Vertebral fractures occur despite control of acromegaly and are predicted by cortical volumetric bone mineral density

2021 ◽  
Author(s):  
Martin Kužma ◽  
Peter Vaňuga ◽  
Ivana Ságová ◽  
Dušan Pávai ◽  
Peter Jackuliak ◽  
...  
Keyword(s):  
Cortical Bone ◽  
Fracture Prediction ◽  
Volumetric Bone Mineral Density ◽  
Disease Group ◽  
Mineral Density ◽  
Lateral Spine ◽  
Spine Imaging ◽  
Fracture Development ◽  
Time Point

Abstract Introduction Recent studies suggest that cortical bone could also play a role in vertebral fracture (VF) development in acromegaly. Objective Evaluate the occurrence of the VF and their relationship to DXA-derived bone parameters. Patients and methods A single-center two year prospective study of acromegaly patients was conducted. Each subject had L1-4 spine, femoral neck and total hip (TH) aBMD measured using DXA, and TBS measurement performed. 3D Shaper™ was used to assess proximal femur trabecular and cortical volumetric (v)BMD, cortical surface (s)BMD and cortical thickness (Cth). VF assessment was performed using the lateral spine imaging IVA™ mode with a Hologic Horizon® densitometer using semi-quantitative approach. Study outcomes were assessed at two time points –baseline and month 24. Results Seventy acromegaly patients (34 M/36F; average 55.1 years) were studied, including 26 with active disease. In 13 patients, nine of whom with controlled disease, VF was observed. A decrease of TBS, sBMD, neck trabecular vBMD, TH and neck cortical vBMD in VF in comparison to non-VF subjects was observed (p<0.05). Multivariate analysis of fracture prediction showed TH cortical vBMD as best fracture prediction parameter with AUC 0.774. TBS was negatively associated with fasting plasma glucose (FPG) and HBA1c at each time point during the follow-up. Conclusions From the total number of 13 VF subjects, 9 of whom occurred in controlled disease group. The most sensitive and specific predictor of incident VF was TH cortical vBMD, suggesting that cortical bone is involved in fracture development.

scholarly journals Vertebral Fractures Occur Regardless of Acromegaly Activity and Are Best Predicted by Proximal Femur Cortical Volumetric Bone Mineral Density

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A638-A638
Author(s):  
Martin Kuzma ◽  
Peter Vanuga ◽  
Ivana Sagova ◽  
Dusan Pavai ◽  
Peter Jackuliak ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Glucose Metabolism ◽  
Trabecular Bone ◽  
Cortical Bone ◽  
Bone Mineral ◽  
Proximal Femur ◽  
Vertebral Fractures ◽  
Fracture Prediction ◽  
Mineral Density

Abstract Introduction: Vertebral fractures (VFs) in patients with acromegaly are not associated with bone mineral density (BMD) decrease. Previous studies showed impaired trabecular bone parameters among acromegaly patients. However, recent studies suggest that cortical bone could also play a role in VF development. Objective: Evaluate the utility of dual energy x-ray absorptiometry (DXA) BMD and bone structural parameters to determine VF risk among acromegaly patients. Patients and Methods: A single-center two years prospective follow up of acromegaly patients regardless of age, gender, disease activity or associated treatments was conducted. Pituitary hormones, glucose metabolism and bone turnover markers in all subjects were assessed. Each subject had L1-4 spine, femoral neck (FN) and total hip (TH) BMD measured using DXA, and TBS measurement performed ± 7 days from blood sampling. 3D Shaper was used to assess proximal femur trabecular and cortical volumetric (v) BMD, cortical surface (s) BMD and cortical thickness (Cth). VF assessment was performed using the lateral spine imaging IVA™ mode with a Hologic Horizon® densitometer using semi-quantitative approach. Study outcomes were assessed at two time points - baseline and month 24. Results: Seventy subjects (34 M/36F), mean age 55.1 years, including 26 with active disease were studied. After two years a significant decrease in IGF-1 (-30%), osteocalcin (-18%) and TH cortical vBMD (-3%; all p≤0.05) was observed. During follow-up, 13 patients nine of them with controlled disease, developed VF; these patients had greater increase in CTx and decrease in TBS, sBMD, cortical and trabecular vBMD at TH and neck. Multivariate analysis of fracture prediction showed cortical vBMD at TH and neck as best parameters for fracture prediction with AUC 0.766 and 0.774; respectively. TBS was negatively associated with fasting plasma glucose (FPG), HBA1c at each time period. Conclusions: Decrease in cortical vBMD was the most sensitive and specific predictor of incident VF suggesting that cortical bone is involved in fracture development among acromegaly patients. In addition, TBS was strongly negatively associated with glucose metabolism, suggesting glucose intolerance could lead to trabecular bone impairment.

scholarly journals Risk Factors for Failure in Conservatively Treated Osteoporotic Vertebral Fractures: A Systematic Review

2021 ◽  
pp. 219256822098227
Author(s):  
Max J. Scheyerer ◽  
Ulrich J. A. Spiegl ◽  
Sebastian Grueninger ◽  
Frank Hartmann ◽  
Sebastian Katscher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Treatment Failure ◽  
Patient Specific ◽  
Mineral Density ◽  
Radiographic Findings ◽  
Specific Risk ◽  
Fracture Development ◽  
Predict Treatment Failure

