P. L. A. van Daele

Vertebral deformities and functional impairment in men and women

The objective of this study was to assess the prevalence and health effects of vertebral deformities in men and women. The study was carried out as part of the cross‐sectional baseline phase of The Rotterdam Study, a prospective population‐based cohort study of residents aged 55 years or over of a district of Rotterdam, The Netherlands. The prevalence of vertebral deformities according to a modification of the Eastell method and concomitant functional impairment were assessed in a random sample of 750 men and 750 women. The prevalence of moderate (grade I) vertebral deformities was 8 and 7% in men and women, respectively. For severe deformities (grade II), these percentages were 4 and 8%. In men, the prevalence of both moderate and severe deformities increased with age. In women, however, the prevalence of moderate vertebral deformities remained constant, opposite to a marked increase in severe deformities. Moderate vertebral deformity was significantly associated with impaired rising in men only. Severe vertebral deformity was associated with a significantly increased risk of general disability and the use of a walking aid in both men and women, impaired bending in men, and impaired rising in women. It is concluded that (1) vertebral deformities are only slightly less common in men than in women from the general population and (2) severe progression with age occurs in women only and (3) severe vertebral deformity is, particularly in men, related to functional impairment.

Case-control analysis of bone resorption markers, disability, and hip fracture risk: the Rotterdam study

Several factors besides bone mineral mass have been related to the risk of hip fracture. Bone quality, the rate of bone loss, and non-skeletal factors have been identified as important.1 2 High rates of bone resorption may be associated with disruption of the trabecular network as well as with an increased rate of bone loss. Furthermore, immobility associated with disability induces bone resorption not followed by increased bone formation.3 Urinary pyridinium crosslinks are markers of bone resorption. We investigated whether these were associated with the risk of hip fracture and also whether such an association was attributable to disability. This nested case-control analysis was conducted as part of the Rotterdam study, a prospective cohort study of the incidence of and risk factors for chronic disabling diseases.4 Briefly, all 10275 residents of a district of Rotterdam aged 55 or over were invited to participate. The study consisted of an initial home interview followed by a series …

The association between age and bone mineral density in men and women aged 55 years and over: The Rotterdam Study

In this cross-sectional study, bone mineral density (BMD) measurements were performed in 1762 ambulatory subjects (678 men and 1084 women) aged 55 years and over from the Rotterdam Study, a population based study of diseases in the elderly. BMD measurements of the proximal femur and lumbar spine were performed using dual energy X-ray absorptiometry. No age-related decline in BMD could be observed in the lumbar spine. Yearly percentage BMD reduction in women and men was -0.6% and -0.3% in the femoral neck, -0.8% and -0.5% in the Wards triangle, and -0.4% and -0.3% in the trochanter, respectively. Late menopause was associated with high BMD in Wards triangle and lumbar spine. We conclude that: (1) accurate assessment of age-related bone reduction in the spine is impossible from cross-sectional studies since BMD measurements in the elderly may be influenced by spinal osteoarthritis; and (2) the rate of age-related bone reduction in the femoral neck appears to be approximately two times higher in women than in men.

Hyperinsulinemia and bone mineral density in an elderly population: The Rotterdam study

We studied the association between insulin and glucose levels and bone mineral density (BMD) in a population based study of 5931 elderly men and women. Serum insulin was measured 2 h after a nonfasting oral glucose load in subjects not using antidiabetes medication. BMD was measured by dual-energy X-ray absorptiometry in the lumbar spine and the proximal femur. In addition, the participants were asked about fractures in the preceding 5 years. Higher bone mass was associated with higher glucose and postload insulin levels at all sites, as well as with increased waist/hip ratio and body mass index. In men, the mean age-adjusted BMD at the lumbar spine (in mg/cm2) increased 4.64 per mmol/L serum glucose (95% CI 1.46-7.82) and 0.35 per mU/L postload insulin (0.17-0.53). In women, these values were 6.88 (4.37-9.39) for glucose and 0.25 (0.11-0.39) for insulin (for all analyses: p < 0.01). The relations were essentially the same with BMD measured in the femur, as well as after adjustment for waist/hip ratio. After adjustment for body mass index, the associations were reduced and lost statistical significance in women. After excluding subjects with diabetes mellitus, the results remained the same. Subjects with a history of nonvertebral fractures had a lower BMD and lower postload insulin levels than those without. The difference in insulin levels was statistically significant in men only (12.5 mU/L, p < 0.001). Excluding men with diabetes mellitus or further adjustment for waist/hip ratio, body mass index or BMD did not change this difference. These results suggest that increased insulin levels are associated with an increased BMD and might be related to a lower fracture rate.

Is imatinib mesylate a promising drug in systemic sclerosis

A patient with therapy-resistant and progressive systemic sclerosis (SSc) with pulmonary involvement who was treated with imatinib mesylate is described herein. Prior to treatment, pulmonary fibroblasts obtained from the patient were cultured and incubated with imatinib mesylate. Preincubation of the fibroblasts for 16 hours with 2.5 microg/ml imatinib mesylate efficiently abrogated platelet-derived growth factor BB-induced fibroblast proliferation. Furthermore, transforming growth factor beta1-induced type I collagen gene transcription was blocked. During treatment, the patients pulmonary involvement stabilized and her skin tightness improved. To our knowledge, this is the first report of a patient with therapy-refractory SSc responding to treatment with imatinib mesylate.

