Fracture resistance of endodontically treated teeth restored with different intraradicular posts with different lengths

Aim: This study compared the resistance to fracture of endodontically treated teeth restored with different intraradicular posts with different lengths and full coverage metallic crowns. Methods: Sixty extracted human canine teeth were randomly divided into 6 groups. Groups CP5, CP75 and CP10 were restored using custom cast post and core (CP) and groups PF5, PF75 and PF10 were restored with provisional pre-fabricated tin post (PF) and composite resin core at 5 mm, 7.5 mm and 10 mm of intraradicular length, respectively. The specimens were submitted to dynamic cyclic loading and those that resisted to this load were submitted to load compression using a universal testing machine. Compressive load was applied at a 45-degree angle to the long axis of the tooth until failure. Results: Kruskal-Wallis one-way analysis of variance by ranks showed statistically significant differences among the groups (p<0.0001). However, when the means were compared using the Tukey’s test, significant differences were noted between groups CP5 and CP10 and between groups CP10 and PF5. All groups presented root fractures and post displacements during mechanical cycling. All teeth in groups CP5 and PF5 failed the dynamic cycling test. Conclusions: This study showed that increasing intraradicular post length also increases resistance to fracture of endodontically treated teeth. On the other hand, most endodontically treated teeth restored with pre-fabricated tin posts (provisional posts) failed in the dynamic cycling test

Increased vertebral morphometric fracture in patients with postsurgical hypoparathyroidism despite normal bone mineral density

Background In human malaria, the naturally-acquired immune response can result in either the elimination of the parasite or a persistent response mediated by cytokines that leads to immunopathology. The cytokines are responsible for all the symptoms, pathological alterations and the outcome of the infection depends on the reciprocal regulation of the pro and anti-inflammatory cytokines. IL-10 and IFN-gamma are able to mediate this process and their production can be affected by single nucleotide polymorphisms (SNPs) on gene of these cytokines. In this study, the relationship between cytokine IL-10/IFN-gamma levels, parasitaemia, and their gene polymorphisms was examined and the participation of pro-inflammatory and regulatory balance during a natural immune response in Plasmodium vivax-infected individuals was observed. Methods The serum levels of the cytokines IL-4, IL-12, IFN-gamma and IL-10 from 132 patients were evaluated by indirect enzyme-linked immunosorbent assays (ELISA). The polymorphism at position +874 of the IFN-gamma gene was identified by allele-specific polymerase chain reaction (ASO-PCR) method, and the polymorphism at position -1082 of the IL-10 gene was analysed by PCR-RFLP (PCR-Restriction Fragment Length Polymorphism). Results The levels of a pro- (IFN-gamma) and an anti-inflammatory cytokine (IL-10) were significantly higher in P. vivax-infected individuals as compared to healthy controls. The IFN-gamma levels in primoinfected patients were significantly higher than in patients who had suffered only one and more than one previous episode. The mutant alleles of both IFN-gamma and IL-10 genes were more frequent than the wild allele. In the case of the IFNG+874 polymorphism (IFN-gamma) the frequencies of the mutant (A) and wild (T) alleles were 70.13% and 29.87%, respectively. Similar frequencies were recorded in IL-10-1082, with the mutant (A) allele returning a frequency of 70.78%, and the wild (G) allele a frequency of 29.22%. The frequencies of the alleles associated with reduced production of both IFN-gamma and IL-10 were high, but this effect was only observed in the production of IFN-gamma. Conclusions This study has shown evidence of reciprocal regulation of the levels of IL-10 and IFN-gamma cytokines in P. vivax malaria, which is not altered by the presence of polymorphism in the IL-10 gene.

Isokinetic analysis of ankle and ground reaction forces in runners and triathletes

OBJECTIVE: To analyze and compare the vertical component of ground reaction forces and isokinetic muscle parameters for plantar flexion and dorsiflexion of the ankle between long-distance runners, triathletes, and nonathletes. METHODS: Seventy-five males with a mean age of 30.26 (±6.5) years were divided into three groups: a triathlete group (n=26), a long-distance runner group (n = 23), and a non-athlete control group. The kinetic parameters were measured during running using a force platform, and the isokinetic parameters were measured using an isokinetic dynamometer. RESULTS: The non-athlete control group and the triathlete group exhibited smaller vertical forces, a greater ground contact time, and a greater application of force during maximum vertical acceleration than the long-distance runner group. The total work (180º/s) was greater in eccentric dorsiflexion and concentric plantar flexion for the non-athlete control group and the triathlete group than the long-distance runner group. The peak torque (60º/s) was greater in eccentric plantar flexion and concentric dorsiflexion for the control group than the athlete groups. CONCLUSIONS: The athlete groups exhibited less muscle strength and resistance than the control group, and the triathletes exhibited less impact and better endurance performance than the runners.

