Lumbar spine

Studies have demonstrated that treatment with soy or phytoestrogen enriched diets is effective in conserving bone in rodent models of osteoporosis (Anderson and Gamer, 1998 Ishimi et al, 2000 Draper et al, 1997). The mechanism of action of phytoestrogens on bone health is unclear but several mechanisms including inhibition of bone resorption and stimulation of bone formation maybe involved (Fanti etal, 1998 Ishimi e/a/., 1999 Picherit eta/., 2000). Limited data from studies in postmenopausal women have indicated that phytoestrogen supplements have a small, beneficial effect on bone loss in the lumbar spine (Alekel et al, 2000 Potter et al, 1998 Somekawa et al, 2001). 

Horiuchi et al., 2000 Japanese postmenopause n = 85 Women with a high soy protein intake showed less bone loss and higher BMD at the lumbar spine Biomarkers urinary deoxypyridinoline (bone resorption) decreased... 

Mei et al., 2001 Chinese postmenopause n = 357 premenopause n = 293 Significant differences found in BMD of the lumbar spine and hip between highest and lowest tertile of isoflavone intake for postmenopausal but not for premenopausal women... 

Somekawa et al., 2001 Japanese peri/post-menopause n = 478 The high isoflavone intake group (65 mg/d) had significantly higher BMD of the lumbar spine compared to the low intake group (35 mg/d). Some menopausal symptoms were better alleviated in the high vs low intake group... 

Potter et al., 1998 American postmenopause n = 66 40 g soy protein (containing 90 mg isoflavones/ day) over 6 months results in 2.5% increase in BMD of the lumbar spine... 

Morabito et al., 2002 European postmenopause placebo, n = 30 genistein, n = 30 HRT, n = 30 First randomized, double-blind placebo-controlled study. Compared to placebo control, genistein (54 mg/day) consumed for 1 year significantly reduced urinary excretion of bone resorption markers and increased bone formation markers at 6 and 12 months BMD was significantly increased at the femoral neck and lumbar spine plasma genistein concentration was around 1.5 pM. HRT showed similar effects to genistein for BMD. 

In placebo-controlled clinical trials, alendronate, ibandronate, and risedronate increased bone mineral density by up to 5% to 8% in the lumbar spine and up to 3% to 5% in the hip.13-16 Additional data suggest that bone mineral density continues to increase with long-term therapy of 7 to 10 years.17,18... 

Upper lumbar spine compression may lead to bowel and bladder dysfunction (constipation and urinary retention) and abnormal extensor plantar reflexes... 

Boden SD (1996) The use of radiographic imaging studies in the evaluation of patients who have degenerative disorders of the lumbar spine. J Bone Joint Surg Am 78(1 ) 114-124... 

Niosi CA, Oxland TR (2004) Degenerative mechanics of the lumbar spine. Spine J 4(6 Suppl) 202S-208S... 

Risbud M, Izzo M, Adams C et al. (2003) Mesenchymal stem cells respond to their microenvironment and in vitro to assume nucleus pulposus-like phenotype. Paper presented at 30th Annual Meeting of the International Society for the Study of the Lumbar Spine. Vancouver, Canada... 

Joints most commonly affected are the DIP and PIP joints of the hand, the first carpometacarpal joint, knees, hips, cervical and lumbar spine, and the first metatarsophalangeal joint of the toe. 

BMD increases are dose dependent and greatest in the first 6 to 12 months of therapy. Small increases continue over time at the lumbar spine but plateau after 2 to 5 years at the hip. After discontinuation, the increased BMD is sustained for a prolonged period that varies depending on the bisphosphonate used. 

The drug reduces fracture risk in postmenopausal women, but no fracture data are available in men. Lumbar spine BMD increases are higher than with any other osteoporosis therapy. Although wrist BMD is decreased, wrist fractures are not increased. 

The relationship between the decrease in BMD and an increased fracture risk has been widely demonstrated, in all the measured skeletal regions and by different techniques (Melton et al. 1993 Marshall et al. 1996 Cummings et al. 1993). Marshall et al. (1996) demonstrated in a metaanalysis that one standard deviation decrease in BMD in lumbar spine, hip, or proximal radius increased the risk of fracture in these locations by 50 to 60% (Fig. 8.2). A different picture is seen, however, when the effects on BMD of the different antiresorptives and their relationship with the fracture risk reduction are analyzed. 

Fig. 8.3. Randomized studies of antiresorptives in postmenopausal women with osteoporosis. Risk of vertebral fractures. Not head-to-head comparison. Increase in lumbar spine BMD vs. placebo (Wright et al. 1994 Liu et al. 2004 Seeman et al. 2003 Ettinger et al. 1998, 1999 Delmas et al. 2002)...

All women included in MORE met criteria for osteoporosis defined as a lumbar spine or femoral neck bone mineral density (BMD) T score equal to or less than 2.5 or as the presence of a radiographic vertebral fracture. These women are considered to be at lower risk for breast cancer than women with normal BMD since this parameter could partially reflect a woman s lifetime exposure to estrogens (Zhang et al. 1997). After the start of MORE, NHANES III criteria standardizing total hip BMD measurements became available allowing part of... 

Alekel, D.L., Germain, A.S., Peterson, C.T., Hanson, K.B., Steward, J.W. and Toda, T. (2000). Isoflavone-rich soy protein isolate attenuate bone loss in the lumbar spine of perimenopausal women, Am. J. Clin. Nutr., 72, 844-852. 

Repeated exposure to excessive concentrations of hydrogen fluoride over a period of years may result in an increased radiographic density of bone and eventually may cause crippling fluorosis (osteosclerosis due to deposition of fluoride in bone)/ The early signs of increased bone density from fluoride deposition are most apparent in the lumbar spine and pelvis and can be detected by X ray. 

Reduction of weight, dietary fat intake, alcohol intake, and dose may reverse the effects on serum triglycerides, allowing patients to continue therapy. Musculoskeletal effects In a clinical trial (N = 217) of a single course of therapy for isotretinoin, 7.9% of patients had decreases in lumbar spine bone mineral density greater than 4%, and 10.6% of patients had decreases in total hip bone mineral density greater than 5%. 

In the same study by Lloyd et al. (1996), but after 2 years of CCM supplementation, the Ca group versus the placebo group demonstrated significantly higher BMD (12.2% vs 10.1% p =. 005) and bone mineral content increases (BMC 39.9% vs 35.7% p =. 01) for total body, while bone area remained similar between groups (p =. 15). At the lumbar spine and pelvis, supplemental Ca improved bone accretion compared to placebo by as much as 12-24%. Annualized bone acquisition rate was highest in Ca supplemented subjects with above-median values for... 

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