Relationship between spine osteoarthritis, bone mineral density and bone turn over markers in post menopausal women.

BACKGROUND: Several studies have observed an inverse relationship between osteoporosis and spinal osteoarthritis, the latter being considered as possibly delaying the development of osteoporosis. The aim of this study was to determine the association between individual radiographic features of spine degeneration, bone mineral density (BMD) and bone-turn over markers. METHODS: It was a cross sectional study of 277 post menopausal women. BMD of all patients was assessed at the spine and hip using dual-energy X-ray absorptiometry. Lateral spinal radiographs were evaluated for features of disc degeneration. Each vertebral level from L1/2 to L4/5 was assessed for the presence and severity of osteophytes and disc space narrowing (DSN). For Bone turn-over markers, we assessed serum osteocalcin and C-terminal cross-linking telopeptide of type I collagen (CTX). Linear regressions and partial correlation were used respectively to determine the association between each of disc degeneration features, BMD, and both CTX and osteocalcin. RESULTS: Mean age of patients was 58.7 +/- 7.7 years. Eighty four patients (31.2%) were osteoporotic and 88.44% had spine osteoarthritis. At all measured sites, there was an increase in BMD with increasing severity of disc narrowing while there was no association between severity of osteophytes and BMD. After adjustment for age and BMI, there was a significant negative correlation between CTX and DSN. However, no significant correlation was found between CTX and osteophytes and between osteocalcin and both osteophytes or DSN. CONCLUSION: In post menopausal women the severity of disc narrowing, but not osteophytes, is associated with a generalized increase in BMD and a decreased rate of bone resorption. These results are consistent with the hypothesis that osteoarthritis, through DSN, has a protective effect against bone loss, mediated by a lower rate of bone resorption. However, spine BMD is not a relevant surrogate marker for the assessment of osteoporosis in the spine in patients with osteoarthritis and debate as to the relationship between OA and OP is still open because of the contradictory data in the literature.

Educational level and osteoporosis risk in postmenopausal Moroccan women: a classification tree analysis.

The objectives of this study are (1) to evaluate whether the prevalence of osteoporosis and peripheral fractures might be influenced by the educational level and (2) to develop a simple algorithm using a tree-based approach with education level and other easily collected clinical data that allow clinicians to classify women into varying levels of osteoporosis risk. A total number of 356 women with a mean age of 58.9±7.7 years were included in this study. Patients were separated into four groups according to school educational level; group 1, no education (n=98 patients); group 2, elementary level (n=57 patients); group 3, secondary level (n=138 patients) and group 4, university level (n=66 patients). We observed dose-response linear relations between educational level and mean bone mineral density (BMD). The mean BMDs of education group 1 (10.39% (lumbar spine), 10.8% (trochanter), 16.8% (wrist), and 8.8% (femoral neck)) were lower compared with those of group IV (p<0.05). Twelve percent of patient had peripheral fractures. The prevalence of peripheral fractures increased with lowered educational levels. Logistic regression analysis revealed a significant independent increase in the risk of peripheral fracture in patients with no formal education (odds ratio, 5.68; 95% , 1.16-27.64) after adjustment for age, BMI and spine BMD. Using the classification tree, four predictors were identified as the most important determinant for osteoporosis risk: the level of education, physical activity, age>62 years and BMI<30 kg/m2. This algorithm correctly classified 74% of the women with osteoporosis. Based on the area under the receiver-operator characteristic curves, the accuracy of the Classification and Regression Tree (CART) model was 0.79. Our findings suggested that a lower level of education was associated with significantly lower BMDs at the lumbar spine and the hip sites, and with higher prevalence of osteoporosis at these sites in a dose-response manner, even after controlling for the strong confounders. On the other hand, our CART algorithm based on four clinical variables may help to estimate the risk of osteoporosis in a health care system with limited resources.

The effect of past use of oral contraceptive on bone mineral density, bone biochemical markers and muscle strength in healthy pre and post menopausal women.

