scholarly journals ĐẶC ĐIỂM LÂM SÀNG, CẬN LÂM SÀNG BỆNH NHÂN XẸP ĐA TẦNG CỘT SỐNG NGỰC VÀ THẮT LƯNG DO LOÃNG XƯƠNG ĐIỀU TRỊ BẰNG PHƯƠNG PHÁP BƠM CEMENT SINH HỌC

2022 ◽  
Vol 509 (1) ◽  
Author(s):  
Trịnh Bá Thắng ◽  
Hoàng Gia Du ◽  
Nguyễn Văn Trung ◽  
Vũ Xuân Phước ◽  
Nguyễn Đức Hoàng ◽  
...  
Keyword(s):  
T Score

Mục đích: Mô tả đặc điểm lâm sàng, cận lâm sàng của các bệnh nhân xẹp đa tầng cột sống ngực, thắt lưng được điều trị bằng phương pháp bơm cement sinh học. Phương pháp nghiên cứu: Mô tả cắt ngang 28 trường hợp xẹp đa tầng cột sống ngực thắt lưng được điều trị bằng phương pháp bơm cement sinh học đa tầng tại Bệnh viện Bạch Mai từ tháng 01 năm 2019 đến tháng 6 năm 2021. Kết quả: Tỷ lệ nữ/ nam: 8.35, tuổi trung bình 70.5 tuổi (44-86), 100% bệnh nhân có bệnh nền. Triệu chứng chính: đau đột ngột tại cột sống do chấn thương nhẹ hoặc tự nhiên kèm hạn chế vận động do đau, VAS trung bình 7.04 điểm (6-9), tổng số 103 đốt xẹp mới, vị trí tổn thương nhiều nhất ở T12 (17 đốt xẹp), chủ yếu là xẹp hình chêm (51.5%), 75% bệnh nhân có biến dạng cột sống, T-Score trung bình -3.89. Kết luận: Xẹp đa tầng cột sống ngực thắt lưng do loãng xương chủ yếu ở bệnh nhân cao tuổi, nữ giới, có bệnh lý nền, khởi phát sau một chấn thương nhẹ hoặc tự nhiên, thường đau kéo dài, tỷ lệ biến dạng cột sống cao, mức độ loãng xương nặng.

Sex Differences in Time Production Revisited

2012 ◽  
Vol 33 (1) ◽  
pp. 35-42 ◽  
Author(s):  
Joseph Glicksohn ◽  
Yamit Hadad
Keyword(s):  
Sex Differences ◽  
Individual Differences ◽  
Sex Difference ◽  
Absolute Error ◽  
Internal Clock ◽  
Target Duration ◽  
Log P ◽  
Men And Women ◽  
Time Production ◽  
T Score

Individual differences in time production should indicate differences in the rate of functioning of an internal clock, assuming the existence of such a clock. And sex differences in time production should reflect a difference in the rate of functioning of that clock between men and women. One way of approaching the data is to compute individual regressions of produced duration (P) on target duration (T), after log transformation, and to derive estimates for the intercept and the slope. One could investigate a sex difference by comparing these estimates for men and women; one could also contrast them by looking at mean log(P). Using such indices, we found a sex difference in time production, female participants having a relatively faster internal clock, making shorter time productions, and having a smaller exponent. The question is whether a sex difference in time production would be found using other methods for analyzing the data: (1) the P/T ratio; (2) an absolute discrepancy (|P-T|) score; and (3) an absolute error (|P-T|/T) score. For the P/T ratio, female participants have a lower mean ratio in comparison to the male participants. In contrast, the |P-T| and |P-T|/T indices seem to be seriously compromised by wide individual differences.