Shear behavior of reinforced concrete slabs under concentrated load: an investigation through Sequentially Linear Analysis

ABSTRACT (italiano) Con crescente attenzione riguardo al problema della sicurezza di ponti e viadotti esistenti nei Paesi Bassi, lo scopo della presente tesi è quello di studiare, mediante la modellazione con Elementi Finiti ed il continuo confronto con risultati sperimentali, la risposta in esercizio di elementi che compongono infrastrutture del genere, ovvero lastre in calcestruzzo armato sollecitate da carichi concentrati. Tali elementi sono caratterizzati da un comportamento ed una crisi per taglio, la cui modellazione è, da un punto di vista computazionale, una sfida piuttosto ardua, a causa del loro comportamento fragile combinato a vari effetti tridimensionali. La tesi è incentrata sull'utilizzo della Sequentially Linear Analysis (SLA), un metodo di soluzione agli Elementi Finiti alternativo rispetto ai classici approcci incrementali e iterativi. Il vantaggio della SLA è quello di evitare i ben noti problemi di convergenza tipici delle analisi non lineari, specificando direttamente l'incremento di danno sull'elemento finito, attraverso la riduzione di rigidezze e resistenze nel particolare elemento finito, invece dell'incremento di carico o di spostamento. Il confronto tra i risultati di due prove di laboratorio su lastre in calcestruzzo armato e quelli della SLA ha dimostrato in entrambi i casi la robustezza del metodo, in termini di accuratezza dei diagrammi carico-spostamento, di distribuzione di tensioni e deformazioni e di rappresentazione del quadro fessurativo e dei meccanismi di crisi per taglio. Diverse variazioni dei più importanti parametri del modello sono state eseguite, evidenziando la forte incidenza sulle soluzioni dell'energia di frattura e del modello scelto per la riduzione del modulo elastico trasversale. Infine è stato effettuato un paragone tra la SLA ed il metodo non lineare di Newton-Raphson, il quale mostra la maggiore affidabilità della SLA nella valutazione di carichi e spostamenti ultimi insieme ad una significativa riduzione dei tempi computazionali. ABSTRACT (english) With increasing attention to the assessment of safety in existing dutch bridges and viaducts, the aim of the present thesis is to study, through the Finite Element modeling method and the continuous comparison with experimental results, the real response of elements that compose these infrastructures, i.e. reinforced concrete slabs subjected to concentrated loads. These elements are characterized by shear behavior and crisis, whose modeling is, from a computational point of view, a hard challenge, due to their brittle behavior combined with various 3D effects. The thesis is focused on the use of Sequentially Linear Analysis (SLA), an alternative solution technique to classical non linear Finite Element analyses that are based on incremental and iterative approaches. The advantage of SLA is to avoid the well-known convergence problems of non linear analyses by directly specifying a damage increment, in terms of a reduction of stiffness and strength in the particular finite element, instead of a load or displacement increment. The comparison between the results of two laboratory tests on reinforced concrete slabs and those obtained by SLA has shown in both the cases the robustness of the method, in terms of accuracy of load-displacements diagrams, of the distribution of stress and strain and of the representation of the cracking pattern and of the shear failure mechanisms. Different variations of the most important parameters have been performed, pointing out the strong incidence on the solutions of the fracture energy and of the chosen shear retention model. At last a confrontation between SLA and the non linear Newton-Raphson method has been executed, showing the better reliability of the SLA in the evaluation of the ultimate loads and displacements, together with a significant reduction of computational times.

