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Z-score comparison of bone density reference databases in children
Abstracts / Bone 44 (2009) S68–S98
S79
Table 1 Hologicmodel
Sex (n)
Kalkwarf et al. (1)
Ward et al. (2)
Kelly (3)
Ellis et al. (4)
Bachrach et al. (5)
Faulkner (6)
QDR-4500A and W, Delphi-A
QDR-4500A
QDR-4500A, Delphi-A
QDR-2000W
QDR-1000W
QDR-2000
−0.93 (−1.78 to −0.08) −1.06 (−1.96 to −0.26) −0.68 (−1.64 to −0.14) −1.19 (−1.96 to −0.34) −1.16 (−2.08 to −0.01) −1.30 (−2.16 to −0.61) −0.05 (−0.67 to 0.71) −0.19 (−0.81 to 0.52)
−1.09 (−2.08 to −0.40) −0.81 (−1.46 to −0.17) – – −1.16 (−1.84 to −0.26) −1.02 (−1.76 to −0.26) −0.29 (−0.42 to 1.11) −0.30 (−0.37 to 0.94)
−0.95 (−1.71 to −0.27) −0.80 (−1.43 to −0.05) −1.01 (−1.69 to −0.23) −1.04 (−1.79 to −0.18) – – −0.15 (−0.66 to 0.45) −0.38 (−0.94 to 0.32)
−1.35 (−2.12 to −0.74) −0.95 (−1.71 to −0.27) −1.22 (−1.90 to −0.50) −080 (−1.43 to −0.05) −1.02 (−1.60 to −0.37) −1.01 (−1.69 to −0.23) −1.13 (−1.96 to −0.11) −1.04 (−1.78 to −0.18) −1.08 (−1.69 to −0.19) −0.98 (−1.76 to −0.12) −1.26 (−2.10 to −0.56) −0.76 (−1.64 to −0.12) 0.16 (−0.34 to 0.70) 0.64 (0.03 to 1.45) 0.58 (−0.18 to 1.25) 0.57 (−0.11 to 1.45)
Median (IQR 25th to 75th) LS FN TH TB
F (201) M (106) F (202) M (101) F (201) M (101) F (168) M (233)
−0.94 (−1.92 to −0.21) −0.73 (−1.60 to −0.13) −1.10 (−1.79 to −0.21) −0.89 (−1.75 to −0.08) −1.23 (−1.98 to −0.24) −1.07 (−2.05 to −0.13) −0.39 (−0.40 to 1.17) −0.45 (−0.30 to 1.20)
Prospective Osteoporosis Study (EPOS). Bone 33:505–513, 2003) A multiple regression model was identified which comprised: use of anti-epileptic medication; having had any type of prior fracture; and being able to verbally localize pain symptoms. Age was not associated with increased numbers of vertebral fractures (p = 0.33). Previously undiagnosed vertebral fractures were more common in participants (n = 20) who were unable to verbally localise their pain (p = 0.056). Further research on reasons for, and prevention of, vertebral fractures and reduced skeletal integrity in adults with an ID is indicated. Clinical emphases given to reporting fortuitous radiographic findings of vertebral fractures and of noting non-verbal indications of pain could reduce the risk of non-diagnosis. (1) Center J, Beange H, McElduff A. People with mental retardation have an increased prevalence of osteoporosis: a population study. Am. J. Ment. Retard. 103:19–28, 1998. (2) Siris ES, Genant HK, Laster AJ, Chen P, Misurski DA, Krege JH. Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Osteoporosis Int. 18:761–770, 2007. (3) Glick NR, Fischer MH, Heisey DM, Leverson GE, Mann DC. Epidemiology of fractures in people with severe and profound developmental disabilities. Osteoporosis Int. 16: 389–396, 2005. (4) Lunt M, et al. Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study (EPOS). Bone 33:505–513, 2003. doi:10.1016/j.bone.2009.01.175
260 Z-score comparison of bone density reference databases in children J. Kocksa, K. Wardb, Z. Mughalc, R. Moncayod, J. Adamsb, W. Höglere Paediatrics, Medical University Innsbruck, Innsbruck, Austria Imaging Sciences and Biomedical Engineering, University of Manchester, Manchester, United Kingdom Paediatric Medicine, Manchester Children's University Hospital, Manchester, United Kingdom Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria Endocrinology, Birmingham Children's Hospital, Birmingham, United Kingdom Several reference databases for different dual-energy X-ray absorptiometry (DXA) machines (brand, model, software) serve interpretation of bone density (BMD) results in children. The diversity of DXA-scanners and reference databases questions if the choice of the reference database generates greater differences in the interpretation of the measured bone density results than expected. This study aimed to compare all currently available paediatric DXA reference databases on Hologic®-scanners, applied on BMD-results of a large series of unselected patients.
