Sally F. Evans

Vertebral deformity, bone mineral density, back pain and height loss in unscreened women over 50 years

Bone mineral density (BMD) was measured in the lumbar spine using dual-energy X-ray absorptiometry in 222 unscreened women (aged 50–82 years), and information on back pain and historic loss of standing height was obtained at interview. Vertebral morphometry was performed on lateral spinal radiographs. The shape of the vertebral body was quantified using appropriate vertebral shape indices (VSIs), and vertebral deformities were identified using thresholds defined in terms of the means (M) and standard deviations (SD) of these VSIs for the whole group. Severity of deformity was defined as either grade 1 (M+2SDM+4SD). Subjects with grade 1 vertebral deformities were older than subjects without such deformities, but did not have a reduced age-related Z-score of BMD. Grade 2 wedge and concave deformities were associated with a reduced age-relatedZ-score of BMD, suggesting that the aetiology of such deformities is closest to conventional concepts of ‘osteoporotic fracture’. Grade 3 deformities were associated with neither increased age nor decreased BMD. Stature decreased in these subjects with age. Subjects reporting historic height loss had a higher mean number of wedge deformities. Subjects with back pain did not have a higher incidence of vertebral deformity than subjects without, confirming that many deformities were asymtomatic. Neither back pain nor historic loss of height were found to be associated with low spinal BMD.

Increased circulating Dickkopf-1 in Paget's disease of bone

UNLABELLED Dickkopf-1 (Dkk-1) is a secreted inhibitor of Wnt signaling which in adults regulates bone turnover. Dkk-1 over-production is implicated in osteolytic disease where it inhibits bone formation and stimulates bone breakdown. Recently it was reported that osteoblastic cells from Pagets disease of bone (PDB) over-expressed Dkk-1. OBJECTIVE To see if increased Dkk-1 was detected in serum from patients with PDB. RESULTS Dkk-1 and total serum alkaline phosphatase activity (tsAP) were significantly elevated in sera from PDB patients. Patients with polyostotic PDB had significantly higher levels of tsAP but not Dkk-1, than monostotic patients. TsAP but not Dkk-1, was significantly lower in sera from bisphosphonate treated versus untreated PDB patients. Dkk-1 and tsAP were not significantly correlated. CONCLUSIONS Dkk-1 may be a useful biomarker of PDB and we speculate that Dkk-1 may play a central role in the etiology of PDB.

A computerized technique for vertebral morphometry

A new technique for morphometric measurement of vertebral bodies has been described, in which a computerized image analysis system was used to digitize and measure standardized lateral radiographs of the thoracic and lumbar spine. The sources of error in the radiographic system and the image analysis system were assessed using vertebral phantoms and test images. Oblique projection in the radiographic image of a vertebra did not produce a significant error in the measured area. The radiographic magnification was approximately 35%. Optical non-uniformity was detected in the image analysis system, and was ascribed to the lens optics. The maximum intra-observer and inter-observer variations in vertebral area were 3.1% and 5.3% respectively for experienced observers. The technique is applicable to clinical studies of large populations, and has value in investigating vertebral deformity in the management of metabolic bone disease.

Matched‐cohort study of body composition, physical function, and quality of life in men with idiopathic vertebral fracture

To determine the effect of 6 years of routine management on body composition, physical functioning, and quality of life, and their interrelationships, in men with idiopathic vertebral fracture.

Lower Limb Metaphyseal Bone Is Lost in Men with Coeliac Disease and Does Not Relate to Parathyroid Status

Aims. To investigate regional lower limb bone density and associations with weight, PTH, and bone breakdown in coeliac men. Methods. From whole body DXA scans bone mineral density (BMD) was measured in 28 coeliac men, in the lower limb (subdivided into 6 regions, 3 being metaphyseal (mainly trabecular) and 2 diaphyseal (mainly cortical)). BMD at femoral neck (FN) and lumbar spine L2-4, body weight, height, serum calcium, alkaline phosphatase, parathyroid hormone (PTH), and urinary calcium and NTx/Cr, a measure of bone breakdown, were also measured. Age matched healthy men provided values for BMD calculation of z and T scores and for biochemical measurements. Results. Low BMD z scores were found at metaphyseal regions in the leg (p < 0.001) and in the FN (p < 0.05). The distal metaphyseal region BMD in the leg was lower than spine or FN (p < 0.05). PTH, urinary calcium/creatinine, and urinary NTx/Cr were similar to controls. Both metaphyseal and diaphyseal BMD z scores were associated with body weight (p < 0.02), but not with either PTH or urinary NTx/Cr. Conclusions. Low BMD lower limb regions comprising mostly trabecular bone occur early in CD and in the absence of elevated PTH or increased bone resorption. Low BMD is associated with low body weight.