Shear behaviour of reinforced cconcrete slab under concentrated load: an investigation through non-linear and sequentially linear analysis

English: The assessment of safety in existing bridges and viaducts led the Ministry of Public Works of the Netherlands to finance a specific campaing aimed at the study of the response of the elements of these infrastructures. Therefore, this activity is focused on the investigation of the behaviour of reinforced concrete slabs under concentrated loads, adopting finite element modeling and comparison with experimental results. These elements are characterized by shear behaviour and crisi, whose modeling is, from a computational point of view, a hard challeng, due to the brittle behavior combined with three-dimensional effects. The numerical modeling of the failure is studied through Sequentially Linear Analysis (SLA), an alternative Finite Element method, with respect to traditional incremental and iterative approaches. The comparison between the two different numerical techniques represents one of the first works and comparisons in a three-dimensional environment. It's carried out adopting one of the experimental test executed on reinforced concrete slabs as well. The advantage of the SLA is to avoid the well known problems of convergence of typical non-linear analysis, by directly specifying a damage increment, in terms of reduction of stiffness and resistance in particular finite element, instead of load or displacement increasing on the whole structure . For the first time, particular attention has been paid to specific aspects of the slabs, like an accurate constraints modeling and sensitivity of the solution with respect to the mesh density. This detailed analysis with respect to the main parameters proofed a strong influence of the tensile fracture energy, mesh density and chosen model on the solution in terms of force-displacement diagram, distribution of the crack patterns and shear failure mode. The SLA showed a great potential, but it requires a further developments for what regards two aspects of modeling: load conditions (constant and proportional loads) and softening behaviour of brittle materials (like concrete) in the three-dimensional field, in order to widen its horizons in these new contexts of study.

Fracture Mechanics Investigation of Structures with Defects

Fracture mechanics plays an important role in the material science, structure design and industrial production due to the failure of materials and structures are paid high attention in human activities. This dissertation, concentrates on some of the fractural aspects of shaft and composite which have being increasingly used in modern structures, consists four chapters within two parts. Chapters 1 to 4 are included in part 1. In the first chapter, the basic knowledge about the stress and displacement fields in the vicinity of a crack tip is introduced. A review involves the general methods of calculating stress intensity factors are presented. In Chapter 2, two simple engineering methods for a fast and close approximation of stress intensity factors of cracked or notched beams under tension, bending moment, shear force, as well as torque are presented. New formulae for calculating the stress intensity factors are proposed. One of the methods named Section Method is improved and applied to the three dimensional analysis of cracked circular section for calculating stress intensity factors. The comparisons between the present results and the solutions calculated by ABAQUS for single mode and mixed mode are studied. In chapter 3, fracture criteria for a crack subjected to mixed mode loading of two-dimension and three-dimension are reviewed. The crack extension angle for single mode and mixed mode, and the critical loading domain obtained by SEDF and MTS are compared. The effects of the crack depth and the applied force ratio on the crack propagation angle and the critical loading are investigated. Three different methods calculating the crack initiation angle for three-dimension analysis of various crack depth and crack position are compared. It should be noted that the stress intensity factors used in the criteria are calculated in section 2.1.

Evolution of the structural and fracture design of the ISS payloads due to the new launchers, specifically applied to Biolab IEC-2 projects

The relatively young discipline of astronautics represents one of the scientifically most fascinating and technologically advanced achievements of our time. The human exploration in space does not offer only extraordinary research possibilities but also demands high requirements from man and technology. The space environment provides a lot of attractive experimental tools towards the understanding of fundamental mechanism in natural sciences. It has been shown that especially reduced gravity and elevated radiation, two distinctive factors in space, influence the behavior of biological systems significantly. For this reason one of the key objectives on board of an earth orbiting laboratory is the research in the field of life sciences, covering the broad range from botany, human physiology and crew health up to biotechnology. The Columbus Module is the only European low gravity platform that allows researchers to perform ambitious experiments in a continuous time frame up to several months. Biolab is part of the initial outfitting of the Columbus Laboratory; it is a multi-user facility supporting research in the field of biology, e.g. effect of microgravity and space radiation on cell cultures, micro-organisms, small plants and small invertebrates. The Biolab IEC are projects designed to work in the automatic part of Biolab. In this moment in the TO-53 department of Airbus Defence & Space (formerly Astrium) there are two experiments that are in phase C/D of the development and they are the subject of this thesis: CELLRAD and CYTOSKELETON. They will be launched in soft configuration, that means packed inside a block of foam that has the task to reduce the launch loads on the payload. Until 10 years ago the payloads which were launched in soft configuration were supposed to be structural safe by themselves and a specific structural analysis could be waived on them; with the opening of the launchers market to private companies (that are not under the direct control of the international space agencies), the requirements on the verifications of payloads are changed and they have become much more conservative. In 2012 a new random environment has been introduced due to the new Space-X launch specification that results to be particularly challenging for the soft launched payloads. The last ESA specification requires to perform structural analysis on the payload for combined loads (random vibration, quasi-steady acceleration and pressure). The aim of this thesis is to create FEM models able to reproduce the launch configuration and to verify that all the margins of safety are positive and to show how they change because of the new Space-X random environment. In case the results are negative, improved design solution are implemented. Based on the FEM result a study of the joins has been carried out and, when needed, a crack growth analysis has been performed.

