| 1. |
- Bergh, Camilla, et al.
(författare)
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Preoperative dual-energy X-ray absorptiometry and FRAX in patients with lumbar spinal stenosis
- 2018
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Ingår i: Journal of Orthopaedic Surgery and Research. - : Springer Science and Business Media LLC. - 1749-799X. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundOsteoporosis implies an increased risk of complications after orthopedic surgery. For the mostly elderly group of patients undergoing lumbar spinal stenosis surgery (LSS), it is important to include skeletal health evaluation in the preoperative planning. The aim of this study was to assess spine and femoral neck (FN) bone mineral density (BMD) in LSS patients and to evaluate whether the World Health Organization (WHO) fracture risk assessment tool (FRAX) can identify patients with reduced BMD levels in the spine.MethodsThe study involved 65 LSS patients and 53 patients with hip osteoarthritis (HOA) for comparison. BMD was measured with dual-energy X-ray absorptiometry (DXA) in the lumbar spine in three projections: anterior-posterior (AP), lateral and lateral-mid (the mid-portion of the vertebrae), and FN. The LSS patients filled out the FRAX questionnaire.ResultsIn the LSS group, 43% of the women and 8% of the men were classified as being osteoporotic/osteopenic by AP spine measurement. The corresponding proportions using the lateral spine T-score -2.5 were 87% and 57%, respectively, and 82% and 53%, respectively, for the FN. The FN BMD T-score was significantly lower in the LSS group compared with the HOA group. The FRAX questionnaire identified 40% of the LSS patients with a moderate/high risk of sustaining an osteoporotic fracture within 10years, with or without simultaneous FN BMD, while 71% of these patients were classified as being osteoporotic with DXA lateral spine measurement.ConclusionIt is common with osteoporosis/osteopenia in patients undergoing spine surgery, and the identification may influence the surgical treatment why the evaluation of BMD is important preoperatively. FRAX evaluation could not replace DXA measurement of the spine regarding the identification of osteoporosis patients in the preoperative planning phase.
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| 2. |
- Hjalmarsson, Elke Schubert, et al.
(författare)
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Central sensitization in adolescents with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome-a feasibility study
- 2023
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Ingår i: Pilot and Feasibility Studies. - 2055-5784. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPain is a major symptom in adolescents with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome. Although the underlying mechanism causing generalized pain in children with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome is unclear, central sensitization has been suggested as a possible explanation. The aim of this study was to explore the feasibility of a study protocol for a future case-control study, investigating features of central sensitization in adolescents with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome.MethodsCentral sensitization features were measured in ten patients and nine healthy controls aged 13-17 years via experimental pain measurement quantifying primary and secondary hyperalgesia, endogenous pain modulation, and exercise-induced hyperalgesia. Descriptive statistics were used. Frequency, median, and range values were calculated.ResultsEleven out of 57 patients chose to participate. No control could be recruited through public schools. Therefore, a convenience sampling strategy was used for the recruitment of the control group. The process of assessing primary and secondary hyperalgesia, endogenous pain modulation, and exercise-induced hyperalgesia was well tolerated by all participants (patients and controls). When assessing endogenous pain modulation via conditioned pain modulation, two participants in the patient group and three in the control group did not achieve a pain experience >= 3 on the numerical rating scale when immersing their hands in cold water.ConclusionThis study investigated the feasibility, safety, and toleration of experimental pain measurements in adolescents with hypermobility spectrum disorder or hypermobile Ehlers-Danlos syndrome. Although the test protocol proved to be sufficiently feasible for use with the participant group, it will need to be adapted in the main study in order to obtain more reliable data. Recruitment, especially of participants for the control group, can be a major obstacle for future studies and requires careful planning.
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| 3. |
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| 4. |
- Kilebrant, Sophie, et al.
