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

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1484-1484 ◽  
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.

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

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 (&lt; 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 &lt; −1 and &gt; −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&lt;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.

Bone Density Measurements in Patients with Severe Chronic Neutropenia On Long-Term G-CSF Therapy.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1362-1362 ◽  
Author(s):  
David C. Dale ◽  
Audrey Anna Bolyard ◽  
Linda A DiMeglio ◽  
Tracy M Marrero ◽  
Laurence A. Boxer
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Bone Health ◽  
Median Dose ◽  
Mineral Density ◽  
Cyclic Neutropenia ◽  
Density Measurements ◽  
Day Range ◽  
Chronic Neutropenia

Abstract Abstract 1362 G-CSF is a very effective treatment for idiopathic, congenital and cyclic neutropenia (SCN). G-CSF also expands myeloid tissues that give rise to osteoclasts that resorb bone. For this reason, the Severe Chronic Neutropenia International Registry (SCNIR) has collected data on fractures in this population for over 15 years. These data indicate that fractures are uncommon events. To expand information on bone health for patients on long-term G-CSF, we collected additional information from a patient survey and reviewed reports of bone mineral density measurements (BMD) in US children and adults in the SCNIR. Letters were sent to 680 patients; 367 responded. 17 of 367 patients reported fractures; 15 were related to accidents (11 extremities, 4 spine) and 2 were categorized as spontaneous (both spine). The frequency of fractures was 0.005 per patient year on G-CSF. 222 patients indicated that they had not had a BMD study. We received 266 BMDs on 145 subjects (45 children {<21 years of age} and 100 adults) having sufficient information in a standard report format for evaluation. There were 82 BMDs in the 45 children and 184 BMDs in the 100 adults. For adults, abnormal BMD was defined as a t score less than -2.5; for children abnormal was a z score of less than -2.0. 205 of 266 BMD reports were normal; BMDs for 34 of 45 children and 85 of 100 adults were normal. 11 BMDs prior to G-CSF treatment were normal (4 children, 5 adults – 2 adults had 2 normal BMDs) and 194 BMDs during G-CSF treatment were normal (30 children, 85 adults). The G-CSF median dose for children with normal scans was 5.1 mcg/kg/day (range 0.0 - 53) and for adults was 1.1 mcg/kg/day (range 0.0 - 38). 61 of 266 scans were abnormal in 11 children and 15 adults. 1 of 6 adult scans prior to G-CSF treatment was abnormal. During G-CSF treatment there were 60 abnormal BMDs in 11 children and 14 adults. The G-CSF median dose for children with abnormal BMDs was 3.6 mcg/kg/day (range 0.0 - 18) and for adults was 2.3 mcg/kg/day (range 0.0 - 37). 28 subjects (8 children, 20 adults) had three or more sequential BMD reports. Of these, 17 subjects (3 children, 14 adults) suggested a trend of decreasing BMD while on G-CSF, 11 subjects (5 children, 6 adults) had normal serial BMDs on G-CSF without trending toward decreased bone mineral density. 33 patients reported treatments with osteoporosis medications; 15(46%) calcium supplements, 12(36%) bisphosphonates, 3(9%) Vitamin D supplements, 2(6%) hormonal supplements, and 1(3%) calcitonin; the effectiveness of these therapies could not be evaluated. This survey confirms that overt fractures are low-frequency events for patients with SCN on many years of G-CSF therapy. The trend toward decreased BMD in approximately 60% of patients with serial assessments suggests that bone loss is a common effect of chronic G-CSF treatment. The data also suggest that baseline and follow-up BMD assessments are useful for determining bone health for SCN patients on long term G-CSF therapy. Disclosures Dale: Amgen Inc.: Consultancy, Honoraria, Research Funding, Speaker. Boxer:Amgen Inc.: Equity Ownership.

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

Medicina ◽  
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.

