Cortical bone resorption in osteoporosis

Osteoporosis is the cause of spontaneous humeral fracture in dairy cows from New Zealand

Outbreaks of humeral fractures in dairy cows have been reported in New Zealand for several years. Gross, histologic, and histomorphometric findings in the humerus from primiparous cows with spontaneous humeral fracture were compared to age-matched control cows. Affected cows had a complete nonarticular spiral fracture of the humerus. Histologically affected humeri had a thicker growth plate with abnormal architecture, thinner cortex with increased abnormal resorption, increased resorption in the distal humerus, decreased trabecular density, abnormal trabecular architecture, presence of growth arrest lines and woven bone formation. Histomorphometry showed reduction in bone volume, trabecular perimeter, and trabecular width. Cows grazed on fodder beet had thicker growth plates with an abnormal appearance compared with cows grazed on pasture, and cows with low/marginal liver copper concentration had more resorption cavities in the distal humerus and thinner cortical bone compared with cows with adequate liver copper concentration. Decreased trabecular density (OR = 249.5), abnormal cortical resorption (OR = 54.2), presence of woven bone formation in the proximal metaphysis (OR = 37.2), and the number of resorption cavities in the distal humerus were significantly associated with a high probability of fracture. Ribs had enlargement of the costochondral junction with fractures in different stages of healing. Histology of the ribs revealed abnormal growth plate appearance, presence of fracture lines, callus tissue, fibrosis, and microfractures. Cows with humeral fracture have osteoporosis due to decreased bone formation and increased bone resorption, likely associated with inadequate feed quality and perhaps copper deficiency leading to a reduction in bone strength and fracture.

Protective effects of honey by bees (Apis dorsata) on decreased cortical thickness and bone impact strength of ovariohysterectomized rats as models for menopause

Aim:

This study aimed to determine the potential of honey as anti-osteoporosis by evaluating its effectiveness in increasing bone impact strength and cortical thickness, through scanning electron microscopy (SEM) examination.

Materials and Methods:

Forty-five female rats at 3 months of age, weighing 150-200 g were used in the study. They were placed in individual cages and adapted to food and environment for 10 days. On the 11^th day, after the animals were adapted for 10 days, the animals were randomly divided into five treatment groups (n=9): Sham operation group (SH); ovariohysterectomized (OVX) group with no treatment; OVX with treatment Apis dorsata 1 g/kg BW (AD-1); OVX with treatment A. dorsata 2 g/kg BW (AD-2); and OVX with treatment A. dorsata 4 g/kg BW (AD-3). Furthermore, those nine rats in each treatment group were divided into three groups. Three of them were observed at months 1^st, 2^nd, and 3^rd so that in each observation taken three rats in each treatment group. At the end of the study, the rats were euthanized and necropsy for taking their second femoral bone, i.e. dexter region for examining their bone impact strength, while the sinister region was used for measure the cortical thickness of the femoral diaphysis and examining their bone microarchitecture using SEM analysis.

Results:

Based on results of the ANOVA test, the cortical thickness measurements of femoral diaphyseal can be seen that from month 1 to month 3 the lowest result was found in the group of rats that were OVX-I. Meanwhile, the highest result was found in the group of rats that were not OVX (SH-III). It was significantly different from the other treatment groups (p<0.05). The groups of rats were OVX with honey supplementation at doses of 2 g/kg BW had shown an increasing pattern in the cortical bone thickness from month 1 to month 3. Even on the observation of the 3^rd month, the cortical bone thickness in the AD-2 (AD-2-III) group was not significantly different (p>0.05) from that in the group of rats was not OVX in month 1 (SH-I). The results of the bone impact strength measurement from month 1 to month 3 indicated that the groups of rats were OVX without the administration of honey supplements had the lowest value. The highest bone impact strength was found in the group of rats that was not OVX, but not significantly different (p>0.05) with the groups of rats that were OVX administered honey supplement with a dose of 2 g/kg BW (AD-2) and 4 g/kg BW (AD-3).

Conclusion:

The supplement of honey A. dorsata at doses of 2 g/kg BW in the group of rats was that OVX can inhibit the decreasing of the cortical bone thickness and repair damage in microarchitecture to generate bone impact strength. As a result, bones are not easily broken.

