scholarly journals Individualized treatment with denosumab in children with osteogenesis imperfecta – follow up of a trial cohort

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Heike Hoyer-Kuhn ◽  
Mirko Rehberg ◽  
Christian Netzer ◽  
Eckhard Schoenau ◽  
Oliver Semler
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Side Effects ◽  
Osteogenesis Imperfecta ◽  
Bone Mineral ◽  
Bone Pain ◽  
Mineral Density ◽  
Osteoclastic Activity ◽  
Activity Marker

Abstract Background Osteogenesis imperfecta (OI) is a rare disease leading to hereditary bone fragility. Nearly 90% of cases are caused by mutations in the collagen genes COL1A1/A2 (classical OI) leading to multiple fractures, scoliosis, short stature and nonskeletal findings as blue sclera, hypermobility of joints, bone pain and delayed motor function development. Bisphosphonates are used in most moderate and severely affected patients assuming that an increase of bone mineral density might reduce fractures and bone pain in patients with OI. Denosumab as a RANK ligand antibody inhibiting osteoclast maturation has been approved for osteoporosis treatment in adults. First data from small clinical trials promised a high efficacy of Denosumab in children with OI. Aim of this analysis was a retrospective evaluation of an individualized biomarker-associated treatment regime with Denosumab in 10 children with classical OI which were followed for 1 year after their participation in a pilot trial with Denosumab. Therefore urinary deoxypyridinoline levels were evaluated frequently as an osteoclastic activity marker and depending on that levels Denosumab injections were scheduled individually. Methods Ten patients (age range: 6.16–12.13 years; all participated in the former OI-AK phase 2 trial (NCT01799798)) were included in the follow-up period. Denosumab was administered subcutaneously depending on the individual urinary excretion course of deoxypyridinoline (DPD/Crea) as osteoclastic activity marker with 1 mg/kg body weight. DPD/Crea levels were evaluated before denosumab administration and afterwards. If patients present after an initial decrease after injection with a re-increase up to the DPD/crea level before Denosumab injection next dosage was planned. Changes of areal bone mineral density (aBMD) using dual energy x-ray absorptiometry of the lumbar spine after 12 month was evaluated. Safety was assessed by bone metabolism markers and side effect reporting. Results During follow-up mean relative change of lumbar aBMD was − 6.4%. Lumbar spine aBMD z-Scores decreased from − 1.01 ± 2.61 (mean ± SD) to − 1.91 ± 2.12 (p = 0.015). Mobility changed not significantly (GMFM-88 -6.49 ± 8.85% (p = 0.08). No severe side effects occurred. Dose intervals could be extended in the mean from 12 weeks previously to 20.3 weeks. Conclusions On average, it was possible to prolong the intervals between drug administrations and to reduce the total dose about by 25% without a decrease of mobility or change of vertebral shape despite a reduction of lumbar aBMD during 1 year of biomarker-directed Denosumab treatment. Further trials are necessary to balance side effects and highest efficacy in children.

scholarly journals Alcohol consumption and bone mineral density in elderly women

2012 ◽  
Vol 16 (4) ◽  
pp. 704-712 ◽  
Author(s):  
Isolde Sommer ◽  
Arja T Erkkilä ◽  
Ritva Järvinen ◽  
Jaakko Mursu ◽  
Joonas Sirola ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Alcohol Consumption ◽  
Femoral Neck ◽  
Bone Mineral ◽  
Alcohol Intake ◽  
Elderly Women ◽  
Mineral Density ◽  
Lifestyle Questionnaire

AbstractObjectiveFindings regarding alcohol consumption and bone mineral density (BMD) in elderly women have been inconsistent. The objective of the present study was to explore the association of alcohol intake with BMD in elderly women.DesignThis cohort study included women from the population-based Kuopio Osteoporosis Risk Factor and Prevention – Fracture Prevention Study (OSTPRE-FPS). Alcohol intake and potential confounders were assessed at baseline and after 3 years of follow-up using a lifestyle questionnaire. In addition, an FFQ was distributed in the third year to measure dietary intake, including alcohol. Women underwent BMD measurements at the femoral neck and lumbar spine at baseline and after 3 years of follow-up.SettingKuopio Province, Finland.SubjectsThree hundred elderly women (mean age 67·8 years) who provided both BMD measurements and FFQ data.ResultsAlcohol consumption estimated from the FFQ and lifestyle questionnaire was significantly associated with BMD at both measurement sites after adjustment for potential confounders, including lifestyle and dietary factors (P < 0·05). Using the FFQ, women drinking >3 alcoholic drinks/week had significantly higher BMD than abstainers, 12·0 % at the femoral neck and 9·2 % at the lumbar spine. Results based on the lifestyle questionnaire showed higher BMD values for all alcohol-consuming women at the femoral neck and for women drinking 1–3 alcoholic beverages/week at the lumbar spine, compared with non-users.ConclusionsThe results from OSTPRE-FPS suggest that low to moderate alcohol intake may exert protective effects on bone health in elderly women.

