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Abstract. Ardizzone S, Bollani S, Bettica P, Bevilacqua M, Molteni P, Bianchi Porro G (`L. Sacco' University-Hospital, Milan, Italy). Altered bone metabolism in inflammatory bowel disease: there is a difference between Crohn's disease and ulcerative colitis. J Intern Med 2000; 247: 63±70.Objectives. The aims of this study were to assess bone metabolism in inflammatory bowel disease (IBD) patients and to evaluate potential differences between Crohn's disease (CD) and ulcerative colitis (UC) with respect to the mechanisms underlying bone loss in this group of diseases. Design and setting. This was a cross-sectional study which started in 1992. Patients were randomly selected for invitation to participate and were examined during the years 1992±95 in one research clinic in Milan. Subjects and methods. Fifty-one patients suffering from CD (30 women and 21 men, mean age 38.7 6 13.2 years) and 40 with UC (15 women and 25 men, mean age 34.4. 6 12.5 years) entered the study. Thirty healthy subjects were selected as sex-and age-matched controls (C). Spine and femoral neck bone mineral density (expressed as T score), calciotropic hormones (parathyroid hormone, PTH; 25-hydroxycholecalciferol, 25(OH)D 3 ; 1,25-hydroxycholecalciferol, 1,25(OH)D 3 ) and biochemical markers of bone turnover (ostecalcin, OC; total alkaline phosphatase, ALP; type I collagen Cterminal telopeptide, ICTP) were evaluated. Results. Spine and femur T scores were similar in the two groups (spine: CD = ±1.49 6 1.46; UC = ± 1.67 6 1.13; femur: CD = ±1.80 6 1.36; UC = ± 1.60 6 1.03). Based upon the WHO guidelines, only 8% of CD patients and 15% of UC patients had a normal bone mineral density (BMD), 55% (CD) and 67% (UC) were osteopenic, and 37% (CD) and 18% (UC) were osteoporotic. The distribution amongst the three different diagnostic groups was not significantly different between CD and UC groups (P = 0.11). PTH and 25(OH)D 3 concentrations were not significantly different between CD and UC patients and controls, whilst 1,25(OH)D 3 concentrations were significantly lower in both CD and UC patients compared with controls (P , 0.05). Bone turnover was increased in UC but not in CD patients, as shown by significantly increased concentrations in UC patients of both OC (CD = 7.77 6 5.06, UC = 10.03 6 6.24, C = 6.58 6 2.87, P , 0.05 vs.C) and ICTP (CD = 5.74 6 3.94, UC = 10.2 6 8.47, C = 3.48 6 0.95, P , 0.05 vs. CD and C). In a stepwise regression that included age, sex, disease duration and cumulative prednisolone dose as independent variables, the femur T score was significantly inversely related to disease duration (r 2 = 0.125, F = 6.06) in CD patients. In UC patients, the spine T score was inversely related to age (r 2 = 0.107, F = 5.49) and significantly related to sex (more negative in males: r 2 = 0.3, F = 16.1); the femur T score was significantly related to sex (more negative in males) and inversely related to the cumulative prednisolone dose (r 2 = 0.283, F = 7.3). Conclusions. These data show that IBD patients have a diffuse osteopenia, the degr...

In order to evaluate the prevalence, risk factors, and clinical consequences of hypovitaminosis D in elderly Italian women a multicenter study of 43 osteoporosis centers from all regions of Italy was carried out. Study population included 700 women aged 60-80 years in whom blood was taken for 25-hydroxyvitamin D (25OHD) and parathyroid hormone (PTH) measurements. All subjects were also questioned to assess the prevalence of several risk factors for hypovitaminosis D, osteoporotic fractures and activities of daily living (ADL). Values of 25OHD lower than 5 ng/ml were found in 27% of the women and lower than 12 ng/ml in 76%. 25OHD and PTH levels were negatively correlated ( r=-0.38, after logarithmic transformation of both variables). 25OHD levels significantly declined with advancing age and number of pregnancies and were positively correlated with educational level (years spent at school), dairy calcium intake, and days spent on holiday by the sea. In a multivariate model including all these variables, the only one that remained significant was the level of education. The lowest age-adjusted 25OH D levels were found in smokers or in women living in central Italy as compared with those living in northern or southern Italy. The mean (+/-SD) age-adjusted 25OH D values were significantly lower in women who sustained a hip fracture (7.1+/-2.2 versus 11.0+/-9.9). Women with low 25OHD levels (<12 ng/ml) had worse scores for ADL and mobility ADL (move outdoors, use stairs, walk at least 400 m, carry a heavy object). Vitamin D deficiency is extremely common among elderly Italian women. Women with lower educational level, living in central Italy, smokers or with lower intake of dairy products are at greater risk. Hypovitaminosis D is associated with worsening of the ability to perform activities of daily living and higher hip fracture prevalence. This finding should lead to an urgent population-based strategy to remedy this condition.

Our study demonstrates that ablation of right APs in children can be performed without fluoroscopy using a single catheter with minimal amounts of RF applications. Our new technique is associated with high success rates.

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