Follow-up of bone mineral density in 27 cases of anorexia nervosa

1996 ◽  
Vol 135 (5) ◽  
pp. 591-597 ◽  
Author(s):  
Yves M Maugars ◽  
Jean-Marie M Berthelot ◽  
Romain Forestier ◽  
Nadia Mammar ◽  
Sylvia Lalande ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Anorexia Nervosa ◽  
Bone Loss ◽  
Femoral Neck ◽  
Bone Mineral ◽  
Controlled Trial ◽  
Osteoporotic Fractures ◽  
Dual Photon Absorptiometry ◽  
Mineral Density

Maugars YM, Berthelot J-MM, Forestier R, Mammar N, Lalande S, Venisse J-L, Prost AM. Follow-up of bone mineral density in 27 cases of anorexia nervosa. Eur J Endocrinol 1996;135:591–7. ISSN 0804–4643 Cortical and trabecular bone loss can lead to osteoporosis in chronic forms of anorexia nervosa (AN). As there is some debate about the reversibility of this condition, we performed a longitudinal follow-up study of 27 cases in which clinical, biological, X-ray and lumbar and femoral neck dual photon absorptiometry examinations were conducted every 6 months for up to 30 months. Three groups were distinguished: G1, untreated amenorrheic AN (N = 14, total follow-up 126 months); G2, effectively treated AN (N = 11, total follow-up 192 months), with two subgroups: fluoride (N = 5) and estrogen (N = 6); and G3, remitting AN with normalization of the gonadic function (N = 2, total follow-up 36 months). Results were adjusted for each patient to a 6-month variation. Semestrial variations in lumbar bone mineral density (BMD) were −2.1 ± 1.3%, +2.8 ± 1.5% and −0.3 ± 1.3% (mean ± sem), respectively for G1, G2 and G3; those for femoral neck BMD semestrial variations were −5.9 ± 2.1%, −3.8 ± 1.2% and −1.0 ± 0.6%. Femoral neck and lumbar BMD variations for G1 were mainly correlated positively with bone-forming markers (serum osteocalcin, alkaline phosphatase) and negatively with initial lumbar BMD. Estrogen alone increased lumbar BMD by +1.4 ± 2.3% every 6 months but did not stabilize femoral neck BMD (−3.5 ± 1.4%). Fluoride increased lumbar BMD by 4.8 ± 1.8%. Both lumbar and femoral neck BMD were stabilized in the remission group (−0.3 ± 1.3% and −1.0 ± 0.6%), despite half of the follow-up time with amenorrhea. In conclusion, untreated AN is associated with a marked trabecular and cortical bone loss (4–10% per year), which can lead to osteoporotic fractures. In prevention of bone loss, the efficacy of estrogen is difficult to investigate in AN, even with a well-controlled trial. Our study could provide argument that, when the observance of this preventive treatment is assessed, lumbar BMD can be stabilized in chronic forms of AN. Yves Maugars, CHU de Nantes, Service de Rhumatologie, 44035 Nantes, Cédex 01, France

scholarly journals Anxiety Levels Predict Bone Mineral Density in Postmenopausal Women Undergoing Oral Bisphosphonates: A Two-Year Follow-Up

2021 ◽  
Vol 18 (15) ◽  
pp. 8144
Author(s):  
Gabriella Martino ◽  
Federica Bellone ◽  
Carmelo M. Vicario ◽  
Agostino Gaudio ◽  
Andrea Caputo ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Mineral ◽  
Rating Scale ◽  
Osteoporotic Fractures ◽  
Oral Bisphosphonates ◽  
Mineral Density ◽  
X Ray ◽  
Hamilton Anxiety Rating Scale ◽  
Anxiety Levels

Clinical psychological factors may predict medical diseases. Anxiety level has been associated with osteoporosis, but its role on bone mineral density (BMD) change is still unknown. This study aimed to investigate the association between anxiety levels and both adherence and treatment response to oral bisphosphonates (BPs) in postmenopausal osteoporosis. BMD and anxiety levels were evaluated trough dual-energy X-ray absorptiometry and the Hamilton Anxiety Rating Scale (HAM-A), respectively. Participants received weekly medication with alendronate or risedronate and were grouped according to the HAM-A scores into tertiles (HAM-A 3 > HAM-A 2 > HAM-A 1). After 24 months, BMD changes were different among the HAM-A tertiles. The median lumbar BMD change was significantly greater in both the HAM-A 2 and HAM-A 3 in comparison with the HAM-A 1. The same trend was observed for femoral BMD change. Adherence to BPs was >75% in 68% of patients in the HAM-A 1, 79% of patients in the HAM-A 2, and 89% of patients in the HAM-A 3 (p = 0.0014). After correcting for age, body mass index, depressive symptoms, and the 10-yr. probability of osteoporotic fractures, anxiety levels independently predicted lumbar BMD change (β = 0.3417, SE 0.145, p = 0.02). In conclusion, women with higher anxiety levels reported greater BMD improvement, highlighting that anxiety was associated with adherence and response to osteoporosis medical treatment, although further research on this topic is needed.

