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Incidence rates of osteoporotic hip fracture (HFx) in the six districts of Rosario city (Argentina)
ABSTRACTS / Bone 40 (2007) S1–S17
This results is a another piece of evidence that NaF and MFP has different action mechanism on bone. doi:10.1016/j.bone.2006.12.026
Hip fracture incidence in women members of a closed health system Claus-Hermberg H, Lozano Bullrich MP, Ilera V, Malter Terrada J, Pozzo MJ. Hospital Alemán, Buenos Aires, Argentina Division of Endocrinology and Metabolism Division of Orthopedics and Traumatology. Hip fracture incidence varies according to demographic and geographic characteristics of the studied populations. This study contemplates the incidence of hip fractures (HF) in women affiliated to a closed health system (Hospital Alemán, Buenos Aires) over a period of 11 years (1/1/94–31/12/04). A total of 183 HF in 75766/person /year were observed, which represents an incidence of 2.41HF/1000 person/year. Mean age was 77.4 ± 8.5 years. Age adjusted incidence was 50–60 years: 0.21; 61– 70 years: 1.04; 71–80 years: 5.55; >80: 22.03 HF/1000 person/ year. Annual incidence variability (range 1.52–3.91 HF/1000 person/year) was not significant (Chi2 > 0.15) and did not show a trend. Nineteen women suffered previous HF (8.7%). Of the 183 HF 117 HP were cervical (C) and 66 trochanteric (T). C/T ratio was 82/36 in women < = 82 years and 35/30 in women > 82 years (Fisher exact test p = 0.026). Fifteen of 161 women died within 12 months after the HP. They had a significantly higher mean age: 84.6 ± 5 years versus 76.6 ± 8.6 years (Mann–Whitney p < 0.01) and a higher proportion of trochanteric fractures: 66% versus 35% (Fisher exact test p = 0.03) than women who survived longer. Logistic regression analysis showed that only age was a predictor of death within a year following the HP. In conclusion, the incidence of HF increases exponentially with age. Hip fractures are highly prevalent in the studied women. The non-significant annual variability and the amount of women/year followed suggest that HP global incidence is a reliable estimate of the studied population. The risk of trochanteric fractures and of death within 12 months after the fracture increases with age. doi:10.1016/j.bone.2006.12.027
Bone mass in adult premenopausal women with two levels of physical activity Saraví FD, Sayegh FC, Furlán S. Facultad de Ciencias Médicas, Universidad Nacional de Cuyo y Escuela de Medicina Nuclear. Mendoza, Argentina. Both excessive physical activity and inactivity are known risk factors for low bone mass, but the effects of intermediate levels of exercise in adult premenopausal women has been less studied. Subjects and methods: women trained for competition (WTC, 21–46 years old, n = 16) at 5 sessions/week were compared with
S9
16 women (24–39 years old) with maintenance exercise (WME, 2–3 sessions/week). All were healthy, non-smokers and had normal menses. Calcium intake was surveyed. Body composition, bone mineral content (BMC) and density (BMD) was measured by DXA (Prodigy, GE Lunar) in whole body, lumbar spine, both hips and non-dominant forearm. Data (mean + SD) were analyzed by Student's t test, Mann–Whitney test, linear regression and multiple regression. Results: there was no significant difference in age, height, weight, body mass index (BMI), fat mass index or calcium intake. WTC had higher fatfree mass index (FFMI; p = 0.003) and BMC (2730 + 375 g vs. WME 2431 + 321 g; p = 0.022). Their BMD was higher by 8% in whole body and by 14 to 24% in spine and hip (p 0.0044 to 0.0007), but not in forearm. Linear regression showed positive correlations between weight vs. BMC, total BMD and lumbar BMD, FFMI vs. BMC and total BMD, and hours of activity (HA) vs. total, spine and hip BMD. Multiple regression indicated no effect for calcium intake or age, a major influence of weight on BMC (r2 = 0.644, p < 0.0001) and spine BMD (r2 = 0.372; p = 0.0041), of weight and HA on total BMD (r2 = 0.342; p = 0.0076), and of HA on hip BMD (r2 0.3574 to 0.4974, p 0.0039 to 0.0006). Conclusion: body weight and a higher level of physical activity were associated with higher total BMC and total, lumbar and hip BMD, while age and calcium intake had negligible effects. doi:10.1016/j.bone.2006.12.028
