This cross-sectional study is based on images from the lower leg as assessed by peripheral quantitative computer tomography (pQCT). Measurements were performed in 39 female and 38 male control ...subjects and 15 female professional volleyball players, all between 18 and 30 years of age. The images were obtained at shank levels of 4%, 14%, 33%, and 66% from the distal end. Bone and muscle cross-sectional areas, and the bones’ density-weighted area moment of resistance and of inertia were assessed. From these, muscle-bone strength indices (MBSIs) were developed for compression (CI = 100 · bone area/muscle area) and bending (BI = 100 · bone area moment of resistance/muscle area/tibia length). Significant correlations between muscle cross-sectional area and bone were found at all section levels investigated. The strongest correlation for compression was observed in the sections at 14% (correlation coefficient
r = 0.74), where 4.10 ± 0.46 cm
2 bone, on average, was related to 100 cm
2 muscle. The compression index (CI) at the 14% level was independent of the tibia length. Interestingly, the 15 athletes had significantly greater CIs than the control subjects. This is most probably due to the greater tension development in the athletes. The highest correlation for bending was for anteroposterior bending at 33% of tibia length (
r = 0.81), where the area moment of resistance,
R, was on, average, 4.21 ± 0.54 cm
3/100 cm
2 muscle/m tibia length. Analysis of the bones’ area moment of inertia showed that buckling is a possible cause of bending at the 33% and 66% levels, but not at the 14% level. No gender differences in MBSI were found. Likewise, age was without significant effect. The data show that bone architecture depends critically on muscle cross section and tension development. Moreover, bone geometry (e.g., the tibia length) influences the geometrical distribution of bone mineral, as it was found that long bones adapted to the same compressive strength are wider than short ones. We conclude that MBSIs offer a powerful diagnostic tool for bone disorders and may contribute to improving the treatment of bone metabolic and other diseases.
Summary
Ibandronate reduces the risk of vertebral and non-vertebral fractures versus placebo in postmenopausal women with osteoporosis. This analysis, in which fractures were reported as safety ...events, showed that long-term use of ibandronate was associated with low fracture rates over 5 years of treatment.
Introduction
A previous post-hoc meta-analysis of 2–3 year studies found that ibandronate regimens with annual cumulative exposure (ACE) of ≥10.8 mg reduced the risk of vertebral and nonvertebral fractures (NVFs) versus placebo in postmenopausal women. This post-hoc analysis used individual patient data from the 2-year monthly oral ibandronate in ladies (MOBILE) and dosing intravenous administration (DIVA) studies, including the 3-year long-term extensions (LTEs), to assess fracture risk in patients treated with ibandronate for 5 years.
Methods
Patients treated for 2 years in MOBILE with monthly oral ibandronate 150 mg (
n
= 176) and in DIVA with IV ibandronate every 2 months 2 mg (
n
= 253) or quarterly 3 mg (
n
= 263) who continued on the same regimens for 3 additional years in the LTEs were included. Three-year placebo data (
n
= 1,924) were obtained from the ibandronate osteoporosis vertebral fracture trial in North America and Europe (BONE) and IV Fracture Prevention trials. The primary endpoint was clinical fracture rate; clinical fracture data were collected as adverse events. Time to fracture was analyzed using Kaplan–Meier and statistical analysis was conducted using the log-rank test. All clinical fractures included all NVFs and symptomatic vertebral fractures.
Results
For ibandronate regimens with ACE ≥10.8 mg, time to fracture was significantly longer for all clinical fractures, NVFs, and clinical vertebral fractures versus placebo (
P
= 0.005). For all fracture types, the rate of fracture appeared stable during the 5-year treatment period.
Conclusion
In women with postmenopausal osteoporosis, continuous treatment with ibandronate over 5 years results in low sustained clinical fracture rate.
Although it is important for prospective studies, the reliability of quantitative measures of cervical muscle size on magnetic resonance imaging is not well established. The aim of the current work ...was to assess the long-term reliability of measurements of cervical muscle size. In addition, we examined the utility of selecting specific sub-regions of muscles at each vertebral level, averaging between sides of the body, and pooling muscles into larger groups. Axial scans from the base of skull to the third thoracic vertebra were performed in 20 healthy male subjects at baseline and 1.5 years later. We evaluated the semi-spinalis capitis, splenius capitis, spinalis cervicis, longus capitis, longus colli, levator scapulae, sternocleidomastoid, anterior scalenes and middle with posterior scalenes. Bland-Altman analysis showed all measurements to be repeatable between testing-days. Reliability was typically best when entire muscle volume was measured (co-efficients of variation (CVs): 3.3-8.1% depending on muscle). However, when the size of the muscle was assessed at specific vertebral levels, similar measurement precision was achieved (CVs: 2.7-7.6%). A median of 4-6 images were measured at the specific vertebral levels versus 18-37 images for entire muscle volume. This would represent considerable time saving. Based on the findings we also recommend measuring both sides of the body and calculating an average value. Pooling specific muscles into the deep neck flexors (CV: 3.5%) and neck extensors (CV: 2.7%) can serve to reduce variability further. The results of the current study help to establish outcome measures for interventional studies and for sample size estimation.