Risikoreduktion für vertebrale Frakturen unter Denosumab bei Patienten mit normaler und osteopenischer Knochendichte

2014 ◽  
Vol 05 (06) ◽  
pp. 251-256
Author(s):  
J. M. Wolff ◽  
P. Hadji ◽  
A. Braun ◽  
C. Ke ◽  
T. Steinle ◽  
...  
Keyword(s):  
T Score ◽  
Post Hoc

ZusammenfassungEinleitung: Die Ergebnisse der HALT-Prostatakarzinom-Studie (1) zeigten, dass Denosumab bei Prostatakarzinompatienten unter hormonablativer Therapie (HALT) die Knochenmineraldichte (BMD) gegenüber Placebo an allen Messorten signifikant erhöhte und die Inzidenz vertebraler Frakturen nach 36 Monaten signifikant um 62 % senkte. Keine Unterschiede wurden hinsichtlich der Zeit bis zur ersten klinischen Fraktur (jegliche nonvertebrale oder klinisch vertebrale Fraktur) beobachtet. In einer Post-hoc-Analyse wurde nun überprüft, ob Denosumab auch bei Patienten mit normaler bis osteopenischer Knochendichte das Risiko für neue vertebrale Frakturen reduziert.Methoden: Hierzu wurde bei allen Teilnehmern der HALT-Studie (n = 1468) mit einem BMD-T-Score > –2,5 an Lendenwirbelsäule (LWS), Gesamthüfte und Schenkelhals sowie auswertbarem Frakturstatus die Inzidenz neuer vertebraler Frakturen nach 36 Mona-ten unter Behandlung mit Denosumab vs. Placebo ermittelt.Ergebnisse: Zu Studienbeginn wiesen 1174 bzw. 80 % der Studienteilnehmer einen BMDT-Score > –2,5 an allen drei Messorten auf. 1087 bzw. 74 % der Studienteilnehmer erfüllten die Kriterien für die Frakturauswertung. In dieser Subgruppe reduzierte Denosumab das Risiko für vertebrale Frakturen nach 36 Mona-ten gegenüber Placebo signifikant um 61 % (Placebo: 2,8 %; Denosumab: 1,1 %; p = 0,0386). Weitere Frakturendpunkte wurden nicht untersucht.Fazit: Denosumab reduzierte das Risiko für vertebrale Frakturen bei Patienten der HALT-Studie mit normaler und osteopenischer Knochendichte in ähnlichem Ausmaß wie im Gesamtkollektiv.

T-score as an Indicator of Fracture Risk on Therapy: Evidence From Romosozumab vs Alendronate Treatment in the ARCH Trial

2020 ◽  
Author(s):  
F Cosman ◽  
E. Michael Lewiecki ◽  
Peter R. Ebeling ◽  
E Hesse ◽  
N Napoli ◽  
...  
Keyword(s):  
Fracture Risk ◽  
T Score ◽  
Alendronate Treatment

scholarly journals Multimarker method in the study of laboratory predictors of vascular wall elasticity as the basis for the development of a personalized approach to the treatment of socially significant diseases

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
T Petelina ◽  
K Avdeeva ◽  
N Musikhina ◽  
L Gapon ◽  
S Bykova ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Postmenopausal Women ◽  
Ldl Cholesterol ◽  
Blood Pressure Monitoring ◽  
Vascular Inflammation ◽  
Fold Increase ◽  
Endothelin 1 ◽  
T Score ◽  
Markers Of Inflammation

Abstract Funding Acknowledgements Type of funding sources: None. Aim To investigate the role of markers of vascular inflammation, vitamin D, parathyroid hormone as predictors of increased pulse-wave velocity (PWV) and degenerative bone changes in postmenopausal women with arterial hypertension (AH). Methods 164 females were examined. Gr.1 included 42 healthy individuals, Gr.2 - 58 patients with AH and Gr.3 - 64 postmenopausal women with AH and osteoporosis. Parameters of blood pressure monitoring; PWV, osteodensitometry (T-Score); inflammatory markers: hsCRP, TNFα, homocysteine, IL-1β, 6, 8, endothelin-1; lipid profile parameters; sex and parathyroid hormones, vitamin D  were measured. Results In Gr.3 excess levels of PWV, hsCRP, homocysteine, IL8, total cholesterol, LDL cholesterol, endothelin-1 and parathyroid hormone was detected with decrease in the level of sex hormones and vitamin D. Besides, negative correlations of T-Score with age, PWV, duration of menopause, IL-6, hsCRP were registered; positive correlations between PWV with IL6, LDL cholesterol, hsCRP, endothelin-1, DBP variability were found. The logistic regression method revealed the main markers that affect increase of PWV, such as hsCRP and endothelin-1.Rise of each marker by unit of measurement leads to increase in PWV by 1.3 times and 2.4%, respectively. In Gr.2 increase in PWV level of more than 12.05 m/s was associated with 3.8-fold increase in the risk of osteoporosis. In Gr.3 increase in PWV level on 1 m/s was associated with 6 fold increase in the risk of osteoporosis. Conclusions Elevated levels of PWV are associated with markers of inflammation, levels of parathyroid hormone, vitamin D, T-Score and may be part of the pathogenesis of the cardiovascular continuum in postmenopausal women, which will require an individual approach to the treatment of AH with comorbid metabolic disorders.