Effect of porosity, tissue density, and mechanical properties on radial sound speed in human cortical bone

PURPOSE

The purpose of this study was to investigate the effect of simultaneous changes in cortical porosity, tissue mineral density, and elastic properties on radial speed of sound (SOS) in cortical bone. The authors applied quantitative pulse-echo (PE) ultrasound techniques that hold much potential especially for screening of osteoporosis at primary healthcare facilities. Currently, most PE measurements of cortical thickness, a well-known indicator of fracture risk, use a predefined estimate for SOS in bone to calculate thickness. Due to variation of cortical bone porosity, the use of a constant SOS value propagates to an unknown error in cortical thickness assessment by PE ultrasound.

METHODS

The authors conducted 2.25 and 5.00 MHz focused PE ultrasound time of flight measurements on femoral diaphyses of 18 cadavers in vitro. Cortical porosities of the samples were determined using microcomputed tomography and related to SOS in the samples. Additionally, the effect of cortical bone porosity and mechanical properties of the calcified matrix on SOS was investigated using numerical finite difference time domain simulations.

RESULTS

Both experimental measurements and simulations demonstrated significant negative correlation between radial SOS and cortical porosity (R(2) ≥ 0.493, p < 0.01 and R(2) ≥ 0.989, p < 0.01, respectively). When a constant SOS was assumed for cortical bone, the error due to variation of cortical bone porosity (4.9%-16.4%) was about 6% in the cortical thickness assessment in vitro.

CONCLUSIONS

Use of a predefined, constant value for radial SOS in cortical bone, i.e., neglecting the effect of measured variation in cortical porosity, propagated to an error of 6% in cortical thickness. This error can be critical as characteristic cortical thinning of 1.10% ± 1.06% per yr decreases bending strength of the distal radius and results in increased fragility in postmenopausal women. Provided that the cortical porosity can be estimated in vivo, the relationship between radial SOS and cortical porosity can be utilized and a porosity based radial SOS estimate could be implemented to determine cortical thickness. This would constitute a step toward individualized quantitative ultrasound diagnostics of osteoporosis.

In vivo evaluation of the presence of bone marrow in cortical porosity in postmenopausal osteopenic women

This is the first observational study examining cortical porosity in vivo in postmenopausal osteopenic women and to incorporate data from two different imaging modalities to further examine the nature of cortical porosity. The goal of this study was to combine high-resolution peripheral computed tomography (HR-pQCT) images, which contain high spatial resolution information of the cortical structure, and magnetic resonance (MR) images, which allow the visualization of soft tissues such as bone marrow, to observe the amount of cortical porosity that contains bone marrow in postmenopausal osteopenic women. The radius of 49 and the tibia of 51 postmenopausal osteopenic women (age 56 ± 3.7) were scanned using both HR-pQCT and MR imaging. A normalized mutual information registration algorithm was used to obtain a three-dimensional rigid transform which aligned the MR image to the HR-pQCT image. The aligned images allowed for the visualization of bone marrow in cortical pores. From the HR-pQCT image, the percent cortical porosity, the number of cortical pores, and the size of each cortical pore was determined. By overlaying the aligned MR and HR-pQCT images, the percent of cortical pores containing marrow, the number of cortical pores containing marrow, and the size of each cortical pore containing marrow were measured. While the amount of cortical porosity did not vary greatly between subjects, the type of cortical pore, containing marrow vs. not containing marrow, varied highly between subjects. The results suggest that cortical pore spaces contain components of varying composition, and that there may be more than one mechanism for the development of cortical porosity.

Joint loading-driven bone formation and signaling pathways predicted from genome-wide expression profiles

Joint loading is a recently developed loading modality that induces anabolic responses by lateral loads applied to a synovial joint such as an elbow and a knee. The present study extended this loading modality to an ankle and addressed a question: does ankle loading promote bone formation in the tibia? If so, what signaling pathways are involved in the anabolic responses? Using C57BL/6 female mice as a model system, lateral loads of 0.5 N were applied to the ankle at 5 Hz for 3 min/day for 3 consecutive days and load-driven bone formation was evaluated at three tibial cross-sections (the proximal, middle, and distal diaphysis). Furthermore, total RNA was isolated for 3 pairs of microarray experiments as well as quantitative real-time PCR analyses. The histomorphometric results revealed that in all cross-sections ankle loading elevated the cortical area and thickness as well as the calcein-labeled surface. Signaling pathway analysis from microarray-derived whole-genome mRNA expression profiles and quantitative real-time PCR predicted that molecules in phosphoinositide 3-kinase (PI3K), ECM-receptor interactions, TGFbeta signaling, and Wnt signaling were involved in the joint-loading driven responses. Since ankle loading stimulates bone formation throughout the tibia both in the endosteum and the periosteum, it may provide a non-pharmacological approach to effectively activate molecular signaling necessary for preventing bone loss.

