Born in Auschwitz and Survived: A Triumph Over Murderers.

BACKGROUND: The discovery of Jewish babies who were born in Nazi concentration camps and survived seems miraculous, but this phenomenon did occur toward the end of World War II. The lives of a small group of mothers and surviving children are of both historical and medical interests. Their survival shows additional support for the hypothesis that maternal nutrition can induce metabolic syndrome and bone demineralization in their offspring. Information obtained through direct contact with some of the surviving children is the basis for this article.

Bone mineralization disorders as a complication of anorexia nervosa - etiology, prevalence, course and treatment. / Zaburzenia mineralizacji kosci jako powiklanie jadlowstretu psychicznego - etiologia, rozpowszechnienie, przebieg i leczenie.

Anorexia nervosa (AN) most often has its onset in adolescence, which is a crucial period to achieve peak bone mass. The hormonal abnormalities (hypoestrogenism, hypercortisolism, decreased secretion of dehydroepiandrosterone, testosterone, insulin-like growth factor) and malnutrition are associated with profound bone mineralization disorders. Densitomertic bone mineral density (BMD) values for osteopenia and osteoporosis were found respectively in 35-98% and 13-50% of women with AN. Prospective studies indicate a further decline in BMD at the beginning of treatment and a crucial importance of weight gain and return of spontaneous menses for its growth. Due to frequent chronic and relapsing course of AN densitometric assessment of BMD is recommended in all patients with AN and amenorrhea lasting around twelve months. In order to establish standards for the treatment of osteoporosis in AN, studies on pharmacological treatment are conducted. There are promising results indicating the improvement in BMD after treatment with physiologic oestrogen replacement treatment and sequential administration of medroxyprogesterone in teenage girls and bisphosphonates in adult women. Supplementation of vitamin D and adequate consumption of calcium from diet are recommended. Further studies on the effectiveness of long-term treatment of osteoporosis with regard to the possibility of increase in BMD and reducing the risk of osteoporotic fractures are needed.

Bone demineralisation in a large cohort of Wilson disease patients.

AIMS AND BACKGROUND: We compared the bone mineral density (BMD) of adult Wilson disease (WD) patients (n = 148), with an age- and gender-matched healthy control population (n = 148). Within the WD cohort, correlations of BMD with WD disease parameters, lab results, type of treatment and known osteoporosis risk factors were analysed. METHODS: Hip and lumbar spine absolute BMD and T-score were measured by dual-energy X-ray absorptiometry. Osteoporosis and osteopenia were defined as a T-score ≤ -2.5, and between -1 and -2.5, respectively. RESULTS: There were significantly more subjects with abnormal T-scores in the WD population (58.8%) than in the control population (45.3%) (χ(2) = 6.65, df = 2, p = 0.036), as there were 50.0% osteopenic and 8.8% osteoporotic WD patients, vs. 41.2% and 4.1%, respectively, in the controls. Especially L2-L4 spine BMD measurements (BMD and T-scores) differed significantly between the WD population and matched controls. L2-L4 spine BMD for WD patients was on average 0.054 g/cm(2) (5.1%) lower than in matched normal controls (0.995 ± 0.156 vs 1.050 ± 0.135; p = 0.002). We found no significant correlation between BMD values and any of the WD disease parameters (e.g. the severity of liver disease), lab results, type of treatment or known osteoporosis risk factors. Duration of D-penicillamine treatment was negatively correlated with femoral BMD value, but in a clinically irrelevant manner, compared to age and gender. Importantly, BMD remained significantly lower in WD patients (n = 89) vs. controls after excluding WD patients with cirrhosis (p = 0.009). CONCLUSIONS: Our study suggests that WD is intrinsically associated with bone demineralisation.

Cystic fibrosis-related bone disease explored using a four step algorithm.

BACKGROUND: A suboptimal bone accrual in young individuals with cystic fibrosis (CF) may be related to the development of a premature CF-related bone disease. Dual energy X-ray absorptiometry (DXA) is the mainstream measure of bone health; however, the influence of body size and lean tissue mass (LTM) on bone data is poorly interpreted. METHODS: Total body dual-energy X-ray absorptiometry (DXA) measurements of bone mineral content (BMC) and LTM in 53 individuals with CF (7.00-17.99years) were compared to 53 sex-matched controls. BMC, height, and LTM in relation to height and BMC Z-scores were calculated and used in a 4-step algorithm. RESULTS: Pubertal females with CF had less total body BMC for age (p=0.02); pre-pubertal males (p=0.05) and pubertal females with CF (p=0.03) were shorter; and pubertal females with CF showed less total body BMC for LTM (p=0.01). CONCLUSIONS: The algorithm showed the following: (1) prior to puberty lowered total body BMC was primarily due to short stature, (2) LTM was appropriate for body size, and (3) pubertal females with CF had significantly less total body BMC for their LTM. Longer controlled trials are needed to clinically interpret CF-related bone disease using DXA derived data that considers patient size and body composition.

