To investigate the relationship between bone mineral density (BMD) and sagittal spinal balance in the Korean elderly population.
The retrospective study included subjects aged 60 years and above, who had whole-spine lateral radiography and dual-energy X-ray absorptiometry (DEXA) within a year's gap between each other. Sagittal vertical axis (SVA) for evaluation of sagittal spinal balance and five spinopelvic parameters were measured through radiography. The presence of compression fracture was identified. Correlations of BMD T-scores with SVA and with the spinopelvic parameters were assessed using Pearson correlation coefficient (PCC). Linear regression analyses were performed between SVA and the clinical and radiologic variables.
One hundred twenty-two subjects (42 males and 80 females; mean age, 69.93±5.5 years) were included in the study. BMD, femur or spine, was not correlated with SVA or any spinopelvic parameters in both genders (PCC<±0.2), except that spine BMD in men was associated with sacral slope. Univariate regression analysis revealed association between SVA and lumbar lordosis, pelvic tilt, and compression fractures in both genders; it was also associated with age and pelvic incidence in females and with sacral slope in males. Multivariate linear regression model showed lumbar lordosis and compression fracture as variables affecting SVA in both sexes; pelvic incidence was another factor affecting SVA in women only.
BMD was not associated with sagittal spinal balance in the aged. Sagittal spinal balance was explained partly by lumbar lordosis and compression fracture. Further study is warranted to understand progression of sagittal imbalance with age.
Citations
To clarify factors affecting bone mineral density (BMD) in adults with cerebral palsy (CP).
Thirty-five patients with CP participated in this study. Demographic data including gender, age, body mass index (BMI), subtype according to neuromotor type and topographical distribution, ambulatory function, and functional independence measure (FIM) were investigated. The BMD of the lumbar spine and femur were measured using Dual-energy X-ray absorptiometry, and the factors affecting BMD were analyzed.
The BMD had no significant association with factors such as gender, age, and subtype in adults with CP. However, BMI was significantly correlated with the BMD of lumbar spine and femur (p<0.05). The FIM score was also positively correlated with the BMD of femur (p<0.05). Moreover, CP patients with higher ambulatory function had significantly higher BMD of femur (p<0.05).
These findings suggest that BMI and functional levels such as FIM and ambulatory function can affect BMD in adults with CP. The results might be used as basic data, suggesting the importance of treatment including weight bearing exercise and gait training in adults with CP.
Citations
MethodThe subjects were 79 hemiplegic stroke patients (39 males, 40 felames, mean age 61.9 years). We measured the BMD of the subjects, compared the BMD of affected sides with that of unaffected sides, and evaluate the BMD in connection with stroke duration and affected sides.
ResultsThe reduction of the BMD in affected sides was highly correlated with the duration of hemiplegia, but the correlation was not shown in the case of those in unaffected sides. In addition, the difference of BMD in affected sides between those in unaffected sides had an obvious negative correlation with the stroke duration of left hemiplegia, but not with that of right hemiplegia.
ConclusionStroke patients have a high prevalence of osteoporosis and this findings were particularly prominent in people who suffer from left hemiplegia. Early rehabilitative care, including weight-bearing exercise and outdoor ambulation, is essential for left side hemiplegic patients in order to prevent possible complications.
Method A heterogeneous group of 18 prepubertal children with CP (age, 8.9±2.9 years; GMFCS level, IV and V) participated. Patients underwent a dual-energy X-ray absorptiometry scan of the lumbar spine (L1-L4) and proximal femur, and the Z scores were calculated by using data obtained from the control group who were normal children (age, 8.8±2.9 years). We divided the patients into 2 groups: group A standing for 2 hours a day, 5 days a week; group B standing for 30 minutes a day, 1 or 2 days a week. We measured BMD after 1 year and compared it to baseline measurements.
Results BMD was significantly higher on L2-L4 vertebrae, femoral neck and trochanter area after exercise in group A (p＜0.05). There was no significant difference in BMI after exercise in the group B (p＞0.05). BMD according to static weight-bearing exercise for 1 year were significantly different between groups A and B on the L1, L4 vertebrae, femoral neck and trochanter area (p＜0.05).
Conclusion This study suggests that weight-bearing exercise may be an important part of a rehabilitation protocol to maintain and improve BMD in children with spastic quadriplegic CP.
Objective: This study is designed to evaluate the relationship between bone mineral density (BMD) and life-style factors such as physical activity, smoking, and alcohol congumption and to offer the information for the modification of life-style.
