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A small number of studies have examined the relationship between bone health and level of physical load. We explored the effect of occupational physical activity on skeletal status in younger sawmill workers using ultrasonic indices of bone density. In a cross-sectional study, we measured bone density with quantitative ultrasound (QUS) in 128 sawmill workers (89 men and 39 women), mean age 39.1 +/- 10.8 years. Back strength was measured by dynamometry. Information on occupational and leisure physical activity, joint pain, education and smoking were obtained with the questionnaire. All QUS bone parameters and back strength were significantly higher in men than in women. A T score for quantitative ultrasound index (QUI) of − 2.2 or lower was found only in two men and one women. QUI did not significantly differ based on presence of parameters of physical occupational activity (carrying loads exceeding 5 kg, repetitive move ments, physical exertion while working and non-sitting position at work). When controlling for age, gender and body mass index, participants with higher smoking index had significantly lower QUI (p=0.004). Physical workload was not significantly associated with QUI. In our working po pulation, some lifestyle habits, such as smoking, had a greater impact on bone health than physical occupational activity. [ABSTRACT FROM AUTHOR]

Since the beginning of the corona virus disease (COVID-19) pandemic, nursing home residents had been under strict quarantine, which greatly affected their lifestyle and health. In this follow-up study, we analysed whether lifestyle changes during the lockdown had an impact on their body composition and nutritional status. For this purpose we determined body composition, nutritional status, and osteosarcopenic adiposity (OSA) prevalence in 24 volunteer nursing home residents just before the February 2020 COVID-19 lockdown and about 15 months into the lockdown. Body composition (total bone mass, lean and fat tissue components) was assessed with bioelectrical impedance. OSA was established if the participants had sarcopenia, osteopenia, and adiposity. Information on dietary habits, weight loss, and selfperception of health were obtained with the Mini Nutritional Assessment (MNA) form, while nutritional status was assessed with the MNA-Short Form (SF). At baseline, OSA was determined in 14 participants and at the follow-up in 16 participants. The results show an overall decrease in bone and lean tissues and increase in fat tissue. There were significantly more participants with a normal nutritional status than those at risk of malnutrition or malnourished (p=0.045). Our findings suggest that negative changes in body composition during the pandemic are owed to age rather than to changes in lifestyle caused by the pandemic. Regular monitoring of body composition in nursing homes may help to preserve the health of older people in general and particularly in cases of possible future lockdowns., (© 2024 Selma Cvijetić et al., published by Sciendo.)

Osteosarcopenic adiposity (OSA) syndrome, the coexistence of osteoporosis, sarcopenia, and adiposity (either excess or redistributed/infiltrated), has been studied globally in different populations and regions (mostly in East Asia, less in Europe and North America), resulting in varied prevalence. We aimed to determine the prevalence of OSA in a large population of apparently healthy Caucasian adults (18-90 years) and to compare it with the prevalence reported in other studies and other ethnicities. This study included 9719 participants (6412 women and 3307 men), stratified into four age-group categories, and recruited from the general medical practices in Italy. OSA was defined based on body composition measurements using bioelectrical impedance BIA-ACC ® , which enables assessment of total bone mass, muscle/lean, and adipose tissues. The overall prevalence of OSA was 21.9% in women and 14.0% in men, and it significantly increased in every subsequent age group for both women and men ( p < 0.001). The OSA prevalence was not significantly different between men and women below 40 years; however, it was considerably higher in women over 40 years. Participants with OSA had a significantly lower BMI compared to those without OSA, indicating OSA is a separate disorder not necessarily related to physiological fluctuations of BMI. The prevalence in Asian populations was lower than in our sample, indicating ethnic specificity. The relatively high prevalence of OSA detected in this study's population across the age groups suggests the necessity for its appropriate and timely identification to prevent possible clinical outcomes, including fracture, dismobility, frailty, or chronic diseases.

The aim was to evaluate body composition and prevalence of osteosarcopenic adiposity (OSA) in nursing home residents (NHR) and to assess their nutritional status. This research builds on our pilot study (conducted prior COVID-19 pandemic) that revealed high OSA prevalence and poor nutritional status in NHR. The current study included newly recruited n = 365 NHR; 296 women, 69 men, aged 84.3 ± 5.6 and 83.1 ± 7.3 years, respectively. Body composition was measured by bioelectrical impedance BIA-ACC®, yielding total bone mass along with all components of lean and adipose tissues. The Mini Nutritional Assessment-Short Form (MNA-SF) was used to assess nutritional status. Participants reported about their present/past diseases, including COVID-19. Mean duration of stay in nursing homes was 46.3 ± 47.0 months. Approximately 30% of participants had COVID-19 prior (median 6.7 months) to entering the study. OSA was diagnosed in 70.8% women and 47.8% men (p < 0.001). Malnourishment was detected in 5.8% women and 6.2% men while the risk of malnourishment was found in 30.8% women and 30.0% men. No significant differences in age, body composition parameters, prevalence of OSA, malnutrition/risk for malnutrition were found in participants who had COVID-19 compared to those who did not. Regression analysis showed that intramuscular adipose tissue (%) was significantly positively, while bone mass was significantly negatively associated with OSA. In this population, the high prevalence of OSA coincided with the high prevalence of malnutrition/risk of malnutrition. Such unfavorable body composition status is more likely a consequence of potentially poor diet quality in nursing homes, rather than of health hazards caused by COVID-19.

