Nearly 8 million American adolescents participate in sports. Many sports (e.g. basketball, volleyball) require powerful muscle movements. Normally, participation declines in young adulthood. The purpose of this study was to assess longitudinal effects of interscholastic high school sport participation and muscle power on young adult bone strength. 295 young adults from the Iowa Bone Development Study participated in this study. Participants were classified into sport participation groups based on an interscholastic sport participation history questionnaire. Groups included Power Sport Participant (PSP), Other Sport Participant (OSP), and Nonparticipant (NP). Current physical activity (PA) behaviors were assessed via questionnaire. Dual x-ray absorptiometry (DXA) assessed hip areal bone mineral density (aBMD) and was used with hip structure analysis (HSA) to estimate femoral neck section modulus (FN Z) and hip cross-sectional area (CSA). Peripheral quantitative computed tomography (pQCT) provided stress-strain index (SSI) and bone strength index (BSI) at 38% and 4% cross-sectional tibial sites respectively. Vertical jump estimated muscle power at age 19. Gender-specific multiple linear regression predicted young adult bone outcomes based on sport participation groups. Mediation analysis analyzed effects of muscle power on relationships between sport participation and bone outcomes. All analyses were adjusted for current PA. For both males and females, bone outcomes for PSPs were greater than bone outcomes for NPs (P < 0.025). Bone outcomes for PSPs were also greater than OSPs in females (P < 0.025). Mean differences for PSPs and NPs differed between 6.5% to 15.7%. 14.2% to 27.5% of the effect of sport participation on bone outcomes was mediated by muscle power. These results provide evidence to say that former male power sport participants and other sport participants and female power sport participants have stronger bones than peers even when adjusting for current PA. Muscle power did not fully explain differences in all bone outcomes suggesting that sport participation has additional bone health benefits.

Purpose: The objective of this study was to examine the timing of the age and the magnitude of peak lean tissue mass accrual (peak lean tissue velocity, PLTV) as it relates to the age and magnitude of peak cross sectional area velocity (PCSAV) and section modulus velocity (PZV) of proximal femur in both males and females during adolescence. We hypothesized that the age of PLTV would precede the age of PCSAV and PZV and that there be a positive relationship between the magnitude of PLTV and both PCSAV and PZV in both genders. <p>Methods: 41 males and 42 females aged 8-18 years were selected from the Saskatchewan Pediatric Bone Mineral Accrual Study (1991-2005). Participants total body lean tissue mass was assessed annually for 6 consecutive years using DXA. Narrow neck, intertrochanteric and femoral shaft cross sectional areas (CSA) and section modulus (Z) were determined annually using the hip structural analysis (HSA) program. Participants were aligned by maturational age (years from peak height velocity). Lean tissue mass, CSA, and Z were converted into whole year velocities and the maturational age of peak tissue velocities was determined using a cubic spline curve fitting procedure. A 2x3 (gender x tissue) factorial MANOVA with repeated measures was used to test for differences between age of PLTV and both, the age of PCSAV and PZV between males and females. Multiple regression analyses were used to determine the relationship between PLTV and both PCSAV and PZV.<p>Results: There were no sex differences in the ages at which tissue peaks occurred when aligned by maturational age. There were significant differences between the age of PLTV and both PCSAV and PZV at the narrow neck (p=0.001) and femoral shaft (p=0.03), where the age of PLTV preceded both PCSAV and PZV when pooled by gender. There were no significant differences at the intertrochanteric site (p=0.814). PLTV was a significant predictor of the magnitude of both PCSAV and PZV at all sites (p<0.05). <p> Conclusions: These findings support the hypothesis that the age of PLTV precedes the age of PCSA and PZV at the proximal femur and provides further evidence to support the muscle-bone relationship, suggesting that lean tissue mass accrual influences bone strength development at proximal femur during pubertal growth.

