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Abstracts / Bone 44 (2009) S339–S450
Methods: A total of 50 Wistar adult rats (300 ± 50 g) were studied; 20 rats were ovariectomized (OVX) and 30 were SHAM operated. During 15 days post-surgery all rats were fed a commercial diet (Granave SA, Bs.As.) which supplied protein 15%, vitamin D 200UI% and 0.6% calcium. After that, rats were divided in 5 groups and for an additional 60 days they received: G1: OVX + 2.5% casein diet + 0% vitamin D G2: OVX + 2.5% casein diet + 200 IU% vitamin D G3: SHAM + 2.5% casein diet + 200 IU% vitamin D G4: SHAM + 2.5% casein diet + 0% vitamin D G5: SHAM + commercial diet (15% protein). At baseline (Tb) and at the end of the experience (Tf) total skeleton bone mineral content (BMC: mg) and density (BMD: mg/cm2) were measured by DXA (Small animal Software, Lunar DPX. Proximal tibia BMD was evaluated using a specific ROI and changes between Tf and Tb were calculated (ch.BMCte and ch.BMDpt, respectively). Serum calcium, phosphorus, 25OHD (ng/ml) and bone alkaline phosphatase (bAL) (IU/L) were also evaluated. At Tf bone volume of tibia (BV/TV %) was measured by histology. Results (mean ± standard error) (Table 1). Results: The low protein intake induced bone loss in both OVX and SHAM rats (G2 and G3, respectively vs. G5) and the addition of vitamin D insufficiency induced a more severe effect in total BMC and proximal tibia BMD (G1 and G4 vs. G5). As expected, the impact was greater in OVX rats (G1 and G2). Conclusions: In conclusion, both vitamin D and/or protein deficiencies may contribute to age-related bone loss. This study highlights the importance of supplying adequate protein and vitamin D intake to preserve skeletal integrity in the elderly. Table 1
25OHD Tf FAO Tf ch.BMDpt ch.BMCte
G1
G2
G3
G4
G5
10.4 ± 4.5a 74 ± 11a 0.0 ± 1.4a − 253 ± 19a
26.6 ± 2.5b 36 ± 3b 2.0 ± 0.1b 717 ± 10b
29.6 ± 2.3b 40 ± 3b 15.5 ± 1.1c 1737 ± 15c
8.6 ± 3.2a 57 ± 16a − 0.3 ± 0.4a 88 ± 10d
29.0 ± 2.8b 40 ± 4b 24.8 ± 1.8d 2706 ± 59e
Different letters indicate a: p < 0.05.
Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.345
P434 Excess mortality in men compared with women following a hip fracture — National analysis of comedications, comorbidity and survival S. van der Mark*a, P.N. Kannegaarda, P.A. Eikenb, B. Abrahamsenc a Geriatric Medicine, Copenhagen Univ Hosp Gentofte, Hellerup, Denmark b Endocrinology, Hillerød Hospital, Hillerød, Denmark c Medicine and Endocrinology, Copenhagen Univ Hosp Gentofte, Hellerup, Denmark Introduction: Osteoporosis is a common disease, and the incidence of osteoporotic fractures is expected to rise with the growing elderly population. Immediately following, and probably several years after a hip fracture, both men and women have a higher risk of dying compared to the general population regardless of age. The aim of this study was to assess excess mortality following hip fracture and, if possible, identify reasons for the difference between mortality for the two genders. Methods: A nationwide register-based cohort study presenting data on mortality, comorbidity and medication for all Danish patients (N = 41,000) experiencing a hip fracture from 1/1/1999 to 31/12/ 2002. Follow-up period until 31/12/2005.
