AB1355 Bone mineral density, t-score and z-score in young men with juvenile idiopathic arthritis

Abstract Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic arthropathy of childhood and is associated with low bone mass, and may hasten the onset of osteoporosis later in life1. Bone loss occurs because of an imbalance between osteoclasts-activating factors like receptor activator of nuclear factor-κB ligand (RANKL) and its inhibitor osteoprotegerin (OPG) 2. Dual energy X-ray absorptiometry (DXA) is the preferred method for measuring bone mineral density (BMD) in children and to identify and follow individuals at risk for fracture 3. The objective is the Evaluation of serum levels of osteoprotegerin and RANKL and their correlation with BMD in JIA patients. Methods Forty JIA patients (according to the revised classification criteria of ILAR) and 40 healthy children individually matched for age, sex and race were included in this study. Children excluded from the study were those with primary and secondary causes of osteoporosis (such as chronic illness). All patients were assessed clinically by: age, sex, body mass index, type of JIA, disease duration and disease activity (by Juvenile Arthritis Disease Activity Score; JADAS 10). The functional disability was assessed by the Childhood Health Assessment Questionnaire (CHAQ). Blood samples were collected from JIA patients and healthy controls to determine serum levels of OPG and RANKL by ELISA. DXA scans were done using GE Healthcare Lunar DPX, Madison, Wisconsin. Bone mineral density of the L1-L4 lumbar spine and total body less head (TBLH) was evaluated in g/cm2 and expressed as Z score for age, sex according to the reference data given for this equipment. Results The study included 40 patients (25 females) with a mean age of 11.14 years and median disease duration of 2.5 years. As regard JIA type, 45% of patients were oligoarticular, 32.5% were polyarticular, and 22.5% were systemic JIA. Median JADAS 10 was 13.95. Patients (especially polyarticular JIA) had significantly higher serum RANKL levels and lower serum OPG and OPG/RANKL ratio when compared with controls (with p-value <0.001, 0.032 and <0.001 respectively). A diagnosis of low BMD (BMD Z-score ≤ -2) was given in 25% of patients (15% polyarticular and 10% systemic) by DXA of lumbar spine, and 20% (10% polyarticular and 10% systemic) by DXA of TBLH. On the other hand, no patient was given a diagnosis of osteoporosis (BMD Z-score ≤ -2 and a significant fracture history). Low BMD at lumbar spine and TBLH was negatively correlated with serum RANKL while positively correlated with OPG/RANKL ratio. Moreover, low BMD at lumbar spine was positively correlated with serum OPG level Conclusion High RANKL and low OPG levels appear to be associated with low bone mass in JIA patients. Patients with JIA (especially polyarticular and systemic subtype) are at increased risk of low bone mineral mass. Disclosure of Interests None declared

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P1621VITAMIN D SUPPLEMENTATION: CHANGES IN BONE MINERAL DENSITY IN KIDNEY TRANSPLANT PATIENTS WITH LONG TERM DURATION OF THE GRAFT

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa143.p1621 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Yuri Battaglia ◽

Michele Provenzano ◽

Francesco Tondolo ◽

Antonio Bellasi ◽

Pasquale Esposito ◽

...

