Seasonal variations of vitamin D status in Greek postmenopausal women receiving enriched dairy products for 30 months: The Postmenopausal Health Study

The effectiveness of a 30-month dietary intervention on vitamin D status of Greek postmenopausal women was examined. Sixty-six postmenopausal women (55-65 years old) were randomized into an intervention group (IG), receiving a daily dose of 7.5 μg of vitamin D3 for 12 months that increased to 22.5 g for the remaining 18 months of intervention through fortified dairy products and attending nutrition and lifestyle counselling sessions, and a control group (CG). After 30 months of intervention, during winter, serum 25-hydroxy vitamin D (25(OH)D) levels significantly decreased in the CG while remained in the same high levels as in the summer period in the IG. Similarly, at 30 months of intervention the prevalence of vitamin D insufficiency was significantly higher in the CG compared to the IG (60.0 vs 25.0%, P=0.006). In conclusion, the current intervention scheme with a daily dose of 22.5 μg of Vitamin D could significantly decrease the prevalence of vitamin D insufficiency during winter time but not entirely prevent it. © 2011 Macmillan Publishers Limited. All rights reserved

Bone disease in anorexia nervosa

Anorexia nervosa is a serious psychiatric disorder accompanied by high morbidity and mortality. It is characterized by emaciation due to self-starvation and displays a unique hormonal profile. Alterations in gonadal axis, growth hormone resistance with low insulin-like growth factor I levels, hypercortisolemia and low triiodothyronine levels are almost universally present and constitute an adaptive response to malnutrition. Bone metabolism is likewise affected resulting in low bone mineral density, reduced bone accrual and increased fracture risk. Skeletal deficits often persist even after recovery from the disease with serious implications for future skeletal health. The pathogenetic mechanisms underlying bone disease are quite complicated and treatment is a particularly challenging task

Strontium ranelate: A novel treatment in postmenopausal osteoporosis

Strontium ranelate (SR) is a novel antiosteoporotic agent, electively concentrated in positions of active bone formation, and especially onto the crystal surface that allows permanent exchanges with extracellular fluid. Although the mechanism(s) of action is still under rigorous research, SR appears to reduce bone resorption by decreasing osteoclast differentiation and activity and to stimulate bone formation by increasing replication of preosteoblast cells, leading to increased matrix synthesis. In the placebo-controlled, phase III trial spinal osteoporosis therapeutic intervention (SOTI) (no = 1442; mean age 69 years), there was a 41% decrease over 3 years in the number of patients with new vertebral fractures in the SR (2 g/day) group versus placebo (P < 0.001), already detected after 12 months (49% lower risk, P < 0.001). The phase III treatment of peripheral osteoporosis (TROPOS) study assessed the efficacy of SR (2 g/day) in preventing nonvertebral fractures in postmenopausal osteoporosis (no = 4932; mean age 77 years). SR reduced nonvertebral fracture risk by 16% versus placebo (P = 0.04) and hip fracture risk by 36% (P = 0.031) in osteoporotic patients older than 74 years. Thus SR is an effective and safe treatment for vertebral and hip osteoporosis with a unique mode of action. © 2006 New York Academy of Sciences

Antibiotic prophylaxis in the surgical treatment of peritrochanteric fractures: A comparative trial between two cephalosporins

In a study of 200 patients scheduled for orthopedic surgery, prophylaxis with either ceftriaxone or cefotaxime was equally effective. No patient developed bacterial infection, either systemic or local, during the first 10 postoperative days. In the 1-year follow-up period, 2 patients developed deep wound infection (1 from each group). Ceftriaxone 1 g was given once only as a single preoperative dose, whereas cefotaxime was, in addition to the preoperative dose, also given postoperatively every 8 h for 3 days (totally 9 doses of 1 g). Emphasis is placed on the practical advantage of the single dose of ceftriaxone, which facilitates nursing of the patient. © 1990 S. Karger AG, Basel

