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 Comparison of Teriparatide and Denosumab in Patients Switching From Long-Term Bisphosphonate Use

2019 ◽  
Vol 104 (11) ◽  
pp. 5611-5620 ◽  
Author(s):  
Houchen Lyu ◽  
Sizheng S Zhao ◽  
Kazuki Yoshida ◽  
Sara K Tedeschi ◽  
Chang Xu ◽  
...  
Keyword(s):  
Femoral Neck ◽  
The United States ◽  
First Year ◽  
Mineral Density ◽  
Total Hip ◽  
Academic Medical ◽  
Hip Bmd ◽  
Observational Cohort ◽  
Transient Loss

Abstract Context Teriparatide and denosumab are effective treatments for osteoporosis and typically reserved as second-line options after patients have used bisphosphonates. However, limited head-to-head comparative effectiveness data exist between teriparatide and denosumab. Objective We compared changes in bone mineral density (BMD) between groups treated with teriparatide or denosumab after using bisphosphonates, focusing on the change in BMD while on either drug over 2 years. Design Observational cohort study using electronic medical records from two academic medical centers in the United States. Participants The study population included osteoporotic patients >45 years who received bisphosphonates >1 year before switching to teriparatide or denosumab. Outcome Measures Annualized BMD change from baseline at the lumbar spine, total hip, and femoral neck. Results Patients treated with teriparatide (n = 110) were compared with those treated with denosumab (n = 105); the mean (SD) age was 70 (10) years and median duration (interquartile range) of bisphosphonate use was 7.0 (5.6 to 9.7) years. Compared with denosumab users, teriparatide users had higher annualized BMD change at the spine by 1.3% (95% CI 0.02, 2.7%) but lower at the total hip by −2.2% (95% CI −2.9 to −1.5%) and the femoral neck by −1.1% (95% CI −2.1 to −0.1%). Those who switched to teriparatide had a transient loss of hip BMD for the first year, with no overall increase in the total hip BMD over 2 years. Conclusions Among patients who use long-term bisphosphonates, the decision of switching to teriparatide should be made with caution, especially for patients at high risk of hip fracture.

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 AB0617 BISPHOSPHONATES DANS L’OSTÉOPOROSE ET LE RISQUE D’OSTÉONÉCROSE DE LA MÂCHOIRE, ENVIRON 896 CAS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1343.1-1343
Author(s):  
A. R. Halidou ◽  
K. Nassar ◽  
S. Janani
Keyword(s):  
Lumbar Spine ◽  
Femoral Neck ◽  
Corticosteroid Therapy ◽  
Osteonecrosis Of The Jaw ◽  
Mineral Density ◽  
Duration Of Treatment ◽  
Treatment Of Osteoporosis ◽  
Total Hip ◽  
T Score

Background:Bisphosphonates (BF) are used in the treatment of osteoporosis, Paget’s disease of bone, hypercalcemia and in patients with cancer. When used to treat osteoporosis, the optimal duration of treatment is 3 to 5 years; however, their long-term use has been rarely associated with osteonecrosis of the jaw.Objectives:To assess the risk of developing osteonecrosis of the jaw in patients followed for osteoporosis and on bisphosphonates (BP).Methods:Type of study: retrospective study conducted at the rheumatology department of the IBN ROCHD CHU in Casablanca.Duration: from October 2013 to October 2020 (7 years).Inclusion criteria: all patients followed for osteoporosis in the weakening osteopathies unit of the bone and treated with oral or intravenous bisphosphonates.Exclusion criteria: patients followed for other than osteoporosis.Results:896 patients were treated during this period. The average age was 62.74 years (28 to 90 years), of which 85.16% were women and 14.84% were men, for a sex ratio (F / M) of 5.74. As a history, 18.75% of patients are diabetic, 26.56% followed for breast neoplasm, 14.06% of patients had received long-term corticosteroid therapy for various pathologies such as chronic inflammatory rheumatism. Osteoporosis was postmenopausal in 687 patients, ie 76.67% of cases, 14.06% after long-term corticosteroid therapy, 8.15% following hormone therapy (anti-aromatases) and 6.92% following chemotherapy; note that 18.16% of these patients were found in at least two of the situations. The mean bone mineral density (BMD), T-score pair considered in all [T-score (BMD)] is -3 (0.736) in the lumbar spine (L1-L4), -2.9 (0.658) at the femoral neck, -2.6 (0.804) at the total hip before the start of treatment. 69.97% of the patients were put on Alendronic acid, 12.50% on Residronic acid, 10.93% on Zolidronic acid, 3.46% on Pamidronic acid and 3.14% received Strontium Ranelate, note that before the start of the treatment all the patients benefited from a dental consultation followed by care of any lesions, the bisphosphonates were only introduced after having ruled out all their dental contraindications, the average duration of treatment for all the molecules was 4.71 years (2 to 5 years) and no patient developed osteonecrosis of the jaw. The change in control BMD on average after 2 years of treatment was -2.7 (0.782) at the lumbar spine, -2.6 (0.749) at the femoral neck and -2.4 (0.713) at the hip total, after 5 years -2.4 (0.874) at the spine, -2.1 (0.809) at the femoral neck and -1.93 (861) at the total hip.Conclusion:The occurrence of ONJ in the treatment of osteoporosis with the use of BFs is rare, and appears to be unpredictable; but maintaining therapeutic caution, consisting in diagnosing and treating any dental lesions before starting treatment, can considerably reduce or even cancel the risk of occurrence; especially in patients treated with long-term intravenous pamidronate.References:[1]Dr Halidou Idrissa Abdoul-Rahamane, Pr Kawtar Nassar, PR Saadia Janani.[2]Rheumatology department of the IBN ROCHD CHU in CASABLANCA. Casablanca Faculty of Medicine and Pharmacy. Hassan II University. MoroccoDisclosure of Interests:None declared.

