Hip Disability and Osteoarthritis Outcome Score and Western Ontario and McMaster Universities Osteoarthritis Index Values in Asymptomatic and Arthritic Cohorts.

The primary aim of this study was to determine whether an electronic, multicenter data collection system could be used to establish normal population reference values for the Hip Disability and Osteoarthritis Outcome Score (HOOS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The secondary aim was to investigate differences in asymptomatic HOOS and WOMAC values reported in 2 geographically distinct English-speaking countries and compare these with a symptomatic arthritic patient cohort. A total of 552 participants were recruited. Asymptomatic Australian and Canadian cohorts were compared; combined asymptomatic cohorts were compared with an arthritic cohort. There was a statistically significant association between age and asymptomatic HOOS (P<.0001) and WOMAC (P<.0001) values; as age increased, values worsened. Females had worse HOOS and WOMAC values (P<.0001). When compared with age- and sex-matched asymptomatic participants, arthritic participants had worse scores (P<.0001). Asymptomatic Australians had a statistically significant 3.8% better (higher) HOOS (P<.0001) in all age groups (P<.0001). When compared with age- and sex-matched asymptomatic participants, younger arthritic participants reported worse activities of daily living and sports and recreation HOOS values. This observational study established an electronic HOOS and WOMAC patient-reported outcome measures database of asymptomatic individuals in 2 geographically distinct countries. An asymptomatic control group should be sourced from the same country of origin as the proposed study. Factors that should be considered when recording the HOOS and WOMAC include age, sex, geographic location, history of an inactive hip problem, contralateral hip disease, and active knee, ankle, or foot problems. [Orthopedics. 2019; 42(2):e216-e224.].

Calcium supplements lower bone resorption after renal transplant.

AIM: Bone loss in renal transplant (RT) patients is a problem that begins during end-stage kidney disease and persists after transplantation. Suppression of parathyroid hormone (PTH) may decrease bone loss and improve fracture rate. METHODS: A single-group prospective intervention study involving 30 patients was performed at a large RT unit. Investigations included dual-emission X-ray absorptiometry scan, vertebral X-ray, calcium absorption test, 24-h urinary calcium and serum measurements of total and ionized calcium, PTH, C-telopeptide cross-links (CTX), osteocalcin, alkaline phosphatase, 25 hydroxyvitamin D (25[OH]D), and 1,25-dihydroxyvitamin D3. Patients were given 500 mg elemental calcium daily for seven d, and serum measurements were repeated. RESULTS: Two-tailed Wilcoxon rank-sum test showed significant decreases in PTH (p<0.01) and CTX (p<0.01) after calcium load. Dietary calcium, mean calcium absorption, and urinary calcium excretion were below desirable levels. Mean 25 hydroxyvitamin D (25(OH)D) was low, but levels of 1,25-dihydroxyvitamin D3 were normal. Calcium absorption significantly correlated with change in PTH (p<0.001), baseline 25(OH)D (p<0.001), and mycophenolate dose (p=0.024). CONCLUSIONS: Calcium malabsorption is prevalent in RT recipients, contributing to bone destruction and compounded by poor dietary intake and low 25(OH)D. Calcium supplementation appears to help overcome this deficiency and acutely suppress PTH. Calcium may be an effective and inexpensive therapy for bone loss in RT recipients.