increasing numbers of atypical subtrochanteric fractures have been reported among long-term bisphosphonate users. However, the nature and extent of the problem are unknown despite recent investigations. The task force of American Society for Bone and Mineral Research (ASBMR) defined major and minor features of complete and incomplete atypical femoral fractures; transverse or short oblique orientation, minimal or no associated trauma, a medial spike when the fracture is complete, and absence of comminution. Minor features include their association with cortical thickening, a periosteal reaction of the lateral cortex, prodromal pain, bilaterality, delayed healing, comorbid conditions, and concomitant drug exposures, including bisphosphonate, glucocorticoids, and proton pump inhibitors. Based on published data, the incidence of atypical femoral fractures associated with bisphosphonate therapy for osteoporosis appears to be very low, particularly compared with the number of vertebral, hip, and other fractures that are prevented by bisphosphonate. Physicians and patients should be aware of the possibility of atypical femoral fractures and of the potential for bilaterality.
Advisory Committees ; Diphosphonates ; Femoral Fractures ; Glucocorticoids ; Hip ; Hip Fractures ; Humans ; Incidence ; Orientation ; Osteoporosis ; Proton Pump Inhibitors

Fracture healing is the ongoing process but it is often delayed in elderly patients. Because the fractures in elderly patients with osteoporosis are severely comminuted and their quality of bone is poor, the associated delay of fracture healing is likely to lead to surgical failure. Recently, as a way to promote healing fractures, intermittent systemic parathyroid hormone treatment has been actively researched. Although the effect of parathyroid hormone, which is demonstrated by animal experiments, is well known, there are not many clinical applications. The authors report 2 cases which had the time-shortened callus formation by intermittent parathyroid hormone (teriparatide) administration after surgical treatment, maximum preservation of periosteum as possible, in elderly patients who have supracondylar fracture on distal femur.
Aged ; Animal Experimentation ; Bony Callus ; Femoral Fractures ; Femur ; Fracture Healing ; Humans ; Osteoporosis ; Parathyroid Hormone ; Periosteum

Although alendronate was considered generally safe and effective to osteoporosis in short-long term studies, it remains the potential risk of severely suppressed bone turnover that causes insufficient fracture of femur. In this report, we describe a patient of atypical subtrochanteric fracture who treated with prolonged alendronate. A 68-years old woman who had a history of medication of alendronate for 12 years was presented to the outpatient clinic with right thigh pain. The radiographs revealed thickening and fracture line of the lateral side of subtrochanteric area of the right femur. She discontinued taking the medicine and follow up closely. After 1 month later, she sustained atypical subtrochanteric femoral fracture after simple fall, and underwent an internal fixation with compression hip screw. After operation, bone biopsy was done with tetracycline staining for valuation of bone metabolism and severe osteoporosis was observed. Although long-term use of bisphosphonate could increase bone mineral density, this case showed that it could lead insufficient fracture by decreasing bone strength through severely suppressed bone turnover, inhibition of normal bone formation and decreased bone quality.
Alendronate ; Ambulatory Care Facilities ; Biopsy ; Bone Density ; Diphosphonates ; Female ; Femoral Fractures ; Femur ; Follow-Up Studies ; Hip ; Humans ; Osteogenesis ; Osteoporosis ; Tetracycline ; Thigh

OBJECTIVES: To evaluate the prevalence of osteoporosis in the Alzheimer's disease patients. METHODS: One hundred and twenty eight patients with Alzheimer's disease were included in this study. The patients are diagnosed with Alzheimer's disease using Korean-Mini Mental Status Examination (K-MMSE) and checked bone mineral density using single-energy (SE) quantitative computed tomography (QCT) in 2010. To define abnormality in terms of QCT of the spine, a bone mineral density (BMD) spine below 80 mg/cm3 is indicative of osteoporosis and BMD between 80 and 120 mg/cm3 is indicative osteopenia. RESULTS: The prevalence of osteoporosis in the control group is 29.73%. The prevalence of osteoporosis in the Alzheimer's disease patients is 96.87%. The prevalence of osteopenia in the Alzheimer's disease patients is 3.12%. The prevalence of severe osteoporosis fracture in the Alzheimer's disease patients is 32.03%. CONCLUSION: The prevalence of osteoporosis in Alzheimer's disease patients is higher than in the control group.
Alzheimer Disease ; Bone Density ; Bone Diseases, Metabolic ; Humans ; Osteoporosis ; Prevalence ; Spine