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 Bone mineral density is increased after a 16-week resistance training intervention in elderly women with decreased muscle strength

2016 ◽  
Vol 175 (6) ◽  
pp. 571-582 ◽  
Author(s):  
Ville Huovinen ◽  
Kaisa K Ivaska ◽  
Riku Kiviranta ◽  
Marco Bucci ◽  
Heta Lipponen ◽  
...  
Keyword(s):  
Resistance Training ◽  
Muscle Strength ◽  
Bone Markers ◽  
Elderly Women ◽  
Osteoporotic Fractures ◽  
Training Intervention ◽  
Mineral Density ◽  
Total Hip ◽  
Hip Bmd

ObjectiveNon-pharmacological interventions are important in reducing risk for osteoporotic fractures. We investigated the effects of a 16-week individualized resistance training intervention on bone mineral density (BMD), bone turnover markers and 10-year relative risk (RR) for osteoporotic fracture.DesignInterventional study with a follow-up.MethodsIn total, 37 elderly women (mean age 71.9 ± 3.1 years) with decreased muscle strength participated in the resistance training intervention three times per week with 60 min per session for 16 weeks under the supervision of a licensed physiotherapist. Total hip BMD with quantitative CT, bone markers (sclerostin, osteocalcin, CTX, PINP, IGF-1, 25(OH)-D) and 10-year RR for osteoporotic fracture were measured at baseline, post-intervention and at 1-year follow-up after the end of the intervention. Eleven age- and sex-matched controls did not participate in the intervention but were studied at baseline and at 1-year follow-up.ResultsResistance training seemed to increase total hip BMD by 6% (P= 0.005). Sclerostin (P< 0.001) and total osteocalcin (P= 0.04) increased while other bone markers remained unchanged. A 10-year RR for major osteoporotic and hip fracture remained unchanged. At follow-up total hip BMD (P< 0.001) decreased back to the baseline level with a simultaneous decrease in serum sclerostin (P= 0.045), CTX (P< 0.001) and an increase in 25(OH)-D (P< 0.001), 10-year RR for major osteoporotic (P= 0.002) and hip fracture (P= 0.01).ConclusionsOur findings suggest an important role of continuous supervised resistance training for the prevention of osteoporotic fractures in elderly women with decreased muscle strength.

scholarly journals Performance of osteoporosis self-assessment tool in detecting low bone mineral density in menopausal women

2017 ◽  
Vol 36 (2) ◽  
pp. 123 ◽  
Author(s):  
Ignatio Rika Haryono ◽  
Nawanto Agung Prastowo
Keyword(s):  
Bone Mineral Density ◽  
High Risk ◽  
Diagnostic Performance ◽  
Assessment Tool ◽  
Mineral Density ◽  
Self Assessment ◽  
Total Hip ◽  
T Score ◽  
Menopausal Women ◽  
Hip Bmd