The population of older adults, especially those living in the nursing homes, is growing. The sedentary lifestyle and possible poor nutrition in nursing homes place residents (NHRs) at risk for body composition impairments, malnutrition, and, subsequently, numerous chronic diseases. The aim of this study was to assess body composition (including body fluids) and dietary intake in NHRs. The association between osteosarcopenic adiposity syndrome (OSA) and its components, osteopenic adiposity (OA), sarcopenic adiposity (SA), and adiposity-only (AD), and specific macro- and micro-nutrients was evaluated as well. The study included 84 participants (82.1% women), aged 65.3-95.2 years. Body composition was assessed with an advanced bioelectrical impedance device BIA-ACC ® and dietary intake was assessed via 24-h recall and analyzed using "Nutrition" software. The majority (95%) of participants were overweight with a high body fat and low muscle and bone mass, leading to a high prevalence of OSA (>50%), OA (13%), and AD (26%). There were only a few participants with SA, and they were not analyzed. The highest extracellular water/total body water ratio was observed in the OSA participants, indicating a heightened inflammatory state. Participants in all three body composition categories had a similar nutrient intake, with protein, fiber, omega-3 fatty acids, and almost all micronutrients being far below recommendations. In conclusion, a high prevalence of OSA among NHRs accompanied by a poor dietary intake, could place these residents at a very high risk for COVID-19 infections. Therefore, optimization of body composition and nutritional status should be included along with standard medical care in order to provide better health maintenance, particularly in the COVID-19 era.

In N = 400 women (46.9 ± 15.5 years), the prevalence of severe (< 25 nmol/l) and mild (≥ 25 and < 50 nmol/l) 25(OH)D deficiency was 7 and 32.2%, respectively, while 60.8% women had adequate status. Serum iPTH increased (> 37.0 pg/ml) when 25(OH)D was < 46.9 nmol/l. BMD was not significantly lower in the participants with iPTH > 37.0 pg/ml., Purpose: Bone mineral density (BMD) is affected by serum 25-hydroxyvitamin D (25(OH)D) and intact parathyroid hormone (iPTH). Our objective was to analyze the association between serum 25(OH)D and iPTH and their mutual regulatory influence on BMD in women with 25(OH)D deficiency. We also attempted to establish a threshold for the serum 25(OH)D below which serum iPTH increases., Methods: The participants were 400 generally healthy women (46.9 ± 15.5 years) recruited from local communities. BMD was measured by dual-energy X-ray absorptiometry, and serum 25(OH)D, iPTH, calcium, phosphorus, alkaline phosphatase, osteocalcin, and C-telopeptide (CTX) were analyzed from the fasting blood samples. Multivariate regression models were used to investigate the relationships among serum 25(OH)D, iPTH, and BMD., Results: Serum iPTH increased when 25(OH)D concentrations were below 46.9 nmol/l. Severe 25(OH)D deficiency (< 25 nmol/l) was found in 7% of the participants and was associated with significantly higher iPTH compared to participants with serum 25(OH)D ≥ 25 nmol/l. BMD was negatively associated with iPTH only in the group with severe 25(OH)D deficiency. However, BMD was not significantly lower in the participants with severe 25(OH)D deficiency compared to those with mild deficiency or with adequate status., Conclusions: Our results showed that threshold level of 25(OH)D below which iPTH started to rise was 46.9 nmol/l. There was no negative impact of iPTH on BMD or bone turnover markers in women with severe 25(OH)D deficiency. This might be due to the relatively young age of our participants in whom the unfavorable effect of 25(OH)D deficiency on bone might have not yet appeared.

