scholarly journals Lipoprotein(a) plasma levels, bone mineral density and risk of hip fracture: a post hoc analysis of the Women’s Health Initiative, USA

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e027257 ◽  
Author(s):  
Bernhard Haring ◽  
Carolyn J Crandall ◽  
Laura Carbone ◽  
Simin Liu ◽  
Wenjun Li ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Postmenopausal Women ◽  
Mineral Density ◽  
Post Hoc Analysis ◽  
T Score ◽  
Health Initiative ◽  
Hip Bmd ◽  
History Of ◽  
Post Hoc

ObjectivesElevated Lipoprotein(a) (Lp[a]) is a well-known risk factor for cardiovascular disease. However, its roles in bone metabolism and fracture risk are unclear. We therefore investigated whether plasma Lp(a) levels were associated with bone mineral density (BMD) and incident hip fractures in a large cohort of postmenopausal women.DesignPost hoc analysis of data from the Women’s Health Initiative (WHI), USA.Setting40 clinical centres in the USA.ParticipantsThe current analytical cohort consisted of 9698 white, postmenopausal women enrolled in the WHI, a national prospective study investigating determinants of chronic diseases including heart disease, breast and colorectal cancers and osteoporotic fractures among postmenopausal women. Recruitment for WHI took place from 1 October 1993 to 31 December 1998.ExposuresPlasma Lp(a) levels were measured at baseline.Outcome measuresIncident hip fractures were ascertained annually and confirmed by medical records with follow-up through 29 August 2014. BMD at the femoral neck was measured by dual X-ray absorptiometry in a subset of participants at baseline.Statistical analysesCox proportional hazards and logistic regression models were used to evaluate associations of quartiles of plasma Lp(a) levels with hip fracture events and hip BMD T-score, respectively.ResultsDuring a mean follow-up of 13.8 years, 454 incident cases of hip fracture were observed. In analyses adjusting for confounding variables including age, body mass index, history of hysterectomy, smoking, physical activity, diabetes mellitus, general health status, cardiovascular disease, use of menopausal hormone therapy, use of bisphosphonates, calcitonin or selective-oestrogen receptor modulators, baseline dietary and supplemental calcium and vitamin D intake and history of fracture, no significant association of plasma Lp(a) levels with low hip BMD T-score or hip fracture risk was detected.ConclusionsThese findings suggest that plasma Lp(a) levels are not related to hip BMD T-score or hip fracture events in postmenopausal women.Trial registration numberNCT00000611; Post-results.

scholarly journals The Impact of Switching from Short-Term Teriparatide Treatment to Denosumab Therapy Compared with Denosumab Alone for Patients with Osteoporotic Hip Fracture: A 1-Year Follow-up Study

2020 ◽  
Author(s):  
Chan Ho Park ◽  
Jun-Il Yoo ◽  
Chang Hyun Choi ◽  
You-Sung Suh
Keyword(s):  
Hip Fracture ◽  
Mineral Density ◽  
Short Term ◽  
Short Term Treatment ◽  
T Score ◽  
The Difference ◽  
Group 2 ◽  
The Impact ◽  
Group 1

Abstract Background: Switching the prescription from bone-forming medication to resorptive agents is reportedly effective for patients with severe osteoporosis. The objective of this study is to determine the impact of implementing short-term teriparatide (TPTD) intervention before denosumab (DMab) therapy compared with DMab therapy alone for 1 year after hip fracture.Methods: TPTD was administered to 24 patients for an average of 12.1 weeks after which the intervention was switched to DMab therapy for 12 months (group 1). DMab alone was administered to 16 patients for 12 months (group 2). Bone mineral density (BMD) was evaluated before and after treatment at the 1-year follow-up. The improvement of BMD and T-score in hip and spine was compared with the levels of bone turnover marker.Results: The difference of hip BMD after osteoporosis treatment was -0.0081±0.03 in group 1 and 0.0074±0.04 in group 2 (p=0.180). The difference of spine BMD was 0.0819±0.04 in group 1 and 0.0145±0.03 in group 2 (p<0.001). BMD and T-score of the spine improved significantly in groups 1 and 2 (p < 0.001). There was no statistical difference in C-terminal telopeptide and osteocalcin level. Conclusion: Short-term TPTD administration followed by DMab alone was effective only in improving spine BMD. Short-term treatment with TPTD caused mild improvement in femur neck BMD compared with DMab alone. However, further research with a longer duration of TPTD treatment is warranted, as our findings lack statistical significance.

scholarly journals A Model of BMD Changes After Alendronate Discontinuation to Guide Postalendronate BMD Monitoring