<p>Background<br />The osteoporosis self-assessment tool (OST) is a simple screening tool to assess risk of osteoporosis and to select high risk women for dual-energy x-ray absorptiometry (DXA) examination. This study aimed to evaluate OST performance in detecting low bone mineral density (BMD) in menopausal women.</p><p>Methods<br />A cross-sectional study involving 60 menopausal women aged 50-65 years. The OST score was calculated from: [weight (kg) – age (yr)] x 0.2. Subjects were classified by OST score into low risk (OST ³2) and high risk (OST&lt; 2) groups. BMD was determined by DXA at 3 bone locations (L1-L4, femoral neck, and total hip). DXA T-scores were categorized into: normal BMD (T-score &gt;-1) and low BMD (T-score £-1). Independent t-test was used to compare subject characteristics between OST groups. Diagnostic performance of OST was evaluated by measuring sensitivity, specificity, positive &amp; negative predictive value (PPV, NPV), positive &amp; negative likelihood ratio (PLR, NLR) and receiver-operating characteristic (ROC). Significance was set at p&lt;0.05.</p><p>Results<br />Subject characteristics and BMD between groups were significantly different (p&lt;0.05). Most subjects (44/73.3%) had high risk of low BMD (OST &lt; 2). Low BMD (T score £-1) was found in 43 subjects (71.7%) at L1-L4, 41 subjects (68.3%) at femoral neck, and 37 subjects (61.7%) at total hip. Diagnostic performance of OST was significant at total hip BMD (sensitivity=0.946, AUC=0.777).</p><p>Conclusion <br />We conclude that use of the OST score in menopausal women is effective and has adequate sensitivity and specificity. The highest diagnostic performance of OST is on total hip BMD.</p>

Effect of Letrozole Versus Placebo on Bone Mineral Density in Women With Primary Breast Cancer Completing 5 or More Years of Adjuvant Tamoxifen: A Companion Study to NCIC CTG MA.17

2006 ◽  
Vol 24 (22) ◽  
pp. 3629-3635 ◽  
Author(s):  
Edith A. Perez ◽  
Robert G. Josse ◽  
Kathleen I. Pritchard ◽  
James N. Ingle ◽  
Silvana Martino ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Resorption ◽  
Bone Mineral ◽  
Controlled Trial ◽  
Bone Alkaline Phosphatase ◽  
Adjuvant Tamoxifen ◽  
Mineral Density ◽  
Total Hip ◽  
Hip Bmd

Purpose Aromatase inhibition depletes estrogen levels and may be associated with accelerated bone resorption. The National Cancer Institute of Canada Clinical Trials Group (NCIC CTG) study MA.17B evaluated bone turnover markers and bone mineral density (BMD) in postmenopausal women randomly assigned to MA.17, a placebo-controlled trial of letrozole after standard adjuvant tamoxifen. Patients and Methods Eligible women had a baseline BMD T score of at least 2.0 in either the hip or L2-4 spine; all received calcium 500 mg and vitamin D 400 U daily. Percentage change in BMD (L2-L4 spine and hip) at 12 and 24 months, rate of osteoporosis, and change in markers of bone formation (serum bone alkaline phosphatase) and resorption (serum C-telopeptide and urine N-telopeptide) at 6, 12, and 24 months were compared. Results Two hundred twenty-six patients (122 letrozole, 104 placebo) were enrolled. Baseline characteristics were similar in the two groups, including BMD, median age of 60.7 years (81% < 70 years), and median follow-up of 1.6 years. At 24 months, patients receiving letrozole had a significant decrease in total hip BMD (−3.6% v −0.71%; P = .044) and lumbar spine BMD (−5.35% v −0.70%; P = .008). Letrozole increased urine N-telopeptide at 6, 12, and 24 months (P = .054, < .001, and .016, respectively). No patient went below the threshold for osteoporosis in total hip BMD, whereas at the L2-L4 (posteroanterior view), more women became osteoporotic by BMD while receiving letrozole (4.1% v 0%; P = .064). Conclusion After 5 years of adjuvant tamoxifen, subsequent letrozole causes a modest increase in bone resorption and reduction in bone mineral density in the spine and hip compared to placebo. Further follow-up is necessary to evaluate the long-term clinical implications of this difference.