Results: We found a substantially higher mortality among male hip fracture patients than female hip fracture patients despite men being 4 years younger at the time of fracture. Both male and female hip fracture patients had an excess mortality rate compared to the general population. The cumulative mortality at 12 months among hip fracture patients compared to the general population was 37.1% (9.9%) in men and 26.4% (9.3%) in women. In the first year, the risk of death increased for women with increasing age (HR 1.06 95% CI [1.06–1.07]), the number of comedications (HR 1.04 95% CI [1.03–1.05]) and the presence of specific Charlson index components and medications described below. For men, age (HR 1.07 [1.07–1.08]), number of comedications (HR 1.06 [1.04–1.07]), and presence of different specific Charlson index components and medications increased the risk. Long term survival analyses revealed significant excess mortality for men compared with women (HR 1.70, 95% CI [1.65–1.75], p < 0.001, even when controlled for age, fracture site, the number of medications, exposure to drug classes A, C, D, G, J, M, N, P, S and for chronic comorbidities. Conclusion: Excess mortality among male patients cannot be explained by controlling for known comorbidity and medications. Besides gender, we found higher age and multimorbidity to be related to an increased risk of dying within the first year after fracture; acute complications might be one of the explanations. This study emphasizes the need for particular rigorous postoperative diagnostic evaluation and treatment of comorbid conditions in the male hip fracture patient. Conflict of interest: S. van der Mark: consultant. Servier. P. Kannegaard: none. B. Abrahamsen: consultant. Amgen, Nycomed, Novartis. Speaker Servier, Eli Lilly and MSD. P. Eiken: consultant Amgen. Speaker Nycomed, Roche and Servier. doi:10.1016/j.bone.2009.03.346
P435 Influence of various chronic hyperthermia modes on a chemical composition of skeleton bones V.I. Luzin, S.M. Smolenchuk*, Y.A. Rykova, A.A. Alieva Department of Normal Anatomy, State Medical University, Luhansk, Ukraine Aim: To study the percentage of water, organic and mineral components of skeleton bones after influence of various chronic hyperthermia (H) modes in experiment. Methods: The research is carried out on 270 white adult rat males divided in 8 groups: 1 (C) are intact animals, 2–8 — during 60 days daily 5 h per day were under the H influence: 2 (He) — at 44–45 °С (extreme H), 3 (Hmed) — at 42–43 °С (medium H), 4 (Hmod) — at 39–41 °С (moderate H), 5–6 — were under the He and Hmed influence in a combination with the physical activity (Ph) (HePh and HmedPh respectively), and 7–8 — were under the He and Hmed influence in a combination with the synthetic metabolic preparation of inosine in a dose of 20 mg/kg per day (HeI and HmedI respectively). Animals were taken out from the experiment on the 1st, 7th, 15th, 30th and 60th days after the completion of the 60-days impact of H. Tibia, hip bone and the 3rd lumbar vertebra were isolated. Chemical composition of bones was determined by a weight method. Results: In bones of the Hmod and HmedI groups the indicators did not differ from C. Influence of H caused decrease in the content of mineral and organic substance in combination with the hyperhydration of bones. Rather small deviations were observed in Hmed and HeI groups where demineralisation was 5.19% and 5.81%, hyperhydration was 6.56% and 11.08% respectively on the 1st day. By the 60th
Abstracts / Bone 44 (2009) S339–S450
day the indicators of the studied groups reliably did not differ from C. More considerable deviations were observed in groups He, HmedPh, HePh where demineralisation on the 1st day was 8.70%, 12.5%, and 14.05% and hyperhydration was 15.78%, 13.49% and 21.60% respectively. By the 60th day the tendency in approaching the C by the studied indicators was registered, however reliability of differences remained. Conclusion: The mode of extreme and medium H and their combination with Ph is accompanied by distinctive and hardly reversible changes in the chemical composition of bones which is manifested by the increase of the water content and decrease of the organic and mineral components. Combined influence of Ph and H worsens studied indicators. Intestinal injection of inosine reduces negative influence of H. During the 60 days of readaptation the indicators of studied groups did not reach control values. The best leveling of the studied deviations was in a group, where inosine was used. Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.347