Ultrasonic assessment of cortical bone thickness in vitro and in vivo

In osteoporosis, total bone mass decreases and the thickness of the cortical layer diminishes in the shafts of the long bones. In this study, a simple ultrasonic in vivo method for determining the thickness of the cortical bone layer was applied, and the suitability of two different signal analysis techniques, i.e., envelope and cepstral methods, for measuring cortical thickness was compared. The values of cortical thickness, as determined with both techniques, showed high linear correlations (r > or = 0.95) with the thickness values obtained from in vitro measurements with a caliper or in vivo measurements by peripheral quantitative CT (pQCT). No systematic errors that could be related to the cortical thickness were found. The in vivo accuracy of the measurements was 6.6% and 7.0% for the envelope and cepstral methods, respectively. Further, the in vivo precision for the envelope and cepstral methods was 0.26 mm and 0.28 mm, respectively. Although the results are similar for both of the techniques, the simplicity of the envelope method makes it more attractive for clinical applications. In conclusion, a simple ultrasound measurement provides an accurate estimate of the cortical bone thickness. The techniques investigated may have clinical potential for osteoporosis screening and therefore warrant more extensive clinical investigations with healthy and osteoporotic individuals.

Effects of long-term immobilisation on cortical bone mass after traumatic amputation of the phalanges estimated by digital X-ray radiogrammetry

Osteopenia of the cortical and trabecular bone partition is a common finding after immobilisation. Digital X-ray radiogrammetry (DXR) seems to quantify cortical demineralisation caused by circular saw amputation already few days after accident.

INTRODUCTION

The study analyses the extent of demineralisation caused by immobilisation in patients with digital amputation after a circular saw injury, and elucidates the period of time which discloses a significant deprivation of bone mineral density estimated at the metacarpalia II-IV using DXR.

METHODS

Twenty-eight patients with digital amputations underwent measurements of bone mineral density, cortical thickness, bone width and metacarpal index using DXR-technology in a follow-up up to 902 days.

RESULTS

The data showed a significant decline of bone mineral density (-10.47%), the metacarpal index (-4.38%), the bone width (-12.06%) and the cortical thickness (-7.04%) after trauma-related amputation. The cortical demineralisation of the metacarpals could already be revealed in two patients after the second day, according to the amputation of phalanges (-3.65%).

CONCLUSIONS

The inhibition of the periosteal bone formation detected by DXR-technique seems to be a specific finding caused by amputation, which thus differs from normal age-related (i.e., endosteal) bone loss and from demineralisation following acute immobilisation (i.e., trabecular osteopenia).

Dynamic mechanical properties of a biomimetic hydroxyapatite/polyamide 6,9 nanocomposite

A biomimetic composite of nanohydroxyapatite (nHap) and semicrystalline polyamide 6,9 (PA 6,9) was synthesized by thermally induced phase separation. The nHap powder was dispersed in a polymer matrix with a low ratio ranging 1-10 wt %. The mean size of the nHap, determined by scanning electron microscopy (SEM) was approximately 100-200 nm (length), 40-60 nm (width). Physicochemical analyses were performed in order to characterize the PA 6,9 and nHap separately on the one hand, and the PA 6,9/nHap composites on the other hand. Differential scanning calorimetry (DSC) and dynamic mechanical analyses (DMA) have pointed out an optimization of the composite physical properties as a function of nHap content till a limit value of 5 wt %. Above this value, the mechanical properties decreased. Four main parameters have been found to influence the composite physical properties improvement: the fillers content, the physical structure of the polymeric matrix, the particles dispersion and the physical interaction strength between organic and inorganic phases. The dynamic mechanical properties of this biomimetic nanocomposite were compared with human cortical bone.

