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

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

OBJECTIVE: Bisphosphonates are the most commonly prescribed medications for the treatment of osteoporosis. This study was designed to analyze the rate of acute phase reaction (APR) following Zoledronate 5 mg administration in patients with osteoporosis who were treated with prior oral bisphosphonate for at least 2 weeks and to compare naive IV 5 mg Zoledronate. METHODS: Between July 2009 and October 2010, 27 patients with osteoporosis who were treated with prior oral bisphosphonate for at least 2 weeks, and maximum 52 weeks (average 18.5 weeks) and were between 42-and 85-year-old at the time of study participation. We prospectively evaluated APR, including fever, flu-like symptoms, headache, arthralgia, and myalgia, after 5 mg zoledronate by questionnaire. Additionally we assessed a visual analogue scale (VAS) by 4-point categorical scale. RESULTS: In this study of 27 patients with osteoporosis, the frequency of APR, flu-like symptom and myalgia were 14.8% and 7.4% and fever, arthralgia, and headache were 3.7% respectively. In VAS, all reactions were mild. The rate of APR rate in this study was statistically decreased compared to previous reports with zoledronate 5 mg IV in bisphosphonate-naive patients. CONCLUSION: Prior oral bisphosphonate administration for at least 2 weeks could significantly reduce the APR of IV zoledronate 5 mg.
Acute-Phase Reaction ; Aged, 80 and over ; Arthralgia ; Diphosphonates ; Fever ; Headache ; Humans ; Imidazoles ; Osteoporosis ; Prospective Studies ; Surveys and Questionnaires

OBJECTIVE: Biodegradation of synthetic calcium phosphate depends on two mechanisms; dissolution in body fluid and a cellular reaction. The chemical dissolution process is well understood, but details of the cellular reaction are not yet fully understood. Thus, we investigated whether the resorption mechanisms of hydroxyapatite (HA) and beta-tricalcium phosphate (beta-TCP) coating layer were identical, and, if not, what differences were observed. METHODS: Titanium discs, 12 mm in diameter and 2 mm in thickness, were coated with HA (n = 40) or beta-TCP (n = 40) by a dip and spin method. In each group, specimens were divided into two subgroups; the Dissolution group (D) and the Osteoclast Culture group (C). Discs in the D group were immersed in the distilled water or cell culture medium for 5 days, whereas, in the C group, osteoclast-like cells, which were obtained from giant cell tumor of bone, were seeded onto specimens and cultured for 5 days. The degradation characteristics of the surface coating were observed by light microscopy and scanning electron microscopy. RESULTS: Extent of the cracks and denudations were much greater in the beta-TCP coating than the HA coating after dissolution. In the C groups, the mean area fraction of resorption lacunae in the HA-C group was 11.62%, which was significantly higher than the 0.73% noted in the beta-TCP-C group (P = 0.001). CONCLUSION: The resorption mechanism of HA and beta-TCP coating was different and the beta-TCP coating was degraded principally by dissolution and separation from the implant, but the HA coating was resorbed by osteoclastic activity.
Body Fluids ; Calcium ; Calcium Phosphates ; Cell Culture Techniques ; Durapatite ; Electrons ; Giant Cell Tumor of Bone ; Light ; Microscopy ; Osteoclasts ; Seeds ; Titanium ; Water

OBJECTIVE: To evaluate the prevalence of osteoporosis and degenerative knee osteoarthritis (OA) in female patients over 50 years, who were surgically indicated for lumbar spinal stenosis (LSS). METHODS: The study subjects were 76 female patients who underwent spinal surgery for LSS between January and December 2006. Radiographs of thoracolumbar spine, hip and knee were taken. Osteoporotic profiles including lumbar and hip bone mineral density (BMD) measurements and proper treatment of osteoporosis were investigated. RESULTS: The mean age was 65.1 (50~86) years old. Seven-teen patients (22.4%) and nine-teen patients (25.0%) had spine and hip BMD below a T score of -2.5. Thirty-two patients (48.0%) and four patients (5.2%) had knee and hip OA of K-L grade III and IV each. Old thoracolumbar osteoporotic compression fractures were confirmed in 6 patients (7.8%). Forty-eight percent (48.0%) of enrolled patients had hypovitaminosis D. According to osteoporosis guidelines from the Korean Society of Bone Metabolism, 31 patients (40.7%) qualified to be candidates of intensive osteoporosis treatments. CONCLUSION: The prevalence of osteoporosis and knee OA in LSS patients was 25.0% and 42.1%. Based on checking up BMD and knee OA in female patient with LSS, proper treatments of osteoporosis and degenerative knee OA should be considered.
Bone Density ; Female ; Fractures, Compression ; Hip ; Humans ; Knee ; Osteoarthritis ; Osteoarthritis, Knee ; Osteoporosis ; Prevalence ; Spinal Stenosis ; Spine

