| 1. |
- Ivaska, Kaisa, et al.
(författare)
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Serial assessment of serum bone metabolism markers identifies women with the highest rate of bone loss and osteoporosis risk.
- 2008
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : The Endocrine Society. - 1945-7197 .- 0021-972X. ; May 6, s. 2622-2632
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Tidskriftsartikel (refereegranskat)abstract
- Context: One of the important challenges in the management of osteoporosis is to identify women who are at high risk of developing osteoporosis and fragility fractures. Objective: To evaluate if assessment of bone metabolism at multiple occasions can identify women with the highest risk for bone loss. Design: The Malmö OPRA study is an ongoing longitudinal study. Participants have been evaluated at baseline and after 1, 3 and 5 years. Setting: Population-based study. Participants: 1044 women, all 75 years old at baseline. Main outcome measures: Seven bone turnover markers were assessed at baseline, 1, 3 and 5 years (n=573). Five year change in areal bone mineral density (aBMD) was also determined. Results: Baseline markers correlated weakly to change in total body aBMD. The associations were more pronounced when the average of the baseline and 1-year measurements was used (standardized regression coefficients -0.12 to -0.23, p<0.01). Adding the 3-year and 5-year measurement further strengthened the correlation (regression coefficients up to -0.30 (p<0.001)). Women with constantly high turnover lost significantly more bone at total body (-2.6%) than women with intermediate (-1.6%) or low turnover (-0.2%, p for trend <0.001). They also had a greater decrease in hip BMD (-8.3%, -6.0% and -5.1%, respectively, p=0.010). Results were similar also in the subgroup of women with osteopenia. Conclusions: Our results suggest that serial assessment of bone turnover improves the identification of women with the highest rate of bone loss and osteoporosis risk.
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| 2. |
- Lekamwasam, Sarath, et al.
(författare)
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Age-related trends in hip geometry in Sri Lankan women: a cross-sectional study
- 2007
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Ingår i: Journal of Bone and Mineral Metabolism. - : Springer Science and Business Media LLC. - 0914-8779 .- 1435-5604. ; 25:6, s. 431-435
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Tidskriftsartikel (refereegranskat)abstract
- Indices of hip geometry are known to be predictive of hip fractures while sex and ethnic differences in hip geometry have been previously demonstrated. Age-related trends in hip geometry among Asians, however, have not been studied sufficiently. A total of 280 healthy, perimenopausal women, aged between 32 and 97 years, were selected from the Community Study Area of the Faculty of Medicine, Galle, Sri Lanka. Hip DXA images were analyzed further to calculate the hip axis length, neck-shaft angle, and femoral neck width at the narrowest point of the femoral neck. Standard formulae were used to calculate cross-sectional area, cross-sectional moment of inertia, and section modulus in the femoral neck region. Mean (SD) age, weight, height, femoral neck bone mineral density (BMD), hip axis length, neck-shaft angle, neck width, cross-sectional area, and cross-sectional moment of inertia of the study sample were 56.8 (13.0) years, 47.8 (10.1) kg, 1.48 (0.06) m, 0.704 (0.147) g/cm(2), 90.6 (5.6) mm, 123.2 (5.7) degrees, 2.99 (0.24) cm, 2.00 (0.42) cm(2), and 1.62 (0.47) cm(4), respectively. Height and weight of subjects had positive correlations with most of the indices of hip geometry. Femoral neck BMD, cross-sectional area and section modulus showed a rapid reduction during the postmenopausal period. With advancing age, there was a marginal but statistically nonsignificant expansion of the neck width, increase in the hip axis length, and narrowing of the neck-shaft angle. In conclusion, this study demonstrated a gradual loss of BMD in postmenopausal age, accompanied by thinning of the cortical shell and deterioration of the resistance to bending in the femoral neck of this group of healthy women. The clinical relevance of the marginal changes seen in other indices such as neck-shaft angle, hip axis length, and neck width is not known.
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| 3. |
- Lekamwasam, Sarath, et al.
(författare)
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Effect of hip flexion on the measurement of spinal bone mineral density in the Norland Eclipse XR
- 2005
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Ingår i: Journal of Clinical Densitometry. - 1094-6950. ; 8:2, s. 183-186
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Tidskriftsartikel (refereegranskat)abstract
- It is recommended that the hip joints be flexed to 90 degrees during dual-energy X-ray absorptiometry scanning of the lumbar spine in the anteroposterior projection; however, some patients are unable to maintain this position because of the presence of degenerative changes in lower limb joints. This study examines the effect of a lesser degree of hip flexion on the lumbar spine bone mineral density (BMD) measurement and its interpretation. Fifty women were scanned on the Norland Eclipse XR, initially in the standard position with the hips flexed to 90 degrees and then in the adjusted position after allowing for some degree of hip extension to keep them comfortable (hip flexion of 60 degrees -70 degrees ).Higher bone mineral content (BMC), surface area, and BMD values were seen in the standard position compared to the adjusted position, but none of the differences was statistically significant. There were strong correlations for BMC,surface area, and BMD measured in the two positions. In the standard position, 26 women were found to have osteoporosis and 18 had osteopenia. In the adjusted position, osteoporosis was noted in 27 women, and 18 had osteopenia.Four women showed a reduction, whereas 12 women showed an increase in BMD in excess of the least significant change at the 95% confidence level, defined as 2.77 times the precision error (0.008 g/cm(2) x 2.77 = 0.120 g/cm(2)). Our study demonstrates that a lesser degree of hip flexion in women who find it difficult to maintain the recommended 90 degrees hip flexion during the lumbar spine BMD measurement would not affect the patient classification based on T-scores recommended by the World Health Organization; however, variation in hip flexion can be a major confounding factor when interpreting a change in BMD over time.