Low bone mineral density has been reported in paediatric and adult patients with different lung diseases, but limited data are available on the association between lung function and bone density in a healthy young population. We explored the predictors of association between bone mass and pulmonary function in healthy first-year university students, focusing on body mass index (BMI). In this cross-sectional study we measured bone density with ultrasound and lung function with spirometry in 370 university students (271 girls and 99 boys). Information on lifestyle habits, such as physical activity, smoking, and alcohol consumption were obtained with a questionnaire. All lung function and bone parameters were significantly higher in boys than in girls (P<0.001). Underweight students had a significantly lower forced vital capacity (FVC%) (P=0.001 girls; P=0.012 boys), while overweight students had a significantly higher FVC% than normal weight students (P=0.024 girls; P=0.001 boys). BMI significantly correlated with FVC% (P=0.001) and forced expiratory volume in 1 second (FEV1 %) in both genders (P=0.001 girls; P=0.018 boys) and with broadband ultrasound attenuation (BUA) in boys. There were no significant associations between any of the bone and lung function parameters either in boys or girls. The most important determinant of lung function and ultrasound bone parameters in our study population was body mass index, with no direct association between bone density and lung function.

Background: The aim of the study was to determine the serum vitamin D levels in patients with psoriatic arthritis (PsA) and compare it with patients with rheumatoid arthritis (RA) and with osteoarthritis (OA), as well as to explore the relationship of the vitamin D level with indices of disease activity and functional ability in a real-life setting in a South-European country., Methods: In a cross-sectional study, 120 adult patients with established diagnosis of PsA, RA and OA were consecutively enrolled. Serum 25-hydroxyvitamin D and intact parathyroid hormone were determined. Parameters of disease activity and functional ability were obtained using standard instruments., Results: Serum vitamin D insufficiency (≤ 75 nmol/L) was found in 74% of patients with PsA, 94% patients with RA and 97% of patients with OA, whereas vitamin D deficiency (≤ 25 nmol/L) was found in 13% of patients with PsA, 39% of patients with RA and in 38% of patients with OA. Compared with RA, patients with PsA had significantly higher serum vitamin D (P = 0.002), and when controlling for age and gender, their serum vitamin D level was significantly associated with disease activity and functional activity., Conclusions: In the group of rheumatic patients, a high prevalence of serum vitamin D insufficiency/deficiency was found regardless of the type of arthritis. Patients with PsA might have higher levels of vitamin D than patients with RA, and this was associated with disease activity and functional ability. The results of this study indicate that prophylactic supplementation with vitamin D might be recommended for all rheumatic patients.

In ankylosing spondylitis, inflammatory activity probably plays a key role in the pathophysiology of bone loss. The aim of the study was to investigate the relationship of bone mineral density (BMD) at the lumbar spine and hip region with some measures of disease activity and functional ability in patients with ankylosing spondylitis. In 80 patients with established ankylosing spondylitis, disease activity and functional ability were determined by C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Bath Ankylosing Spondylitis Functional Index (BASFI). Spinal pain and patient global health were assessed using horizontal visual analog scale. BMD was measured by dual-energy X-ray absorptiometry. There was a significant negative correlation of bone density T scores with acute-phase reactants (i.e., patients with lower T scores had higher level of CRP and ESR). That relationship was reflected more reliably at proximal femur sites than at the lumbar spine. There were also significant differences in ESR, BASDAI, BASFI, spinal pain and global health between three groups of patients according to WHO classification of osteoporosis (normal, osteopenic and osteoporotic). Significantly, more patients with osteopenia at the lumbar spine had lower BASDAI index than those with normal BMD (P = 0.030). Our results indicate an association of low BMD with high disease activity in patients with AS. Femoral BMD seems to be more associated with disease activity and functional ability than lumbar spine BMD.

Vegetarian diets attract more and more attention due to growing concerns about health, ecology and/or animal welfare in general population. The main purpose of this paper was to examine whether vegetarianism could be associated with some specific personality characteristics, with the emphasis on the main motivational factors which determined acquiring the diet. Since the nutrition is also an important determinant of bone health we additionally analyzed the association between personal characteristics and bone density. On a sample of 109 adult vegetarians of both sexes we applied Eysenck Personality Questionnaire (including Psychoticism, Extraversion, Neuroticism and Lie scale), bone densitometry and questionnaire on dominant motives for dietary choices. The results on overall personality characteristics, bone density and basic anthropometric measures were within expected values for age. Vegetarian men had significantly more fractures during lifetime and lower neuroticism scores than women. Dominant motivational factors for acquiring vegetarianism were moral values. In addition "moral vegetarians" showed more pronounced introversion compared to "health vegetarians", lending further support to the argument that personality plays an important role in the structure of motivation.