scholarly journals Bone mineral density assessment by DXA in rheumatic patients with end-stage osteoarthritis undergoing total joint arthroplasty

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Moritz Mühlenfeld ◽  
André Strahl ◽  
Ulrich Bechler ◽  
Nico Maximilian Jandl ◽  
Jan Hubert ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Rheumatic Diseases ◽  
Total Joint Arthroplasty ◽  
Joint Destruction ◽  
Joint Arthroplasty ◽  
Mineral Density ◽  
T Score ◽  
End Stage ◽  
Rheumatic Patients

Abstract Background Patients with rheumatic diseases have a high risk for joint destruction and secondary osteoarthritis (OA) as well as low bone mineral density (BMD, i.e., osteoporosis). While several factors may lead to low BMD in these patients, the value of BMD measurements in rheumatic patients with end-stage OA scheduled for total joint arthroplasty is unknown. Methods In this retrospective cross-sectional study of 50 adults with secondary OA due to rheumatic diseases, we evaluated dual energy X-ray absorptiometry (DXA) measurements of both hips and the spine performed within 3 months prior to arthroplasty (n = 25 total hip arthroplasty, THA; n = 25 total knee arthroplasty, TKA). We analyzed various demographic and disease-specific characteristics and their effect on DXA results by using group comparisons and multivariate linear regression models. Results Although patients undergoing TKA were younger (63.2 ± 14.2 vs. 71.0 ± 10.8 yr., p = 0.035), osteoporosis was observed more frequently in patients scheduled for TKA than THA (32% vs. 12%). Osteopenia was detected in 13/25 patients (52%) in both the THA and TKA cohort. In the THA cohort, female sex, lower BMI and prednisolone use were associated with lower T-score in the hip. In TKA patients, higher OA grade determined by Kellgren-Lawrence score was associated with lower T-score in the hip of the affected side. Conclusions Osteoporosis is present in a considerable frequency of rheumatic patients with end-stage OA, and THA and TKA patients show distinct frequencies and risk factors of low BMD. Our findings point to a potential value of DXA regarding preoperative evaluation of bone status.

scholarly journals AB0267 BODY COMPOSITION IN PATIENTS WITH RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1432.2-1432
Author(s):  
N. Toroptsova ◽  
O. Dobrovolskaya ◽  
N. Demin ◽  
L. Shornikova
Keyword(s):  
Rheumatoid Arthritis ◽  
Body Composition ◽  
Muscle Mass ◽  
Dual Energy ◽  
X Ray ◽  
T Score ◽  
Osteosarcopenic Obesity ◽  
The Mean ◽  
Total Fat ◽  
Appendicular Muscle Mass

