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1.
J Cell Biol ; 108(2): 719-27, 1989 Feb.
Article in English | MEDLINE | ID: mdl-2493001

ABSTRACT

Thrombospondin, the most abundant protein of platelet alpha granules, is a biosynthetic product of a variety of connective tissue cells and a component of many extracellular matrices. In this study, thrombospondin distribution in bone was investigated using a monoclonal antibody specific for the human protein. Thrombospondin was localized in osteoid of undemineralized, frozen sections of fetal subperiosteal bone, and identified as a component of mineralized bone matrix of neonatal and/or young (growing) bone of many animal species by Western blot analysis. Adult human bone cells were demonstrated to contain mRNA for thrombospondin by hybridization of a cDNA thrombospondin probe to a 6.1 kb mRNA. Pulse-chase experiments indicated that the protein was synthesized and the majority was secreted from osteoblastic cells. Treatment of the cells with TGF-beta (0.01-10 ng/ml) slightly decreased total thrombospondin synthesis, but caused an increase in the retention on newly synthesized thrombospondin in the cell layer/matrix fraction. In cell attachment assays, thrombospondin mediated adhesion, but not spreading of adult human bone cells.


Subject(s)
Bone Matrix/analysis , Bone and Bones/analysis , Glycoproteins/analysis , Minerals/metabolism , Osteoblasts/metabolism , Animals , Blotting, Western , Bone Development , Bone and Bones/embryology , Cattle , Cell Adhesion , Chickens , DNA Probes , Dogs , Glycoproteins/biosynthesis , Glycoproteins/genetics , Haplorhini , Humans , Mice , Nucleic Acid Hybridization , Quail , RNA, Messenger/analysis , Rabbits , Rats , Sheep , Swine , Thrombospondins , Transforming Growth Factors/pharmacology
2.
Science ; 209(4464): 1532-4, 1980 Sep 26.
Article in English | MEDLINE | ID: mdl-7001623

ABSTRACT

Nubian bone recovered from an X-group cemetery (A.D. 350 to 550) exhibits a pattern of fluorescence identical to that of modern tetracycline-labeled bone. When it is viewed under ultraviolet light at 490 angstroms, fluorophors are visible as a characteristic yellow-green fluorescence on surfaces that were actively mineralizing at the time of exposure. Contamination of stored grains provided the proper environment for cultivation of tetracycline-producing Streptomycetes. Evidence for exposure to antibiotics in an archeological population is relevant to studies of the evolution of R factors and to the interpretation of health and disease within the population.


Subject(s)
Bone and Bones/analysis , Tetracycline/history , Diet , Fluorescence , History of Medicine , Streptomyces , Sudan , Tetracycline/analysis
3.
Science ; 164(3883): 1051-2, 1969 May 30.
Article in English | MEDLINE | ID: mdl-5769759

ABSTRACT

A liquid-chromatography method has been developed for the separation of amino acids with the same specific activity in radiocarbon from bones impregnated with isotopically dead petroleum compounds found in the La Brea tar pits. This technique permits the application of radiocarbon dating to such bone assemblages.


Subject(s)
Bone and Bones/analysis , Petroleum/analysis , California , Carbon Isotopes , Chromatography , Methods , Paleontology , Time Factors
4.
Science ; 167(3923): 1370-2, 1970 Mar 06.
Article in English | MEDLINE | ID: mdl-5413160

ABSTRACT

With a new combination of two techniques, (i) alpha-particle or fission fragment registration in thin polymer foils by etching and (ii) automatic counting and magnification of the etched perforations by local evaporation of a thin metal layer with an electric spark, the sensitivity of conventional photographic methods for determining quantity and spatial distribution of alpha emitters, fissile materials, and of elements undergoing (n, alpha) reactions can be drastically improved, without need for darkroom processing and microscopic evaluation.


Subject(s)
Alpha Particles , Autoradiography , Neutrons , Animals , Bone and Bones/analysis , Dogs , Methods , Photography , Plutonium/analysis , Technology, Radiologic
5.
Science ; 220(4604): 1381-3, 1983 Jun 24.
Article in English | MEDLINE | ID: mdl-6344217

ABSTRACT

The delta 15N values of bone collagen from Eskimos and from Northwest Coast Indians dependent on salmon fishing are about 10 per mil more positive than those from agriculturalists in historic times. Among prehistoric humans, two groups dependent on marine food sources show bone collagen delta 15N values that are 4 to 6 per mil more positive than those from two agricultural groups. The nitrogen isotope ratios of bone collagen from prehistoric inhabitants of the Bahamas are anomalously low for reasons that relate to the biogeochemical cycle of nitrogen in coral reefs.


