Vertebral fracture assessment: impact of instrument and reader.

PURPOSE: Many osteoporotic vertebral fractures are not clinically recognized but increase fracture risk. We hypothesized that a newer generation densitometer increases the number of evaluable vertebrae and vertebral fractures detected. We also explored the impact of reader experience on vertebral fracture assessment (VFA) interpretation. METHODS: VFA images obtained using Prodigy and iDXA densitometers in 103 older adults were evaluated for vertebral visualization and fracture presence in the T4-L5 region. A "true" read for each densitometer was achieved by consensus. If readers disagreed, the evaluation of a third expert physician was taken as true. Main outcomes were evaluable vertebrae, vertebral fractures, and intrareader/interreader reproducibility. RESULTS: Using the "true" reads, 92% of vertebrae were visualized on iDXA and 76% on Prodigy. Numerically, more fractures were identified with iDXA; the "true" reads found 43 fractures on iDXA and 21 on Prodigy. The experienced reader had better intrareader and interreader reproducibility than the inexperienced reader when compared with the "true" read. CONCLUSIONS: Using the newer iDXA densitometer for VFA analysis improves vertebral body visualization and fracture detection. Training and experience enhance result reproducibility.

Elevated plasma levels of interleukin-6 in postmenopausal women do not correlate with bone density.

OBJECTIVE: To determine if plasma levels of Interleukin-6 (IL-6) across the lifespan correlate with bone density or plasma osteocalcin. DESIGN: Cross-sectional study. PARTICIPANTS: Forty-five healthy community-dwelling volunteers aged 25-74 years. Exclusion criteria were smoking use of medications known to affect bone metabolism (corticosteroids, heparin, thyroxine, thiazides, and anticonvulsants), and presence of chronic inflammatory disease. MEASUREMENTS: Bone density was measured by dual-energy X-ray absorptiometry at the femoral neck and lumbar spine. Plasma levels of IL-6 and osteocalcin were determined by ELISA and RIA, respectively. RESULTS: Plasma levels of IL-6 increased with advancing age (P < .0001) and correlated with postmenopausal status (P < .0001). No correlation was observed between plasma IL-6 level and bone mineral density at either the lumbar spine or femoral neck, and none was observed with plasma osteocalcin. CONCLUSIONS: The elevation of plasma IL-6 observed following menopause is consistent with the proposed importance of estrogen in the regulation of IL-6. These findings do not provide support for a role of IL-6 in determination of peak bone density or subsequent development of osteoporosis. However, it is possible that plasma levels of IL-6 differ from those in the bone microenvironment.

Muscular strength and bone density with weight training in middle-aged women.

Previous research has demonstrated positive correlations between bone mass and both physical activity and muscular strength. There is a paucity of information describing the specific type of exercise which most benefits the human skeleton. The effects of a 1 yr weight training program on 18 middle-aged women participating in an endurance dance program (E + W) compared with 17 other women in the endurance dance program only (E) and with 19 sedentary controls (C) were studied by measuring muscular strength and bone mineral density (BMD). Eighteen women in the E + W group demonstrated increases in all strength measurements, whereas the E and C groups either had smaller increases or had declined. A significant group x test interaction term, indicating that groups responded differently over time, was observed for nondominant isokinetic elbow flexion measured through the range of motion at a constant velocity of 60 degrees.s-1 (P less than 0.05), nondominant isokinetic elbow extension at 180 degrees.s-1 (P less than 0.01), and nondominant isokinetic elbow flexion at 180 degrees.s-1 (P less than 0.05). BMD did not change significantly except that a significant group x test interaction term appeared for the radius ultradistal site (P less than 0.01). BMD of the humerus and femoral Ward's triangle increased nonsignificantly in both E and E + W over the year. This weight training program increased muscular strength but did not increase measured bone mass.

Dual photon absorptiometry of the proximal tibia.

Bone mineral content (BMC) and bone mineral density (BMD) of the proximal tibia were determined by dual photon absorptiometry on 44 women, aged 23-87 years. The area of the tibia measured was a 2.01 cm region immediately distal to the medial and lateral tuberosities. Values of BMC ranged between 5.09 and 14.57 g and BMD between 0.380 and 1.180 g/cm2. Both tibial BMC and BMD declined with age and tibial BMD was significantly correlated with lumbar spine (r = 0.70), femoral neck (r = 0.73), and femoral trochanter (r = 0.74). However, the large standard errors of estimate (SEE) (0.08-0.14 g/cm2) do not allow for reliable prediction in an individual of other skeletal sites by the tibia. Repeated measurements demonstrated that dual photon absorptiometry of the proximal tibia is a reliable measurement and may be a useful tool in the monitoring of therapeutic or intervention modalities in those individuals with skeletal diseases in whom measurement of the lumbar spine or proximal femur may not be possible.