Normative data for digital X-ray radiogrammetry from a female and male German cohort

This study presents German reference data for digital X-ray radiogrammetry (DXR) differentiated by males as well as females, and quantifies for gender-specific and age-related differences including all DXR parameters. This study also documents the effects of different X-ray settings (e.g., radiographs of the wrist or the hand) on DXR measurements. There were 2085 patients who were prospectively enrolled (954 females and 1131 males) from a data pool of 11,915 patients with radiographs of the nondominant hand or wrist. All patients underwent measurements of bone mineral density (BMD), cortical thickness, bone width, and the metacarpal index (MCI) using DXR technology. These data showed a continuous age-related increase of the DXR parameters to the point of peak bone mass, then a continuous decline beyond the peak bone mass with accentuated age-related cortical bone loss in women. Peak bone mass is reached at approximately 30-34 yr for women and 45-49 yr for men. In addition, men had a significantly higher DXR BMD (mean: +12.8%) compared with woman in all age groups. Regarding the impact of various X-ray settings (e.g., X-ray(wrist) vs. X-ray(hand)), no significant difference was observed between both groups, men as well as women. The development of digital imaging technology has enabled more precise measurements of several radio-geometric features. The present study estimated normative reference values for DXR in German Caucasian women and men. Based on this reference data, a valid and reliable quantification of disease-related demineralization based on measurements of DXR BMD and MCI is now available for the Caucasian ethnic group.

Computerized quantification of joint space narrowing and periarticular demineralization in patients with rheumatoid arthritis based on digital x-ray radiogrammetry

OBJECTIVES

The aim of our work was to evaluate digital x-ray radiogrammetry (DXR) for the quantification of disease-related periarticular demineralization and computerized analysis of joint space distances (JSDA) for the measurement of joint space narrowing as a new diagnostic method for the early detection of joint-associated alterations and for monitoring disease progression in patients with rheumatoid arthritis (RA).

MATERIALS AND METHODS

Digital radiographs in 313 patients with varying severity of RA were performed annually and assessed by 2 radiologists using modified Larsen and also the Sharp scores within an observation period of 3 years. The hand radiographs underwent measurements of bone mineral density (BMD) and metacarpal index (MCI) by DXR, as well as computerized JSDA at the metacarpal-phalangeal articulation (JSD-MCP) for a cross-sectional and longitudinal study design.

RESULTS

Both DXR-BMD (-29.6%; P < 0.01) and DXR-MCI (-31.0%; P < 0.01) revealed a notable reduction dependent on the severity of RA (from grade 1 to grade 5 of the modified Larsen score); the severity dependent decrease of mean JSD-MCP ranged from -31.9% (P < 0.01; Sharp erosion part) to -39.1% (P < 0.01) for the modified Larsen score. Over an observation period of 3 years, a significant decrease of DXR-BMD (-22.3%) and DXR-MCI (-23.3%) as well as JSD-MCP mean (-17.5%) was observed (P < 0.05), whereas an accentuated decline of DXR and JSDA parameters was verified for patients without disease-modifying antirheumatic drugs or methotrexate therapy.

CONCLUSION

Computerized analysis of hand radiographs by DXR and JSDA is a promising approach to assess the severity and to monitor the progression of RA because DXR and JSDA are timely able to measure periarticular demineralization and also narrowing of JSD-MCP dependent on the severity, the medical treatment and the course of RA.

Age-related cortical bone loss in women from a 3rd–4th century AD population from England

Age-dependent cortical bone loss in adult females from a skeletal assemblage from 3rd-4th century AD England was studied using metacarpal radiogrammetry. Results showed reduced peak cortical bone thickness compared with modern subjects, and the magnitude of cortical bone loss in older females compared with their younger counterparts was greater than that documented for a modern reference population. An elevated prevalence of fractures classically associated with osteoporosis was also observed in the over-50-year cohort. The severity of osteoporosis in this group is difficult to explain in terms of extraneous factors relating to 3rd-4th century lifestyles. Given the important genetic component in osteoporosis, the results may indicate some inherent susceptibility in this particular population to the disease, and ways in which this possibility might be further explored are suggested.

