Journal Articles

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    Ecological study of fractures in paedatric Melanesian communities with varying endemic environmental fluoride exposure
    (MDPI (Basel, Switzerland), 2021-09) Webb E; Elmansouri A; Ross R; Clynes M; Tangis J; Stewart C; Dennison EM; Bahamonde RG
    Introduction: Osteoporotic fracture is a major public health burden worldwide, causing significant mortality and morbidity. Studies that have reported bone health in areas of high endemic fluorosis have commonly reported adverse skeletal, as well as dental effects. Vanuatu, sited in the Pacific, and never previously studied with regard to bone health, has six continuous degassing volcanoes on separate islands, resulting in a natural experiment for an ecological study of relationships between naturally occurring fluoride exposure and fracture incidence in paediatric populations. Methods: This ecological study recruited 1026 lifetime residents of the rural Vanuatu islands. A short questionnaire was administered detailing gender, age, and residential history. Participants were asked if they had broken a bone and, if so, were asked to mark its location on a questionnaire manikin. Dental fluorosis was assessed using Dean’s index. Community drinking-water samples were sampled for fluoride concentration. Results: The measured water fluoride concentration and recorded dental fluorosis displayed expected gradients from Aneityum (low) to Ambrym (high) (p < 0.001). The age of participants studied varied from 7.8 (SD 1.2) in Aneityum to 10.6 (3.7) in Lamap/Uliveo. The highest self-reported fracture rates were recorded in the area with medium fluoride levels (Lamap/Uliveo), where 14.9% of boys and 15.6% of girls sampled reported a fracture. In Ambrym, where the mean age of participants was similar, corresponding fracture rates were 4.5% and 2.6%. (p value for differences all < 0.05). Conclusions: Reports of fractures were common in children living in Vanuatu, but demonstrably higher in Lamap, the region with medium fluoride concentrations, rather than Ambrym which had very high rates of naturally occurring fluoride levels. Longer term studies that report validated fracture after peak bone mass acquisition are required.
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    Bone health among premenopausal female alcoholics: A pilot study
    (27/01/2014) Clynes MA; Wyawahare P; Robinson G; Denison HJ; Evans G; Gilmour M; Dennison EM
    We report a pilot study of bone health of alcohol dependent women. Women admitted to an alcohol-withdrawal unit (cases) and a convenience sample of controls (nursing staff) were recruited and asked to complete a lifestyle questionnaire before undergoing heel ultrasound measurements. Fasting blood samples were obtained on the day of admission (day 1) and at 5 days. Bone turnover markers (P1NP and CTX) and vitamin D levels were measured in a subset of the alcohol dependent population. Cases were less physically active than controls. Alcoholic women had lower heel ultrasound derived Stiffness Index scores [mean 85.2 (17.6)] compared with controls [mean 95.5 (18.7)] (p=0.07). P1NP rose significantly over the detoxification programme [day 1: 28.35 ng/l (12.25); day 5: 34.19 ng/l (13.16), p=0.003] but CTX change was not significant. Lifestyle factors associated with poor bone health are prevalent in female alcoholics. Significant increase in bone formation was observed 5 days after alcohol withdrawal.