Low bone density, vertebral fracture and FRAX score in kidney transplant recipients: A cross-sectional cohort study

Background Kidney transplantation (KT) recipients are at increased risk of low bone density (LBD) and fractures. In this retrospective study, we investigated bone mineral density (BMD), vertebral fractures, calculated risk for major osteoporotic fractures (MOF), and hip fractures in the KT recipients. Patients-method Patients who completed at least one year after KT were included in the analysis. Demographic, clinical, and laboratory data were recorded. Measurements of BMD were performed by dual-energy X-ray absorptiometry. Vertebral fractures were assessed using semi-quantitative criteria with conventional radiography. The ten-year risk for MOF and hip fracture were calculated using the FRAX@ tool with BMD. Results One hundred fifty-three KT recipients were included in the study. The population included 77 women. The mean age at evaluation was 46,5±11,9 years. Seventy-eight (50.9%) patients had normal femoral neck BMD while osteoporosis and osteopenia at the femoral neck were present in 12 (7.8%) and 63 (41.1%) of the patients, respectively. Age at evaluation was the risk factor for LBD (OR 1.057; 95% CI 1.024–1.091; p = 0.001). In female KT recipients, LBD was principally affected by menopausal status whereas in males, mammalian target of rapamycin (mTOR) inhibitor use and lower BMI levels were the risk factors. The prevalent vertebral fracture was found in 43.4% of patients. In multivariate analysis, only steroid use (OR 0.121; 95% CI 0.015–0.988; p = 0.049) was found to be associated with prevalent fracture. Among all KT recipients, 1.9% had a high MOF probability (≥20% risk of fracture), and 23.5% had high hip fracture probability (≥3% risk of hip fracture) according to FRAX. Conclusion Exploring the prevalence of LBD and vertebral fracture and the risk factors would help clinicians to modify long-term follow-up strategies. Furthermore, the high hip fracture risk probability in our cohort suggested that there is a need for longitudinal studies to confirm the validity of the FRAX tool in the transplant population.

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Faktor risiko osteoporosis pada wanita usia 40-80 tahun: status menopause dan obesitas

Jurnal Gizi Klinik Indonesia ◽

10.22146/ijcn.24872 ◽

2017 ◽

Vol 14 (2) ◽

pp. 45

Author(s):

Fillah Fithra Dieny ◽

Deny Yudi Fitranti

Keyword(s):

Risk Factors ◽

Bone Density ◽

Body Fat ◽

Fat Body ◽

Menopausal Status ◽

Density Measurement ◽

Influential Factors ◽

Mineral Density ◽

Low Bone Density ◽

Obesity Status

Background: Osteoporosis is a disease of the musculoskeletal system which are common in women. Menopausal status which affects the production of oestrogen and obesity status that describes mass and distribution of body fat have the potential to affect bone density, which in turn may have an impact on the incidence of osteoporosis.Objective: To analyze the menopausal and obesity status as risk factors for osteoporosis in women aged 40-80 years.Method: Cross-sectional study was conducted on 224 women aged 40-80 years in Ngemplak Simongan, Semarang. Status of obesity was determined by percent of body fat, body mass index (BMI), waist circumference, and waist-hip ratio (WHR). Menopausal status was determined based on the occurrence of menstruation in the past one year, and the age was calculated from the difference between date of birth and date of measurement. Bone density was assessed frombone mineral density measurement. Chi-square test and logistic regression were used to determine the relationship and the most influential factors. The risk was expressed in ratio prevalence (RP).Results: The prevalence of low bone density and obesity in each age range, were 43.8% and 57.9% for ages 40-50 years, 67.7% and 58.6% for ages 51-60 years, 84.9% and 49.1% for ages 61-70 year, 86.7% and 66.7% for ages 71-80 years. There were significant relationships between age, menopausal status, BMI, WHR and bone density (p=0.000, p=0.032, p=0.043, p=0.017, respectively). Osteoporosis (13.3%) and osteopenia (58.7%) were most widely experienced by subjects with high WHR and menopause. Percentage of osteopenia in high WHR and non-menopause subjects (60%) was higher than normal WHR and menopause subjects (52.9%). Age 61-80 years, high WHR, and non-obese BMI were the most influenced risk factorsfor the incidence of low bone density (p=0.001, p=0.038, p=0.043). Ratio prevalence of elderly, high WHR and non-obese BMI were 1.448, 1.326, 1.208.Conclusion: High WHR explains the role of android obesity and visceral fat as risk factors for low bone density. Premenopausal women will be more at risk of having low bone density if they have high WHR.