OBJECTIVES: The purpose of this study was to determine the association between the bone mineral density (BMD) and severity of spinal osteoarthritis (spondylosis) in osteoporotic spinal compression fracture. METHODS: Fifty six patients were evaluated 66 cases had an osteoporotic thoracolumbar compression fracture between January 2008 and June 2010. The average patient age was 76.2 years (M/F : 8/48). Age and body mass index (BMI, kg/m2) were measured, and the BMD was performed using peripheral quantitative computed tomography (pQCT). Simple thoracolumbar (T-L) spine lateral radiography was evaluated for three criteria: presence of osteophytes, disc space narrowing and vertebral body sclerosis. The findings were graded 0 to 3 and analyzed statistically for a correlation with the BMD and fractured vertebrae. RESULTS: Acute compression fractures comprised of 15 cases and the most common site of acute fractures with old fractures was lumbar spine (L1; 30 cases, 45.4%). The average of BMI was 23.32 and BMD (T-score) was -4.47. Pearson's rho showed a positive association between the weight, height and the BMD (P < 0.01). In terms of the BMD versus spondylosis, there was a positive association with high score in the high order cortical bone. Compression fractures occurrence rate in the absent and present of spondylosis was 74.3% and 22.4%, and 69% occur in the spinal segmental with no bony spur with chi-square test (P < 0.01). CONCLUSION: In the present of spondylosis was high score of cortical BMD and low rate of compression fracture. Spondylosis could be one of a factor of the occurrence in acute and adjacent compression fracture after old fractures.
Body Mass Index ; Bone Density ; Fractures, Compression ; Humans ; Osteoarthritis, Spine ; Osteophyte ; Sclerosis ; Spine ; Spondylosis

OBJECTIVES: To analyze the fracture type and adjacency of accompanied fractures in acute osteoporotic spinal compression fracture using whole spine sagittal MRI (WS-MRI), and to know the relation of sagittal vertical axis (SVA), body mass index (BMI), and lumbar bone mineral density (BMD). METHODS: From June 2007 to December 2010, 167 patients who had acute spinal compression fractures confirmed by WS-MRI divide in three groups. 82 patients (M/F : 25/57) who had acute fractures only were in group 1, 79 patients who had acute and old fractures were in group 2, and 20 patients who had acute fractures after vertebroplasy were in group 3. To analyze the fracture type and adjacency of accompanied fractures in acute osteoporotic spinal compression fractures which combined chronic fracture or vertebroplasty using the WS-MRI and compared with the control group who had no spinal fractures measured the SVA. In all groups, we measured BMI, and BMD. RESULTS: In WS-MRI, 31 patients in group 1 had L1 which was the most common fracture site. Twenty two patients had chronic fractures and more than 3 remote levels at the acute fracture site in group 2 and especially among there 14 patients have each level in cervicothoracic and lumbar vertebrae. In group 3 had old fracture and adjacent fracture was 14 and 11 patients. Compared with the control group, all groups had increased SVA, especially in group 2 which has acute and chronic compression fractures. They have no significantly difference of BMI in each group, but group 2 and 3 had a significant lower BMD than group 1. CONCLUSION: Fourteen patients of coexisting fractures in acute osteoporotic spinal compression fractures with WS-MRI which could be missed in the conventional MRI. Additionally this study suggests that longer SVA causes sagittal imbalance, and BMD is more relative than BMI in refractures of chronic compression fracture patients.
Axis, Cervical Vertebra ; Body Mass Index ; Bone Density ; Fractures, Compression ; Humans ; Lumbar Vertebrae ; Osteoporosis ; Spinal Fractures ; Spine ; Vertebroplasty