(författare)
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WHOLE-BODY VIBRATION THERAPY IN CHILDREN WITH SEVERE MOTOR DISABILITIES
- 2015
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Ingår i: Journal of Rehabilitation Medicine. - : Foundation for Rehabilitation Information. - 1650-1977 .- 1651-2081. ; 47:3, s. 223-228
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To study the effect of whole-body vibration therapy on bone mass, bone turnover and body composition in severely disabled children. Methods: Nineteen non-ambulatory children aged 5.1-16.3 years (6 males, 13 females) with severe motor disabilities participated in an intervention programme with standing exercise on a self-controlled dynamic platform, which included whole-body vibration therapy (vibration, jump and rotation movements). Whole-body vibration therapy was performed at 40-42 Hz, with an oscillation amplitude of 0.2 mm, 5-15 min/treatment, twice/week for 6 months. Bone mass parameters and bone markers were measured at the study start, and after 6 and 12 months. Results: Whole-body vibration therapy was appreciated by the children. Total-body bone mineral density increased during the study period (p less than0.05). Z-scores for total-body bone mineral density ranged from -5.10 to -0.60 at study start and remained unchanged throughout. Approximately 50% of the subjects had increased levels of carboxy-terminal telopeptides of type I collagen and decreased levels of osteocalcin at the start. Body mass index did not change during the intervention period, but had increased by the 12-month follow-up (pless than 0.05). Conclusion: Whole-body vibration therapy appeared to be well tolerated by children with severe motor disabilities. Total-body bone mineral density increased after 6 months of whole-body vibration therapy. Higher carboxy-terminal telopeptides of type I collagen and lower osteocalcin values indicated that severely disabled children have a reduced capacity for bone acquisition.
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| 5. |
- Kroksmark, Anna-Karin, et al.
(författare)
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Low bone mineral density and reduced bone-specific alkaline phosphatase in 5q spinal muscular atrophy type 2 and type 3: A 2-year prospective study of bone health
- 2023
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Ingår i: ACTA PAEDIATRICA. - : WILEY. - 0803-5253 .- 1651-2227. ; 112:12, s. 2589-2600
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Tidskriftsartikel (refereegranskat)abstract
- AimIndividuals with spinal muscular atrophy (SMA) are at risk of developing skeletal problems. This study investigated bone mineral density (BMD), bone turnover markers and motor function in children and adolescents with SMA type 2 and type 3 over a two-year period. The effect of nusinersen was studied in a subgroup.MethodsSingle-centre study, including 20 patients, 2-18 years, of whom ten patients received nusinersen treatment. BMD was measured by dual-energy X-ray absorptiometry.ResultsAll patients had low BMD levels at baseline; mean Z-score -2.3 for total body less head (TBLH) and -2.9 for total hip left (THL). Significant correlations were found both at baseline and for the follow-up change for motor function and Z-scores (TBLH and THL). For the whole study group, reduced bone formation and unchanged bone resorption, assessed by bone-specific alkaline phosphatase (BALP) (p = 0.0006, ES = -0.83) and C-terminal cross-linking telopeptide of type I collagen (CTX), respectively, were found over the study period. However, BALP decreased less in the nusinersen treatment group, which suggests a positive development on bone mass in these patients.ConclusionBone health evaluation is important in follow-up programmes for SMA patients. Further investigations are warranted for individuals on survival motor neuron-targeted treatments.
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| 6. |
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| 7. |
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| 8. |
- Söderpalm, Ann-Charlott, 1961, et al.
(författare)
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Bone mass development in patients with Duchenne and Becker muscular dystrophies: a 4-year clinical follow-up
- 2012
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Ingår i: Acta Paediatrica. - : Wiley-Blackwell. - 0803-5253 .- 1651-2227. ; 101:4, s. 424-432
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate the longitudinal development of bone mass in patients with Duchenne and Becker muscular dystrophies and to study the impact of muscle strength and motor function on bone mass in these patients. less thanbrgreater than less thanbrgreater thanMethods: Eighteen patients with Duchenne muscular dystrophy (2.3-19.7 years at baseline) and six patients with the milder Becker muscular dystrophy (10.8-18.9 years at baseline) were followed during a 4-year period with respect to areal bone mineral density (BMD), motor function and muscle strength. less thanbrgreater than less thanbrgreater thanResults: Greater bone mineral accretion was observed in the Becker patient group compared with the age-related Duchenne group above 10 years of age, and the older patients with Duchenne experienced decreased femoral neck BMD during the study period. In the study group, significant correlations were found between BMD in the lower extremities and muscle function parameters. less thanbrgreater than less thanbrgreater thanConclusions: The differences in BMD between patients with Duchenne and Becker as well as between different bone measurement sites demonstrated in the present study point out the importance of preserving muscle strength and motor function in patients with muscular dystrophy. Moreover; it highlights the value of performing region-specific analysis of the bone quality in these patients.