BACKGROUND: during adulthood, most studies have reported that oral contraceptive (OC) pills had neutral, or possibly beneficial effect on bone health. We proposed this study of pre and post menopausal women assessing BMD, bone biochemical markers and physical performance among OC past users and comparable women who have never use Ocs. METHODS: A cross-sectional study comparing the bone density, bone biochemical markers (osteocalcin, CTX) and three measures to assess physical performance: timed get-up-and-go test "TGUG", five-times-sit-to-stand test "5 TSTS" and 8-feet speed walk "8 FSW" of users and never users OC. We were recruited 210 women who used OC for at least 2 years with that of 200 nonusers was carried out in pre and postmenopausal women (24-86 years). RESULTS: when analysing the whole population, BMD and biochemical markers values were similar for Ocs past users and control subjects. However when analysing the subgroup of premenopausal women, there was a statistically significant difference between users and never-users in osteocalcin (15,5 +/- 7 ng/ml vs 21,6 +/- 9 ng/ml; p = 0,003) and CTX (0,30 +/- 0,1 ng/ml vs 0,41 +/- 0,2 ng/ml; p = 0,025). This difference persisted after adjustment for age, BMI, age at menarche and number of pregnancies. In contrast, in post menopausal women, there was no difference in bone biochemical markers between OC users and the control. On the other hand OC past users had a significant greater performance than did the never users group. And when analysing the physical performance tests by quartile OC duration we found a significant negative association between the three tests and the use of OC more than 10 years. CONCLUSION: the funding show no evidence of a significant difference in BMD between Ocs users and never user control groups, a decrease in bone turn over in OC pre menopausal users and a greater physical performances in patients who used OC up than 10 years.

Low bone mineral density is related to atherosclerosis in postmenopausal Moroccan women.

BACKGROUND: Some studies have implicated several possible metabolic linkages between osteoporosis and vascular calcification, including estrogen deficiency, vitamin D excess, vitamin K deficiency and lipid oxidation products. Nevertheless, it remains unclear whether osteoporosis and atherosclerosis are related to each other or are independent processes, both related to aging. The aim of this cross-sectional study was to evaluate the correlation between arterial thickening and bone status in a sample of apparently healthy Moroccan women. METHODS: Seventy-two postmenopausal women were studied. All patients were without secondary causes that might affect bone density. Bone status was assessed by bone mineral density (BMD) in lumbar spine and all femoral sites. Arterial wall thickening was assessed by intima-media thickness (IMT) in carotid artery (CA) and femoral artery (FA). Prevalent plaques were categorized into four groups ranging from low echogenicity to high echogenicity. RESULTS: The mean age was 59.2 +/- 8.3 years. 84.7% had at least one plaque. By Spearman Rank correlation, CA IMT was negatively correlated to Femoral total BMD (r = -0.33), Femoral neck BMD (r = -0.23), Ward triangle BMD (r = -0.30) and Trochanter BMD (r = -0.28) while there was no association with lumbar BMD. In multiple regression analysis, CA IMT emerged as an independent factor significantly associated with all femoral sites BMD after adjusting of confounding factors. FA IMT failed to be significantly associated with both Femoral and Lumbar BMD. No significant differences between echogenic, predominantly echogenic, predominantly echolucent and echolucent plaques groups were found concerning lumbar BMD and all femoral sites BMD CONCLUSION: Our results demonstrate a negative correlation between bone mineral density (BMD) qnd carotid intima-media thickness (IMT) in postmenopausal women, independently of confounding factors. We suggest that bone status should be evaluated in patients with vascular disease to assess whether preventive or therapeutic intervention is necessarry.

Relationship between historical height loss and vertebral fractures in postmenopausal women.

The aim of this study was to evaluate the relationship between historical height loss (HHL) and prevalent vertebral fractures (VF) in postmenopausal Moroccan women and to estimate its accuracy as a clinical test for detecting VF. Two hundred eighty-eight postmenopausal women were studied. All subjects had bone density measurements and spinal radiographs. Vertebral bodies (T4-L4) were graded using the semi-quantitative method of Genant. HHL was calculated as the difference between a patient's tallest recalled height and the current measured height. The mean age was 58.4 +/- 7.8 years. Thirty-one percent of patients were osteoporotic, and 46.5% had VF. Patients with VF had lost more height than those without VF (median, 2.0 cm (0.26-3.3) vs 0.96 cm (0.33-2.4), p < 0.05). In univariate analysis, HHL was positively correlated to both number and grade of prevalent VF (p < 0.05). The area under the receiver operating characteristics curve for the ability of HHL to detect VF was 0.60 (95% confidence interval (CI), 0.52, 0.69). Our HHL threshold for detecting VF was >1.5 cm, its sensitivity was 58%, and its specificity was 61%. The positive predictive value was 53%, and the negative predictive value was 65%. With HHL >1.5 cm, positive likelihood ratio was 1.49 with 95% CI, 1.07, 2.06. Our results demonstrate significant positive associations between HHL, VF, number of VF, and grade of VF. However, this relationship is not clinically pertinent. Consequently, HHL cannot be used as a reliable clinical test for detecting VF in postmenopausal Moroccan women.

