BACKGROUND: In the life cycle, bone mineral density (BMD) is the most optimal condition in the 20s. In Korea, vitamin D deficiency status is very serious in Korean women due to recent lack of activity, weight polarization, and inadequate nutritional intake. The purpose of this study was to compare serum vitamin D and BMD according to obesity status in Korean young adult women. METHODS: A total of 143 female college students participated in the research. Body fat and lean body status were analyzed using a body composition analyzer. Nutrient intakes of the subjects were assessed by 3-days food record method. The BMDs was measured by dual energy X-ray absorptiometry. The subjects were divided into normal weight group and obesity group on their body mass index. RESULTS: Obesity group showed significantly higher weight, body fat (%), and body fat (kg) than normal weight group and T-scores of lumbar-2 spines were significantly lower. Obesity group showed high triglyceride and low-density lipoprotein cholesterol levels and vitamin D levels were significantly lower. Physical fitness and activity status showed that sit and reach and sit up were significantly lower in obesity group. The intake of carbohydrates was higher in the obesity group than in the normal weight group, and the intake of vitamin C and vitamin D was significantly lower. Factors affecting serum vitamin D were analyzed as body fat (%), lumbar-2 T-score, triglyceride, and carbohydrate intake. CONCLUSIONS: Obese women need more effort to manage their serum vitamin D status and balanced nutrition to prevent bone loss.
Absorptiometry, Photon ; Adipose Tissue ; Ascorbic Acid ; Body Composition ; Body Mass Index ; Body Weight ; Bone Density ; Carbohydrates ; Cholesterol ; Female ; Humans ; Korea ; Life Cycle Stages ; Lipoproteins ; Methods ; Nutritional Status ; Obesity ; Physical Fitness ; Spine ; Triglycerides ; Vitamin D Deficiency ; Vitamin D ; Vitamins ; Young Adult

OBJECTIVE: To explore the screening value of osteoporosis self-assessment tool for Asians (OSTA) and the optimal cut-off value in Chinese healthy physical examination population. METHODS: We selected a healthy physical examination population for bone mineral density screening at the Health Examination Center in Peking University Third Hospital from 2013 to 2016. Quantitative ultrasound (QUS) results were used as the gold standard, and T value ≤-2.5 was defined as osteoporosis patients. Diagnostic test methods were used to analyze the sensitivity, specificity, likelihood ratio and area under curve (AUC) of different cut points of OSTA. The screening accuracy of OSTA at different cut points was compared and the optimal cut-point value determined. RESULTS: A total of 5 833 subjects were included in the study, with an average age of (48.3±17.5) years and 2 594 women (44.5%). The QUS test showed 403 patients with osteoporosis (6.9% of the total population), 343 female osteoporosis patients (13.22% of the female population). In the whole age group, AUC at the international routine cut-off value (OSTA ≤-1) screening for osteoporosis was 0.815 (95%CI: 0.804-0.825), and screening accuracy was higher in the women (AUC=0.837, 95%CI: 0.823-0.851) than that in the men (AUC=0.767, 95%CI: 0.752-0.781; P<0.05). In the whole age group, when the optimal cut-off value was 0, its AUC 0.842 (95%CI: 0.832-0.851) was significantly higher than that when the cut-off value was -1 (P<0.01), and net reclassification improvement (NRI) increased by 5.5%. In the 40 to 65-year-old group, when OSTA cut-off value ≤0, the screening accuracy was significantly higher (NRI=19.5%, P=0.003) than that when it was -1. CONCLUSION The OSTA screening tool had good osteoporosis screening value in healthy people, and the screening accuracy in women is higher than that in men. Increasing the screening cut-off value of OSTA would be helpful to improve the screening accuracy in the whole and 40 to 65-year-old population. There may be different optimal cut-off values for different age group population.
Absorptiometry, Photon ; Adult ; Aged ; Asians ; Bone Density ; Female ; Humans ; Male ; Middle Aged ; Osteoporosis ; Physical Examination ; Risk Assessment ; Self-Assessment ; Sensitivity and Specificity