Subject(s)
Bone and Bones/analysis , Collagen/analysis , Diet , Nitrogen Isotopes , History, Ancient , Humans , Indians, North American/history , Indians, South American/history , Inuit/history
6.
Science ; 153(3743): 1523-5, 1966 Sep 23.
Article in English | MEDLINE | ID: mdl-5917783

ABSTRACT

Quantitative infrared spectrophotometric analysis of whole femurs from male rats demonstrates that anorphous calcium phosphate is a major component of bone mineral. The amount of amorphous calcium phosphate in whole bone decreases while the crystalline bone apatite increases during early stages of bone formation. Mature rat bone contains constant levels of both amorphous and crystalline calcium phosphate.


Subject(s)
Apatites/analysis , Bone and Bones/analysis , Calcium Phosphates/analysis , Dental Enamel/analysis , Dentin/analysis , Femur/analysis , Animals , Humans , Infrared Rays , Male , Rats , Spectrophotometry
7.
Science ; 184(4140): 989-92, 1974 May 31.
Article in English | MEDLINE | ID: mdl-4826170

ABSTRACT

Most of the lead contained in sedge and voles (mountain meadow mice) within one of the most pristine, remote valleys in the United States is not natural but came from smelter fumes and gasoline exhausts. In a food chain, natural mechanisms do not allow lead to accompany the bulk of the nutritive metals as they proceed to higher trophic levels. This exclusion can be expressed quantitatively by a comparison of lead/calcium ratios at successive trophic levels. This ratio decreased by an overall factor of 200 in proceeding from rock, to soil moisture, to sedge, to vole. This factor would have been 1200 if lead aerosols had not collected on sedge leaves and circtumvented the tendency by sedge to exclude lead from the nutritive metals it absorbed from soil moisture.


Subject(s)
Environmental Pollution/analysis , Lead/analysis , Air Pollution/analysis , Animals , Bone and Bones/analysis , Calcium/analysis , Isotopes , Muscles/analysis , Rodentia
8.
Science ; 161(3842): 687-8, 1968 Aug 16.
Article in English | MEDLINE | ID: mdl-4298852

ABSTRACT

Carbon dioxide from calcium carbonate in fossil bone can be selectively separated from carbon dioxide in bone apatite by hydrolyzing the sample first in acetic acid and then in hydrochloric acid. Radiocarbon analyses of the inorganic carbon dioxide in three samples of known age clearly show calcium carbonate in fossil bone to be secondary and the carbonate of bone apatite to be indigenous and suitable for dating in some cases. Agreement between dates on collagen-bone apatite pairs increases the level of confidence.


Subject(s)
Apatites/analysis , Bone and Bones/analysis , Calcium Carbonate/analysis , Carbon Isotopes/analysis , Dental Enamel/analysis , Paleontology , Acetates , Age Determination by Skeleton , Age Determination by Teeth , Animals , Arizona , Artiodactyla , Benzopyrans/analysis , Collagen , Humic Substances/analysis , Hydrochloric Acid , X-Ray Diffraction
9.
Science ; 184(4138): 791-3, 1974 May 17.
Article in English | MEDLINE | ID: mdl-4595240

ABSTRACT

Ages of several Californzia Paleo-Indlian skeletons have been deduced from the extent of aspartic acid racemization. These dates suggest that man was present in North America at least 50,000 years before the present.


Subject(s)
Anthropology, Physical , Aspartic Acid/analysis , Bone and Bones/analysis , Indians, North American/history , California , Carbon Radioisotopes , Chemistry , Collagen , Half-Life , History, Ancient , Humans , Isomerism , Mandible/analysis , Paleontology , Ribs/analysis , Skull/analysis
10.
Science ; 174(4012): 947-9, 1971 Nov 26.
Article in English | MEDLINE | ID: mdl-5123811

ABSTRACT

A scanning electron microscope was converted to an electron microprobe with high spatial resolution by the addition of a transmitted electron detector and a solid-state x-ray detector. Spectra obtained from mitochondrial granules of chondrocytes in situ confirm the suspected presence of calcium and phosphorus. Contamination during analysis can lead to false indications of silicon in living tissue.