The biomechanical capacity of the periosteum in intact long bones

Introduction: The biological function of the periosteum is profusely described but its contribution to the biomechanical properties of the bone has been considered negligible. The purpose of this study was to examine the biomechanical properties of periosteum-preserved long bones. Materials and methods: The biomechanical properties of both femora and tibiae of 30 male, 4-month-old Wistar rats were evaluated using a destructive three-point-bending testing protocol. In both bones from one side the periosteum was preserved, while in the contralateral bones the periosteum was stripped off. Ultimate strength, stiffness, energy absorption and deflection were derived automatically from the load-deformation curve recorded for each bone. Results: As regards the femur, the periosteum-covered bones displayed statistically significant higher values for all parameters measured compared to the periosteum-stripped bones. Ultimate strength, stiffness, absorbed energy and deflection of stripped and periosteum-covered femora were, respectively, 146.76 ± 44.71 and 196.01 ± 41.47 N, 44.25 ± 17.35 and 61.62 ± 15.07 N/mm, 0.00054 ± 0.00274 and 0.00011 ± 0.00354 Nmm, 0.67 ± 0.25 and 1.07 ± 0.28 mm. In the tibia, only energy absorption (0.00353 ± 0.00199 and 0.0010 ± 0.00339 Nmm) and deflection (1.71 ± 0.56 and 0.86 ± 0.36 mm) were significantly higher in the periosteum-covered bones. The pattern of bone failure was also different in the two groups. In periosteum-covered bones the two bone parts remained in close apposition stabilized by the periosteal membrane, while in a few cases the periosteum was stretched or torn opposite the loading site. Conclusion: The periosteum not only has significant biological function but also provides mechanical support to the bone and amplifies the biomechanical capacity of intact rat long bones in bending, probably taking advantage of its fibrous and elastic properties. © Springer-Verlag 2007

The effects of a 30-month dietary intervention on bone mineral density: The postmenopausal health study

Low dietary Ca intake and vitamin D insufficiency have been implicated as part of the aetiology leading to osteoporosis. The aim of the present study was to examine the effects of a 30-month dietary intervention that combined supplementation of dairy products fortified with Ca and vitamin D3 and lifestyle and nutrition counselling sessions on bone mineral density (BMD) of postmenopausal women. Sixty-six postmenopausal women (aged 55-65 years) were randomised into a dietary group (DG; n 35), receiving daily and for the first 12 months 1200mg Ca and 75 μg vitamin D3, while for the next 18 months of intervention 1200mg Ca and 225 μg vitamin D3 through fortified dairy products, and a control group (CG; n 31) receiving neither counselling nor dairy products. The DG was found to have more favourable changes in arms (P<0001), total spine (P=0001) and total body BMD (P<0001) compared with the CG. Furthermore, a significant increase was observed for the DG in lumbar spine BMD (0056; 95% CI 0009, 0103), which was not found to differentiate significantly compared with the change observed in the CG (P=0075). In conclusion, the present study showed that intakes of vitamin D of about 225g/d and of Ca close to the recommended level of 1200mg from fortified dairy foods for 30 months, with compliance ensured by lifestyle and nutrition counselling sessions, can induce favourable changes in arms, total spine and total body BMD of postmenopausal women. © 2010 The Authors

Changes in biochemical indexes of bone metabolism and bone mineral density after a 12-mo dietary intervention program: The Postmenopausal Health Study

Background: In southern Europe, calcium supplementation alone is a common practice for osteoporosis prevention. Objective: We examined whether calcium supplementation could be as effective in achieving favorable bone mass changes in postmenopausal women as is a holistic dietary approach including dairy products fortified with calcium and vitamin D3. Design: A sample of 101 postmenopausal women were randomly assigned to a dairy intervention group (n = 39) who received daily ≈1200 mg Ca and 7.5 μg vitamin D3 via fortified dairy products and attended biweekly nutrition education sessions; a calcium-supplemented group (n = 26) who received a total of 1200 mg Ca/d; and a control group (n = 36). Results: The increases observed in serum concentrations of insulin-like growth factor I were greater in the dairy intervention group than in the 2 other groups, especially during the first 5 mo of intervention (P = 0.034). The decreases and increases observed during 5 and 12 mo, respectively, in serum 25-hydroxyvitamin D3 were significant in all groups (P = 0.050). Serum parathyroid hormone increased only in the control group, and serum type 1 collagen cross-linked C-telopeptide decreased only in the dairy intervention group during both 5 and 12 mo of intervention (P = 0.035 and 0.047, respectively). The dairy intervention group had greater improvements in pelvis (P = 0.040), total spine (P = 0.001), and total-body (P = 0.001) bone mineral density than did the other 2 groups. Conclusion: The application of a holistic intervention approach combining nutrition education and consumption of fortified dairy products for 12 mo can induce more favorable changes in biochemical indexes of bone metabolism and bone mineral density than can calcium supplementation alone. © 2007 American Society for Nutrition