Analysis of retrieved shoulder prostheses

In the last years the number of shoulder arthroplasties has been increasing. Simultaneously the study of their shape, size and strength and the reasons that bring to a possible early explantation have not yet been examined in detail. The research carried out directly on explants is practically nonexistent, this means a poor understanding of the mechanisms leading the patient and so the surgeon, to their removal. The analysis of the mechanisms which are the cause of instability, dislocation, broken, fracture, etc, may lead to a change in the structure or design of the shoulder prostheses and lengthen the life of the implant in situ. The idea was to analyze 22 explants through three methods in order to find roughness, corrosion and surface wear. In the first method, the humeral heads and/or the glenospheres were examined with the interferometer, a machine that through electromagnetic waves gives information about the roughness of the surfaces under examination. The output of the device was a total profile containing both roughness and information on the waves (representing the spatial waves most characteristic on the surface). The most important value is called "roughness average" and brings the average value of the peaks found in the local defects of the surfaces. It was found that 42% of the prostheses had considerable peak values in the area where the damage was caused by the implant and not only by external events, such as possibly the surgeon's hand. One of the problems of interest in the use of metallic biomaterials is their resistance to corrosion. The clinical significance of the degradation of metal implants has been the purpose of the second method; the interaction between human body and metal components is critical to understand how and why they arrive to corrosion. The percentage of damage in the joints of the prosthetic components has been calculated via high resolution photos and the software ImageJ. The 40% and 50% of the area appeared to have scratches or multiple lines due to mechanical artifacts. The third method of analysis has been made through the use of electron microscopy to quantify the wear surface in polyethylene components. Different joint movements correspond to different mechanisms of damage, which were imprinted in the parts of polyethylene examined. The most affected area was located mainly in the side edges. The results could help the manufacturers to modify the design of the prostheses and thus reduce the number of explants. It could also help surgeons in choosing the model of the prosthesis to be implanted in the patient.

Surgical hip dislocation for osteochondral transplantation as a salvage procedure for a femoral head impaction fracture

Obturator anterior hip dislocation is very rare. Poor results are described in patients with additional large transchondral fractures and treatment of these injuries remains challenging. Appropriate treatment recommendations are missing in the literature. This case report introduces surgical hip dislocation for osteochondral autograft transplantation with graft harvest from the nonweightbearing area of the head-neck junction as a salvage procedure in a large femoral head defect. We report the treatment and outcome of a 48-year-old man who sustained an anterior dislocation of the left hip after a motorcycle accident. After initial closed reduction in the emergency room, imaging analysis revealed a large osteochondral defect of the femoral head within the weightbearing area (10 × 20 mm, depth: 5 mm). The hip was exposed with a surgical hip dislocation using a trochanteric osteotomy. An osteochondral autograft was harvested from a nonweightbearing area of the femoral head and transferred into the defect. The patient was prospectively examined clinically and radiologically. Two years postoperatively, the patient was free of pain and complaints. The function of the injured hip was comparable to that of the contralateral, healthy hip and showed satisfying radiologic results. Surgical hip dislocation with a trochanteric flip osteotomy is a simple, one-step technique that allows full inspection of the hip to treat osteochondral femoral defects by osteochondral transplantation. The presented technique, used as a salvage procedure in a large femoral head defect, yielded good clinical and satisfying radiologic outcomes at the midterm.

Processing and Composition Effects on the Fracture Behavior of Spray-Formed 7XXX Series Al Alloys

The fracture properties of high-strength spray-formed Al alloys were investigated, with consideration of the effects of elemental additions such as zinc,manganese, and chromium and the influence of the addition of SiC particulate. Fracture resistance values between 13.6 and 25.6 MPa (m)1/2 were obtained for the monolithic alloys in the T6 and T7 conditions, respectively. The alloys with SiC particulate compared well and achieved fracture resistance values between 18.7 and 25.6 MPa (m)1/2. The spray-formed materials exhibited a loss in fracture resistance (KI) compared to ingot metallurgy 7075 alloys but had an improvedperformance compared to high-solute powder metallurgy alloys of similar composition. Characterization of the fracture surfaces indicated a predominantly intergranular decohesion, possibly facilitated by the presence of incoherent particles at the grain boundary regions and by the large strength differentialbetween the matrix and precipitate zone. It is believed that at the slip band-grain boundary intersection, particularly in the presence of large dispersoids and/or inclusions, microvoid nucleation would be significantly enhanced. Differences in fracture surfaces between the alloys in the T6 and T7 condition were observed and are attributed to inhomogeneous slip distribution, which results in strain localization at grain boundaries. The best overall combination of fracture resistance properties were obtained for alloys with minimum amounts of chromium and manganese additions.