Background:Rheumatoid arthritis (RA) is a complex inflammatory disease that modifies body composition. Using the dual-energy x-ray absorptiometry (DXA) in RA patients could be a method for body composition changes detection.Objectives:To study the body composition using DXA in patients with RA.Methods:The study involved 79 women with RA, median age 60 [55; 65] years. The bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry using «Discovery A» (Hologic, USA). Assessment of body composition was carried out, using the program «Whole body». Sarcopenia (SP) was diagnosed as a decrease in appendicular mass index (AMI) <6.0 kg/m2. Osteoporosis (OP) was diagnosed as a decrease in T-score <-2.5 SD. Osteosarcopenia was determined when T-score was <-1.0 SD, AMI was <6.0 kg/m2, osteosarcopenic obesity - T-score was <-1.0 SD, AMI was <6.0 kg/m2and total fat was >35%.Results:The mean duration of RA was 9 [3; 11] years. The mean body mass index (BMI) was 27.6±4.8 kg/m2. Disease activity score in 28 joints-erythrocyte sedimentation rate was 4.5±1.3 points for the group. 39 (49.3%) patients used oral glucocorticoids continuously. Appendicular muscle mass and AMI were on average 17.8±3.0 kg and 6.8±1.0 kg/m2, respectively. AMI <6 kg/m2was detected in 20 (25.3%) patients. 56 (70.9%) women with RA had total fat > 35%, while only 22 (27.8%) of women with RA had obesity according to BMI (BMI >30 kg/m2). Isolated OP was found in 13 (16.5%), osteosarcopenia in 7 (8.9%) and osteosarcopenic obesity in 13 (16.5%) patients RA. No cases with isolated sarcopenia or sarcopenic obesity were detected. Only 3 (3.8%) patients did not have appendicular muscle mass, AMI and BMD decrease and overfat or obesity.Conclusion:About 97% women with RA had abnormal body composition phenotype: 16,5% - OP, 8.9% -osteosarcopenia, 16,5% - osteosarcopenic obesity and 54,4% - overfat.Disclosure of Interests:None declared

scholarly journals POS1018 IMPORTANCE OF LATERAL SPINE VIEW IN DXA BONE DENSITOMETRY IN PATIENTS WITH SPONDYLOARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 776.3-777
Author(s):  
S. Miri ◽  
H. Ferjani ◽  
K. Maatallah ◽  
A. Kasraoui ◽  
D. Kaffel ◽  
...  
Keyword(s):  
Femoral Neck ◽  
Structural Changes ◽  
Age Of Onset ◽  
Posterior Part ◽  
Lateral View ◽  
Mineral Density ◽  
Lateral Spine ◽  
Male Predominance ◽  
T Score ◽  
The Mean

Background:Osteoporosis is an increasingly important health problem among patients with spondyloarthritis (SPA). The Measure of Bone Mineral Density BMD is routinely carried out in an anteroposterior (AP) view of the spine. However, the syndesmophytes, ligaments calcifications, and the posterior part of vertebrae affect AP scanning. A lateral spine view is a more sensitive tool in assessing bone loss in trabecular bone.Objectives:We aimed to evaluate the association between lateral lumbar DXA and syndesmophyte grading in patients with SPA.Methods:We conducted a retrospective study including 75 patients with SPA. Bone density of the hip and lumbar spine was measured with a GE Lunar Prodigy Advance Bone Densitometer equipment. All patients had lumbar lateral, AP, and proximal femur DXA scans. The T-score, which measures the difference between a patient’s BMD and young-normal subjects, was computed and age-matched.Results:The mean age of the patients was 36±11 years. Male predominance was noted with a sex ratio of 4.76. The mean BMI was 25±5 kg/m2. Eight percent were obese. Fifty-two percent had Vitamin D deficiency.Forty-eight percent of the patients had axial SPA, while 52% had axial and peripheral symptoms.The mean age of onset was 27±7 years. Fifty-two percent of the patients had high inflammatory biomarkers. The BASDAI, ASDAS-VS, and ASDAS-CRP mean levels were respectively: 3.5±2.4, 3.1±0.9, and 3±0.8. The mean BASRI and mass were respectively 8 + 4.8 and 16.4 + 19.4. Analyses of T-score values obtained over the femoral neck revealed osteoporosis in 18.7% of the cases and osteopenia in 32% of the cases. On the other hand, analyses of AP, spine views revealed osteoporosis in 25.3% and osteopenia in 45.3% of patients (p=0.028, r=0.254). We detected the highest percentage of osteoporosis in lateral lumbar view and T-scores matched more closely with femoral neck values; osteoporosis in 29.3%, and osteopenia in 22.7% of the patients (p<10-3, r=0.562). BMD measured in AP, and lateral views were in good agreement (p<10-3, p=0.592). Age was inversely but not significantly associated with BMD in lateral (p=0.442, r=-0.09), AP (p=0.319, r=-0.117) and femoral neck projections (p=0.179, r=-0.157). Femoral neck BMD was associated with the activity of SPA (ASDAS vs (p=0.027, r= -0.295), and the mobility limitation BASMI (p=0.032, r= -0.247). Coxitis, BASRI, or mSASS were independent of BMD.Conclusion:We conclude that spine lateral view in DXA accurately measures BMD exceeding the AP spine views and femoral neck values. Therefore, structural changes do not affect this measurementDisclosure of Interests:None declared.

