scholarly journals Recurrent Atraumatic Pelvic Fractures in a Patient With Cushing’s Disease - Is DEXA Scan Really Useful to Predict the Future Fracture Risk?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A218-A219
Author(s):  
Kalyan Mansukhbhai Shekhda ◽  
Ali Rathore ◽  
Taofeek Ojewuyi ◽  
James Ahlquist
Keyword(s):  
Bone Mineral Density ◽  
Cushing’S Disease ◽  
Reference Range ◽  
Pelvic Fractures ◽  
Cushing's Disease ◽  
Z Score ◽  
Mineral Density ◽  
Pubic Ramus ◽  
T Score ◽  
Trabecular Bones

Abstract Background: Cushing’s disease may present with a variety of clinical features, including osteoporosis and fracture. Due to the inhibitory effects of cortisol on osteoblastic activity and enhancing effects on osteoclastic activity, these patients are more prone to have osteoporotic fractures. We report a case of ACTH dependent Cushing’s disease presenting with recurrent atraumatic pelvic fractures in a woman despite normal bone mineral density for her age. Clinical Case: A 56 year-old-woman was referred to the endocrinology department for suspected Cushing’s syndrome following a recent atraumatic fracture of right pubic ramus. She had a history of weight gain and easy fatigue. On examination, she had subtle changes suggestive of Cushing’s syndrome, including mild truncal obesity, minimal bruising and moon face. She had been taking hormone replacement therapy for 3 years for the post-menopausal symptoms. Her bone mineral density was normal for her age on a recent DEXA scan [femoral neck T score: -0.9, Z score: 0.1, lumbar spine (L1-L4) T score: -1.2, Z score: -0.1]. Her vitamin D, serum calcium and parathyroid hormone levels were normal. Her 24-hour urinary cortisol was 688 nmol/day (reference range: <200 nmol/day), low dose dexamethasone suppression cortisol 525 nmol/L (reference range: <50 nmol/day), ACTH 96 ng/L (reference range: <50 ng/L), indicating ACTH dependent Cushing syndrome. MRI pituitary showed 7 mm right sided hypoenhancing area suggestive of a pituitary microadenoma. CT neck, thorax, abdomen and pelvis did not show any source of ectopic ACTH secretion but did show generalised osteopenia, with old fractures of the ribs and left ilium. She was referred for trans-sphenoidal resection of pituitary tumour. While awaiting pituitary surgery she was treated with metyrapone: at this time she suffered a further atraumatic fracture of the left pubic ramus. Conclusion: Glucocorticoid excess predominantly affects trabecular bones (pelvis, ribs, lumbar spine) as compared to cortical bones. Due to micro-architectural changes, reduction in bone strength is disproportionately greater than would be expected from BMD measured by DEXA. Clinicians should be aware that recurrent fracture of trabecular bones may indicate Cushing’s disease even though other clinical features of cortisol excess are minimal or absent.

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 (< 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 < −1 and > −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<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.

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.

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.

ASYMMETRY OF BONE MINERAL DENSITY OF THE HIPS IN PATIENTS WITH UNILATERAL KNEE OSTEOARTHRITIS: A CROSS-SECTIONAL STUDY

2011 ◽  
Vol 14 (01) ◽  
pp. 1150005 ◽  
Author(s):  
Alireza Ashraf ◽  
Seyed Mostafa Jazayeri Shooshtari ◽  
Kaynoosh Homayouni ◽  
Sharareh Roshanzamir ◽  
Mohsen Zafarghasempoor ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Knee Osteoarthritis ◽  
Bone Mineral ◽  
Lumbar Vertebrae ◽  
Cross Sectional Study ◽  
Z Score ◽  
Sectional Study ◽  
Mineral Density ◽  
Cross Sectional ◽  
T Score

Background: Osteoarthritis of any joint may exert different effects on bone mineral density that may be the result of several mechanisms including change in the pattern of weight load distribution. In this cross-sectional study we tried to find correlations between unilateral knee osteoarthritis and bone mineral density of hips and lumbar vertebrae. Methods: Forty three patients with knee osteoarthritis (unilateral or more severe in one side) were recruited in this study. The American college of Rheumatology Criteria was followed for the diagnosis of osteoarthritis. Dual X-Ray absorptiometry was used to obtain the T score and the Z score of the hips and lumbar vertebrae. Results: The T score and Z score of the hip and T score of the femoral neck, at the side with ipsilateral knee osteoarthritis was lower than the other side (p < 0.05). The mean Z score and T score of the vertebrae was negative irrespective of the side of osteoarthritis. Conclusions: Bone mineral density of the hip with ipsilateral knee osteoarthritis was lower than the other side, which suggests that BMD may be sensitive to some extent in detecting osteoporosis in these patients; it has also been observed that osteoarthritis might not affect bone mineral density of the hips and lumbar vertebrae in the same manner or to the same extent.