Subject(s)
Bone and Bones/analysis , Calcium/analysis , Mitochondria/analysis , Phosphorus/analysis , Animals , Bone and Bones/cytology , Methods , Mice , Microscopy, Electron, Scanning , Silicon/analysis , Spectrum Analysis
11.
J Clin Invest ; 80(4): 979-82, 1987 Oct.
Article in English | MEDLINE | ID: mdl-3654981

ABSTRACT

We measured bone mineral density (BMD) at the midradius and lumbar spine in 106 normal women, ages 23-84 yr (61 were postmenopausal). Three to nine measurements (median, four) were made over 2.6 to 6.6 yr (mean, 4.1 yr). The correlation between calcium intake (range, 260-2,035 mg/d) and rate of change in BMD was not significant at the midradius (r = 0.06) or lumbar spine (r = 0.08), even after adjusting for age, menopausal status, and serum estrogen levels by multiple regression analysis. Women in the lower (mean, 501 mg/d) and in the upper (mean, 1,397 mg/d) quartiles of dietary intake had similar rates of change in BMD (%/yr [mean +/- SE], at midradius, -0.78 +/- 0.24 and -0.91 +/- 0.17 for lower and upper quartiles, respectively; at lumbar spine, -1.06 +/- 0.24 and 0.98 +/- 0.24). These data do not support the hypothesis that insufficient dietary calcium is a major cause of bone loss in women.


Subject(s)
Calcium, Dietary/administration & dosage , Osteoporosis/physiopathology , Adult , Aged , Aged, 80 and over , Bone and Bones/analysis , Densitometry , Estrogens/blood , Female , Humans , Menopause , Middle Aged , Minerals/analysis
12.
J Clin Invest ; 50(3): 679-87, 1971 Mar.
Article in English | MEDLINE | ID: mdl-4322721

ABSTRACT

Vitamin D in all body tissues was radio-labeled by supplementing completely vitamin D-deficient weanling rats with oral vitamin D(3)-4-(14)C for 2 wk. All vitamin D was then withheld, and radioactivity and vitamin D content in a variety of organs and tissues were measured. Adipose tissue was found to contain by far the greatest quantity of radioactivity throughout the 3 month experimental period. Immediately after supplementation, half of the total radioactivity in adipose tissue corresponded to unaltered vitamin D(3), and the other half to polar metabolites and esters of vitamin D(3) and unidentified peak II. 1 month later there was approximately the same proportion but a decrease in the total quantity of each form. We conclude that adipose tissue is the major storage site for vitamin D(3) in its several forms. Unaltered vitamin D(3) was the principal storage form observed and presumably a source available for conversion to other metabolites during deprivation.


Subject(s)
Adipose Tissue/metabolism , Cholecalciferol/metabolism , Adipose Tissue/analysis , Animals , Bone and Bones/analysis , Brain Chemistry , Calcium/blood , Carbon Isotopes , Cholecalciferol/administration & dosage , Cholecalciferol/analysis , Cholecalciferol/blood , Chromatography , Chromatography, Thin Layer
13.
J Clin Invest ; 77(5): 1487-91, 1986 May.
Article in English | MEDLINE | ID: mdl-3700651

ABSTRACT

We made longitudinal measurements of bone mineral density (BMD) in 139 normal women (ages 20-88 yr) at midradius (99% cortical bone) and lumbar spine (approximately 70% trabecular bone) by single- and dual-photon absorptiometry. BMD was measured 2-6 (median, 3) times over an interval of 0.8-3.4 yr (median, 2.1 yr). For midradius, BMD did not change (+0.48%/yr, NS) before menopause but decreased (-1.01%/yr, P less than 0.001) after menopause. For lumbar spine, there was significant bone loss both before (-1.32%/yr, P less than 0.001) and after (-0.97%/yr, P = 0.006) menopause; these rates did not differ significantly from each other. Our data show that before menopause little, if any, bone is lost from the appendicular skeleton but substantial amounts are lost from the axial skeleton. Thus, factors in addition to estrogen deficiency must contribute to pathogenesis of involutional osteoporosis in women because about half of overall vertebral bone loss occurs premenopausally.