scholarly journals POS0163 INCIDENT FRACTURE RISK PREDICTION USING THE FRAGILITY SCORE CALCULATED BY LUMBAR SPINE RADIOFREQUENCY ECHOGRAPHIC MULTI SPECTROMETRY (REMS) SCANS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 294.2-294
Author(s):  
D. Ciardo ◽  
P. Pisani ◽  
F. A. Lombardi ◽  
R. Franchini ◽  
F. Conversano ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Fracture Risk ◽  
Fragility Fracture ◽  
Osteoporotic Fractures ◽  
Fragility Fractures ◽  
Bone Fragility ◽  
P Value ◽  
T Score ◽  
Caucasian Women

Background:The main consequence of osteoporosis is the occurrence of fractures due to bone fragility, with important sequelae in terms of disability and mortality. It has been already demonstrated that the information about bone mass density (BMD) alone is not sufficient to predict the risk of fragility fractures, since several fractures occur in patients with normal BMD [1].The Fragility Score is a parameter that allows to estimate skeletal fragility thanks to a trans-abdominal ultrasound scan performed with Radiofrequency Echographic Multi Spectrometry (REMS) technology. It is calculated by comparing the results of the spectral analysis of the patient’s raw ultrasound signals with reference models representative of fragile and non-fragile bones [2]. It is a dimensionless parameter, which can vary from 0 to 100, in proportion to the degree of fragility, independently from BMD.Objectives:This study aims to evaluate the effectiveness of Fragility Score, measured during a bone densitometry exam performed with REMS technology at lumbar spine, in identifying patients at risk of incident osteoporotic fractures at a follow-up period of 5 years.Methods:Caucasian women with age between 30 and 90 were scanned with spinal REMS and DXA. The incidence of osteoporotic fractures was assessed during a follow-up period of 5 years. The ability of the Fragility Score to discriminate between patients with and without incident fragility fractures was subsequently evaluated and compared with the discriminatory ability of the T-score calculated with DXA and with REMS.Results:Overall, 533 women (median age: 60 years; interquartile range [IQR]: 54-66 years) completed the follow-up (median 42 months; IQR: 35-56 months), during which 73 patients had sustained an incident fracture.Both median REMS and DXA measured T-score values were significantly lower in fractured patients than for non-fractured ones, conversely, REMS Fragility Score was significantly higher (Table 1).Table 1.Analysis of T-score values calculated with REMS and DXA and Fragility Score calculated with REMS. Median values and interquartile ranges (IQR) are reported. The p-value is derived from the Mann-Whitney test.Patients without incident fragility fracturePatients with incident fragility fracturep-valueT-score DXA[median (IQR)]-1.9 (-2.7 to -1.0)-2.6 (-3.3 to -1.7)0.0001T-score REMS[median (IQR)]-2.0 (-2.8 to -1.1)-2.7 (-3.5 to -1.9)<0.0001Fragility Score[median (IQR)]29.9 (25.7 to 36.2)53.0 (34.2 to 62.5)<0.0001By evaluating the capability to discriminate patients with/without fragility fractures, the Fragility Score obtained a value of the ROC area under the curve (AUC) of 0.80, higher than the AUC of the REMS T-score (0.66) and of the T-score DXA (0.64), and the difference was statistically significant (Figure 1).Figure 1.ROC curve comparison of Fragility Score, REMS and DXA T-score values in the classification of patients with incident fragility fractures.Furthermore, the correlation between the Fragility Score and the T-score values was low, with Pearson correlation coefficient r=-0.19 between Fragility Score and DXA T-score and -0.18 between the Fragility Score and the REMS T-score.Conclusion:The Fragility Score was found to be an effective tool for the prediction of fracture risk in a population of Caucasian women, with performances superior to those of the T-score values. Therefore, this tool presents a high potential as an effective diagnostic tool for the early identification and subsequent early treatment of bone fragility.References:[1]Diez Perez A et al. Aging Clin Exp Res 2019; 31(10):1375-1389.[2]Pisani P et al. Measurement 2017; 101:243–249.Disclosure of Interests:None declared

scholarly journals Patient-proxy agreement on change in acute stroke patient-reported outcome measures: a prospective study