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| 9. |
- Söderpalm, Ann-Charlott, 1961
(författare)
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Bone Mineral Density Determination in Children. Evaluation of a novel method and application to Duchenne muscular dystrophy
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: The overall aims of this thesis were to evaluate the dual-energy X-ray and laser (DXL) method for bone densitometry measurements of the calcaneus in children, to provide reference data for bone mineral density (BMD) in the heel bone in young children and to apply the DXL technique to patients with Duchenne muscular dystrophy (DMD) and conduct a survey about bone health of DMD patients. Study populations and methods: The DXL Calscan method was modified and adapted for measurements in children and applied to bone densitometry in all subsequent studies. To provide percentile reference data for the DXL measurements, a total of 334 healthy children aged 2, 4 and 7 years were measured (Study I). Measurement data were collected from 112 individuals, aged 2-21 years, to evaluate the relationship between the heel DXL measurements and whole-body dual-energy X-ray absorptiometry (DXA) measurements (Study II). In a cross-sectional study, 24 DMD patients, aged 2-20 years, were compared with 24 healthy age- and gender-matched controls with special emphasis on bone mass assessed at different skeletal sites and bone turnover (Study III). In a longitudinal study, 18 DMD patients from Study III and 6 patients with Becker muscular dystrophy (MD) were followed for 4 years with the emphasis on bone mass development, body composition, muscle strength and motor function (Study IV). Results: The DXL method was readily applied, both in the very young children and in the children with various disabilities. Reference data for BMD were provided as percentile values for children aged 2, 4 and 7. Additional data (a total of 645 DXL Calscan measurements (328 girls/317 boys)) from a follow-up study enabled the presentation of BMD reference curves (mean ± 2 SD) for children (girls and boys respectively) between 2 and 10 years of age. A high correlation was found between the heel DXL measurements and DXA measurements in the hip, in the spine and in the total body. The DXL measurements predicted the lowest DXA-determined BMD values at these sites with high sensitivity (0.9-1.0) and high specificity (0.86-0.95). In the DMD patients, the BMD levels were generally lower compared with the healthy controls. These differences increased with increasing age and were particularly evident in the hip and the heel. Biochemical markers of bone turnover demonstrated reduced bone formation as well as reduced bone resorption in the DMD patients. The fracture rate was no higher in the DMD group compared with the control group, but the fractures were more frequently located in the lower extremities in the patient group. The BMD values were significantly reduced in the DMD patients, even when compared with Becker MD patients. The Becker MD patients, in turn, showed significantly reduced BMD levels compared with healthy controls at most sites. A significant association was found between the changes in lean mass (muscle mass) and bone mass with time and there was also a strong association between BMD measurements and muscle function parameters. Conclusions: It is feasible to perform DXL bone densitometry measurements of the calcaneus in very young children as well as in children with disabilities. The DXL measurements can predict low BMD values as measured by whole-body DXA. DMD patients had both reduced bone turnover and reduced BMD values compared with healthy controls. The impaired muscle strength and reduced motor function, as observed in the DMD patients, were associated with reduced bone mass during growth. The level of disability appeared to have a major effect on skeletal development, which was, for example, demonstrated as a decrease in hip BMD in the DMD patients with time.
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| 10. |
- Söderpalm, Ann-Charlott, 1961, et al.
(författare)
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DXL measurements children 2-10 years.
- 2013
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Ingår i: Bone Abstracts, 6th International Conference on Childrens Bone Health. Rotterdam. - 2052-1219. ; 2:June (P12)
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 11. |
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| 12. |
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| 13. |
- Söderpalm, Ann-Charlott, 1961, et al.
(författare)
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Hallux valgus; An observational study on patient characteristics, surgical treatment and pre-operative HRQoL from the Swedish foot and ankle register (Swefoot)
- 2023
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Ingår i: Foot. - 0958-2592 .- 1532-2963. ; 57
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Hallux valgus (HV) is a common condition with impact on pain, function and HrQoL. International consensus does not exist on operative treatment of HV and population-level data regarding surgical treatment of HV is lacking. In this study we aimed to present base-line data from surgically treated HV patients reported to the Swedish register for foot and ankle surgery (Swefoot) during the period 2014–2021. Material and Methods: In total, 7543 feet in 6770 patients were analyzed regarding patient characteristics, grading of HV, surgical procedures and pre-operative PROMs Euroqol-5 Dimension-3 L (EQ-5D-3 L) and Self-reported Foot and Ankle Score (SEFAS). Results: Median age was 55 years (range 15–91) and 87% were women. The surgeon classified 63% of the cases as moderate HV, 15% as mild and 22% as severe. The Chevron osteotomy was the preferred surgical method and was used in 74% of all cases. Out of these, 58% were fixated with a screw. The Offset-V osteotomy was the most performed shaft osteotomy. Proximal osteotomies and lateral releases were less common. The pre-operative mean EQ-5D-3 L index and SEFAS summary score were low and HV patients with overweight and rheumatoid arthritis had significantly lower scores. Conclusion: This is the first report from Swefoot describing surgeon- and patient reported pre-operative data in patients with surgical treated HV.