Effect of Zoledronic Acid on Bone Mineral Density in Thalassemia-Induced Osteoporosis: Results of a Phase II Clinical Trial.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3826-3826
Author(s):  
Ali Taher ◽  
Sami Azar ◽  
Wael Shamseddeen ◽  
Dany Habr ◽  
Adlette Inati ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Zoledronic Acid ◽  
Femoral Neck ◽  
Adverse Events ◽  
Bone Mineral ◽  
Beta Thalassemia ◽  
Mineral Density ◽  
Significant Change

Abstract Background: Osteoporosis is an important cause of morbidity in beta-thalassemia patients. Bisphosphonates are potent inhibitors of osteoclast activity and have been recently used for the treatment of osteoporosis in beta-thalassemia. The aim of this study is to assess the efficacy and safety of zoledronic acid in Lebanese thalassemics with osteoporosis. Methods: Eighteen thalassemic patients (13 thalassemia major and 5 intermedia) with osteoporosis defined as Z-score &lt;−2.5 were given zoledronic acid 4 mg i.v. every 3 months over a period of 12 months (Total of 4 doses administered). The efficacy of treatment was assessed by measuring Bone Mineral Density (BMD) at the lumbar spine, femoral neck and hip at baseline, 6 and 12 months. Other efficacy measurements included markers of bone formation and resorption (bone alkaline phosphatase (BAP), osteocalcin (OC), and urinary deoxypyridinoline (Dpd)), assessment of pain score, analgesic score, and performance score measured at baseline and at 3-month intervals. Safety assessment included regular physical exams, standard hematology and clinical chemistry tests, and adverse events recording. All patients were on Ca/Vitamin D supplementation prior to and during the study. Ten thalassemic osteoporotic patients were followed up only with serial BMDs as controls. Results: The characteristics of all patients are shown in Table 1. Both groups had no significant difference with respect to age, gender and baseline BMD. Patients taking zoledronic acid had a significant increase in their spine, femoral neck, trochanter and total hip BMD measurements over the 12-month period (all p-values&lt;0.05). Patients in the control group, on the other hand, did not have any significant change except in the spine BMD. The BMD values are presented in Table 2. There was a significant change in the levels of the OC and BAP over the 12-month follow-up in the treatment group (p=0.00 for both). Dpd levels did not significantly change overall (p=0.06) although they decreased throughout the study. Reported adverse events included joint pain in 9 patients (50%) after the 1st dose and in 2 (11.1%) after the 2nd dose and responding very well to oral analgesics. Two patients (11.1%) had perioral numbness and 3 (16.7%) had low grade fever after the 1st dose. No treatment-related adverse events were reported after the 3rd and 4th doses. No patients withdrew from the study. Conclusions: Treatment of Lebanese thalassemic osteoporotic patients with zoledronic acid 4 mg every 3 months is effective in increasing BMD at the lumbar spine and hip and is well-tolerated. Well-controlled studies with longer follow-up are needed to determine the fracture-reduction benefits and the most optimal zoledronic acid treatment dose and frequency in this patient population. Table 1: Main characteristics of the studied groups Table 2: BMD values of the treatment and control groups

HRT preserves increases in bone mineral density and reductions in body fat after a supervised exercise program

1998 ◽  
Vol 84 (5) ◽  
pp. 1506-1512 ◽  
Author(s):  
Wendy M. Kohrt ◽  
Ali A. Ehsani ◽  
Stanley J. Birge
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Bone Mineral ◽  
Exercise Program ◽  
Treatment Phase ◽  
Mineral Density ◽  
Supervised Exercise ◽  
Total Body ◽  
Exercise Induced