scholarly journals An Increased Bone Mineral Density As an Adverse Prognostic Factor in Patients with Systemic Mastocytosis

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4185-4185
Author(s):  
Mohamad Jawhar ◽  
Juliana Schwaab ◽  
Nicole Naumann ◽  
Georgia Metzgeroth ◽  
Alice Fabarius ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Mast Cell ◽  
Research Funding ◽  
Systemic Mastocytosis ◽  
Organ Damage ◽  
Z Score ◽  
Serum Tryptase ◽  
Mineral Density ◽  
T Score ◽  
Bone Marrow Mast Cell

Systemic mastocytosis (SM) is characterized by expansion of clonal mast cells that infiltrate various organ systems. The extent of organ infiltration and subsequent organ damage distinguishes between indolent SM (ISM) and advanced SM (AdvSM). ISM patients usually present with a low mast cell burden and have a nearly normal life expectancy while AdvSM patients have a high disease burden, multiple organ damage and poor prognosis. In ISM patients, measurement of the bone mineral density (BMD) frequently reveals osteopenia and osteoporosis (lumbar spine BMD T-score of ≤ −2.5 standard deviation [SD]). In contrast, the association between increased BMD and osteosclerosis, respectively, and the various SM subtypes is unclear. We therefore sought to evaluate the BMD in 61 patients (ISM, n = 29, 48%; AdvSM, n = 32, 52%) and correlated the prevalence of osteoporosis, increased BMD and osteosclerosis with clinical parameters and prognosis. All patients were scanned on the same 16 row CT Scanner (SOMATOM Emotion 16, Siemens Healthcare Sector, Forchheim, Germany). The results were expressed as T-score (SD below the mean of young healthy adults) and as Z-score (SD below the age- and gender-matched mean reference value). According to established WHO criteria, osteoporosis was defined as a lumbar spine BMD T-score of ≤ −2.5 SD. Increased BMD and osteosclerosis were defined as Z-score > 1 SD and > 2 SD, respectively. Osteoporosis was detected in 11/29 (38%) patients with ISM and 2/32 (6%) patients with AdvSM (p = 0.004). Bone marrow mast cell infiltration (median 10% versus 20%, p=0.035) and serum tryptase levels (median 31 µg/L versus 58 µg/L, p = 0.047) were significantly lower in ISM patients with osteoporosis as compared to those without osteoporosis (n=18, 62%). No significant differences were seen regarding age, gender, blood counts, and overall survival. An elevated BMD was detected in 1/29 (3%) patient with ISM and 24/32 (75%) patients with AdvSM (p < 0.001) while osteosclerosis was only detected in AdvSM patients (16/32, 50%). AdvSM patients with increased BMD were older (median 77 years versus 68 years, p = 0.0043), had lower platelet counts (median 111 x 109/L versus 238 x 109/L, p = 0.041) and higher levels of bone marrow mast cell infiltration (50% versus 10%, p=0.002), serum tryptase (median 262 µg/L versus 62 µg/L, p = 0.003) and alkaline phosphatase (238 U/L versus 74 U/L, p < 0.0001). In consequence, prognosis of AdvSM patients with increased BMD was significantly inferior as compared to those without increased BMD (median overall survival 3.6 years versus not reached, p = 0.031). In conclusion, i) osteoporosis is a common feature in ISM but not in AdvSM patients, ii) an increased BMD is frequent in AdvSM but not in ISM patients, iii) osteosclerosis is restricted to AdvSM patients, and iv) an elevated BMD is associated with a more aggressive phenotype and inferior survival (Figure A-B). Disclosures Fabarius: Novartis: Research Funding. Reiter:Novartis: Consultancy, Honoraria, Other: Travel reimbursement, Research Funding; Blueprint: Consultancy, Honoraria, Other: Travel reimbursement; Deciphera: Consultancy, Honoraria, Other: Travel reimbursement.