Influence of image-capturing parameters on digital X-ray radiogrammetry

The purpose of this study was to evaluate the importance of different image-capturing conditions, which might influence the characteristics of radiographs and, consequently, impact calculations of bone mineral density (BMD) and Metacarpal Index (MCI) using digital X-ray radiogrammetry (DXR). Radiographs of the left hand of deceased males were acquired three times using systematically varied parameters: 4-8 miliamp seconds (mA); 40-52 kV; film-focus distance (FFD); 90-130 cm; film sensitivity, 200/400; and different image modalities (conventional vs original digital radiographs as well as digital printouts). Furthermore, the interradiograph reproducibility using both conventional equipment and printouts vs originals of digital images and the intraradiograph reproducibility (either conventional or digital printouts) were evaluated. All BMD and MCI measurements were obtained with the DXR technology. The interradiograph reproducibility of DXR-BMD using conventional images under standardized conditions (6 mAs; 42 kV; 1 m FFD; film sensitivity of 200) was calculated to be coefficient of variation (CV) = 0.49% for Agfa Curix film and CV = 0.33% for Kodak T-MAT-Plus film, whereas reproducibility error using digital images ranged from CV = 0.57% (digital printouts; Philips) to CV = 1.50% (original digital images; Siemens). The intraradiograph reproducibility error was observed to be CV = 0.13% (conventional; Kodak film) vs CV = 0.27% (digital printouts; Philips). The BMD calculation was not noticeably affected by changes of FFD, exposure level, or film sensitivity/film brand, but was influenced by tube voltage (CV = 0.99% for Kodak film to CV = 2.05% for Siemens digital printouts). No significant differences were observed between the BMD and MCI data. DXR provides measurements of MCI and BMD with high precision and reproducibility. The measurements are unaffected by all tested image-capturing conditions, with the exception of tube voltage. In addition, different digital image devices clearly have an effect on DXR reproducibility.

Semi-automated evaluation of the cortico-medullar index on radius radiographs: a study in prepubertal girls

The aim of the study was to validate a non-invasive method allowing a semi-automatic cortico-medullar index (CMI) computation from standard radiographs. Fifty-five radiographs of the non-dominant radius of prepubertal girls (aged 10.12+/-1.47 years) were scanned (100 microm scanning resolution) by the same observer. To detect the grey level peaks, we used the Deriche's recursive filter applied to the grey level gradients and we defined the cortical areas by thresholding (iterative contour detection). The CMI was calculated as cortical areas divided by the total bone area. The reproducibility was tested through the analysis of ten radiographs scanned twice, on 5, 10, 15, 20, 30 and 40 lines at each side of a reference line located at the distal third part of the radius. We used the root mean square coefficient of variation (RMS-CV) as verification. Dual-Energy X-ray (DXA) was used for densitometry measurements of the whole body, and non dominant radius (mid-, distal third and ultra distal). The result attaining the best reproducibility concerned the 15-line position (Mean CMI=0.58+/-0.005 with a 1.36% RMS-CV). CMI correlated significantly with Bone Mineral Density (BMD) (r=0.40, 0.33 and 0.50, P<0.01, respectively, at the whole body, mid- and third distal of the radius), Bone Mineral Content (BMC) (r=0.32, 0.36, 0.34 and 0.35, respectively, at the whole body (P=0.01), mid- (P=0.007), third distal (P=0.01) and ultra distal of the radius (P=0.01)) but not with BMD at the ultra distal of the radius (r=-0.01, P=0.9). This semi-automated new method has been easily implemented, reproducible, and therefore, could be useful tool for the bone CMI computation.

The association between bone mineral density, metacarpal morphometry, and upper limb fractures in children: a population-based case-control study

The aim of this population-based case-control study was to examine the association between bone mass and upper limb fractures in children aged 9-16 yr. Areal bone mineral density and bone mineral apparent density (BMAD) were measured by both dual energy absorptiometry (DXA) and metacarpal index (MI) by hand radiograph. A total of 321 fracture cases and 321 randomly selected individually matched controls were studied. For all fractures, cases had lower DXA measures at all sites (1.1-3.3%; all P < 0.05). A larger reduction was observed for those with wrist and forearm fractures (1.2-4.5%; all P < 0.05, except total body BMAD) but not other upper limb fractures (hand, -1.6 to +1.2%; upper arm: 0.9-4.8%; all P > 0.05). For metacarpal measures, cases had a thinner cortical width and lower MI for wrist and forearm fractures only. In multivariate modeling, both spine BMAD (odds ratio, 1.4/SD reduction) and MI (odds ratio, 1.5/SD reduction) remained statistically significant predictors of wrist and forearm fractures. In conclusion, both DXA measures and MI are independently associated with wrist and forearm but not other upper limb fractures. The magnitude of this association is somewhat weaker than in adults but suggests that optimizing age-appropriate bone mass will lessen the risk of fracture in children.