Purpose: The objective of this study was to examine the timing of the age and the magnitude of peak lean tissue mass accrual (peak lean tissue velocity, PLTV) as it relates to the age and magnitude of peak cross sectional area velocity (PCSAV) and section modulus velocity (PZV) of proximal femur in both males and females during adolescence. We hypothesized that the age of PLTV would precede the age of PCSAV and PZV and that there be a positive relationship between the magnitude of PLTV and both PCSAV and PZV in both genders. <p>Methods: 41 males and 42 females aged 8-18 years were selected from the Saskatchewan Pediatric Bone Mineral Accrual Study (1991-2005). Participants total body lean tissue mass was assessed annually for 6 consecutive years using DXA. Narrow neck, intertrochanteric and femoral shaft cross sectional areas (CSA) and section modulus (Z) were determined annually using the hip structural analysis (HSA) program. Participants were aligned by maturational age (years from peak height velocity). Lean tissue mass, CSA, and Z were converted into whole year velocities and the maturational age of peak tissue velocities was determined using a cubic spline curve fitting procedure. A 2x3 (gender x tissue) factorial MANOVA with repeated measures was used to test for differences between age of PLTV and both, the age of PCSAV and PZV between males and females. Multiple regression analyses were used to determine the relationship between PLTV and both PCSAV and PZV.<p>Results: There were no sex differences in the ages at which tissue peaks occurred when aligned by maturational age. There were significant differences between the age of PLTV and both PCSAV and PZV at the narrow neck (p=0.001) and femoral shaft (p=0.03), where the age of PLTV preceded both PCSAV and PZV when pooled by gender. There were no significant differences at the intertrochanteric site (p=0.814). PLTV was a significant predictor of the magnitude of both PCSAV and PZV at all sites (p<0.05). <p> Conclusions: These findings support the hypothesis that the age of PLTV precedes the age of PCSA and PZV at the proximal femur and provides further evidence to support the muscle-bone relationship, suggesting that lean tissue mass accrual influences bone strength development at proximal femur during pubertal growth.

Abstract Hip fracture is a trauma with serious consequences, especially in the elderly. Etiological factors should be known better than nowadays to recognize the individuals at high risk. Also, the treatment of displaced femoral neck fractures has been controversial, and the factors leading to a functional outcome are not known well. The true impact of deep infection on the outcome after hip fracture surgery has also been insufficiently examined. The thesis is based on two etiological studies. In the first study, the geometrical parameters of the upper femur and pelvis in postmenopausal women with hip fracture were (n=70) compared to age-adjusted controls (n=40). Measurements were made from position-standardized and calibrated pelvic plain x-rays. The differences between the two different types of hip fracture, femoral neck fractures (n=46) and trochanteric fractures (n=24) were also defined. High femoral neck/shaft angle (NSA), thin femoral cortices, low femoral shaft diameter (FSD) and trochanter width and the pelvic dimensions associate strongly with the hip fracture risk in postmenopausal women. Greater NSA, smallest outer pelvic diameter and acetabular width, narrower FSD and smaller femoral neck/shaft cortex ratio were associated with femoral neck fracture rather than trochanteric fracture in postmenopausal women. In the second study, lifetime factors, some bone metabolism markers and bone mineral density were analyzed from postmenopausal women (n=74; 49 with femoral neck fracture, 25 with trochanteric fracture) and age-adjusted controls (n=40). Impaired functional ability, use of loop diuretics, antidiabetic, antidepressant and neuroleptic drugs, some concurrent diseases, such as stroke, diabetes, malignancy, cardiovascular diseases, low bone mineral density of the upper femur, low serum calcium, low serum 25-hydroxyvitamin D and high serum calcitonin, seem to be related to the risk of hip fracture, while low bone mineral density and low serum calcitonin are related to the trochanteric type of fracture in postmenopausal women. The treatment of displaced femoral fractures included two prospective case-control studies, and the first of these involved a comparison (357 matched pairs) of patients with osteosynthesis (OS) with two pins in Lund and patients with uncemented hemiarthroplasty (HA) in Oulu. The patients treated with OS had 4 months after fracture better ambulatory capacity, used walking aids less often and had less pain than the patients treated with HA. The other comparison (84 matched pairs) was made between OS with three screws and uncemented HA, and it revealed no significant differences between HA and OS in the short-term functional outcome. Both studies revealed a higher re-operation rate in OS patients than uncemented HA patients. The case-control study with 29 matched pairs showed that deep infection after a hip fracture operation impairs the short-term functional outcome and slightly increases mortality, with an attributable mortality rate of 10 %. In conclusion, this thesis suggests that the geometry of the upper femur and pelvis, the aforesaid lifetime factors, the aforesaid metabolism markers and bone mineral density are associated with the etiopathology and type of hip fracture in postmenopausal women. The short-term functional outcome was better in OS patients treated with two pins compared to uncemented HA, but the higher re-operation rate should be considered among the OS patients. Deep infection is a serious complication of hip fracture surgery, which impairs function and increases mortality.

