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What is normal bone density?
3% RESORPTIONCAVITYCHARACTERISTICSIN PATIENTSWITH PRIMARYAND SECONDARY C)STEOPOROSIS. PI Croucher. S Vedi, Nl Garrahan 1E Comoston. Dept Medicine, University of Cambridge, UK and Department of Pathology, University of Wales College of Medicirs, UK. The remodelling imbalance which occurs in osteoporosis may result from an increase in the amount of bone resorbed, a decrease in that formed, or both. We assessed resorption cavity characteristics in patients withprimary osteoporosis(100P)and osteoporosis secondary to intestinal malabsorption (ZOOI'). Transiliac biopsies were obtained kom 16 patients with
397 WHAT w.
IS NORMAL
C Tuss. I,.
BONE DENSITY
?
M Miiller. I Ra&
Osreopenia Center. University Hospital of Linkijping, Sweden In order to obtain clinically useful reference values for bone mineral density we studied a random sample of the popularion of males and females aged 20 - 70 ycars.ln total I IO0 subjects were investigated by single photon densitomeuy (ND 11OOm) and quantitative digital radiograpphy
(Hologic looOm).
IOOP,10 female (aged k-72 yrsj, .:nd 19 patients, 11 female (aged 21-78yrs) with 200t’. Using 8 pm undecnlcified sections, the erodecl kur\e surface was reconstructed and measurements of cavity characteristics made automatically, Wall width was measured directly. In POP resorption cavity size W.S similar to that in control subjects, whereas wall width was smaller (p-cO.01).Maximum resorption depth and surface extent were smi\ller in 2aOP than controls (pcO.001and p
Subje& with diseases and certain drug: of impenance for bone mass were excluded. Life style factors and other risk dcternrmnnrs for bone mass were assessedby questionnaire. Preliminlvy results show lower BMD values in sedentary subjects, in smokers and in those with fracture among close 19.29 30.39 40.49 SO.59 60.69 rclatibes. The impact of n8e different risk faciors in males and frmlales in different ages will be shown. As an example mean values for sedenrary subjects (lowest quartile on a physical activity scale index ) in reladon to the rota1 group areshown in figure. In conclusion we suggest that reference values calculated from crude population samples. for clinical use, should consider nor only drugs and diseases but also life style factars and other major determinants of importance for bone mass.
398
399
HYPOVITAMiNOSIS D IS THE MAIN DETERMINANT OF SECONDi’.RY
HYPERPARATHYROiDlSM
WHICH
CONTRlBUTES TO BONE FRAGILITYIN ELDERLY WOMEN WITH HIP FRACTURES AND OTHER NON VERTEBRAL FRACTURES.
WQ hnvrpreviously ahown in an interim report (16 mth) of a 3 yenrs Prospective study involving 3270 women (mean age : 84* in nursing homes and having a low calcium intake and R low wrum 25 OHD that vitamin D3 ~600 IUIdayI and calcium au\eeDlrmenb WOO m&day) were capable of reducing the incidence of noi’vartebral FraPtureIA&BMR, 19~11. In the meaniime, serum PTH hPTW1 was reduced aF46% ond 250HD restored to normal values. In order to understand the main determinant of increased PTH and the respective effect of vitamin D3 and calcium, we have studied the variations in sPTH,250HD,and serum creotinine in a subpup of 98 women. 66 were treated (D3-Ca gr.) and 40 untreated (plac. Qr). They all had measurements at the beginning of the study (MO) and at _ the End ofthe 16th month (Ml& At baseline, no relationship was found between calcium intake and the studied biochemical parameters values for the whole moua of 96 women. In contrast &Tti was dependant of seru; 250HD, crsatinine and weight (sPTH = 3.1 creatinine - O.Q(250HD) + 0.4 Weight; R P 0.44 ; p: 0.004). At baseline, 25 OHD was only dapendant oPsPTH (250HD o 20.6 - 0.1 sFTH; r = 0.32 ; p = e 0.01). At Ml& in theplac.poup. sPTfi was dependant of both sPTH at MO and 26QHD at Ml6 (s89’H~lQ = O.?sPTH MO -1.3 (28OHD1~18 + 31.2, R zz0.86, p = 0.0001). At Ml& in the D3Ga group, delta PTH was independant of calcium intake at baseline and only dependent of PTH at MO (Delta PTH = -9.3 - 0.5 tPl'H MO,r: 0.42 : p = 0.0001). In conclusion, the decrease of 250HD is mainly responsible for the increase of sPTH in old women with low calcium intake and this awsts that the protective effet obtained in our large scale study a&nst femur fragility was probably more dependant on the vitamin D3 supplement than on the calcium supplement. The latter was however justified by the low mean calcium intake. t%rk sulpwted by grant CNAMTS-INSERM.by Duphar and Merck-Ctevenot bbwatodes
which
respectiwty
provided
viramin
CU)DI
03 and cakium
174
397 WHAT w.
IS NORMAL
C Tuss. I,.
