Prevalence of Osteoporosis and Low Bone Mass in Older Chinese Population Based on Bone Mineral Density at Multiple Skeletal Sites.

Diagnosis of osteoporosis is based on bone mineral density (BMD) measurement, which is site dependent and commonly discordant between measurement sites. We aimed to determine the prevalence of osteoporosis diagnosed based on BMD T-scores measured by dual-energy x-ray absorptiometry (DXA) at different sites: the lumbar spine (LS) alone, femoral neck (FN) alone, or both. A total of 1712 women and 2028 men with LS and FN BMD measurements were enrolled. Over 50% discordance was found between osteoporosis classifications based on T-scores measured at the LS and FN. Use of the lowest T-scores measured at both the LS and right and left FN (rather than one site) significantly increased the prevalence of osteoporosis from 4.03 to 10.75% in postmenopausal women and 1.82 to 4.29% in men aged ≧50 years (p < 0.001). The trends of overall and age-adjusted prevalence of osteoporosis were similar in women and men. Osteoporosis was diagnosed at a higher rate if the USA reference rather than the Asia reference was used to calculate the T-score (26.64% vs. 10.75%). In conclusion, diagnosis based on the lowest T-score from multiple site BMD measurement can increase the prevalence of osteoporosis, demonstrating the higher sensitivity of the multiple site measurement strategy.

Consensus of official position of IOF/ISCD FRAX initiatives in Asia-Pacific region.

The fracture risk assessment tool (FRAX(®)) has been developed for the identification of individuals with high risk of fracture in whom treatment to prevent fractures would be appropriate. FRAX models are not yet available for all countries or ethnicities, but surrogate models can be used within regions with similar fracture risk. The International Society for Clinical Densitometry (ISCD) and International Osteoporosis Foundation (IOF) are nonprofit multidisciplinary international professional organizations. Their visions are to advance the awareness, education, prevention, and treatment of osteoporosis. In November 2010, the IOF/ISCD FRAX initiative was held in Bucharest, bringing together international experts to review and create evidence-based official positions guiding clinicians for the practical use of FRAX. A consensus meeting of the Asia-Pacific (AP) Panel of the ISCD recently reviewed the most current Official Positions of the Joint Official Positions of ISCD and IOF on FRAX in view of the different population characteristics and health standards in the AP regions. The reviewed position statements included not only the key spectrum of positions but also unique concerns in AP regions.

Estimated risk score for spine fracture in the specific bending activity of normal Taiwanese men and women.

OBJECTIVE: To investigate the effects of biologic age, as well as chronologic age, on the vertebral ultimate load (strength) and risk score of vertebral fracture (Phi) between the genders. SUMMARY OF BACKGROUND DATA: Previous studies have shown a good correlation between the biomechanical strength of vertebral bodies and measured bone mineral parameters, whereas other factors also contribute to the bone strength and risk of fractures. Combining multiple factors into a single assessment may provide more comprehensive and individualized estimations of the fracture risk. In this study, we applied the measured bone mineral content (BMC) and bone projection area of the second through the fourth lumbar vertebrae (L2-L4) to assess the biomechanical strength of lumbar vertebrae. In addition, we used the body segment model to estimate the load of the L3 vertebral body during a bending-forward activity, to then estimate the risk score (Phi) of vertebral compression fracture in healthy Chinese volunteers in Taiwan, and to analyze the effects of gender and age on the risk score (Phi). METHODS: A total of 611 females and 235 males aged 22-80 years were included in this study. The anteroposterior BMC and projection area of lumbar spine were measured by a Norland XR-26 dual energy radiograph absorptiometer (Norland Corp., Ft. Atkinson, WI). The estimated ultimate strength (L) of lumbar spine was calculated from the regression equation using anteroposterior lumbar BMC and bone area according to Bassman et al (Paper presented at: 39th Annual Meeting of Orthopedic Research Society; February 1993; San Francisco, CA). The estimated spinal load (F) for a person bending over with back horizontal, either with hand free (F0), lifting a 20 kg weight (F20), or a 30 kg weight (F30), was calculated from a force diagram according to William and Lissner. Risk score (Phi) was defined as the quotient of F/L. RESULTS: The results showed an age-related decrease of bone mineral density (P < 0.001) in both genders corrected for weight and height. Using the multiple linear regression analysis and analysis of covariance, Phi for F0, F20, and F30 increased significantly, with increasing age only in females (P < 0.0001), especially after menopause, but not in males. The Phi of postmenopausal females was significantly larger than those of younger females (i.e., F0 (Phi) 0.533 +/- 0.075 vs. 0.458 +/- 0.064, P < 0.001; F20 (Phi) 0.903 +/- 0.101 vs. 0.789 +/- 0.080, P < 0.001; and F30 (Phi) 1.087 +/- 0.117 vs. 0.954 +/- 0.090, respectively, P < 0.001). In females, the ultimate load of the spine and Phi began to decrease to a significant level since the fifth decade, whereas in the males, the similar trends occurred since the sixth decade. Comparing both genders, the F0 (Phi) was slightly yet significantly larger in the young males (< 50 years) than the premenopausal females with similar ages (P < 0.001), but older females had higher F0 (Phi) values than males older than 60 years. Moreover, the Phi increased more prominently in the postmenopausal females with the weight lifted. As a result, both F20 (Phi) and F30 (Phi) were significantly larger in females older than 50 years as compared to males with the similar ages (P < 0.001). CONCLUSIONS: Our findings emphasize the importance of Phi, which considers BMC, bone size, body weight, body height, and weight lifted, for evaluating a more individualized risk of spine fracture in elderly men and postmenopausal women. The Phi increased more prominently with lifting weight and increased with aging only in the early postmenopausal females. The study showed that a combination of bone mass and anthropometric parameters provides a more individualized assessment of fracture risk than bone mineral density alone.