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| 4. |
- Lekamwasam, Sarath, et al.
(författare)
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Tooth loss and bone mineral density among women: a cross-sectional survey
- 2006
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Ingår i: The Ceylon medical journal. - 0009-0875. ; 51:3, s. 102-105
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: We examined the association between total tooth loss and bone mineral density to determine whether the former can be used as a surrogate marker of the latter. DESIGN: A community based cross-sectional survey. SETTING: The community-study area of the Faculty of Medicine, Galle. PARTICIPANTS: A group of randomly selected 327 women volunteers aged 32 to 97 years. MEASUREMENTS: Anthropometry, total number of teeth lost and bone mineral density (BMD) of the lumbar spine and proximal femur. RESULTS: In categorical analysis, after adjusting for possible confounding factors, mean BMDs of the spine and proximal femur showed no significant differences in the thirds of the total tooth loss. In regression analysis, a loss of one tooth was negatively associated with spine BMD of premenopausal women by 0.003 g/cm2 and the trochanteric BMD of postmenopausal and all women by 0.001 g/cm2. These associations, however, were not seen in other skeletal sites. CONCLUSIONS: Total tooth loss did not show a uniform and significant association with bone mineral density, measured at relevant skeletal sites. Total tooth loss as a surrogate marker of low bone density cannot be justified in this population of women.
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| 5. |
- Lenora, Janaka
(författare)
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Bone turnover markers and prediction of bone loss in elderly women
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Around 70,000 osteoporosis-related fractures occur in Sweden annually and approximately half of the women in western world will sustain a fragility fracture after the age of 50 years. Fracture preventive efforts require the identification of individuals who are at high risk. Biochemical markers of bone turnover (BTMs) have shown some degree of fracture predictability. There is also a correlation between rate of decrease of areal bone mineral density (aBMD) and incident fractures. In this study, the correlation between BTMs and rate of bone loss (change of aBMD and ultrasound variables) over 5 years was investigated in the Malmö OPRA cohort of 75-year old women (n = 506 to 601). In addition, correlation of BTMs and bone metabolism, as assessed by scintigraphy, was tested in postmenopausal women (n = 22). Finally, the effect of precision error on the longitudinal monitoring of change in aBMD was assessed in elderly women (n = 690) and in elderly men (n = 211). There was a strong correlation between all bone turnover markers and the results of scintigraphy (total skeletal uptake of 99mTc-labelled methylene diphosphonate), with no significant difference between bone formation markers and bone resorption markers. BTMs correlated to the 5-year rate of change of aBMD, especially in the legs and the total body, and 5-year change in speed of ultrasound. When serial measurements of BTMs were analysed, the mean value of measurements were correlated more strongly to aBMD change than single measurements, and women with constantly high levels of BTMs had higher rates of bone loss. Precision error of aBMD measurement by dual-energy X-ray absorptiometry has an influence on the detection of individuals with aBMD change exceeding the least significant level. The calculated follow-up interval for detection of a change in aBMD beyond the least significant level in more than half of the elderly individuals ranged from 3–32 years, and was dependent on the equipment used and the skeletal site tested. The results of this study indicate that currently available BTMs are associated with future bone loss. However, these correlations may not be strong enough to be predictive of bone loss at the individual level. DXA also has some limitations when used in the longitudinal setting in elderly individuals. DXA is therefore of limited use in the longitudinal monitoring of bone loss. Further studies with novel bone turnover markers may improve the ability of BTMs to predict bone loss.
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| 6. |
- Lenora, Janaka, et al.
(författare)
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Bone turnover markers are correlated with total skeletal uptake of 99mTc-methylene diphosphonate (99mTc-MDP).