Method: Eight hundred and sixty nine inhabitants (354 males and 515 females whose age was 55.0⁑13.9 years- old) were participated in this study. BMD was measured in the right calcaneus by quantitative ultrasound (Mark 6000Ⱂ, Medison). Amount of physical activity, smoking, and alcohol consumption were got through the closely designed interview. Independent sample T-test and simple regression were used for data analysis. Results: Amount of physical activities were 2656.8⁑732.3 cal/day, smokers were 329 persons (37.9% of inhabitants), and amount of alcohol consumption were 26.2⁑53.3 g/day. Increasing the amount of physical activity, BMD showed significantly higher T-score (p＜0.01). Increasing the amount of alcohol consumption, BMD showed significantly lower T-score (p＜0.01). BMD in smokers appeared significantly lower T-score than non-smokers (p＜0.01).
Conclusion: Life-style factors significantly effect on bone mineral density. Therefore prevention of osteoporosis through maintenance or augmentation of BMD needs proper physical activity, cessation of smoking, and no heavy drinking. (J Korean Acad of Rehab Med 2002; 26: 606-614)
Objective: To evaluate the effects of back extensor strengthening exercise on improving the pain, activities of daily living (ADL) and bone mineral density in the chronic low back pain patients.
Method: 21 patients with chronic low back pain participated in back school program. Before program, measurement of lumbar extensor strength with MedXⰒ (Ocala, USA), visual analogue scale (VAS) for pain, level of ADL and bone mineral density (BMD) with DEXA (LunarⰒ, GE, USA) were done. For 12 weeks subjects had received the training for strengthening of back extensor and then, checked up with the above variables again.
Results: The results were as follows: 1) After 12 weeks of lumbar extensor strengthening program, isometric lumbar extensor strength was increased significantly (p＜0.01), 2) VAS and ADL were significantly improved from 5.1 to 3.3, and 8.1 to 9.9, respectively (p＜0.01), 3) BMD of lumbar spine were significantly improved from 1.1 to 0.8 (p＜0.05)
Conclusion: Twelve weeks lumbar extensor strengthening program with pelvic stabilization may be the effective therapeutic program for patients with chronic low back pain. (J Korean Acad Rehab Med 2002; 26: 576-580)
Objective: To examine the relation of shoulder adhesive capsulitis and local bone loss to affected limb.
Method: Twenty-nine patients with the adhesive capsulitis of the shoulder were studied. For reference, 29 patients, without history of injury or disease in the upper limbs, were randomly selected. Areal bone mineral density (BMD) was measured from the proximal humerus, distal humerus and forearm of upper limbs using a ProdigyⰒ (Lunar, USA). The BMD of the affected side versus the unaffected were compared.
Results: The reference group: no significant difference between the mean BMDs in the right and left upper limb. The adhesive capsulitis group: 1) The mean BMD in the proxi-mal humerus of the affected upper limb was significantly lower than the unaffected limb (0.85 g/cm2 vs 0.88 g/cm2; p＜0.05). 2) No significant difference between the mean BMDs in the distal humerus of the affected and unaffected limb (1.10 g/cm2 vs 1.10 g/cm2). 3) No significant difference between the mean BMDs in the forearm of the affected and unaffected limb (0.82 g/cm2 vs 0.82 g/cm2).
Conclusion: In patients with adhesive capsulitis of the shoulder, the mean BMD of the affected limb, compared with the unaffected side, was significantly lower in the proximal humerus. But distal humerus and forearm showed no significant side-to-side differences. (J Korean Acad Rehab Med 2002; 26: 327-331)
Objective: To investigate the changes of bone mineral density (BMD), biochemical bone markers, and lipid profiles according to the duration of menopause in postmenopausal osteoporosis patient receiving continuous hormonal replacement therapy (c-HRT).
Method: Sixty seven patients with postmenopausal osteoporosis who have been under c-HRT for more than two years were used as subjects and divided into two groups according to the time past menopause: group I (0∼10 years), group II (over 10 years). The changes of BMD, biochemical bone markers, lipid profiles on one year and two years of c-HRT were comparatively analyzed in each group.
Results: 1) BMD of lumbar vertebra was increased and biochemical bone markers were decreased after c-HRT in both groups, but BMD of femur from both groups showed no statistical significant changes. 2) The changes in lumbar vertebra, deoxypyridinoline and osteocalcin were significantly higher after first one year than next one year of c-HRT in both groups, with no statistical differences between two groups. 3) Total cholesterol and LDL-cholesterol were decreased, but HDL-cholesterol and triglyceride showed no significant changes after c-HRT in both groups.
Conclusion: The effects of c-HRT on BMD, biochemical bone markers, lipid profiles were not influenced by postmenopausal period. And the effects of c-HRT during first one year were more prominent than those of c-HRT during next one year.
