Abstract: Along with the global aging of population, the number of people with somatic diseases is increasing, including such interrelated pathologies as obesity, osteoarthritis (OA) and osteoporosis (OP). The objective of the study is to examine the connection between body mass index (BMI), OA and bone mineral density (BMD) of lumbar spine, femoral neck and trabecular bone score (TBS) in postmenopausal women with OA. We have observed 359 postmenopausal women (50-89 years old) and divided them into four groups by age: 50-59 yrs, 60-69 yrs, 70-79 yrs and over 80 years old. In addition, according to the American College of Rheumatology (ACR) Clinical classification criteria for knee and hip OA, we divided them into 2 groups: group I – 117 females with symptomatic OA (including 89 patients with knee OA, 28 patients with hip OA) and group II –242 women with a normal functional activity of large joints. Analysis of data was performed taking into account their BMI, classified by World Health Organization (WHO). Diagnosis of obesity was established when BMI was above 30 kg/m2. In woman with obesity, a symptomatic OA was detected in 44 postmenopausal women (41.1%), a normal functional activity of large joints - in 63 women (58.9%). However, in women with normal BMI – 73 women, who account for 29.0% of cases, a symptomatic OA was detected. According to a chi-squared (χ2) test, a significantly higher level of BMI was detected in postmenopausal women with OA (χ2 = 5.05, p = 0.02). Women with a symptomatic OA had a significantly higher BMD of lumbar spine compared with women who had a normal functional activity of large joints. No significant differences of BMD of femoral necks or TBS were detected in either the group with OA or with a normal functional activity of large joints.
Abstract: This study evaluates the management of osteoporosis in a tertiary care government hospital in Malaysia. As the number of admitted patients having osteoporotic fractures is on the rise, osteoporotic medications are an increasing financial burden to government hospitals because they account for half of the orthopedic budget and expenditure. Comprehensive knowledge among practitioners is important to detect early and avoid this preventable disease and its serious complications. The purpose of this study is to evaluate the awareness, knowledge, and practices in managing osteoporosis among practitioners in Hospital Tengku Ampuan Rahimah (HTAR), Klang. A questionnaire from an overseas study in managing osteoporosis among primary care physicians is adapted to Malaysia’s Clinical Practice Guideline of Osteoporosis 2012 (revised 2015) and international guidelines were distributed to all orthopedic practitioners in HTAR Klang (including surgeons, orthopedic medical officers), endocrinologists, rheumatologists and geriatricians. The participants were evaluated on their expertise in the diagnosis, prevention, treatment decision and medications for osteoporosis. Collected data were analyzed for all descriptive and statistical analyses as appropriate. All 45 participants responded to the questionnaire. Participants scored highest on expertise in prevention, followed by diagnosis, treatment decision and lastly, medication. Most practitioners stated that own-initiated continuing professional education from articles and books was the most effective way to update their knowledge, followed by attendance in conferences on osteoporosis. This study confirms the importance of comprehensive training and education regarding osteoporosis among tertiary care physicians and surgeons, predominantly in pharmacotherapy, to deliver wholesome care for osteoporotic patients.
Abstract: Osteoporosis is a multifactorial disease that results in reduced quality of life, causes decreased bone strength, and changes in their microarchitecture. Mostly postmenopausal women are at risk. In our study, we measured anthropometric parameters of postmenopausal women (104 women of control group – CG and 105 women of osteoporotic group - OG) and determined TSH hormone levels and PTH as well as mineral elements - Ca, P, Mg and enzyme alkaline phosphatase. Through the correlation analysis in CG, we have found association based on age and BMI, P and Ca, as well as Mg and Ca; in OG we determined interdependence based on an association of age and BMI, age and Ca. Using the Student's t test, we found significantly important differences in biochemical parameters of Mg (p ˂ 0,001) and TSH (p ˂ 0,05) between CG and OG.
