Influence of age and gender on spine bone density and TBS microarchitectural texture parameters in infants

Background:The prevalence of osteoporosis in inflammatory rheumatic diseases such as psoriatic arthritis (PsA) has not been sufficiently clarified yet, and the data in the literature are heterogeneous. In addition, it is still unclear to what extent patients with PsA differ in terms of bone density from patients with other forms of spondyloarthritis such as ankylosing spondylitis (AS).Objectives:In an interim analysis of the Rh-GIOP Study (ClinicalTrials.gov IdentifierNCT02719314), we observed that PsA patients demonstrated more frequently normal bone density than any other patient group analyzed (suffering from e.g. rheumatoid arthritis or systemic sclerosis). The main objective of this investigation was to compare bone density data from patients with PsA and AS, as both diseases belong to the spondyloarthritis group. 1100 patients with inflammatory rheumatic diseases provided the basis of Rh-GIOP, a prospective study monitoring glucocorticoid (GC)-induced osteoporosis in patients with rheumatic diseases. Rh-GIOP was established in 2015 at the Charité University Hospital. Bone mineral density data were measured by dual x-ray absorptiometry (DXA).Methods:92 patients with PsA (65% female) were compared with 51 patients suffering from AS (35% female). Potential risk and protective factors (e.g. data on GC treatment, anti-rheumatic therapy), laboratory parameters (e.g. Vitamin D, alkaline phosphatase, calcium and inflammatory markers) and functional status (e.g. Health Assessment Questionnaire, sporting activities, back pain) were compared between these groups. Statistical analysis was performed descriptively using mean and standard deviation, t-tests for metric variables, and chi-square tests for nominal variables. Due to the heterogeneous gender distribution, an additional statistical matching was performed to compare patients matched by age and gender.Results:Patients with PsA displayed significantly higher minimal T-scores than patients with AS (p=0.003) even though patients with AS were younger and more often male (p<0.001). AS patients showed a higher frequency of osteopenic bone densities (p<0.05), however, no differences in the frequency of osteoporotic bone densities were found. Body-mass-index (BMI) was significantly higher (p<0.001) in PsA patients. PsA patients demonstrated a higher frequency of csDMARD use (p<0.001). Additional analyses among PsA patients with and without csDMARDs revealed also significantly higher minimal T-scores in PsA patients taking csDMARDs (90% Methotrexate), and both groups showed the same average of age and gender distribution. Furthermore, AS patients complained significantly more often of back pain (96 % vs. 74%, p=0.001) than PsA patients. No differences in GC use or cumulative GC dose were found. All results could be confirmed when groups were matched by age and gender.Conclusion:Our results demonstrate that patients with PsA display higher bone density compared to age and gender matched patients with ankylosing spondylitis. Possible influencing factors could be the higher frequency of csDMARD use, higher BMI or the lower frequency of back pain in PsA patients. Multivariate tests and additional biomarker investigations in larger cohorts are necessary to corroborate these findings and to identify underlying pathogenic differences which could serve for an explanation.Disclosure of Interests:Desiree Freier: None declared, Edgar Wiebe: None declared, Robert Biesen: None declared, Thomas Buttgereit: None declared, Sandra Hermann: None declared, Timo Gaber: None declared, Frank Buttgereit Grant/research support from: Amgen, BMS, Celgene, Generic Assays, GSK, Hexal, Horizon, Lilly, medac, Mundipharma, Novartis, Pfizer, Roche, and Sanofi.

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Early Indicators of the Dysmetabolic Syndrome in Young Survivors of Acute Lymphoblastic Leukemia in Childhood.

Blood ◽

10.1182/blood.v106.11.4543.4543 ◽

2005 ◽

Vol 106 (11) ◽

pp. 4543-4543

Author(s):

Maria Moschovi ◽

Georgios Trimis ◽

John Papassotiriou ◽

Georgios Chrousos ◽

Fotini Tzortzatou-Stathopoulou

Keyword(s):

Acute Lymphoblastic Leukemia ◽

Bone Density ◽

Lymphoblastic Leukemia ◽

Cranial Irradiation ◽

Age And Gender ◽

Amyloid A ◽

History Of ◽

Young Survivors ◽

And Gender ◽

Early Indicators

Abstract An increased incidence of obesity and cardiovascular morbidity and mortality was recently observed in adult survivors of childhood malignancies younger than 45 years. The purpose of this study was to investigate the presence of early indicators of the dysmetabolic syndrome in a population of young survivors of acute lymphoblastic leukemia (ALL) in childhood. Patients and methods: Our study included 58 patients (31 males), aged 5–24 years (mean 12.9 years) with ALL, who had finished their treatment by the same protocol at least 2 years before the study (mean 5.1 years, range 2–10 years). Ten patients had received cranial irradiation (18 Gy). No patient had a history of thyroid disease or diabetes mellitus or received hormonal substitution. We obtained a detailed history of their diet habits and level of physical activity and measured their body mass index (BMI) and blood pressure (BP). Complete blood counts and blood chemistry tests were also obtained. Finally, bone density was measured in the lumbar spine and femur with DEXA. Results: Diet enriched in lipids and low carbohydrates was reported by 43/58 (74%), while absence of any athletic activity by 38/58 (65%) of the patients. Frank obesity with a BMI >30 or its equivalent for age and gender was observed in 12/58 (21%) of the patients, while 25/58 (43%) were overweight, with a BMI >25<30 or its equivalent for age and gender.1 Increased systolic and/or diastolic BP (>95th percentile) was observed in 13/58 patients (22%), while in 25/58 (43%) it was > the 75th percentile. Dyslipidemia characterized by one, two, or three indices (serum cholesterol, triglycerides or LDL concentrations >95th percentile) was respectively detected in 20/58 (35%), 13/58 (22%), and 7/58 (12%) of the patients. Reduced serum HDL concentrations (<5th percentile) was observed in 12/58 (21%) of the patients. Slightly elevated free fatty acids were detected in 11/58 (19%) and hepatic enzymes in 7/58 (12%) of the patients. Increased fasting insulin was seen in 14/58 (24%) of the patients and HbA1c in 11/58 (19%) of them, however, fasting blood glucose was normal in all patients. Finally, increased inflammatory indices, namely C-reactive protein (CRP) or serum amyloid A (SAA), were detected in 9/58 patients (15%), reduced IGF-1 in 9/58 (15%) and thyroid hormone abnormalities in 5/58 (9%). All the patients with thyroid dysfunction, however, had received cranial irradiation. Osteopenia [Ζ score matched for age and gender of T score bone density: -(1–2.5) SD] was detected in 41/58 (71%) of the patients. None had frank osteoporosis. Conclusion: Survivors of childhood ALL have early indicators of high risk for the dysmetabolic syndrome. Modification of diet, body weight control, stress reduction, and reinforcement of an exercise program will hopefully be helpful in preventing the cardiovascular sequelae of the syndrome, improve the quality of life and enhance the life expectancy in this group of patients.

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