Background: The aim of this study was to determine the relationship between body mass index, biochemical parameters, and 5-hydroxytryptamine (5-HT) genetic polymorphisms and prostate dysfunction in an elderly general male population., Results: One hundred and seventeen elderly male subjects [60 men without symptoms of prostate hyperplasia, 42 men with untreated benign prostatic hyperplasia (BPH), and 15 men with prostate cancer (PCa)] treated with finasteride or flutamide were included. Multiple comparisons showed significant difference in age, T-score, concentration of phosphorus, calcium, C-reactive protein, and prostate-specific antigen (PSA) between the groups. T-score was the lowest and phosphorus concentration was the highest in the PCa group. Highest PSA, proteins, calcium, and Hekal's formula score were found in the BPH group. Patients with PCa were more frequent GG+GA carriers of 5-HT1B 1997A/G gene polymorphism (p=0.035). Univariate regression analysis showed association of PCa-treated subjects with age (p=0.010) and 5-HT1B genetic polymorphism (p=0.018). Antiandrogen therapy affects T-score (p=0.017), serum phosphorus (p=0.008), glucose (p=0.036), and total proteins (p=0.050). Multivariate-stepwise logistic regression analysis showed the significant association of treated PCa with age (p=0.028) and inorganic phosphorus (p=0.005), and a marginal association with ultrasonographic T-score (p=0.052)., Conclusions: Antiandrogen therapy might induce bone mineral loss in elderly PCa patients. Preliminary data imply that the genetic variants of the 5-HT1B receptor might be associated with PCa.

Purpose: The relationship of homocysteine (Hcy), folate and vitamin B(12) with bone mineral density (BMD) has been studied in various populations but still remains inconsistent. The aim of this study was to test whether the levels of plasma Hcy, serum and red blood cell folate, and vitamin B(12) are related to BMD in the group of adult Croatian women regardless of menopausal status. Some other lifestyle and dietary habits like smoking, physical activity and alcohol consumption were also observed in relation to BMD., Methods: One-hundred and thirty-one women, aged 45-65 years participated in the study. BMD was measured using dual-energy X-ray absorptiometry. Measurements were made at the lumbar spine (L1-L4), left femoral neck, total femur and distal third of the radius. Plasma total Hcy, serum folate, red blood cell folate and serum vitamin B(12) were also determined., Results: No significant correlations were found between Hcy, folate and/or vitamin B(12) and BMD of measured skeletal sites. Body mass index (BMI), age, as well as alcohol consumption were significantly correlated with BMD at the lumbar spine. Positive significant correlation was found between BMI and BMD at the femoral neck and total femur while BMI and age were significant predictors of BMD at the radius (multiple regression analysis). When only postmenopausal women were included, significant predictors of BMD at the lumbar spine were age, BMI, alcohol consumption and intake of hormone replacement therapy., Conclusion: Results of this study suggest that Hcy, folate or vitamin B(12) levels were not related to BMD in population of healthy Croatian women aged 45-65. In the group of postmenopausal Croatian women, beside BMI and age, alcohol consumption was significant positive predictor of BMD at the lumbar spine.

Aims: Although considered as a feature of inflammatory rheumatic diseases, there is a lot of controversy around low bone mass in patients with psoriatic arthritis. The aim of this cross-sectional study was to analyze bone mineral density in patients with psoriatic arthritis, as well as to investigate its possible association with some measures of disease activity and functional capacity., Subjects and Methods: Sixty-nine patients with established psoriatic arthritis (mean age 56.20 ± 12.23 years) and who have not been treated with specific antiosteoporotic drugs were recruited from the out-patient clinic database. Bone mineral density was measured by dual-energy X-ray absorptiometry at the lumbar spine and at the left hip. Disease activity measures included: duration of morning stiffness, tender and swollen joint count, patient's and physician's global assessment, presence of dactylitis and enthesitis, ESR, CRP and Disease Activity Score 28. Health Assessment Questionnaire was used to assess functional status., Results: According to WHO definition, spinal osteoporosis was found in 7.2% of patients, total hip osteoporosis in 1.4% of patients and femoral neck osteoporosis in 2.9% of patients. There was no significant association of any of the measures of disease activity with BMD at any site. Higher HAQ scores were associated with lower total hip BMD., Conclusions: In our sample of patients with psoriatic arthritis we did not find increased prevalence of osteoporosis. There was no association of BMD with indices of disease activity, while negative correlation was found between HAQ and total hip BMD.

Aim: To explore the relationship between muscle strength and bone density in patients with different rheumatic diseases and to examine whether inflammatory arthritis was more harmful for muscle strength and bone loss than degenerative joint diseases., Methods: The study included 361 men and women with a mean±standard deviation age of 60.5±11.4 years and different rheumatic conditions: regional syndromes, osteoarthritis of the hands, shoulders, knees, and hips, and inflammatory arthritis. Maximum voluntary back strength was measured by isometric dynamometry. Bone mineral density (BMD; g/cm2) of the lumbar spine, femoral neck, and distal radius was measured by dual-energy x-ray absorptiometry. Anthropometry and lifestyle characteristics were also assessed., Results: Back strength was lowest in patients with hand and shoulder osteoarthritis (20.0±17.9 kg), followed by patients with inflammatory arthritis (24.8±19.2 kg). Patients with inflammatory arthritis had the lowest BMD at the mid-radius (0.650±0.115 g/cm2) and femoral neck (0.873±0.137 g/cm2), while patients with hand and shoulder osteoarthritis had the lowest BMD at the mid-radius (0.660±0.101). In both sexes, muscle strength was significantly lower in patients who had lower BMD (T score<-1.0). Multiple regression analysis identified significant predictors of back strength to be spine BMD (P=0.024) and body mass index (P=0.004) in men and femoral neck BMD in women (P=0.004)., Conclusion: Muscle strength decline may be connected to bone loss in patients with rheumatic conditions, especially those with inflammatory joint diseases.

