Test-retest reliability of measurements of abdominal and multifidus muscles using ultrasound imaging in adults aged 50-79 years.

Test-retest reliability of the combined process of ultrasound imaging (USI) and image measurement of thickness of abdominal and upper lumbar multifidus (MF) muscles and MF cross sectional area (CSA) of older adults has not been established. Imaging muscles of older adults can be challenging due to age-related changes in the spine and skeletal muscle so establishing test-retest reliability in this population is important. This study aimed to evaluate test-retest reliability of USI of abdominal and MF muscle thickness and MF CSA for adults aged 50-79 years. One operator took single sets of ultrasound images of abdominal and MF muscles of 23 adults aged 50-79 years participating in a clinical trial of vitamin D supplementation for knee osteoarthritis, on two occasions, one week apart. Images were subsequently measured by a single examiner. Test-retest reliability for abdominal muscle thickness and MF CSA was substantial (intraclass correlation coefficients (ICC) > 0.81) and for MF thickness ranged from fair to substantial (ICC 0.55-0.86). The standard error of measurement (SEM) was low (0.02-0.21) in every case. ICCs were low and SEM values were high for percentage thickness change. The substantial test-retest reliability of abdominal and MF (L4-L5) muscle thickness and of MF CSA supports the use of USI as a clinical and research tool to assess abdominal and MF muscle thickness and MF CSA of older adults.

Knee effusion-synovitis volume measurement and effects of vitamin D supplementation in patients with knee osteoarthritis.

OBJECTIVE: To develop a measure of knee joint effusion-synovitis volume and to examine the effect of vitamin D supplementation on effusion-synovitis in people with knee osteoarthritis (OA) and low vitamin D levels over 24 months. METHOD: Symptomatic knee OA patients with low 25-(OH)D levels (12.5-60 nmol/l) were recruited for a multi-centre, randomised, placebo-controlled and double-blind trial. Participants (age 63 ± 7 years, 208 females) were allocated to either 50,000 IU monthly vitamin D3 (n = 209) or placebo (n = 204) for 24 months. Knee effusion-synovitis volume in suprapatellar and other regions was measured on magnetic resonance imaging (MRI) using OsiriX software. The intra-class correlation coefficients (ICCs) were used to test inter- and intra-rater reliabilities. The least significant change criterion was used to define the increase/decrease in effusion-synovitis volume. RESULT: The reproducibilities of effusion-synovitis volume measurement were high with ICCs ranging from 0.93 to 0.99. Over 24 months, effusion-synovitis volume remained stable in the vitamin D group but increased in placebos with a significant between-group difference (-1.94 ml, 95% confidence interval (CI): -3.54, -0.33). This effect was evident in those with baseline effusion-synovitis and with suprapatellar effusion-synovitis. The proportion with an increase in effusion-synovitis volume was lower in the vitamin D group than placebo (risk ratio (RR): 0.87, 95% CI: 0.77, 0.97). CONCLUSION: This highly reproducible effusion-synovitis volume measurement could be a promising outcome measure in OA trials. Vitamin D supplementation could retard the progression of effusion-synovitis which can potentially benefit people with an inflammatory OA phenotype.

Associations between endogenous sex hormones and MRI structural changes in patients with symptomatic knee osteoarthritis.

OBJECTIVE: To investigate the longitudinal association between endogenous sex hormones and knee osteoarthritis (OA) structures and pain. METHOD: We examined 200 participants (mean age 63.0 ± 7.3 years) from a clinical trial of vitamin D supplement for symptomatic knee OA. Serum levels of estradiol, progesterone, testosterone and sex hormone binding globulin (SHBG) were analyzed at baseline and 24 months later. Magnetic resonance imaging (MRI) scans of selected knee were obtained at both baseline and follow-up for the measurement of cartilage volume, cartilage defects, bone marrow lesions (BMLs) and effusion-synovitis volume. Knee pain was assessed using a 100 mm visual analogue scale (VAS). Longitudinal data were analyzed using linear mixed-effects model. RESULTS: One hundred and seven males and 93 females were included in this study. For females, after adjustment for age, body mass index (BMI), and vitamin D level, progesterone was positively associated with cartilage volume (ß = 0.12 mm3 per quartile, P < 0.01). Estradiol levels were associated with lower grades of BMLs (ß = -0.46 per quartile, P = 0.03), while estradiol (ß = -1.28 per quartile, P = 0.04), progesterone (ß = -1.56 per quartile, P < 0.01) and testosterone (ß = -1.51 per quartile, P = 0.01) were inversely associated with effusion-synovitis volume. Testosterone was inversely associated with knee pain. No consistent associations were observed for males. CONCLUSION: In women but not men, low serum levels of endogenous estradiol, progesterone and testosterone are associated with increased knee effusion-synovitis and possibly other OA-related structural changes. This may contribute to observed sex differences in knee OA.

