Effect of lumbar spinal stenosis on bone mineral density in osteoporosis patients treated with ibandronate.

BACKGROUND: Lumbar spinal stenosis (LSS) can cause various neurological symptoms and reduce the daily activity of patients. Many studies have shown that free physical activities and exercise can improve bone mineral density (BMD) in patients with osteoporosis. However, the effect of LSS on BMD has not been reported. The purpose of this study was to investigate the effects of LSS on BMD in patients treated with ibandronate for newly diagnosed osteoporosis. METHODS: Group 1 included 83 patients treated for osteoporosis alone, and group 2 included 76 patients treated for both osteoporosis and symptomatic LSS. We confirmed four BMD values presented as T-score at initial, and 1-, 2-, and 3-year follow-ups. Mean BMD and annual changes of BMD for three years were compared between the two groups. Correlations between initial BMD and total change of BMD, and related factors for continuous BMD improvement for three years were also evaluated. RESULTS: Mean annual BMDs were significantly higher in group 1 compared than in group 2 (-3.39 vs. -3.58 at 1-year; -3.27 vs. -3.49 at 2-year; -3.13 vs. -3.45 at 3-year; all p < 0.05). Annual change of BMD at 1-year follow-up (0.32 vs. 0.21, p = 0.036) and total change of BMD for three years (0.57 vs. 0.35, p = 0.002) were significantly higher in group 1. Group 1 had a strong negative correlation (r = -0.511, P = 0.000) between initial BMD and total change of BMD, whereas group 2 showed a weak negative correlation (r = -0.247, p = 0.032). In multivariate analysis, symptomatic LSS was the only independent risk factor for continuous BMD improvement (Odds ratio = 0.316, p = 0.001). CONCLUSIONS: Symptomatic LSS may interfere with BMD improvement in the treatment of osteoporosis with ibandronate. Active treatment for LSS with more potent treatment for osteoporosis should be taken to increase BMD for patients with osteoporosis and LSS.

Significance of Soluble CD93 in Type 2 Diabetes as a Biomarker for Diabetic Nephropathy: Integrated Results from Human and Rodent Studies.

Cluster of differentiation 93 (CD93) is a glycoprotein expressed in activated endothelial cells. The extracellular portion of CD93 can be secreted as a soluble form (sCD93) under inflammatory conditions. As diabetic nephropathy (DN) is a well-known inflammatory disease, we hypothesized that sCD93 would be a new biomarker for DN. We prospectively enrolled 97 patients with type 2 diabetes and evaluated the association between serum sCD93 and DN prevalence. The association between CD93 and development of DN was investigated using human umbilical cord endothelial cells (HUVECs) in vitro and diabetic db/db mice in vivo. Subjects with higher sCD93 levels had a lower estimated glomerular filtration rate (eGFR). The sCD93 level was an independent determinant of both the albumin-to-creatinine ratio (ACR) and the eGFR. The risk of prevalent DN was higher in the high sCD93 group (adjusted odds ratio 7.212, 95% confidence interval 1.244-41.796, p = 0.028). In vitro, CD93 was highly expressed in HUVECs and both CD93 expression and secretion were upregulated after lipopolysaccharides (LPS) stimulation. In vivo, peritoneal and urine sCD93 levels and the renal glomerular expression of CD93 were significantly higher in the db/db mice than in the control db/m+ mice. These results suggest the potential of sCD93 as a candidate biomarker associated with DN.

Serum ferritin levels are associated with arterial stiffness in healthy Korean adults.

Although an association between serum ferritin and atherosclerosis has been suggested, limited epidemiologic data are available regarding the association between ferritin and arterial stiffness in healthy adults. A total of 2932 healthy subjects were enrolled in this study. Anthropometric and biochemical profiles including ferritin were measured. The arterial stiffness was measured using brachial-ankle pulse wave velocity (baPWV). Serum ferritin levels were classified into quartiles and baPWV values gradually increased with each ferritin quartile. Multiple regression analysis showed that ferritin levels were independently correlated with baPWV. After adjusting for multiple risk factors, as compared with the lowest quartile, the odds ratios for high baPWV (>75(th) percentile) were 1.15 (0.84-1.56), 1.37 (0.97-1.73), and 1.46 (1.29-2.17) among men (p for trend < 0.05) and 1.24 (0.87-1.79), 1.53 (1.09-2.16), and 1.80 (1.25-2.82) among women (p for trend < 0.05), for the second, third, and fourth quartiles of ferritin, respectively. In conclusion, serum ferritin levels are independently associated with arterial stiffness in healthy Korean adults.

Complications of medial unicompartmental knee arthroplasty.

BACKGROUND: We report intra- and postoperative complications of unicompartmental knee arthroplasty (UKA). METHODS: This study was conducted on 246 cases of UKA which were performed for degenerative osteoarthritis confined to the medial compartment, from May 2002 to May 2010, for which follow-up periods longer than one year were available. Complications were divided into intra- and postoperative complications. Pre- and postoperative clinical scores, the range of motion, and radiologic findings were analyzed. RESULTS: Complications developed in a total of 24 cases (9.8%, 24/246). Among them, 6 cases had intraoperative complications while 18 had postoperative complications. Among the 6 intraoperative complications, one fracture of the medial tibial condyle, two fractures of the intercondylar eminence, one rupture of the medial collateral ligament, one widening of the peg hole leading to femoral component malposition and late failure, and one total knee arthroplasty (TKA) conversion of a large bony defect of tibial avascular necrosis were observed. Among the 18 postoperative complications, four cases of aseptic loosening of the femoral component, one soft tissue impingement due to malalignment, nine cases of polyethylene bearing dislocation, one case of suprapatellar bursitis, one periprosthetic fracture, one TKA conversion due to medial component overhanging, and one TKA conversion due to pain of unexplained cause were observed. CONCLUSIONS: The mid-term clinical outcomes of UKA were excellent in our study. However, the incidence of complications was very high (9.8%). To prevent intra- and postoperative complications, proper selection of the patients and accurate surgical techniques are required.

Association between Apolipoprotein B/Apolipoprotein A-1 and arterial stiffness in metabolic syndrome.

BACKGROUND: Apolipoprotein B/Apolipoprotein A-1 ratio (Apo B/Apo A-1) is known to be associated with atherosclerotic vascular disease. However, few studies have investigated the relationship between Apo B/Apo A-1 ratio and arterial stiffness, thus we investigated the relationships between Apo B/Apo A-1 and arterial stiffness in patients with metabolic syndrome (MetS). METHODS: 1252 subjects with MetS according to the Adult Treatment Panel III were enrolled in our study. Anthropometric profiles and serum concentrations of Apo B, Apo A-1, fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), and high density lipoprotein cholesterol (HDL-C) were measured. Pulse wave velocity (PWV) was evaluated to assess arterial stiffness. RESULTS: The subjects were stratified into four groups according to their Apo B/Apo A-1 ratios. PWV gradually increased according to Apo B/Apo A-1 quartiles. After adjusting for age, arterial stiffness was significantly correlated with systolic blood pressure, diastolic blood pressure, FPG, homeostasis model assessment (HOMA-IR), Apo B and Apo B/Apo A-1. In multiple logistic regression analysis after adjusting for risk factors, Apo B/Apo A-1 ratio was a significant contributor to increased PWV. CONCLUSION: These results suggest that Apo B/Apo A-1 is independently associated with increased arterial stiffness in patients with MetS.