Abstract: Medical, social, and economic relevance of osteoporosis is caused by reducing quality of life, increasing disability and mortality of the patients as a result of fractures due to the low-energy trauma. This study is aimed to examine the associations of metabolic syndrome components, bone mineral density (BMD) and trabecular bone score (TBS) in menopausal women with non-vertebral fractures. 1161 menopausal women aged 50-79 year-old were examined and divided into three groups: A included 419 women with increased body weight (BMI - 25.0-29.9 kg/m2), B – 442 females with obesity (BMI >29.9 kg/m2)i and C – 300 women with metabolic syndrome (diagnosis according to IDF criteria, 2005). BMD of lumbar spine (L1-L4), femoral neck, total body and forearm was investigated with usage of dual-energy X-ray absorptiometry. The bone quality indexes were measured according to Med-Imaps installation. All analyses were performed using Statistical Package 6.0. BMD of lumbar spine (L1-L4), femoral neck, total body, and ultradistal radius was significant higher in women with obesity and metabolic syndrome compared to the pre-obese ones (p
Abstract: Osteoporosis is a common disease characterized by low bone mass and deterioration of micro-architectural bone tissue, which provokes an increased risk of fracture. This work treats the texture characterization of trabecular bone radiographs. The aim was to analyze according to clinical research a group of 174 subjects: 87 osteoporotic patients (OP) with various bone fracture types and 87 control cases (CC). To characterize osteoporosis, Fractal and MultiFractal (MF) methods were applied to images for features (attributes) extraction. In order to improve the results, a new method of MF spectrum based on the q-stucture function calculation was proposed and a combination of Fractal and MF attributes was used. The Support Vector Machines (SVM) was applied as a classifier to distinguish between OP patients and CC subjects. The features fusion (fractal and MF) allowed a good discrimination between the two groups with an accuracy rate of 96.22%.
Abstract: Osteoporosis and obesity are widespread diseases in people over 50 years associated with changes in structure and body composition. Нigher body mass index (BMI) values are associated with greater bone mineral density (BMD). However, trabecular bone score (TBS) indirectly explores bone quality, independently of BMD. The aim of our study was to evaluate the relationship between the BMD and TBS parameters in Ukrainian men suffering from obesity. We examined 396 men aged 40-89 years. Depending on their BMI all the subjects were divided into two groups: Group I – patients with obesity whose BMI was ≥ 30 kg/m2 (n=129) and Group II – patients without obesity and BMI of < 30 kg/m2 (n=267). The BMD of total body, lumbar spine L1-L4, femoral neck and forearm were measured by DXA (Prodigy, GEHC Lunar, Madison, WI, USA). The TBS of L1- L4 was assessed by means of TBS iNsight® software installed on DXA machine (product of Med-Imaps, Pessac, France). In general, obese men had a significantly higher BMD of lumbar spine L1-L4, femoral neck, total body and ultradistal forearm (p < 0.001) in comparison with men without obesity. The TBS of L1-L4 was significantly lower in obese men compared to non-obese ones (p < 0.001). BMD of lumbar spine L1-L4, femoral neck and total body significantly differ in men aged 40-49, 50-59, 60-69, and 80-89 years (p < 0.05). At the same time, in men aged 70-79 years, BMD of lumbar spine L1-L4 (p=0.46), femoral neck (p=0.18), total body (p=0.21), ultra-distal forearm (p=0.13), and TBS (p=0.07) did not significantly differ. A significant positive correlation between the fat mass and the BMD at different sites was observed. However, the correlation between the fat mass and TBS of L1-L4 was also significant, though negative.
Abstract: Osteoporosis is one of the important problems in postmenopausal women due to an increased risk of sudden and unexpected fractures. This study is aimed to determine the connection between bone mineral density (BMD) and trabecular bone score (TBS) in Ukrainian women suffering from metabolic syndrome. Participating in the study, 566 menopausal women aged 50-79 year-old were examined and divided into two groups: Group A included 336 women with no obesity (BMI ≤ 29.9 kg/m2), and Group B – 230 women with metabolic syndrome (diagnosis according to IDF criteria, 2005). Dual-energy X-ray absorptiometry was used for measuring of lumbar spine (L1-L4), femoral neck, total body and forearm BMD and bone quality indexes (last according to Med-Imaps installation). Data were analyzed using Statistical Package 6.0. A significant increase of lumbar spine (L1-L4), femoral neck, total body and ultradistal radius BMD was found in women with metabolic syndrome compared to those without obesity (p < 0.001) both in their totality and in groups of 50-59 years, 60-69 years, and 70-79 years. TBS was significantly higher in non-obese women compared to metabolic syndrome patients of 50-59 years and in the general sample (p < 0.05). Analysis showed significant positive correlation between body mass index (BMI) and BMD at all levels. Significant negative correlation between BMI and TBS (L1-L4) was established. Despite the fact that BMD indexes were significantly higher in women with metabolic syndrome, the frequency of vertebral and non-vertebral fractures did not differ significantly in the groups of patients.