The aims of this study were to confirm our previous finding that hormone-replacement therapy (HRT) augments exercise-induced increases in bone mineral density (BMD) in older women and to determine whether HRT preserves the adaptations when exercise is reduced or discontinued. The study included an 11-mo treatment phase and a 6-mo follow-up phase. Participants, aged 66 ± 3 yr, were assigned to control (Con; n = 10), exercise (Ex; n = 18), HRT ( n = 10), and Ex+HRT ( n = 16) groups. HRT was continued during the follow-up. After the treatment phase, changes in total body BMD were −0.5 ± 1.7, 1.5 ± 1.4, 1.2 ± 0.8, and 2.7 ± 1.2% in Con, Ex, HRT, and Ex+HRT, respectively. Ex+HRT was more effective than HRT in increasing BMD of the total body and tended ( P = 0.08) to be more effective at the lumbar spine. Ex+HRT was more effective than Ex in increasing BMD of the total body, lumbar spine, and trochanter. Exercise-induced gains in BMD were preserved during the follow-up only in those individuals on HRT. HRT also attenuated fat accumulation, particularly in the abdominal region, after the exercise program. These findings suggest that HRT is an important adjunct to exercise for the prevention not only of osteoporosis but also of diseases related to abdominal obesity.

scholarly journals Restoration of the coupling process and normalization of bone mass following successful treatment of endogenous Cushing’s syndrome: A prospective, long-term study

2006 ◽  
Vol 154 (1) ◽  
pp. 109-118 ◽  
Author(s):  
Cybèle Kristo ◽  
Rune Jemtland ◽  
Thor Ueland ◽  
Kristin Godang ◽  
Jens Bollerslev
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Bone Mineral ◽  
Cushing’S Syndrome ◽  
Biochemical Markers ◽  
Cushing's Syndrome ◽  
Mineral Density ◽  
Long Term Outcome

Objective: Endogenous Cushing’s syndrome (CS) is associated with bone loss and an increased risk of fractures. However, the long-term outcome of treatment on bone health has not been adequately clarified. Design: We followed 33 patients with active CS prospectively before and twice after treatment (mean follow-up 33 (n = 25) and 71 months (n = 18), respectively). The patients were compared to age-, sex- and body mass index (BMI)-matched controls, also followed longitudinally. Methods: Bone mineral indices (bone mineral density (BMD), bone mineral content (BMC) and bone area) were evaluated in the lumbar spine (LS), femoral neck (FN), and total body (TB) by dual-energy X-ray absorptiometry (DXA). Biochemical markers of bone turnover were assessed by serum levels of osteocalcin and C-terminal telopeptides of Type-1 collagen (CTX-1). Results: Mann–Whitney rank sum tests showed that BMD of the LS, FN and TB was reduced by 14.8% (P < 0.001), 15.7% (P < 0.001), and 9.2% (P < 0.001) in CS vs. controls at baseline, with markedly reduced serum osteocalcin (P = 0.014) and increased CTX-1 (P = 0.012) levels, but no correlation between markers. At first follow-up, BMD was increased in LS (7.9%, P < 0.001) and FN (3.5%, P = 0.003) compared to baseline. The time-dependent rise in BMD (LS (r = 0.59; P = 0.002) and FN (r = 0.52; P = 0.007); Spearman’s rank correlation), in CS was paralleled by increased osteocalcin (275%, P < 0.001) and correlation between biochemical markers (r = 0.92, P < 0.001; Pearson’s correlation). TB BMD did not increase significantly before the second follow-up, when BMD Z-scores were normalized in all three compartments. Conclusion: Our observations demonstrate restoration of coupled bone remodeling and normalization of bone mineral density in all measured skeletal compartments of treated CS patients after prolonged recovery, first significant in predominantly trabecular bone (i.e. lumbar spine).

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 Zoledronate and ibandronate treatments provide a significant improvement in BMD values in osteoporosis patients

2018 ◽  
Vol 1 (3) ◽  
pp. 01-05
Author(s):  
Jaxon Dawson
Keyword(s):  
Bone Mineral Density ◽  
Single Dose ◽  
Side Effects ◽  
Bone Mineral ◽  
Oral Drug ◽  
Multiple Drug ◽  
Drug Infusion ◽  
Mineral Density ◽  
One Year