Social disadvantage, bone mineral density and vertebral wedge deformities in the Tasmanian Older Adult Cohort.

UNLABELLED: The relationship between social disadvantage and bone mineral density (BMD) is complex and remains unclear; furthermore, little is known of the relationship with vertebral deformities. We observed social disadvantage to be associated with BMD for females, independent of body mass index (BMI). A lower prevalence of vertebral deformities was observed for disadvantaged males. INTRODUCTION: The relationship between social disadvantage and BMD appears complex and remains unclear, and little is known about the association between social disadvantage and vertebral wedge deformities. We examined the relationship between social disadvantage, BMD and wedge deformities in older adults from the Tasmanian Older Adult Cohort. METHODS: BMD and wedge deformities were measured by dual-energy X-ray absorptiometry and associations with extreme social disadvantage was examined in 1,074 randomly recruited population-based adults (51 % female). Socioeconomic status was assessed by Socio-economic Indexes for Areas values derived from residential addresses using Australian Bureau of Statistics 2001 census data. Lifestyle variables were collected by self-report. Regression models were adjusted for age, BMI, dietary calcium, serum vitamin D (25(OH)D), smoking, alcohol, physical inactivity, calcium/vitamin D supplements, glucocorticoids and hormone therapy (females only). RESULTS: Compared with other males, socially disadvantaged males were older (65.9 years versus 61.9 years, p = 0.008) and consumed lower dietary calcium and alcohol (both p ≤ 0.03). Socially disadvantaged females had greater BMI (29.9 ± 5.9 versus 27.6 ± 5.3, p = 0.002) and consumed less alcohol (p = 0.003) compared with other females. Socially disadvantaged males had fewer wedge deformities compared with other males (33.3 % versus 45.4 %, p = 0.05). After adjustment, social disadvantage was negatively associated with hip BMD for females (p = 0.02), but not for males (p = 0.70), and showed a trend for fewer wedge deformities for males (p = 0.06) but no association for females (p = 0.85). CONCLUSIONS: Social disadvantage appears to be associated with BMD for females, independent of BMI and other osteoporosis risk factors. A lower prevalence of vertebral deformities was observed for males of extreme social disadvantage. Further research is required to elucidate potential mechanisms for these associations.

Vitamin D and bone health in childhood and adolescence.

Vitamin D plays a key role in bone metabolism. The link between vitamin D deficiency and rickets is well understood. However, subclinical vitamin D deficiency may also be detrimental to bone health in childhood. Its effects on bone mineralization have the potential to result in lower peak bone mass being attained, which could in turn contribute to increased fracture risk in both childhood and older adult life. As vitamin D deficiency is common globally, any detrimental effects of vitamin D deficiency on bone health are likely to have substantial public health implications. This review describes the current literature relevant to vitamin D and bone health in childhood and adolescence, with a particular emphasis on evaluating the emerging evidence for the impact of subclinical vitamin D deficiency on bone health and the effectiveness of vitamin D supplementation. The evidence suggests that subclinical vitamin D deficiency does affect bone acquisition, potentially beginning in utero and extending into adolescence. However, the effectiveness of vitamin D supplementation for improving bone health in situations of subclinical deficiency remains unclear, particularly in early life where there are few trials with bone density outcomes. The available evidence suggests that benefits are likely to be greatest in or even restricted to children with serum 25-hydroxyvitamin D levels at least below 50 nmol/L and possibly even lower than this. Trials of sufficient duration in deficient pregnant mothers, infants, and children are urgently required to address critical evidence gaps.

Intermittent high-dose vitamin D corrects vitamin D deficiency in adolescents: a pilot study.

We aimed to assess the safety and efficacy of high-dose intermittent vitamin D supplementation in adolescents. Twenty-two healthy adolescents with serum 25 hydroxy-vitamin D (25-OHD) of 12.5-50 nmol/l were randomised to receive 300,000 IU or 150,000 IU of vitamin D3, or placebo orally 6-monthly for 1 year. At 12 months, the average vitamin D levels for the 300,000 IU, 150,000 IU and placebo groups were 63.0, 41.1 and 35.8 nmol/l, respectively, (P=0.004 for difference between 300 000 IU group and placebo after adjustment for age, sex and seasonal variation). At 12 months, one participant receiving 300,000 IU was mildly deficient (25-OHD 49 nmol/l), whereas five out of six (83%) in the placebo and four out of seven participants (57%) in the 150,000 IU group remained deficient. There were no adverse events. Compliance was high. This suggests that 300,000 IU vitamin D3 orally 6-monthly may safely and effectively correct vitamin D deficiency in adolescents.