Study Design: Systematic review. Objectives: Osteoporosis is one of the most common diseases of the elderly, whereby vertebral body fractures are in many cases the first manifestation. Even today, the consequences for patients are underestimated. Therefore, early identification of therapy failures is essential. In this context, the aim of the present systematic review was to evaluate the current literature with respect to clinical and radiographic findings that might predict treatment failure. Methods: We conducted a comprehensive, systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) checklist and algorithm. Results: After the literature search, 724 potentially eligible investigations were identified. In total, 24 studies with 3044 participants and a mean follow-up of 11 months (range 6-27.5 months) were included. Patient-specific risk factors were age >73 years, bone mineral density with a t-score <−2.95, BMI >23 and a modified frailty index >2.5. The following radiological and fracture-specific risk factors could be identified: involvement of the posterior wall, initial height loss, midportion type fracture, development of an intravertebral cleft, fracture at the thoracolumbar junction, fracture involvement of both endplates, different morphological types of fractures, and specific MRI findings. Further, a correlation between sagittal spinal imbalance and treatment failure could be demonstrated. Conclusion: In conclusion, this systematic review identified various factors that predict treatment failure in conservatively treated osteoporotic fractures. In these cases, additional treatment options and surgical treatment strategies should be considered in addition to follow-up examinations.

scholarly journals Effects of Estrogen with Micronized Progesterone on Cortical and Trabecular Bone Mass and Microstructure in Recently Postmenopausal Women

2013 ◽  
Vol 98 (2) ◽  
pp. E249-E257 ◽  
Author(s):  
Joshua N. Farr ◽  
Sundeep Khosla ◽  
Yuko Miyabara ◽  
Virginia M. Miller ◽  
Ann E. Kearns
Keyword(s):  
Bone Mass ◽  
Trabecular Bone ◽  
Cortical Bone ◽  
Distal Radius ◽  
Thoracic Spine ◽  
Quantitative Computed Tomography ◽  
Volumetric Bone Mineral Density ◽  
Mineral Density ◽  
Trabecular Microarchitecture ◽  
Micronized Progesterone

Abstract Context: In women, cortical bone mass decreases significantly at menopause. By contrast, loss of trabecular bone begins in the third decade and accelerates after menopause. Objective: The aim of the study was to investigate the effects of estrogen on cortical and trabecular bone. Design: The Kronos Early Estrogen Prevention Study is a double-blind, randomized, placebo-controlled trial of menopausal hormone treatment (MHT) in women, enrolled within 6–36 months of their final menstrual period. Setting: The study was conducted at the Mayo Clinic, Rochester, Minnesota. Intervention: Subjects were treated with placebo (n = 31), or .45 mg/d conjugated equine estrogens (n = 20), or transdermal 50 μg/d 17β-estradiol (n = 25) with pulsed micronized progesterone. Main Outcome Measures: Cortical and trabecular microarchitecture at the distal radius was assessed by high-resolution peripheral quantitative computed tomography. Results: At the distal radius, cortical volumetric bone mineral density (vBMD) decreased, and cortical porosity increased in the placebo group; MHT prevented these changes. By contrast, MHT did not prevent decreases in trabecular microarchitecture at the radius. However, MHT prevented decreases in trabecular vBMD at the thoracic spine (assessed in a subset of subjects; n = 51). These results indicate that MHT prevents deterioration in radial cortical vBMD and porosity in recently menopausal women. Conclusion: The maintenance of cortical bone in response to estrogen likely has important clinical implications because cortical bone morphology plays an important role in bone strength. However, effects of MHT on trabecular bone at the radius differ from those at the thoracic spine. Underlying mechanisms for these site-specific effects of MHT on cortical vs trabecular bone require further investigation.

scholarly journals Astragalus Extract Mixture HT042 Improves Bone Growth, Mass, and Microarchitecture in Prepubertal Female Rats: A Microcomputed Tomographic Study

2017 ◽  
Vol 2017 ◽  
pp. 1-7
Author(s):  
Jungbin Song ◽  
Sung Hyun Lee ◽  
Donghun Lee ◽  
Hocheol Kim
Keyword(s):  
Bone Mass ◽  
Cortical Bone ◽  
Bone Growth ◽  
Volume Fraction ◽  
Control Diet ◽  
Female Rats ◽  
Volumetric Bone Mineral Density ◽  
Mineral Density ◽  
Longitudinal Bone Growth ◽  
Tibial Length

Astragalus extract mixture HT042 is a standardized multiherbal mixture comprising Astragalus membranaceus, Eleutherococcus senticosus, and Phlomis umbrosa, which has proven to promote children’s height growth. The aim of this study was to investigate the effects of HT042 on longitudinal bone growth, bone mass, and bone microstructure in growing rats using a high-resolution microcomputed tomography system. Four-week-old female rats were fed an HT042-containing diet for 2 weeks. Tibial length was measured at baseline and weekly in vivo. At the end of the study, volumetric bone mineral density (vBMD) and microarchitectural parameters were estimated in the trabecular and cortical bone of the tibia. Tibial length gain was significantly increased by HT042 compared to that reported with the control diet. In the proximal tibial metaphysis, HT042-treated rats had significantly higher trabecular vBMD, bone volume fraction, and trabecular number and lower trabecular separation, trabecular pattern factor, and structure model index values than control rats did. Total cross-sectional area and bone area of the cortical bone in the tibial diaphysis also increased. These findings suggest that HT042 increases longitudinal bone growth rate, improves trabecular bone mass, and enhances the microarchitecture of trabecular and cortical bone during growth.

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