scholarly journals Bone mineral density and explanatory factors in children and adults with juvenile dermatomyositis at long term follow-up; a cross sectional study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Henriette Schermacher Marstein ◽  
Kristin Godang ◽  
Berit Flatø ◽  
Ivar Sjaastad ◽  
Jens Bollerslev ◽  
...  
Keyword(s):  
Bone Turnover ◽  
Inflammatory Markers ◽  
Juvenile Dermatomyositis ◽  
Inflammatory Myopathy ◽  
Disease Onset ◽  
Whole Body ◽  
Mineral Density ◽  
Z Scores

Abstract Background Juvenile dermatomyositis (JDM) is the most common idiopathic inflammatory myopathy in children and adolescents. Both the disease and its treatment with glucocorticoids may negatively impact bone formation. In this study we compare BMD in patients (children/adolescence and adults) with long-standing JDM with matched controls; and in patients, explore how general/disease characteristics and bone turnover markers are associated with BMD. Methods JDM patients (n = 59) were examined median 16.8y (range 6.6–27.0y) after disease onset and compared with 59 age/sex-matched controls. Dual-energy X-ray absorptiometry (DXA) was used to measure BMD of the whole body and lumbar spine (spine) in all participants, and of ultra-distal radius, forearm and total hip in participants ≥20y only. Markers of bone turnover were analysed, and associations with outcomes explored. Results Reduced BMD Z-scores (<−1SD) were found in 19 and 29% of patients and 7 and 9% of controls in whole body and spine, respectively (p-values < 0.05). BMD and BMD Z-scores for whole body and spine were lower in all patients and for < 20y compared with their respective controls. In participants ≥20y, only BMD and BMD Z-score of forearm were lower in the patients versus controls. In patients, BMD Z-scores for whole body and/or spine were found to correlate negatively with prednisolone use at follow-up (yes/no) (age < 20y), inflammatory markers (age ≥ 20y) and levels of interferon gamma-induced protein 10 (IP-10) (both age groups). In all patients, prednisolone use at follow-up (yes/no) and age ≥ 20y were independent correlates of lower BMD Z-scores for whole body and spine, respectively. Conclusion In long-term JDM, children have more impairment of BMD than adults in spine and whole-body. Associations with BMD were found for both prednisolone and inflammatory markers, and a novel association was discovered with the biomarker of JDM activity, IP-10.

scholarly journals Long-term clinical and radiological outcome in patients with severe Legg-Calvé-Perthes disease after Chiari pelvic osteotomy: a mean of 14 years follow-up

2021 ◽  
pp. 112070002098815
Author(s):  
Dammerer Dietmar ◽  
Braito Matthias ◽  
Peter Ferlic ◽  
Kaufmann Gerhard ◽  
Juana Kosiol ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Pelvic Osteotomy ◽  
Perthes Disease ◽  
Total Hip ◽  
Joint Incongruence ◽  
Chiari Pelvic Osteotomy

Introduction: The Chiari pelvic osteotomy (CPO) has been recommended as a salvage procedure to improve head coverage in case of hip joint incongruence in paediatric hip disease. In this study, we aimed to assess the long-term results of CPO for severe Legg-Calvé-Perthes disease (LCPD). Methods: A total of 39 patients who underwent a CPO at our department between 1995 and 2010 were prospectively followed both radiologically (Stulberg classification) and clinically (Harris Hip Score [HHS], conversion into total hip arthroplasty). In this study, we retrospectively reviewed the cases of 12 hips (12 patients, 3 girls, 8 left hips) treated by CPO for severe LCPD (Catterall grade 3 or 4) with hip joint incongruence. Mean follow-up was 14.0 (range 7.6–21.3) years. Results: Mean age at surgery was 10.2 (range 8.2–17.8) years. Additional femoral osteotomy was performed in 8 patients. A good radiological result (Stulberg I or II) was achieved in 2 patients, a fair result (Stulberg III) in 4 patients, and a poor outcome (Stulberg IV or V) in 6 patients. Mean postoperative HHS averaged 93 (range 65–100) points. An excellent functional outcome (HHS 90–100 points) was achieved in 9 patients. No patient underwent total hip arthroplasty during follow-up. Postoperative limb-length discrepancy was found in 3 patients. Conclusions: CPO for severe LCPD with hip joint incongruence resulted in good long-term clinical outcome in about ⅔ of our patients after a mean of 14 years. Our results suggest that CPO can still be considered as a salvage joint-conserving procedure in this selected group of younger patients.

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