OBJECTIVES: The inhibitory effect of Dickkopf (Dkk)-1 on osteoblastic differentiation through blocking Wnt signaling has been well studied. However, the role of other members of the subfamily of Dkks remains unclear. We have examined the role of different Dkks on osteoblastic differentiation of mesenchymal progenitor cells and apoptosis of osteoblasts. METHODS: Osteoblastic differentiation was induced by treatment of Wnt-3a with Dkks or vehicle in C3H10T1/2 cells and alkaline phosphatase (ALP) activity was measured. Serum deprivation induced apoptosis was performed with pre-treatment of Dkks or vehicle in MC3T3-E1 cells and methyl thiazolyl tetrazolium (MTT) assay was done. RESULTS: Dkk-2 at low concentrations (5 and 20 nM) and Dkk-3, -4 at any concentrations (5 to 100 nM) significantly increased Wnt-3a-induced ALP activity, whereas Dkk-2 at high concentration (100 nM) significantly reduced. Treatment of Dkk-2, -3 and -4 at high concentration (100 nM) showed significant decreases of Wnt/beta-catenin transcriptional activity, whereas no effects were seen at low concentration (20 nM). In parallel experiments, treatment of Dkk-1 showed robust dose dependent inhibition not only in ALP activity but also in Wnt/beta-catenin transcriptional activity. Dkk-2, -3 and -4 increased serum deprivation-induced apoptosis in MC3T3-E1 mouse osteoblasts, while Dkk-1 had no effect. CONCLUSIONS: We found that unlike Dkk-1, Dkk-3 and -4 stimulated early osteoblastic differentiation at various concentrations regardless of their inhibitory effects on Wnt/beta-catenin transcriptional activity at high concentration. Dkk-2 had a biphasic effect where the lower doses significantly increased ALP activity while the high dose was inhibitory. Dkk-2, -3 and -4 stimulated osteoblast apoptosis whereas Dkk-1 had no effect.
Alkaline Phosphatase ; Animals ; Apoptosis ; Mesenchymal Stromal Cells ; Mice ; Osteoblasts

The relationship between long-term bisphosphonate usage and insufficiency fracture in osteoporotic elderly patients has been increased interest in recent years. Most reported insufficiency fractures are predominantly concentrated on proximal femoral shaft or pelvic bone. However, there was no report about insufficiency femoral neck fracture after long term use of bisphosphonate in domestic. We experienced a rare case of a 70-years-old woman who was diagnosed with bilateral insufficiency femoral neck fracture after 8 years use of alendronate. We performed an internal fixation using 6.5 mm diameter cannulated screws for the both insufficiency femoral neck fracture. Symptoms disappeared immediately after the surgery and there was no radiologic and clinical complication such as nonunion or delayed union up to the latest follow-up at 12 months postoperatively.
Aged ; Alendronate ; Female ; Femoral Neck Fractures ; Femur ; Femur Neck ; Follow-Up Studies ; Fractures, Stress ; Humans ; Pelvic Bones

OBJECTIVE: The aim of this study was to evaluate the association between the components of the metabolic syndrome (MS) and bone mineral density (BMD). METHODS: We conducted a retrospective cross-sectional analysis for 128 men (mean age 50.4 +/- 8.3 years) and 391 women (mean age 46.9 +/- 11.6 years) in Korea University Guro Hospital, Korea. Height (cm), weight (kg), waist circumference (cm), and blood pressure (mmHg) were measured. Fasting plasma glucose (FPG), high-density lipoprotein cholesterol (HDL-C), and triglycerides were measured. BMD at the total hip and lumbar spine was measured by dual X-ray densitometry. All participants completed a standardized questionnaire including medical history, smoking history, alcohol consumption, physical activity and menopausal status. RESULTS: Women with MS had lower BMD at lumbar and total hip sites (0.937 +/- 0.136 g/cm2, P-value 0.010; 0.875 +/- 0.113 g/cm2, P-value 0.045, respectively) than did women without MS. These differences at the spine and femoral neck were persisted after adjusting for age, body mass index, menopause status, alcohol consumption, smoking and physical activity. However, no significant differences in BMD were found in men between those with and without MS. In linear regression analyses, waist circumferences were highly associated with BMD at lumbar and total hip sites in women (beta -0.003, P-value < 0.001; beta -0.001, P-value 0.001, respectively). However, no significant differences were found in men between BMD and components of the MS. CONCLUSION: Among components of MS, waist circumference was associated with BMD in women. But no association was found in men. Women with MS had lower BMD than did women without MS.
Absorptiometry, Photon ; Alcohol Drinking ; Blood Pressure ; Body Mass Index ; Bone Density ; Cholesterol ; Cross-Sectional Studies ; Fasting ; Female ; Femur Neck ; Glucose ; Hip ; Humans ; Korea ; Linear Models ; Lipoproteins ; Male ; Menopause ; Motor Activity ; Osteoporosis ; Plasma ; Retrospective Studies ; Smoke ; Smoking ; Spine ; Triglycerides ; Waist Circumference ; Surveys and Questionnaires