Subject(s)
Bone and Bones/analysis , Menopause , Minerals/analysis , Adult , Aged , Densitometry , Estradiol/blood , Estrone/blood , Female , Humans , Lumbar Vertebrae/analysis , Middle Aged , Osteoporosis/etiology , Sex Hormone-Binding Globulin/analysis , Testosterone/blood
14.
J Clin Invest ; 66(5): 878-83, 1980 Nov.
Article in English | MEDLINE | ID: mdl-6968755

ABSTRACT

gamma-Carboxyglutamic acid-containing protein of bone (BGP) is an abundant noncollagenous protein of mammalian bone. BGP has a molecular weight of 5,800 and contains three residues of the vitamin K-dependent amino acid, gamma-carboxyglutamic acid. We have applied a radioimmunoassay based on calf BGP for the measurement of the protein in the plasma of 109 normal humans and 112 patients with various bone diseases. BGP in human plasma was demonstrated to be indistinguishable from calf BGP by assay dilution studies and gel permeation chromatography. The mean (+/- SE) concentration of BGP in normal subjects was 6.78 (+/- 0.20) ng/ml, 7.89 (+/- 0.32) for males and 4.85 (+/- 0.35) for females. Plasma BGP was increased in patients with Paget's disease of bone, bone metastases, primary hyperparathyroidism, renal osteodystrophy, and osteopenia. Plasma BGP did correlate with plasma alkaline phosphatase (AP) in some instances, but there were dissociations between the two. It was additionally observed that patients with liver disease had normal plasma BGP despite increased plasma AP, a reflection of the lack of specificity of AP measurements for bone disease. Our studies indicate that the radioimmunoassay of plasma BGP can be a useful and specific procedure for evaluating the patient with bone disease.


Subject(s)
Alkaline Phosphatase/blood , Blood Proteins , Bone Diseases, Metabolic/blood , Bone and Bones/analysis , Age Factors , Animals , Cattle , Chromatography, Gel , Female , Humans , Hyperparathyroidism/blood , Male , Osteitis Deformans/blood , Osteocalcin , Osteomalacia/blood , Osteoporosis/blood , Radioimmunoassay , Sex Factors
15.
J Clin Invest ; 46(10): 1572-8, 1967 Oct.
Article in English | MEDLINE | ID: mdl-6061734

ABSTRACT

The effects of treatment with vitamin D, calcium, or lactose on the responsiveness of vitamin D-deficient rats to parathyroid hormone were compared. In the absence of vitamin D, parenteral calcium or dietary lactose administration resulted in increases in serum calcium concentration although not to the normal values obtained in animals given vitamin D. Dietary lactose also partially restored the low bone calcium content of vitamin D-deficient rats. Untreated vitamin D-deficient rats showed no significant changes in serum calcium concentration after parathyroidectomy or parathyroid extract administration. Vitamin D, lactose, and calcium all restored responsiveness to parathyroid hormone; serum calcium concentration decreased after parathyroidectomy and showed a dose-related increase in response to parathyroid extract. Hence, the unresponsiveness to parathyroid hormone in vitamin D deficiency may be due to a lack of calcium at a local site of action, presumably bone, rather than to the absence of vitamin D as a specific cofactor.


Subject(s)
Calcium/pharmacology , Lactose/pharmacology , Parathyroid Hormone/pharmacology , Vitamin D Deficiency/metabolism , Vitamin D/pharmacology , Animals , Body Weight , Bone and Bones/analysis , Calcium/blood , Diet , Male , Parathyroid Glands/physiology , Phosphorus/blood , Rats
16.
J Clin Invest ; 58(6): 1327-38, 1976 Dec.
Article in English | MEDLINE | ID: mdl-186489