The Wisconsin noncemented femoral stem. A prospective study with 5 to 9 years of follow-up evaluation.

In an attempt to decrease aseptic loosening, total joint components are now being used without cement. Most components are designed to achieve fixation biologically. The radiographic results of 144 primary uncemented total hip arthroplasties and the clinical results of 89 arthroplasties that were performed using a proximally porous-coated titanium alloy femoral stem between November 1983 and June 1989 are reported. On the acetabular side, a threaded component or a hemispherical porous-coated component was used. The patients were followed prospectively for 5 to 9 years postsurgery. During the study period, the threaded acetabular component had a high failure rate. Because it was not possible to determine accurately from which component a particular sign or symptom arose, clinical analysis was restricted to only those hips without a failed or revised cup. Eighty-nine hips in 71 patients with a minimum follow-up period of 5 years were available for clinical review. Radiographic review of the femoral stem was completed on all hips with 5 or more years of radiographic follow-up evaluation regardless of the status of the acetabular component. One hundred twelve hips in 85 patients were analyzed radiographically. At a latest mean follow-up period of 6.7 years, the mean Iowa hip score was 91.4 +/- 8.0 with a 5.4% incidence of thigh pain. Throughout the follow-up period, the patients with thigh pain had a statistically lower mean Iowa pain subscore when compared with those patients without thigh pain (P=.0001). Endosteal erosion was seen in two hips (1.8%) and longitudinal loss of the medial neck greater than 2 mm was noted in two hips. One femoral stem was revised for aseptic loosening. The clinical results of this femoral stem equal or exceed the published accounts of other arthroplasties. The results indicate that the stem is associated with good clinical results, minimal bone loss, and little osteolysis. Continued follow-up evaluation of patients with this femoral stem is necessary to assess the durability of these encouraging results.

Effects of recombinant human interleukin-6 administration on bone in rhesus monkeys.

The role of interleukin-6 in the bone microenvironment is controversial. We studied the effect of recombinant human interleukin-6 (rhIL-6) administration on bone metabolism in 10 adult female rhesus monkeys (age 12-27 years). Monkeys received rhIL-6 (15 micrograms/kg/day) daily by subcutaneous injection for 28 days. Serum alkaline phosphatase, osteocalcin, and 24 h urinary calcium excretion were determined before, during (at weeks 2 and 4), and after (at week 6) treatment. Transilial biopsies (right and left) were obtained before treatment was initiated and just after the final (28th) dose at week 4. The serum alkaline phosphatase significantly increased at 2 and 4 weeks of rhIL-6 administration. Osteocalcin and urinary calcium excretion significantly decreased at week 2. Upon treatment with rhIL-6 significant reductions in OS/BS and Ob.S/BS were observed without changes in other static histomorphometry parameters. The reductions in urinary calcium excretion, serum osteocalcin, and the static bone parameters are consistent with an IL-6 induced reduction in bone formation or turnover. Whether this pharmacologic effect is relevant at the physiologic level remains to be determined.

Measurement of bone mineral density by dual-energy x-ray absorptiometry in patients with the Wisconsin hip, an uncemented femoral stem.

Although qualitative evidence of femoral bone remodeling, secondary to total hip arthroplasty (THA), is apparent on radiographs, quantification of change in bone mass from radiographs is limited. Dual-energy x-ray absorptiometry overcomes many of the limitations and yields accurate and precise bone mineral density (BMD) data. In this study, regional changes in femoral BMD were examined in 89 THA patients with a 2-year follow-up period. Thirty-two patients were evaluated initially before surgery and followed through the first 2 postoperative years. A second group was comprised of 57 patients whose surgery had been performed 1 to 6 years prior to entry into the study; they were also followed for 2 years hence. Thus, both immediate and later bone responses were evaluated prospectively. Maximal bone remodeling was seen in the first 6 months after THA and with a near plateau by the end of the first year. A slow yearly decline in BMD appeared to occur as long as 8 years after THA, thus demonstrating the long-term effects of the introduction of a femoral stem. Variance in preoperative BMD was explained by disease only; no other factors (age, weight, sex) showed significant associations, and body weight was the only variable that affected rate of remodeling after THA (not age, weight, sex, prosthesis size, nor disease). All patients were healthy, relatively young individuals who were good candidates for uncemented implantation, and none showed evidence of clinical complications or surgical failure. It is therefore suggested that the patterns and results reported here be viewed as normative data, that is, the typical skeletal adaptation to THA. In future application, observation of disparate BMD results as compared with these "normal" data may be predictive of abnormal response to surgery and potential for later problems.