Objective: To investigate the relationship between the plasma leptin concentration and bone metabolism in postmenopausal women with osteoporosis to improve the understanding of the role of leptin in controlling bone mass.
Method: Fifty four postmenopausal women (ages 64⁑8.59 years, body weights 58.14⁑6.92 kg) with osteoporosis were included. The biochemical markers of bone metabolism and serum leptin concentration were measured using the radioimmunoassay. Bone mineral densities were measured by dual energy X-ray absorptiometry. And we investigate the correlation between serum leptin concentration and the biochemical markers of bone metabolism or bone mineral density.
Results: The bone mineral densities were 0.639⁑0.130 g/cm2 in mid-lumbar area, 0.684⁑0.098 g/cm2 in femoral neck and 0.491⁑0.117 g/cm2 in Ward's triangle. The mean value of serum osteocalcin was 26.84⁑16.73 ng/ml, the mean value of urine deoxypyridinoline was 11.84⁑6.08 nmol/mmol Cr, and the plasma concentration of leptin was 11.51⁑8.64 ng/ml. There was no correlation between plasma leptin concentrations and the markers of bone metabolism or bone mineral density.
Conclusion: We could not confirm the significant correlation between the circulating leptin concentration and the bone mass in postmenopausal women. Our data suggest circulating plasma leptin does not have a significant direct influence on bone metabolism and bone mass in postmenopausal women.
Objective: The purpose of this study is to evaluate the loss of bone mineral density on ovariectomized (ovx) rat in young and old rats.
Method: Total 110 Sprague-Dawley female rats which composed of 3 months aged 88 rats and 12 months aged 22 rats were used. They were divided randomly into 5 ovx groups (15 rats for each group) and 5 sham operation group (7 rats for each group). The bone mineral density was measured by Hologic 4,500 Fan Beam bone densitometry at the time of second postoperation week, 4th week, 8th week, and 16th week in young aged group and 4th, 8th week in old aged group.
Results: The bone mineral density in young ovx rats was decreased measured at 2 week, 4 week and 8 week, but not 16 week compared with that of sham operation rats (p＜0.05). In old rats, there was no significant change in bone mineral density between ovx and sham group (p＞0.05).
Conclusion: For the purpose of osteoporosis inducing experiment, young aged rat is more reliable for the detection of bone density change than old aged rat and the bone mineral density change will be continued at least 16 week postovariectomy period.
Objective: To evaluate (1) the effect of chronic low back pain on bone mineral density, and (2) the effect of chronic low back pain on trunk muscle strength in women.
Method: Subjects were 118 women patients (ages of 28∼65 years) suffering from chronic low back pain more than three months and control groups were 218 healthy women (age of 26∼72 years). We measured bone mineral density (BMD) at the lumbar spine and proximal femur using Dual X-ray absorptiometry and trunk muscle strength using Cybex 660 dynamometer.
Results: There was no significant difference between groups in lumbar spine BMD, in proximal femur BMD, or in trunk flexor muscle strength. However, trunk extensor muscle strength was reduced significantly in patient group. Trunk extensor muscle peak torque was 64.69⁑18.48 Nm in the patient group and 73.84⁑22.50 Nm in the control group in 30o/sec, and 58.65⁑18.59 Nm in the patient group and 65.68⁑20.28 Nm in the control group in 60o/sec.
Conclusion: The results suggest that chronic low back pain does not affect the BMD. However, it causes trunk extensor muscle weakness; therefore, trunk extension exercise will be help to the patients with chronic low back pain.
Objective: To examine the correlation between bone mineral density and intervertebral disc degeneration through retrospective study.
Method: Bone mineral density (BMD) and Magnetic resonance (MR) image of lumbar spine from 61 postmenopausal women were assessed to examine the correlation between bone mineral density and intervertebral disc degeneration. We determined BMD of lumbar spine using the dual energy X-ray absorptiometry (DEXA). And we evaluated signal intensity of intervertebral disc, disc height and disc herniation at each lumbar disc level using the MR image. The correlation between BMD (mean value of 2nd, 3rd and 4th lumbar spine BMD) and the sum of grading scores of intervertebral disc degeneration was assessed in all the patients.
Results: There was a positive correlation between BMD of lumbar spine and the sum of grading scores of intervertebral disc degeneration (r=0.415, p value=0.00087).
Conclusion: Bone mineral density has an inverse correlation to intervertebral disc degeneration and which is important when considering degenerative spinal disease and osteoporosis.
