Fredrik Nyquist

Bone Loss and Fracture Risk After Reduced Physical Activity

Former male young athletes partially lost benefits in BMD (g/cm2) with cessation of exercise, but, despite this, had a higher BMD 4 years after cessation of career than a control group. A higher BMD might contribute to the lower incidence of fragility fractures found in former older athletes ⩾60 years of age compared with a control group.

Association between findings on delayed gadolinium-enhanced magnetic resonance imaging of cartilage and future knee osteoarthritis.

OBJECTIVE To examine the predictive value of the delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) index with regard to future radiographic osteoarthritis (OA). METHODS In 1998, 17 knees in 11 men and 4 women with knee pain, normal results of weight-bearing radiography, and arthroscopic cartilage changes ranging from superficial fibrillation to fissuring and softening were examined using dGEMRIC. Six years later, 16 of the 17 knees were reassessed for radiographic OA changes. RESULTS At followup, 9 of the 16 knees showed radiographic OA changes. Two of them had undergone a knee joint replacement due to OA. In the knees with radiographic OA, the dGEMRIC index at baseline was lower than that in the knees without radiographic OA (P = 0.03). CONCLUSION The results of the present study support the dGEMRIC index as a clinically relevant measure of cartilage integrity and suggest that a low index may be predictive of the development of knee OA.

Reduced training is associated with increased loss of BMD.

This 8‐year controlled, follow‐up study in 66 Swedish soccer women evaluated the effect of training and reduced training on BMD. The players who retired during the follow‐up lost BMD in the femoral neck, whereas the controls did not.

Assessment of sex hormones and bone mineral density in relation to occurrence of fracture in men : A prospective population-based study

Patients with fragility fractures have low bone mineral density (BMD)--this statement is supported mainly by data on women. In this study, including only men, the objectives were to determine whether a decline in BMD alone or in combination with data on male sex hormones and skinfold thickness could be of value in predicting forthcoming fractures. We also wanted to find out whether high consumers of alcohol can be identified by measuring BMDs and male sex hormones. A prospective, population-based study was performed in the city of Malmö, Sweden. 242 men were randomly selected; all were of Scandinavian ethnic background, and were aged 50, 60, 70, and 80 years. Forearm BMD, testosterone, sex-hormone-binding globulin (SHBG), and skinfold thickness were analyzed. In addition, alcohol consumption and carbohydrate-deficient transferrin (CDT)--a marker of alcohol abuse--were analyzed. The study group was followed prospectively for 7 years and all fractures sustained were recorded. Prospectively, for a 1 SD decrease in forearm BMD, the Cox proportional hazard model gave a relative risk (RR) of 1.75 with a 95% confidence interval of 1.08-2.83 for a forthcoming fracture and 3.88 (1.30-11.57) for a hip fracture. For a 1 SD change in skinfold thickness, measured on the dorsum of the hand, a RR of 1.69 (0.99-2.87) for a forthcoming fracture was found and the corresponding value for hip fracture was 2.34 (1.10-5.00). Testosterone and SHBG did not enhance fracture prediction. Abusers of alcohol had, retrospectively, significantly more fractures. Individuals with alcohol consumption rates in the highest quartile had significantly higher CDT levels, but we were unable to identify high consumers of alcohol by analyzing BMD or sex hormones. In this study we found that forearm BMD and skinfold thickness could be used in predicting forthcoming fractures in men.

Low regional tibial bone density in athletes with medial tibial stress syndrome normalizes after recovery from symptoms

Background Although the exact cause of medial tibial stress syndrome is unclear, changes in bone metabolism are likely to be involved. Hypothesis Localized low bone mineral density at the junction of the middle and distal thirds of the tibia in patients with medial tibial stress syndrome develops in conjunction with the symptoms; these changes are reversible and are not inherited. Study Design Prospective cohort study. Methods Bone mineral density in 14 adult male athletes with long-standing medial tibial stress syndrome was measured when they were symptomatic and after recovery (mean follow-up, 5.7 years). Repeat measurements were also made prospectively in 13 nonathlete control subjects and single measurements were made in 18 healthy athletes. Results Bone mineral density was 9% ± 11% higher in the proximal tibia but 11% ± 12% lower in the tibial region corresponding to pain in patients when compared with nonathlete control subjects. It increased by 19% ± 11% in the region of pain after recovery from symptoms and, at follow-up, was no lower than in nonathlete control subjects. Conclusion Athletes with medial tibial stress syndrome and increased scintigraphic uptake regain normal tibial bone mineral density after recovery from symptoms. Initially localized low bone mineral density is not an inherited condition, but instead may develop in conjunction with the symptoms.