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Risk Factors for Low Bone Density in Inflammatory Bowel Disease: Use of Glucocorticoids, Low Body Mass Index, and Smoking

Digestive Diseases ◽

10.1159/000496935 ◽

2019 ◽

Vol 37 (4) ◽

pp. 284-290 ◽

Cited By ~ 7

Author(s):

Razi Even Dar ◽

Yoav Mazor ◽

Amir Karban ◽

Sofia Ish-Shalom ◽

Elena Segal

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Inflammatory Bowel Disease ◽

Bone Density ◽

Body Mass ◽

Bowel Disease ◽

Mineral Density ◽

Low Bone Density ◽

Low Body Mass Index ◽

Inflammatory Bowel

Background: Inflammatory bowel disease (IBD) patients are reported to have lower bone density compared to healthy controls. There is limited consensus regarding factors affecting bone density among these patients. Our aim, therefore, was to determine clinical and genetic variables that contribute to lower bone mineral density (BMD) in IBD patients. Methods: A cross-sectional study of IBD patients treated in a tertiary referral center was performed. Epidemiological and clinical data were collected, and genetic testing for the common mutations in Nucleotide-binding Oligomerization Domain-containing protein (NOD)2 was performed. We examined correlations between the different variables and BMD in the total hip, femoral neck, and lumbar spine. Results: Eighty-nine patients (49% males, 67 Crohn’s disease [CD]) participated in the study. 42Forty-two (63%) of the CD and 13 (59%) of the ulcerative colitis patients met the criteria for osteoporosis/osteopenia. Factors associated with lower Z scores were low body mass index (BMI; r = –0.307, p = 0.005), use of glucocorticoids (likelihood ratio [LR] 5.1, p = 0.028), and a trend for male gender (LR = 3.4, p = 0.079). Among CD patients, low bone density showed borderline significance for association with gastrointestinal surgery (LR = 4.1, p = 0.07) and smoking (LR = 3.58, p = 0.06). Low levels of 25OHD were not associated with low BMD, nor were mutations in NOD2. No increased rate of fractures was seen among patients with osteopenia or osteoporosis. Conclusion: In addition to the generally accepted risk factors for osteoporosis (glucocorticoids, low BMI, smoking), male IBD patients had a trend toward lower BMD. Carrying a mutaticon in NOD2 did not confer a risk for bone loss.

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Associations Between Bone Impact Microindentation and Clinical Risk Factors for Fracture

Endocrinology ◽

10.1210/en.2019-00415 ◽

2019 ◽

Vol 160 (9) ◽

pp. 2143-2150 ◽

Cited By ~ 4

Author(s):

Pamela Rufus-Membere ◽

Kara L Holloway-Kew ◽

Adolfo Diez-Perez ◽

Mark A Kotowicz ◽

Julie A Pasco

Keyword(s):

Risk Factors ◽

Hip Fracture ◽

Clinical Risk Factors ◽

Material Strength ◽

Mineral Density ◽

Clinical Risk ◽

Increased Risk ◽

Vitamin D Levels ◽

Prior Fracture ◽

Impact Microindentation

Abstract Impact microindentation (IMI) measures bone material strength index (BMSi) in vivo. However, clinical risk factors that affect BMSi are largely unknown. This study investigated associations between BMSi and clinical risk factors for fracture in men. BMSi was measured using the OsteoProbe in 357 men (ages 33 to 96 years) from the Geelong Osteoporosis Study. Risk factors included age, weight, height, body mass index (BMI), femoral neck bone mineral density (BMD), parental hip fracture, prior fracture, type 2 diabetes mellitus (T2DM), secondary osteoporosis, smoking, alcohol consumption, sedentary lifestyle, medications, diseases, and low serum vitamin D levels. BMSi was negatively associated with age (r = −0.131, P = 0.014), weight (r = −0.109, P = 0.040), and BMI (r = −0.083, P = 0.001); no correlations were detected with BMD (r = 0.000, P = 0.998) or height (r = 0.087, P = 0.10). Mean BMSi values for men with and without prior fracture were 80.2 ± 6.9 vs 82.8 ± 6.1 (P = 0.024); parental hip fracture, 80.1 ± 6.1 vs 82.8 ± 6.9 (P = 0.029); and T2DM, 80.3 ± 8.5 vs 82.9 ± 6.6 (P = 0.059). BMSi did not differ in the presence vs absence of other risk factors. In multivariable models, mean (± SD) BMSi remained associated with prior fracture and parental hip fracture after adjusting for age and BMI: prior fracture (80.5 ± 1.1 vs 82.8 ± 0.4, P = 0.044); parental fracture (79.9 ± 1.2 vs 82.9 ± 0.4, P = 0.015). No other confounders were identified. We conclude that in men, BMSi discriminates prior fracture and parental hip fracture, which are both known to increase the risk for incident fracture. These findings suggest that IMI may be useful for identifying men who have an increased risk for fracture.