Whiplash injury usually occurs in traffic accidents. Persons experienced this injury might have an impairment of proprioception clinically expressed as inability to determine the exact position of their heads. The aim of this study was to examine the loss of proprioception in people who had a whiplash injury. The study included 60 subjects with cervical spine injury, aged 20 to 50 years and 60 healthy volunteers matched by sex and age. The instrument used for cervical spine mobility assessment was the Cervical Measurement System (CMS), which determines the ability of subjects to return their head in the exact position as it was before they turned it 30 degrees left or right. Patients with cervical spine injury showed significant impairment of proprioception in comparison with healthy subjects (P < 0.001). The results support the hypothesis that subject with recent cervical spine injury have incorrect perception of their head position. Therefore, their rehabilitation should include the correction of proprioception and head coordination.

In many countries, including Croatia, there is no disease registry for osteoporosis and osteoporotic fractures. Epidemiological data show that the prevalence of osteoporosis is much higher in Asian people than in white European or North American populations, where the prevalence ranges between 10% and 15%. Epidemiological characteristics of osteoporosis in Croatia are similar to other European countries, though the incidence of osteoporotic fractures is somewhat higher. According to the annual report of registered diseases, the number of patients with osteoporosis and osteoporotic fractures increased during the last 10 years. In 2004, 0.70 % of all registered diseases in Croatia referred to osteoporosis and osteomalacia. The most important risk factors for osteoporosis are age, heredity, lifestyle, chronic diseases, hormonal abnormalities and physical characteristics of bone. Like in other chronic diseases, prevention measures are most important for disease control.

There is no disease registry for osteoporosis and osteoporotic fractures in Croatia. According to the annual report of registered diseases, the number of patients with osteoporosis and osteoporotic fractures increased during the last 10 years. In 2004, 0.70% of all registered diseases in Croatia referred to osteoporosis and osteomalacia. Epidemiological data show that the prevalence of osteoporosis in Croatia is similar to other European countries, while the prevalence and incidence of osteoporotic fractures is somewhat higher. It is estimated that 90 000 men and 77 000 women in Croatia older than 50 years have vertebral fractures. The prevalence is more frequent in older age and in women, although the great number of men (16.2%) were diagnosed as having osteoporosis using ultrasound densitometry. Calcium intake is found to be a dominant risk factor for building-up and maintenance of bone density.

The aim of this study was to measure bone mineral density (BMD) in healthy people and examine the influence of age, anthropometry, and postmenopause on calculated bone mineral apparent density (BMAD). The study included 541 healthy subjects (249 men and 292 women), aged 20 to 79 years. Anthropometric measurements included height, weight, and body mass index (BMI). Bone mineral content (BMC) and areal BMD were measured at the lumbar spine and proximal femur, using dual-energy X-ray absorptiometry (DXA). The calculation of volumetric density relied on the formula BMAD=BMD/ square root BA (where BA = bone area). Association between densitometric parameters and age, height, weight, and postmenopause was analyzed with multiple regression. BMC and BMD decreased with age, especially in postmenopausal women. The average annual bone loss in spine was 0.2% in both sexes, whereas femur loss was 0.5% in men and 0.3% in women. Bone area slightly increased with age in both sexes, and BMD loss after the age of 50 could be attributed to bone area increase. To minimize the effect of bone size on bone density, volumetric density and areal density were regressed to age, anthropometry, and postmenopause. Age and postmenopause were significantly associated with BMD and BMAD in the spine and femur. Furthermore, BMD showed a stronger association with height and weight than BMAD, in both regions. Weaker association of body height and weight with BMAD than with BMD suggests that BMD depends on the bone size and body size and that the different BMDs could be the consequence of the difference in those parameters.

The aim of this study was to analyze the progression of hand osteoarthritis in rural population and to determine the factors which could influence that progression. Participants of both sexes were 54-56 years of age at the first visit. Radiographs of both hands, anthropometry and blood pressure measurement were performed at baseline and than repeated 10 years later. Total number of 286 participants completed the study. Radiographs were red according to Kellgren-Lawrence criteria. Distal interphalangeal (DIP) joints were most frequently affected with osteoarthritis at the baseline and after 10 years. The worst deterioration (three grades) was found in DIP joints in women and in proximal interphalangeal joints in men. Grip strength in men was significantly related with progression of the disease, which allow us to conclude that in our population sample mechanical factors, probably occupational workload, are associated with the more rapid progression of the disease.