[Bone loss in women with malignant genital neoplasms]. / Utrata masy kostnej u pacjentek z notwtworami zlosliwymi narzadów plciowych.

Nowadays, women with genital cancers live longer due to early diagnosis and better treatment schemes. Only few studies assessed bone mass in patients with genital cancer Osteoporosis is a condition characterized by progressive loss of bone mass, weakening of the spatial structure of the bone, and increased susceptibility to fractures. Osteopenia is a condition of reduced, but not yet reaching the pathological values, bone density in relation to norms for age and sex. Metastases are the primary cause of death in cancer patients. It is estimated that approximately half of people dying due to cancer have bone metastases. Osteoporosis in neoplastic disease may occur due to bone metastases or therapy-related adverse effects, i.e. reduced bone mineral density (BMD). Bone microenvironment provides a good medium for the growth of cancer cells. BMD of the femur and spine should be measured by DXA. Computed tomography (CT) and magnetic resonance imaging (MRI) are the techniques used to detect bone metastases. Lifestyle is the key to improving the quality of life and maximize any pharmacological treatment in cancer patients. It is proposed that treatment of cancer without bone metastases does not require therapy increasing bone mass. Further studies in women treated for gynecological malignancies undergoing oophorectomy and adjuvant treatment are needed to elucidate the mechanisms associated with bone loss.

Enfermedad hepática alcohólica y alteraciones de la densidad mineral ósea / Alcoholic liver disease and changes in bone mineral density

La osteoporosis y la osteopenia son alteraciones de la densidad mineral ósea (DMO) que se desarrollan frecuentemente en la enfermedad hepática crónica (EHC). Dichas alteraciones han sido estudiadas predominantemente en la enfermedad colestásica crónica y en la cirrosis hepática. El consumo de alcohol es un factor de riesgo independiente para la aparición de osteoporosis, cuya prevalencia estimada en pacientes con enfermedad hepática por alcohol (EHA) varía entre un 5 % y un 40 %. La pérdida de DMO en la EHA se produce por un disbalance entre formación y resorción ósea. Su etiopatogenia es multifactorial y comprende la toxicidad del alcohol sobre el hueso, las alteraciones endocrinológicas y nutricionales secundarias al alcoholismo y el déficit de osteocalcina, vitamina D e IGF-1, entre otras. El diagnóstico de las alteraciones de la DMO en la EHA se basa en su medición mediante densitometría ósea. El tratamiento incluye el abandono del alcohol y medidas generales de tipo nutricional, abandono del tabaco y ejercicio físico. La suplementación con calcio y vitamina D se recomienda en todos los pacientes con EHA y osteoporosis. Los bisfosfonatos son los principales fármacos para el tratamiento específico de esta entidad. Otras alternativas son el raloxifeno, el tratamiento hormonal sustitutivo y la calcitonina. La presente revisión abordará los aspectos más relevantes para el manejo clínico de las alteraciones de la DMO en el contexto de la EHA, incluyendo su prevalencia, etiopatogenia y diagnóstico. Por otra parte, se efectuará una revisión del tratamiento de la osteoporosis en la EHC en general, incidiendo en los aspectos específicos relacionados con la pérdida de masa ósea en la EHA (AU)

Osteoporosis and osteopenia are alterations in bone mineral density (BMD) that frequently occur in the context of chronic liver disease (CLD). These alterations have been studied predominantly in chronic cholestatic disease and cirrhosis of the liver. Alcohol consumption is an independent risk factor for the onset of osteoporosis, whose estimated prevalence in patients with alcoholic liver disease (ALD) ranges between 5 % and 40 %. The loss of BMD in ALD is the result of an imbalance between bone formation and resorption. Its pathogenesis is multifactorial and includes the toxic effects of alcohol on bone and endocrine and nutritional disorders secondary to alcoholism and a deficiency of osteocalcin, vitamin D and insulin growth factor-1. The diagnosis of BMD alterations in ALD is based on its measurement using bone densitometry. Treatment includes smoking and alcohol cessation and general measures such as changes in nutrition and exercise. Calcium and vitamin D supplements are recommended in all patients with ALD and osteoporosis. Bisphosphonates are the most commonly prescribed drugs for the specific treatment of this condition. Alternatives include raloxifene, hormone replacement therapy and calcitonin. This review will address the most important aspects involved in the clinical management of abnormal BMD in the context of ALD, including its prevalence, pathogenesis and diagnosis. We will also review the treatment of osteoporosis in CLD in general, focusing on specific aspects related to bone loss in ALD (AU)