BONE DENSITY
?
M Miiller. I Ra&
Osreopenia Center. University Hospital of Linkijping, Sweden In order to obtain clinically useful reference values for bone mineral density we studied a random sample of the popularion of males and females aged 20 - 70 ycars.ln total I IO0 subjects were investigated by single photon densitomeuy (ND 11OOm) and quantitative digital radiograpphy
(Hologic looOm).
IOOP,10 female (aged k-72 yrsj, .:nd 19 patients, 11 female (aged 21-78yrs) with 200t’. Using 8 pm undecnlcified sections, the erodecl kur\e surface was reconstructed and measurements of cavity characteristics made automatically, Wall width was measured directly. In POP resorption cavity size W.S similar to that in control subjects, whereas wall width was smaller (p-cO.01).Maximum resorption depth and surface extent were smi\ller in 2aOP than controls (pcO.001and p
Subje& with diseases and certain drug: of impenance for bone mass were excluded. Life style factors and other risk dcternrmnnrs for bone mass were assessedby questionnaire. Preliminlvy results show lower BMD values in sedentary subjects, in smokers and in those with fracture among close 19.29 30.39 40.49 SO.59 60.69 rclatibes. The impact of n8e different risk faciors in males and frmlales in different ages will be shown. As an example mean values for sedenrary subjects (lowest quartile on a physical activity scale index ) in reladon to the rota1 group areshown in figure. In conclusion we suggest that reference values calculated from crude population samples. for clinical use, should consider nor only drugs and diseases but also life style factars and other major determinants of importance for bone mass.
398
399
HYPOVITAMiNOSIS D IS THE MAIN DETERMINANT OF SECONDi’.RY
HYPERPARATHYROiDlSM
WHICH
CONTRlBUTES TO BONE FRAGILITYIN ELDERLY WOMEN WITH HIP FRACTURES AND OTHER NON VERTEBRAL FRACTURES.
WQ hnvrpreviously ahown in an interim report (16 mth) of a 3 yenrs Prospective study involving 3270 women (mean age : 84* in nursing homes and having a low calcium intake and R low wrum 25 OHD that vitamin D3 ~600 IUIdayI and calcium au\eeDlrmenb WOO m&day) were capable of reducing the incidence of noi’vartebral FraPtureIA&BMR, 19~11. In the meaniime, serum PTH hPTW1 was reduced aF46% ond 250HD restored to normal values. In order to understand the main determinant of increased PTH and the respective effect of vitamin D3 and calcium, we have studied the variations in sPTH,250HD,and serum creotinine in a subpup of 98 women. 66 were treated (D3-Ca gr.) and 40 untreated (plac. Qr). They all had measurements at the beginning of the study (MO) and at _ the End ofthe 16th month (Ml& At baseline, no relationship was found between calcium intake and the studied biochemical parameters values for the whole moua of 96 women. In contrast &Tti was dependant of seru; 250HD, crsatinine and weight (sPTH = 3.1 creatinine - O.Q(250HD) + 0.4 Weight; R P 0.44 ; p: 0.004). At baseline, 25 OHD was only dapendant oPsPTH (250HD o 20.6 - 0.1 sFTH; r = 0.32 ; p = e 0.01). At Ml& in theplac.poup. sPTfi was dependant of both sPTH at MO and 26QHD at Ml6 (s89’H~lQ = O.?sPTH MO -1.3 (28OHD1~18 + 31.2, R zz0.86, p = 0.0001). At Ml& in the D3Ga group, delta PTH was independant of calcium intake at baseline and only dependent of PTH at MO (Delta PTH = -9.3 - 0.5 tPl'H MO,r: 0.42 : p = 0.0001). In conclusion, the decrease of 250HD is mainly responsible for the increase of sPTH in old women with low calcium intake and this awsts that the protective effet obtained in our large scale study a&nst femur fragility was probably more dependant on the vitamin D3 supplement than on the calcium supplement. The latter was however justified by the low mean calcium intake. t%rk sulpwted by grant CNAMTS-INSERM.by Duphar and Merck-Ctevenot bbwatodes
which
respectiwty
provided
viramin
CU)DI
03 and cakium
174