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| 14. |
- Söderpalm, Ann-Charlott, 1961, et al.
(författare)
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Low bone mineral density and decreased bone turnover in Duchenne muscular dystrophy
- 2007
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Ingår i: Neuromuscular Disorders. - : Elsevier BV. - 0960-8966 .- 1873-2364. ; 17:11-12, s. 919-928
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Tidskriftsartikel (refereegranskat)abstract
- This cross-sectional study examined bone mineral density, bone turnover, body composition and calciotropic hormones in 24 boys with Duchenne muscular dystrophy (DMD) (2.3-19.7 years), most of whom were being treated with prednisolone, and 24 age-matched healthy boys. Our study demonstrated lower bone mineral density in the DMD group for total body, spine, hip, heel and forearm measurements. These differences between DMD patients and controls increased with increasing age. Biochemical markers of both bone formation and resorption revealed reduced bone turnover in DMD patients. The fracture rate was not higher in DMD patients. The DMD group had low vitamin D levels but high leptin levels in comparison with the control group. Muscle strength correlated with bone mineral density assessed at the hip and heel in the DMD group. Interventions that increase bone formation should be considered, as DMD patients have reduced bone turnover in addition to their low bone mineral density. © 2007 Elsevier B.V. All rights reserved.
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| 15. |
- Söderpalm, Ann-Charlott, 1961, et al.
(författare)
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Pediatric reference data for bone mineral density in the calcaneus for healthy children 2, 4, and 7 years of age by dual-energy x-ray absorptiometry and laser
- 2005
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Ingår i: J Clin Densitom. - 1094-6950. ; 8:3, s. 305-13
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Tidskriftsartikel (refereegranskat)abstract
- Dual-energy X-ray absorptiometry and laser (DXL) Calscan measures bone mineral density (BMD) in the calcaneus. In the present study, the DXL Calscan device has been modified for use in pediatric practice. It includes a function for measuring calcaneal height, which makes it possible to calculate volumetric bone mineral apparent density (BMAD). The aims of the present study were to evaluate the method when used in children, to create pediatric reference values in healthy Swedish 2-, 4-, and 7-yr-old children for BMD, bone mineral content (BMC), and BMAD, and to study whether these parameters were related to auxological data. The method was well tolerated by all children. Intraindividual coefficients of variation for BMC and BMD decreased with increasing age. The mean BMD was 0.17+/-0.003 g/cm2 in 2-yr-old children, 0.22+/-0.003 g/cm2 in 4-yr-old children, and 0.30+/-0.005 g/cm2 in 7-yr-old children. This study provides normative data as percentile values for BMD, BMC, and BMAD in young children measured with DXL Calscan. BMD was significantly correlated with age (p<0.001), height (p=0.001), weight (p<0.001), and body mass index standard deviation score (p<0.001). Seven-year-old girls showed significantly higher BMD than boys.
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| 16. |
- Söderpalm, Ann-Charlott, 1961, et al.
(författare)
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Reference data for BMD in children 2-10 years of age assessed by DXL Calscan.