2014 ◽  
Vol 99 (11) ◽  
pp. 4094-4100 ◽  
Author(s):  
Brian McNabb ◽  
Eric Vittinghoff ◽  
Richard Eastell ◽  
Ann V. Schwartz ◽  
Douglas C. Bauer ◽  
...  
Keyword(s):  
Multicenter Clinical Trial ◽  
Intervention Trial ◽  
Mineral Density ◽  
Management Change ◽  
Total Hip ◽  
T Score ◽  
Hip Bmd ◽  
The Given

Context: Women stopping alendronate are commonly monitored with serial bone mineral density (BMD) measurements, yet no information exists on how frequently or for whom these measurements should be performed. Objective: The objective of the study was to develop a tool to guide post-alendronate BMD monitoring. Design: A predictive model was constructed to estimate the time until a given percentage of women's BMD T-scores drop below a given threshold that indicates a management change (such as retreatment) would be considered. This model was then used to estimate the time it would take for groups of women defined by their baseline BMDs to drop below the given threshold. Setting: Data were derived from the Fracture Intervention Trial Long Term Extension (FLEX), the largest multicenter clinical trial of its type to date. Participants: Four hundred four women who had received an average of 5.1 years of alendronate during the Fracture Intervention Trial and were subsequently observed for 5 treatment-free years (on placebo) during the FLEX trial were used to estimate the change in BMD over time. Results: If a management change such as alendronate reinitiation would be considered when BMD T-score drops below −2.5, the model shows that women with total hip BMD greater than −1.9 T-scores at the time of alendronate discontinuation have less than a 20% probability that at follow-up, monitoring BMD will be below the threshold within 5 years. The model performed similarly, and results are provided over a range of management change thresholds from −1.75 to −3 T-scores. Conclusions: Using the tool developed in this analysis, it is possible to estimate when BMD repeat measurement after alendronate discontinuation could potentially be useful. Measuring BMD within 5 years after alendronate discontinuation is unlikely to change management for women with total hip BMD 0.6 T-scores above a prespecified retreatment threshold within the range of −1.75 to −3 T-scores.

scholarly journals POS1106 FRAX AND THE EFFECT OF TERIPARATIDE ON BONE MINERAL DENSITY IN SECONDARY OSTEOPOROSIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 833.2-834
Author(s):  
S. Garcia ◽  
B. M. Fernandes ◽  
M. Rato ◽  
F. Oliveira Pinheiro ◽  
D. Fonseca ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Hip Fracture ◽  
Lumbar Spine ◽  
Femoral Neck ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Fracture Probability ◽  
Mineral Density ◽  
T Score

Background:Teriparatide has been shown to increase spine and hip bone mineral density (BMD) and to reduce vertebral and non-vertebral fractures. (1) It is currently not clear whether the effect of teriparatide is dependent on the baseline risk of fracture or osteoporosis (OP) type, a finding that could have an impact on our therapeutic decision.Objectives:Investigate if there is a relationship between teriparatide effect in BMD and baseline 10-year fracture probability, assessed using FRAX®, in primary and secondary OP patients.Methods:This is a longitudinal, retrospective study including consecutive patients with the diagnosis of OP treated with teriparatide for 24 months, with a ten-year follow-up period, at our rheumatology department. Demographic, clinical, laboratorial, BMD and occurrence of fracture data were collected. The 10-year risk of osteoporotic fracture was estimated using the fracture risk assessment tool (FRAX) v 4.1 with the Portuguese population reference. Statistical analysis was performed using the software SPSS 23.0. Correlations between continuous variables were evaluated with spearman coefficient. p<0.05 was considered statistically significant.Results:Eighty patients (88.8% female, median age 65.00 (59; 75)) were included. Forty-nine patients (61.3%) has secondary OP, mainly of cortisonic etiology (61.2%, n=30). Before treatment, median lumbar spine BMD was 0.870 [0.767, 0.964] g/cm2, median T-score of -2.60 (-3.30, -1.90); median total femur BMD was 0.742 [0.667, 0.863] g/cm2, median T-score of -2.10 (-2.80, -1.30); median femoral neck BMD was 0.671 [0.611, 0.787] g/cm2, median T-score of -2.50 [-3.20, -1.85]. Regarding fracture risk, median FRAX-based 10-year major fracture risk (with BMD) at baseline was 16% [10.0; 23], and median hip fracture risk was 7.2% [3.4; 13.8].The median variation of BMD, after finishing teriparatide treatment, in the spine was 0.107 [0.029; 0.228]; median BMD variation in total femur was 0.013 [-0.013; 0.068] and median BMD femoral neck was 0.046 [-0.002; 0.109]. We observed a numerically superior effect, albeit without any statistical significance, of teriparatide on bone mineral density gain in secondary OP (versus primary OP) at lumbar spine, total femur and femoral neck.Most patients continued anti-osteoporotic treatment with a bisphosphonate (81.2%, n=65) and, during follow-up, 17 patients had an incident fracture (8 hip fractures and 6 vertebral fractures), median of 5 [1.75, 8.25] years after ending teriparatide.We found a discrete correlation between FRAX-based hip fracture probability and the variation of bone mineral density in total femur (Spearman’s coefficient 0.248, p = 0.04). There was no correlation between FRAX-based major fracture probability and and the variation of bone mineral density in the spine or femur. When we separately analyze the relationship between the variation in total hip BMD and the FRAX-based fracture risk, depending on whether it is a secondary or primary OP, we find that the correlation is stronger and only remains in secondary OP (Spearman’s coefficient 0.348, p = 0.03).Conclusion:Our data suggest that teriparatide could be an important weapon in the treatment of secondary cause OP, particularly cortisonic, and in patients at high fracture risk, although further larger studies are needed to confirm these findings.References:[1]Kendler DL, Marin F, Zerbini CAF, Russo LA, Greenspan SL, Zikan V, Bagur A, Malouf-Sierra J, Lakatos P, Fahrleitner-Pammer A, Lespessailles E, Minisola S, Body JJ, Geusens P, Möricke R, López-Romero P. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet. 2018 Jan 20;391(10117):230-240. doi: 10.1016/S0140-6736(17)32137-2.Disclosure of Interests:None declared.