Simulation-based cost-utility analysis of population screening-based alendronate use in Switzerland

A simulation model adopting a health system perspective showed population-based screening with DXA, followed by alendronate treatment of persons with osteoporosis, or with anamnestic fracture and osteopenia, to be cost-effective in Swiss postmenopausal women from age 70, but not in men. INTRODUCTION: We assessed the cost-effectiveness of a population-based screen-and-treat strategy for osteoporosis (DXA followed by alendronate treatment if osteoporotic, or osteopenic in the presence of fracture), compared to no intervention, from the perspective of the Swiss health care system. METHODS: A published Markov model assessed by first-order Monte Carlo simulation was refined to reflect the diagnostic process and treatment effects. Women and men entered the model at age 50. Main screening ages were 65, 75, and 85 years. Age at bone densitometry was flexible for persons fracturing before the main screening age. Realistic assumptions were made with respect to persistence with intended 5 years of alendronate treatment. The main outcome was cost per quality-adjusted life year (QALY) gained. RESULTS: In women, costs per QALY were Swiss francs (CHF) 71,000, CHF 35,000, and CHF 28,000 for the main screening ages of 65, 75, and 85 years. The threshold of CHF 50,000 per QALY was reached between main screening ages 65 and 75 years. Population-based screening was not cost-effective in men. CONCLUSION: Population-based DXA screening, followed by alendronate treatment in the presence of osteoporosis, or of fracture and osteopenia, is a cost-effective option in Swiss postmenopausal women after age 70.

In vitro fracture strength and thermal shock resistance of metal-ceramic crowns with cast and machined AuTi frameworks

STATEMENT OF PROBLEM: AuTi alloys with 1.6% to 1.7% (wt%) Ti provide sufficient bond strength to veneering ceramics, but the strength of entire metal-ceramic restorations fabricated from these alloys is not known. However, this information is important to assess the clinical performance of such materials. PURPOSE: This in vitro study evaluated the fracture strength and thermal shock resistance of metal-ceramic crowns with AuTi frameworks produced by milling or casting. MATERIAL AND METHODS: Frameworks of the alloy Au-1.7Ti-0.1Ir (wt%) (Esteticor Vision) were produced by milling or casting (test groups). A high-gold alloy (Esteticor Special) was used as the control. The frameworks were veneered with ceramic (VMK 95). Specimens (n=7) were loaded until fracture. Loads at failure (N) were recorded and the mean values statistically evaluated using 1-way analysis of variance and a post hoc Dunnett test (alpha=.05). To assess the crazing resistance of the veneering ceramic, 6 additional crowns of each group were subjected to a thermal shock test. Fractured surfaces were documented by scanning electron microscopy. Coefficients of thermal expansion of the materials used were measured (n=2) to assess the thermal compatibility between alloys and ceramic. RESULTS: The mean fracture strength of the crowns with machined AuTi frameworks (1294 +/- 236 N) was significantly lower (P=.012) than that of the cast AuTi frameworks (1680 +/- 150 N), but statistically not different than the high-gold alloy (1449 +/- 159 N). Bonding failure to the AuTi alloy predominantly occurred at the alloy-oxide interface. For the high-gold alloy, more ceramic residues were observed. In the thermal shock test, crowns with milled AuTi frameworks showed significantly higher thermal shock resistance compared to the other groups. The coefficients of thermal expansion (Esteticor Vision cast: 14.5 microm/m.K; Esteticor Vision milled: 14.3 microm/m.K; Esteticor Special cast: 13.7 microm/m.K) did not correlate with the results of the thermal shock test. CONCLUSION: The in vitro fracture strength of crowns with milled AuTi frameworks is lower than that obtained with cast AuTi frameworks, but comparable to those crowns produced with a high-gold alloy.