2027 DXA-scans of paediatric patients were extracted from Hologic®-QDR-4500A machines at our institutions. Age- and sexspecific BMD-z-scores, calculated according to sex-specific equations from six published international databases [Kalkwarf HJ et al. JCEM 2007;92:2087–99; Ward KA et al. Arch, Dis. Child 2007;92:53–59; Kelly T. Bone 2005; 36:Suppl 1:S30; Ellis KJ et al. JBMR 2001;16:1658– 64; Bachrach LK. JCEM 1999;84:4702–12; Faulkner RA. Calcif. Tissue Int. 1996;59:344–51], were compared for the lumbar spine (LS) femoral neck (FN), total hip (TH), and total body (TB). Analysis was restricted to the age-range between 8 and 17 years, which was covered by most databases. The final dataset included 1313 scans (772 of girls). Average zscores differed significantly (p < 0.001) in each scan region (except for FN male), in particular the TB (see Table 1). Although z-scores calculated from different databases were highly correlated, there were significant differences between z-scores. Our results indicate that interpretation of DXA-results is only as good as the reference database used, including the possibility of false diagnosis and unnecessary therapies. This study was not designed to determine the optimal reference database and there are other differences in children's bone mass, shape, strength and body size that are undetectable by DXA. Ideally, z-scores should be calculated using model-, brand-, and software-specific reference curves for age, sex and ethnic group. (1) Kalkwarf HJ et al. JCEM 2007;92:2087–99. (2) Ward KA et al. Arch, Dis. Child 2007;92:53–59. (3) Kelly T. Bone 2005; 36:Suppl 1:S30. (4) Ellis KJ et al. JBMR 2001;16:1658–64. (5) Bachrach LK. JCEM 1999;84:4702–12. (6) Faulkner RA. Calcif. Tissue Int. 1996;59:344–51. doi:10.1016/j.bone.2009.01.176
261 Effects of Piper sarmentosum on bone resorption and its relationship to plasma cortisol in rats S. Ima-Nirwanaa, M.R. Elvy-Suhanab, O. Faizahb, S. Farihahb Pharmacology, Universiti Kebangsaan Malaysia, Kuala Lumpur, WP, Malaysia Anatomy, Universiti Kebangsaan Malaysia, Kuala Lumpur, WP, Malaysia Osteoporosis is a proven complication of long-term glucocorticoid therapy. High levels of serum glucocorticoids inhibit bone formation and increase bone resorption activity. Glucocorticoids also inhibit calcium absorption from the intestines and increase calcium loss via the kidneys. Piper sarmentosum is an erect herb with long creeping stems. It has long been used by villagers as a traditional remedy for cough, fever, toothache and fungal skin infection. The methanolic extract of
S79
Table 1 Hologicmodel
Sex (n)
Kalkwarf et al. (1)
Ward et al. (2)
Kelly (3)
Ellis et al. (4)
Bachrach et al. (5)
Faulkner (6)
QDR-4500A and W, Delphi-A
QDR-4500A
QDR-4500A, Delphi-A
QDR-2000W
QDR-1000W
QDR-2000
−0.93 (−1.78 to −0.08) −1.06 (−1.96 to −0.26) −0.68 (−1.64 to −0.14) −1.19 (−1.96 to −0.34) −1.16 (−2.08 to −0.01) −1.30 (−2.16 to −0.61) −0.05 (−0.67 to 0.71) −0.19 (−0.81 to 0.52)
−1.09 (−2.08 to −0.40) −0.81 (−1.46 to −0.17) – – −1.16 (−1.84 to −0.26) −1.02 (−1.76 to −0.26) −0.29 (−0.42 to 1.11) −0.30 (−0.37 to 0.94)
−0.95 (−1.71 to −0.27) −0.80 (−1.43 to −0.05) −1.01 (−1.69 to −0.23) −1.04 (−1.79 to −0.18) – – −0.15 (−0.66 to 0.45) −0.38 (−0.94 to 0.32)
−1.35 (−2.12 to −0.74) −0.95 (−1.71 to −0.27) −1.22 (−1.90 to −0.50) −080 (−1.43 to −0.05) −1.02 (−1.60 to −0.37) −1.01 (−1.69 to −0.23) −1.13 (−1.96 to −0.11) −1.04 (−1.78 to −0.18) −1.08 (−1.69 to −0.19) −0.98 (−1.76 to −0.12) −1.26 (−2.10 to −0.56) −0.76 (−1.64 to −0.12) 0.16 (−0.34 to 0.70) 0.64 (0.03 to 1.45) 0.58 (−0.18 to 1.25) 0.57 (−0.11 to 1.45)
Median (IQR 25th to 75th) LS FN TH TB
F (201) M (106) F (202) M (101) F (201) M (101) F (168) M (233)
−0.94 (−1.92 to −0.21) −0.73 (−1.60 to −0.13) −1.10 (−1.79 to −0.21) −0.89 (−1.75 to −0.08) −1.23 (−1.98 to −0.24) −1.07 (−2.05 to −0.13) −0.39 (−0.40 to 1.17) −0.45 (−0.30 to 1.20)