OBJECTIVE: Craniovertebral junctional anomalies constitute a technical challenge. Surgical opening of atlantoaxial joint region is a complex procedure especially in patients with nuchal deformity like basilar invagination. This region has actually very complicated anatomical and functional characteristics, including multiple joints providing extension, flexion, and wide rotation. In fact, it is also a bottleneck region where bones, neural structures, and blood vessels are located. Stabilization surgery regarding this region should consider the fact that the area exposes excessive and life-long stress due to complex movements and human posture. Therefore, all options should be considered for surgical stabilization, and they could be interchanged during the surgery, if required.METHODS: A 53-year-old male patient applied to outpatients’ clinic with complaints of head and neck pain persisting for a long time. Physical examination was normal except increased deep tendon reflexes. The patient was on long-term corticosteroid due to an allergic disease. Magnetic resonance imaging and computed tomography findings indicated basilar invagination and atlantoaxial dislocation. The patient underwent C0–C3–C4 (lateral mass) and additional C0–C2 (translaminar) stabilization surgery.RESULTS: In routine practice, the sites where rods are bound to occipital plates were placed as paramedian. Instead, we inserted lateral mass screw to the sites where occipital screws were inserted on the occipital plate, thereby creating a site where extra rod could be bound. When C2 translaminar screw is inserted, screw caps remain on the median plane, which makes them difficult to bind to contralateral system. These bind directly to occipital plate without any connection from this region to the contralateral system. Advantages of this technique include easy insertion of C2 translaminar screws, presence of increased screw sizes, and exclusion of pullout forces onto the screw from neck movements. Another advantage of the technique is the median placement of the rod; i.e., thick part of the occipital bone is in alignment with axial loading.CONCLUSION: We believe that this technique, which could be easily performed as adjuvant to classical stabilization surgery with no need for special screw and rod, may improve distraction force in patients with low bone density.
Atlanto-Axial Joint ; Blood Vessels ; Bone Density ; Congenital Abnormalities ; Dislocations ; Head ; Humans ; Joints ; Magnetic Resonance Imaging ; Male ; Methods ; Middle Aged ; Neck ; Neck Pain ; Occipital Bone ; Physical Examination ; Posture ; Reflex, Stretch ; Spine

OBJECTIVES: A lack of understanding in menopausal and postmenopausal women's (PMW) risk perception towards osteoporosis and breast cancer still exists, which is explored in this study. This information might allow health professionals to conduct interventions to improve health behaviors before menopause-related diseases are imminent. METHODS: Between 10 December 2015 and 31 January 2016, 573 menopausal or PMW were successfully interviewed on 17 questions, comprising separate sections for osteoporosis and breast cancer. The target respondents were menopausal or PMW aged 45 to 60 years, with no previous diagnosis of osteoporosis or breast cancer, who attended private clinics across Hong Kong for annual physical examination. RESULTS: Regarding menopausal issues, the top three concerns were osteoporosis and fracture (72%), breast cancer (44%), and sleep disorder/insomnia/headache (40%). Among 314 respondents (55%) who tried to prevent osteoporosis, 74% of them began to do it after they were 40 years old. On the other hand, 65% of respondents never had a bone density test. For respondents who said “I'm too young, so I don't need to check”, their mean age was 52 years old. Ninety percent of respondents mistakenly believed that regular breast examination, regular breast massage, drink soy milk, or vaccine can prevent breast cancer. CONCLUSIONS: This survey revealed osteoporosis and breast cancer as the top concerns among menopausal and PMW in Hong Kong. Inadequate health behaviors and misconceptions still exist despite widespread health education in the recent years.
Bone Density ; Breast Neoplasms* ; Breast* ; Diagnosis ; Female ; Hand ; Health Behavior ; Health Education ; Health Occupations ; Hong Kong* ; Humans ; Massage ; Osteoporosis* ; Physical Examination ; Soy Milk ; Surveys and Questionnaires