Calcium supplementation for improving bone mineral density in children.

BACKGROUND: Clinical trials have shown that calcium supplementation in children can increase bone mineral density (BMD) although this effect may not be maintained. There has been no quantitative systematic review of this intervention. OBJECTIVES: . To determine the effectiveness of calcium supplementation for improving BMD in children. . To determine if any effect varies by sex, pubertal stage, ethnicity or level of physical activity, and if any effect persists after supplementation is ceased. SEARCH STRATEGY: We searched CENTRAL, (Cochrane Central Register of Controlled Trials) (Issue 3, 2005), MEDLINE (1966 to 1 April 2005), EMBASE (1980 to 1 April 2005), CINAHL (1982 to 1 April 2005), AMED (1985 to 1 April 2005), MANTIS (1880 to 1 April 2005) ISI Web of Science (1945 to 1 April 2005), Food Science and Technology Abstracts (1969 to 1 April 2005) and Human Nutrition (1982 to 1 April 2005). Conference abstract books (Osteoporosis International, Journal of Bone and Mineral Research) were hand-searched. SELECTION CRITERIA: Randomised controlled trials of calcium supplementation (including by food sources) compared with placebo, with a treatment period of at least 3 months in children without co-existent medical conditions affecting bone metabolism. Outcomes had to include areal or volumetric BMD, bone mineral content (BMC), or in the case of studies using quantitative ultrasound, broadband ultrasound attenuation and ultrasonic speed of sound, measured after at least 6 months of follow-up. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data including adverse events. We contacted study authors for additional information. MAIN RESULTS: The 19 trials included 2859 participants, of which 1367 were randomised to supplementation and 1426 to placebo. There was no heterogeneity in the results of the main effects analyses to suggest that the studies were not comparable. There was no effect of calcium supplementation on femoral neck or lumbar spine BMD. There was a small effect on total body BMC (standardised mean difference (SMD) +0.14, 95% CI+0.01, +0.27) and upper limb BMD (SMD +0.14, 95%CI +0.04, +0.24). Only the effect in the upper limb persisted after supplementation ceased (SMD+0.14, 95%CI+0.01, +0.28). This effect is approximately equivalent to a 1.7% greater increase in supplemented groups, which at best would reduce absolute fracture risk in children by 0.1-0.2%per annum. There was no evidence of effect modification by baseline calcium intake, sex, ethnicity, physical activity or pubertal stage. Adverse events were reported infrequently and were minor. AUTHORS' CONCLUSIONS: While there is a small effect of calcium supplementation in the upper limb, the increase in BMD which results is unlikely to result in a clinically significant decrease in fracture risk. The results do not support the use of calcium supplementation in healthy children as a public health intervention. These results cannot be extrapolated to children with medical conditions affecting bone metabolism.

A mother-based intervention trial for osteoporosis prevention in children.

OBJECTIVE: To assess whether a lifestyle intervention delivered to mothers might impact on osteoporosis preventive behaviors in their children. METHODS: We performed a 2-year randomized controlled trial of individualized bone mineral density feedback with either an osteoporosis information leaflet, or small group education, in a population-based sample of 354 mothers from Southern Tasmania, Australia in 2000-02. Main outcomes were maternal report of calcium intake and physical activity change in their children. RESULTS: Receiving small group education was associated with mothers' report of increasing children's calcium intake (odds ratio 2.3, 95% confidence interval 1.4, 3.8), as was low t-score feedback (odds ratio 2.0, 95% confidence interval 1.2, 3.3). Mothers who increased their own physical activity were more often reported increasing both physical activity (odds ratio 2.7, 95% confidence interval 1.5, 5.0) and calcium intake in their children (odds ratio 2.2, 95% confidence interval 1.3, 3.7). Mothers who commenced calcium supplements more often reported increasing children's calcium intake (odds ratio 2.6, 95% confidence interval 1.0, 6.7) but not physical activity. CONCLUSIONS: Both bone mineral density feedback and small group education delivered to mothers are effective at inducing maternally reported osteoporosis preventive behavior change in their children. These results require confirmation by studies with objective outcome measures.