Densidad mineral ósea y adecuación de la dieta en pacientes con enfermedad renal crónica en hemodiálisis / Bone mineral density and adequacy of dietary pattern of patients with chronic kidney disease in hemodialysis

Introducción: La desnutrición es común en la enfermedad renal crónica (ERC), junto a una menor masa muscular y densidad mineral ósea (DMO), aumentando el riesgo de morbilidad. Objetivo: Comparar la composición corporal (CC), DMO y el contenido mineral óseo (CMO) entre pacientes con ERC y sujetos sanos, relacionándolos con ingesta energética, de macro y micronutrientes. Métodos: Se evaluó CC en 30 pacientes en hemodiálisis y 28 voluntarios sanos con DEXA. Los pacientes llenaron tres registros de 24 horas de ingesta alimentaria. Resultados: Los pacientes con ERC presentaron una menor DMO (p < 0,01) y CMO (p < 0,0l) y una tendencia a tener menos masa libre de grasa (MLG) que los controles (p = 0,06). En los hombres, las diferencias en la DMO y CMO pierden significación al ajustar por masa grasa (%) y MLG (kg). En los pacientes con ERC, un 34,5% y 27,6% tuvo una ingesta adecuada de energía y proteínas, respectivamente. Sin embargo, se observó un déficit de la ingesta de energía y proteínas en 31,0% y 44,8% de los pacientes, respectivamente. No se encontró correlación en los pacientes con ERC entre la ingesta de macronutrientes y de calcio y DMO o CMO. Conclusiones: Los pacientes con ERC tienen menor DMO y CMO que los voluntarios sanos. Estas diferencias pierden su importancia en los hombres, después de ajustar por parámetros de composición corporal. Se observó una pobre adecuación de la dieta en la mayoría de los pacientes con ERC, no observándose asociación entre estas variables y la composición corporal o densidad mineral ósea (AU)

Background: In chronic kidney disease (CKD) patients, malnutrition is common with loss of muscle mass and decreased bone mineral density (BMD), increasing the risk of morbidity. Objective: To compare body composition, bone mineral density (BMD) and bone mineral content (BMC) between CKD patients and healthy subjects, and relate these parameters with energy, macronutrients and micronutrients intake. Methods: Body composition was assessed 30 haemodialysis patients and compared with 28 healthy volunteers with DEXA. In patients, three 24 hours records of dietary intake were filled. Results: A significantly lower BMD (p < 0.01) and BMC (p < 0.0) were found in CKD patients. There was a trend for patients to have lower fat free mass (FFM) than controls (p = 0.06). In men, differences in BMD and BMC lost significance when adjusting for fat mass FM (%) and FFM (kg). In CKD, 34.5% and 27.6% of patients had an adequate intake of energy and protein, respectively. However, it was observed a deficit of energy and protein intake in 31.0% and 44.8% of patients, respectively. No significant correlation was found in CKD patients between macronutrient and calcium intake and BMD or BMC. Conclusions: CKD have lower BMD and BMC than healthy volunteers. These differences lost significance in men, after adjusting for body composition parameters. A poor dietary adequacy was found in most patients with CKD, but no association was observed between these variables and body composition or bone mineral density (AU)

A study to evaluate the cause of bone demineralization in gynecological cancer survivors.

