Follow-up study of bone mineral density and C-terminal telopeptide marker as predicators of fracture risk

Osteoporosis is a major health problem in many countries. Osteoporotic fractures are the main consequence of osteoporosis. Our aim was to identify the usefulness of bone mineral density and C-terminal telopeptide of type 1 collagen as predictors of fracture risk. We evaluated both BMD and serum carboxy-terminal pyridinoline cross-linked telopeptide of type I collagen [ICTP] in 212 subjects recruited from the community. This included healthy postmenopausal women and males over 60 years. Subjects were followed up for the occurrence of fractures jar one year. X-ray radio graphs of thoracic and lumber regions were done to detect silent vertebral fractures at baseline, and at the end of 1 year. Male gender was associated with a higher level of serum ICTP. BMD was insignificantly higher in males compared with females. Age, weight, BMI were significantly correlated with BMD. Age was significantly correlated with ICTP levels. BMD proved to be a strong predictor of incident fracture specially vertebral and hip fractures. Serum levels of ICTP were also predictors of incident fracture and this observation was more evident in females compared to males. Advancing age and low weight were predictors of increased incidence of fractures. Coffee was found to increases bone resorption, accordingly has a detrimental effect on bone strength. Other caffeine containing beverages [tea, cola] were not fond to have a significant effect on bone resorption

Detection of vertebral fractures versus bone mineral density in early ankylosing spondylitis

To determine bone mineral density [BMD] in patients with mild ankylosing spondylitis [AS], to establish the prevalence of vertebral fractures and fracture risk in these patients, and to determine the relationship between BMD and vertebral fractures. Twenty patients were compared with five healthy subjects were included in the study as a control group. Bone mineral density [BMD] was evaluated at the lumbar spine, forearm and femoral neck by dual X-ray absorptiometry [DXA] and A clinical index of disease activity [BASDAI; Bath Ankylosing Spondylitis Activity Index] was also evaluated and plain radiographs of the thoracic and lumbar spine were obtained in all subjects. In patients with AS, BMD was reduced in both the lumbar spine T score -1.0700 +/- 1.9572] and femoral neck [T score -1.3850 +/- 1.2999] and forearm [T score-.9150 +/- 7969] There was no correlation between BMD of the lumbar spine, forearm or femoral neck and duration of disease in patients with AS. four of 20 [20%] patients with AS had a vertebral fracture. Patients with AS with fractures were not significantly older [mean age 34.0 +/- 2.120P=0.301], but had significantly longer disease duration [7.4500 +/- 1.1459, P<0.05] than patients without fractures. No significant correlation between indices of disease activity [ESR and BASDAI] and vertebral fractures in patients with AS. No significant correlation was observed between BMD of the lumbar spine, forearm or femoral neck and vertebral fractures in patients with AS. In addition, there was no significant difference in the lumbar spine, forearm or femoral neck BMD in AS patients with fractures compared with those without. Osteopenia of spine, forearm and femur and vertebral fractures are a feature of mild AS. However, there was no correlation between BMD and vertebral fractures in these patients. AS patients with mild disease had a higher risk of fractures compared with the normal population and this increased with the duration of disease

Enhanced fracture healing with pulsed electromagnetic field

Our study was designed to examine the effect of pulsed electromagnetic field [PEMF], capacitative technique, on the healing of fractures at different stages. Forty-four patients were included in the study. They were divided into three groups. The first group comprised twenty-three patients who were subjected to PEMF after application of plaster cast [early treatment group]. The second included six patients who received PEMF after removal of the cast at 8 weeks [late treatment group]. The third group comprised fifteen patients who were only treated with fixation in plaster cast and served as a control group. The three groups were investigated using cross-sectional osteocalcin level at the start and at 8 and 12 weeks. Plain x-rays were done every 2 weeks and bone mineral density [BMD] was assessed with the quantitative CT of periosteal callus and expressed as F [fracture] / N [normal]% at 8 and 12 weeks. Laboratory and radiological data were statistically analyzed. We concluded that PEMF accelerates bone healing as there was a statistically significant difference in osteocalcin level between early treated patients and controls at 8 weeks and a highly significant difference at 12 weeks for patients who continued treatment. Late treatment patients were found to have increased osteocalcin level too. Radiological results confirmed the laboratory results for the positive effect of PEMF on bone healing. We recommend the use of PEMF for enhancement of fracture healing in cases of delayed union and in old age