Incidence rates of osteoporotic hip fracture (HFx) in the six districts of Rosario city (Argentina) Morosano ME, Pezzotto SM, Sánchez A, Tamaño VF, Masoni AM. Chair of Biochemistry and Institute of Immunology, School of Medical Sciences, National University of Rosario; Center of Endocrinology, Rosario. The city of Rosario has six administrative districts that are markedly different in demographic structure and social and sanitary indicators. This study was undertaken in order to: (1) calculate global, specific and adjusted incidence rates of HFx in all districts. (2) Determine whether there is a homogeneous distribution of HFx among them. (3) To evaluate the association between HFx, socio-economic indicators and demographic variables. The HFx study database in Rosario (Osteop Int, 2005) was used. Indicators: Mortality rates, Unmet Basic Needs, Housing, Rooms/inhabitant, Mothers aged <20 years, Precarious housing, Free space, Low-weight newborns. Statistical analysis: Calculation of global incidence rates; truncated (≥ 65 years old) incidence rates; sex and age specific incidence rates; adjusted incidence rates in each district; correlation between rates and socio-economic indicators. Multivariate analysis using Poisson's regression, and calculation of rate ratios (RR). There was no significant association between socio-economic indicators and HFx rates in either sex. In the multivariate analysis the incidence rates of HFx were dependent on sex (p < 0.0001), age (p < 0.0001), age–sex interaction (p < 0.05), and independent of
S10
ABSTRACTS / Bone 40 (2007) S1–S17
district (p = 0.61). The RR as a function of age increases in both sexes. From 80 years on, the risk of HFx in women is higher than in men. The results of the present study indicate that the incidence of osteoporotic HFx has homogeneous distribution within the city of Rosario which is not influenced by socioeconomic factors. RR increases with age in both sexes. Above 80 years such increment is higher in women. doi:10.1016/j.bone.2006.12.029
Evidence of an antiosteogenic mechanism in mandible response in a nutritional dwarfing rat model Olivera M, Compagnucci G, Compagnucci C, Roig M, Mandalunis P, Morgazo C, Hope S, Bianciotti L, Vatta M, Elverdin J, Alippi R, Boyer P. Department of Physiology, School of Dentistry, Department of Histology and Embryology, FOUBA, and Department of Physiology and Physiopathology, (IQUIMEFA-CONICET), FFyB, University of Bs As, Argentina. Malnutrition during development can increase the risk of osteoporosis and bone fragility. There is evidence of neural and humoral control in bone remodelation. The aim of the present study was to evaluate the effect of mild chronic energy restriction on axial skeleton in a Nutritional Dwarfing animal model, its recovery after realimentation, and a possible roll of the noradrenergic hypothalamic activity and of the leptin in the bone response to nutritional stress. Wistar male rats were divided in C and ED groups. C rats were fed ad libitum. ED received 80% of the diet consumed by C during 4 weeks and refed ad libitum for 8 weeks. At T4, T8 and T12 a subgroup was autopsied. Neuronal uptake and release of norepinephrine and tyrosine hydroxilase activity and serum leptin levels were assessed. Left interradicular mandible volume was determined by histomorphometry. Right hemimandibles were submitted to a tree-point bending test. Graphics of load/deformation obtained were analyzed to determine ultimate strength, elastic load-resistance and bone rigidity. Energy restriction affected negatively body and mandible growth, bone volume and biomechanical competence. A significant increase in total noradrenergic activity was observed in ED vs. C. Leptin levels were 50% less in ED animals. All parameters normalized at T12. Our results suggest that nutritional stress produced an inappropriate bone mechanical competence of mandible associated to an antiosteogenic mechanism probably due to an increased central noradrenergic activity and a diminished positive periphery effect from leptin. doi:10.1016/j.bone.2006.12.030
Pathological findings in the spines of a prehistoric population that dwelled at the alluvial banks of the Paraná river Cornero S, Curetti P, Puche RC. Laboratorio de Biología Osea y Museo Universitario. U.N. Rosario.