Maintaining neuromuscular function in older age is an important topic for aging societies, especially for older women with low bone density who may be at risk of falls and bone fracture. This ...randomized controlled trial investigated the effect of resistive exercise with either whole-body vibration training (VIB) or coordination/balance training (BAL) on neuromuscular function (countermovement jump, multiple 1-leg hopping, sit-to-stand test). 68 postmenopausal women with osteopenia or osteoporosis were recruited for the study. 57 subjects completed the 9-month, twice weekly, intervention period. All subjects conducted 30 min of resistance exercise each training day. The VIB-group performed additional training on the Galileo vibration exercise device. The BAL-group performed balance training. An "intent-to-treat" analysis showed greater improvement in the VIB-group for peak countermovement power (p=0.004). The mean 95% confidence interval effect size for this parameter was a + 0.90.3 to 1.5 W/kg greater change in VIB than BAL after 9 months. In multiple 1-leg hopping, a significantly better performance in the VIB-group after the intervention period was seen on a "per-protocol" analysis only. Both groups improved in the sit-to-stand test. The current study provides evidence that short-duration whole-body vibration exercise can have a greater impact on some aspects of neuromuscular function in post-menopausal women with low bone density than proprioceptive training.
Vibration exercise (VbX) is a new type of physical training to increase muscle power. The present study was designed to assess the influence of whole-body VbX on metabolic power. Specific oxygen ...uptake (sVO(2)) was assessed, testing the hypotheses that sVO(2) increases with the frequency of vibration (tested in 10 males) and with the amplitude (tested in 8 males), and that the VbX-related increase in sVO(2) is enhanced by increased muscle force (tested in 8 males). With a vibration amplitude of 5 mm, a linear increase in sVO(2) was found from frequencies 18 to 34 Hz (p < 0.01). Each vibration cycle evoked an oxygen consumption of approximately 2.5 micro l x kg(-1). At a vibration frequency of 26 Hz, sVO(2) increased more than proportionally with amplitudes from 2.5 to 7.5 mm. With an additional load of 40 % of the lean body mass attached to the waist, sVO(2) likewise increased significantly. A further increase was observed when the load was applied to the shoulders. The present findings indicate that metabolic power in whole-body VbX can be parametrically controlled by frequency and amplitude, and by application of additional loads. These results further substantiate the view that VbX enhances muscular metabolic power, and thus muscle activity.
Background
Frailty is a geriatric syndrome associated with multiple negative health outcomes. However, its prevalence varies by population and instrument used. We investigated frailty and pre-frailty ...prevalence by 5 instruments in community-dwelling older adults enrolled to a randomized-controlled trial in 5 European countries.
Methods
Cross-sectional baseline analysis in 2,144 DO-HEALTH participants recruited from Switzerland, Austria, France, Germany, and Portugal with complete data for frailty. Frailty status was assessed by the Physical Frailty Phenotype PFP, SOF-Frailty Index SOF-FI, FRAIL-Scale, SHARE-Frailty Instrument SHARE-FI, and a modified SHARE-FI, and compared by country, age, and gender. Logistic regression was used to determine relevant factors associated with frailty and pre-frailty.
Results
Mean age was 74.9 (±4.4) years, 61.6% were women. Based on the PFP, overall frailty and pre-frailty prevalence was 3.0% and 43.0%. By country, frailty prevalence was highest in Portugal (13.7%) and lowest in Austria (0%), and pre-frailty prevalence was highest in Portugal (57.3%) and lowest in Germany (37.1%). By instrument and overall, frailty and pre-frailty prevalence was highest based on SHARE-FI (7.0% / 43.7%) and lowest based on SOF-FI (1.0% / 25.9%). Frailty associated factors were residing in Coimbra (Portugal) OR 12.0, CI 5.30–27.21, age above 75 years OR 2.0, CI 1.17–3.45, and female gender OR 2.8, CI 1.48–5.44. The same three factors predicted pre-frailty.
Conclusions
Among relatively healthy adults age 70 and older enroled to DO-HEALTH, prevalence of frailty and pre-frailty differed significantly by instrument, country, gender, and age. Among instruments, the highest prevalence of frailty and pre-frailty was documented by the SHARE-FI and the lowest by the SOF-FI.
Abstract Osteonecrosis of the jaw (ONJ) is a rare but severe disease which has been diagnosed in women with breast cancer on a bisphosphonate (BP) therapy. Thus, the German society of senology ...appointed a multidisciplinary task force to establish a consensus on the use of bisphosphonates in breast cancer patients with bone metastases, considering in particular the possible risk of ONJ. This report summarizes the results and recommendations for the prevention and treatment of ONJ in breast cancer patients receiving BP.