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Vitamin D Deficiency ◽

Kidney Transplant ◽

Bone Mineral ◽

Categorical Variables ◽

Z Score ◽

Mineral Density ◽

T Score

Abstract Background and Aims In the medical literature, several studies have linked bone mineral density (BMD) with vitamin D deficiency in kidney transplant patients (KTRs). However, in spite of the fact that ergocalciferol, cholecalciferol and calcifediol reduce parathyroid hormone (PTH) and improves calcium levels, their effects on the bone mineral density (BMD) in KTRs remain undefined. In consideration of the lack of data available, we aim at investigating the effect of inactive form of vitamin D supplementation on the BMD over a follow-up period up to 2 year, in a real-life cohort of long-term kidney transplant(KT). Method This study was carried out in KTRs who were followed up in a Nephrology Unit. Exclusion criteria were parathyroidectomy, therapy with bisphosphonate, previous history of bone fractures. Demographic, clinical and immunosuppressive agents were collected. Based on 25-OH-D levels, KTRs were classified as suffering from deficiency (< 30 ng/mL). BMD was evaluated at lumbar vertebral bodies (LV) and right femoral hip (FH) by a single operator, using a standard dual energy X-ray absorptiometry. According to WHO criteria, results were expressed as T-score (standard deviation [SD] relative to young healthy adults), and Z-score (SD relative to age-matched controls). Osteoporosis and osteopenia were defined as T score ≤ −2.5 SD and T score < −1 and > −2.5 SD, respectively. Laboratory data, 25-OH-D, and BMD were measured at baseline and after 24 months of supplementation therapy. Vitamin D deficiency was corrected using standard treatment strategy recommended for general population. Continuous variables were expressed as mean ± SD whereas categorical variables as percentage. The Student’s t test and chi-square test were used to compare to compare continuous and categorical variables, respectively. For before and after comparisons of continuous variables, the paired t-test or one-sample Wilcoxon signed rank test were used based on variable’s distribution. Results Data pertaining to 111 out of 133 consecutive outpatients were collected, of whom most were males (69.4%), no-smokers (89.1%) and treated with glucocorticoids (84%). The mean age was 53.9±11.6 years and months after transplant was 161.6±128.3. No statistical differences were found among patients with normal BMD, osteopenia or osteoporosis at LV and FH in terms of age at transplant, gender distribution, time on dialysis, BMI and eGFR, serum calcium, serum phosphate, 25-OH-D and iPTH. At baseline, 25-OH-D was 13.9±7.2 ng/ml and the prevalence of osteopenia/osteoporosis was 40.9% (T-Score -1.69±0.37; Z-score -1.16±1.09) and 21.8 % (T-Score -3.15±0.50; Z-score -2.27±0.58) at LV; 55.3 % (T-Score -1.8±0.46; Z-score -0.84±0.633) and 14 % (T-Score -2.83±0.39; Z-score -1.65±0.49) at FH. After 27.6±3.7 months of therapy with cholecalciferol at mean dose of 13.396±7.537 UI at week, 25-OH-D values increased to 29.4±9.4 ng/ml (p<0.0001) while no statistically significant changes were found in Z-score and T-score at both sites, except for a mild improvement in lumbar vertebral Z-score, reaching −0.82± 0.7 (p = 0.06) in KTRs with osteopenia Conclusion Our study showed BMD remained stable after up to 2 years of inactive vitamin D therapy in long-term kidney transplant with vitamin D deficiency. A mild increase in Z-score was observed in the L-spine. Further designated studies should be conducted to demonstrate the effect of vitamin D on BMD.

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Computed Tomography Diagnostic of Uncommon Case of Osteopetrosis in 80-Year-Old Man—Case Report

Medicina ◽

10.3390/medicina56100518 ◽

2020 ◽

Vol 56 (10) ◽

pp. 518

Author(s):

Witold Krupski ◽

Joanna Kruk-Bachonko ◽

Marcin R. Tatara

Keyword(s):

Computed Tomography ◽

Bone Mineral Density ◽

Bone Mineral ◽

Quantitative Computed Tomography ◽

Volumetric Bone Mineral Density ◽

Z Score ◽

Mineral Density ◽

T Score ◽

Uncommon Case ◽

Densitometric Data

Background and Objectives: During osteopetrosis course, impaired bone remodeling induces skeletal osteosclerosis and abnormally dense bones, which, however, are brittle and susceptible to low-energy fractures. In this study, radiological evaluation and densitometric measurements of several bones of the skeleton in one of the oldest patients in the world suffering from osteopetrosis was presented. Materials and Methods: Volumetric bone mineral density measurements of the examined bones in an 80-year-old man were performed using two different quantitative computed tomography techniques. Results: The obtained results show higher values of the volumetric bone mineral density of the trabecular bone in lumbar spine than in the cortical bone compartment. T-score and Z-score in this patient reached values of 27–28 and 31–32, respectively. Conclusions: The obtained densitometric data may serve for further diagnostic purposes of osteopetrosis. As documented, the severity of the osteosclerotic changes of bones were higher in this patient than in most other described cases. Moreover, radiological signs diagnosed in this patient were characteristic for all types of osteopetrosis making this case very uncommon.