Bone mineral density at diagnosis and following successful treatment of pediatric Cushing’s disease

2005 ◽  
Vol 28 (5) ◽  
pp. 231-235 ◽  
Author(s):  
S. Scommegna ◽  
J. P. Greening ◽  
H. L. Storr ◽  
K. M. Davies ◽  
N. J. Shaw ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Successful Treatment ◽  
Cushing’S Disease ◽  
Cushing's Disease ◽  
Mineral Density

Increased Cortical Bone Mineralization in Imatinib Treated Patients with Chronic Myelogenous Leukemia.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 2940-2940
Author(s):  
Sofia Jonsson ◽  
Yuan Wei ◽  
Bob Olsson ◽  
Claes Ohlsson ◽  
Mattias Lorentzon ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Chronic Phase ◽  
Serum Levels ◽  
Volumetric Bone Mineral Density ◽  
P Value ◽  
Z Score ◽  
Mineral Density ◽  
Bone Specific Alkaline Phosphatase ◽  
T Score

Abstract Background: Imatinib mesylate (Gleevec™) is the drug of choice for most patients with chronic phase CML. It was recently suggested that hypophosphatemia develops in imatinib treated patients as a consequence of suppression of bone turnover and renal phosphate wasting. Aim: To study the mineral metabolism, and areal and volumetric bone mineral density in chronic phase CML patients treated with imatinib. Material and methods: Seventeen imatinib treated CML patients (11 males/6 females; mean age 60±11 (SD) years) and 17 healthy volunteers (11 males/6 females; mean age 59±11 (SD) years) were included. All CML patients were treated in first chronic phase, targeting an imatinib dose of 400 mg q.d. At time of study, all patients were in complete cytogenetic remission and the mean imatinib treatment duration was 50±19 (SD) months. Serum levels of total and ionized calcium, phosphate, magnesium, parathyroid hormone (PTH), and markers of bone formation (osteocalcin and bone specific alkaline phosphatase) and bone resorption (carboxyterminal cross-linked telopeptide of type I collagen) were analyzed. Twenty-four hours urine collections, for determination of calcium and phosphate excretion, were also obtained from all patients and controls. Areal and volumetric bone mineral density (aBMD and vBMD) were evaluated by dual energy x-ray absorptiometry (DXA) and peripheral quantitative computerized tomography (pQCT), respectively. Results: Imatinib treated patients had significantly lower serum levels of ionized calcium, phosphate, magnesium, osteocalcin and bone specific alkaline phosphatase. Serum PTH was higher in the patients compared the controls (p=0.06). The patients also excreted less calcium in the urine. aBMD were increased in hip and lumbar spine compared to controls. The results of the DXA measurements. T-score is the difference of BMD from young adult (20–40 years; same sex) mean value normalised to the population SD. Z-score is the difference of BMD from age-matched (same sex) mean value normalised to the population SD. vBMD was increased in cortical but not trabecular bone of tibia and radius. The results of pQCT-measurements. vBMD and cross sectional area were measured at *4% and **25% bone length in the proximal direction. Conclusion: Our data show that imatinib increases cortical bone mineral density and clearly rules out the previous concern of “imatinib induced osteomalacia”. It can be speculated that tyrosine kinase inhibitors could be novel antiosteolytic agents in skeletal disorders such as osteoporosis, myelomatosis and bone marrow metastatic diseases. Indeed, previous animal studies have shown that imatinib decreases osteoclastogenesis and osteoclast activity. DXA CML (n=17) Controls (n=17) P-value Hip bone (total) aBMD (g/cm2) 1.08±0.2 0.95±0.1 0.025 T-score 0.07±1.42 −0.82±0.83 Z-score 0.46±1.37 −0.26±0.85 Lumbar spine aBMD (g/cm2) 1.27±0.22 1.12±0.15 0.029 T-score 0.38±1.77 −0.82±1.23 Z-score 0.57±1.72 −0.36±1.29 pQCT CML (=17) Controls (n=17) P-value Radius Trabecular vBMD* (mg/cm3) 190.9±34.2 193.9±28.8 ns Cortical vBMD** (mg/cm3) 1211.3±23.8 1181.1±38.7 0.01 Cortical area** (mm2) 95.1±16.3 88.6±18.7 ns Tibia Trabecular vBMD* (mg/cm3) 240.2±47.3 226.2±23.9 ns Cortical vBMD* (mg/cm3) 1185.6±23.5 1159.4±36.2 0.017 Cortical area** (mm2) 262.6±50.7 261.3±44.4 ns

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