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Treatment of Postmenopausal Osteoporosis: Focus on Strontium Ranelate

Clinical Medicine Insights Women s Health ◽

10.4137/cmwh.s5149 ◽

2011 ◽

Vol 4 ◽

pp. CMWH.S5149

Author(s):

Bernard Cortet

Keyword(s):

Risk Factors ◽

Hip Fracture ◽

Vertebral Fracture ◽

High Risk ◽

Hip Fractures ◽

Strontium Ranelate ◽

Phase Iii ◽

Increased Risk ◽

Long Term Treatment

Given its increasing incidence and serious complications, osteoporosis requires safe and effective long-term treatment. Strontium ranelate (SR), a new anti-osteoporotic treatment with a unique mode of action, has been investigated in the Spinal Osteoporosis Therapeutic Intervention (SOTI) and the Treatment Of Peripheral OSteoporosis (TROPOS) trials, two major 3-year multinational placebo-controlled Phase III randomized clinical trials. In SOTI, SR treatment reduced the risk of vertebral fracture by 41% (20.9% vs. 32.8%, P < 0.001); in TROPOS, it reduced the risk of non-vertebral fracture by 16% (11.2% vs. 12.9%, P = 0.04), and the risk of hip fracture in patients at high risk by 36% (4.3% vs. 6.4%, P = 0.046). Also SR has been shown to decrease the risk of vertebral fracture after 4 years of treatment and the risk of nonvertebral fracture after 5 years. Also it demonstrated for high risk patients a significant decrease of the risk of hip fractures (–43%) after 5 years of treatment. Unlike antiresorptive agents, SR produced steady and significant BMD increases that correlated directly with decreases in vertebral and hip fracture risk. Preplanned analysis of the pooled dataset from SOTI and TROPOS showed that SR was effective whether or not patients had key risk factors for fractures at baseline. SR was also effective in patients with osteopenia and younger postmenopausal patients aged 50–65 years. It was also effective for preventing both vertebral and nonvertebral fractures in the elderly (>80 years). Also, SR significantly attenuated height loss and decreased back pain. Finally long-term follow-up showed that BMD gains were maintained through a 8 year-period with maintaining the incidence of fracture between the first 3 years and the last 3 years of treatment. The safety profile of SR was almost similar to placebo in both trials. A slight but significant increased risk of thromboembolism events was noted from the pooled phase III studies data. However this increased was not found in a large retrospective observational study. Thus, SR demonstrates broad spectrum safety and efficacy in reducing the risks of both vertebral and non-vertebral (including hip) fractures in a wide variety of patients, and should be considered as a first-line option to treat women at risk of osteoporotic fractures, whatever their age, the severity of the disease, and their risk factors.

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SAT0475 DENOSUMAB VERSUS ORAL BISPHOSPHONATE FOR OSTEOPOROSIS IN LONG-TERM GLUCOCORTICOID USERS: A 12-MONTH RANDOMIZED CONTROLLED TRIAL

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.4679 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1194.3-1194

Author(s):

C. C. Mok ◽

L. Y. Ho ◽

K. L. Chan ◽

S. M. Tse

Keyword(s):

