Postmenopausal osteoporosis: simple screening method for diagnosis before structural failure.

Concurrent measurements of combined cortical thickness (CCT) at the midshaft of the second metacarpal and at the proximal juxtametaphyseal radial cortex were made in 234 healthy women aged 46-80 years (group 1) and in 52 women with symptomatic osteoporosis (at least two spontaneous vertebral compressions) (group 2). When -2 standard deviations (SDs) of the mean values in young healthy women (aged 21-45 years) were used as the lower limit of normal measurements, 47% of the subjects in group 1 showed abnormalities: in 25% both bones were abnormal, in 12% the radius alone was abnormal, and in 10% the second metacarpal alone was abnormal. Because 98% of the subjects in group 2 had abnormal CCT measurements, the -2-SD limit of the younger healthy subjects appears to constitute a satisfactory "fracture threshold.

Longitudinal microradioscopic comparisons on endosteal and juxtaendosteal bone loss in premenopausal and postmenopausal women, and in those with end-stage renal disease.

Endosteal bone resorption is the principal mechanism of bone loss in involutional osteoporosis and in renal osteodystrophy. In the cortical bone it is often accompanied by juxtaendostal bone resorption. Using fine-detail radiographs and x6 magnified viewing, longitudinal radiographic observations and measurements were made on these two forms of bone resorption in the metacarpals II, III, and IV in three groups of women: (1) premenopausal, (2) postmenopausal, and (3) patients with end-stage renal disease.

Quantitative radionuclide scanning in metabolic bone disease.

A simple method of quantifying skeletal uptake of 99Tcm-methylene diphosphonate, using a rectilinear scanner and a simultaneously image standard, is described. The pattern of quantified uptake in ten regions of the skeleton, the sacro-iliac joints and kidneys in 57 controls and 54 patients with various metabolic bone disease is presented. This method distinguishes patients with primary hyperparathyroidism and osteomalacia from controls with a sensitivity adequate for clinical purposes.

Evaluation of cortical bone mass, thickness and density by z-scores in osteopenic conditions and in relation to menopause and estrogen treatment.

Z-scores express differences from normals in standard deviation units, and are particularly useful for comparison of changes where normal values are age- and sex-dependent. We determined z-scores for bone mineral mass, cortical thickness, and bone mineral density in the radius in various conditions and diseases in both sexes. In the males, z-scores were calculated for age, but in the females z-scores for menopausal status (years postmenopausal exclusive of years on estrogen treatment) were found to be more appropriate.

Periosteal resorption of finger phalanges: radial versus ulnar surfaces.

Measurement of periosteal resorption (PR) at the radial and ulnar surfaces of the second, third and fourth middle phalanges of one hand in 60 normals and 61 chronic renal failure (CRF) patients showed generally higher involvement at the radial than the ulnar surfaces; however, best diagnostic results were achieved when PR was measured at both radial and ulnar surfaces of the index finger only. With the quantitative method, 31 of 61 CRF patients showed changes, whereas only 22 were identified with the grading method.

Compact bone mineral density of the normal human radius.

Compact bone mineral density was determined by roentgen ray photodensitometry in the proximal radius of 292 normal men and 302 normal women in the 20 to 90 years age range. Between 20 and 49 years, the bone mineral density did not change significantly. The normal bone mineral density was found to be slightly higher in women than in men.

Microradioscopic quantitation of periosteal resorption in secondary hyperparathyroidism of chronic renal failure.

The feasibility of expressing periosteal resorption (PR) in hand bones quantitatively as a measure of skeletal involvement of hyperparathyroidism, was tested by measuring the length of surface irregularities in medial and lateral surfaces of the middle phlanges of digits II--IV in one hand. Measurements were made to 0.1 mm by microradioscopy of fine detail radiographs using a X 6 measuring magnifier.

A roentgenologic study of cortical bone resorption in chronic renal failure.

Periosteal, intracortical, and endosteal resorptive changes were evaluated in both hands and the proximal radius in 161 chronic renal-failure patients by microradioscopy, radiographic morphometry, and photodensitometry. These changes were compared to abnormalities found in skeletal surveys. A combination of microradioscopy and morphometry of hand bones was sufficiently sensitive for early detection of bone loss in renal osteodystrophy in 61% of the patients.

Menopausal bone loss and estrogen replacement.

Throughout adult life the bone mineral mass of the radius is greater in males than in females. In males, it decreases after 60 years of age, while in females, it decreases earlier, at approximately 50 years, and the loss is greater. At the average age of 67 years, one half of the normal white female population has less than the normal amount of bone in the radius.

Improved roentgenologic diagnosis of osteomalacia by microradioscopy of hand bones.

Microradioscopic study of metacarpals in 24 osteomalacic and 34 osteoporotic patients revealed excessive intracortical resorption (striations) in approximately 60 percent of patients suffering from osteomalacia, but in none of the osteoporotics. Phalangeal periosteal resorption was found less frequently in osteomalacia than metacarpal striations, and was absent in osteoporotics. On the other hand, quantitative evaluation of cortical thickness, percent cortical area, bone mineral mass, and density did not show any clear differences between the two study groups.

Preventive effect of estrogen on postmenopausal bone loss.

Follow-up studies of bone mineral content in the radius were done in 82 postmenopausal women 4 to 10 years after the first examination. These patients were subdivided into four groups depending on the type of menopause (artificial or natural) and estrogen administration (treated or untreated). Bone mineral mass and combined cortical thickness decreased significantly in both groups of untreated women.

The relationship of diabetes mellitus and body weight to osteoporosis in elderly females.

Assessment of roentgenographic measurements of cortical bone of the radius in 196 elderly females, including 63 diabetics, revealed that: (1) in the non-diabetic group there was a significant loss of cortical bone relative to the number of years after the menopause and to body weight; (2) although there was a significant loss of cortical bone relative to years postmenopausal in a group of diabetic patients the cortex in the diabetic group was better preserved than in those non-diabetic controls in whom no vertebral compressions were diagnosed in the roentgenograms; no correlation between bone loss and body weight was found among the diabetics; (3) the thinnest cortical bone and the lowest average body weight was found in the 34 non-diabetics with vertebral compression deformities. It thus appears that involutional osteoporosis will be less prevalent among old women suffering from diabetes mellitus than in comparable non-diabetic subjects, and more prevalent among non-diabetics of low body weight than in old women who are obese or of normal weight.