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Fractures, Bone Mineral Density, and Final Height in Craniopharyngioma Patients with a Follow-up of 16 Years

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgz279 ◽

2020 ◽

Vol 105 (4) ◽

pp. e1397-e1407 ◽

Cited By ~ 1

Author(s):

Selveta S van Santen ◽

Daniel S Olsson ◽

Marry M van den Heuvel-Eibrink ◽

Mark Wijnen ◽

Casper Hammarstrand ◽

...

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Bone Health ◽

Final Height ◽

Z Score ◽

Mineral Density ◽

Childhood Onset ◽

Cross Sectional ◽

T Score

Abstract Context Pituitary hormonal deficiencies in patients with craniopharyngioma may impair their bone health. Objective To investigate bone health in patients with craniopharyngioma. Design Retrospective cross-sectional study. Setting Dutch and Swedish referral centers. Patients Patients with craniopharyngioma (n = 177) with available data on bone health after a median follow-up of 16 years (range, 1-62) were included (106 [60%] Dutch, 93 [53%] male, 84 [48%] childhood-onset disease). Main outcome measures Fractures, dual X-ray absorptiometry-derived bone mineral density (BMD), and final height were evaluated. Low BMD was defined as T- or Z-score ≤-1 and very low BMD as ≤-2.5 or ≤-2.0, respectively. Results Fractures occurred in 31 patients (18%) and were more frequent in men than in women (26% vs. 8%, P = .002). Mean BMD was normal (Z-score total body 0.1 [range, -4.1 to 3.5]) but T- or Z-score ≤-1 occurred in 47 (50%) patients and T-score ≤-2.5 or Z-score ≤-2.0 in 22 (24%) patients. Men received less often treatment for low BMD than women (7% vs. 18%, P = .02). Female sex (OR 0.3, P = .004) and surgery (odds ratio [OR], 0.2; P = .01) were both independent protective factors for fractures, whereas antiepileptic medication was a risk factor (OR, 3.6; P = .03), whereas T-score ≤-2.5 or Z-score ≤-2.0 was not (OR, 2.1; P = .21). Mean final height was normal and did not differ between men and women, or adulthood and childhood-onset patients. Conclusions Men with craniopharyngioma are at higher risk than women for fractures. In patients with craniopharyngioma, a very low BMD (T-score ≤-2.5 or Z-score ≤-2.0) seems not to be a good predictor for fracture risk.

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The Risk of Low Bone Mineral Density with Long-Term G-CSF Therapy for Severe Chronic Neutropenia.

Blood ◽

10.1182/blood.v116.21.1484.1484 ◽

2010 ◽

Vol 116 (21) ◽

pp. 1484-1484 ◽

Cited By ~ 1

Author(s):

L. A. DiMeglio ◽

Audrey Anna Bolyard ◽

Tracy M. Marrero ◽

Blanche P Alter ◽

Mary Ann Bonilla ◽

...

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Sufficient Information ◽

Z Score ◽

Mineral Density ◽

Cyclic Neutropenia ◽

T Score ◽

Low Bone Mineral Density ◽

Chronic Neutropenia

Abstract Abstract 1484 Low bone mineral density (BMD) is a known risk factor for fractures. Low BMD has been reported in individuals with severe chronic neutropenia (SCN), and attributed both to the diseases causing neutropenia and to G-CSF therapy. However, given the rarity of SCN, few data exist regarding associations of BMD z-scores with disease characteristics such as type of neutropenia and duration of G-CSF therapy. We present data here obtained from BMD reports collected through the Severe Chronic Neutropenia International Registry (SCNIR). We reviewed BMDs on 128 subjects [40 children (< 21 years of age), 87 females] having sufficient information about lumbar spine BMD by dual-xray absorptiometry (DXA) for evaluation. For subjects with multiple BMD measurements available, the most recent one was used for analysis. Mean age was 32.0 years (range 0.6–85 years). 57 subjects had idiopathic SCN (mean age 40 years), 40 had congenital (mean age 15 years), 28 were cyclic (mean age 41 years) and 3 were autoimmune (mean age 18 years). 122 subjects had received G-CSF at the time of the BMD assessment (mean 8.8 years, range 0.1–19.9 years). 11 of the adults were on bisphosphonate therapy for low BMD at the time of the BMD assessment; no children were on anti-resorptive therapy. BMDs in these subjects were, on average, low. For the children, the BMD z-score (age matched mean ±1 standard deviation) was -1.0 ± 1.1, with 17.5% of children having BMDs that were low for age (Z-score < -2.0). For the adults the BMD t-score was -1.1 ± 1.4, with 46% of adults meeting t-score criteria for osteopenia (≤ -1.0) and 9% meeting criteria for osteoporosis (< -2.5). BMDs were lowest in those with congenital neutropenia, followed by those with cyclic neutropenia. For children, BMDs were lower in those who had received longer G-CSF therapy (r= -0.506, p=0.002). This association was not seen in adults (r= 0.074, p= 0.5). The low BMDs and the correlation of lower BMD with longer G-CSF treatment in children suggests there is an association of bone loss with the childhood diseases causing SCN. The data also suggest that regular assessments of bone health should be made in SCN patients, particularly those on long-term G-CSF therapy. Disclosures: Boxer: Amgen, Inc.: Equity Ownership. Dale:Amgen: Consultancy, Research Funding.

