Reference microarchitectural values measured by HR-pQCT in a Franco-Swiss cohort of young adult women.

Bone microarchitecture assessed by high-resolution peripheral quantitative computed tomography varies across populations of different origin. The study presents a reference dataset of microarchitectural parameters in a homogeneous group of participants aged within 22-27 range determined by a discriminant analysis of a larger cross-sectional cohort of 339 women. INTRODUCTION: High-resolution peripheral quantitative computed tomography (HR-pQCT) non-invasively measures three-dimensional bone microarchitectural parameters and volumetric bone mineral density. Previous studies established normative reference HR-pQCT datasets for several populations, but there were few data assessed in a reference group of young women with Caucasian ethnicity living in Western Europe. It is important to obtain different specific reference dataset for a valid interpretation of cortical and trabecular microarchitecture data. The aim of our study was to find the population with the most optimal bone status in order to establish a descriptive reference HR-pQCT dataset in a young and healthy normal-weight female cohort living in a European area including Geneva, Switzerland, Lyon and Saint-Etienne, France. METHODS: We constituted a cross-sectional cohort of 339 women aged 19-41 years with a BMI > 18 and < 30 kg/m2. All participants had HR-pQCT measurements at both non-dominant distal radius and tibia sites. RESULTS: We observed that microarchitectural parameters begin to decline before the age of 30 years. Based on a discriminant analysis, the optimal bone profile in this population was observed between the age range of 22 to 27 years. Consequently, we considered 43 participants aged 22-27 years to establish a reference dataset with median values and percentiles. CONCLUSION: This is the first study providing reference values of HR-pQCT measurements considering specific age bounds in a Franco-Swiss female cohort at the distal radius and tibia sites.

Spectacular improvement in vitamin D status in elderly osteoporotic women: 8-year analysis of an osteoporotic population treated in a dedicated fracture liaison service.

UNLABELLED: In a population of postmenopausal women with a fragility fracture, we found a drastic reduction in the proportion of women with severe (<25 nmol/L) and moderate (25 to 75 nmol/L) hypovitaminosis D, especially from 2009 onwards. These results show that supplementation has been very widely integrated into current practice. INTRODUCTION: Vitamin D (25(OH)D) is essential for bone health. In institutionalised osteoporotic women, it reduces the risk of fragility fractures. Numerous articles suggesting the possibility of extraosseous effects have generated a growing number of publications and recommendations on more widespread administration, to limit the risks of moderate or severe hypovitaminosis D. We assessed the impact on clinical practice of these recommendations concerning 25(OH)D supplementation in elderly at-risk populations. METHODS: A total of 1486 postmenopausal osteoporotic women were seen in the context of a fracture liaison service (i.e. a rheumatology consultation following a peripheral fragility fracture), between May 2005 and December 2012. Of these, 1107 had a 25(OH)D assay (femur, n = 520; humerus, n = 207; wrist, n = 380). RESULTS: The average age of the total population was 76.7 ± 9.9 years, while for women with an available 25(OH)D assay, the average age was 75.1 ± 11.8 years. The average 25(OH)D (nmol/L) level was similar for the three fracture sites: femur, 30 ± 36.2; humerus, 27.5 ± 24; and wrist, 31 ± 26. A drastic reduction in the proportion of women with severe (<25 nmol/L) and moderate (25 to 75 nmol/L) hypovitaminosis D was observed, especially from 2009 onwards, with a mean prevalence of 69 and 30 % respectively before that year and 35 and 52 % thereafter. Conversely, the proportion of women with 25(OH)D at the threshold value of 75 nmol/L increased from 1.2 to 24 %. Overall, mean serum 25(OH)D levels were significantly higher when comparing the two periods 2005-2008 and 2009-1012 (17.6 ± 14.6 and 48.4 ± 39.2 nmol/L, respectively; p < 0.0001). CONCLUSION: These results show that supplementation has been very widely integrated into current practice. We can expect it to yield beneficial effects in osseous and extraosseous terms in osteoporotic women, particularly the very elderly.

A species' Odyssey: evolution of obstetrical mechanics from Australopithecus Lucy to nowadays.