BACKGROUND: An association between treatment for gynecological cancers and risk of osteoporosis has never been formally evaluated. Women treated for these cancers are now living longer than ever before, and prevention of treatment-induced morbidities is important. We aimed to distinguish, in gynecological cancer survivors, whether cancer therapy has additional detrimental effects on bone health above those attributable to hormone withdrawal. METHODS: We performed a retrospective cross-sectional analysis of dual energy x-ray absorptiometry (DEXA) scan results from 105 women; 64 had undergone bilateral salpingo-oophorectomy (BSO) followed by chemotherapy or radiotherapy for gynecological malignancies, and 41 age-matched women had undergone BSO for benign etiologies. All were premenopausal prior to surgery. RESULTS: The median age at DEXA scan for the cancer group was 42 years, and 66% had received hormonal replacement therapy (HRT) following their cancer treatment. For the benign group, the median age was 40 years, and 87% had received HRT. Thirty-nine percent of cancer survivors had abnormal DEXA scan results compared to 15% of the control group, with the majority demonstrating osteopenia. The mean lumbar spine and femoral neck bone mineral densities (BMDs) were significantly lower in cancer patients. A history of gynecological cancer treatment was associated with significantly lower BMD in a multivariate logistic regression. CONCLUSIONS: Women treated for gynecological malignancies with surgery and adjuvant chemotherapy have significantly lower BMDs than age-matched women who have undergone oophorectomy for noncancer indications. Prospective evaluation of BMD in gynecological cancer patients is recommended to facilitate interventions that will reduce the risk of subsequent fragility fractures.

Mandibular bone changes in 24 years and skeletal fracture prediction.

OBJECTIVES: The objectives of the investigation were to describe changes in mandibular bone structure with aging and to compare the usefulness of cortical and trabecular bone for fracture prediction. MATERIALS AND METHODS: From 1968 to 1993, 1,003 women were examined. With the help of panoramic radiographs, cortex thickness was measured and cortex was categorized as: normal, moderately, or severely eroded. The trabeculation was assessed as sparse, mixed, or dense. RESULTS: Visually, the mandibular compact and trabecular bone transformed gradually during the 24 years. The compact bone became more porous, the intertrabecular spaces increased, and the radiographic image of the trabeculae seemed less mineralized. Cortex thickness increased up to the age of 50 and decreased significantly thereafter. At all examinations, the sparse trabeculation group had more fractures (71-78 %) than the non-sparse group (27-31 %), whereas the severely eroded compact group showed more fractures than the less eroded groups only in 1992/1993, 24 years later. Sparse trabecular pattern was associated with future fractures both in perimenopausal and older women (relative risk (RR), 1.47-4.37) and cortical erosion in older women (RR, 1.35-1.55). RR for future fracture associated with a severely eroded cortex increased to 4.98 for cohort 1930 in 1992/1993. RR for future fracture associated with sparse trabeculation increased to 11.43 for cohort 1922 in 1992/1993. CONCLUSION: Dental radiographs contain enough information to identify women most at risk of future fracture. CLINICAL RELEVANCE: When observing sparse mandibular trabeculation, dentists can identify 40-69 % of women at risk for future fractures, depending on participant age at examination.

[Mid-term effectiveness of total hip arthroplasty with collum femoris preserving prosthesis].

OBJECTIVE: To discuss the clinical application of total hip arthroplasty (THA) with collum femoris preserving (CFP) prosthesis and to analyze the mid-term effectiveness. METHODS: Between January 2004 and February 2007, 45 patients (48 hips) underwent THA with CFP prosthesis. There were 29 males (31 hips) and 16 females (17 hips) with an average age of 48.8 years (range, 38-60 years), including 20 left hips, 22 right hips, and 3 bilateral hips. The causes of hip replacement were osteoarthritis (20 cases), avascular necrosis of femoral head (13 cases), dysplasia (4 cases), rheumatoid arthritis (3 cases), posttraumatic osteoarthritis (2 cases), ankylosing spondylitis (2 cases), and Perths disease (1 case). The average disease duration was 6.1 years (range, 2-13 years). Harris scores, visual analogue scale (VAS) score, and the hip range of motion (ROM) were recorded at pre- and post-operation. The X-ray films were taken at pre- and post-operation to observe the position, loosening of the prosthesis, and ectopic ossification. The gait of patients were also evaluated during follow-up. Short-form 36 health survey scale (SF-36) was used to evaluate the life quality of patients. RESULTS: All 45 patients were followed up 5-8 years with an average of 6.4 years. All the incisions healed by first intention. No infection, hip dislocation, nerve injury, or deep vein thrombosis occurred. Six cleavage fractures (13.3%) of the lateral femoral diaphysis at the distal prosthesis occurred during operation, which healed at 8 months postoperatively without any treatment. Mild ectopic ossification occurred in 4 patients (8.9%) who had no discomfort. Five patients (11.1%) had bone mineral density loss in the region of the proximal femur. The survival rates of the cups and stems were all 100% at last follow-up. The results of Harris score, VAS score, and ROM of the hip joint at 1 year postoperatively and last follow-up were significantly better than preoperative ones (P < 0.05). No significant difference was found in VAS score and ROM of the hip joint between at 1 year postoperatively and at last follow-up (P > 0.05) except the Harris score (P < 0.05). According to Harris functional assessment at last follow-up, the results were excellent in 31 hips, good in 11 hips, and fair in 6 hips with an excellent and good rate of 87.5%. The physiological role, body pain, and total health scores were significantly lower than the reference value of urban men from Sichuan province (P < 0.05), but no significant difference was found in the other scores of the SF-36 when compared with the reference value (P > 0.05). CONCLUSION: THA with CFP prosthesis is a good option for the young patient with complete collum femoris and without osteoporosis, and can achieve good mid-term effectiveness.

