Bone mineral density (BMD) has been known to decline in middle-aged and elderly individuals, but when this decline begins and the rate at which it occurs remain unclear. We thus undertook this study to examine the association between BMD and age by their mean values in women visiting the Shimane Institute of Health Science for medical examination. We performed dual energy X-ray absorptiometry measurement of lumbar vertebrae in 1,167 women, and of the entire skeleton in 1,038 women. The ages of subjects ranged from 30 to 70 years. We found that the mean value of whole-body and lumbar BMD changed little in the age range of 30-51 years, and any change after 58 years was a gradual decrease, unlike the sharp decrease found between 52 and 57 years of age. The effects of endocrine kinetics may be reflected in women by the decrease of bone density relative to age. In conclusion, BMD declines more rapidly in women within the age range of 52-57 years than in those 58 years and over. This regression line is considered useful in predicting BMD of whole-body skeleton and lumbar vertebrae relative to age for the prevention of osteoporosis in women.
A deceased 59-year-old woman with insulin dependent diabetes mellitus complicated by chronic thyroiditis and chronic hepatitis was autopsied. She had had diabetes mellitus since she was 30 years old, and insulin therapy was started at 34 years. Laboratory findings were as follows: s-GOT 85, s-GPT 31, gamma-globulin 2.45 g/dl. Immunological tests were positive for anti-smooth muscle antibody and anti-ENA antibody with high titers of antithyroglobulin and anti-microsome antibodies. HLA analysis revealed the presence of DR-4. The thyroid biopsy specimen showed microscopic features characteristic of chronic thyroiditis at 52 years of age. She had been repeatedly admitted for the control of diabetes mellitus. She was admitted for the 9th time in June, 1987 following complaints of abdominal pain. After admission, her general condition became gradually worse, and she died of peritonitis in September, 1987. Pathological examination of the liver revealed an expansion of fibrous tissue on Glisson's capsule accompanied by lymphocytic infiltration and was diagnosed to be chronic inactive hepatitis. As for the thyroid gland, fibrous tissue replaced an extensive area of the thyroid gland, and normal thyroid tissue was not observed. Lymphocytic infiltration was less in comparison with that in the previous biopsy. As for the pancreas, atrophy of exocrine pancreatic tissue and fibrous change in interstitial tissue was observed. Lymphocytic infiltration was also seen in the interstitial exocrine tissue but not in the islet. Immunohistochemical examination of the islets using anti-insulin, glucagon and somatostatin antibodies by ABC peroxidase method showed the selective disappearance of B cells in the islets. The pathological changes in the thyroid gland, liver and pancreas suggest that autoimmune mechanism may be involved in the pathogenesis of chronic thyroiditis, chronic hepatitis and IDDM with exocrine pancreatic impairment in this case.
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