Objective: To determine whether estradiol (E2), lipid profile, biochemical markers, and bone mineral density (BMD) are related according to postmenopausal period.
Method: One hundred fifty four women were divided into four groups according to the time past menopause: group I (0∼5 years), group II (6∼10 years), group III (11∼15 years), group IV (more than 16 years). Group I, II, III were subdivided into osteoporosis group (t-score＜2.5) and non-osteoporosis group (t-score≥2.5). E2, lipid profile, osteocalcin, alkaline phosphatase, deoxypyridinoline, and BMD by DEXA were measured in all groups.
Results: There were significant inverse correlation between BMD and postmenopausal period (p＜0.05). Deoxypyridinoline and osteocalcin were correlated with postmenopausal period but there was no statistical significance. Deoxypyridinoline and osteocalcin were increased in osteoporosis group compared to non-osteoporosis group but there was no statistical significance. E2 had significant inverse correlations with postmenopausal period (p＜0.05). E2 had no correlation with factors such as biochemical markers and lipid profile in group I, II, III but had adverse correlation with deoxypyridinoline in group IV.
Conclusion: No specific biochemical markers regarding the duration of menopause were found. Regardless of the duration of menopause, checking both osteocalcin and deoxypyridinoline was statistically significant for the evaluation of postmenopausal osteoporosis.
Objective: To investigate bone mineral density (BMD) and biochemical markers of bone turnover in cerebral palsy patients according to the severity and type.
Method: BMD and biochemical markers of bone turnover were examined in 30 normal children and 57 children with cerebral palsy. They were 10 to 15 years old and divided into 5 groups: Group I, 30 normal children; Group II, 11 with moderate spastic cerebral palsy; Group III, 10 with moderate non-spastic cerebral palsy; Group IV, 24 with bed-ridden spastic cerebral palsy; Group V, 13 with bed-ridden non-spastic cerebral palsy. The bed-ridden cerebral palsy subjects were further divided into two groups: one with treatment of anticonvulsants more than 5 years; the other with no experience of anticonvulsants treatment. BMD and its T-score on the dominant forearm were measured in all subject, and the level of serum osteocalcin and urine deoxypyridinoline were measured in cerebral palsy patients in early morning.
Results: The bed-ridden cerebral palsy children were shorter, weighed less, and also showed significantly lower value of BMD and T-score on the distal radio-ulnar and the distal end of radial bones compared to those of the normal and the moderate cerebral palsy. These parameters were not significantly different between spastic and non-spastic types of same severity of cerebral palsy. There's no difference in the level of serum osteocalcin and urine deoxypyridinoline between each group of cerebral palsy. In cerebral palsy groups, the level of serum osteocalcin remained in the normal range of the same age group of the normal, however, the urine deoxypyridinoline levels were significantly higher than those of the same age groups of the normal. No difference in either BMD or biochemical markers of bone turnover was observed in bed-ridden cerebral palsy groups regardless of anticonvulsants treatment.
Conclusion: A couple of factors accounting for lower BMD in bed-ridden cerebral palsy are as follows: 1) the increase in activity of bone resorption rather than formation, 2) the diminish of muscle use and the decrease of mechanical stresses on the bone. In addition, these results also suggest no effect of anticonvulsants on lower BMD.
Objective: To determine the correlation between osteoporosis and the related factors through retrospective study.
Method: Data from 1002 patients (834 women and 168 men) were analyzed through medical records [bone mineral density (BMD), age, height (Ht), body weight (BW), body mass index (BMI), and the accompanying conditions]. BMD of lumbar spine (L1-4) and femur (neck, Ward's triangle, trochanter, and shaft) were measured using dual energy x-ray absorptiometry (DEXA) and were correlated with age, Ht, BW, BMI, and accompanying diseases, and fracture incidence.
Results: 1) BMD of lumbar spine and femur neck in women significantly correlated with age and that of lumbar spine in men significantly correlated with BMI, Ht, BW. 2) The accompanying conditions in osteoporosis were diabetes mellitus (5.9%), Cushing syndrome (3.7%), oophorectomy (2.8%), hyperthyroidism (2.6%), and chronic renal failure (1.0%). 3) Fracture sites and their incidences were single spine (4.89%), multiple spine (2.99%), and femur (2.0%). 4) Mean BMD and T-score in fracture group was 0.687±0.16 g/cm2, 3.51±1.3 in lumbar spine and 0.578±0.14 g/cm2, 2.70±1.1 in femur, respectively.
Conclusion: Osteoporosis is a major public health problem among the elderly, demanding effective strategic approach for prevention and treatment. We concluded that further studies of male osteoporosis are required.