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Brittany R. Lapin ◽  
Nicolas R. Thompson ◽  
Andrew Schuster ◽  
Irene L. Katzan
Keyword(s):  
Physical Function ◽  
Inpatient Rehabilitation ◽  
Patient Reported Outcome Measures ◽  
Meaningful Change ◽  
Meaningful Improvement ◽  
T Score ◽  
Patient Reported ◽  
Exact Agreement ◽  
Over Time

Abstract Objectives Research has indicated proxies overestimate symptoms on patients’ behalves, however it is unclear whether patients and proxies agree on meaningful change across domains over time. The objective of this study is to assess patient-proxy agreement over time, as well as agreement on identification of meaningful change, across 10 health domains in patients who underwent acute rehabilitation following stroke. Methods Stroke patients were recruited from an ambulatory clinic or inpatient rehabilitation unit, and were included in the study if they were undergoing rehabilitation. At baseline and again after 30 days, patients and their proxies completed PROMIS Global Health and eight domain-specific PROMIS short forms. Reliability of patient-proxy assessments at baseline, follow-up, and the change in T-score was evaluated for each domain using intra-class correlation coefficients (ICC(2,1)). Agreement on meaningful improvement or worsening, defined as 5+ T-score points, was compared using percent exact agreement. Results Forty-one patient-proxy dyads were included in the study. Proxies generally reported worse symptoms and functioning compared to patients at both baseline and follow-up, and reported less change than patients. ICCs for baseline and change were primarily poor to moderate (range: 0.06 (for depression change) to 0.67 (for physical function baseline)), and were better at follow-up (range: 0.42 (for anxiety) to 0.84 (for physical function)). Percent exact agreement between indicating meaningful improvement versus no improvement ranged from 58.5–75.6%. Only a small proportion indicated meaningful worsening. Conclusions Patient-proxy agreement across 10 domains of health was better following completion of rehabilitation compared to baseline or change. Overall change was minimal but the majority of patient-proxy dyads agreed on meaningful change. Our study provides important insight for clinicians and researchers when interpreting change scores over time for questionnaires completed by both patients and proxies.

scholarly journals Evaluation of association of fragility fracture and bone mineral density in Nepalese population

2013 ◽  
Vol 2 (2) ◽  
pp. 130-134
Author(s):  
Md. Farid Amanullah ◽  
BP Shrestha ◽  
GP Khanal ◽  
NK Karna ◽  
S Ansari ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Risk Factor ◽  
Alcohol Consumption ◽  
Bone Mineral ◽  
Fragility Fracture ◽  
High Energy ◽  
Medical Illness ◽  
Mineral Density ◽  
T Score ◽  
Study Results

Background: Fragility fractures are one of the major health problems. Many factors are associated with it some of which are modifiable and some are not. If we know the value of T-score at which fragility fracture occurs and associated factors responsible for fragility fracture than we will be able to control this burden to the society. The objective of this study is to determine association between fragility fracture and bone mineral density (BMD) using bone densitometry and to know the value of T-score at which fragility fracture occurs. Methods: Patients presenting to B.P. Koirala Institute of Health Sciences with fragility fracture of distal end of radius, fracture around hip and vertebral fractures were included in the study to know the value of T-score at which fragility fracture occurs and their associated risk factor. Patients less than 50 years of age, high energy trauma fracture and pathological fractures were excluded from the study. Results: We found that being multipara, smoking, alcohol consumption, post-hysterectomized patients and steroid intake had significant association with fragility fracture. There was no association with religion, geographic location, associated medical illness, age, sex, associated injury and site of injury. Conclusion: The patients with risk factor for fragility fracture like smoking, alcohol consumption, multipara women, post-hysterectomized women and those who are on long term steroid therapy should undergo BMD test and the value at -3.254 are prone to fragility fracture and should be treated accordingly. Nepal Journal of Medical Sciences | Volume 02 | Number 02 | July-December 2013 | Page 130-134 DOI: http://dx.doi.org/10.3126/njms.v2i2.8956

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