Longitudinal assessment of bone mineral density in children and adolescents with inflammatory bowel disease.

OBJECTIVES: Low bone mineral density (BMD) is recognized as a potential problem in children with inflammatory bowel disease (IBD). We aimed to describe the longitudinal development of BMD in a population of Swedish pediatric patients with IBD. METHODS: A total of 144 patients with IBD (93 males; 83 with ulcerative colitis [UC], 45 with Crohn disease [CD]) were examined with dual-energy x-ray absorptiometry at baseline. At follow-up 2 years later, 126 of the initial 144 patients were reexamined. BMD values are expressed as z scores. RESULTS: Children with UC and CD had significantly lower mean BMD z scores for the lumbar spine (LS) at baseline and after 2 years. The reduction in BMD was equally pronounced in patients with UC and CD, and neither group improved their z score during the follow-up period. Furthermore, significantly lower mean BMD z scores for the LS were found at baseline in boys (-1.1 SD, ±2.7 SD, P < 0.001), but not in girls (-0.0 SD, ±3.0 SD). This finding remained unchanged at follow-up. Subanalyses of the different age groups at baseline showed the lowest BMD values in the group of patients ages 17 to 19 years in boys (mean z score for the LS 1.59 SD, ±3.1 SD) and in girls (mean z score for the LS -3.40 SD, ±3.1 SD); however, at follow-up, these patients had improved their BMD significantly (mean change z score for the LS 1.00 SD, 95% CI 0.40-1.60; 1.90 SD, 95% CI 0.60-3.20). CONCLUSIONS: In this longitudinal study, the entire group of pediatric patients with IBD showed permanent decreases in their BMD z scores for the LS; however, our data indicate that afflicted children have the potential to improve their BMD by the time they reach early adulthood.

Adherence to treatment with selective serotonin reuptake inhibitors and the risk for fractures and bone loss: a population-based cohort study.

BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are suspected of increasing the risk of bone loss and osteoporotic fractures. OBJECTIVE: The aim of this study was to investigate the association between adherence to SSRI treatment and the risk of bone loss-related events. METHODS: The data used in this retrospective cohort study are part of the ongoing medical documentation routinely collected in a large health maintenance organization in Israel. Specifically, we used the information collected between January 2004 and April 2010. The study cohort included 10 621 women who were new users of SSRIs. Bone loss-related events were defined as fractures or initiation of bisphosphonate treatment. Adherence level was assessed by calculating the proportion of days covered (PDC) with an SSRI from the date of first dispensed SSRI (index date) to the end of follow-up and was categorized as low (PDC ≤20%), intermediate (PDC 21-79%) and high (PDC ≥80%). To validate the study model, we conducted a similar analysis on patients using antiepileptic drugs, which are known to be positively associated with an increased risk of osteoporotic fractures. RESULTS: Higher adherence to SSRI treatment was significantly associated with an increased risk of bone loss-related events in a dose-response manner. The adjusted hazard ratio for bone loss-related events adjusted for age, physician visits and body mass index in patients who were covered with an SSRI for 21-79% of the time and 80% or more of the time was 1.15 (95% CI 0.97, 1.37) and 1.40 (95% CI 1.14, 1.73) compared with patients who were covered for less than 21% of the follow-up period. CONCLUSION: Exposure to SSRI treatment is associated with an increased risk of bone loss-related events. Further studies are required to determine the causality of the association and its relevance to the clinical use of SSRIs.