Anatomic and radiographic considerations for placement of transiliac screws in lumbopelvic fixations

Lumbopelvic fixation in spinal and pelvic surgery relies on rods or screws as an iliac anchor. Secure placement of screws with maximum diameter and length for the greatest pullout strength requires knowledge of the iliac structure and of intraoperative fluoroscopic landmarks for secure placement. Therefore, the authors evaluated the intrailiac length, inner width, and cortical thickness of three different transiliac screw anchor paths aimed toward the anterior inferior iliac spine and initiated at the iliac tubercle, posterior superior iliac spine, or posterior inferior iliac spine. Measurements were made using two- and three-dimensional computed tomographic reformations in 40 consecutive trauma patients (27 measurements in 21 males, 16 to 75 years old; 28 measurements in 19 females, 16 to 78 years old). In addition, fresh and dry human cadaveric specimens were marked with metal wires at the previously determined optimal screw path to determine fluoroscopic landmarks for easiest and best controlled transiliac screw placement. The posterior superior iliac spine-anterior inferior iliac spine path had the largest bony canal lengths, with 141 mm in male and 129 mm in female patients. Two stereotypic iliac constrictions allowed placement of 8-mm implants in male and 6- to 7-mm implants in female patients. Cortical thickness at that optimal extraarticular path was 5.2 mm in the male and 4.7 mm in the female patients. Transiliac screws can be placed during operation under fluoroscopic control using standard lateral and obturator oblique-outlet views, the latter presenting a stereotypical teardrop figure above the acetabulum.

Circumferential variation in human second metacarpal cortical thickness: sex, age, and mechanical factors

Variation in cortical thickness (CT) in four quadrants of the human second metacarpal was investigated in a sample (100 males and 72 females, skeletal age 20 to 50+ years) from a 19th-century cemetery. Both left and right elements were studied (total N = 344). Multivariate analysis of covariance (MANCOVA) (for age, sex, and side, controlling for absolute size) was used to test the hypothesis of equality of thickness in the dorsal, palmar, medial, and lateral quadrants. Differences in regional CT posits localized regulation of resorption and formation adapting bone shape to functional loads, with implications for activity-modulation of skeletal senescence. The palmar cortex was found to be uniformly thicker in both sexes and both sides, and at all ages (young, middle, and old adult); the medial, lateral, and dorsal cortices did not differ significantly. Patterns of age-related loss occurring preferentially at the endocortical surface differed between men and women, with women showing significant declines across all age groups for all quadrants, and males only small decrements after middle age. The greater CT in the palmar quadrant corresponds to the region of maximum compressive strain in the second metacarpal for functions involving full flexion (grasping). Although the palmar cortex is thicker at all ages, women lose mass in that quadrant at the same rate as in other quadrants, suggesting that function does not offer protection against endocrinologically-mediated depletion of bone mass (postmenopausal osteopenia).

Assessment of bone status using speed of sound at multiple anatomical sites

Studies in vitro and in vivo have shown that quantitative ultrasound (QUS) is a valid tool for the assessment of bone status. Current QUS methods using the transmission technique are limited to one peripheral bone site. A new system, Sunlight Omnisense (Omnisense, Sunlight Medical Ltd., Rehovot, Israel), measures speed of sound (SOS, in m/s) along the surface of the bone based on an axial transmission technique. The Omnisense can measure SOS at several anatomical sites. This study evaluated the SOS at different anatomical sites in a healthy population. A total of 334 adult women from three research centers in the USA and Canada with a mean (+/- SD) age of 48.8 (+/- 17.4) years were enrolled in this study. SOS was measured at the proximal third phalanx, distal one third radius, midshaft tibia, and fifth metatarsal. The mean SOS (+/- SD) values for the phalanx, radius, tibia and metatarsal were 3984 (+/- 221), 4087 (+/- 147), 3893 (+/- 150) and 3690 (+/- 246) m/s, respectively. Each anatomical site SOS was significantly different (p < 0.001) from that of the other sites. SOS at the different anatomical sites was modestly, but significantly, correlated (r = 0.31 to 0.56, p < 0.001). Similar correlation coefficients were obtained for the T scores. The mean T scores for subjects over the age of 60 years were -1.94, -2.01, -0.97 and -1.42 for the phalanx, radius, tibia and metatarsal, respectively. The age of peak SOS and the rate of change thereafter varied with anatomical site, implying that the prevalence of osteopenia and osteoporosis was site-dependent if only one T score cut-off point was used. Comparing individuals, 10% to 17% of patients had T scores that differed by more than a factor of 2 between sites. Weight and age were some of the contributing factors to this heterogeneity. The Omnisense provides an opportunity to assess bone status at different anatomical sites. Whether or not combining measurements from all these anatomical sites will improve osteoporosis management still needs to be determined.

