Discordance between the degree of osteopenia and the prevalence of spontaneous vertebral fractures in Crohn's disease.

BACKGROUND: A high prevalence of osteoporosis has been noted in Crohn's disease, but data about fractures are scarce. METHODS: The relationship between low bone mineral density and the prevalence of vertebral fractures was studied in 271 patients with ileo-caecal Crohn's disease in a large European/Israeli study. One hundred and eighty-one currently steroid-free patients with active Crohn's disease (98 completely steroid-naive) and 90 steroid-dependent patients with inactive or quiescent Crohn's disease were investigated by dual X-ray absorptiometry scan of the lumbar spine, a standardized posterior/anterior and lateral X-ray of the thoracic and lumbar spine, and an assessment of potential risk factors for osteoporosis. RESULTS: Thirty-nine asymptomatic fractures were seen in 25 of 179 steroid-free patients (14.0%; 27 wedge, 12 concavity), and 17 fractures were seen in 13 of 89 steroid-dependent patients (14.6%; 14 wedge, three concavity). The prevalence of fractures in steroid-naive patients was 12.4%. The average bone mineral density, expressed as the T-score, of patients with fractures was not significantly different from that of those without fractures (-0.759 vs. -0.837; P=0.73); 55% of patients with fractures had a normal T-score. The bone mineral density was negatively correlated with lifetime steroids, but not with previous bowel resection or current disease activity. The fracture rate was not correlated with the bone mineral density (P=0.73) or lifetime steroid dose (P=0.83); in women, but not in men, the fracture rate was correlated with age (P=0.009). CONCLUSIONS: The lack of correlation between the prevalence of fractures on the one hand and the bone mineral density and lifetime steroid dose on the other necessitates new hypotheses for the pathogenesis of the former.

[The assessment of the public health status of flight personnel]. / Otsenka sostoianiia obshchestvennogo zdorov'ia letnogo sostava.

A set of the objective quantitative parameters characterizing a pilot health status in a generalized form is required to manage the medical examination system. The medical and statistical data are proposed to be used. The major indices of health status of a group of pilots (public health) are: 1. Probability estimation of threat to space mission safety due to a sudden incapacitation of a pilot; 2. Evaluation of medical disqualification rate per mile of pilots tested; 3. Flying longevity of the pilots evaluated as an average duration of forthcoming flying activity; 4. Prevalence of diseases and factors of their risk determined from the standardized criteria. The methods of obtaining the mentioned and some other quantitative data on pilot personnel of the former Soviet Civil Aviation are discussed. It is indicated that at present the level of health threat to flight safety conforms to the general safety standards.