Parathyroid Hormone Disturbances in Postmenopausal Women with Distal Forearm Fracture.

BACKGROUND: Primary hyperparathyroidism (PHPT) is a common endocrine disorder with a wide range of adverse effects, such as osteoporosis. Many women are not diagnosed due to asymptomatic disease or vague symptoms but are still at risk of severe adverse effects. Early identification of patients with PHPT is therefore of importance. The aim of this study was to determine PHPT prevalence among postmenopausal women with a distal forearm fracture. METHODS: Recruitment was conducted in conjunction with the occurrence of a distal forearm fracture at Karolinska University Hospital. In total, 161 postmenopausal women were included in a cross-sectional study with repeated evaluations. Analyzes of serum calcium, ionized calcium, phosphate, parathyroid hormone (PTH), and vitamin D were performed. Diagnosis of PHPT was based on clinical evaluations and biochemical definitions of serum calcium and PTH in coherence with previous population prevalence reports. RESULTS: Mean age was 64.7 (9.5) years, serum calcium 2.33 (0.10) mmol/L, ionized calcium 1.25 (0.05) mmol/L and PTH 54 (26) ng/L. PTH was elevated in 32 (20%) women. In total, 11 (6.8%) women were diagnosed with PHPT; 6 with classical PHPT and 5 with mild PHPT. The prevalence of PHPT was significantly increased compared to the population prevalence of 3.4% (p = 0.022). CONCLUSION: Screening postmenopausal women in conjunction with low-energy distal forearm fracture revealed a large number of women with parathyroid disturbance. Evaluation of parathyroid hormone and calcium status in this group of patients seems beneficial.

Site-Specific Volumetric Skeletal Changes in Women with a Distal Forearm Fracture.

PURPOSE: To assess site-specific volumetric bone and muscle changes, as well as demographic and biochemical changes, in postmenopausal women with a low-energy distal forearm fracture. METHODS: In a cross-sectional case-control study, postmenopausal women with a distal forearm fracture were compared with age- and gender-matched controls. In total, 203 postmenopausal women (104 cases and 99 controls), with a mean age of 65 years, were included. Measurements included peripheral quantitative computed tomography (pQCT) and dual-energy X-ray absorptiometry (DXA) as well as blood sampling and questionnaires. RESULTS: Forearm trabecular volumetric BMD and total BMD assessed with pQCT were significantly lower in fracture cases compared to controls (p < 0.001). Significantly higher cross-sectional area, lower cortical BMD, and lower cortical thickness were seen in women with fracture (p < 0.033, p < 0.001, and p < 0.001, respectively). Postmenopausal women with fracture had significantly lower hip and spine areal BMD assessed with DXA (p < 0.001). Activity level was higher and a history of falling was more frequent in women with fracture (p < 0.019 and p < 0.001, respectively). Vertebral fracture was observed in 24 women (22%) with a distal forearm fracture. Muscle area, muscle density, PTH, and 25OHD did not differ between fracture cases and controls. CONCLUSION: A distal forearm fracture was associated with site-specific and central bone changes. Postmenopausal women with fracture had a larger bone area in combination with a thinner cortex and lower site-specific total BMD. In addition, women with fracture had a higher activity level, an increased occurrence of previous fall accidents, and a high prevalence of vertebral fractures. Forearm muscle composition, PTH, and 25OHD were not associated with forearm fracture. Fracture preventive measures following a low-energy distal forearm fracture seem beneficial.

Bone health in adolescents with idiopathic scoliosis.

AIMS: Idiopathic scoliosis is the most common spinal deformity in adolescents and children. The aetiology of the disease remains unknown. Previous studies have shown a lower bone mineral density in individuals with idiopathic scoliosis, which may contribute to the causation. The aim of the present study was to compare bone health in adolescents with idiopathic scoliosis with controls. METHODS: We included 78 adolescents with idiopathic scoliosis (57 female patients) at a mean age of 13.7 years (8.5 to 19.6) and 52 age- and sex-matched healthy controls (39 female patients) at a mean age of 13.8 years (9.1 to 17.6). Mean skeletal age, estimated according to the Tanner-Whitehouse 3 system (TW3), was 13.4 years (7.4 to 17.8) for those with idiopathic scoliosis, and 13.1 years (7.4 to 16.5) for the controls. Mean Cobb angle for those with idiopathic scoliosis was 29° (SD 11°). All individuals were scanned with dual energy x-ray absorptiometry (DXA) and peripheral quantitative CT (pQCT) of the left radius and tibia to assess bone density. Statistical analyses were performed with independent-samples t-test, the Mann-Whitney U test, and the chi-squared test. RESULTS: Compared with controls, adolescents with idiopathic scoliosis had mean lower DXA values in the left femoral neck (0.94 g/cm2 (SD 0.14) vs 1.00 g/cm2 (SD 0.15)), left total hip (0.94 g/cm2 (SD 0.14) vs 1.01 g/cm2 (SD 0.17)), L1 to L4 (0.99 g/cm2 (SD 0.15) vs 1.06 g/cm2 (SD 0.17)) and distal radius (0.35 g/cm2 (SD 0.07) vs 0.39 g/cm2 (SD 0.08; all p ≤ 0.024), but not in the mid-radius (0.72 g/cm2 vs 0.74 g/cm2; p = 0.198, independent t-test) and total body less head (1,559 g (SD 380) vs 1,649 g (SD 492; p = 0.0.247, independent t-test). Compared with controls, adolescents with idiopathic scoliosis had lower trabecular volume bone mineral density (BMD) on pQCT in the distal radius (184.7 mg/cm3 (SD 40.0) vs 201.7 mg/cm3 (SD 46.8); p = 0.029), but not in other parts of the radius or the tibia (p ≥ 0.062, Mann-Whitney U test). CONCLUSION: In the present study, idiopathic scoliosis patients seemed to have lower BMD at central skeletal sites and less evident differences at peripheral skeletal sites when compared with controls. Cite this article: Bone Joint J 2020;102-B(2):268-272.

