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  • 1
    Electronic Resource
    Electronic Resource
    Tergurid bei Hyperprolaktinämie — Erfahrungen bei 5 Patienten (1990)
    Springer
    Journal of molecular medicine 68 (1990), S. 384-387 
    Details
    ISSN: 1432-1440
    Keywords: Hyperprolactinemia ; Prolactinoma ; Dopamine agonists ; Terguride
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Hyperprolactinemia can successfully be treated by dopaminagonists such as bromocriptin or lisuride. About 10% of patients complain about side effects like orthostatic hypotension, nausea or vomiting, which may lead to discontinuation of treatment. We therefore conducted a study using terguride — a new dopaminagonist — in 5 patients with hyperprolactinemia and intolerable side effects under conventional treatment. Terguride is the transdihydroderivative of lisuride (Dopergin®). We treated 5 patients, 2 men with macroprolactinoma and 3 women with microprolactinoma with terguride. The mean duration of treatment was 15.6 months (7–37 months). Patients were treated with up to 5 mg terguride daily. All 5 patients had a marked initial decrease of elevated prolactin levels 8 h after administration of 0.25 mg terguride orally. Three patients became normoprolactinemic after sufficient increase of the dose of terguride, 2 female patients with a microprolactinoma got eumenorrhoeic thereafter. The treatment with terguride was tolerated without side effects by all patients. There were no significant changes of the examined parameters of clinical chemistry nor the other pituitary hormones. Results of cranial computertomography did not change in 4 patients, one patient had tumor progression. Tergurid as a dopaminagonist is an effective inhibitor of prolactin with little side effects and thus a useful drug in the treatment of hyperprolactinemia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01650889
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  • 2
    Electronic Resource
    Electronic Resource
    Reduced bone mineral density and low parathyroid hormone levels in patients with the adult form of hypophosphatasia (1992)
    Springer
    Journal of molecular medicine 70 (1992), S. 560-565 
    Details
    ISSN: 1432-1440
    Keywords: Hypophosphatasia ; Bone mineral density ; Intact parathyroid hormone ; Serum alkaline phosphatase ; Bone metabolism
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Hypophosphatasia is a heritable metabolic bone disease with characteristically reduced levels of alkaline phosphatase (ALP) in the blood, liver, kidney and bone. ALP levels are normal in the intestine and placenta. About 300 patients have been reported so far in the literature. Three kindreds with 52 known subjects are described here, whereby 12 subjects could be examined osteologically. Four subjects were patients and had clinical signs of the disease: spontaneous fractures of the metatarsals or femora and low ALP serum levels ranging between 8 and 23 U/1 (normal range 40–170 U/1). Four other members without fractures had reduced ALP levels; they might be carriers of the disease and develop symptoms later in life. The four remaining subjects had normal ALP levels and no signs of the disease. Serum levels of intact parathyroid hormone (iPTH) were found to be in the lower normal range and serum calcium levels in the upper normal range. There was a significant (P〈0.05) negative correlation between iPTH and serum calcium levels (r=−0.78). Urinary calcium excretion was increased in 3 subjects with fractures. 25-OH-D3 levels were increased in 6 of 8 subjects without any treatment. The bone mineral density (BMD) was measured using dual X-ray absorptiometry of the lumbar spine, representing mainly trabecular bone, and single-photon absorptiometry of the forearm, measuring mainly cortical bone. Z-scores of the spinal bone mass ranged between 0.38 and −1.95 SD; Z-scores of the forearm bone mass ranged between 0.53 and −2.47 SD with the lowest values in patients with fractures. There was a significant (P〈0.05) correlation between serum ALP levels and forearm BMD (r=0.83). We conclude from these data that patients with the adult form of hypophosphatasia have decreased forearm and subnormal spinal bone mass, as well as reduced serum levels of iPTH.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00184792
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  • 3
    Electronic Resource
    Electronic Resource
    Erhöhte Prävalenz von Osteoporose und Arteriosklerose bei konventionell substituierter Hypophysenvorderlappeninsuffizienz: Bedarf einer zusätzlichen Wachstumshormonsubstitution? (1991)
    Springer
    Journal of molecular medicine 69 (1991), S. 769-773 
    Details
    ISSN: 1432-1440
    Keywords: Pituitary insufficiency ; Osteoporosis ; Bone mineral density ; Arteriosclerosis ; Hyperlipidemia ; Growth hormone deficiency