OBJECTIVE: Study of obstetrical mechanics of Australopithecus Lucy, Homo neanderthalensis and Homo erectus relative to modern Homo sapiens and the Catarrhines. STUDY DESIGN: The material comprised a total of 360 pelves: 3 fossil pelves reconstructed using casts (Australopithecus afarensis Lucy or AL 288-1, Homo erectus KNM-WT 15000, H. neanderthalensis or Kebara 2), 305 female modern adult pelves and 52 female Catarrhine pelves (29 gorillas, 18 chimpanzees, 5 orang-utans). All these pelves were reconstructed in order to carry out 11 pelvimetric measurements. Each measurement was carried out twice and by two different operators. RESULTS: The pelvis of Lucy was platypelloid at each pelvic plane. The pelvic inlet of H. neanderthalensis was anteroposteriorly oval whereas the midplane and the outlet were transversely oval. The pelvis of H. erectus was globally round. In modern women, the inlet was transversely oval. The pelvic midplane and outlet were anteroposteriorly oval. In the great apes, the shape of all three pelvic planes was anteroposteriorly oval. The discriminating value of the various pelvimetry measurements place Australopithecus Lucy, H. neanderthalensis Kebara 2, and H. erectus KNM-WT 15000 close to modern humans and less similar to the great apes. CONCLUSION: Obstetrical mechanics evolved from dystocic delivery with a transverse orientation in Australopithecus to delivery with a modern human-like rotational birth and an increase in the anteroposterior diameters in H. erectus, H. neanderthalensis and modern H. sapiens.

[Lucy's parturition, a way towards extinction?]. / La parturition de Lucy, chemin vers l'extinction ?

OBJECTIVES: To compare pelvic cavities in australopithecines, modern humans and non-hominid primates in order to discuss the obstetrical mechanisms in australopithecines MATERIAL AND METHODS: Bony pelves from fossil material (Australopithecus afarensis AL 288-1, Australopithecus africanus Sts14, Australopithecus Stw 431 and Mh2), 133 modern humans (82 adult females and 51 adult males) and 67 anthropoid primates (36 gorilla, 26 Pan troglodytes, 5 Pongo pygmaeus) were reconstructed and compared (shape and morphometric analysis) using 16 pelvimetric mesasurements. RESULTS: Pelves of australopithecines were characterized by lower anteroposterior (AP) and transverse (TRV) diameters in inlet pelvis than in other species. Index (AP/TRV) of pelvic inlet, midpelvis and pelvic outlet in the australopithecines were the lowest (<100) and the pelvic shape was platypelloid. A logarithmic factorial analysis showed that the pelvic morphology of australopithecines was different from humans and non-hominid primates but nearer the humans. DISCUSSION AND CONCLUSION: In contrast with apes where obstetrical mechanics seem to be easier, and because of platypelloidy, mechanism of birth in australopithecines was as difficult as in modern homo sapiens. Birth without cesarean was probably possible in an asynclitic TRV orientation.

[Anthropometric analysis of obstetrical pelvis from Neolithic area: obstetrical consequences. Preliminary study]. / Analyse anthropométrique du bassin obstétrical datant du Néolithique : conséquences obstétricales. Étude préliminaire.

OBJECTIVES: To study female pelves from Neolithic area (5000 years AD) in order to better understand the evolution of obstetrical mecanisms. MATERIALS AND METHODS: The fossil material comprised 73 Homo sapiens pelves: we reconstructed all the 20 adult female bony pelves. We realised the shape and morphometric analysis of the pelvic cavity. Changes in pelvic neolithic morphology were compared with pelvic modern morphology. RESULTS: The pelves of prehistoric female were similar in shape with modern female. However, they differ in relative dimensions (transversal diameter of the pelvis inlet: respectively 118 mm vs 125 mm, p=0.02). DISCUSSION AND CONCLUSION: Reconstructions based on Neolithic hominin fossils suggest that obstetrical mechanisms were probably common to Neolithic and modern humans: childbirth would probably require social adaptations and risks of perinatal and obstetric complications were undoubtedly high. However, the differences in morphometric analysis could suggest a change of human pelvis and raise the question of the evolution in obstetrical mechanisms in the future.