Vertebral ankylosing hyperostosis is a common skeletal disorder among Pima Indians. Prevalence rates of approximately 50% have been reported in Pima Indian males aged 55 or older. The HLA-B27 antigen is also found more commonly in Pima Indians than in Caucasians (18% versus 6%). Because of the increased prevalence of both vertebral ankylosing hyperostosis and HLA-B27 in Pima Indians, a possible association between the two was thought to exist. Therefore, histocompatibility testing was done on 44 adult male Pima Indians age 55 or older with classic vertebral ankylosing hyperostosis and 33 agematched controls. No significant association between any histocompatibility antigen phenotype or haplotype and vertebral ankylosing hyperostosis was found. This disease, therefore, cannot be classified with the HLA-B27 associa ted spondylarthropathies. Vertebral ankylosing hyperostosis (Forestier's disease) is a disease of the spine characterized radiographically by the formation of large osseous spurs or bridges connecting adjacent vertebrae. Also seen radiographically are ligamentous ossification, paraarticular osteophytes, and fluffy periostitis at the sites of ligament and tendon insertions (1,2). Originally described in the nineteenth century, the disease was rediscovered in 1950 by Forestier and Rot&-Querol who renamed it "senile ankylosing hyperostosis of the spine" (3). Later, the term "senile" was omitted since cases were reported in young adults (4).The bony bridges in vertebral ankylosing hyperostosis are usually found in the lower dorsal spine, but involvement of the cervical and lumbar spine is not uncommon ( 13). The bony bridges are most marked on the anterolateral surfaces of the vertebral bodies and differ radiographically and morphologically from the bony bridges (syndesmophytes) seen in ankylosing spondylitis.Julkunen et ul. (6) described a prevalence rate in Finland for vertebral ankylosing hyperostosis of 3.8% in men and 2.6% in women aged 40 years and over. Vernon-Roberts et al. (7) reported a 6% autopsy prevalence. However, Henrard and Bennett (5) have described overall prevalence rates of this disease of 25% in Pima Indian men and 4.7% in Pima Indian women aged 15 and over living in Arizona. In male Pima Indians aged 55 and older the prevalence rate was 48%, and in Pima women of similar age the prevalence rate was 12%.
To determine whether highly saturated bile is a congenital or acquired characteristic of Pima Indians and to elucidate the basis of the rapid postpubertal increase in gallstones in Pimas, we studied the bile of 66 Pimas nine to 21 years of age. Highly saturated bile is not prevalent among Pimas under the age of 13, but bile saturation increases significantly (P less than 0.05) in both sexes during pubertal growth and development. Bile saturation was 15 per cent higher in females than males. Bile acid pools increased with age in the young men, but not in women. Bile cholesterol saturation correlated with obesity (r = 0.41; P less than 0.001) and urinary estrogen excretion (r = 0.44; P less than 0.001). Highly saturated bile may be present for several years before the onset of cholesterol cholelithiasis.
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