- 2012
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Ingår i: Thirty-third Annual Meeting of the American Society for Bone and Mineral Research. Minneapolis, USA.. ; okt:SA134
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Aim To collect normative data in order to generate pediatric reference values for calcaneal bone mineral density (BMD) in healthy 2 - 10-yr-old Swedish children. Background Site-specific information on bone mass development is important when investigating children with different disorders. The lower extremities e.g., are affected at an early stage in children with neuromuscular disorders such as Duchenne muscular dystrophy. Dual energy X-ray absorptiometry (DXA) in combination with a laser measurement of the heel thickness, DXL Calscan (Demetech AB), measures BMD in the heel bone and an apparent density (BMAD) is calculated. The DXL Calscan is portable, easy to use, has a short measurement time, gives a low absorbed radiation dose and the method is applicable in very young children and in individuals with disabilities. Subjects and Method Healthy, Swedish children were randomly included. The left foot was scanned in 117 2-yr-old, 110 4-yr-old and 107 7-yr-old children, 50% were boys, using the DXL Calscan technique. More than 35 % of the children from each age group were followed for another 2 years. A total of 645 measurements in children aged 2 – 10 yrs were performed. Height and weight were determined annually and questionnaires concerning general health were completed at every visit. Results The mean BMD in the 2-yr-olds was 0.17 ± 0.003 g/cm2, in the 4-yr-olds 0.22 ± 0.003 g/cm2 and in the 7-yr-olds 0.30 ± 0.005 g/cm2. The 7-yr-old girls had a significantly higher BMD than the boys (p=0.026) but there were no significant gender differences in the calcaneal BMD in 2- and 4-yr-olds. BMD was significantly correlated with age (p<0.001, r=0.78). A weaker correlation was found between BMAD and age (p<0.001, r=0.23). Based on the data from the 2-yr follow-up; a total of 645 (328 girls/ 317 boys) measurements, reference curves (mean ± 2 SD) were produced for calcaneal BMD in girls and boys aged 2 - 10 yrs according to age and height. Conclusions Gender differences are present in the heel bone BMD at an early age. This study presents gender specific reference curves for heel BMD for children 2-10 yrs of age. These data will be valuable in future research and for evaluating the bone health in children with different disorders and a useful complement when other bone mass measurement techniques are not possible to use, e.g. due to metallic implants.BMAD may reflect mineralization without the influence of bone size. Disclosures: None
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| 17. |
- Söderpalm, Ann-Charlott, 1961, et al.
(författare)
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The Relationship Between Dual Energy X-Ray Absorptiometry (DXA) and DXA With Laser (DXL) Measurements in Children
- 2008
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Ingår i: Journal of Clinical Densitometry. - : Elsevier BV. - 1094-6950. ; 11:4, s. 555-60
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Tidskriftsartikel (refereegranskat)abstract
- The present study was designed to examine the relationship between bone mineral density (BMD) measurements performed using conventional dual energy X-ray absorptiometry (DXA) in total body (TB), spine, and hip and the more recent technique of DXA with laser (DXL) in the calcaneus in a young population and to explore the diagnostic capacity of the heel DXL. One hundred and twelve persons, 2.2-20.6yr of age, were studied using the 2 techniques. Significant correlations were observed between the heel BMD and BMD values in TB (r=0.73, p<0.001), TB(head excluded(HE)) (r=0.83, p<0.001), spine (r=0.72, p<0.001), and hip (r=0.90, p<0.001). The relationships between DXA and DXL measurements with 95% tolerance intervals are presented. Using heel DXL measurements to predict the lowest DXA quartiles at all the other measured sites revealed sensitivity levels of 0.9 (TB, spine, hip) and 1.0 (TB(HE)) and specificity levels of 0.86 (TB), 0.94 (TB(HE)), 0.92 (spine), and 0.95 (hip). We conclude that BMD values obtained with DXA and DXL correlate well and that the DXA and DXL techniques effectively identify the same individuals with low BMD. The DXL, which is portable, easy to use and gives a low radiation dose, can be useful for assessing bone mass in a young population.
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| 18. |
- Söderpalm, Ann-Charlott, 1961, et al.
(författare)
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Whole body vibration therapy in patients with Duchenne muscular dystrophy - A prospective observational study
- 2013
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Ingår i: Journal of Musculoskeletal and Neuronal Interactions - JMNI. - : International Society of Musculoskeletal and Neuronal Interactions. - 1108-7161. ; 13:1, s. 13-18
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:To study the tolerability of whole body vibration (WBV) exercise in patients with Duchenne muscular dystrophy (DMD) and its effects on muscle and bone.METHODS:WBV was performed two to three times a week for three months. Motor function, muscle strength, bone mass and biochemical markers of bone and mineral metabolism were analyzed before and after the WBV period at 0, 3, 6 and 12 months.RESULTS:Six ambulatory patients with DMD aged 5.7-12.5 years completed the study. No changes in creatine kinase activity were found, indicating that the WBV exercise did not further damage the skeletal muscle. No significant changes in bone mass, muscle strength or bone markers were found. However, there was a non-significant trend for the bone formation marker, bone-specific alkaline phosphate, to increase from a mean of 59 U/L to 73 U/L after three months of WBV. The bone formation marker levels returned to baseline three months after discontinuing WBV and were still at that level after nine months.CONCLUSIONS:WBV therapy appears to be safe and well tolerated among ambulatory DMD patients. The potential benefits of WBV on bone and muscle in DMD remain to be elucidated.
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