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary In a retrospective study of 632 patients with pituitary disease we diagnosed pituitary insufficiency without hypersecretion of any pituitary hormone in 122 patients. Patients were substituted with sex hormones (76%), hydrocortisone (74%) and/or L-thyroxine (77%). 76% had additional growth hormone deficiency, as shown by an increase of growth hormone of less than 5 ng/ml after i.v. administration of L-arginine. In 17% of all patients the diagnosis of osteoporosis was proven or suspected radiologically. 57% had low bone mass of lumbar spine (dualphotonabsorptiometry) and 73% had low bone mass of the proximal forearm (singlephotonabsorptiometry). BMD values of pituitary insufficient patients were in the same range as those of patients with established osteoporosis. More than half of all patients (53%) complained of tiredness, exhaustion and muscle weakness. 40% suffered from adipositas. 77% had hyperlipidemia (68% hypertriglyceridemia and 42% hypercholesterinemia), 18% had hypertension. 14% of the patients had arteriosclerotic events in their history (myocardial infarction or stroke). These figures are higher than incidences shown in the German PROCAM-study. These data show an increased prevalence of osteoporosis and vascular diseases. This is in contrast to the general opinion, that patients with pituitary insufficiency are adequately treated by substitution with adrenal, thyroid and sex hormones. Whether other factors such as the additional growth hormone deficiency are responsible for these diseases has to be examined in prospective studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01797616
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  • 4
    Electronic Resource
    Electronic Resource
    Sex Difference in the Validity of Vertebral Deformities as an Index of Prevalent Vertebral Osteoporotic Fractures: A Population Survey of Older Men and Women (2000)
    Springer
    Osteoporosis international 11 (2000), S. 102-119 
    Details
    ISSN: 1433-2965
    Keywords: Key words:Bone mineral density – Differential diagnosis – Fractures – Osteoarthritis – Osteoporosis – Vertebral deformity
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: Morphometric methods have been developed for standardized assessment of vertebral deformities in clinical and epidemiologic studies of spinal osteoporosis. However, vertebral deformity may be caused by a variety of other conditions. To examine the validity of morphometrically assessed vertebral deformities as an index of osteoporotic vertebral fractures, we developed an algorithm for radiological differential classification (RDC) based on a combination of quantitative and qualitative assessment of lateral spinal radiographs. Radiographs were obtained in a population of 50- to 80-year-old German women (n= 283) and men (n = 297) surveyed in the context of the European Vertebral Osteoporosis Study (EVOS). Morphometric methods (Eastell 3 SD and 4 SD criteria, McCloskey) were validated against RDC and against bone mineral density (BMD) at the femur and the lumbar spine. According to RDC 36 persons (6.2%) had at least one osteoporotic vertebral fracture; among 516 (88.9%) nonosteoporotics 154 had severe spondylosis, 132 had other spinal disease and 219 had normal findings; 14 persons (2.4%) could not be unequivocally classified. The prevalence of morphometrically assessed vertebral deformities ranged from 7.3% to 19.2% in women and from 3.5% to 16.6% in men, depending on the stringency of the morphometric criteria. The agreement between RDC and morphometric methods was poor. In men, 62–86% of cases with vertebral deformities were classified as nonosteoporotic (severe spondylosis or other spinal disease) by RDC, compared with 31–68% in women. Among these, most had wedge deformities of the thoracic spine. On the other hand, up to 80% of osteoporotic vertebral fractures in men and up to 48% in women were missed by morphometry, in particular endplate fractures at the lumbar spine. In the group with osteoporotic vertebral fractures by RDC the proportion of persons with osteoporosis according to the WHO criteria (T-score 〈−2.5 SD) was 90.0% in women and 86.6% in men, compared with 67.9–85.0% in women and 20.8–50.0% in men with vertebral deformities by various methods. Although vertebral deformities by most definitions were significantly and inversely related to BMD as a continuous variable in both sexes [OR; 95% CI ranged between (1.70; 1.07–2.70) and (3.69; 1.33–10.25)], a much stronger association existed between BMD and osteoporotic fractures defined by RDC [OR; 95% CI between (4.85; 2.30–10.24) and (15.40; 4.65–51.02)]. In the nonosteoporotic group individuals with severe spondylosis had significantly higher BMD values at the femoral neck (p 〈0.01) and lumbar spine (p 〈0.0004) compared with the normal group. On the basis of internal (RDC) and external (BMD) validation, we conclude that assessment of vertebral osteoporotic fracture by quantitative methods alone will result in considerable misclassification, especially in men. Criteria for differential diagnosis as used within RDC can be helpful for a standardized subclassification of vertebral deformities in studies of spinal osteoporosis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00004172
