Preventive effects by traditional Chinese (Kampo) medicines, Unkei-to, Hachimi-jio-gan, and Juzen-taiho-to, on the progress of bone loss induced by ovariectomy in rats were investigated for a period of 49 days. The bone mineral density (BMD) of tibia in ovariectomized (OVX) rats decreased by 20% from those in sham-operated (Sham) rats, with the decrease completely inhibited by the administration of any one of these Kampo medicines or 17β-estradiol. From scanning electron microscopic (SEM) analyses, the surface of a trabecular bone of tibia in OVX rats had a porous or erosive appearance, whereas that of the same bone in Sham rats was composed of fine particles. The administration of three Kampo medicines and 17β-estradiol to OVX rats preserved the fine particle surface of the trabecular bone. These results strongly suggest that any of these three gynecological Kampo medicines is as effective as 17β-estradiol in preventing the development of bone loss induced by ovariectomy in rats.

Preventive Effects of Traditional Chinese (Kampo) Medicines on Experimental Osteoporosis Induced by Ovariectomy in Rats

Bone mass is a function of bone size and volumetric bone mineral density (BMD) and is a key determinant of bone strength. As recognition of the importance of bone accrual during childhood has increased, so has the demand for non-invasive methods to assess bone mass. Dual energy x-ray absorptiometry (DXA) is the most widely available technique for the assessment of bone mass. In 2007, the International Society of Clinical Densitometry conducted a Pediatric Position Development Conference to address skeletal health assessment in children and adolescents. The guidelines recommended DXA scans as part of a comprehensive skeletal health assessment in patients at increased risk of fracture. Although there is increasing evidence that DXA measures are associated with fractures in children, DXA has important limitations. These include difficulties in interpretation in children with poor growth and delayed maturation, limited ability to distinguish between cortical and trabecular bone, and differences in hardware and software that compromise the generalizability of reference data. Quantitative computed tomography (QCT) has the advantage that is provides three-dimensional discrete measures of BMD and geometry. Recent years have seen a marked increase in QCT studies to define sex-, race- and age-specific increases in trabecular and cortical BMD and dimensions in healthy children, and to characterize disease effects on trabecular and cortical bone. QCT applications are limited by a lack of standardized measurement sites and protocols. Additional available methods include radiogrammetry, radiographic absorptiometry, and bone ultrasound. This chapter reviews the methods, strengths and limitations of each of these techniques, and highlights examples of applications in children.

Non-invasive Techniques for Bone Mass Measurement

http://www.vision.uji.es/~sotoca/papers/bonemass.pdf

Hand bone segmentation in radioabsorptiometry images for computerised bone mass assessment.

This chapter discusses the pediatric use of dual-energy X-ray absorptiometry (DXA), quantitative computed tomography (QCT), peripheral QCT (pQCT), quantitative ultra- sound (QUS), magnetic resonance imaging (MRI), and X-ray radiogrammetry for bone mass measurement. These techniques can be compared using several criteria, including speed of measurement, radiation exposure, cost, and regions of the skeleton that can be scanned. These techniques also vary in accuracy (the difference between bone measurement and ash weight) and precision (the reproducibility of repeated measurements). For clinical purposes, precision is of greater importance than accuracy. QCT and MRI can distinguish trabecular from cortical bone, whereas DXA provides only a composite measurement of both compartments. There are differences in the availability of normative pediatric data to be used as reference values when interpreting scans performed for clinical purposes. The recognition of importance of early bone health has increased the demand for bone mineral assessments in children and adolescents. For clinicians, densitometry is important for screening the bone health of young patients with myriad chronic diseases associated with low bone mass and fractures early in life. The goal of mass assessments in this setting is to identify patients with skeletal fragility and to monitor response to therapy.

CHAPTER 12 – Noninvasive Techniques for Bone Mass Measurement

1. Films are Acquired and Analyzed Locally. Examples include the Bonalyzer (model THE-40, Teijin, Tokyo, Japan), and the Osteoradiometer (N1M, Verona, Italy) [7,12]. For the Bonalyzer, a single radiograph including both hands is obtained using standard radiologieal equipment. An aluminum wedge (3 cm wide x 15 cm long) with progressively thieker (l mm to 15 mm) steps is positioned in the center of the film, between the hands. Typieal exposure conditions are 50 kV at 1.5 rnAs using standard film and cassette [13]. Bone mass at the distal radius can also be measured by using film large enough (maximum size is approximately 25 x 35 cm for the Bonalyzer) to include this region [12,14-16]. After films are acquired, they can be analyzed immediately using the analyzer. The Bonalyzer digitizes the optical image from the film, and then calculates the density of the central region of the second metacarpal by comparlng the optical density of the bone with the alurninum wedge (Fig. 1). Thus, this measurement primarily represents cortical bone. The bone mass results are expressed as alurninum equivalents [17]; the mass is expressed in units of alurninum thickness (mmAl), and the metacarpal index (a measure of the quantity of bone tissue, derived from the estimated cortieal thickness) is also calculated. Measurements of bone mass (or bone mineral density, BMD) are widely used for evaluating the severity of osteoporosis and risk of fractures. Direct measurements of bone mass are the only reliable method of accurately assessing skeletal status [1,2]. Approximately 84% of all postmenopausal white women have osteopenia (low bone mass) or osteoporosis [3]. However, only a small proportion of people have been evaluated. Techniques that are fast, inexpensive and widely available are needed to allow more people to be evaluated at low cost. Perhaps the earliest technique for measuring bone mass is radiographie absorptiometry (RA). The technique has been evolving for more than 50 years [4-11]. RA uses a radiographie film image, usually of the hand or fingers, to measure bone mass by comparing the optical density of the region of interest (bone) with a calibration standard (such as an alurninum wedge) that is included in the exposure field. Corrections for variations related to soft tissue and X-ray technique have also been incorporated [5]. As described below, some advantages of RA include the following:

Radiographie absorptiometry for measuring bone mass

Assessment of bone density in the distal radius with computer assisted X-ray densitometry (CXD).

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Assessment of bone density in the distal radius with computer assisted X-ray densitometry (CXD).