Ultrasound bone measurement in healthy Croatian children and adolescents has been evaluated. Relationships between pubertal status, anthropometry, nutrition, and physical activity with ultrasound bone parameter were analyzed. A total number of 501 children and adolescents of both sexes participated in the study. There were 244 prepubertal children (120 boys and 122 girls) and 259 postpubertal adolescents (112 boys and 147 girls). Anthropometric measurements included height, weight, percent of fat tissue, and body mass index. Quantitative ultrasound measurements of the heel (nondominant side) were performed using "Sahara" sonometer and included speed of sound (SOS), broad-band ultrasound attenuation (BUA), and calculated bone stiffness (QUI). Dietary data were assessed using specially designed semiquantitative food frequency questionnaire calculations based on the daily intakes of calcium, carbohydrates, fats, and proteins. Quantitative ultrasound bone measurements (BUA, SOS, and QUI) were similar in prepubertal boys and girls. Adolescent boys had significantly higher BUA (P<.01) than girls. The percentage of children and adolescents who consumed more than 1,000 mg of calcium per day were 54.8% and 48.7%, respectively. Body weight and pubertal status and activity were significantly correlated with bone stiffness but not the calcium intake. In this study, bone stiffness in children and adolescents is determined by pubertal status and body weight, rather than by calcium intake.

The aim of this study was to analyse the quality of life in osteoporotic patients with hip fracture and those without fractures. The study included postmenopausal women, 35 with hip fracture and 33 without fractures. The control group included 44 age-matched healthy women. Osteoporosis Quality of Life Questionnaire was used to assess the health-related quality of life (HRQL). Patients with hip fracture had significantly lower scores in symptoms, physical function and leisure (P < 0.05), than patients without fractures. Both groups of patients had significantly lower scores than controls in all domains except Leisure. Analysing several health and social factors that could influence HRQL, we found that bone mass in spine and femoral neck significantly correlated with HRQL. Since patients with osteoporosis usually have no symptoms before fracture, early diagnosis and the treatment of the disease are of key importance to the quality of life in these patients.

Metabolic bone disorder develops during chronic renal failure and chronic dialysis treatment, continues after successful kidney transplantation, and is further aggravated by corticosteroids and immunosuppressants. The recognized risk factors for bone loss, i.e. parathyroid hormone (PTH) secretion, age, duration of hemodialysis, sex and post-transplantation period, were examined in this cross-sectional study of 91 stable kidney transplant recipients. Patient age was 21-67 years, time spent on dialysis 1-216 months, and post-transplantation period 1-228 months. Bone mineral density was measured by dual energy x-ray absorptiometry at the lumbar spine, femoral neck and radius. T-scores (bone mineral density expressed as standard deviation of healthy young population) were used in statistical analyses to avoid sex differences in bone mass. PTH was measured by a commercial kit (9.07 +/- 11.81 pmol/L). The femoral neck and radius correlated negatively with PTH and hemodialysis duration both in simple correlations and multiple regression, and femoral neck additionally with age. The lumbar spine correlated negatively only with PTH. Post-transplantation time did not correlate significantly with the three densitometry sites. Also, the frequency of osteoporosis or osteopenia for the femoral neck and spine did not differ between the first 12 months and subsequent period, but was positively influenced by hemodialysis duration. There was no sex difference for the variables analyzed in the study. The results indicated that prolonged hemodialysis treatment and consequently increased PTH secretion had unfavourable effect on the femoral neck and radius bone in kidney transplant recipients. Regarding predictors in this study, only PTH was found to adversely affect the lumbar spine. Further deterioration of change in the skeletal status could not be demonstrated, which might be explained by the reduction in PTH secretion and possibly by improvement of the bone disorder.

Aim: To analyze bone metabolism and the risk factors of bone loss in kidney transplant recipients., Methods: The bone mineral density (BMD) of the lumbar spine, femoral neck, and radius was determined by dual-energy X-ray absorptiometry in 52 patients 8 days to 228 months after kidney transplantation. Total and bone alkaline phosphatase (BAP), osteocalcin, procollagen, type I collagen telopeptide, collagen cross links, calcium, intact parathyroid hormone (iPTH), and creatinine were measured in all patients., Results: The BMD of the spine and femoral neck was reduced in 57%, and of the radius in 72% of the patients. Reduced BMD was associated with significantly increased levels of iPTH, osteocalcin, and procollagen. Dialysis duration negatively correlated with the radius BMD in all patients and the femoral neck BMD in women. No relationship between BMD and length of post-transplantation time, age, cumulative steroid dose, or serum creatinine level was established. All biochemical parameters negatively correlated with the spine BMD, but not with the BMD of the femoral neck and radius. The correlation between BAP and telopeptide and length of post-transplantation time was also negative. No difference in the incidence of osteopenia was found between genders., Conclusion: Osteopenia/osteoporosis and increased bone turnover were present in more than a half of the kidney transplant recipients. Reduced BMD was associated with enhanced bone remodeling, primarily mediated by PTH hypersecretion. The length of post-transplantation period, cumulative steroid dose, gender, and age could not be identified as risk factors of reduced BMD.