This report describes the frequencies of vertebral pathologies in a skeletal sample dated 1700 years BP with the radiocarbon technique. Skeletons were exhumated at a site of funeral activity at the north of the Santa Fe province. The presence of arthrosic lesions (osteophytes), Schmorl nodules and compression fractures were investigated in a sample of 217 vertebral bodies, belonging to 11 adults (7 men and 4 women). Osteophytes: 36% (61/169) of the vertebrae from both sexes exhibited osteophytes. These were significantly more frequent in the female (25/51) than in the male group (P = 0.027). In both sexes this lesions were more frequent in the thoracic than in cervical or lumbar segments (males χ2 = 20.5 P < 0.0001; females χ2 = 20.1 P < 0.0001). Schmorl nodules: one third of the bone pieces (36/ 117) presented this lesion. No significant association with sex was observed (χ2 = 0.085 P < 0.775). Vertebral fractures: five vertebral collapses were observed in the male group (between T11 and L5) and one cervical in the female group. This difference was non significant (χ2 = 0.539, P < 0.463). The high frequency of healthy vertebrae with small osteophytes together with the small number of compression fractures suggested that these subjects did not load critically their vertebral columns. Coastal dwellers based their survival on hunting, fishing and collecting activities. These would not have demanded great physical efforts. The absence of differences associated with sex in the incidence of Schmorl nodules, vertebral fractures and the distribution of arthrosic lesions along the spinal segments suggests that both sexes attended daily chores of similar intensity. doi:10.1016/j.bone.2006.12.031
Rapid bone mass increase in patients with type I gaucher disease (GDI) under pamidronate (P) treatment Mastaglia S, Degrandi M, Parisi M, Oliveri B. Sección Osteopatías Médicas, Hospital de Clínicas, UBA, Argentina. GDI is characterized by a deficit of b-glucosidase activity and a buildup of glucocerebrosides in several organs. 80% patients with GDI have their bones affected, often showing osteopenia/ osteoporosis. ERT's efficacy to revert them seems limited. Our aim was to report 3 GDI cases: 2 on ERT regularly and one, irregularly. They received 60 mg of P (iv) every 3 months for 9 m; 800 IU/day of vitamin D2 and 500 mg/day of calcium. CASES: (1) Woman (21), diagnosed GDI at 4, on ERT irregularly, with diverse fractures, generalized bone pain and avascular necrosis of left femoral head (LFN). She presented a decrease of BMD (g/cm2) in lumbar spine (LS) 0.886 (Z − 2.62), total skeleton (TS) 0.857 (Z − 3.35) and right femoral neck (RFN) 0.710 (Z − 2.25), and was infused P. After 3 infusions, BMD was checked and showed an increase of BMD in LS 0.935 (+ 5.5%), TS 0.901 (+ 5.1%) and NF 0. 723 (+ 1.8%). No new fractures reported. Bone pain decreased significantly. (2) Man (29), diagnosed GDI at 4, regularly on ERT since 18 (60 UI/kg/15 days) with a history of fractures and a single bone crisis episode.
This results is a another piece of evidence that NaF and MFP has different action mechanism on bone. doi:10.1016/j.bone.2006.12.026
Hip fracture incidence in women members of a closed health system Claus-Hermberg H, Lozano Bullrich MP, Ilera V, Malter Terrada J, Pozzo MJ. Hospital Alemán, Buenos Aires, Argentina Division of Endocrinology and Metabolism Division of Orthopedics and Traumatology. Hip fracture incidence varies according to demographic and geographic characteristics of the studied populations. This study contemplates the incidence of hip fractures (HF) in women affiliated to a closed health system (Hospital Alemán, Buenos Aires) over a period of 11 years (1/1/94–31/12/04). A total of 183 HF in 75766/person /year were observed, which represents an incidence of 2.41HF/1000 person/year. Mean age was 77.4 ± 8.5 years. Age adjusted incidence was 50–60 years: 0.21; 61– 70 years: 1.04; 71–80 years: 5.55; >80: 22.03 HF/1000 person/ year. Annual incidence variability (range 1.52–3.91 HF/1000 person/year) was not significant (Chi2 > 0.15) and did not show a trend. Nineteen women suffered previous HF (8.7%). Of the 183 HF 117 HP were cervical (C) and 66 trochanteric (T). C/T ratio was 82/36 in women < = 82 years and 35/30 in women > 82 years (Fisher exact test p = 0.026). Fifteen of 161 women died within 12 months after the HP. They had a significantly higher mean age: 84.6 ± 5 years versus 76.6 ± 8.6 years (Mann–Whitney p < 0.01) and a higher proportion of trochanteric fractures: 66% versus 35% (Fisher exact test p = 0.03) than women who survived longer. Logistic regression analysis showed that only age was a predictor of death within a year following the HP. In conclusion, the incidence of HF increases exponentially with age. Hip fractures are highly prevalent in the studied women. The non-significant annual variability and the amount of women/year followed suggest that HP global incidence is a reliable estimate of the studied population. The risk of trochanteric fractures and of death within 12 months after the fracture increases with age. doi:10.1016/j.bone.2006.12.027