- 2009
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Ingår i: BMC Medical Physics. - : Springer Science and Business Media LLC. - 1756-6649. ; 9, s. 3-3
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Tidskriftsartikel (refereegranskat)abstract
- ABSTRACT: BACKGROUND: Skeletal uptake of 99mTc labelled methylene diphosphonate (99mTc-MDP) is used for producing images of pathological bone uptake due to its incorporation to the sites of active bone turnover. This study was done to validate bone turnover markers using total skeletal uptake (TSU) of 99mTc-MDP. METHODS: 22 postmenopausal women (52-80 years) volunteered to participate. Scintigraphy was performed by injecting 520 MBq of 99mTc-MDP and taking whole body images after 3 minutes, and 5 hours. TSU was calculated from these two images by taking into account the urinary loss and soft tissue uptake. Bone turnover markers used were bone specific alkaline phosphatase (S-Bone ALP), three different assays for serum osteocalcin (OC), tartrate resistant acid phosphatase 5b (S-TRACP5b), serum C-terminal cross-linked telopeptides of type I collagen (S-CTX-I) and three assays for urinary osteocalcin (U-OC). RESULTS: The median TSU of 99mTc-MDP was 23% of the administered activity. All bone turnover markers were significantly correlated with TSU with r-values from 0.52 (p = 0.013) to 0.90 (p < 0.001). The two resorption markers had numerically higher correlations (S-TRACP5b r = 0.90, S-CTX-I r = 0.80) than the formation markers (S-Total OC r = 0.72, S-Bone ALP r = 0.66), but the difference was not statistically significant. TSU did not correlate with age, weight, body mass index or bone mineral density. CONCLUSION: In conclusion, bone turnover markers are strongly correlated with total skeletal uptake of 99mTc-MDP. There were no significant differences in correlations for bone formation and resorption markers. This should be due to the coupling between formation and resorption.
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| 7. |
- Lenora, Janaka, et al.
(författare)
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Effect of Precision on Longitudinal Follow-Up of Bone Mineral Density Measurements in Elderly Women and Men.
- 2010
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Ingår i: Journal of Clinical Densitometry. - : Elsevier BV. - 1094-6950. ; 13:4, s. 407-412
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Tidskriftsartikel (refereegranskat)abstract
- Precision error of dual-energy X-ray absorptiometry exceeds the expected annual rate of bone loss in the elderly. The capacity to detect changes in areal bone mineral density (aBMD; g/cm(2)) over a 5-yr period was assessed. Six hundred ninety-one women, 75.2 (0.1)yr, from the Malmö OPRA-study, were measured using Lunar DPX-L (GE Lunar, Madison, WI), and 211 men, 74.7 (3.2)yr, from the Malmö Mr Os-study, were measured using Lunar Prodigy (GE Lunar) with follow-up 5yr later. Precision error was determined with 30 degrees of freedom. Least significant change (LSC, i.e., 2.77xprecision error) was calculated. Women's precision errors (g/cm(2)) for DPX-L were 0.028 (total hip [TH]) and 0.016 (lumbar spine [LS]), and for Prodigy, they were 0.009 (TH) and 0.039 (LS). In men, corresponding results for Prodigy were 0.014 and 0.031. In women, 41% and in men, 39% had aBMD changes exceeding the LSC at TH. Follow-up intervals (i.e., LSC/median rate of aBMD change) for both women and men were 8yr (TH) and 13yr (LS). Based on Prodigy precision data, follow-up intervals for women were 3 and 32yr at TH and LS. In summary, several years were needed to detect change. Only when a high rate of bone loss is suspected, a short follow-up time is possible, in elderly persons.
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| 8. |
- Lenora, Janaka, et al.
(författare)
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Effects of multiparity and prolonged breast-feeding on maternal bone mineral density : a community-based cross-sectional study
- 2009
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Ingår i: BMC Women's Health. - : Springer Science and Business Media LLC. - 1472-6874. ; 9, s. 1-6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studies conducted in Western countries have shown that bone loss associated with pregnancy and breast-feeding is recovered after weaning. However, it is not clear whether recovery takes place after repeated pregnancies followed by prolonged periods of breast-feeding; especially in developing countries where nutritional intake is comparatively low.This study was designed to examine the effects of multiparity and prolonged breast-feeding on maternal bone mineral density (BMD) in a community-based sample of 210 Sri Lankan women, aged between 46 and 98 years.Methods: BMD of the lumbar spine (L 2-L 4) and femoral neck were measured by dual-energy X-ray absorptiometry. Reproductive history was recorded by using a questionnaire. Women were, first, divided into groups according to parity (nulliparous, 1-2, 3-4, and 5 or more children), and BMDs in different groups were compared, initially unadjusted and then adjusted for age. Same subjects were subdivided, again, according to the total duration of breast-feeding (0, 1-48, 49-96, and 97 months or more) and similar analysis was carried out.Results: Women who had 5 or more children and women who had breast-fed for 97 months or more were older than the other women (p < 0.01) but no differences in height, weight or BMI were observed among the groups. Age adjusted BMD at lumbar spine and femoral neck BMDs of women grouped according to parity were not significantly different. Neither was there any difference between lumbar spine or femoral neck BMD in groups based on duration of breast-feeding.Conclusion: From this population-based study conducted in a developing country, we infer that history of multiparity or prolonged breast-feeding has no detrimental effects on maternal BMD in post-menopausal age.
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