The relationship between physical performance measures, bone mineral density, falls, and the risk of peripheral fracture: a cross-sectional analysis.

BACKGROUND: Several factors, in addition to low bone mineral density (BMD), have been identified as risks for fractures, including reduced levels of physical activity, poor balance and low physical performance. The aim of this study was to evaluate the relationship between physical performance measures, BMD, falls, and the risk of peripheral fracture in a population sample of Moroccan women. METHODS: 484 healthy women were included. Three measures were used to assess physical performance: timed get-up-and-go test 'TGUGT', five-times-sit-to-stand test '5 TSTS' and 8-feet timed walk '8 FTW'. The association between physical performance measures and BMD, peripheral fracture and falls was performed by univariate and multivariate analysis. RESULTS: The mean age was 55.1 years. Higher 'TGUGT', '5 TSTS', '8 FTW' test scores were associated with lower BMD measured at different sites (p range from < 0.001 to 0.005). The relationship between the three tests and BMD in all measured sites remained significant after multiple linear regression (p range from <0.001 to 0.026). In the group of post-menopausal patients, the scores of 'TGUGT' and '8 FTW' were significantly higher in fractured patients compared with patients without. After logistic regression, a score of 'TGUGT' > 14.2 sec, a score of '5 TSTS' > 12.9 sec and a score of '8 FTW' > 4.6 sec respectively, increased the probability of anterior peripheral fracture by 2.7, 2.2 and 2.3 (OR = 2.7; 95% CI = 1.2-6.4, OR = 2.2; 95% CI = 1.1-5.2; and OR = 2.3; 95% CI = 1.1-5.1). There was a significant positive correlation between the number of fall/year and the 3 tests. This correlation persisted after poisson regression. CONCLUSION: This study suggested that low physical performance is associated with low BMD, and a high risk of history of falls and fractures.

Factors influencing quality of life in Moroccan postmenopausal women with osteoporotic vertebral fracture assessed by ECOS 16 questionnaire.

OBJECTIVE: The aim of the study was to evaluate factors influencing quality of life (QOL) in Moroccan postmenopausal women with osteoporotic vertebral fracture assessed by the Arabic version of ECOS 16 questionnaire. METHODS: 357 postmenopausal women were included in this study. The participants underwent bone mineral density (BMD) measurements by DXA of the lumbar spine and the total hip as well as X-ray examination of the thoraco-lumbar spine to identify subclinical vertebral fractures. Patients were asked to complete a questionnaire on clinical and sociodemographic parameters, and osteoporosis risk factors. The Arabic version of the ECOS16 (Assessment of health related quality of life in osteoporosis questionnaire) was used to assess quality of life. RESULTS: The mean age was 58 +/- 7.8 years, and the mean BMI was 28.3 +/- 4.8 kg/m2. One hundred and eight women (30.1%) were osteoporotic and 46.7% had vertebral fractures. Most were categorized as Grade1 (75%). Three independent factors were associated with a poor quality of life: low educational level (p = 0,01), vertebral fracture (p = 0,03), and history of peripheral fracture (p = 0,006). Worse QOL was observed in the group with vertebral fracture in all domains except "pain": Physical functioning (p = 0,002); Fear of illness (p = 0,001); and Psychosocial functioning (p = 0,007). The number of fractures was a determinant of a low QOL, as indicated by an increased score in physical functioning (p = 0,01), fear of illness (p = 0,007), and total score (p = 0,01) after adjusting on age and educational level. Patients with higher Genant score had low QOL in these two domains too (p = 0,002; p = 0,001 respectively), and in the total score (p = 0,01) after adjusting on age and educational level. CONCLUSION: Our current data showed that the quality of life assessed by the Arabic version of the ECOS 16 questionnaire is decreased in post menopausal women with prevalent vertebral fractures, with the increasing number and the severity of vertebral fractures.

[True intra-articular lipoma in a rheumatoid knee]. / Lipome intra-articulaire vrai sur un genou rhumatoïde.