scholarly journals P129 Predictors of low bone mineral density in rheumatoid arthritis

Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Malika A Swar ◽  
Marwan Bukhari
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Bone Mineral Density ◽  
Family History ◽  
Bone Loss ◽  
Femoral Neck ◽  
Bone Mineral ◽  
Fragility Fracture ◽  
Mineral Density ◽  
History Of

Abstract Background/Aims  Osteoporosis (OP) is an extra-articular manifestation of rheumatoid arthritis (RA) that leads to increased fracture susceptibility due to a variety of reasons including immobility and cytokine driven bone loss. Bone loss in other populations has well documented risk factors. It is unknown whether bone loss in RA predominantly affects the femoral neck or the spine. This study aimed to identify independent predictors of low bone mineral density (BMD) in patients RA at the lumbar spine and the femoral neck. Methods  This was a retrospective observational cohort study using patients with Rheumatoid arthritis attending for a regional dual X-ray absorptiometry (DEXA) scan at the Royal Lancaster Infirmary between 2004 and 2014. BMD in L1-L4 in the spine and in the femoral neck were recorded. The risk factors investigated were steroid use, family history of osteoporosis, smoking, alcohol abuse, BMI, gender, previous fragility fracture, number of FRAX(tm) risk factors and age. Univariate and Multivariate regression analysis models were fitted to explore bone loss at these sites using BMD in g/cm2 as a dependant variable. . Results  1,527 patients were included in the analysis, 1,207 (79%) were female. Mean age was 64.34 years (SD11.6). mean BMI was 27.32kg/cm2 (SD 5.570) 858 (56.2%) had some steroid exposure . 169(11.1%) had family history of osteoporosis. fragility fracture history found in 406 (26.6%). 621 (40.7%) were current or ex smokers . There was a median of 3 OP risk factors (IQR 1,3) The performance of the models is shown in table one below. Different risk factors appeared to influence the BMD at different sites and the cumulative risk factors influenced BMD in the spine. None of the traditional risk factors predicted poor bone loss well in this cohort. P129 Table 1:result of the regression modelsCharacteristicB femoral neck95% CIpB spine95%CIpAge at scan-0.004-0.005,-0.003<0.01-0.0005-0.002,0.00050.292Sex-0.094-0.113,-0.075<0.01-0.101-0.129,-0.072<0.01BMI (mg/m2)0.0080.008,0.0101<0.010.01130.019,0.013<0.01Fragility fracture-0.024-0.055,0.0060.12-0.0138-0.060,0.0320.559Smoking0.007-0.022,0.0350.650.0286-0.015,0.0720.20Alcohol0.011-0.033,0.0 5560.620.0544-0.013,0.1120.11Family history of OP0.012-0.021,0.0450.470.0158-0.034,0.0650.53Number of risk factors-0.015-0.039,0.0080.21-0.039-0.075,-0.0030.03steroids0.004-0.023,0.0320.030.027-0.015,0.0690.21 Conclusion  This study has shown that predictors of low BMD in the spine and hip are different and less influential than expected in this cohort with RA . As the FRAX(tm) tool only uses the femoral neck, this might underestimate the fracture risk in this population. Further work looking at individual areas is ongoing. Disclosure  M.A. Swar: None. M. Bukhari: None.

Lumbar Bone Mineral Density in Patients With Major Depression: Evidence of Increased Bone Loss at Follow-Up

2000 ◽  
Vol 157 (1) ◽  
pp. 118-120 ◽  
Author(s):  
Ulrich Schweiger ◽  
Bettina Weber ◽  
Michael Deuschle ◽  
Isabella Heuser
Keyword(s):  
Bone Mineral Density ◽  
Major Depression ◽  
Bone Loss ◽  
Bone Mineral ◽  
Lumbar Bone Mineral Density ◽  
Mineral Density

scholarly journals Association of total protein intake with bone mineral density and bone loss in men and women from the Framingham Offspring Study

