scholarly journals 829. Incidence of Low BMD and Barriers to Routine Screening for Osteoporosis in HIV Patients in Eastern North Carolina

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S507-S507
Author(s):  
Smit Rajput ◽  
Dora Lebron ◽  
Alicia Lagasca ◽  
Jaffer Hussain ◽  
Ogheneruona Odili ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Insurance Coverage ◽  
Antiretroviral Drugs ◽  
Routine Screening ◽  
Mineral Density ◽  
Hiv Patients ◽  
Major Barrier ◽  
Dxa Scan ◽  
Hiv Therapy ◽  
T Score

Abstract Background With HIV therapy, the life expectancy of persons with HIV (PWH) has improved and complications associated with long-standing HIV and antiretroviral drugs have become more apparent. Low bone mineral density (BMD) (defined by T score < -1) and osteoporosis (defined by T-score < -2.5) are common in PWH. In a meta-analysis of 884 HIV-infected patients, 67% had reduced BMD, of whom 15% had osteoporosis which is 3 times greater than HIV uninfected controls. IDSA guidelines recommend routine screening for osteoporosis in PWH aged ≥ 50 years, yet the rate of screening for osteoporosis in these patients remains low (7.4%-17%). This QI project aimed to estimate the frequency of and identify the barriers to screening for osteoporosis in eligible HIV patients. Methods This prospective observational study was conducted in the HIV clinic at East Carolina University from 2018-2019. A sample of 104 HIV patients, ≥ 50 years were selected randomly. Data regarding referral for DXA (dual X-ray absorptiometry) scan, its results, and their insurance provider was collected. The plan was to analyze the barriers associated with guideline-recommended BMD screening and implement it in eligible patients. Results From a total of 104, 89 patients (85.6%) were referred for a DXA scan. The reasons for lack of referral were obesity, insurance barrier, wheelchair-bound, and test ordered by another provider. Of the 89 patients referred for DXA, only 49 (47% of total) underwent the scan. In terms of barriers, insurance limitation was the most common reason. Out of the patients that had DXA scans, 19 (39%) were found to have low bone density and 1 had osteoporosis. Low BMD was more common in men (63%) as compared to women (37%) in this group. Percentage of patients who underwent a DXA scan and the barriers in those who didn’t Frequency of BMD screening Incidence of Low BMD BMD results Conclusion In our study, 47% of patients had a BMD assessment. This is better than what has been reported in other single-center studies, however, it is not ideal. About 34% of the patients had insurance coverage as the major barrier for routine screening, as has been mentioned in other similar studies. Of the patients who underwent the DXA scan, 41 % had a low BMD. Other studies have reported variable prevalence of abnormal BMD, from 47-93%. Interestingly, the prevalence of low BMD in our cohort was close to the national average in non-HIV patients. Disclosures All Authors: No reported disclosures

scholarly journals Can Melatonin Improve the Osteopenia of Perimenopausal and Postmenopausal Women? A Meta-Analysis

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Tingting Bao ◽  
Liuting Zeng ◽  
Kailin Yang ◽  
Yuehua Li ◽  
Fengying Ren ◽  
...  
Keyword(s):  
Postmenopausal Women ◽  
Meta Analysis ◽  
Analysis Data ◽  
Nutritional Supplement ◽  
Current Evidence ◽  
Control Group ◽  
Mineral Density ◽  
T Score ◽  
Registration Number ◽  
Substantial Heterogeneity

Objective. To assess the effectiveness and safety of melatonin for perimenopausal and postmenopausal women with osteopenia. Methods. In this meta-analysis, data from randomized controlled trials were obtained to assess the effects of melatonin versus placebo or western medicine in perimenopausal and postmenopausal women with osteopenia. The study’s registration number is CRD42018086238. The primary outcomes included bone mineral density (BMD) and T-score. Result. From 551 articles retrieved, three trials involving 121 patients were included. Due to the high-to-substantial heterogeneity (BMD: I2=96.9%, P=0.000; T-score: I2=74.9%, and P=0.019), the statistical analysis of BMD and T-score was abandoned. A systematic review was undergone for the two outcomes. Compared with the control group, melatonin may increase osteocalcin (WMD 4.97; 95% CI 3.14, 6.79; P<0.00001). Conclusion. Based on current evidence, melatonin might be used as a safe nutritional supplement to improve bone density in perimenopausal and postmenopausal women, but its efficacy needs to be further affirmed.

The effect of aromatase inhibitors on bone mineral density measured by serial DXA scans

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 11065-11065 ◽  
Author(s):  
K. J. Whannel ◽  
J. C. Doughty ◽  
C. R. Wilson ◽  
A. McLellan
Keyword(s):  
Bone Mineral Density ◽  
Endocrine Therapy ◽  
Bone Mineral ◽  
Aromatase Inhibitors ◽  
Fracture Rate ◽  
Mineral Density ◽  
First Line ◽  
Dxa Scan ◽  
T Score ◽  
Dxa Scans