Bone mass in adult premenopausal women with two levels of physical activity Saraví FD, Sayegh FC, Furlán S. Facultad de Ciencias Médicas, Universidad Nacional de Cuyo y Escuela de Medicina Nuclear. Mendoza, Argentina. Both excessive physical activity and inactivity are known risk factors for low bone mass, but the effects of intermediate levels of exercise in adult premenopausal women has been less studied. Subjects and methods: women trained for competition (WTC, 21–46 years old, n = 16) at 5 sessions/week were compared with
S9
16 women (24–39 years old) with maintenance exercise (WME, 2–3 sessions/week). All were healthy, non-smokers and had normal menses. Calcium intake was surveyed. Body composition, bone mineral content (BMC) and density (BMD) was measured by DXA (Prodigy, GE Lunar) in whole body, lumbar spine, both hips and non-dominant forearm. Data (mean + SD) were analyzed by Student's t test, Mann–Whitney test, linear regression and multiple regression. Results: there was no significant difference in age, height, weight, body mass index (BMI), fat mass index or calcium intake. WTC had higher fatfree mass index (FFMI; p = 0.003) and BMC (2730 + 375 g vs. WME 2431 + 321 g; p = 0.022). Their BMD was higher by 8% in whole body and by 14 to 24% in spine and hip (p 0.0044 to 0.0007), but not in forearm. Linear regression showed positive correlations between weight vs. BMC, total BMD and lumbar BMD, FFMI vs. BMC and total BMD, and hours of activity (HA) vs. total, spine and hip BMD. Multiple regression indicated no effect for calcium intake or age, a major influence of weight on BMC (r2 = 0.644, p < 0.0001) and spine BMD (r2 = 0.372; p = 0.0041), of weight and HA on total BMD (r2 = 0.342; p = 0.0076), and of HA on hip BMD (r2 0.3574 to 0.4974, p 0.0039 to 0.0006). Conclusion: body weight and a higher level of physical activity were associated with higher total BMC and total, lumbar and hip BMD, while age and calcium intake had negligible effects. doi:10.1016/j.bone.2006.12.028
Incidence rates of osteoporotic hip fracture (HFx) in the six districts of Rosario city (Argentina) Morosano ME, Pezzotto SM, Sánchez A, Tamaño VF, Masoni AM. Chair of Biochemistry and Institute of Immunology, School of Medical Sciences, National University of Rosario; Center of Endocrinology, Rosario. The city of Rosario has six administrative districts that are markedly different in demographic structure and social and sanitary indicators. This study was undertaken in order to: (1) calculate global, specific and adjusted incidence rates of HFx in all districts. (2) Determine whether there is a homogeneous distribution of HFx among them. (3) To evaluate the association between HFx, socio-economic indicators and demographic variables. The HFx study database in Rosario (Osteop Int, 2005) was used. Indicators: Mortality rates, Unmet Basic Needs, Housing, Rooms/inhabitant, Mothers aged <20 years, Precarious housing, Free space, Low-weight newborns. Statistical analysis: Calculation of global incidence rates; truncated (≥ 65 years old) incidence rates; sex and age specific incidence rates; adjusted incidence rates in each district; correlation between rates and socio-economic indicators. Multivariate analysis using Poisson's regression, and calculation of rate ratios (RR). There was no significant association between socio-economic indicators and HFx rates in either sex. In the multivariate analysis the incidence rates of HFx were dependent on sex (p < 0.0001), age (p < 0.0001), age–sex interaction (p < 0.05), and independent of
S10
ABSTRACTS / Bone 40 (2007) S1–S17
district (p = 0.61). The RR as a function of age increases in both sexes. From 80 years on, the risk of HFx in women is higher than in men. The results of the present study indicate that the incidence of osteoporotic HFx has homogeneous distribution within the city of Rosario which is not influenced by socioeconomic factors. RR increases with age in both sexes. Above 80 years such increment is higher in women. doi:10.1016/j.bone.2006.12.029