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ASYMMETRY OF BONE MINERAL DENSITY OF THE HIPS IN PATIENTS WITH UNILATERAL KNEE OSTEOARTHRITIS: A CROSS-SECTIONAL STUDY

Journal of Musculoskeletal Research ◽

10.1142/s0218957711500059 ◽

2011 ◽

Vol 14 (01) ◽

pp. 1150005 ◽

Cited By ~ 1

Author(s):

Alireza Ashraf ◽

Seyed Mostafa Jazayeri Shooshtari ◽

Kaynoosh Homayouni ◽

Sharareh Roshanzamir ◽

Mohsen Zafarghasempoor ◽

...

Keyword(s):

Bone Mineral Density ◽

Knee Osteoarthritis ◽

Bone Mineral ◽

Lumbar Vertebrae ◽

Cross Sectional Study ◽

Z Score ◽

Sectional Study ◽

Mineral Density ◽

Cross Sectional ◽

T Score

Background: Osteoarthritis of any joint may exert different effects on bone mineral density that may be the result of several mechanisms including change in the pattern of weight load distribution. In this cross-sectional study we tried to find correlations between unilateral knee osteoarthritis and bone mineral density of hips and lumbar vertebrae. Methods: Forty three patients with knee osteoarthritis (unilateral or more severe in one side) were recruited in this study. The American college of Rheumatology Criteria was followed for the diagnosis of osteoarthritis. Dual X-Ray absorptiometry was used to obtain the T score and the Z score of the hips and lumbar vertebrae. Results: The T score and Z score of the hip and T score of the femoral neck, at the side with ipsilateral knee osteoarthritis was lower than the other side (p < 0.05). The mean Z score and T score of the vertebrae was negative irrespective of the side of osteoarthritis. Conclusions: Bone mineral density of the hip with ipsilateral knee osteoarthritis was lower than the other side, which suggests that BMD may be sensitive to some extent in detecting osteoporosis in these patients; it has also been observed that osteoarthritis might not affect bone mineral density of the hips and lumbar vertebrae in the same manner or to the same extent.

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Bone mineral density in children with juvenile idiopathic arthritis after one year of treatment with etanercept

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh170811175s ◽

2018 ◽

Vol 146 (5-6) ◽

pp. 297-302

Author(s):

Gordana Susic ◽

Marija Atanaskovic ◽

Roksanda Stojanovic ◽

Goran Radunovic

Keyword(s):