ABSTRACT

The ionophores A23187 and X-537A were used as probes to investigate the possible role of calcium uptake by bone as a mediator for the stimulation of bone resorption induced by parathyroid hormone (PTH) and other agents in cultured mouse calvaria. The ionophores alone at concentrations from 1 nM to 20 muM did not stimulate bone resorption, nor did they potentiate bone resorption stimulated by submaximal concentrations of PTH after either brief (15-60 min) or extended (1-3 day) exposure to the ionophores. Unexpectedly, we found that the ionophores inhibit in a dose-dependent manner bone resorption stimulated by PTH and a wide variety of other compounds (prostaglandin E2, 1alpha-hydroxycholecalciferol, 3-isobutyl-1-methyl-xanthine, and phorbol myristate acetate). This inhibition was not due to irreversible damage to the bones by the ionophores, because the inhibition was reversible even after 24 h of treatment. Inhibition of bone resorption by the ionophores was observed in media of both high and low calcium concentration, indicating that the inhibition was not due to a critical extracellular calcium concentration. Inhibition by the ionophores differs qualitatively in several ways from that produced by calcitonin, a natural inhibitor of bone resorption. Furthermore, A23187 at 1.0 mug/ml had no effect on the accumulation of cyclic AMP in the medium of either control, PTH- or calcitonin treated calvaria. We conclude that the ionophores A23187 or X537A do not stimulate bone resorption nor potentiate the effects of stimulators of bone resorption; instead they are inhibitors of bone resorption stimulated by a wide variety of compounds.


Subject(s)
Anti-Bacterial Agents/pharmacology , Bone Resorption/drug effects , Calcimycin/pharmacology , Lasalocid/pharmacology , Animals , Bone and Bones/analysis , Calcitonin/physiology , Calcium/physiology , Cyclic AMP/analysis , Mice , Organ Culture Techniques , Parathyroid Hormone/pharmacology , Time Factors
17.
J Clin Invest ; 54(5): 1074-81, 1974 Nov.
Article in English | MEDLINE | ID: mdl-4418467

ABSTRACT

In vivo and in vitro studies were carried out to characterize the exchangeable bone magnesium pool and determine what effect age and magnesium depletion has on bone magnesium. A highly significant correlation was found between the size of the in vitro elutable and in vivo exchangeable bone magnesium (r=0.97). To show that the exchangeable bone magnesium was the surface-limited bone magnesium, elution studies were performed 4 h after the in vivo administration of radiomagnesium. Specific activity in the eluant was 85% of that found in the serum at time of death, suggesting that the elutable and exchangeable bone magnesium pools were largely the same pool. Bone magnesium concentration fell with increasing age. The entire fall in bone magnesium was a result of a decrease in the surface-limited fraction. Since bone crystals have been shown to enlarge with aging with resulting contraction of the surface area, this would be the most apparent explanation for this finding. During magnesium depletion, magnesium concentration in both the exchangeable and nonexchangeable pools decreased. The fractional change in the exchangeable pool was much larger than the change in total or nonexchangeable bone magnesium, suggesting that the surface-limited magnesium pool is available during magnesium depletion. The change in size of the nonexchangeable bone magnesium pool appeared to be more related to the duration of magnesium depletion than the change in serum magnesium levels. The fall in magnesium concentration in this pool is probably a consequence of continuing formation of low magnesium bone during the depletion period.


Subject(s)
Aging , Bone and Bones/metabolism , Magnesium Deficiency/metabolism , Magnesium/metabolism , Animals , Bone and Bones/analysis , Erythrocyte Count , Erythrocytes/metabolism , Femur/analysis , Femur/metabolism , Magnesium/analysis , Magnesium/blood , Male , Radioisotopes , Rats , Spectrophotometry, Atomic
18.
J Clin Invest ; 53(1): 52-8, 1974 Jan.
Article in English | MEDLINE | ID: mdl-4808647

ABSTRACT

Calcium, phosphorus, sodium, carbonate, magnesium, and hydroxyproline were measured in iliaccrest biopsies of 22 normal volunteers and 24 selected patients with renal osteodystrophy. Histologic classification revealed that 10 were mildly abnormal, 8 osteomalacic, and 6 osteofibrotic. Bone density measurements were performed on an additional 12 normal, 11 mildly abnormal, 6 osteomalacic, and 10 osteofibrotic subjects. The results revealed an increase in magnesium and adecrease in carbonate apparent in the minimal and osteomalacic lesions and a much greater change in osteofibrosis. The bone density was decreased in patients with osteofibrosis. These observations would appear to be explained by postulation of an impairment of the normal maturational process of bone whereby there is an increase in amorphous calcium phosphate and a decrease in apatite crystal. The data suggest that the maturational defect is present as soon as any abnormality can be identified histologically, is present to the same degree in osteomalacia, and is most severe in osteofibrosis. In comparison of two sets of six patients matched for age and duration of dialysis, neither acidosis nor vitamin D therapy appeared to influence the severity of the maturational defect.