OBJECTIVE: Supplementation with vitamin E is able to protect bone against free radical-induced elevation of bone-resorbing cytokines. We examined gene expression by microarray analysis during the differentiation of human mesenchymal stem cells treated with vitamin E into osteoblasts in vitro. METHODS: Human bone marrow stem cells were cultured in osteogenic differentiation medium and vitamin E was added. A colorimetric immunoassay for the quantification of cell proliferation was used to measure osteoblast differentiation. Gene expression was analyzed using a microarray technique. We also used a real time reverse transcription-polymerase chain reaction (RT-PCR). RESULTS: It was found that vitamin E enhanced cell proliferation when compared to cells cultured in media without vitamin E. We focused on 68 genes which are related to osteogenesis and osteoclastogenesis. Alkaline phosphatase, transforming growth factor-beta 1, fibroblast growth factor receptor 1, matrix metalloproteinase 2, muscle segment homeobox 2, bone morphogenetic protein 1, biglycan, vascular endothelial growth factor B, dentin sialophosphoprotein, cartilage oligomeric matrix protein, runt-related transcription factor 2, fibroblast growth factor receptor 3, and SMAD2 were upregulated > 2-fold compared to the control. Conversely, osteopetrosis-associated transmembrane protein 1, microphthalmia-associated transcription factor, and epidermal growth factor receptor were downregulated > 2-fold compared to the control. Vitamin E produced a 1.5-fold increase in the expression of runt-related transcription factor 2 and transforming growth factor-beta 1 as determined by real time RT-PCR. CONCLUSION: Vitamin E had a positive effect on the gene expressions regarding osteogenic differentiation of mesenchymal stem cells.
Alkaline Phosphatase ; Biglycan ; Bone Marrow ; Bone Morphogenetic Protein 1 ; Cartilage ; Cell Proliferation ; Cytokines ; Dentin ; Durapatite ; Extracellular Matrix Proteins ; Gene Expression ; Genes, Homeobox ; Glycoproteins ; Humans ; Immunoassay ; Matrix Metalloproteinase 2 ; Mesenchymal Stromal Cells ; Microarray Analysis ; Microphthalmia-Associated Transcription Factor ; Muscles ; Osteoblasts ; Osteogenesis ; Phosphoproteins ; Receptor, Epidermal Growth Factor ; Receptor, Fibroblast Growth Factor, Type 1 ; Receptor, Fibroblast Growth Factor, Type 3 ; Sialoglycoproteins ; Stem Cells ; Transcription Factors ; Vascular Endothelial Growth Factor B ; Vitamin E ; Vitamins

OBJECTIVE: To compare the treatment thresholds for osteoporosis medication based on bone mineral density (BMD) results and fracture risk assessment tool (FRAX) risks in patients with a distal radius fracture. METHODS: The data of 116 consecutive women aged 50~89 years (mean 64.5 years) with a distal radius fracture were collated to identify clinical risk factors, which were inserted into the FRAX algorithm to calculate 10-year fracture risks. Proportions of patients indicated for osteoporosis medication based on BMD alone and based on FRAX risks were determined. Sensitivity estimation was done with FRAX plus BMD as a gold standard measurement for osteoporosis treatment. RESULTS: Of the 116 patients, 38% needed osteoporosis medication based on BMD alone, and 41% were indicated for treatment based on FRAX plus BMD. These proportions were not significantly different (P = 0.481). However, 56% of patients were indicated for treatment based on FRAX excluding BMD, which was significantly larger than the proportion determined by BMD alone (P = 0.001) or FRAX plus BMD (P = 0.003). Sensitivity, specificity, positive predictive value, negative predictive value for BMD alone were 75%, 93%, 90%, 82% and those for FRAX without BMD were 83%, 70%, 69%, 84%. CONCLUSION: No difference was found in the proportion of patients that need osteoporosis medication based on BMD results alone and FRAX plus BMD risks, suggesting BMD measurement can be sufficient to detect candidates for osteoporosis medication in patients with a distal radius fracture. FRAX excluding BMD may include too many patients that do not need osteoporosis treatment.
Aged ; Bone Density ; Female ; Humans ; Osteoporosis ; Radius ; Radius Fractures ; Risk Assessment ; Risk Factors ; Sensitivity and Specificity

OBJECTIVE: To investigate the prevalence of vitamin D inadequacy in an elderly patients with hip fracture. METHODS: A prospective study was carried out for 2 years (January 2008 - December 2009). Patient records were searched for hip fracture admission and cross matched with serum vitamin D levels and bone densitometry carried out within 3 days of the hip fracture admission. RESULTS: There were data for 115 hip fracture patient, 69% of the patients were women (n = 79). The mean age at the time of fracture was 76.1 years. The mean of bone densitometry was -2.8 +/- 0.8. About 40% of the patients had a bone mineral density (BMD) below -3.0. The mean vitamin D (25-OH) level was 20.9 +/- 10 ng/mL. Over 80% of patients had a vitamin D level below 30 ng/mL. Especially, patients (n = 17) admitted from assisted nursing home had less a vitamin D level (16.3 ng/mL) than patients admitted from home (22.9 ng/mL). There were no significant differences by age or sex however, there was seasonal differences in vitamin D. CONCLUSION: This study reveals universal vitamin D inadequacy in hip fracture patients.
Aged ; Bone Density ; Collodion ; Densitometry ; Female ; Hip ; Hip Fractures ; Humans ; Nursing Homes ; Osteoporosis ; Prevalence ; Prospective Studies ; Seasons ; Vitamin D ; Vitamins