2013 ◽  
Vol 17 (11) ◽  
pp. 2570-2576 ◽  
Author(s):  
Shivani Sahni ◽  
Kerry E Broe ◽  
Katherine L Tucker ◽  
Robert R McLean ◽  
Douglas P Kiel ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Bone Loss ◽  
Bone Mineral ◽  
Protein Intake ◽  
Mineral Density ◽  
Cross Sectional ◽  
Total Protein Intake ◽  
Multivariable Regression ◽  
The Impact

AbstractObjectiveTo examine (i) the association of percentage of total energy intake from protein (protein intake %) with bone mineral density (BMD, g/cm2) and bone loss at the femoral neck, trochanter and lumbar spine (L2–L4) and (ii) Ca as an effect modifier.SettingThe Framingham Offspring Study.SubjectsMen (n 1280) and women (n 1639) completed an FFQ in 1992–1995 or 1995–1998 and underwent baseline BMD measurement by dual-energy X-ray absorptiometry in 1996–2000. Men (n 495) and women (n 680) had follow-up BMD measured in 2002–2005.DesignCohort study using multivariable regression to examine the association of protein intake % with each BMD, adjusting for covariates. Statistical interaction between protein intake % and Ca (total, dietary, supplemental) intake was examined.ResultsThe mean age at baseline was 61 (sd 9) years. In the cross-sectional analyses, protein intake % was positively associated with all BMD sites (P range: 0·02–0·04) in women but not in men. Significant interactions were observed with total Ca intake (<800 mg/d v. ≥800 mg/d) in women at all bone sites (P range: 0·002–0·02). Upon stratification, protein intake % was positively associated with all BMD sites (P range: 0·04–0·10) in women with low Ca intakes but not in those with high Ca intakes. In the longitudinal analyses, in men, higher protein intake % was associated with more bone loss at the trochanter (P = 0·01) while no associations were seen in women, regardless of Ca intake.ConclusionsThis suggests that greater protein intake benefits women especially those with lower Ca intakes. However, protein effects are not significant for short-term changes in bone density. Contrastingly, in men, higher protein intakes lead to greater bone loss at the trochanter. Longer follow-up is required to examine the impact of protein on bone loss.

scholarly journals Alcohol consumption and bone mineral density in elderly women

2012 ◽  
Vol 16 (4) ◽  
pp. 704-712 ◽  
Author(s):  
Isolde Sommer ◽  
Arja T Erkkilä ◽  
Ritva Järvinen ◽  
Jaakko Mursu ◽  
Joonas Sirola ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Alcohol Consumption ◽  
Femoral Neck ◽  
Bone Mineral ◽  
Alcohol Intake ◽  
Elderly Women ◽  
Mineral Density ◽  
Lifestyle Questionnaire

AbstractObjectiveFindings regarding alcohol consumption and bone mineral density (BMD) in elderly women have been inconsistent. The objective of the present study was to explore the association of alcohol intake with BMD in elderly women.DesignThis cohort study included women from the population-based Kuopio Osteoporosis Risk Factor and Prevention – Fracture Prevention Study (OSTPRE-FPS). Alcohol intake and potential confounders were assessed at baseline and after 3 years of follow-up using a lifestyle questionnaire. In addition, an FFQ was distributed in the third year to measure dietary intake, including alcohol. Women underwent BMD measurements at the femoral neck and lumbar spine at baseline and after 3 years of follow-up.SettingKuopio Province, Finland.SubjectsThree hundred elderly women (mean age 67·8 years) who provided both BMD measurements and FFQ data.ResultsAlcohol consumption estimated from the FFQ and lifestyle questionnaire was significantly associated with BMD at both measurement sites after adjustment for potential confounders, including lifestyle and dietary factors (P < 0·05). Using the FFQ, women drinking >3 alcoholic drinks/week had significantly higher BMD than abstainers, 12·0 % at the femoral neck and 9·2 % at the lumbar spine. Results based on the lifestyle questionnaire showed higher BMD values for all alcohol-consuming women at the femoral neck and for women drinking 1–3 alcoholic beverages/week at the lumbar spine, compared with non-users.ConclusionsThe results from OSTPRE-FPS suggest that low to moderate alcohol intake may exert protective effects on bone health in elderly women.