Changes in the musculoskeletal system due to aging lead to muscle weakness, muscle atrophy, degenerative changes in joints and cartilage, and decreased bone density. Pain in the joints is a very common and subjective symptom. There are various causes, such as referred pain or neurological pain that make it difficult to diagnose correctly. Especially, in elderly patients, their detailed history and a physical examination are important for the diagnosis of arthritis, and consideration of the effects of underlying diseases and drugs is essential. In this review, we first describe the clinical approach to diagnosis of arthritis, and briefly describe the diagnosis and treatment of osteoarthritis, rheumatoid arthritis, and gout, which are common arthritis causing gait disorders in the elderly.
Aged ; Aging ; Arthritis* ; Arthritis, Rheumatoid ; Bone Density ; Cartilage ; Diagnosis* ; Gait ; Gout ; Humans ; Joints ; Muscle Weakness ; Muscular Atrophy ; Musculoskeletal System ; Osteoarthritis ; Pain, Referred ; Physical Examination

BACKGROUND: There are several studies about the relationship between serum homocysteine levels and bone mineral density (BMD), but the results are varied, and the studies are limited in Korea. In our study, the relationship between serum homocysteine levels and BMD by part according to age and sex is investigated. METHODS: From March 2012 to July 2015, the 3,337 healthy adults who took a medical examination were recruited. Subjects filled in the self-recording type questionnaire and physical examination, blood test, BMD of lumbar spine and femur were measured. After sorting by aging (≤49 year old, 50-59 year old, ≥60 year old) and sex, the results were adjusted with age and body mass index (BMI) and the relationship between serum homocysteine levels and BMD by lumbar spine and femur was analyzed by multiple regression analysis. RESULTS: As results of analysis, with the adjustment with age and BMI, all age groups of men had no significant relationship between log-converted serum homocysteine levels and BMD. In women aged under 50, there were significantly negative relationships at lumbar spine (β=-0.028, P=0.038), femur neck (β=-0.062, P=0.001), and total hip (β=-0.076, P<0.001), but there was no significant relationship in other age groups (50-59 year old and ≥60 year old). CONCLUSIONS: As the serum homocysteine levels increased in women aged under 50, BMD of the lumbar spine and femur decreased, and correlations between homocysteine and BMD were different by sex and age.
Adult* ; Aging ; Body Mass Index ; Bone Density* ; Female ; Femur ; Femur Neck ; Hematologic Tests ; Hip ; Homocysteine* ; Humans ; Korea ; Male ; Osteoporosis ; Physical Examination ; Spine

Pycnodysostosis is an autosomal recessive disorder characterized by osteosclerosis, small stature, acro-osteolysis of the distal phalanges, loss of the mandibular angle, separated cranial sutures with open fontanels, and frequent fractures. One identified cause of the disease is reduced activity of the cysteine protease cathepsin K. A 48-year-old woman with a history of frequent fractures presented with a severe gait disturbance. Radiography, computed tomography, magnetic resonance imaging, and gene analysis were performed. Physical examination revealed open fontanels, and radiographs showed increased bone density. DNA sequence analysis revealed a deletion mutation of the cathepsin K gene. We diagnosed pycnodysostosis based on these findings. The magnetic resonance and computed tomography images demonstrated multilevel spinal canal stenosis due to ossification of the yellow ligament. We performed a laminectomy, and the patient's neurological signs and symptoms improved. To our knowledge, this is the first case of pycnodysostosis with ossification of the yellow ligament.
Acro-Osteolysis ; Bone Density ; Cathepsin K ; Constriction, Pathologic* ; Cranial Sutures ; Cysteine Proteases ; Female ; Gait ; Humans ; Laminectomy ; Ligaments* ; Magnetic Resonance Imaging ; Middle Aged ; Osteosclerosis ; Physical Examination ; Pycnodysostosis* ; Radiography ; Sequence Analysis, DNA ; Sequence Deletion ; Spinal Canal*