Biochemical markers of bone metabolism after short and long time ethanol withdrawal in alcoholics

The etiology of ethanol-associated osteopenia is not fully understood. A direct inhibitory effect of ethanol on osteoblast function has been suggested by in vitro and in vivo studies. In this study, we measured biochemical markers for bone formation (osteocalcin, bone specific alkaline phosphatase, procollagen-1-c-terminal peptide) and resorption (c-terminal telopeptide and urine deoxypyridinoline) in 18 otherwise healthy, but severely alcoholic men during a 10-day period of alcohol withdrawal. The same tests were performed in a group of 18 male abstainers, with more than 5 years of proven alcohol withdrawal. The results were compared with 29 male controls, randomly selected. In the group of alcoholics, osteocalcin (Oc) was significantly decreased at day 1 (p > 0.001; compared with controls). The low serum Oc levels normalized during the observation period and no significant difference was seen after 10 days. After a 5-year withdrawal, the bone-specific alkaline phosphatase was increased (p = 0.040) and there was a tendency, but not significant, of a persistent high level of Oc when compared with controls. A significant increase in fasting urinary secretion of deoxypyrodinoline was seen among the alcoholics (p = 0.001 compared with controls). The increase did not normalize during the 10-day observation period. Also, the abstainers had a significantly higher fasting urinary secretion of deoxypyridinoline after a 5-year alcohol withdrawal (p = 0.022 compared with controls). The present study suggests that there is an imbalance between bone formation and bone resorption among alcoholics that could result in rapid bone loss. Although most directions tended to normalize shortly after alcohol withdrawal, biochemical data suggest that there may still be a persistent high bone turnover after more than 5 years.

Ethanol and its effects on fracture healing and bone mass in male rats

Operatively induced, standardized tibia fractures in 42 10-week-old male rats were fixed with intramedullary nails. 21 of the rats were fed liquid containing 15% ethanol. 5 weeks after inducing the fracture, the rats were killed and the total body bone mineral density (BMD) was analyzed with the DEXA technique, and the mechanical properties of the fractured and the unfractured tibiae as well as the ipsi- and contralateral femoral shaft and femoral neck were tested. The rats given a liquid containing 15% ethanol were found to have significantly lower total BMD and total calcium than the controls. We also found a significantly lower bending moment and bending stiffness both in the fractured and unfractured tibiae among rats fed on ethanol. The energy absorption until refracture was less in rats fed on ethanol. Posttraumatic osteopenia was present, as judged by the mechanical tests of the ipsilateral femoral shaft and the femoral neck in all animals. There was no difference in this respect between the animals fed on ethanol and the controls. We found that ethanol disturbs bone metabolism which reduces the mechanical properties of the tibiae and femora of rats, but the healing process of an induced tibial shaft fracture was not affected.

Former male elite athletes have lower incidence of fragility fractures than expected.

PURPOSE Physical activity during growth is associated with high peak bone mass and may, as a result, prevent osteoporosis later in life. It is therefore possible that athletic activity during youth could lower the risk of fragility fractures in old age. Although this is currently unclear and based on evaluations of surrogate skeletal end point variables in former athletes, we hypothesized that this is not the case. METHODS In a retrospective matched controlled cohort study design, we calculated the lifetime incidence of fractures from the results of a mailed questionnaire sent to 709 former male elite athletes with a mean age of 69 yr (range = 50-93 yr) who had given up regular sports activity a mean of 34 yr (range = 1-63 yr) earlier, and to 1368 matched controls. Estimates of time to first fracture were analysed using Poisson regression, and for analyses of covariance, Cox Regression was used. Data are presented as rate ratios (RR) with 95% confidence interval (CI). RESULTS After retirement from sports, the former athletes had an RR of 0.70 (0.52-0.93) for any fracture, an RR of 0.50 (0.27-0.89) for any fragility fracture, and an RR of 0.29 (0.09-0.74) for distal radius fractures. When adjusting for occupation, smoking, alcohol, disease, and medication the hazard ratio (HR) of any fracture after an active career was 0.73 (95% CI = 0.54-0.99) and the hazard ratio of any fragility fracture after age 50 yr was 0.63 (95% CI = 0.35-1.16). CONCLUSIONS In men, elite sports during adolescence are associated with a lower fracture risk after career end. The former athletes were overall healthier, which may have influenced the results.

Mason type IV fractures of the elbow: A 14- TO 46-YEAR FOLLOW-UP STUDY

A total of 14 women and seven men with a mean age of 43 years (18 to 68) who sustained a Mason type IV fracture of the elbow, without an additional type II or III coronoid fracture, were evaluated after a mean of 21 years (14 to 46). Primary treatment included closed elbow reduction followed by immobilisation in a plaster in all cases, with an additional excision of the radial head in 11, partial resection in two and suturing of the annular ligament in two. Delayed radial head excision was performed in two patients and an ulnar nerve transposition in one. The uninjured elbows served as controls. Nine patients had no symptoms, 11 reported slight impairment, and one severe impairment of the elbow. Elbow flexion was impaired by a mean of 3 degrees (sd 4) and extension by a mean of 9 degrees (sd 4) (p < 0.01). None experienced chronic elbow instability or recurrent dislocation. There were more degenerative changes in the formerly injured elbows, but none had developed a reduction in joint space. We conclude that most patients with a Mason type IV fracture of the elbow report a good long-term outcome.