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

2020 ◽  
Vol 105 (4) ◽  
pp. e1397-e1407 ◽  
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.

scholarly journals Frequency of Low Bone Mineral Density (BMD) in Patients with Liver Cirrhosis

2021 ◽  
pp. 47-52
Author(s):  
Ihsanullah Rajar ◽  
Nasrullah Aamer ◽  
Narindar Kumar ◽  
Prem Kumar ◽  
Kapeel Raja ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Liver Cirrhosis ◽  
Bone Mineral ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Mineral Density ◽  
Cross Sectional ◽  
T Score ◽  
Low Bone Mineral Density ◽  
Femur Neck

Objective: The objective of this study was to evaluate the low bone mineral density (BMD) in patients with liver cirrhosis. Methodology: This cross sectional study on 151 Liver cirrhotic patients was conducted at Liaquat University Hospital Hyderabad/Jamshoro. This study duration was 6 months, July 2015 to December 2015. The Assessment of bone mineral density (BMD) for each relevant patient was done using ultrasound impedance Dual Energy X-ray Absorptiometry  (DEXA) by senior pathologist having ≥05 years of experience, across the calcaneum, at lumbar spine  (LS) and femur neck (FN),  were computed by using computer supported device. The BMD was expressed in terms of T score. The WHO standard value was utilized to define the low BMD / osteoporosis is T score -1.5. Results: The mean age of subjects was 31.32±6.18 years. Out of all, 62.9% were males whereas 37.1% were females. About 21% patients had low/abnormal bone mineral density (BMD). Among these, 17.9% had bone mineral density (BMD) of -1.5 to -2.5 and 4% had BMD of <-2.5. Rest of 78.1% patients had a normal (>-1.5) bone mineral density (BMD). Majority of patients, 63.6% had a CTP grade B of liver cirrhosis, whereas 22.5% had A grade and 13.9% had C grade of liver cirrhosis. Conclusion: Conclusively, the risk of low bone mineral density (BMD) was evidently high for patients with hepatic cirrhosis. Male gender and age above 30 years were found at greater risk and CTP grade B of cirrhosis was most common.

Timing of low bone mineral density and predictors of bone mineral density trajectory in children on long-term warfarin: a longitudinal study

2015 ◽  
Vol 27 (4) ◽  
pp. 1547-1557 ◽  
Author(s):  
M. L. Avila ◽  
E. Pullenayegum ◽  
S. Williams ◽  
A. Shammas ◽  
J. Stimec ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Longitudinal Study ◽  
Bone Mineral ◽  
Mineral Density ◽  
Low Bone Mineral Density

The Prevalence of Disordered Eating, Menstrual Dysfunction, and Low Bone Mineral Density among US Collegiate Athletes

2006 ◽  
Vol 16 (1) ◽  
pp. 1-23 ◽  
Author(s):  
Katherine A. Beals ◽  
Amanda K. Hill
Keyword(s):  
Bone Mineral Density ◽  
Disordered Eating ◽  
Bone Mineral ◽  
Collegiate Athletes ◽  
Z Score ◽  
Mineral Density ◽  
Menstrual Dysfunction ◽  
X Ray ◽  
Low Bone Mineral Density ◽  
Menstrual History

The purpose of this study was to examine the prevalence of disordered eating (DE), menstrual dysfunction (MD), and low bone mineral density (BMD) among US collegiate athletes (n = 112) representing 7 different sports (diving, swimming, x-country, track, tennis, field hockey, and softball) and determine differences in prevalence existed between athletes participating in lean-build (LB) and non-lean build (NLB) sports. DE and MD were assessed by a health, weight, dieting, and menstrual history questionnaire. Spinal BMD was determined via dual energy x-ray absorptiometry. Twenty-eight athletes met the criteria for DE, twenty-nine for MD, and two athletes had low BMDs (using a Z score below −2.0). Ten athletes met the criteria for two disorders (one with disordered eating and low BMD and nine with disordered eating and menstrual dysfunction), while only one athlete met the criteria for all three disorders. Using a Z score below −1.0, two additional athletes met the criteria for all three disorders and three more athletes met the criteria for a combination of two disorders. With the exception of MD, which was significantly more prevalent among LB vs. NLB sports (P = 0.053), there were no differences between the groups in the prevalence of individual disorders or combinations of disorders. These data indicate that the combined prevalence of DE, MD, and low BMD among collegiate athletes is small; however, a significant number suffer from individual disorders of the Triad.

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