Bone Mineral Density ◽

Juvenile Idiopathic Arthritis ◽

Rheumatoid Factor ◽

Bone Mineral ◽

Mineral Metabolism ◽

Z Score ◽

Mineral Density ◽

Bone Mineral Metabolism ◽

Systemic Jia ◽

One Year

Introduction/Objective. Juvenile idiopathic arthritis (JIA) is the most frequent chronic inflammatory, rheumatic disease of childhood, associated with disturbance of bone mineral metabolism, which develops gradually and progressively, and if untreated eventually leads to osteoporosis in adulthood. The aim of our study was to evaluate bone mineral density (BMD) in patients with JIA treated with etanercept over a period of one year. Methods. The prospective cohort study included 94 JIA patients (66 female, 28 male), their median age being 14.77 years. BMD was measured by dual-energy X-ray absorptiometry on the lumbar spine. Disease activity was assessed using the American College of Rheumatology Pedi 50 criteria. Results. After one year of treatment with etanercept, we found a statistically significant increment in all osteodensitometry variables (p < 0.001). Annual enhancement for the whole group was as follows: bone mineral content 15.8%, BMD 7.2%, BMDvol 4.2%. Z-score improved from -0.86 to -0.58 SD at the last visit, but decreased in rheumatoid factor-positive polyarthritis patients. Patients with systemic JIA had the lowest Z-score. Z-score correlated with functional disability level. BMD was lower in the group treated with glucocorticoids. Conclusion. Our results showed significant improvement of bone mineral density in children with JIA after one year of treatment with etanercept. Rheumatoid factor-positive and systemic JIA subtypes and treatment with glucocorticoids are the risk factors for impairing bone mineral metabolism.

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Increased Cortical Bone Mineralization in Imatinib Treated Patients with Chronic Myelogenous Leukemia.

Blood ◽

10.1182/blood.v110.11.2940.2940 ◽

2007 ◽

Vol 110 (11) ◽

pp. 2940-2940

Author(s):

Sofia Jonsson ◽

Yuan Wei ◽

Bob Olsson ◽

Claes Ohlsson ◽

Mattias Lorentzon ◽

...

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Chronic Phase ◽

Serum Levels ◽

Volumetric Bone Mineral Density ◽

P Value ◽

Z Score ◽

Mineral Density ◽

Bone Specific Alkaline Phosphatase ◽

T Score

Abstract Background: Imatinib mesylate (Gleevec™) is the drug of choice for most patients with chronic phase CML. It was recently suggested that hypophosphatemia develops in imatinib treated patients as a consequence of suppression of bone turnover and renal phosphate wasting. Aim: To study the mineral metabolism, and areal and volumetric bone mineral density in chronic phase CML patients treated with imatinib. Material and methods: Seventeen imatinib treated CML patients (11 males/6 females; mean age 60±11 (SD) years) and 17 healthy volunteers (11 males/6 females; mean age 59±11 (SD) years) were included. All CML patients were treated in first chronic phase, targeting an imatinib dose of 400 mg q.d. At time of study, all patients were in complete cytogenetic remission and the mean imatinib treatment duration was 50±19 (SD) months. Serum levels of total and ionized calcium, phosphate, magnesium, parathyroid hormone (PTH), and markers of bone formation (osteocalcin and bone specific alkaline phosphatase) and bone resorption (carboxyterminal cross-linked telopeptide of type I collagen) were analyzed. Twenty-four hours urine collections, for determination of calcium and phosphate excretion, were also obtained from all patients and controls. Areal and volumetric bone mineral density (aBMD and vBMD) were evaluated by dual energy x-ray absorptiometry (DXA) and peripheral quantitative computerized tomography (pQCT), respectively. Results: Imatinib treated patients had significantly lower serum levels of ionized calcium, phosphate, magnesium, osteocalcin and bone specific alkaline phosphatase. Serum PTH was higher in the patients compared the controls (p=0.06). The patients also excreted less calcium in the urine. aBMD were increased in hip and lumbar spine compared to controls. The results of the DXA measurements. T-score is the difference of BMD from young adult (20–40 years; same sex) mean value normalised to the population SD. Z-score is the difference of BMD from age-matched (same sex) mean value normalised to the population SD. vBMD was increased in cortical but not trabecular bone of tibia and radius. The results of pQCT-measurements. vBMD and cross sectional area were measured at *4% and **25% bone length in the proximal direction. Conclusion: Our data show that imatinib increases cortical bone mineral density and clearly rules out the previous concern of “imatinib induced osteomalacia”. It can be speculated that tyrosine kinase inhibitors could be novel antiosteolytic agents in skeletal disorders such as osteoporosis, myelomatosis and bone marrow metastatic diseases. Indeed, previous animal studies have shown that imatinib decreases osteoclastogenesis and osteoclast activity. DXA CML (n=17) Controls (n=17) P-value Hip bone (total) aBMD (g/cm2) 1.08±0.2 0.95±0.1 0.025 T-score 0.07±1.42 −0.82±0.83 Z-score 0.46±1.37 −0.26±0.85 Lumbar spine aBMD (g/cm2) 1.27±0.22 1.12±0.15 0.029 T-score 0.38±1.77 −0.82±1.23 Z-score 0.57±1.72 −0.36±1.29 pQCT CML (=17) Controls (n=17) P-value Radius Trabecular vBMD* (mg/cm3) 190.9±34.2 193.9±28.8 ns Cortical vBMD** (mg/cm3) 1211.3±23.8 1181.1±38.7 0.01 Cortical area** (mm2) 95.1±16.3 88.6±18.7 ns Tibia Trabecular vBMD* (mg/cm3) 240.2±47.3 226.2±23.9 ns Cortical vBMD* (mg/cm3) 1185.6±23.5 1159.4±36.2 0.017 Cortical area** (mm2) 262.6±50.7 261.3±44.4 ns