El complejo escenario de las alteraciones de metabolismo óseo y mineral en la enfermedad renal crónica / Chronic kidney disease-mineral and bone disorder: a complex scenario

Las alteraciones del metabolismo óseo en el escenario de la enfermedad renal crónica (CKD-MBD) constituyen un dinámico campo de estudio. Al conjunto de reguladores clásicos del metabolismo óseo tales como calcio, fósforo, hormona paratiroidea (PTH) y calcitriol se ha añadido el factor de crecimiento fibroblástico 23 (FGF-23). La calcificación vascular, una de las complicaciones más importantes de la enfermedad renal crónica, está sujeta a una compleja regulación en la que intervienen factores promotores e inhibidores del proceso de mineralización. La asociación entre calcificación vascular, desmineralización ósea y mortalidad y la existencia de factores y vías de señalización comunes está siendo objeto de interesantes investigaciones (AU)

The chronic kidney disease-bone and mineral disorders (CKD-MBD) represents a dinamic area of research. Recently, new factors such as FGF-23 have been added to the classic list of regulators of bone metabolism, which include calcium, phosphorus, PTH and calcitriol. Vascular calcification, one of the most important complication of CKD-MBD is regulated by a complex variety of promoters and inhibitors. The relationship between vascular calcification, bone loss and mortality, together with the existence of likely common signaling pathways are subject of interesting investigations (AU)

Corticosteroid exposure not associated with long-term bone mineral density in pediatric liver transplantation.

OBJECTIVES: The aim of the study was to examine the association of corticosteroid exposure and other skeletal risk factors with bone mineral density (BMD) and fractures following pediatric liver transplantation (LT) at a large single center. PATIENTS AND METHODS: Lumbar spine BMD, measured using dual-energy x-ray absorptiometry (DXA), was corrected for bone age in 52 ambulatory children ages 4 to 18 years, at least 1 year post-LT. Potential risk factors for skeletal health such as corticosteroid exposure, dietary and lifestyle factors, and growth and fracture occurrence, were related to BMD using univariate and multivariate regression analyses. RESULTS: The prevalence of low BMD (z score <-2) and post-LT fractures was 3 of 52 (5.8%) and 11 of 52 (21%), respectively. Univariate analysis revealed age >10 years at LT and body mass index (BMI) < 85th percentile at time of DXA were significantly associated with BMD (both P = 0.02). BMD did not correlate with corticosteroid dosage in the first year post-LT, the year before DXA or cumulative lifetime exposure. A cholestatic primary LT indication, acute rejection episodes, and fractures post-LT were not associated with BMD. Extracurricular physical activity, vitamin D, and calcium intake were not associated with BMD or fractures. Multivariate linear regression revealed increased time post-LT (P = 0.04) and higher BMI z score at time of DXA (P = 0.02) as the strongest independent variables associated with greater BMD. CONCLUSIONS: Neither corticosteroid exposure nor a cholestatic primary indication for LT influenced BMD, which was largely normal in this ambulatory group. Children and adolescents undergoing LT after the age of 10 years and those with low BMI post-LT may be at greatest risk of poor skeletal health later in life, and thus a potential target patient population to benefit from preventive interventions.

Association between periodontal disease and bone mineral densityin postmenopausal women: A cross sectional study

Objectives: Both periodontitis and osteoporosis represent major health problems especially in elderly women. Therelationship between the two diseases and oral bone loss is important having significant public health impact inthe prevention of morbidity and mortality related to these disorders. The present study was aimed to investigatethe possible association between osteoporosis and periodontal disease among postmenopausal women residing inGoa, India. Study design: A complete periodontal examination (all teeth except third molar) including plaqueindex (PI), gingival index (GI), clinical attachment loss (CAL) measurement was performed on 80 dentate Goanpostmenopausal women (age ≥ 50 yrs) with generalized chronic periodontitis. Mean alveolar bone loss (ABL)was measured from full mouth intraoral periapical radiographs, by recording the distance from cementoenameljunction (CEJ) and the most coronal portion of alveolar crest at mesial and distal aspect of all teeth exceptcanines and third molars. Systemic bone loss was determined from hand-wrist radiograph of the patientthrough Digital X-Ray Radiogrammetry. Statistical analysis was done to assess the relationships between periodontalvariables and bone mineral density (BMD) after adjusting for age, years since menopause, body massindex (BMI), smoking, number of remaining teeth, PI and GI. Results: Age of the patient, years since menopauseand BMI showed significant correlation with BMD. CAL and ABL showed mildly negative and statistically nonsignificantcorrelation with the BMD. Of all the variables studied, only smoking and BMI were strong predictorsof BMD. Conclusion: Skeletal BMD is related to interproximal ABL and CAL, though not to a statistically significantlevel; implicating postmenopausal osteopenia as a risk indicator for periodontal disease (AU)

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Bone mineral disorders in pediatric and adolescent renal transplant recipients.