Background and aims: Osteopenia and osteoporosis are frequent in Crohn’s disease. However, there are few data on related vertebral fractures. Therefore, we evaluated prospectively the prevalence of ...osteoporotic vertebral fractures in these patients. Methods: A total of 293 patients were screened with dual energy x ray absorptiometry of the lumbar spine (L1-L4) and proximal right femur. In 156 patients with lumbar osteopenia or osteoporosis (T score <−1), x ray examinations of the thoracic and lumbar spine were performed. Assessment of fractures included visual reading of x rays and quantitative morphometry of the vertebral bodies (T4-L4), analogous to the criteria of the European Vertebral Osteoporosis Study. Results: In 34 (21.8%; 18 female) of 156 Crohn’s disease patients with reduced bone mineral density, 63 osteoporotic vertebral fractures (50 fx. (osteoporotic fracture with visible fracture line running into the vertebral body and/or change of outer shape) and 13 fxd. (osteoporotic fracture with change of outer shape but without visible fracture line)) were found, 50 fx. in 25 (16%, 15 female) patients and 13 fxd. in nine (5.8%, three female) patients. In four patients the fractures were clinically evident and associated with severe back pain. Approximately one third of patients with fractures were younger than 30 years. Lumbar bone mineral density was significantly reduced in patients with fractures compared with those without (T score −2.50 (0.88) v −2.07 (0.66); p<0.025) but not at the hip (−2.0 (1.1) v −1.81 (0.87); p=0.38). In subgroups analyses, no significant differences were observed. Conclusions: In patients with Crohn’s disease and reduced bone mineral density, the prevalence of vertebral fractures—that is, manifest osteoporosis—was strikingly high at 22%, even in those aged less than 30 years, a problem deserving further clinical attention.
Vibration exercise (VE) is a new neuromuscular training method which is applied in athletes as well as in prevention and therapy of osteoporosis. The present study explored the physiological ...mechanisms of fatigue by VE in 37 young healthy subjects. Exercise and cardiovascular data were compared to progressive bicycle ergometry until exhaustion. VE was performed in two sessions, with a 26 Hz vibration on a ground plate, in combination with squatting plus additional load (40% of body weight). After VE, subjectively perceived exertion on Borg’s scale was 18, and thus as high as after bicycle ergometry. Heart rate after VE increased to 128 min–1, blood pressure to 132/52 mmHg, and lactate to 3·5 m
M. Oxygen uptake in VE was 48·8% of VO2max in bicycle ergometry. After VE, voluntary force in knee extension was reduced by 9·2%, jump height by 9·1%, and the decrease of EMG median frequency during maximal voluntary contraction was attenuated. The reproducibility in the two VE sessions was quite good: for heart rate, oxygen uptake and reduction in jump height, correlation coefficients of values from session 1 and from session 2 were between 0·67 and 0·7. Thus, VE can be well controlled in terms of these parameters. Surprisingly, an itching erythema was found in about half of the individuals, and an increase in cutaneous blood flow. It follows that exhaustive whole‐body VE elicits a mild cardiovascular exertion, and that neural as well as muscular mechanisms of fatigue may play a role.
Summary
Quantitative ultrasound (QUS) measurement variables vary between European countries in a different way to hip bone mineral density. Standardization of data can be achieved through statistical ...approaches to reduce any between-center differences in QUS measurement variables. However, further validation of this method is required before it can be widely applied.
Introduction
European between-center differences in hip bone mineral density (BMD) have been shown to exist; however, little is known about the geographical heterogeneity of QUS measurement variables. We aimed to examine the differences in QUS variables between three different European countries.
Methods
Five calcaneal and phalangeal QUS devices in Sheffield, Aberdeen (UK), Kiel and Berlin (Germany), and three devices in Paris (France) were used to measure QUS variables in younger (
n
= 463, 20–39 years old) and older (
n
= 2,399, 55–79 years old) women participating in the European multicenter Osteoporosis and Ultrasound (OPUS) study. Broadband ultrasound attenuation, speed of sound, stiffness index, amplitude-dependent speed of sound, bone transmission time, and ultrasonic bone profiler index data were collected. Between-center differences were examined using ANOVA followed by post hoc Fisher's least significant difference tests, and ANCOVA with linear contrasts.
p
< 0.05 indicated statistical significance.
Results
Between-center differences in nonstandardized QUS measurement variables existed for younger (
p
= 0.0023 to
p
< 0.0001) and older women (
p
< 0.001). Anthropometric characteristics exerted a significant influence on nonstandardized data (
p
= 0.045 to
p
< 0.001). However, following statistical standardization, based on height and weight or based on measurements made in young people, geographical heterogeneity in QUS measurement variables was no longer apparent.
Conclusions
QUS measurement variables vary between European countries in a different way to those for hip BMD. Standardization of data can be achieved through statistical approaches to reduce any between-center differences in QUS measurement variables. However, further validation of this method is required before it can be widely applied.
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