Abstract: In the diagnostics of osteoporosis, the gold standard is considered to be bone mineral density; however, X-ray densitometry is not an accurate indicator of osteoporotic fracture risk under all circumstances. In this regard, the search for new methods that could determine the indicators not only of the mineral density, but of the bone tissue quality, is a logical step for diagnostic optimization. One of these methods is the evaluation of trabecular bone quality. The aim of this study was to examine the quality and mineral density of spine bone tissue, femoral neck, and body composition of women depending on the duration of the postmenopausal period, to determine the correlation of body fat with indicators of bone mineral density and quality. The study examined 179 women in premenopausal and postmenopausal periods. The patients were divided into the following groups: Women in the premenopausal period and women in the postmenopausal period at various stages (early, middle, late postmenopause). A general examination and study of the above parameters were conducted with General Electric X-ray densitometer. The results show that bone quality and mineral density probably deteriorate with advancing of postmenopausal period. Total fat and lean mass ratio is not likely to change with age. In the middle and late postmenopausal periods, the bone tissue mineral density of the spine and femoral neck increases along with total fat mass.
Abstract: Physical activity as a part of people’s everyday life reduces the risk of many diseases, including those induced by lifestyle, e.g. obesity, type 2 diabetes, osteoporosis, coronary heart disease, degenerative arthritis, and certain types of cancer. That refers particularly to professionally active people, including the early senior group working on non-manual positions. The aim of the study is to evaluate the relationship between physical activity and the socio-economic status of non-manual workers from Wroclaw—one of the biggest cities in Poland, a model setting for such investigations in this part of Europe. The crucial problem in the research is to find out the percentage of respondents who meet the health-related recommendations of the World Health Organization (WHO) concerning the volume, frequency, and intensity of physical activity, as well as to establish if the most important socio-economic factors, such as gender, age, education, marital status, per capita income, savings and debt, determine the compliance with the WHO physical activity recommendations. During the research, conducted in 2013, 1,170 people (611 women and 559 men) aged 21–60 years were examined. A diagnostic poll method was applied to collect the data. Physical activity was measured with the use of the short form of the International Physical Activity Questionnaire with extended socio-demographic questions, i.e. concerning gender, age, education, marital status, income, savings or debts. To evaluate the relationship between physical activity and selected socio-economic factors, logistic regression was used (odds ratio statistics). Statistical inference was conducted on the adopted ex ante probability level of p
Abstract: The purpose of the study is to develop a finite element model based on 3D bone structural images of Micro-CT and to analyze the stress distribution for the osteoporosis mouse femora. In this study, results of finite element analysis show that the early osteoporosis of mouse model decreased a bone density in trabecular region; however, the bone density in cortical region increased.
Abstract: Background: Maintaining the correct body balance is
essential in the prevention of falls in the elderly, which is especially
important for women because of postmenopausal osteoporosis and
the serious consequences of falls. One of the exercise methods which
is very popular among adults, and which may affect body balance in
the positive way is the Pilates method. The aim of the study was to
evaluate the effect of regular Pilates exercises on the ability to
maintain body balance in static conditions in adult healthy women.
Material and methods: The study group consisted of 20 healthy
women attending Pilates twice a week for at least 1 year. The control
group consisted of 20 healthy women physically inactive. Women in
the age range from 35 to 50 years old without pain in musculoskeletal
system or other pain were only qualified to the groups. Body balance
was assessed using MatScan VersaTek platform with Sway Analysis
Module based on Matscan Clinical 6.7 software (Tekscan Inc.,
U.S.A). The balance was evaluated under the following conditions:
standing on both feet with eyes open, standing on both feet with eyes
closed, one-leg standing (separately on the right and left foot) with
eyes open. Each test lasted 30 seconds. The following parameters
were calculated: estimated size of the ellipse of 95% confidence, the
distance covered by the Center of Gravity (COG), the size of the
maximum shift in the sagittal and frontal planes and load distribution
between the left and right foot, as well as between rear- and forefoot.
Results: It was found that there is significant difference between the
groups in favor of the study group in the size of the confidence
ellipse and maximum shifts of COG in the sagittal plane during
standing on both feet, both with the eyes open and closed (p
Abstract: Cole-Cole parameters of 40 post-menopausal women
are compared with their DEXA bone mineral density measurements.