Incomplete resolution of abnormalities of mineral metabolism associated with CRF results in the relatively high prevalence of ROD in pediatric kidney recipients. This non-randomized, cross-sectional, and analytic-descriptive study on bone density, vitamin D, and mineral metabolism was performed in 57 children and adolescents who had received a total of 60 renal allografts in Shiraz, Iran. The height and weight of the patients were measured; their serum calcium (Ca), phosphorus (P), Alk-P, PTH, 25(OH)-vitamin D(3), BUN, creatinine, and electrolyte levels were analyzed, and a complete blood count was performed. In addition, standard radiologic bone assessments, which included conventional left hand-wrist radiography and bone mineral densitometry by the DXA technique, were carried out. Special pediatric software was used for age-related interpretation of the Z-scores of BMD. SPSS(®) software (version 15) was used for statistical analyses. We studied 57 patients (27 males [47.4%]) with a mean age of 18.7 ± 4.25 (9-27) yr and a mean age at transplantation of 13.1 ± 3.46 (4.5-20) yr. They had a post-transplantation follow-up of 67.1 ± 33.8 (6-132) months, and all had well-functioning allografts at enrollment. The mean height age of the patients was 11.9 ± 1.8 (6-15.5), and the mean bone age was 15.6 ± 3.3 (7-19) yr, which corresponded to mean height-age and bone-age retardations of 5.7 ± 2.3 (0.5-10.5) and 1.22 ± 1.47 (0-7) yr, respectively. Hyperphosphatemia and hypercalcemia were each found in nine patients (15.8%), hypophosphatemia in five (8.8%), and hypocalcemia in none of the patients. Seven out of 57 patients (12.3%) had a (Ca×P) product of more than 55 mg(2)/dL(2). Hyperparathyroidism was found in 27 (47.3%) and vitamin D(3) deficiency in four (7%) of the cases. The serum level of Alk-P was higher than the age-related normal range in 20 patients (35%). Left hand-wrist radiography showed no radiologic sign of ROD in any patient. The mean BMD Z-score was -1.77 ± 1.13 (-4.2-1.1) for the lumbar spine and -1.64 ± 0.89 (-3.9 to 1.9) for the femoral neck. "Stepwise backward regression" revealed a significant inverse correlation between the serum level of PTH and the GFR of the transplanted kidney; this correlation was independent from the influence of other variables such as Ca, P, and Alk-P (p = 0.011, ß = -1.556). Bone age and height age both showed significant correlations with age at transplantation and serum levels of P (p < 0.001), but only bone age had a meaningful correlation with Alk-P (p = 0.036). The BMD Z-scores showed statistically meaningful correlations with the serum level of Alk-P, which were independent from the influence of other variables such as Ca, P, and PTH (p ≤ 0.002). Our study revealed a relatively high prevalence of bone mineral disorder in pediatric kidney recipients, which suggests the need for a routine program for periodic screening of these patients to facilitate early diagnosis of either persistent or evolving manifestations of disturbed mineral metabolism, especially ROD.

[Adolescents do not lose bone mineral density postpartum: comparative study with adult women]. / Las adolescentes no pierden densidad mineral ósea en el posparto: estudio comparativo con adultas.

OBJECTIVE: To analyze the pattern of bone mineral density (BMD), serum concentrations of estradiol and calcium levels, dietary calcium, body mass index (BMI), and lactation in adolescents and adult women at 15, 90, and 365 postpartum days (ppd). MATERIAL AND METHODS: A prospective cohort study was conducted of 33 adolescents and 39 adult women. Anthropometric and dietetic evaluations were performed, as well as evaluations of bone mineral density in L2-L4 and femur neck. Estradiol concentrations and calcium serum levels were determined. RESULTS: L2-L4 BMD increased by 16% in adolescents, and 3% in adult women from day 15 to 365 ppd. While age was associated with this change (ß=13.779, EE=3.5, p=0.001), lactation was not (ß=-0.705, EE=0.647, p=0.283). The adult women had a higher L2-L4 BMD at 15, 90, and 635 ppd (1.151 vs 0.978 g/cm², 1.195 vs 1.070 g/cm², 1.195 vs 1.123 g/cm², respectively) (p<0.003). CONCLUSIONS: Adolescents' BMD increased three times more than that of adult women. For all women, BMD was dependent of age and independent of lactation.