Effect of Zoledronic Acid on Bone Mineral Density in Thalassemia-Induced Osteoporosis: Results of a Phase II Clinical Trial.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3826-3826
Author(s):  
Ali Taher ◽  
Sami Azar ◽  
Wael Shamseddeen ◽  
Dany Habr ◽  
Adlette Inati ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Lumbar Spine ◽  
Zoledronic Acid ◽  
Femoral Neck ◽  
Adverse Events ◽  
Bone Mineral ◽  
Beta Thalassemia ◽  
Mineral Density ◽  
Significant Change

Abstract Background: Osteoporosis is an important cause of morbidity in beta-thalassemia patients. Bisphosphonates are potent inhibitors of osteoclast activity and have been recently used for the treatment of osteoporosis in beta-thalassemia. The aim of this study is to assess the efficacy and safety of zoledronic acid in Lebanese thalassemics with osteoporosis. Methods: Eighteen thalassemic patients (13 thalassemia major and 5 intermedia) with osteoporosis defined as Z-score &lt;−2.5 were given zoledronic acid 4 mg i.v. every 3 months over a period of 12 months (Total of 4 doses administered). The efficacy of treatment was assessed by measuring Bone Mineral Density (BMD) at the lumbar spine, femoral neck and hip at baseline, 6 and 12 months. Other efficacy measurements included markers of bone formation and resorption (bone alkaline phosphatase (BAP), osteocalcin (OC), and urinary deoxypyridinoline (Dpd)), assessment of pain score, analgesic score, and performance score measured at baseline and at 3-month intervals. Safety assessment included regular physical exams, standard hematology and clinical chemistry tests, and adverse events recording. All patients were on Ca/Vitamin D supplementation prior to and during the study. Ten thalassemic osteoporotic patients were followed up only with serial BMDs as controls. Results: The characteristics of all patients are shown in Table 1. Both groups had no significant difference with respect to age, gender and baseline BMD. Patients taking zoledronic acid had a significant increase in their spine, femoral neck, trochanter and total hip BMD measurements over the 12-month period (all p-values&lt;0.05). Patients in the control group, on the other hand, did not have any significant change except in the spine BMD. The BMD values are presented in Table 2. There was a significant change in the levels of the OC and BAP over the 12-month follow-up in the treatment group (p=0.00 for both). Dpd levels did not significantly change overall (p=0.06) although they decreased throughout the study. Reported adverse events included joint pain in 9 patients (50%) after the 1st dose and in 2 (11.1%) after the 2nd dose and responding very well to oral analgesics. Two patients (11.1%) had perioral numbness and 3 (16.7%) had low grade fever after the 1st dose. No treatment-related adverse events were reported after the 3rd and 4th doses. No patients withdrew from the study. Conclusions: Treatment of Lebanese thalassemic osteoporotic patients with zoledronic acid 4 mg every 3 months is effective in increasing BMD at the lumbar spine and hip and is well-tolerated. Well-controlled studies with longer follow-up are needed to determine the fracture-reduction benefits and the most optimal zoledronic acid treatment dose and frequency in this patient population. Table 1: Main characteristics of the studied groups Table 2: BMD values of the treatment and control groups

scholarly journals POS1106 FRAX AND THE EFFECT OF TERIPARATIDE ON BONE MINERAL DENSITY IN SECONDARY OSTEOPOROSIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 833.2-834
Author(s):  
S. Garcia ◽  
B. M. Fernandes ◽  
M. Rato ◽  
F. Oliveira Pinheiro ◽  
D. Fonseca ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Hip Fracture ◽  
Lumbar Spine ◽  
Femoral Neck ◽  
Fracture Risk ◽  
Bone Mineral ◽  
Fracture Probability ◽  
Mineral Density ◽  
T Score

