Impact of degenerative radiographic abnormalities and vertebral fractures on spinal bone density of women with osteoporosis

CONTEXT: Measurements of bone density taken by dual-energy x-ray absorptiometry are the most accurate procedure for the diagnosis of osteoporosis. This procedure has the disadvantage of measuring the density of all mineral components, including osteophytes, vascular and extra vertebral calcifications. These alterations can influence bone density results and densitometry interpretation. OBJECTIVE: To correlate radiography and densitometry findings from women with osteoporosis, analyzing the influence of degenerative processes and vertebral fractures on the evaluation of bone density. DESIGN: Retrospective study. SETTING: Osteoporosis outpatients' clinic at Hospital das Clínicas, Universidade Estadual de Campinas. PARTICIPANTS: Ninety-six postmenopausal women presenting osteoporosis diagnosed by bone density. MAIN MEASUREMENTS: Bone mineral density of the lumbar spine and femoral neck were measured by the technique of dual-energy x-ray absorptiometry, using a LUNAR-DPX densitometer. Fractures, osteophytes and aortic calcifications were evaluated by simple x-rays of the thoracic and lumbar spine. RESULTS: The x-rays confirmed vertebral fractures in 41.6 percent, osteophytes in 33.3 percent and calcifications of the aorta in 30.2 percent. The prevalence of fractures and aortic calcifications increased with age. The mean bone mineral density was 0.783g/cm² and the mean T-score was --3.47 DP. Neither fractures nor aortic calcifications had significant influence on bone mineral density (P = 0.36 and P = 0.09, respectively), despite the fractured vertebrae having greater bone mineral density (P < 0.02). Patients with lumbar spine osteophytes showed greater bone mineral density (P = 0.04). Osteophytosis was associated with lumbar spine bone mineral density after adjustment for fractures and aortic calcifications by multiple regression (P = 0.01). CONCLUSION: Osteophytes and lumbar spine fractures can overestimate bone density interpretation. The interpretation of densitometry results should be carried out together with the interpretation of a simple lumbar spine x-ray in elderly women

Weismann-Neter-Stuhl: uma síndrome não tão rara. Relato de dois casos / Weismann-Netter-Stuhl syndrome. A report of two cases

A síndrome de Weisann-Netter-Stuhl é uma displasia óssea conhecida desde 1954. Caracteriza-se por um arqueamento ântero-medial convexo, geralmente bilateral e simétrico dos membros inferiores, envolvendo tíbias e fíbulas. Desde que originalmente descrita, 82 casos foram relatados. Incide nos dois sexos, desde a infância até a oitava ou nona décadas de vida. Até o presente momento foram relatados 14 casos na infância. Os autores descrevem dois casos, sendo o primeiro em um adulto com todas as características da síndrome e o segundo em uma criança com manifestações clínicas e radiográficas sugestiva dessa patologia. É possível que essa síndrome seja mais comum do que a literatura sugere, devendo ser incluída no diagnóstico diferencial de raquitismo/osteomalacia, lues congênita e em alguns casos de doença de Paget

Bone mineral density, vitamin D and anticonvulsant therapy

The aim of this study was to assess bone mineral density and vitamin D metabolism in patients on chronic anticonvulsant therapy. METHODS: Sixty-nine men, outpatients on chronic anticonvulsant therapy, who had been treated for at least 5 years, were studied, comparing them to thirty healthy controls. Bone mineral density was measured as well as serum levels of calcium, ionized calcium, alkaline phosphatase, PTH, 25-hydroxycholecalciferol and 1,25-dihydroxycholecalciferol. RESULTS: No differences in bone mineral density, serum levels of vitamin D and intact-PTH were observed between patients and controls. Bone mineral density was not associated with chronic anticonvulsant therapy. CONCLUSION: Those adult patients who were on chronic anticonvulsant therapy and who lived in low latitude regions had normal bone mineral density as well as vitamin D serum levels