Inter- and intra-rater reliability of vertebral fracture classifications in the Swedish fracture register.

AIM: To investigate the inter- and intra-rater reliability of the vertebral fracture classifications used in the Swedish fracture register. METHODS: Radiological images of consecutive patients with cervical spine fractures (n = 50) were classified by 5 raters with different experience levels at two occasions. An identical process was performed with thoracolumbar fractures (n = 50). Cohen's kappa was used to calculate the inter- and intra-rater reliability. RESULTS: The mean kappa coefficient for inter-rater reliability ranged between 0.54 and 0.79 for the cervical fracture classifications, between 0.51 and 0.72 for the thoracolumbar classifications (overall and for different sub classifications), and between 0.65 and 0.77 for the presence or absence of signs of ankylosing disorder in the fracture area. The mean kappa coefficient for intra-rater reliability ranged between 0.58 and 0.80 for the cervical fracture classifications, between 0.46 and 0.68 for the thoracolumbar fracture classifications (overall and for different sub classifications) and between 0.79 and 0.81 for the presence or absence of signs of ankylosing disorder in the fracture area. CONCLUSION: The classifications used in the Swedish fracture register for vertebral fractures have an acceptable inter- and intra-rater reliability with a moderate strength of agreement.

External validity of a population-based study on osteoporosis and fracture.

BACKGROUND AND PURPOSE: Little is known about the characteristics of non-participants in epidemiological studies. We evaluated external validity by comparing fracture and mortality rate in participants and non-participants in a longitudinal study on risk factors for fracture. METHODS: 1,604 randomly selected women, 75 years of age, were invited to attend a study on osteoporosis and fracture. 1,044 women attended the study (participants) and 560 women did not participate (non-participants). Fracture data for all were obtained prospectively from radiographic records. Mortality data were obtained through the population register. Mean follow-up was 13 (11-15) years. Cumulative survival was compared with the log-rank test. Fracture incidence rates per 1,000 person-years were compared with Mann-Whitney U-tests. In addition, fracture comparisons were made with the cumulative incidence function and Gray's test. RESULTS: 454 participants (44%) died during the follow-up, as compared to 372 of the non-participants (66%) (p < 0.001). The fracture incidence rate for any type of fracture was 43 for participants and 47 for non-participants (p = 1.0). The fracture incidence rate for typical osteoporotic fracture was 36 for participants and 39 for non-participants (p = 0.6). The corresponding values for distal forearm fracture were 11 and 7 (p = 0.002), they were 8 and 9 for proximal humerus fracture (p = 0.9), 13 and 10 for vertebral fracture (p = 0.007), 15 and 18 for hip fracture (p = 0.8), and they were 6 and 5 for pelvic fracture (p = 0.3). The cumulative incidence function confirmed the results. INTERPRETATION: Our findings suggest that participants had a lower mortality rate than non-participants. Distal forearm and vertebral fractures were more frequent in participants. However, the external validity for fractures in general appeared to be satisfactory.

Incidences of kidney, pelvis, ureter, and bladder cancer in a nationwide, population-based cancer registry, Denmark, 1944-2003.

OBJECTIVES: To determine changes in the population-based incidence rates, degree of histologic verification, and morphologic distribution of tumors of the kidney, pelvis, and ureter and bladder in both sexes for the duration of 60 years in Denmark. METHODS: Age-standardized incidence rates in 5-year age and calendar intervals, histologic verification and morphologic distribution were derived from reports to the Danish Cancer Registry. RESULTS: The incidence of kidney tumors increased by 78% among men and 32% among women during the study period; the incidence of pelvis and ureter tumors increased by 1070% and 2785%, respectively, and those of bladder tumors increased by 325% and 195%, respectively. The incidence of Wilms tumor was stable; the incidence of other kidney tumors leveled out during the last 30 years of the period and those of other 2 groups during the last 20 years. The frequency of histologic verification was stable for pelvis and ureter cancers and Wilms tumor and increased for kidney and bladder tumors. Most of the kidney tumors were of epithelial origin and most others were of urothelial origin. CONCLUSIONS: The overall incidences of all tumors increased in both sexes during the 60-year period. Some of the increase could be due to improved diagnosis. The recent decline in rates might be due to reduced exposure to risk factors.