Objective: The purpose of this study was to investigate a correlation between the muscle strength of trunk and bone mineral density (BMD) in women.
Method: A total of 218 healthy women participated in the study. Their age ranged from 26 to 72 years. Dual X-ray absorptiometry was used to measure the BMD of lumbar spine and the trunk muscle strength was assessed by a Cybex NORMTM system. Under the standard criteria of World Health Organization for the dual X-ray absorptiometry analysis, we divided spine T-score into three groups(group 1: osteoporosis, group 2: osteopenia, and group 3: normal).
Results: The data revealed a siginificant correlation (r=0.455, p=0.0001) between the age and BMD of lumbar spine. Trunk extensor muscle strength revealed 56.27⁑18.08 Nm (mean⁑SD) in osteoporosis group, 72.84⁑21.69 Nm in osteopenic group, and 77.90⁑22.28 Nm in normal group. Trunk flexor muscle strength was 82.73⁑23.30 Nm in osteoporosis group, 86.00⁑19.77 Nm in osteopenic group, and 98.91⁑18.29 Nm in normal group.
Conclusion: These results indicated that the trunk extensor muscle was weaker than the flexor muscle in osteoporotic group. As the bone mineral density reduced, the strength of both trunk extensor and flexor decreased. However the weakness of trunk flexor occurred at the earlier stage of osteoporosis than the weakness of trunk extensor.
Objective: To evaluate and correlate three biochemical markers of bone turnover and bone mineral density in the lumbar spine.
Method: Eighty seven adults with the low back pain(45 men and 42 women) were enrolled in this study. Bone mineral density in the lumbar spine was evaluated by a quantitative computed tomography. Serum osteocalcin, serum alkaline phosphatase, and urinary deoxypyridinoline were measured in the early morning.
Results: The mean serum osteocalcin values were 5.61 ng/ml in men and 5.68 ng/ml in women. The mean urinary deoxypyridinoline values were 6.54 nM/mM.Cr. in men and 10.0 nM/mM.Cr. in women. Among women, the values of serum osteocalcin and alkaline phosphatase were significantly higher in the postmenopausal group than the premenopausal group(p＜0.01). And, they were inversely related to bone mineral density in lumbar spine.
Conclusion: These findings suggest that the measurement of serum osteocalcin, alkaline phosphatase, and urinary deoxypyridinoline can be used as indirect indicators of the current bone status, and can be effectively used in the evaluation and treatment of osteoporosis.
The main objectives of this study were to assess the age related changes of biochemical indices of bone turnover in postmenopausal osteoporotic females, and to assess the correlations of these indices with bone mineral density(BMD) of lumbar spine measured by dual energy X-ray absorptiometry(DEXA). Subgects were 70 osteoporotic women in pre and postmenopausal periods. The results showed that Postmenopausal women had higher level of Osteocalcin(OS) and Deoxypyridinoline(DPYD) with lower level BMD of lumbar spine compared with premenopausal women. Age, height, and weight had significant correlations with BMD of lumbar spine. Also a significant correlation was observed between the OS and DPYD. Pre and postmenopausal osteoporotic women(5, 10, 15 year duration) were similar for the rate of bone turnover. These results indicate that the biochemical indices used in our study are the potential markers to predict an age related change of BMD, as well as bone turnover rate of the lower BMD subjects. The combination of BMD measurement and assessment of the bone turnover rate by measuring biochemical indices would be helpful for the screening and treatment of patients with risks of osteoporosis.
Parkinson's disease(PD) is characterized clinically by bradykinesia, rigidity, tremor, and disturbance of posture and equilibrium. A higher incidence of fractures in PD patient has been reported, however the studies of musculoskeletal complications in PD have been negligible.
The purposes of this study were to investigate the incidence of osteoporosis and spinal compression fracture in PD patients and to evaluate whether the incidence were affected by the severity of PD.
Bone mineral density(BMD) in 21 patients(5 males and 16 females) with idiopathic PD was measured by dual energy X-ray absorptiometry(DXA) and compared with an age adjusted control group(32 females). The patients were divided into two groups according to the Hoehn and Yahr(H-Y) stage as mild or severe and the BMD was compared. Simple x-ray studies of thoracolumbar spine were performed to find out the presence of spinal compression fractures.
The results showed that the BMD of PD patients was significantly lower than control subjects. The PD patients with high H-Y stage(severe group) had lower BMD scores with no statistical significance. The spinal compression fractures were noted mainly at mid-thoracic area and thoraco-lumbar junction. Spinal t-score in patients with a compression fracture was significantly reduced. No significant correlation exists between back pain and a compression fracture.
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