11065 Background: We are now using aromatase inhibitors (AI) in increasing numbers of women as treatment in the breast cancer care pathway. Studies have reported a loss of bone mineral density (BMD) with use of all AIs. It has been shown in our unit that 5 years of tamoxifen (T) in post-menopausal women prior to commencing an AI does not offer sufficient protection to prevent significant BMD loss when an AI is introduced, with 25% requiring concurrent bisphosphonate (BP) therapy. The aim of this study was to determine changes in serial DXA scan results over a 12month period in women taking AIs. Method: 62 women being considered for or in early stages of use of an AI attended for a DXA scan and re-scan at 12 months. Vertebral morphometry and fracture rate were assessed and risk factors for osteoporosis noted. Scan results were compared ( Table 1 ). Results: Mean age was 67yrs [standard deviation (SD) 9yrs]. The patients were grouped according to initial endocrine therapy. 13 (21%) switched from tamoxifen to arimidex after 2years, 3 (4.8%) switched from tamoxifen to exemestane after 3 years and 30 (48.4%) switched from tamoxifen to letrozole after 5 years. 11 (17.7%) had been on arimidex as first line endocrine therapy for <=2 years and 5 (8.1%) had been on letrozole as first line endocrine therapy for <=1 year. Mean t-score and SD was calculated at each site and results categorised by lowest t-score at any site. The overall decrease in BMD measured at 1.66% over the 12 months. Conclusion: We have demonstrated a decrease in BMD with AI treatment of 1.66% per year as well as an increase in fracture incidence and increased need for bisphosphonate therapy whilst on an AI. We would recommend that all patients on any AI receive annual DXA scans. [Table: see text] No significant financial relationships to disclose.

scholarly journals Ibandronate: A Review of its Vertebral and Nonvertebral Antifracture Efficacy

2009 ◽  
Vol 5 (5) ◽  
pp. 467-473 ◽  
Author(s):  
Michael Amling ◽  
Andreas Kurth
Keyword(s):  
Bone Mineral Density ◽  
Vertebral Fracture ◽  
Oral Treatment ◽  
Meta Analysis ◽  
Cumulative Exposure ◽  
High Efficacy ◽  
Mineral Density ◽  
Good Tolerability ◽  
T Score ◽  
Tolerability Data

After the Ibandronate Osteoporosis Vertebral Fracture Trial in North America and Europe (BONE) study had demonstrated the strong vertebral and nonvertebral antifracture efficacy of daily and intermittent oral ibandronate, the Monthly Oral Ibandronate In Ladies (MOBILE) study gave evidence for an increased efficacy on the bone mineral density (BMD) of higher intermittent oral ibandronate doses (150 mg monthly) compared with 2.5 mg daily. The BONE study also observed nonvertebral antifracture efficacy in patients with a high risk for fractures (mean femoral neck T score of −3.0 or less). A recently published meta-analysis assessing the nonvertebral antifracture efficacy corresponding to the annual cumulative exposure (ACE) of ibandronate demonstrated a significantly better antifracture efficacy of higher compared with lower doses of ibandronate. The Dosing Intravenous Administration (DIVA) study demonstrated evidence for the high efficacy and good tolerability of intravenous ibandronate delivered by quarterly injections. This review summarizes the efficacy and tolerability data of ibandronate concerning monthly oral treatment as well as quarterly injection therapy.

A Systematic Review and Meta-Analysis about the Effect of Bisphosphonates on the Risk of Skeletal-Related Event in Men with Prostate Cancer

2020 ◽  
Vol 20 (13) ◽  
pp. 1604-1612
Author(s):  
Congcong Wu ◽  
Hua Jiang ◽  
Jianghua Chen
Keyword(s):  
Prostate Cancer ◽  
Fixed Effects ◽  
Data Extraction ◽  
Controlled Trial ◽  
Meta Analysis ◽  
Control Group ◽  
Fixed Effects Model ◽  
Related Event ◽  
Mineral Density ◽  
Skeletal Related Event

Background: Although the adjuvant therapy of bisphosphonates in prostate cancer is effective in improving bone mineral density, it is still uncertain whether bisphosphonates could decrease the risk of Skeletal- Related Event (SRE) in patients with prostate cancer. We reviewed and analyzed the effect of different types of bisphosphonates on the risk of SRE, defined as pathological fracture, spinal cord compression, radiation therapy to the bone, surgery to bone, hypercalcemia, bone pain, or death as a result of prostate cancer. Methods: A systemic literature search was conducted on PubMed and related bibliographies. The emphasis during data extraction was laid on the Hazard Ratio (HR) and the corresponding 95% Confidence Interval (CI) from every eligible Randomized Controlled Trial (RCT). HR was pooled with the fixed effects model, and preplanned subgroup analyses were performed. Results: 5 RCTs (n = 4651) were included and analyzed finally after screening 51 articles. The meta-analysis of all participants showed no significant decrease in the risk of SRE when adding bisphosphonates to control group (HR = 0.968, 95% CI = 0.874 - 1.072, p = 0.536) with low heterogeneity (I2 = 0.0% (d.f. = 4) p = 0.679). There was no significant improvement on SRE neither in the subgroups with Metastases (M1) or Castration-Sensitive Prostate Cancer (CSPC) (respectively HR = 0.968, 95% CI = 0.874 - 1.072, p = 0.536, I2 = 0.0% (d.f. = 4) p = 0.679; HR = 0.954, 95% CI = 0.837 - 1.088, p = 0.484, I2 = 0.0% (d.f. = 3) p = 0.534). Conclusion: Our study demonstrated that bisphosphonates could not statistically significantly reduce the risk of SRE in patients with prostate cancer, neither in the subgroups with M1 or CSPC.

Sign in / Sign up

Export Citation Format

Share Document