Separate and combined effects of growth hormone and parathyroid hormone on cortical bone osteopenia in ovariectomized aged rats

The focus of this study is on whether cortical osteopenia occurs in ovariectomized aged female rats, and if so, whether growth hormone (GH) and parathyroid hormone (PTH) independently or together (GH+PTH) can rebuild the lost cortical bone. Tibio-fibula junction was analyzed by histomorphometry and peripheral quantitative computerized tomography (pQCT) densitometry. Significant loss of cortical bone area (Ct. BAr), cortical bone mineral content (Ct. BMC), cortical thickness (Ct. Th) and increase of endocortical perimeter occurred 4 months after ovariectomy. The rats were given GH, PTH, GH+PTH or vehicle for 2 months and sacrificed. GH, PTH and GH+PTH increased Ct. BAr, Ct. BMC, Ct. Th, periosteal perimeter, periosteal double-labeled perimeter, mineral apposition rate, and bone formation rate, but decreased marrow area. PTH and GH+PTH decreased endocortical perimeter, and increased endocortical double labeled perimeter and bone formation rate. In conclusion, ovariectomy induced cortical bone loss in aged rats by increasing endocortical bone resorption. Growth hormone increased periosteal bone formation, while PTH stimulated endocortical bone formation and in combination GH+PTH produced complementary effects thereby reversing osteopenia.

[Cortical bone mass and risk factors for osteoporosis among postmenopausal women in our environment]

OBJECTIVE

To evaluate the relevance of the so called risk factors for osteoporosis among women.

MATERIALS AND METHODS

A total of 150 consecutive postmenopausal women who had been enrolled in the gynecology outpatient clinics of the Health Areas affiliated to the Alcalá de Henares University Hospital. Bone mass of these women was calculated as index of metacarpal cortical area/total area (CA/TA) (mm2), measured by radiogrammetry.

RESULTS

With the ANOVA test, a late menarchial age and a shorter reproductive life induced a lower bone mass (p < 0.0005 and < 0.05, respectively); also, a history of bone fractures without previous relevant trauma (p < 0.05) was obtained. By correlational studies, there was a negative significance between CA/TA index and chronological age, menarchial age, menopausal age and number of fractures (r = -0.20 to -0.30; p < 0.05 to < 0.0001) and a positive significance with years of reproductive life (r = 0.17; p < 0.05). These values virtually remain unchanged when with partial correlation are weight adjusted, but with the multiple regression model, the CA/TA index is negatively significant only with menopause years (p < 0.005). Taking the average of the metacarpal CA/TA index as value, a sensitivity of 50% and an specificity of 78% were obtained to indicate fractures and a negative predictive value of 92%.

CONCLUSION

These results indicate the greater importance of menarchial age, of reproductive life years and therefore of menopausal years, as determinants of postmenopausal bone mass and show a very acceptable specificity of the CA/TA index as predictive for bone fracture.

Estimation of wrist fracture load using phalangeal speed of sound: an in vitro study

This study aimed to evaluate the ability of speed of sound (SOS) measured at the phalanges to estimate simulated wrist fracture load and stress. SOS was measured along the proximal phalanges of the second, third and fourth fingers using an ultrasound (US) system operating in axial transmission mode. The bone mineral density (BMD) of the radius and the phalanges was also measured with quantitative computed tomography (QCT) and dual x-ray absorptiometry (DXA), and the combined cortical thickness (CCT) of the phalanges was measured from hand radiographs. After the measurements were completed, the radius was excised from the cadaver, embedded in polymethylmethacrylate and tested to failure on a servohydraulic testing machine. The configuration of the radius was chosen to simulate a fall onto the hand. Linear regression analysis showed a highly significant correlation between SOS (r = 0.76-0.94, p < 0.001), CCT (r = 0.86-0.90, p < 0.001) and BMD (r = 0.92-0.96, p < 0.0001) in the three proximal phalanges measured. SOS, BMD and CCT were significant predictors of fracture load (r = 0.60-0.69, p < 0.03) and stress (r = 0.65-0.77, p < 0.02). Cortical area and bone mineral content (BMC) of the radius were consistently higher predictors of fracture load (r = 0.76-0.82, p < 0.01 for area and r = 0.78-0.88, p < 0.01 for BMC) than BMD. The correlation of BMC and area was poorer with fracture stress. In a step-wise regression analysis using both phalangeal BMD and SOS, only SOS remained a significant predictor of fracture stress. In forward stepwise regression analysis, both cortical area and SOS were entered into the regression model to estimate fracture load. Only SOS remained significant in the model for estimating fracture stress. Phalangeal BMD was only entered in the combined model with the cortical area at the 4% site (r = 0.84, p = 0.002). Phalangeal SOS is a useful parameter in the assessment of bone status of the radius.