Evidence of an antiosteogenic mechanism in mandible response in a nutritional dwarfing rat model Olivera M, Compagnucci G, Compagnucci C, Roig M, Mandalunis P, Morgazo C, Hope S, Bianciotti L, Vatta M, Elverdin J, Alippi R, Boyer P. Department of Physiology, School of Dentistry, Department of Histology and Embryology, FOUBA, and Department of Physiology and Physiopathology, (IQUIMEFA-CONICET), FFyB, University of Bs As, Argentina. Malnutrition during development can increase the risk of osteoporosis and bone fragility. There is evidence of neural and humoral control in bone remodelation. The aim of the present study was to evaluate the effect of mild chronic energy restriction on axial skeleton in a Nutritional Dwarfing animal model, its recovery after realimentation, and a possible roll of the noradrenergic hypothalamic activity and of the leptin in the bone response to nutritional stress. Wistar male rats were divided in C and ED groups. C rats were fed ad libitum. ED received 80% of the diet consumed by C during 4 weeks and refed ad libitum for 8 weeks. At T4, T8 and T12 a subgroup was autopsied. Neuronal uptake and release of norepinephrine and tyrosine hydroxilase activity and serum leptin levels were assessed. Left interradicular mandible volume was determined by histomorphometry. Right hemimandibles were submitted to a tree-point bending test. Graphics of load/deformation obtained were analyzed to determine ultimate strength, elastic load-resistance and bone rigidity. Energy restriction affected negatively body and mandible growth, bone volume and biomechanical competence. A significant increase in total noradrenergic activity was observed in ED vs. C. Leptin levels were 50% less in ED animals. All parameters normalized at T12. Our results suggest that nutritional stress produced an inappropriate bone mechanical competence of mandible associated to an antiosteogenic mechanism probably due to an increased central noradrenergic activity and a diminished positive periphery effect from leptin. doi:10.1016/j.bone.2006.12.030
Pathological findings in the spines of a prehistoric population that dwelled at the alluvial banks of the Paraná river Cornero S, Curetti P, Puche RC. Laboratorio de Biología Osea y Museo Universitario. U.N. Rosario.
This report describes the frequencies of vertebral pathologies in a skeletal sample dated 1700 years BP with the radiocarbon technique. Skeletons were exhumated at a site of funeral activity at the north of the Santa Fe province. The presence of arthrosic lesions (osteophytes), Schmorl nodules and compression fractures were investigated in a sample of 217 vertebral bodies, belonging to 11 adults (7 men and 4 women). Osteophytes: 36% (61/169) of the vertebrae from both sexes exhibited osteophytes. These were significantly more frequent in the female (25/51) than in the male group (P = 0.027). In both sexes this lesions were more frequent in the thoracic than in cervical or lumbar segments (males χ2 = 20.5 P < 0.0001; females χ2 = 20.1 P < 0.0001). Schmorl nodules: one third of the bone pieces (36/ 117) presented this lesion. No significant association with sex was observed (χ2 = 0.085 P < 0.775). Vertebral fractures: five vertebral collapses were observed in the male group (between T11 and L5) and one cervical in the female group. This difference was non significant (χ2 = 0.539, P < 0.463). The high frequency of healthy vertebrae with small osteophytes together with the small number of compression fractures suggested that these subjects did not load critically their vertebral columns. Coastal dwellers based their survival on hunting, fishing and collecting activities. These would not have demanded great physical efforts. The absence of differences associated with sex in the incidence of Schmorl nodules, vertebral fractures and the distribution of arthrosic lesions along the spinal segments suggests that both sexes attended daily chores of similar intensity. doi:10.1016/j.bone.2006.12.031
Rapid bone mass increase in patients with type I gaucher disease (GDI) under pamidronate (P) treatment Mastaglia S, Degrandi M, Parisi M, Oliveri B. Sección Osteopatías Médicas, Hospital de Clínicas, UBA, Argentina. GDI is characterized by a deficit of b-glucosidase activity and a buildup of glucocerebrosides in several organs. 80% patients with GDI have their bones affected, often showing osteopenia/ osteoporosis. ERT's efficacy to revert them seems limited. Our aim was to report 3 GDI cases: 2 on ERT regularly and one, irregularly. They received 60 mg of P (iv) every 3 months for 9 m; 800 IU/day of vitamin D2 and 500 mg/day of calcium. CASES: (1) Woman (21), diagnosed GDI at 4, on ERT irregularly, with diverse fractures, generalized bone pain and avascular necrosis of left femoral head (LFN). She presented a decrease of BMD (g/cm2) in lumbar spine (LS) 0.886 (Z − 2.62), total skeleton (TS) 0.857 (Z − 3.35) and right femoral neck (RFN) 0.710 (Z − 2.25), and was infused P. After 3 infusions, BMD was checked and showed an increase of BMD in LS 0.935 (+ 5.5%), TS 0.901 (+ 5.1%) and NF 0. 723 (+ 1.8%). No new fractures reported. Bone pain decreased significantly. (2) Man (29), diagnosed GDI at 4, regularly on ERT since 18 (60 UI/kg/15 days) with a history of fractures and a single bone crisis episode.