INTRODUCTION: Lipoma is a frequent benign tumor of the soft tissue, but intra-articular locations are rare. We report a case that occurred in a rheumatoid knee. CASE: A 50-year-old woman had been treated for 17 years for seronegative deforming rheumatoid arthritis. Disease course under corticotherapy (7.5 mg/day) proceeded by flares and remissions. She had reported arthritis of the left knee for the past two years; concern about infection led to aspiration of the knee joint, which found inflammatory aseptic fluid, and radiography of the knee was normal. The patient was unable to afford magnetic resonance imaging or computed tomography. Synovial biopsy showed nonspecific chronic synovitis. Repeated corticosteroid injections produced no improvement. A second synovial biopsy was performed without specific results. Surgical biopsy followed and identified an intra-articular fatty mass, which was then excised surgically. Histologic examination showed a true synovial lipoma. DISCUSSION: True intra-articular lipoma, found mostly in the knee, is extremely rare and usually occurs de novo. For our patient its appearance in an arthritic knee required that lipoma arborescens be ruled out. MRI can provide a positive and differential diagnosis, but nonetheless requires histologic confirmation. It shows an encapsulated adipose mass, surrounded by synovial membrane, while lipoma arborescens is a villous proliferation in which fat cells infiltrate the synovium. Treatment is surgical or arthroscopic.

Progressive pseudorheumatoid dysplasia: three cases in one family.

UNLABELLED: Progressive pseudorheumatoid dysplasia is an inherited skeletal dysplasia with autosomal recessive transmission. Radiographs of the spine show abnormalities similar to those seen in spondyloepiphyseal dysplasia tarda. The clinical presentation, but not the imaging study findings, suggest juvenile idiopathic arthritis. We report 3 cases of progressive pseudorheumatoid dysplasia in the same family. CASE-REPORTS: A 4-year-old girl had been receiving follow-up for 3 years for seronegative, polyarticular juvenile idiopathic arthritis progressing by flares and remissions. The disease was unresponsive to anti-inflammatory medications. Findings at admission included inflammatory joint pain, joint swelling, range-of-motion limitation, and joint deformities in the hands, wrists, ankles, and knees. The hips were normal. Normal values were found for the erythrocyte sedimentation rate and C-reactive protein level. Synovial fluid removed from one of the knees exhibited mechanical properties. Plain radiographs of the hands and forefeet showed no evidence of joint destruction. Bilateral hip dysplasia was noted on a radiograph of the pelvis. The diagnosis of juvenile idiopathic arthritis was reconsidered. A study of the family identified two similar cases, in a brother and paternal uncle. The brother, who was 14 years old, had similar manifestations without laboratory evidence of inflammation; radiographs disclosed dysplasia of the hips and metacarpophalangeal epiphyses. Manifestations in a paternal uncle consisted of spinal stiffness, thoracic kyphosis, and motion-range limitation at the hips; radiographs showed normal sacroiliac joints and bilateral hip dysplasia. A diagnosis of progressive pseudorheumatoid dysplasia with polyarticular involvement was given. DISCUSSION: Progressive pseudorheumatoid dysplasia is an autosomal recessive disease characterized by abnormal cartilage homeostasis. It should be included among the differential diagnoses of juvenile idiopathic arthritis.

Performance of the osteoporosis risk assessment tool in Moroccan men.

Measuring bone mineral density (BMD) is a widely accepted strategy for identifying subjects with an increased risk of fracture. However, because of limited availability of BMD technology in some communities and cost considerations, it has been proposed that BMD measurements be targeted to subjects with risk factors for osteoporosis. Osteoporosis self-assessment tool (OST) using age and weight have been developed to identify women who are more likely to have low BMD and thus undergo BMD testing. To study the performance of OST in identifying osteoporotic white men in Morocco. We analysed in an epidemiological cross-sectional study the records for 229 white Moroccan men seen at an out-patient rheumatology centre. OST was compared to bone density T scores and the ability of OST to identify men with osteoporosis (T < -2.5) was evaluated. Using an OST score < 2 to recommend dual X-ray absorptiometry (DXA) referral, sensitivity ranged from 63% at the lumbar spine to 87% at the total hip to detect BMD T scores of -2.5 and specificity from 58 to 59%. The negative predictive value was high at all skeletal sites (87-98%), demonstrating the usefulness of the OST to identify patients who have normal BMD and should not receive DXA testing. The performance of OST among men in Morocco was similar to that reported earlier for the other samples in Asian countries and the USA. The OST is an effective and efficient tool to help target high-risk men for DXA measurement.