Impedance characteristics of four extremities are compared; left and
right extremities are statistically same, but lower extremities are
statistically different than upper ones due to their different fat
content. The correlation of Cole-Cole impedance parameters to bone
mineral density (BMD) is observed to be higher for dominant arm.
With the post-menopausal population, ANOVA tests of the dominant
arm characteristic frequency, as a predictor for DEXA classified
osteopenic and osteoporic population around lumbar spine, is
statistically very significant. When used for total lumbar spine
osteoporosis diagnosis, the area under the Receiver Operating Curve
of the characteristic frequency is 0.830, suggesting that the Cole-Cole
plot characteristic frequency could be a useful diagnostic parameter
when integrated into standard screening methods for osteoporosis.
Moreover, the characteristic frequency can be directly measured by
monitoring frequency driven angular behavior of the dominant arm
without performing any complex calculation.
Abstract: The purpose of this study is the discrimination of 28
postmenopausal with osteoporotic femoral fractures from an agematched
control group of 28 women using texture analysis based on
fractals. Two pre-processing approaches are applied on radiographic
images; these techniques are compared to highlight the choice of the
pre-processing method. Furthermore, the values of the fractal
dimension are compared to those of the fractal signature in terms of
the classification of the two populations. In a second analysis, the
BMD measure at proximal femur was compared to the fractal
analysis, the latter, which is a non-invasive technique, allowed a
better discrimination; the results confirm that the fractal analysis of
texture on calcaneus radiographs is able to discriminate osteoporotic
patients with femoral fracture from controls. This discrimination was
efficient compared to that obtained by BMD alone. It was also
present in comparing subgroups with overlapping values of BMD.
Abstract: Obesity and osteoporosis are the two diseases whose
increasing prevalence and high impact on the global morbidity and
mortality, during the two recent decades, have gained a status of
major health threats worldwide. Obesity purports to affect the bone
metabolism through complex mechanisms. Debated data on the
connection between the bone mineral density and fracture prevalence
in the obese patients are widely presented in literature. There is
evidence that the correlation of weight and fracture risk is sitespecific.
This study is aimed at determining the connection between
the bone mineral density (BMD) and trabecular bone score (TBS)
parameters in Ukrainian women suffering from obesity. We
examined 1025 40-89-year-old women, divided them into the groups
according to their body mass index: Group A included 360 women
with obesity whose BMI was ≥30 kg/m2, and Group B – 665 women
with no obesity and BMI of
Abstract: The aim of this study is to evaluate the effects of the
laser and partial vibration stimulation on the mice tibia with
morphological characteristics. Twenty female C57BL/6 mice (12
weeks old) were used for the experiment. The study was carried out on
four groups of animals each consisting of five mice. Four groups of
mice were ovariectomized. Animals were scanned at 0 and 2 weeks
after ovariectomy by using micro computed tomography to estimate
morphological characteristics of tibial trabecular bone. Morphological
analysis showed that structural parameters of multi-stimuli group
appear significantly better phase in BV/TV, BS/BV, Tb.Th, Tb.N,
Tb.Sp, and Tb.pf than single stimulation groups. However, single
stimulation groups didn’t show significant effect on tibia with Sham
group. This study suggests that multi-stimuli may restrain the change
as the degenerate phase on osteoporosis in the mice tibia.
Abstract: Bone properties and response behavior after static or
dynamic activation (loading) are still interesting topics in many fields
of the science especially in the biomechanical problems such as bone
loss of astronauts in space, osteoporosis, bone remodeling after
fracture or remodeling after surgery (endoprosthesis and implants)
and in osteointegration. This contribution deals with the relation
between physiological, demineralized and deproteinized state of the
turkey long bone – tibia. Three methods for comparison were used: 1)
densitometry, 2) three point bending and 3) frequency analysis. The
main goal of this work was to describe the decrease of the protein
(collagen) or mineral of the bone with relation to the fracture in three
point bending. The comparison is linked to the problem of different
bone mechanical behavior in physiological and osteoporotic state.
Abstract: Osteoporosis is a common multifactorial disease with
a strong genetic component characterized by reduced bone mass and
increased risk of fractures. Genetic factors play an important role in
the pathogenesis of osteoporosis. The aim of our study was to
identify the genotype and allele distribution of T245G polymorphism
in OPG gene in Slovak postmenopausal women. A total of 200
unrelated Slovak postmenopausal women with diagnosed
osteoporosis and 200 normal controls were genotyped for T245G
(rs3134069) polymorphism of OPG gene. Genotyping was performed
using the Custom Taqman®SNP Genotyping assays. Genotypes and
alleles frequencies showed no significant differences (p=0.5551;
p=0.6022). The results of the present study confirm the importance of
T245G polymorphism in OPG gene in the pathogenesis of
osteoporosis.