Age-dependent cortical bone loss in women from 18th and early 19th century London

Age-dependent cortical bone loss was investigated in an earlier British population. The study sample comprised female skeletons from the 18th/19th century crypt at Christ Church, Spitalfields, London. Bone loss was monitored using metacarpal radiogrammetry. Age at death was known exactly from coffin plates. Results indicated that peak cortical thickness was less than in modern subjects. Continuing periosteal apposition was evident throughout adulthood, and the rate of increase in metacarpal diameter resembled that in modern subjects. Bone loss from the endosteal surface was evident from the fifth decade onwards, and this outstripped the rate of subperiosteal gain so that there was a net loss of cortical bone with age. Cortical bone loss occurred at a similar rate to that in modern subjects. In contrast to modern populations, there was no evidence that loss of cortical bone was associated with increased propensity to fracture. The present results, together with those previously published for a British medieval skeletal assemblage, suggest that patterns of cortical bone loss in women have remained unchanged over at least the last millennium in Britain. Given the great changes in lifestyle which have occurred during this period, this suggests that lifestyle factors may be rather less important than is sometimes asserted in influencing the severity of osteoporosis, at least as far as loss of cortical bone is concerned.

Factors influencing the speed of sound through the proximal phalanges

The amplitude-dependent speed of sound (AD-SOS) in the proximal phalanges is reported to be sensitive to osteoporotic changes. We investigated the influence of bone thickness and cortical thickness on AD-SOS. Phantoms made of Perspex were designed to simulate different bone width (11-16 mm) and cortical thickness (3-7.5 mm). The phantoms were designed with two opposing flat and cylindrical surfaces. The effect of cortical thickness was examined by drilling holes (simulating the medullary canal) of different diameters (1-7 mm) in the middle of the Perspex cylinders. The effect of sample thickness was investigated on solid Perspex phantoms of varied lengths. The standardized precision errors of AD-SOS measurement in vivo and in vitro on volunteers and phantoms were 2.8 and 0.9%, respectively. AD-SOS was influenced by the bone width, cortical thickness, and location along the phalanx. A decrease in either cortical width or cortical thickness resulted in a decrease in AD-SOS. The effect is dependent on whether the contact surface is curved or flat. It is possible that a curved surface has a focusing effect on the wave through the porous core, whereas for a flat surface, the path of the waves might not pass through the center. When cortical thickness and bone width were expressed as a ratio, there was a linear relationship between this ratio and AD-SOS through the phantoms. AD-SOS was independent of thickness for samples greater than 11 mm.

Second metacarpal midshaft geometry in an historic cemetery sample

Study of bone mass at the second metacarpal midshaft has contributed to our understanding of skeletal growth and aging within and between populations and has relied extensively on noninvasive techniques and in particular radiogrammetric data. This study reports age, sex, and side variation in size and shape data acquired from direct measurement of cross-sections obtained from a large (n = 356), homogeneous skeletal sample. Correlation analysis and three-way ANOVA of size-adjusted data confirm general impressions of patterned variation in this element: males have absolutely but not necessarily relatively larger bones than females; the right side is larger than the left, though a larger than expected proportion (approximately 25%) of left metacarpals exhibits greater values than the right; and bone mass but not strength (in males) declines with age. Contrary to the widely accepted assumption of circularity for this location, direct measurement of cross-sectional geometry confirms previous biplanar radiogrammetric conclusions regarding the noncircularity of the second metacarpal midshaft and identifies a significant difference between males and females, with the latter having a more cylindrical diaphysis. Deviation of the axes of maximum and minimum bending strength associated with noncircularity suggests a distribution of bone mass to resist bending moments perpendicular to the distal palmar arch, though this conclusion awaits more robust study of the functional anatomy of the metacarpal diaphysis.