Aim of the Study: We investigated the association between vertebral osteophytosis and vertebral deformities in an elderly population sample, and the influence of some risk factors on spinal osteophytosis and deformities., Subjects and Methods: A population sample of 280 women and 263 men, all Zagreb residents older than 45 years, participated in the study. Radiographs of the thoracic and lumbar spine were evaluated for the presence of osteophyte formation and vertebral deformities. Osteophyte size was graded on a scale from 0 to 4. Vertebral deformities were determined by the semiquantitative method of McCloskey. The chi-square test was used to analyse the association between vertebral osteophytes and deformities, and the influence of several risk factors was investigated by discriminate analysis., Results: The prevalence of vertebral osteophytosis was 47.9% in men (36.5% in the thoracic and 21.3% in the lumbar spine) and 56.0% in women (36.0% in the thoracic and 23.9% in the lumbar spine). The prevalence of vertebral deformities was 8.3% in men (5.3% in the thoracic and 3.4% in the lumbar spine) and 12.5% in women (7.9% in the thoracic and 5.4% in the lumbar segment). There was a significant association between deformities and osteophytosis on the lumbar segment of the spine (P = 0.0240 men, P = 0.0152 women). Analysing the influence of several risk factors, age was found to be the most associated with both vertebral deformities and osteophytosis. Obesity was significantly associated with osteophytosis., Conclusions: We found a significant association between vertebral osteophytosis and deformities in the lumbar segment and no relationship in the thoracic segment. This implicates different etiologies of vertebral deformities in the thoracic and lumbar spine.

Aim: To determine the prevalence of radiographic osteoarthritis on five joint groups in an urban population sample of 306 women and 304 men over the age of 45 and to assess the influence of some risk factors on osteoarthritis. The validity of concept of generalized osteoarthritis was also examined by analyzing the association of osteoarthritis on different joint sites., Methods: Radiographs of both hands, both knees, and the right hip were taken. Osteoarthritic changes on distal interphalangeal, proximal interphalangeal, first carpometacarpal joints, knees, and hip were graded according to the Kellgren-Lawrence scale. The association among osteoarthritis on different joint sites was analyzed using logistic regression. Subjects were tested for age, duration of postmenopause, anthropometric measures, blood pressure, and smoking as risk factors for osteoarthritis., Results: Hip was the most frequent site of osteoarthritis in men (27.3%), whereas distal interphalangeal joints predominated in women (43.5%). Polyarticular osteoarthritis (+/-3 joints) was present in 10.8% women and 5.9% men. There was a significant influence of age on single joint osteoarthritis, but not on multiple joint involvement. Obesity was significantly correlated with knee osteoarthritis in women and with osteoarthritis on distal interphalangeal joints in men. CONCLUSIONS. In our population sample, the prevalence of knee osteoarthritis was lower and the prevalence of hip osteoarthritis higher than reported for most of other populations. The tendency towards polyarticular osteoarthritis that is more common than would be expected by age, suggests a subset of generalized osteoarthritis.

The authors investigated the influence of physical strain at work on radiological signs of hip osteoarthritis. The study included 295 men and 298 women aged over 45 from an urban area who were classified in four groups according to physical demands of their occupation. The evaluation included clinical and radiological signs of hip osteoarthritis. The association between hip osteoarthritis and occupation was analysed using logistic regression. Though not significantly, radiological signs of hip osteoarthritis were common in subjects who worked in a standing position (odds 1.45 for men, 1.50 for women). Clinical signs of osteoarthritis in women were significantly associated with performance in a standing position (odds 3.00), whereas in men the association was more significant for jobs with high physical strain (odds 2.19). There was a sustained trend toward an increase in health risk with years of work in all job categories. Occupation did not appear to influence the development of radiological hiposteoarthritis, but the authors did establish association between clinical signs of hip osteoarthritis and work.