scholarly journals Social and mental functioning in postmenopausal women with low bone mineral density

2018 ◽  
Vol 71 (5-6) ◽  
pp. 171-179
Author(s):  
Jelena Zvekic-Svorcan ◽  
Martina Miklos ◽  
Karmela Filipovic ◽  
Milan Cvetkovic ◽  
Miljanka Vuksanovic ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Bone Mineral Density ◽  
Femoral Neck ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Mental Functioning ◽  
Mineral Density ◽  
T Score ◽  
History Of

Introduction. Osteoporosis is a systemic, metabolic, progressive bone disease characterized by reduced bone mineral density leading to bone fragility and reduced quality of life. The objective of this study was to examine the quality of social and mental functioning in postmenopausal women with reduced mineral bone density. Material and Methods. This prospective cross-sectional study included 210 postmenopausal women aged ? 50 years, who were referred for osteodensitometry to the Special Hospital for Rheumatic Diseases Novi Sad, Serbia. The study was conducted in the period from February 24 to April 3, 2017. All women completed the Serbian version of the Quality of Life Questionnaire of the European Foundation for Osteoporosis (41). They all underwent bone mineral density measurement in two regions of interest, and the results were interpreted according to the current definition of osteoporosis. The participants? social and mental functioning was analyzed including the following variables: age, place of residence, educational attainment, employment, nutritional status, bone mineral density, and low-trauma fractures. Statistical processing and analyses were performed using Statistical Package for the Social Sciences, version 20. Results. A statistically significant negative correlation was noted between social functioning and the T-score for the femoral neck (r = -0.438), hip (r = -0.412) and spine (r = -0.226), as well as mental functioning with the T-score for the femoral neck (r = -0.424), hip (r = -0.454) and spine (r = -0.319). Patients with a history of fractures had a poorer quality of social functioning (t = 2.17, p < 0.05). Conclusion. The examinees of older age, with poor socio-demographic status, reduced bone mineral density, history of low-trauma fractures presented with lower quality of social and mental functioning.

scholarly journals Association between Geriatric Nutrition Risk Index and Skeletal Muscle Mass Index with Bone Mineral Density in Post-Menopausal Women Who Have Undergone Total Thyroidectomy

Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1683
Author(s):  
Tai-Hua Chiu ◽  
Szu-Chia Chen ◽  
Hui-Chen Yu ◽  
Jui-Sheng Hsu ◽  
Ming-Chen Shih ◽  
...  
Keyword(s):  
Skeletal Muscle ◽  
Total Thyroidectomy ◽  
Postmenopausal Women ◽  
Muscle Mass ◽  
Skeletal Muscle Mass ◽  
Mineral Density ◽  
Total Hip ◽  
T Score ◽  
Hip Bmd ◽  
Skeletal Muscle Mass Index