Objective: In this study, we aimed to make a comparative analysis of short term clinical effectivity and side effects of intravenous zoledronate administration as single dose yearly and intravenous ibandronate administration as four doses per year. Methods: The patients whom were included in our study had osteoporosis according to WHO criteria and were treated with either parenteral zoledronate or ibandronate. 43 patients were treated with single dose of 5mg intravenous zolendronat which was applied once in a year; whereas in 39 patients were treated with 3 mg intravenous ibandronate which was applied four times in a year in three months intervals. Biochemical tests were performed in all patients before intravenous drug infusion. Side effects during drug administration and also in the first three months of the treatment were noted for all patients. Clinical effectivity was analyzed according to changes in bone mineral density (BMD) at the end of two year after treatment. Results: Eighty-two patients who were followed-up and evaluated for the effectivity and side effects of the treatment were included in our study. The compliance of patients were 100% in both groups. Mean age was 75.23±6.9 years and mean body mass index (BMI) was 26.94±7.2. In zoledronate group in which there were 23 females and 20 males. Mean age was 73.64±8.7 years and mean BMI was 27.34±4.4. In ibandronate group in which there were 39 females. There were no statistically significant differences between the groups in terms of gender (p=0.000) Mean age, BMI and rate of diagnosed side effects were not statistically significant in between the groups. According to a one-year follow-up in both groups comparison with before application had a statistically significant increase in BMD (p<0.01). However, a one-year follow-up between the two groups in terms of mean values of bone mineral density did not differ significantly (p>0.05). Conclusion: Choice of medical treatment is decided according to bone mineral density and personal risk factors in osteoporosis. Parenteral agents in the treatment of osteoporosis may be the preferred choice for the patients with comorbid diseases, using multiple drug therapies, or having trouble in using oral drug therapy. However, it should always be kept in mind that drug related side effects may be seen more commonly with parenteral agents. Clinicians should be aware of the probable side effects during and after application.

scholarly journals Impact of serum magnesium and bone mineral density on systemic fractures in chronic hemodialysis patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251912
Author(s):  
Mayuko Hori ◽  
Kaoru Yasuda ◽  
Hiroshi Takahashi ◽  
Chikao Yamazaki ◽  
Kunio Morozumi ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Bone Mineral ◽  
Serum Magnesium ◽  
Threshold Value ◽  
Incidence Rates ◽  
Chronic Hemodialysis ◽  
Maintenance Hemodialysis ◽  
Mineral Density

Introduction Bone mineral density (BMD) measured with dual-energy X-ray absorptiometry (DXA) can be used to predict fractures, but its clinical utility has not been fully established in chronic kidney disease (CKD) patients. Magnesium is an essential trace element. Although magnesium is associated with the risk of fractures in non-CKD populations, the relationship is unknown in CKD patients. Methods BMD and serum magnesium levels were measured in 358 stable outpatients undergoing maintenance hemodialysis therapy. The primary outcome was fragility fracture. Patients were divided into groups according to the median level of magnesium and the normal threshold value of lumbar spine BMD. Results During the median follow-up period of 36 months, 36 (10.0%) fractures occurred. The cumulative incidence rates of fractures were 17.6% and 5.2% [adjusted hazard ratio (aHR) 2.31, 95% confidence interval (CI) 1.03–5.17, P = 0.030] in the lower (<2.6 mg/dL) and higher (≥2.6 mg/dL) magnesium (Mg) groups, respectively, and 21.2% and 7.3% (aHR 2.59, 95% CI 1.09–6.16, P = 0.027) in the low- and high-BMD groups, respectively. The lower-Mg and low-BMD group had a 9.21-fold higher risk of fractures (95% CI; 2.35–47.00; P = 0.0010) than the higher-Mg and high-BMD group. Furthermore, adding both magnesium levels and lumbar spine BMD levels to the established risk factors significantly improved the prediction of fractures (C-index: 0.784 to 0.830, p = 0.041). Discussion/Conclusions The combination of serum magnesium and lumbar spine BMD can be used for fracture risk stratification and synergistically improves the prediction of fractures in CKD patients.

Disordered Eating, Development of Menstrual Irregularity, and Reduced Bone Mass Change After a 3-Year Follow-Up In Female Adolescent Endurance Runners

2021 ◽  
pp. 1-8
Author(s):  
Michelle T. Barrack ◽  
Marta D. Van Loan ◽  
Mitchell Rauh ◽  
Jeanne F. Nichols
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Bone Mass ◽  
Disordered Eating ◽  
Bone Mineral ◽  
Female Adolescent ◽  
Mineral Density ◽  
Menstrual Cycles ◽  
Endurance Runners