The aim of the study was to determine the influence of replacement and suppressive thyroxine therapy on bone mineral density (BMD). 30 postmenopausal women; 19 on replacement therapy (dose 1.22 +/- 0.35 micrograms/kg; duration 11.4 +/- 7.2 years) and 11 on suppressive therapy (dose 1.45 +/- 0.71 micrograms/kg; duration 9.5 +/- 7.2 years). Controls were 60 healthy women matched for age and menopausal status. BMD at the lumbar spine (L2-L4), femoral neck, Ward's triangle and trochanter was measured by dual-energy absorptiometry. Forearm BMD at distal site was measured by single-photon absorptiometry. Mean thyroid hormone values and TSH were within normal limits, although the patients on suppressive therapy had significantly higher T3 (p < 0.05) than the patients on replacement therapy. BMD on each site was significantly lower in the replacement treated group than in controls. BMD in patients on suppressive therapy was lower, but not significantly, compared to controls. Thyroxine therapy could have an adverse effect on BMD. The magnitude of bone loss depends on the serum level of thyroid hormones and on the functional state of thyroid hormone receptor in bone tissue, as well.

The objective of this retrospective study was to see whether the effect on bone mineral density (BMD) and response to the intermittent cyclic treatment with etidronate (E) + nandrolone-decanoate (ND + calcium (Ca) (group A--combined regimen--400 mg E daily for 2 weeks, followed by 500 mg Ca daily for the next 10 weeks + 50 mg ND once a month i.m., for 3 months in every other E cycle) was of greater benefit than cyclic E + Ca treatment (group B--standard regimen--E + Ca given in the same manner as in group A) or Ca treatment alone (group C--calcium regimen--500 mg Ca daily, continuously for 1 year). Group A comprised 30, group B 27 and group C 26 postmenopausal women with spinal BMD > or = 1 standard deviation below young adult mean (T score < or = -1) without vertebral fractures. BMD was measured by dual energy X-ray absorptiometry in the lumbar spine and femoral neck before (baseline values) and after one year treatment period. A similar, statistically significant increase in BMD was noted at lumbar spine in groups A and B (3.6% and 3.8%, respectively) and at femoral neck in groups A and B (1.7% and 2.5%, respectively). In group C, the bone loss at lumbar spine was prevented but no significant increase was recorded (0.3%) and at femoral neck an insignificant decrease in BMD was recorded (-0.3%). Percentages of change from baseline were significantly higher in groups A and B in respect to those in group C but there were no significant differences between groups A and B either at lumbar spine or at femoral neck. In about 30% of women from groups A and B, spinal BMD increased by more than 4.2% ("real" responders to the given therapy). A femoral BMD increase of more than 5.6% was recorded in about 13% of women from groups A and B. In group C, no such increase was recorded. In conclusion, combined intermittent cyclical regimen of E + ND + Ca has not proven to be superior to the intermittent cyclic regimen of E + Ca.

Although osteoporosis has been considered a disease of women, there are many evidences of high prevalence of osteoporosis in men, in which cases the risk factors are often recognised. We have presented four patients, age 39-71 years, with bone mineral density loss, which could have been connected with risk factor. Those risk factors in our patients were: malabsorpcy syndrome, heavy metal intoxication, aethilismus, smoking. We conclude that secondary osteoporosis in men appears to be an evident and growing health problem.

Degenerative changes in the finger joints were studied in 550 Zagreb inhabitants, above the age of 45. The sample was selected by the method of unproportional stratified choice according to age and sex. Radiographs of both hands were taken and osteoarthrosis on the proximal and distal interphalangeal joints was graded according to the five-point Kellgren-Lawrence scale. Body weight, height and arterial blood pressure were measured and occupational work load was evaluated. The prevalence of osteoarthrosis in the finger joints was significantly higher in women (40.9%) than in men (24.8%). It increased with age so that 18.7% of men and 15.0% of women aged 45-54 had finger osteoarthrosis compared to 36.3% of men and 68.2% of women aged 75 and older. Distal interphalangeal joints were more often involved (22.8% of men and 37.9% of women) than the proximal ones (9.7% of men and 19.6% of women). The factors most closely associated with osteoarthrosis were age and body weight. Occupational work load, as classified in this study, was not significantly related to the development of osteoarthrosis, except in the group of housewives, in whom the prevalence of finger arthrosis was greater than in the other groups of women.

The results of measurement of bone mass in three areas (lumbar spine, femoral neck and radius) where osteoporotic fractures most commonly occur are presented. The sample of 103 women was divided into three groups: premenopausal, early menopausal (up to 5 years of menopause) and late menopausal (more than 5 years of menopause). Both menopausal groups were additionally divided in two subgroups regarding the previous fractures. A statistically significant difference (p < 0.01) was found between bone mineral density (lumbar spine, femoral neck) and bone mineral content (radius) among all the groups. No difference was established for bone mass between postmenopausal women with and without fractures (> 0.05) by using the Kruskal-Wallis analysis of variance. A significant negative correlation (p < 0.01) was found between bone mass in all three tested regions on one side vs age of women as well as the period of menopause on the other. These results indicate that bone mass is significantly decreased in postmenopausal women. Therefore, the authors recommend densitometry to be employed in all postmenopausal women.