P436 Representations of osteoporosis at the time of announcement of the diagnosis — ROAD T.T.T. Thomasa,*, E.E.L. Lespessaillesb, F.F.L.V. Lévy-Weilc, S.S.L. Lesortd, G.G.B. Bonnelyee, G.G.R. Reachf, C.C.L. Lambertg a Rhumatologie, CHU de Saint Etienne, Hôpital Bellevue, Saint Etienne, France b Rhumatologie, CH La source, Orléans, France c Rhumatologie, CH, Argenteuil, France d Rhumatologie, Médecine Générale, Orléans, France e Rhumatologie, TNS Healthcare, Montrouge, France f Diabetologie, CH, Bobigny, France g Diabetologie, Ipsen, Boulogne-Billancourt, France Objectives: To evaluate women representations of osteoporosis and their future and to investigate the perception of osteoporosis consequences on quality of life and level of activities in their future among newly diagnosed women and women in the general population. Methods: ROAD is the first cross-sectional psychobehavioural study conducted on representations of osteoporosis in France. The first part of this study (ROAD 1) conducted throughout France among general practitioners (n = 1000) and private rheumatologists (n = 200) is still ongoing. The second part (ROAD 2) was launched in the general population, evaluating unselected women of the same age-group (> 55 years) by means of a structured post-mail questionnaire. The response rate was around 90%. 2200 participants were osteoporosis-free and 571 osteoporotic women. The prevalence of osteoporosis was higher than 20%. First results of ROAD 2: When asked “Do you fear osteoporosis?”, only one half of the women agreed (57.4% of osteoporotic vs. 51.3% of osteoporosis-free women). Osteoporotic women perceived their disease more negatively: 63.6% of those considered osteoporosis as a fatality which will affect everyone (vs. 55.7% of osteoporosis-free women) and 70.2% perceived osteoporosis as a consequence of ageing (vs. 65.7%). Osteoporotic women more significantly considered osteoporosis as a pain-free disease until the first fracture (58.5% vs. 52.3%, p < 0.05). Only 22.9% of all participants perceived osteoporosis as a hereditary disease while 88.1% of them considered that osteoporosis can cause damage. When asked “Is there any recommended treatment?” 87.6% of osteoporotic and 84.2% of osteoporotic-free women agreed. The
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consequences of osteoporosis were judged severe by 98.8% and 96.9% and extremely severe by 43.3% and 39.9% respectively. Conclusion: Results expected for the 1st quarter 2009. Overall, whether osteoporotic or not, French women appear to be informed of osteoporosis and aware of its consequences. However they don't seem worried about the diagnosis or its consequences. This may explain in part, the current poor adherence to treatment. Further analysis will compare other points of view. Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.348
P437 Influence of inflammation on bone density in patients with inflammatory bowel disease — Different effects on different structures within bone? T.J. Clasena,*, D. Raddatza, R. Schnella, W. Noltea, A. Pressa, H. Siggelkowb a Gastroenterology and Endocrinology, University of Goettingen, Germany b Gastroenterology and Endocrinology, Endokrinologikum, Göttingen, Germany Patients with inflammatory bowel disease (IBD) are at risk to develop osteoporosis. The influence of inflammation on bone density has been shown in earlier studies. In this cross-sectional study 111 unselected patients with IBD underwent bone density measurements at lumbar spine (LS) and proximal femur (PF) with dual energy X-ray absorptiometry (DXA) (Hologic, Siemens, Germany) and at the calcaneus (C) with ultrasound (Achilles, LUNAR, Germany). In this group of patients a correlation analysis using a non-parametric ANOVA was used to correlate the results of different bone measurement methods with the inflammationmarkers C-reactive protein (CRP) and the erythrocyte sedimentation rate (ESR) after 1 and 2 h. In the group of patients suffering from Crohn's disease (CD) the correlation analysis between ultrasound (C) and ESR after 1 and 2 h analysed in 37 patients showed a strong correlation between the “stiffness” with R = 0.44 (p = 0.006) after 1 h and R = 0.44 (p = 0.007) after 2 h. The “speed of sound” (SOS) showed a strong correlation (1 h: R = 0.44 (p = 0.007), 2 h: R = 0.41 (p = 0.012)). The “broadband ultrasound attenuation” (BUA) correlated strongly with the ESR (1 h: R = 0.37 (p = 0.023), 2 h: R = 0.37 (p = 0.024). Correlation between DXAmeasurements and ESR showed no significant results. Colitis ulcerosa patients (CU) had no significant correlation between the ESR and bone measurement methods used. For patients with CD the correlation between CRP > 5 mg/l and the DXA-measurements showed the following results: LS showed a bone mineral density (BMD) correlation of R = 0.56 (p = 0.008) and T-score of R = 0.55 (p = 0.010) to CRP > 5 mg/l. PF analysis showed a BMD correlation of R = 0.67 (p = 0.001), T-score correlation of R = 0.68 (p = 0.001) and Z-score correlation of R = 0.65 (p = 0.001). A correlation between ultrasound results and CRP > 5 mg/l showed no significant results. Also no correlation between DXA and ultrasound results to CRP > 5 mg/l was found in CU patients. Our results suggest that the underlying inflammation in CD influenced not only bone mineral density measured by DXA but also bone parameters measured by quantitative ultrasound. Differences between ESR and CRP and the measured correlation to bone density parameters suggest that inflammation responses might trigger different changes concerning bone structure, quality and/or density. Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.349