Postural profile and falls of osteoporotic women

Objectives: 1. To compare postural alignment in erect standing between osteoporotic fallers, osteoporotic non-fallers and healthy women. 2. To compare BMI, number of fractures and intensity of pain between osteoporotic fallers and non-fallers. Methods: Thirty-six osteoporotic women with vertebral fractures and 40 healthy women participated in the study. Spinal curvatures were assessed with a digital inclinometer. Photographic measurements of knee, hip, shoulder and head were carried out in sagittal plane. Results: Significant differences were found between osteoporotic fallers and healthy women in the head (p=0.040), and thoracic angles (p=0.001). Significant differences were found between fallers and non-fallers in BMI (p=0.000), number of fractures (p=0.033) and pain (p=0.005), with fallers being heavier, with less fractures and pain than non-fallers. Conclusions: Osteoporotic fallers probably differ from osteoporotic non-fallers and healthy women. Researchers and clinicians may consider, in the future, the above differences when planning research and clinical intervention in this field. Replication studies are necessary to confirm the present findings. © 2012 - IOS Press and the authors. All rights reserved

Incidence of hip fractures in Greece during a 30-year period: 1977-2007

The incidence of hip fractures doubled in Greece from 1977 to 2007 among people aged 50 and over. A mild decrease was observed after 2002, although the future trend cannot be safely anticipated at the moment. Half of all hip fractures in 2007 were derived from the age group of 80 and over. Introduction: The purpose of this study was to determine the incidence of hip fractures during a 30-year period in Greece among people aged 50 and over and to document possible alterations in secular trends. Methods: We studied hip fractures during 2007 and compared them with those of previous years starting from 1977 with an in-between 5-year interval (1977, 1982, 1987, 1992, 1997, 2002). Age- and sex-specific incidence was calculated, and secular trends were recorded. The relative risk of hip fracture in every age group was estimated according to the corresponding incidence of 1977. Results: The adjusted incidence of hip fractures increased approximately 100 % throughout the study; it progressively increased from 1977 to 2002 and exhibited a mild significant decrease thereafter. The relative risk of hip fractures among subjects aged 60-69 in 2007 has declined compared with 1977 [0.85, 95 % confidence intervals (CI) 0.79-0.92, p < 0.0005]. Among people aged 70-79, an increased relative fracture risk (1.53, 95 % CI 1.45-1.61, p < 0.0005) was estimated in 2007 compared with 1977. People ≥80 years old were responsible for half of the hip fractures in 2007 but only for the 22.5 % of fractures in 1977. The relative fracture risk in people aged ≥80 was 2.81 times higher (95 % CI 2.64-2.98, p < 0.0005) in 2007 than in 1977. Conclusions: The incidence of hip fractures doubled during the last 30 years among people aged ≥50 years, although a mild decrease was observed in almost all age groups after 2002. The most affected group is 80 and over. © 2012 International Osteoporosis Foundation and National Osteoporosis Foundation

Management of bisphosphonate-related osteonecrosis of the jaw: A literature review

Osteonecrosis of the jaw (ONJ) is a serious side effect of bisphosphonate use in patients with osteoporosis, Paget's disease, hypercalcemia of malignancy, metastatic bone disease and multiple myeloma, although recently this complication has also been reported in patients under non-bisphosphonate medication, such as denosumab and bevacizumab. The occurrence of ONJ is higher in oncology patients treated with high-dose iv bisphosphonates than in osteoporosis patients treated with oral bisphosphonates. Although multiple hypotheses have been proposed, the exact pathogenic mechanism of ONJ still remains unclear. As treatment protocols based on randomized controlled trials (RCTs) do not exist, we critically reviewed the existing data concerning the management of bisphosphonate-related osteonecrosis of the jaw, including the most recent data for the use of teriparatide and hyperbaric oxygen. © 2015 John Wiley & Sons A/S