Conversely, AA lost femoral neck BMD over the winter and this was not recovered over the summer, although the increase in width of the femoral neck may have partly compensated BMD loss to maintain strength in bending. The final prospective analysis was conducted in a separate sample of female athletes who were diagnosed with a stress fracture injury. The aim of this analysis was to determine the magnitude and time scale of bone loss following a stress fracture injury and subsequent regain following retaining. A group of 4 stress fracture cases and 3 controls were followed for a period of 6-8 months following a stress fracture injury. BMD and BMC (lumbar spine, femoral neck, and trochanter) and estimations of geometric properties CSA, Z and buckling ratio) were assessed using DXA. The mean difference of bone loss and bone regain was determined by BMD, BMC and geometric parameters from baseline to 6-8 weeks and 6-8 weeks to 6-8 months respectively. No significant bone loss was found in either cases or controls from baseline to 6-8 weeks at any of the bone parameters. A significant difference at the femoral neck was found in the injured leg of the stress fracture cases from 6-8weeks to 6-8months (mean (SE) 1.042(0.102) to 1.070(0.102) g/cm2, p=0.004) with no significant change in the contra-lateral case leg 1.036 (0.102) to 1.054(0.109) g/cm2). No significant bone regain was found in the control subjects (health or injured legs ). Thus athletes do not seem to lose significant BMD during the recovery phase of training when partial weight bearing is required. Subsequent bone regain above the initial baseline value does seem to occur in the injured leg within 8 months following the stress fracture once training is resumed. In conclusion the work within this thesis has not only reinforced previous stress fracture findings, showing that a history of stress fracture is increased in athletes with a history of amenorrhoea, but has identified novel results indicating a lower incidence of stress fracture in female endurance athletes than previously reported. Exercise cognitions have been identified as risk factors for stress fracture history independent of menstrual dysfunction. Furthermore and potentially the most novel finding of this research is the importance for the examination of bone geometric properties in amenorrhoeic athletes. Findings suggest that possible structural adaptations counteract the effects of low BMD and annual losses of BMD during seasonal training in amenorrhoeic endurance athletes. In light of these findings this thesis highlights scope for further longitudinal research in the area of structural adaptation to bone in amenorrhoeic athletes. Keywords: Stress fracture, bone mineral density, bone geometry, endurance athletes, menstrual dysfunction, eating and exercise cognitions.

Midshaft clavicle fractures are very common. Current treatment of choice involves internal fixation with superior or anterior clavicle plating, however their clinical success and patient satisfaction are slowly decreasing. The design of intramedullary (IM) devices is on the rise, but data describing the IM canal parameters is lacking. The aim of this study is to quantify morphometry of the clavicle and its IM canal, and to evaluate the effect of gender and anatomical side. This study used 3-dimensional (3D) image-based models with novel and automated methods of standardization, normalization and bone cross-section evaluation. The data obtained in this thesis presents IM canal and clavicle radius and center deviation parameterized as a function of clavicle length, in addition, its radius of curvature and true length. Results showed that right-sided clavicles tended to be shorter and thicker than left-sided, but only males showed a statistically significant difference in size compared to females (p<.0001). The smallest IM canal and clavicle radii were seen at different clavicle lengths (54% and 49%), suggesting that the narrowest region of IM canal cannot be appreciated based on external visualization of the clavicle alone. The narrowing of the IM canal is of special interest because this a potential limiting region for IM device design. Furthermore, the location and value of maximum lateral curvature displacement is different in the IM canal, implying there exists an eccentricity of the IM canal center with respect to the clavicle center.