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  • 5
    Electronic Resource
    Electronic Resource
    Forearm BMD as measured by peripheral quantitative computed tomography (pQCT) in a German reference population (1994)
    Springer
    Osteoporosis international 4 (1994), S. 179-184 
    Details
    ISSN: 1433-2965
    Keywords: Bone densitometry ; Dual X-ray absorptiometry ; Osteoporosis ; Peripheral quantitative computed tomography ; Reference values
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Low bone mass as estimated by decreased bone mineral density (BMD) is an established predictor of osteoporotic fractures. One of the latest developments in bone densitometry is peripheral quantitative computed tomography (pQCT) of the forearm. In Germany, the CT bone scanner XCT 900 has already been widely used; however, interpretation of measurements with respect to osteoporosis risk assessment can be improved by better defined and validated reference data. In the present study, this device was used to measure BMD at the distal radius in a well-defined healthy population of 179 German adults (91 men, 88 women) aged 20–79 years. In vivo precision was 1.67% for trabecular and 0.81% for total BMD measurements. Peak values of trabecular and total BMD were observed at the ages 40–50 years in women and 30–40 years in men. Beyond these ages, both trabecular and total BMD showed a linear decline with age, decreasing by 0.85% and 1.08% per year in women and by 0.59% and 0.54% in men, respectively. Measures of BMD were not influenced by weight, height or body mass index (BMI). In both sexes, trabecular and total radial BMD showed a positive and significant correlation with femoral BMD measures obtained by dual X-ray absorptiometry (DXA). Weaker correlations were observed with DXA measures of the lumbar spine. Compared with the 95% reference range provided by the manufacturer, the distribution of age- and sex-specific values of trabecular BMD of the distal radius was shifted to lower values by up to 1 standard deviation. Thus, 17% (30 of 179) of our apparently healthy population had BMD values falling short of the suggested lower reference limit. On the other hand, the distribution of total BMD values was shifted to higher values by up to 2 standard deviations in the younger age groups. We conclude that pQCT of the radius is a precise method for measuring BMD, but that its use for osteoporosis risk assessment crucially depends on both well-defined reference data and the results of prospective studies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01623237
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  • 6
    Electronic Resource
    Electronic Resource
    Ultrasound Measurements at the Proximal Phalanges in Healthy Women and Patients with Hip Fractures (1998)
    Springer
    Osteoporosis international 8 (1998), S. 393-398 
    Details
    ISSN: 1433-2965
    Keywords: Key words:Bone mineral density – Calcaneus – Hip fracture – Osteoporosis – Phalangeal ultrasonography – Quantitative ultrasound
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: Measurements of bone mineral density (BMD) are useful for the assessment of fracture risk in osteoporosis. First prospective studies showed that quantitative ultrasound as measured at the calcaneus also predicts future hip fracture risk, independently of BMD and as accurately as BMD. The aim of this study was to compile a reference population for a new ultrasound device that determines amplitude-dependent speed of sound (AD-SOS) through the proximal phalanges of the hand and to prove its ability to distinguish between health volunteers and osteoporotic patients. In a case–control study we examined 139 healthy women aged 21–94 years and a group of 24 female patients aged 69–94 years with recent hip fractures. In the healthy reference population additional BMD measurements were performed with dual-energy X-ray absorptiometry (DXA) and quantitative ultrasound measurements at the calcaneus were carried out. In vivo precision of AD-SOS measurements through the phalanges was 0.52% CV. Simple regression analyses showed a negative correlation with age (r= 70.73, p50.001); modest significant correlations with BMD of the lumbar spine (r= 0.36, p50.001) and BMD of the femoral neck (r= 0.37, p= 0.002) as measured with DXA were shown. The comparison with another ultrasound device measuring SOS and broadband ultrasound attenuation (BUA) through the calcaneus showed correlation with SOS (r= 0.50, p50.001); no significant correlation was found with BUA measurements. Furthermore a dependency of AD-SOS values in anthropometric factors such as body mass index (r= 0.37, p50.001), height (r= 0.40, p50.001) and weight (r= 0.23, p50.05) was shown. First study results on 24 clinically diagnosed osteoporotic patients, defined as patients with recent (51 week) pertrochanteric or femoral neck fractures, showed a good separation between age- and sex-matched controls and osteoporotic patients (Z= 72.0 SD). Receiver operating characteristic (ROC) curves showed an area under the fitted curve of 0.83 + 0.06. These results are powerful for a device measuring AD-SOS through the proximal phalanges of the hand, and further prospective studies have proven the capability of phalangeal ultrasound in fracture risk assessment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001980050081