Abstract: Osteoporosis is a complex health disease characterized by low bone mineral density, which is determined by an interaction of genetics with metabolic and environmental factors. Current research in genetics of osteoporosis is focused on identification of responsible genes and polymorphisms. TNFRSF11B gene plays a key role in bone remodeling. The aim of this study was to investigate the genotype and allele distribution of A163G (rs3102735) osteoprotegerin gene promoter and G1181C (rs2073618) osteoprotegerin first exon polymorphisms in the group of 180 unrelated postmenopausal women with diagnosed osteoporosis and 180 normal controls. Genomic DNA was isolated from peripheral blood leukocytes using standard methodology. Genotyping for presence of different polymorphisms was performed using the Custom Taqman®SNP Genotyping assays. Hardy-Weinberg equilibrium was tested for each SNP in the groups of participants using the chi-square (χ2) test. The distribution of investigated genotypes in the group of patients with osteoporosis were as follows: AA (66.7%), AG (32.2%), GG (1.1%) for A163G polymorphism; GG (19.4%), CG (44.4%), CC (36.1%) for G1181C polymorphism. The distribution of genotypes in normal controls were follows: AA (71.1%), AG (26.1%), GG (2.8%) for A163G polymorphism; GG (22.2%), CG (48.9%), CC (28.9%) for G1181C polymorphism. In A163G polymorphism the variant G allele was more common among patients with osteoporosis: 17.2% versus 15.8% in normal controls. Also, in G1181C polymorphism the phenomenon of more frequent occurrence of C allele in the group of patients with osteoporosis was observed (58.3% versus 53.3%). Genotype and allele distributions showed no significant differences (A163G: χ2=0.270, p=0.605; χ2=0.250, p=0.616; G1181C: χ2= 1.730, p=0.188; χ2=1.820, p=0.177). Our results represents an initial study, further studies of more numerous file and associations studies will be carried out. Knowing the distribution of genotypes is important for assessing the impact of these polymorphisms on various parameters associated with osteoporosis. Screening for identification of “at-risk” women likely to develop osteoporosis and initiating subsequent early intervention appears to be most effective strategy to substantially reduce the risks of osteoporosis.
Abstract: This paper presents a novel method for prediction of
the mechanical behavior of proximal femur using the general
framework of the quantitative computed tomography (QCT)-based
finite element Analysis (FEA). A systematic imaging and modeling
procedure was developed for reliable correspondence between the
QCT-based FEA and the in-vitro mechanical testing. A speciallydesigned
holding frame was used to define and maintain a unique
geometrical reference system during the analysis and testing. The
QCT images were directly converted into voxel-based 3D finite
element models for linear and nonlinear analyses. The equivalent
plastic strain and the strain energy density measures were used to
identify the critical elements and predict the failure patterns. The
samples were destructively tested using a specially-designed gripping
fixture (with five degrees of freedom) mounted within a universal
mechanical testing machine. Very good agreements were found
between the experimental and the predicted failure patterns and the
associated load levels.
Abstract: Transpedicular screw fixation in spinal fractures,
degenerative changes, or deformities is a well-established procedure.
However, important rate of fixation failure due to screw bending,
loosening, or pullout are still reported particularly in weak bone stock
in osteoporosis. To overcome the problem, mechanism of failure has
to be fully investigated in vitro. Post-mortem human subjects are less
accessible and animal cadavers comprise limitations due to different
geometry and mechanical properties. Therefore, the development of a
synthetic model mimicking the realistic human vertebra is highly
demanded. A bone surrogate, composed of Polyurethane (PU) foam
analogous to cancellous bone porous structure, was tested for 3
different densities in this study. The mechanical properties were
investigated under uniaxial compression test by minimizing the end
artifacts on specimens. The results indicated that PU foam of 0.32
g.cm-3 density has comparable mechanical properties to human
cancellous bone in terms of young-s modulus and yield strength.
Therefore, the obtained information can be considered as primary
step for developing a realistic cancellous bone of human vertebral
body. Further evaluations are also recommended for other density
groups.