Osteopenia in Puerto Ricans with Crohn's disease

BACKGROUND: Osteopenia has been reported in association to Inflammatory Bowel Disease, and in particular Crohn's disease. The use of corticosteroids, resection of the ileum, malabsorption, poor calcium intake, and the effect of inflammatory cytokines have all been considered as contributing factors. As Crohn's disease is more prevalent in young people, when peak bone mass is achieved, the presence of osteopenia is especially significant. OBJECTIVES: The aim of this study was to evaluate the bone density of patients with Crohn's disease in the University of Puerto Rico IBD Clinic; to determine the prevalence of osteopenia in these patients and to correlate bone mineral density with risk factors for osteopenia. METHODS: Sixty-six patients, 30 males and 36 females were included. After informed consent, demographic, clinical and metabolic data was obtained. Serum albumin, calcium, inorganic phosphorus and alkaline phosphatase were measured. Body mass index (BMI) was calculated. Bone density was determined by DEXA of the lumbar spine and femur and expressed as the Z score (standard deviations from normal correlated with sex and age). Severe osteopenia was a Z score > or = -2 and osteopenia was Z < or = -1.99 or > or = 1.01. Results were expressed in means. Pearson correlation coefficient was used for quantitative variables and Pearson chi-square for categorical values. RESULTS: Osteopenia was present in the hip in 69 and in the lumbar spine in 68. Most patients had received steroids; the difference between treated and not treated patients was not significant. Osteopenia did not correlate with ileal resection, gender, BMI, disease characteristics or biochemical parameters. CONCLUSIONS: Low bone density was frequent in patients with Crohn's disease, but no specific risk factors could be identified. Bone density should be determined in patients with Crohn's disease in order to institute appropriate therapeutic measures.

Clinical profile of 128 subjects operated for primary hyperparathyroidism

From 1960 to 1990, one hundred twenty eight (128) subjects with primary hyperparathyroidism were operated in the University Hospital. The medical records were reviewed. Serum and urine chemistries were done by conventional methods, serum PTH was done by RIA's (N-, C-, and midregion) and intact by IRMA and 1,25 dihydroxycholecalciferol by a non equilibrium receptor assay from calf thymus and preceded by double Sep-Pak chromatography. The distal third of the radius (nondominant arm) was used to evaluate radial bone density (RBD), using single photon absorptiometry (Norland) and the lumbar bone density (LBD) was measured by dual energy X Ray absorptiometry (DEXA). The RBD was done in 41 females and 15 males and the LBD in 12 females and 4 males. The series comprised 95 females, age range from 15 to 79 years, and 33 males, age range from 14 to 69 years. Prominent clinical features included nephrolithiasis in 72 subjects (56 per cent), osteitis fibrosa cystica in 2, isolated familial hyperparathyroidism in 4 subjects in one family, 7 subjects with MEN-1 in 3 families, and 4 subjects with MEN-2 in one family. Only 7 subjects were asymptomatic. Serum calcium was elevated in all, serum alkaline phosphatase was elevated in 24 per cent and urinary hydroxiproline was increased in 48 per cent. Serum phosphorus was low in 92 per cent. PTH assay was either elevated or inappropriately normal for the serum calcium in all patients tested. Serum 1,25 D was elevated in 57 per cent. The PTH level was positively correlated with the serum calcium (r = 0.70), but had no significant correlation with the serum phosphorus and the 1,25 D. The RBD expressed as the standard deviation from that of the mean for age and sex matched controls was > or = 2 SD below the mean in 39 per cent of females and in 40 per cent of males. In contrast to the RBD none of the subjects tested had a LBD > or = 2 SD below the age and sex adjusted mean. 103 subjects had adenomas, 20 primary hyperplasia, 2 carcinomas and in 3 surgical exploration was unsuccessful. As to the outcome of Surgery, 117 (93 per cent) were cured. Thus, in this series, successful surgery for primary hyperparathyroidism is the rule. Primary hyperparathroidism is rarely asymptomatic and appendicular bone disease and nephrolithiasis are commonly seen.