Post-traumatic ligamentum flavum hematoma: a case report.

We present the case of a 64-year-old female treated surgically for ligamentum flavum hematoma that caused progressive radiculopathy. Initially, she suffered from an acute onset of lower back pain. Only a history of minor back injury was discovered. She rapidly became unable to walk. Magnetic resonance imaging demonstrated an epidural mass lesion at L3 to L4 that was continuous with the left ligamentum flavum. The mass was hypointense on T1-weighted images and centrally hyperintense and marginally hypointense on T2-weighted images. The margin was well enhanced by gadopentetate dimeglumine administration. After removal of the mass, the patient's symptoms completely resolved. Before surgery, we believe accurate diagnosis of ligamentum flavum hematoma can be based on magnetic resonance imaging.

Tl-201 myocardial SPECT in differentiation of ischemic from nonischemic dilated cardiomyopathy in patients with left ventricular dysfunction.

BACKGROUND: The differentiation between ischemic and nonischemic cardiomyopathy by noninvasive modalities is of clinical importance. Whether thallium 201 single photon emission computed tomography (SPECT) could accurately distinguish the two groups remains unclear. METHODS AND RESULTS: Twenty-nine patients with chronic heart failure (left ventricular ejection fraction < or =40%), including fourteen patients with ischemic cardiomyopathy and fifteen patients with nonischemic dilated cardiomyopathy, underwent Tl-201 SPECT. The stress protocols included treadmill exercise in 8 patients, dipyridamole in 6 patients, and dobutamine infusion in 15 patients. Myocardial SPECT was interpreted with the use of a 17-segment model and 0- to 4-point scale system. Patients with ischemic cardiomyopathy had higher summed stress defect scores (27.9 +/- 9.4 vs 20.6 +/- 8.9, P =.04), more fixed defect segments (5.9 +/- 2.9 vs 3.8 +/- 2.9, P =.05), and more moderate or severe perfusion defect segments on stress scan (7.2 +/- 2.0 vs 4.5 +/- 2.6, P =.004) than did those with nonischemic dilated cardiomyopathy. However, considerable overlap of the scan patterns between the two groups existed. Moderate or severe perfusion defects on stress scan in at least 7 segments were noted in 71% of patients (10/14) with ischemic cardiomyopathy, as compared with 20% of patients (3/15) with nonischemic cardiomyopathy (P =.016). CONCLUSIONS: Assessment of Tl-201 myocardial SPECT yields only modest value to distinguish nonischemic dilated cardiomyopathy from ischemic cardiomyopathy in patients with chronic heart failure. This technique cannot clearly differentiate individual patients.