Las adolescentes no pierden densidad mineral ósea en el posparto: estudio comparativo con adultas / Adolescents do not lose bone mineral density postpartum: comparative study with adult women

OBJETIVO: Analizar el patrón de la densidad mineral ósea (DMO), calcio y estradiol séricos, consumo de calcio, índice de masa corporal (IMC) y lactancia en adolescentes y adultas a 15, 90 y 365 días posparto (dpp). MATERIAL Y MÉTODOS: Cohorte prospectivo en 33 adolescentes y 39 adultas con evaluación antropométrica, dietética y ósea en L2-L4 y cuello de fémur; bioquímica con estradiol y calcio séricos. RESULTADOS: Las adolescentes aumentaron de los 15 a los 365 dpp 16 por ciento su DMO de L2-L4, las adultas 3 por ciento. La edad se asoció a este cambio (β=13.779, EE=3.5, p=0.001); la lactancia no se asoció (β=-0.705, EE=0.647, p=0.283). Las adultas presentaron mayor DMO de L2-L4 a 15, 90 y 365 dpp respectivamente (1.151vs 0.978g/cm², 1.195vs1.070g/cm², 1.195vs1.123g/cm², p<0.003). CONCLUSIONES: Las adolescentes incrementaron su DMO tres veces más que las adultas. El cambio en la DMO fue dependiente de la edad e independiente de la práctica de lactancia.

OBJECTIVE: To analyze the pattern of bone mineral density (BMD), serum concentrations of estradiol and calcium levels, dietary calcium, body mass index (BMI), and lactation in adolescents and adult women at 15, 90, and 365 postpartum days (ppd). MATERIAL AND METHODS: A prospective cohort study was conducted of 33 adolescents and 39 adult women. Anthropometric and dietetic evaluations were performed, as well as evaluations of bone mineral density in L2-L4 and femur neck. Estradiol concentrations and calcium serum levels were determined. RESULTS: L2-L4 BMD increased by 16 percent in adolescents, and 3 percent in adult women from day 15 to 365 ppd. While age was associated with this change (β=13.779, EE=3.5, p=0.001), lactation was not (β=-0.705, EE=0.647, p=0.283). The adult women had a higher L2-L4 BMD at 15, 90, and 635 ppd (1.151 vs 0.978g/cm², 1.195 vs 1.070g/cm², 1.195 vs 1.123g/cm², respectively) (p<0.003). CONCLUSIONS: Adolescents' BMD increased three times more than that of adult women. For all women, BMD was dependent of age and independent of lactation.

[Hepatic osteodystrophy in patients with liver cirrhosis].

The article presents research data of BMD in 106 patients with liver cirrhosis. The core group of examined patients presented with LC patients the etiology of alcohol--37.7% and primary biliary cirrhosis--35.8%. In 68.9% of patients with established deficits of bone mineral density, by 24.6%--at the level of osteoporosis. Was detected influence of the etiology of the disease on the frequency of osteopenia and osteoporosis containment. Was made analysis of dependence of the frequency of osteopenia, and/or osteoporosis of population risk factors, duration of disease, grade of liver failure on the Child-Pugh. A comparative assessment of the effectiveness treatment of disorders of BMD active metabolite of vitamin D3--alpha caltsidol and drugs from the group of bisphosphonates.

Severe bone demineralisation is associated with higher mortality in children with cystic fibrosis.

Decreased bone mineral density (BMD) is an emerging problem for clinicians who care for children with Cystic fibrosis (CF). The aim of this study was to determine prevalence and assess risk factors for reduced BMD in our adolescent population with CF. All bone densitometry scans (n=99) performed on children (n=79) with a mean age 13.6 (10-19.2) years over a 7 year period (2000-2007) were reviewed. Patient records were reviewed for correlating clinical data. Low BMD is frequently present in adults and children with variable reports (36-66%). In our study, BMD expressed as z score of L2-L4 spine was reduced in a total of 50% children with a preponderance of males. Bone demineralization was strongly associated with increasing age (p=0.03), diminished lung function (p=0.027), reduced body mass index (p=0.001) and treatment with oral corticosteroids (p=0.02).