Subject(s)
Bone and Bones/analysis , Chronic Kidney Disease-Mineral and Bone Disorder/pathology , Biopsy , Bone Development , Bone and Bones/pathology , Calcium/analysis , Carbonates/analysis , Humans , Hydroxyproline/analysis , Magnesium/analysis , Osteomalacia/pathology , Phosphorus/analysis , Sodium/analysis
19.
J Clin Invest ; 52(12): 3000-10, 1973 Dec.
Article in English | MEDLINE | ID: mdl-4750437

ABSTRACT

Studies were carried out to evaluate the mechanism of hypocalcemia in magnesium depletion. Day old chicks fed a magnesium deficient diet developed marked hypocalcemia, with a direct relation between serum calcium (y) and magnesium (x): y = 2.68 x + 4.24, r = 0.84 (both in mg/100 ml). Injections of parathyroid extract that increased serum calcium 2-3 mg/100 ml in normals had no effect in Mg-depleted birds. Very large dietary supplements of calcium or vitamin D(3) increased mean serum calcium only from 5.3 to 7.7 and 7.8 mg/100 ml, respectively, while a normal magnesium diet for 3 days increased calcium from 5.3 to 9.9 mg/100 ml despite absence of dietary calcium. Intestinal calcium transport, studied in vitro, and the calcium concentration of the carcass was significantly increased in magnesium-depleted chicks, making it unlikely that reduced intestinal absorption of calcium caused the hypocalcemia. In magnesium-deficient chicks, the bone content of magnesium was decreased by 74%, the calcium content was unchanged, and the cortical thickness of bone was markedly increased. After 3 days of magnesium-repletion, cortical thickness was reduced with increased endosteal resorption. There was an increase in unmineralized osteoid tissue in the magnesium-depleted chicks. Parathyroid gland size and histology did not differ in magnesium-depleted and control birds. The results suggest that hypocalcemia develops due to altered equilibrium of calcium between extracellular fluid and bone, favoring increased net movement into the latter. Failure of parathyroid gland function could also exist, and unresponsiveness to parathyroid hormone (PTH) may also contribute to the hypocalcemia. However, failure of PTH action is probably due to the presence of excess osteoid tissue rather than a primary event leading to hypocalcemia.


Subject(s)
Hypocalcemia/etiology , Magnesium Deficiency/complications , Animals , Bone and Bones/analysis , Calcium/analysis , Calcium/blood , Calcium, Dietary , Chickens , Diet , Disease Models, Animal , Kidney/analysis , Magnesium/blood , Muscles/analysis , Myocardium/analysis , Phosphorus/analysis , Potassium/analysis , Sodium/analysis
20.
J Clin Invest ; 83(1): 168-74, 1989 Jan.
Article in English | MEDLINE | ID: mdl-2910906

ABSTRACT

We measured bone mineral density (BMD) at the lumbar spine (LS-BMD) and ultradistal radius (UDR-BMD) in 42 postmenopausal normal women and in 108 postmenopausal osteoporotic women (55 with vertebral fracture, 34 with Colles' fracture, and 19 with both fractures). By receiver operating characteristic analysis, LS-BMD was better than UDR-BMD (P less than 0.01) as an indicator of vertebral fracture; the converse was true for Colles' fracture (P less than 0.01). Although UDR-BMD and LS-BMD were lower in each of the three fracture groups than in controls (P less than 0.01), the pattern of bone loss differed (P less than 0.001, analysis of variance): with vertebral fracture, LS-BMD decreased relatively more than UDR-BMD; with Colles' fracture, UDR-BMD decreased relatively more than LS-BMD; and with both fractures, decreases in LS-BMD and UDR-BMD were similar. We conclude that both types of fracture are caused by excessive bone loss but the difference in bone loss at the two sites is a major factor in determining which will fracture.


Subject(s)
Bone and Bones/pathology , Colles' Fracture/pathology , Fractures, Bone/pathology , Minerals/analysis , Osteoporosis/pathology , Radius Fractures/pathology , Spinal Injuries/pathology , Absorptiometry, Photon , Adult , Aged , Bone and Bones/analysis , Female , Humans , Image Processing, Computer-Assisted , Male , Menopause , Middle Aged
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