Background: Osteoporosis is highly prevalent in postmenopausal women and may result in fractures and disabilities. Total thyroidectomy has also been associated with loss of bone mass. The aim of this cross-sectional study was to evaluate associations among nutritional status, skeletal muscle index and markers of bone turnover to bone mineral density in postmenopausal women who had undergone total thyroidectomy. Methods: Fifty postmenopausal women who had undergone total thyroidectomy were included. Body composition was measured using dual-energy X-ray absorptiometry (DXA). The Geriatric Nutritional Risk Index (GNRI) was calculated using baseline body weight and serum albumin level. Skeletal muscle mass index was calculated as the appendicular skeletal muscle mass (ASM) divided by the height squared and assessed using DXA. Results. Multivariate stepwise linear regression analysis showed that a low GNRI was significantly associated with low lumbar spine bone mineral density (BMD) and T-score, and that a low ASM/height2 was significantly associated with low femoral neck BMD and T-score. A low vitamin D level was significantly associated with low femoral neck BMD and T-score and low total hip BMD and T-score. A high bone alkaline phosphatase (ALP) level was significantly associated with low femoral neck T-score and low total hip BMD and T-score. A low insulin-like growth factor-1 (IGF-1) was significantly associated with low total hip BMD and T-score. Conclusion: In the postmenopausal women who had undergone total thyroidectomy in this study, BMD was positively associated with GNRI, skeletal muscle mass index, and levels of vitamin D and serum IGF-1, and inversely associated with bone ALP level. Nutritional status, skeletal muscle mass index and bone turnover biomarkers can be used to early identify patients with a high risk of osteoporosis in this high-risk group.

scholarly journals The effect of body mass index on bone mineral density in postmenopausal women

2018 ◽  
Vol 6 (11) ◽  
pp. 3482 ◽  
Author(s):  
Yusuf Serdar Gürlek ◽  
Ahmet Kalaycıoğlu ◽  
Beril Gurlek
Keyword(s):  
Lumbar Spine ◽  
Waist Circumference ◽  
Bone Density ◽  
Postmenopausal Women ◽  
Positive Impact ◽  
Mineral Density ◽  
T Score ◽  
Healthy Female ◽  
Negative Effect ◽  
History Of

Background: The aim of this study was to evaluate the association between BMI and BMD among postmenopausal women.Methods: A total of 121 healthy female patients, aged 65.67±8.59 years, previously menopaused, were enrolled. Subjects were divided into five subgroups according to their BMI. History of fracture and BMD were recorded and compared between groups.Results: Among the 121 subjects, 77 (63.6%) individuals had a normal BMD, 32 (26.4%) had osteopenia, and 12 (9.9%) were diagnosed with osteoporosis. Mean of waist circumference was 96.1±8.52cm. The prevalence of fractures was 29.8% in this study. A simple correlation analysis revealed that waist circumference was negatively related to lumbar spine BMD (r= -0.374, p=0.03) and lumbar spine BMD T score (r= -0,352 p=0.002) whereas body weight was positively related to BMD of lumbar spine BMD (r=0.41, p=0.0001) and lumbar spine BMD T score (r=0,31 p=0.001). Age and years since menopause (YSM) were negatively correlated with BMD and T score (p=0.001, p=0.0001, respectively).Conclusions: Even though higher BMI seems to have positive impact on bone density thanks to hormonal and mechanical reasons, increased waist circumference is a sign of a metabolic syndrome and systemic inflammation which are known as having negative effect on bone density. Therefore, postmenopausal women specifically with abdominal obesity should be evaluated for osteoporosis. 

scholarly journals Prevalence of Fracture Risk Factors in Postmenopausal Women Enrolled in the POSSIBLE US Treatment Cohort

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Nicole Yurgin ◽  
Sally Wade ◽  
Sacha Satram-Hoang ◽  
David Macarios ◽  
Marc Hochberg
Keyword(s):  
Risk Factors ◽  
Fracture Risk ◽  
Postmenopausal Women ◽  
Osteoporosis Treatment ◽  
Mineral Density ◽  
Parental History ◽  
T Score ◽  
History Of ◽  
Loss Experience ◽  
Reported Data

Subject- and physician-reported data from 4,429 postmenopausal women receiving osteoporosis treatment in the Prospective Observational Scientific Study Investigating Bone Loss Experience (POSSIBLE US) were used to assess the prevalence of risk factors (RFs) and on-study fracture. RFs assessed at study entry were age >70 years; fracture since age 50; minimum T-score (hip/spine) ≤−2.5 at diagnosis; body mass index <18.5 kg/m2; rheumatoid arthritis; parental history of hip fracture; current smoking; and recent oral glucocorticoid use. Data were collected with semiannual self-administered questionnaires. Results were stratified by physician-reported osteoporosis/osteopenia diagnosis. Low T-score and age >70 years were the most common RFs in the osteoporosis group, and age >70 years and prior fracture were the most common risk factors in the osteopenia group. Multiple RFs were more common than a single RF in osteoporotic women (54.2% versus 34.6%;P<0.0001) but not osteopenic women (13.8% versus 33.6%;P<0.0001). Women with multiple RFs had more on-study osteoporosis-related fractures than women with a single RF (osteoporosis group: 9.9% versus 6.2%;P=0.0092; osteopenia group: 11.2% versus 4.7%;P<0.0001). In postmenopausal women receiving osteoporosis treatment, multiple RFs increased fracture risk. RFs, in addition to bone mineral density, can help identify candidates for osteoporosis treatment.

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