Osteoporotic fractures are one of the most common causes of disability and a major contributor to medical care costs worldwide. Prior osteoporotic fracture at any site is one of the strongest risk factors for a new fracture, which occurs very soon after the first fracture. Bone mineral density (BMD) scan, a conventional diagnostic tool for osteoporosis, has clear limitations in diagnosing osteoporotic fractures and identifying the risk of subsequent fractures. Therefore, early and accurate diagnosis of osteoporotic fractures using the clinical definition which is applicable practically and independent of BMD, is essential for preventing subsequent fractures and reducing the socioeconomic burden of these fractures. Fractures caused by low-level trauma equivalent to a fall from a standing height or less at major (hip, spine, distal radius, and proximal humerus) or minor (pelvis, sacrum, ribs, distal femur and humerus, and ankle) sites in adults over age 50, should be first regarded as osteoporotic. In addition, if osteoporotic fractures are strongly suspected on history and physical examination even though there are no positive findings on conventional X-rays, more advanced imaging techniques such as computed tomography, bone scan, and magnetic resonance imaging are necessary as soon as possible.
Adult ; Bone Density ; Diagnosis ; Femur ; Health Care Costs ; Humans ; Humerus ; Magnetic Resonance Imaging ; Osteoporosis ; Osteoporotic Fractures* ; Physical Examination ; Practice Guidelines as Topic ; Radius ; Ribs ; Risk Factors ; Sacrum ; Spine

OBJECTIVES: The aim of this study was to identify the relationship between serum gamma-glutamyltransferase (GGT) and bone mineral density (BMD) in postmenopausal women. METHODS: We evaluated 200 postmenopausal women who were visiting a health promotion center at a university hospital from January 2009 to December 2011. Their current medical diseases and medication history were collected through medical records. Basic physical examinations and laboratory tests were performed on all subjects. RESULTS: The levels of serum GGT within their normal range were positively correlated with waist circumference (P = 0.01), triglycerides (P <0.001), alkaline phosphatase (P = 0.009), and uric acid (P = 0.01). The serum GGT within their normal range were negatively associated with the femur neck BMD (P = 0.002). In adjusted analysis including age and body mass index, the BMD of the femur neck was more strongly associated with a high-normal serum GGT level among the postmenopausal women as compared with those with a low-normal serum GGT level (P = 0.02). CONCLUSIONS: Serum GGT within its normal range is negatively correlated with the BMD in the femur neck among postmenopausal women. It can be useful for selecting a group that is at high risk for the bone fracture regardless of the underlying mechanism.
Alkaline Phosphatase ; Body Mass Index ; Bone Density ; Female ; Femur Neck ; Fractures, Bone ; gamma-Glutamyltransferase ; Health Promotion ; Humans ; Medical Records ; Physical Examination ; Postmenopause ; Reference Values ; Triglycerides ; Uric Acid ; Waist Circumference

OBJECTIVES: To evaluate the efficacy of alendronate for premenopausal women with low bone density not resulted from secondary causes. MATERIALS AND METHODS: Forty thee women who was diagnosed low bone mineral density (BMD) before menopause were included. All patients were evaluated by history taking, physical examination, and laboratory investigation to rule out underlying secondary causes of osteoporosis. They were randomized into two groups: Group I was administered oral alendronate 70 mg per week and Group II was not. All the participants received calcium carbonate 1,250 mg and cholecalciferol 1,000 IU daily. Bone mineral density by dual energy X-ray absorptiometry was measured before and after 1 year of treatment. RESULTS: At baseline, there were no significant differences among the two groups in patient's age, body mass index (BMI), and BMD. After 1 year of treatment, Group I showed significant increase in BMD. CONCLUSIONS: In premenopausal women with low BMD in the absence of secondary causes for osteoporosis, alendronate treatment for 1 year may increase BMD. We suggest that management of low bone density in the premenopausal women without secondary causes should be considered.
Absorptiometry, Photon ; Alendronate ; Body Mass Index ; Bone Density ; Calcium Carbonate ; Cholecalciferol ; Female ; Humans ; Menopause ; Osteoporosis ; Physical Examination ; Premenopause