Systemic sclerosis and its pulmonary complications in the Netherlands An epidemiological study

The prevalence and incidence of systemic sclerosis (SSc) in The Netherlands is unknown. The same holds true for its leading causes of death: pulmonary fibrosis and pulmonary arterial hypertension (PAH), for which effective treatment options have recently become available. Objective: To establish the prevalence and incidence of SSc and its pulmonary complications. Methods: Detailed information on patients in the POEMAS registry, “Pulmonary Hypertension Screening, a Multidisciplinary Approach in Scleroderma”, consisting of 819 patients, was combined with a nationwide questionnaire. Results: By combining the two sources the prevalence of SSc was found to be 8.9 per 100 000 adults. The incidence was 0.77 patients per 100 000 per year. PAH was diagnosed in 9.9% of SSc patients. The prevalence of interstitial lung disease in SSc varied from 19% to 47% depending on the definition used. Conclusion: This study clarifies the epidemiology of SSc in The Netherlands and confirms the frequent occurrence of pulmonary complications, based on 654 cases. This can and will be studied further in the ongoing POEMAS study.

Longitudinal changes in ultrasound parameters of the calcaneus

We examined with a median follow-up of 1.4 years (range 1.0–2.0 years) the rates of change per year in ultrasound parameters of the calcaneus. Speed of sound (SOS), Broadband ultrasound attenuation (BUA) and Stiffness were measured twice in 543 subjects (224 men) participating in the Rotterdam Study. SOS fell by −2.5 m/s per year in both sexes (95% CI −4.0 to −1.1 m/s per year in men and −3.6 to −1.4 m/s per year in women). Stiffness decreased by −0.62 (−1.33 to 0.09) per year in men and −0.66 (−1.24 to −0.08) per year in women. In men the rate of change in SOS and Stiffness tended to increase with age. BUA did not change significantly during follow-up in either sex. The prospectively assessed rates of loss differed considerably from those observed cross-sectionally, especially for SOS in men (cross-sectional −0.7 m/s per year, longitudinal −2.5 m/s per year). There was substantial variation between individuals both in changes per year in SOS and in changes per year in BUA. With a median follow-up time of 1.4 years, approximately 27% of the variation in the rate of change for SOS could be explained by measurement error while for BUA this was approximately 9% and for Stiffness 11%. Only a small percentage of subjects had changes larger than could be accounted for by measurement error (SOS: men 26.8%, women 21.6%; BUA: men 28.5%, women: 38.8%; Stiffness: men 32.6%, women 35.1%). The latter may limit the use of ultrasound measurements as a follow-up tool in individuals rather than in populations.

Ultrasound measurement of bone

Bone mass measurements are of major importance in the detection and follow-up of subjects with various metabolic bone diseases, although they are most frequently used in osteoporosis. Currently available non-invasive techniques to measure bone mass include: single-photon absorptiometry (SPA), dual-energy X-ray absorptiometry (DXA) and quantitative computed tomography (QCT). However, all these techniques have the disadvantages of being expensive, time consuming (except for the newest DXA systems) and associated with exposure to ionizing radiation, although the level of radiation associated with DXA is so low that it cannot really be regarded as a hazard. Furthermore, none of these techniques gives insight into qualitative factors of bone tissue, such as trabecular bone structure. Qualitative aspects alone may account for up to 30% of the capability of bone to resist force (Einhorn, 1992). Ultrasonic assessment of bone has been proposed as an inexpensive and radiation free screening device for low bone mass. Furthermore, it has been suggested that by using ultrasonic techniques one may get insight into the qualitative aspects that determine bone strength (Hans et al., 1993; Kaufman & Einhorn, 1993). In this article we will first discuss briefly the fundamentals of ultrasound measurement of bone. Thereafter, we will summarize the present state of the art by reviewing the published literature.

Evidence for uncoupling of bone formation and bone resorption in women with hip fractures: A prospective study

The purpose of the study was to compare two types of control chart commonly used in the long term , quality control of DEXA measurements: multi-rule Shewart charts and Cusum charts. Method. Routine, daily measurements of a Hologic spine phantom collected on Hologic QDR 2000 scanner. The target value for both methods was determined by taking the mean BMD measured daily over 25 days. Three fault conditions were induced in the quality control data: a step change in the mean BMD, a change in the scatter about the mean and a trend. The methods were compared using ROC analysis. Results. Shewart charts performed as well or better than Cusum, and was significantly better at detecting trends (area under the ROC curve: .958 • .014 (Shewart) .869 ~ .026 (Cusum) p<.005 ). However, Cusum charts Glearly demonstrated the changes to the underlying data. Conclusions. Shewart charts performed better than Cusum charts at detecting faults, but the stringency of the rules must be relaxed. Cusum charts allow decisions to be made about the changes in underlying data. Both should be used.

Complicaties van behandeling met biologicals

Er is geen groep geneesmiddelen die zo snel groeit als de groep biologicals. Net als alle andere medicamenten hebben biologicals hun bijwerkingen. In deze bijdrage wordt op deze bijwerkingen ingegaan.