Background:Teriparatide has been shown to increase spine and hip bone mineral density (BMD) and to reduce vertebral and non-vertebral fractures. (1) It is currently not clear whether the effect of teriparatide is dependent on the baseline risk of fracture or osteoporosis (OP) type, a finding that could have an impact on our therapeutic decision.Objectives:Investigate if there is a relationship between teriparatide effect in BMD and baseline 10-year fracture probability, assessed using FRAX®, in primary and secondary OP patients.Methods:This is a longitudinal, retrospective study including consecutive patients with the diagnosis of OP treated with teriparatide for 24 months, with a ten-year follow-up period, at our rheumatology department. Demographic, clinical, laboratorial, BMD and occurrence of fracture data were collected. The 10-year risk of osteoporotic fracture was estimated using the fracture risk assessment tool (FRAX) v 4.1 with the Portuguese population reference. Statistical analysis was performed using the software SPSS 23.0. Correlations between continuous variables were evaluated with spearman coefficient. p<0.05 was considered statistically significant.Results:Eighty patients (88.8% female, median age 65.00 (59; 75)) were included. Forty-nine patients (61.3%) has secondary OP, mainly of cortisonic etiology (61.2%, n=30). Before treatment, median lumbar spine BMD was 0.870 [0.767, 0.964] g/cm2, median T-score of -2.60 (-3.30, -1.90); median total femur BMD was 0.742 [0.667, 0.863] g/cm2, median T-score of -2.10 (-2.80, -1.30); median femoral neck BMD was 0.671 [0.611, 0.787] g/cm2, median T-score of -2.50 [-3.20, -1.85]. Regarding fracture risk, median FRAX-based 10-year major fracture risk (with BMD) at baseline was 16% [10.0; 23], and median hip fracture risk was 7.2% [3.4; 13.8].The median variation of BMD, after finishing teriparatide treatment, in the spine was 0.107 [0.029; 0.228]; median BMD variation in total femur was 0.013 [-0.013; 0.068] and median BMD femoral neck was 0.046 [-0.002; 0.109]. We observed a numerically superior effect, albeit without any statistical significance, of teriparatide on bone mineral density gain in secondary OP (versus primary OP) at lumbar spine, total femur and femoral neck.Most patients continued anti-osteoporotic treatment with a bisphosphonate (81.2%, n=65) and, during follow-up, 17 patients had an incident fracture (8 hip fractures and 6 vertebral fractures), median of 5 [1.75, 8.25] years after ending teriparatide.We found a discrete correlation between FRAX-based hip fracture probability and the variation of bone mineral density in total femur (Spearman’s coefficient 0.248, p = 0.04). There was no correlation between FRAX-based major fracture probability and and the variation of bone mineral density in the spine or femur. When we separately analyze the relationship between the variation in total hip BMD and the FRAX-based fracture risk, depending on whether it is a secondary or primary OP, we find that the correlation is stronger and only remains in secondary OP (Spearman’s coefficient 0.348, p = 0.03).Conclusion:Our data suggest that teriparatide could be an important weapon in the treatment of secondary cause OP, particularly cortisonic, and in patients at high fracture risk, although further larger studies are needed to confirm these findings.References:[1]Kendler DL, Marin F, Zerbini CAF, Russo LA, Greenspan SL, Zikan V, Bagur A, Malouf-Sierra J, Lakatos P, Fahrleitner-Pammer A, Lespessailles E, Minisola S, Body JJ, Geusens P, Möricke R, López-Romero P. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet. 2018 Jan 20;391(10117):230-240. doi: 10.1016/S0140-6736(17)32137-2.Disclosure of Interests:None declared.

scholarly journals Time-averaged disease activity of rheumatoid arthritis associated with long-term bone mineral density changes

2020 ◽  
Vol 11 ◽  
pp. 204062232098151
Author(s):  
Chung-Yuan Hsu ◽  
Jia-Feng Chen ◽  
Yu-Jih Su ◽  
Ying-Chou Chen ◽  
Han-Ming Lai ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Bone Mineral Density ◽  
Bone Loss ◽  
Disease Activity ◽  
Bone Mineral ◽  
Osteoporosis Treatment ◽  
High Disease Activity ◽  
Mineral Density

Background: Rheumatoid arthritis (RA) is associated with poor bone mineral density (BMD). We designed the current study owing to the lack of long-term prospective studies regarding whether a high disease activity leads to increased bone loss. Methods: We have continually enrolled patients with RA. According to the average disease activity score in 28 joints based on the erythrocyte sedimentation rate (DAS28-ESR) during follow-up, the patients were classified into remission, low disease activity, and moderate or high disease activity groups. Patients were examined with dual-energy X-ray absorptiometry at baseline and after 3 years of follow-up. BMD changes were compared among the groups. Results: We have studied 477 patients. Overall BMD was significantly reduced from baseline to the 3-year follow-up ( p < 0.05). After stratifying according to the time-averaged DAS28-ESR levels and use of anti-osteoporosis treatment (AOT), the BMD values of the femur and spine significantly increased in patients in the remission group with AOT. The BMD changes of different DAS28-ESR patients were further compared using the generalized estimation equation model. For the patients on AOT, the negative change in femoral BMD values of the moderate or high activity group was significant when compared with the remission group with positive BMD changes (regression coefficient, –0.038; 95% confidence interval, –0.055 to –0.021). Conclusion: For RA patients, if remission is achieved, AOT can better improve BMD, especially in the femur. In addition, moderate or high disease activity will lead to significant bone loss; therefore, disease activity must be actively controlled.

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