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  • 7
    Electronic Resource
    Electronic Resource
    Experience with deflazacort in children and adolescents after renal transplantation (2000)
    Springer
    Pediatric nephrology 14 (2000), S. 457-463 
    Details
    ISSN: 1432-198X
    Keywords: Key words Deflazacort ; Renal transplantation ; Renal function ; Body growth ; Obesity ; Bone mineralization
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Deflazacort (DFZ) has been proposed as an alternative drug for immunosuppression after renal transplantation (TX), with fewer side effects than conventional glucocorticoids. We investigated renal function, body growth, body fat, and bone mineral density (BMD) after switching from oral methylprednisolone (MPR) to equivalent doses of DFZ 1–9 years after TX in 20 patients aged 5–20 years, selected because of severe adverse effects from previous steroid therapy. At conversion the patients received a mean dose of 7.4±2.4 mg DFZ/m2 per day. The drug was continued for a mean of 3.7 (1.2–5.5) years. Under DFZ, the glomerular filtration rate dropped slightly (NS). A single rejection episode occurred. Growth velocity significantly improved in the 1st year on DFZ treatment and height standard deviation score (SDS) increased steadily after introduction of DFZ (from –2.64 to –1.96 after 4 years, P=0.06). However, in 10 prepubertal children the height gain (+0.20 SDS in 2 years on DFZ) was not significant and the overall mean annual growth rate after TX was similar to that in 10 matched prepubertal TX children on continued MPR treatment. Relative obesity, estimated from mean body mass index corrected for height, was reduced from +1.11 SDS at the start of DFZ to +0.71 SDS after 2 years (P=0.03) and to +0.39 SDS after 4 years (NS). BMD-SDS of the lumbar spine (L2–4) increased after 1 year on DFZ (P=0.005). In conclusion, DFZ is well tolerated and safe in pediatric patients after TX. It improves relative obesity and bone mineralization. However, body growth is not significantly influenced pre puberty.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004670050792
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  • 8
    Electronic Resource
    Electronic Resource
    Weight-/height-related bone mineral density is not reduced after renal transplantation (1998)
    Springer
    Pediatric nephrology 12 (1998), S. 343-348 
    Details
    ISSN: 1432-198X
    Keywords: Key words: Renal transplantation ; Bone mineral density ; Growth ; Corticosteroids
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Growth retardation is a frequent finding in patients after renal transplantation (Tx). Areal bone mineral density (BMD) in these patients has usually been reported to be low for age. We investigated the possible influence of height and weight retardation on the measurement of BMD in lumbar spine (BMDL2-4) and total body (BMDbody) using dual-energy X-ray absorptiometry in 44 (13 female) pediatric Tx patients with a median age of 13.1 (range 3.3–23.1) years. Patients were studied at 2.9 (range 1–10) years after Tx. Median body height in female and male patients was –2.10 (–3.6 to -0.3) and –2.35 (–5.3 to +1.0) standard deviation score (SDS), respectively. BMD expressed as grams per square centimeter bone area according to age was below the 5th percentile in 10 of 44 patients, but only 1 patient had low values for BMDL2-4, and none for BMDbody, when the data were corrected for height or weight. BMDbody was closely correlated with height, weight, and body surface area (r=0.88), whereas the correlation for BMDL2-4 was less (r=0.76). In 6 patients who achieved final height, height SDS was –2.27 (–4.3–0.4). Z-scores for BMDbody related to age, height, and weight were –1.0 (–2.6 to –2.3), 1.25 (0.1–3.4), and 0.81 (0.0–2.4), respectively. There was no age-dependent change when areal BMD values (g/cm2) were corrected for vertebral size to obtain bone volumetric density (BMDvol, g/cm3). Independent of height, cumulative methylprednisolone dose correlated negatively with BMDL2-4 only in patients who had received a total dose of more than 6 g/m2 of the drug (r =–0.54, P = 0.045). In conclusion, BMD in pediatric patients after Tx is no longer diminished when the data are corrected for height or weight rather than age, or when the data are expressed as bone volumetric density.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004670050464
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