Finite element study on fracture patterns in human scaphoid wrist bone due to free fall

Scaphoid is one of the 8 carpal bones found adjacent to the thumb supported proximally by Radius bone. During the free fall, on outstretched hand, the impact load gets transferred to the scaphoid at its free anterior end. Unique arrangement of other carpal bones in the palm is also one of the reasons for the load to get transferred to scaphoid. About half of the total load acting upon carpal bone gets transferred to scaphoid at its distal pole. There are about 10 to 12 clinically observed fracture pattern in the scaphoid due to free fall. The aim of the study is to determine the orientation of the load, magnitude of the load and the corresponding fracture pattern. This study includes both static and dynamic finite element models validated by experiments. The scaphoid model has been prepared from CT scans of a 27 year old person. The 2D slices of the CT scans have been converted to 3D model by using MIMICS software. There are four cases of loading studied which are considered to occur clinically more frequently. In case (i) the load is applied at the posterior end at distal pole whereas in case (ii), (iii) and (iv), the load is applied at anterior end at different directions. The model is given a fixed boundary condition at the region which is supported by Radius bone during the impact. Same loading and boundary conditions have been used in both static and dynamic explicit finite element analysis. The site of fracture initiation and path of fracture propagation have been identified by using max principal stress / gradient and max principal strain / gradient criterion respectively in static and dynamic explicit finite element analysis. Static and dynamic impact experiments were performed on the polyurethane foam specimens to validate the finite element results. Experimental results such as load at fracture, site of fracture initiation and path of fracture propagation have been compared with the results of finite element analysis. Four different types of fracture patterns observed in clinical studies have been identified in this study.

Effect of once-yearly zoledronic acid 5 mg on fracture risk and change in femoral neck bone mineral density

Context: In the Health Outcomes and Reduced Incidence with Zoledronic Acid Once Yearly - Pivotal Fracture Trial (HORIZON-PFT), zoledronic acid (ZOL) 5 mg significantly reduced fracture risk. Objective: To identify factors associated with greater efficacy during ZOL 5 mg treatment. Design, Setting and Patients: Subgroup analysis (preplanned and post hoc) of a multicenter, double-blind, placebo-controlled, 36-month trial in 7765 women with postmenopausal osteoporosis. Intervention: Single infusion of ZOL 5 mg or placebo at baseline, 12 and 24 months. Main Outcome Measures: Primary endpoints: new vertebral fracture and hip fracture. Secondary endpoints: non-vertebral fracture, change in femoral neck bone mineral density (BMD). Baseline risk factor subgroups: age, BMD T-score and vertebral fracture status, total hip BMD, race, weight, geographical region, smoking, height loss, history of falls, physical activity, prior bisphosphonates, creatinine clearance, body mass index (BMI), concomitant osteoporosis medications. Results: Greater ZOL induced effects on vertebral fracture risk with younger age (treatment-by-subgroup interaction P=0.05), normal creatinine clearance (P=0.04), and BMI >/=25 kg/m(2) (P=0.02). There were no significant treatment-factor interactions for hip or non-vertebral fracture or for change in BMD. Conclusions: ZOL appeared more effective in preventing vertebral fracture in younger women, overweight/obese women and women with normal renal function. ZOL had similar effects irrespective of fracture risk factors or femoral neck BMD.

Low bone mineral density, renal dysfunction, and fracture risk in HIV infection: a cross-sectional study

BACKGROUND: Reduced bone mineral density (BMD) is common in adults infected with human immunodeficiency virus (HIV). The role of proximal renal tubular dysfunction (PRTD) and alterations in bone metabolism in HIV-related low BMD are incompletely understood. METHODS: We quantified BMD (dual-energy x-ray absorptiometry), blood and urinary markers of bone metabolism and renal function, and risk factors for low BMD (hip or spine T score, -1 or less) in an ambulatory care setting. We determined factors associated with low BMD and calculated 10-year fracture risks using the World Health Organization FRAX equation. RESULTS: We studied 153 adults (98% men; median age, 48 years; median body mass index, 24.5; 67 [44%] were receiving tenofovir, 81 [53%] were receiving a boosted protease inhibitor [PI]). Sixty-five participants (42%) had low BMD, and 11 (7%) had PRTD. PI therapy was associated with low BMD in multivariable analysis (odds ratio, 2.69; 95% confidence interval, 1.09-6.63). Tenofovir use was associated with increased osteoblast and osteoclast activity (P< or = .002). The mean estimated 10-year risks were 1.2% for hip fracture and 5.4% for any major osteoporotic fracture. CONCLUSIONS: In this mostly male population, low BMD was significantly associated with PI therapy. Tenofovir recipients showed evidence of increased bone turnover. Measurement of BMD and estimation of fracture risk may be warranted in treated HIV-infected adults.