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AB0714 THE ROLE OF AGE, DURATION OF THE DISEASE AND CUMULATIVE GLUCOCORTICOID DOSE IN THE FORMATION OF DISORDERS OF THE STRUCTURAL AND FUNCTIONAL STATE OF BONE TISSUE IN MEN WITH ANKYLOSING SPONDYLITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3077 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1652.2-1653

Author(s):

S. Shevchuk ◽

O. Pavliuk

Keyword(s):

Bone Mineral Density ◽

Lumbar Spine ◽

Ankylosing Spondylitis ◽

Bone Mineral ◽

Age Group ◽

Z Score ◽

Mineral Density ◽

Important Place ◽

T Score

Background:In recent years, it is becoming increasingly clear that osteoprosis (OP) holds the important place among complications of ankylosing spondylitis (AS). The frequency of emergence of OP, according to the data of last investigations, ranges from 18.7 to 62%, osteopenic syndrome – from 50 to 92%. It is known that decrease of bone mineral density (BMD) in patients with AS is caused not only by the action of traditional risk factors (age, sex, genetic predisposition, low body mass, and others) but also by the action of factors associated with the disease itself such as: duration of AS, activity of the inflammatory process, administration of glucocorticoids (GC), deficiency of Vitamin D, low physical activity of patients and so on. However, until now there are no clear data about the role of each of them in the formation of disorders of bone metabolism in men with AS. In the Ukrainian population of patients with AS such investigations have not been conducted.Objectives:To investigate the role of age, duration of disease andcumulative glucocorticoid dosein the formation of disorders of bone mineral density (BMD) in men with AS.Methods:The investigation of 108 men with AS at the age of 40.74 ± 0.87 years and 25 normal control subjects of the same age and sex has been carried out. The diagnosis of AS was established on the basis of modified New York criteria. BMD of the lumbar spine and femoral neck was determined by dual-energy X-ray absorptiometry on the apparatus ‘Hologic Discovery Wi’ (S / N 87227). The diagnosis of osteoporosis in men over 50 years was considered in case of decrease of BMD by T-score ≤ – 2.5 SD, osteopenia corresponded to T-score from –1 to –2.5 SD, for men under the age of 50, the Z-score was used, and its decrease ≤ – 2.0 SD and more indicated the significant loss of bone mass.Results:A decrease of BMD at the level of the lumbar spine and femur neck was found in 61 (56.5%) patients, of these 29 (27.7%) had osteoporosis, 31 (29.5%) had osteopenia. In the control group, decrease of BMD was detected in 6 (24%) patients, of these osteoporosis was diagnosed in 1 (4%), and osteopenia was diagnosed in 5 (20%) patients. In the age group of below 35 years, 18 (64.3%) patients had a decrease in BMD, 35 (56.5%) patients – in the 36-55 age group, and 8 (53.3%) patients – over the age of 45. The index of BMD also did not differ significantly between the groups. As for the duration of the disease, the largest proportion of 33 (75%) patients with decreased BMD was found in the group of patients with duration of the disease from 5 to 10 years. In the group of patients with duration of the disease up to 5 years, patients with decrease in the Z-score were 11 (55%), and in the group with duration of the disease more than 10 years - 17 (41.6%) patients. Decrease of BMD was associated withcumulative glucocorticoid dose. In particular, in the group of patients with acumulativedose of glucocorticoids less than 12.6 g Z-score at the level of the lumbar spine was -0.98 ± 0.17 SD, in the group with acumulativedose of GC 12.6-21.6 g Z-score was equal to –0.43 ± 0.40 SD, and in the group withcumulativeglucocorticoid dose – above 21.6 g the Z-score was –1.69 ± 0.30 SD. As the glucocorticoid dose increased, the proportion of patients with decreased BMD increased. In the group of patients with the highest dose of GC there were 67.7% such patients, while in the group with the lowest dose – only 30 (57.6%). Significant correlation (r = -0.24) was established between Z-score of the lumbar spine and the total dose of GC.Conclusion:In 61 (56.5%) patients with AS decreased BMD at the level of the lumbar spine and neck of the femur is revealed. Decrease of BMD in patients with AS does not depend on the age and duration of the disease, but is associated with thecumulativedose of GC.Disclosure of Interests:Sergii Shevchuk Grant/research support from: Celltrion, Inc, Oksana Pavliuk: None declared