Prevalence of osteopenia and osteoporosis in a normal female Puerto Rican population

The World Health Organization criteria for the diagnosis of Osteopenia and Osteopoposis was applied to a control group of 33 females ages 50 to 59 years and 24 females ages 60 to 69 years. The general exclusion criteria for the selection of subjects included early menopause and diseases, use of drugs and toxic habits such as smoking and alcoholism, known to affect bone and mineral metabolism. Bone mineral densities were measured with a DEXA Hologic, model 1000. In the reference population mean peak bone mineral density expressed in g/cm2 was 1.051 (SD = 0.119) for the lumbar spine at age 30 to 39 years and for the femoral neck 0.861 (SD = 0.098) at age 20 to 29 years. Bone densities below 1 to 2.5 SD from mean peak bone mass ranged from 0.932 to 0.754 g/cm2 in the lumbar spine and 0.763 to 0.616 g/cm2 for the femoral neck. The mean age of the pooled group was 58.4 years. The prevalence of osteopenia in the pooled group was 42 per cent for the lumbar spine and 56 per cent for the femoral neck and of osteoporosis, 12 per cent for the lumbar spine and 8.7 per cent for the femoral neck. A similar prevalence has been found by other investigators in hispanic populations. Such a high percentage of females with osteopenia implicates that bone densitometry must be done in the perimenopausal years and in young individuals at risk so as to proceed with early medical intervention to prevent osteoporosis.

Efficacy of 1, alpha 25-dihidroxyvitamin D (calcitriol) in the treatment of psoriasis vulgaris: an open study

Several reports have appeared in the literature suggesting that Vitamin D metabolites and analogues may be useful for the treatment of psoriasis. This is a report of an open study in which the efficacy of 1, Alpha-25-dihydroxyvitamin D (Calcitriol) is evaluated in cases of moderate to severe psoriasis. Study of ten cases showed moderate improvement in four when using calcitriol at a daily dose of 0.5 ug for a period of three months. All Vitamin D metabolites were within normal limits during and after the trial. Further trials with calcitriol as an adjuvant therapy to topical steroids or photochemotherapy, as well as the development of topical Vitamin D analogues may be the future of this novel therapeutic alternative for psoriasis

The kinetics of D3-3H metabolism in tropical sprue

El metabolismo de vitamin D3 rotulada con titrio (D3-3H) fue estudiado en un grupo pequeño de sujetos controles y sujetos con esprú tropical, al cual les fue administrado de 8 a 10 microcuries del isotopo por vía oral o intravenosa. La media vida del isotopo (D3-3H) fue hallada normal en 2 controles, baja en un sujeto con esprú tropical que presentaba esteatorrea y disminuída en un sujeto con esprú tropical sin esteatorrea. Cuando la dosis fue administrada por vía oral la media vida de D3-3H fue de 35 horas en el control, y no se detectó ninguna radioactividad en el plasma del sujeto con esprú tropical y esteatorrea. A las 24 horas de haber recibido la dosis por vía intravenosa el porciento de radioactividad en el plasma como HCC-3H fue dos veces mayor en los sujetos con esprú tropical que en los controles. La absorción oral del D3-3H fue de 50,5% en el sujeto con esprú tropical y esteatorrea y 86,8% en el sujeto con esprú tropical parcialmente tratado. Estos resultados demostraron una depuración rápida del D3-3H en el sujeto con esprú tropical y esteatorrea indicando depleción de las reservas de vitamina D3 en los tejidos y una disminución de la absorción oral del D3-3H. La presencia de un porciento de la radioactividad en el plasma como HCC-3H dos veces mayor en los sujetos con esprú tropical que en los controles, al administrarse la dósis por vía intravenosa y oral indica que no existe ninguna alteración en el metabolismo de vitamina D3 en esprú tropical