Fracture risk reduction is the main goal of treating osteoporosis, a condition which, in the absence of fragility fractures, is diagnosed by bone densitometry. Bone density, however, although an important factor predicting fracture risk, is not the only one and several other factors modulate the fracture risk such as the patient's age, body mass index, family history, cigarette smoking, medications and the risk of falling: most fractures are preceded by falls. When developing a treatment strategy it is therefore important to take into consideration other factors apart from bone density. Several algorithms and instruments are available for this purpose. The FRAX (Fracture Risk Assessment) tool developed under the aegis of the World Health Organization and the Garvan Fracture Risk Calculator are commonly used to estimate the patient's fracture risk. Both have advantages and limitations. It must be emphasized, however, that treatment decisions are clinical ones.

Fracture risk reduction is the main goal of treating osteoporosis, a condition which, in the absence of fragility fractures, is diagnosed by bone densitometry. Bone density, however, although an important factor predicting fracture risk, is not the only one and several other factors modulate the fracture risk such as the patient's age, body mass index, family history, cigarette smoking, medications and the risk of falling: most fractures are preceded by falls. When developing a treatment strategy it is therefore important to take into consideration other factors apart from bone density. Several algorithms and instruments are available for this purpose. The FRAX (Fracture Risk Assessment) tool developed under the aegis of the World Health Organization and the Garvan Fracture Risk Calculator are commonly used to estimate the patient's fracture risk. Both have advantages and limitations. It must be emphasized, however, that treatment decisions are clinical ones.

No description available.

<p> This thesis focuses on an examination of cortical and trabecular bone density and geometry at the radius and tibia in postmenopausal women, primarily women with history of breast carcinoma, while also assessing musculoskeletal changes in postmenopausal breast cancer patients after treatment with the Aromatase Inhibitor, Anastrozole. The first sub-study is an investigation of the reproducibility of the pQCT measurement parameters at the radius and tibia in healthy pre-and postmenopausal women. Results indicated that the reproducibility was good at the radius and even better at the tibia for all parameters measured. The second study is an appraisal of the level of osteoporosis knowledge in a cohort of postmenopausal women. The participants were assessed via the Facts on Osteoporosis Quiz, a well validated questionnaire, and the data revealed significantly lower test scores among the breast cancer subjects in comparison with healthy postmenopausal women. In the remaining group of studies, pQCT technology was utilized to describe trabecular and cortical bone at the radius and tibia in postmenopausal women and women with a history of breast carcinoma whom had been prescribed Anastrozole. The following measurement sites were significantly lower in the breast cancer subjects: TOT_DEN and TOT_CNT at the 4% radius; CRT_DEN, TOT_CNT, and CRT_CNT at the 20% radius; TOT_DEN at the 4% tibia; and CRT_DEN at the 38% tibia. With respect to time on Anastrozole, TOT_CNT at the 4% radius (r=-0.36); TOT_CNT (r=-0.33), CRT_CNT (r=-0.34) and CRT_DEN (r=-0.44) at the 20% radius; and CRT_DEN (r=-0.39) and CRT_CNT (r=-0.27) at the 38% tibia were significantly negatively correlated with days on Anastrozole. Furthermore, after two years of Anastrozole treatment in a small cohort of breast cancer subjects, there was a significant decrease in CRT_DEN (p=0.025) at the 20% diaphyseal radius and also at the 38% diaphyseal tibia (p=0.051). Together, the sub-studies that comprise this thesis demonstrate that there are noteworthy deficiencies in osteoporosis knowledge among postmenopausal women, particularly those with a history of breast carcinoma, and yet, these are the same women that have an increased need to understand the preventative and treatment options regarding this disease as they demonstrate reduced bone density at all measurement sites. It also appears that time on Anastrozole primarily affects cortical bone density in these women. In summary, this thesis provides novel details regarding cortical bone in breast cancer subjects and emphasizes the need for a normative database of bone quality parameters at different skeletal sites in order to gain a better understanding of the utility of each skeletal site with regard to fracture risk prediction. </p> / Thesis / Doctor of Philosophy (PhD)