Prospective Osteoporosis Study (EPOS). Bone 33:505–513, 2003) A multiple regression model was identified which comprised: use of anti-epileptic medication; having had any type of prior fracture; and being able to verbally localize pain symptoms. Age was not associated with increased numbers of vertebral fractures (p = 0.33). Previously undiagnosed vertebral fractures were more common in participants (n = 20) who were unable to verbally localise their pain (p = 0.056). Further research on reasons for, and prevention of, vertebral fractures and reduced skeletal integrity in adults with an ID is indicated. Clinical emphases given to reporting fortuitous radiographic findings of vertebral fractures and of noting non-verbal indications of pain could reduce the risk of non-diagnosis. (1) Center J, Beange H, McElduff A. People with mental retardation have an increased prevalence of osteoporosis: a population study. Am. J. Ment. Retard. 103:19–28, 1998. (2) Siris ES, Genant HK, Laster AJ, Chen P, Misurski DA, Krege JH. Enhanced prediction of fracture risk combining vertebral fracture status and BMD. Osteoporosis Int. 18:761–770, 2007. (3) Glick NR, Fischer MH, Heisey DM, Leverson GE, Mann DC. Epidemiology of fractures in people with severe and profound developmental disabilities. Osteoporosis Int. 16: 389–396, 2005. (4) Lunt M, et al. Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European Prospective Osteoporosis Study (EPOS). Bone 33:505–513, 2003. doi:10.1016/j.bone.2009.01.175
260 Z-score comparison of bone density reference databases in children J. Kocksa, K. Wardb, Z. Mughalc, R. Moncayod, J. Adamsb, W. Höglere Paediatrics, Medical University Innsbruck, Innsbruck, Austria Imaging Sciences and Biomedical Engineering, University of Manchester, Manchester, United Kingdom Paediatric Medicine, Manchester Children's University Hospital, Manchester, United Kingdom Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria Endocrinology, Birmingham Children's Hospital, Birmingham, United Kingdom Several reference databases for different dual-energy X-ray absorptiometry (DXA) machines (brand, model, software) serve interpretation of bone density (BMD) results in children. The diversity of DXA-scanners and reference databases questions if the choice of the reference database generates greater differences in the interpretation of the measured bone density results than expected. This study aimed to compare all currently available paediatric DXA reference databases on Hologic®-scanners, applied on BMD-results of a large series of unselected patients.
2027 DXA-scans of paediatric patients were extracted from Hologic®-QDR-4500A machines at our institutions. Age- and sexspecific BMD-z-scores, calculated according to sex-specific equations from six published international databases [Kalkwarf HJ et al. JCEM 2007;92:2087–99; Ward KA et al. Arch, Dis. Child 2007;92:53–59; Kelly T. Bone 2005; 36:Suppl 1:S30; Ellis KJ et al. JBMR 2001;16:1658– 64; Bachrach LK. JCEM 1999;84:4702–12; Faulkner RA. Calcif. Tissue Int. 1996;59:344–51], were compared for the lumbar spine (LS) femoral neck (FN), total hip (TH), and total body (TB). Analysis was restricted to the age-range between 8 and 17 years, which was covered by most databases. The final dataset included 1313 scans (772 of girls). Average zscores differed significantly (p < 0.001) in each scan region (except for FN male), in particular the TB (see Table 1). Although z-scores calculated from different databases were highly correlated, there were significant differences between z-scores. Our results indicate that interpretation of DXA-results is only as good as the reference database used, including the possibility of false diagnosis and unnecessary therapies. This study was not designed to determine the optimal reference database and there are other differences in children's bone mass, shape, strength and body size that are undetectable by DXA. Ideally, z-scores should be calculated using model-, brand-, and software-specific reference curves for age, sex and ethnic group. (1) Kalkwarf HJ et al. JCEM 2007;92:2087–99. (2) Ward KA et al. Arch, Dis. Child 2007;92:53–59. (3) Kelly T. Bone 2005; 36:Suppl 1:S30. (4) Ellis KJ et al. JBMR 2001;16:1658–64. (5) Bachrach LK. JCEM 1999;84:4702–12. (6) Faulkner RA. Calcif. Tissue Int. 1996;59:344–51. doi:10.1016/j.bone.2009.01.176
261 Effects of Piper sarmentosum on bone resorption and its relationship to plasma cortisol in rats S. Ima-Nirwanaa, M.R. Elvy-Suhanab, O. Faizahb, S. Farihahb Pharmacology, Universiti Kebangsaan Malaysia, Kuala Lumpur, WP, Malaysia Anatomy, Universiti Kebangsaan Malaysia, Kuala Lumpur, WP, Malaysia Osteoporosis is a proven complication of long-term glucocorticoid therapy. High levels of serum glucocorticoids inhibit bone formation and increase bone resorption activity. Glucocorticoids also inhibit calcium absorption from the intestines and increase calcium loss via the kidneys. Piper sarmentosum is an erect herb with long creeping stems. It has long been used by villagers as a traditional remedy for cough, fever, toothache and fungal skin infection. The methanolic extract of