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Effects of Short Term Alendronate Administration on Bone Mineral Density in Patients with Chronic Kidney Disease

PRILOZI ◽

10.2478/prilozi-2018-0019 ◽

2018 ◽

Vol 39 (1) ◽

pp. 5-13 ◽

Cited By ~ 1

Author(s):

H. K. Aggarwal ◽

Deepak Jain ◽

Pulkit Chhabra ◽

R. K. Yadav

Keyword(s):

Bone Mineral Density ◽

Bone Mineral ◽

Z Score ◽

Mineral Density ◽

T Score ◽

Ckd Stage ◽

Significant Difference ◽

Insignificant Difference ◽

The Difference ◽

Group B

AbstractBackground:Osteoporosis is highly prevalent in CKD patients and is characterized by low bone mass leading to decreased bone strength. It is associated with an increased risk of fracture, thus increasing morbidity and mortality. Bisphosphonate administration decreases fracture risk in postmenopausal females with osteoporosis. There are limited studies showing effects of short term alendronate administration on BMD in predialysis osteoporotic patients with CKD.Methods:This study was conducted on fifty adult patients with chronic kidney disease. Patients were divided into two groups. Group A consisted of seventeen patients with CKD stage 3 (eGFR 45-30 ml/min/1.73m2) and Group B comprised thirty three patients with CKD stage 4 (eGFR 30-15 ml/min/1.73m2). The study included male patients between age 18-75 years and premenopausal non pregnant females older than 18 years of age. All the patients were osteoporotic having T score < −2.5 on DEXA scan. The patients were administered 70 mg alendronate tablet once a week for 6 weeks. Renal parameters, parathyroid hormone, calcium, phosphorous and alkaline phosphatase levels were assayed at baseline for 6 months. Serum (iPTH) level (pg/ml) was measured by chemiluminescent immune assay (CLIA) method and serum 25 Hydroxy Vitamin D level (ng/ml) was measured by enzyme linked immunosorbent assay (ELISA) method. Bone Mineral Density (BMD) was measured at baseline for 6 months, by dual energy x-ray absorptiometry at lumbar spine and neck of femur and lowest values were included. The results were obtained for T score, Z score and bone mineral density (g/cm2).Results:The BMD, T score and Z score increased in both groups after 6 months with a statistically significant difference in the treatment group. In Group A, T score, Z score and BMD (g/cm2) increased from −2.60±0.086, −2.13±0.28, and 0.80±0.008 at baseline to −2.57±0.097, −2.11±0.26 and 0.81±0.008 after six months. In Group B, the T score, Z score and BMD (g/cm2) increased from −3.17±0.24, −2.82±0.33 and 0.738±0.03 to −3.16±0.25, −2.66±0.95 and 0.743±0.03 after six months with a statistically significant difference. eGFR decreased in both groups but the difference was statistically non-significant (P>0.05). The serum iPTH levels increased after 6 months in both groups with a statistically insignificant difference. There was an increase in serum calcium and decrease in serum phosphate levels after six months, however the difference was statistically insignificant (p>0.05). The SAP values decreased in both groups after six months with a statistically insignificant difference. The main side-effect in the alendronate group was the occurrence of gastroesophageal reflux symptoms in two subjects.Conclusion:Low-dose alendronate, administered for a limited duration, appears to be well tolerated in CKD patients. The BMD increased in both groups suggesting a bone-preserving effect of alendronate.

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