This prospective study evaluated the 3-year change in menstrual function and bone mass among 40 female adolescent endurance runners (age 15.9 ± 1.0 years) according to baseline disordered eating status. Three years after initial data collection, runners underwent follow-up measures including the Eating Disorder Examination Questionnaire and a survey evaluating menstrual function, running training, injury history, and prior sports participation. Dual-energy X-ray absorptiometry was used to measure bone mineral density and body composition. Runners with a weight concern, shape concern, or global score ≥4.0 or reporting >1 pathologic behavior in the past 28 days were classified with disordered eating. Compared with runners with normal Eating Disorder Examination Questionnaire scores at baseline, runners with disordered eating at baseline reported fewer menstrual cycles/year (6.4 ± 4.5 vs. 10.5 ± 2.8, p = .005), more years of amenorrhea (1.6 ± 1.4 vs. 0.3 ± 0.5, p = .03), and a higher proportion of menstrual irregularity (75.0% vs. 31.3%, p = .02) and failed to increase lumbar spine or total hip bone mineral density at the 3-year follow-up. In a multivariate model including body mass index and menstrual cycles in the past year at baseline, baseline shape concern score (B = −0.57, p value = .001) was inversely related to the annual number of menstrual cycles between assessments. Weight concern score (B = −0.40, p value = .005) was inversely associated with lumbar spine bone mineral density Z-score change between assessments according to a multivariate model adjusting for age and body mass index. These finding support associations between disordered eating at baseline and future menstrual irregularities or reduced accrual of lumbar spine bone mass in female adolescent endurance runners.

Impact of adjuvant aromatase inhibitors on bone mineral density in breast cancer patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e11616-e11616
Author(s):  
C. N. Lai ◽  
P. D. Correa ◽  
A. Alhasso
Keyword(s):  
Risk Factors ◽  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Bone Mineral ◽  
Aromatase Inhibitors ◽  
Mineral Density ◽  
Osteoporosis Therapy ◽  
T Score ◽  
Estrogen Production

e11616 Aims: It is well known that aromatase inhibitors (AI) are associated with significant reduction in bone mineral density (BMD) through suppression of estrogen production. This effect has been confirmed in several studies. It is considered important that we evaluate our patients and assess their baseline BMD in the adjuvant setting in relation to the use of AIs. Methods: 122 patients on adjuvant AI were evaluated retrospectively. AIs were used either as upfront, early switch or extended adjuvant therapy. BMD (T score for hip and lumbar spine) was evaluated using DEXA scanning at baseline and annually thereafter. Risk factors for osteoporosis were assessed prior to each scan. Results: Mean baseline T scores for lumbar spine and hip were - 0.95 and - 0.79 respectively. The corresponding T scores after 1 year of treatment were -1.06 and -0.92 respectively. This represents 10.6% and 17.4% reduction in T scores for the spine and hip. 24 patients (19.7%) required anti osteoporosis therapy on the basis of their baseline T Score and they were predominantly osteoporotic. 77 patients had chemotherapy as well and had a more significant reduction in their T scores (29% reduction at the hips) in comparison to non chemotherapy patients. Patients on upfront AIs had lower baseline mean T scores (- 0.932 at hip and - 1.119 at L- Spine) and at follow up (- 1.066 at hip and -1.165 at L spine) in comparison to those on the switch approach (baseline: - 0.666 hip, - 0.816 spine; follow up: - 0.809 hip, - 0.974 spine) Conclusions: AIs are associated with decreased BMD particularly for patients who had chemotherapy. Normal T scores at baseline are reassuring and in the absence of other risk factors probably do not require further scanning. Those with low T scores (<-1.5) will require continued follow up, however, the optimal scanning interval is not yet fully established and longer follow up is required. No significant financial relationships to disclose.

scholarly journals Bone Mineral Density Utilization in Patients with Newly Diagnosed Multiple Myeloma: A Single Center Experience

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 5386-5386
Author(s):  
Eli Muchtar ◽  
Adi Zelig ◽  
Eyal Robenshtok ◽  
Tzippy Shochat ◽  
Nino Oniashvili ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Vertebral Fracture ◽  
Bone Mineral ◽  
Advisory Board ◽  
Time Interval ◽  
Mineral Density ◽  
T Score ◽  
The Mean

