Calcaneal BMD Obtained by Dual X-Ray and Laser Predicts Future Hip Fractures-A Prospective Study on 4 398 Swedish Women.

The predictive value of dual X-ray and laser (DXL) calcaneal BMD (BMD(DXL)) on hip fractures was prospectively studied in 4,398 females aged 55 to 99 years. The average follow-up period was 3 years and 11 months with a total of 17,270 person years. Fractures were identified from the national patient register. After inclusion, 130 females sustained a hip fracture. The age adjusted hazard ratio for T-score <-2.5 versus >-2.5 was 2.64. Of all patients who sustained a hip fracture 78% had a T-score of -2.5 or below. The annual hip fracture rate was 0.26% at T-scores ≥-2, but 1.5% at T-scores ≤-2.5. The area under curve for the model including calcaneal BMD(DXL), follow-up time, and age to prospectively predict hip fractures was 0.84. Conclusions. Calcaneal BMD(DXL) obtained by DXL Calscan predicts hip fractures and may therefore be suitable for diagnosing osteoporosis and for predicting fracture risk.

Calcaneus BMD short-term precision in young and elderly subjects using the DXL Calscan.

In this study, the short-term reproducibility and agreement between individual units of dual X-ray and laser (DXL) Calscan (version 2), a new bone densitometry device based on dual X-ray absorptiometry and Laser technique, were evaluated. The variations in bone mineral density (BMD) and T-score between the right and the left foot were also studied retrospectively in 334 individuals. The short-term CV%, based on 19 healthy individuals scanned twice on 4 different units, was 2.1%, and the average CV% per scanner ranged from 1.1% to 1.8%. The short-term CV% in 33 elderly individuals (aged 83+/-6 yr) was 3.9% and in a subgroup with a calcaneal T-score of -2.5 or below (n=16) 5.1%. There was no statistical difference between the average BMD of the right and left foot, and (r2) between the right and left side was 0.84. The observed short- and long-term reproducibilities, as well as the acceptable variation between individual machines, show that this version of Demetech DXL Calscan is suitable for measuring BMD.

Infected joint replacements in HIV-positive patients with haemophilia.

Joint replacement in HIV-positive patients remains uncommon, with most experience gained in patients with haemophilia. We analysed retrospectively the outcome of 102 replacement arthroplasties in 73 HIV-positive patients from eight specialist haemophilia centres. Of these, 91 were primary procedures. The mean age of the patients at surgery was 39 years, and the median follow-up was for five years. The overall rate of deep sepsis was 18.7% for primary procedures and 36.3% for revisions. This is a much higher rate of infection than that seen in normal populations. A total of 44% of infections resolved fully after medical and/or surgical treatment. The benefits of arthroplasty in haemophilic patients are well established but the rates of complications are high. As this large study has demonstrated, high rates of infection occur, but survivorship analysis strongly suggests that most patients already diagnosed with HIV infection at the time of surgery should derive many years of symptomatic relief after a successful joint replacement. Careful counselling and education of both patients and healthcare workers before operation are therefore essential.

Vitamin B12 binding proteins in amniotic fluid.

The cobalamin-binding proteins in amniotic fluid are determined by assaying the unsaturated cobalamin-binding capacity of haptocorrin (R-proteins, cobalophilin, or transcobalamin I-like protein and any coexisting intrinsic factor) and non-haptocorrin. Forty-five specimens obtained by amniocentesis, and ninety-two obtained at parturition are analysed. The haptocorrin cobalamin-binding capacity increases rapidly after a gestational age of about 15 weeks. At parturition the concentration varies from 1.4 to 26.8 nmol/l. The non-haptocorrin cobalamin-binding capacity is less than 1% of the total binding capacity. The unsaturated cobalamin-binding capacities do not correlate significantly with birth weight, placental weight, or total protein concentration of the amniotic fluid. The ratio between haptocorrin concentration in amniotic fluid and maternal plasma is about 3:1. The unsaturated cobalamin-binding capacity of haptocorrin in amniotic fluid is significantly higher in pregnancies with female than with male fetuses, and is relatively high in one case of twins. It is suggested that haptocorrin in amniotic fluid originates mainly from the fetus, and may have a bacteriostatic effect.