Risk Factors ◽

Lumbar Spine ◽

Femoral Neck ◽

Adverse Events ◽

Menopausal Status ◽

Gastrointestinal Symptoms ◽

Upper Respiratory Tract ◽

Mineral Density ◽

History Of

Background:Objectives:To compare the efficacy of denosumab (DEN) and oral alendronate (ALN) on spinal bone mineral density (BMD) in long-term glucocorticoid users.Methods:Patients receiving long-term prednisolone treatment for medical illnesses were recruited. Inclusion criteria: (1) adult patients ≥18 years of age; (2) prednisolone ≥2.5mg/day for ≥1 year. Exclusion criteria: (1) previous use of DEN, teriparatide; (2) plan for pregnancy; (3) metabolic bone disease or unexplained hypocalcemia; (4) renal insufficiency. Participants were randomized to receive either: (1) DEN (60mg subcutaneously every 6 months); or (2) ALN (70mg/week). Calcium (Caltrate 3000mg/day) and vitamin D3 (cholecalciferol 1000IU/day) was given. BMD (femoral neck, total hip, lumbar spine) at month 0, 6 and 12 months were performed. Markers of bone turnover (serum P1NP and CTX) were also assayed at the same time points. The primary outcome was the difference of lumbar spine BMD change at month 12 between the two groups.Results:139 subjects were recruited (age 50.0±12.7 years): 69 assigned DEN and 70 assigned ALN. Underlying medical diseases: SLE (81%), RA (9.4%) and myositis (5%). Prednisolone dose at entry was 5.7±2.1mg/day. 56% of female patients were postmenopausal. 73(53%) of patients were osteoporotic (T score <-2.5) at the hip, femoral neck or lumbar spine. The mean body mass index (BMI) was 23.1±4.1kg/m2 (11% patients had BMI<18kg/m2). 82(59%) patients were naive to bisphosphonates. Pre-existing fragility or vertebral fracture was present in 19 (14%) patients and 18 patients (13%) had a family history of fractures. Baseline demographic data, osteoporotic risk factors, and BMD at various sites were not significantly different between the two groups at entry. At month 12, a significant gain in BMD at the lumbar spine (+3.5±2.5%; p<0.001) and the hip (+0.9±2.8%; p=0.01) was observed in DEN-treated patients, whereas the corresponding change was +2.5±2.9% (p<0.001) and +1.6±2.7% (p<0.001) in the ALN group. The spinal BMD at month 12 was significantly higher in the DEN than ALN group after adjustment for BMD values at baseline, age, sex and other osteoporosis risk factors that included smoking, drinking, cumulative steroid doses in one year, BMI, menopausal status and personal history of fracture (p=0.045). The differences in hip and femoral neck BMD were not significantly different between the two groups after adjustment for the same confounding factors. No new symptomatic fractures occurred in any participants at month 12. Adverse events were similar in frequency between the two treatment arms. Major infective episodes were uncommon (0.06/patient/year) and similar in the two groups. Minor upper gastrointestinal symptoms and non-specific dizziness were numerically more common in the ALN but arthralgia, minor infections (eg. upper respiratory tract) and new hypertension was more commonly reported in the DEN group. Three patients from ALN and 2 patients from DEN group were withdrawn from the study because of non-compliance but none withdrew because of adverse events.Conclusion:In patients receiving long-term glucocorticoids, DEN is superior to ALN in raising the spinal BMD after 12 months’ treatment. Both DEN and ALN were well tolerated.Acknowledgments:NILDisclosure of Interests:None declared

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Relationship between Bone Mineral Density Changes and Fracture Risk Reduction in Patients Treated with Strontium Ranelate

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2006-2758 ◽

2007 ◽

Vol 92 (8) ◽

pp. 3076-3081 ◽

Cited By ~ 96

Author(s):

Olivier Bruyere ◽

Christian Roux ◽

Johann Detilleux ◽

Daniel O. Slosman ◽

Tim D. Spector ◽

...

Keyword(s):

Bone Mineral Density ◽

Vertebral Fracture ◽

Femoral Neck ◽

Outcome Measures ◽

Bone Mineral ◽

Proximal Femur ◽

Vertebral Fractures ◽

Strontium Ranelate ◽

Mineral Density ◽

Nonvertebral Fractures

Abstract Objective: Our objective was to analyze the relationship between bone mineral density (BMD) changes and fracture incidence during 3-yr treatment with strontium ranelate. Patients: Women from the strontium ranelate arm of the Spinal Osteoporosis Therapeutic Intervention study and the TReatment Of Peripheral OSteoporosis study were evaluated. Outcome Measures: The outcome measures included BMD at the lumbar spine, femoral neck, and total proximal femur assessed at baseline and after a follow-up of 1 and 3 yr; semiquantitative visual assessment of vertebral fractures; and nonvertebral fractures based on written documentation. Results: After 3 yr of strontium ranelate treatment, each percentage point increase in femoral neck and total proximal femur BMD was associated with a 3% (95% adjusted confidence interval, 1–5%) and 2% (1–4%) reduction in risk of a new vertebral fracture, respectively. The 3-yr changes in femoral neck and total proximal femur BMD explained 76% and 74%, respectively, of the reduction in vertebral fractures observed during the treatment. Three-year changes in spine BMD were not statistically associated with the incidence of new vertebral fracture (P = 0.10). No significant associations were found between 3-yr changes in BMD and incidence of new nonvertebral fractures, but a trend was found for femoral neck BMD (P = 0.09) and for total proximal femur BMD (P = 0.07). An increase in femoral neck BMD after 1 yr was significantly associated with the reduction in incidence of new vertebral fractures observed after 3 yr (P = 0.04). Conclusion: During 3-yr strontium ranelate treatment, an increase in femoral neck BMD was associated with a proportional reduction in vertebral fracture incidence.

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