Abstract Introduction: Bone disease is a major cause for morbidity in multiple myeloma (MM), mainly manifested by osteolytic lesions. Bone mineral loss is another aspect of bone involvement, although osteoporosis (with or without compression fractures) in the absence of osteolytic lesions is no more a criterion for treatment initiation in MM. Methods: We performed a retrospective study to evaluate the use of bone mineral density (BMD) exams by dual-energy X-ray absorptiometry (DXA) among MM patients in a tertiary medical care facility. We included 173 patients with symptomatic MM diagnosed between January 2007 and September 2014 who underwent BMD exam at diagnosis. The T-scores of lumbar spine (LS), left femur neck (FN) and left total hip (TH) were obtained and analyzed. In addition, we have specified the lowest T-score at each site. In patients with follow-up exam, we calculated the relative difference between the baseline and follow-up exams as the percentage change in absolute BMD value expressed in g/cm2 as follows: [(BMD at follow-up) - (BMD at baseline)/(BMD at baseline)]*100. Results: The mean lumbar spine T-score was (-1.3), while the low lumbar spine T-score was (-2.0). At the femur level, the mean FN T-score was (-1.5), while the mean TH T-score was (-1.1) and the mean low femur T-score was (-2.2). There was a strong correlation between spine and femur T-scores (r=0.56-0.61, p<0.0001). Nevertheless, on a multivariate regression analysis, different parameters correlated with the T-scores of the LS and the femur sites. The following variables were encountered as significantly associated with the mean T-score value at the lumbar spine: sex (β coefficient= (-0.17), p=0.05), BMI (β coefficient=0.21, p=0.02) and vertebral fracture(s) (β coefficient= (-0.23), p=0.01). Conversely, the following variables were found to be independent predictors of the FN T-score: age (β coefficient= (-0.37), p<0.0001) and vertebral fracture (s) (β coefficient= (-0.25), p=0.005), whereas vitamin D showed a strong trend towards significance (β coefficient= (-0.15), p=0.08). Patients with light chain only disease had lower T-score values compared with patients with IgG myeloma, reaching significance at the femur sites [FN T-score (-1.7) vs. (-1.3), p=0.06; TH T-score (-1.3) vs. (-0.9), p=0.02; femur low T-score (-2.4) vs. (-1.8), p=0.008]. Patients with vertebral fracture(s) had significantly lower T-scores of the spine compared to patients without vertebral fractures. Sixty-three patients (36.4% of all patients) had a follow-up DXA exam at a median of 25 months from the baseline test (range, 12-82 months). Basically, LS T-scores increased, while femur sites' T-scores decreased during follow-up. This did not include patients who achieved complete response (CR) and/or retained it during follow-up, who had improved BMD results at the femur sites as well (Table). Conclusion: DXA-based BMD assessment of myeloma bone disease is a valuable tool that illustrates a differential myeloma-induced bone mineral loss regarding the lumbar spine and femur. Table.Variables associated with change of bone mineral density values at follow-up DXA exam in relation to exam at diagnosisVariable mean [range]Mean change at lumbar spine (LS)Mean change at femur neck (FN)Mean change at total hip (TH)Time interval between tests12-24 months (n=31)4.1% [(-10%) - 25.2%]-4.3% [(-24.8%) - 10.6%]-0.1% [(-17.4%) - 10.4%]Time interval >24 months (n=32)4.8% [(-3.8) - 16.4%]-1.7%[(-19.5%) - 27.2%]-0.1%[(-18.8%) - 14.9%]P value0.500.220.96Autologous stem cell transplantationYes (n=35)4.5% [(-7.6%) - 25.2%]-3.4%[(-24.8%) - 27.2%]-1.1%[(-18.8%) - 14.9%]No (n=28)4.3% [(-10.8) - 19.4%]-2.7%[(-18.3%) - 11.1%]-0.1%[(-17.9%) - 10.4%]P value0.890.760.77Response to first line treatmentCR/sCR (n=22)4.3%[(-10.8%) - 18.1%]0.1%[(-12%) - 18.1%]2.1%[(-10.6%) - 10.4%]Less than CR (n=41)4.5%[(-5.5) - 25.2%]-5%[(-24.8%) - 8.6%]-2.5%[(-18.8%) - 14.9%]P value0.910.010.01Disease status at FU testCR/sCR (n=15)3.9% [(-10.8%) - 19.4%]-1.2%[(-24.8%) - 27.2%]2.4%[(-10%) - 10.4%]Less than CR* (n=48)4.6% [(-5.5%) - 19.4%]-3.6%[(-10%) - 10.9%]-1.9%[(-18.8%) - 14.9%]P value0.80.350.03* All patients with partial response or very good partial response Disclosures Raanani: Pfizer: Other: Advisory Board; Novartis: Other: Advisory Board, Research Funding; BMS: Other: Advisory Board; Ariad: Other: Advisory Board.

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