Osteoporosis and Bone Metabolism in Treatment-naive Primary Prostate Adenocarcinoma Patients

2018 ◽  
Vol 69 (5) ◽  
pp. 1099-1105
Author(s):  
Violeta Bojinca ◽  
Claudiu Popescu ◽  
Andra Rodica Balanescu ◽  
Serban Mihai Balanescu ◽  
Mihai Bojinca

The objectives of the study were to evaluate bone metabolism in primary prostate cancer (PCa) patients prior to any treatment and to compare estrogens and anti-androgens in terms of bone metabolism. The study prospectively included consecutive patients with primary PCa who were proposed for radical prostatectomy and androgen deprivation therapy (ADT; either estrogens-group E, or anti-androgens -group A) and age-matched controls. Bone markers (osteoprotegerin -OPG; osteocalcin; deoxypyridinoline) were measured before treatment and after 6 months. Bone mineral density (BMD) was measured by dual X-ray absorptiometry before treatment and after 12 months (osteoporosis was defined as a spine or hip T score � -2.5). Continuous variables are reported as mean � standard deviation. The study included 30 controls (aged 70 � 6 years), 15 patients treated with estrogens (aged 71 � 6 years) and 15 patients with anti-androgens (aged 72 � 5 years). At baseline, 0% of controls, 33.3% of group E (p = 0.002 versus controls) and 53.3% of group A (p = 0.0001 versus controls) had osteoporosis. In group E, compared to baseline, OPG (4.67 � 1.38 versus 5.27 � 1.89; p = 0.043) and DPD (6.85 � 3.24 versus 8.63 � 2.42; p = 0.008) increased, while spine (0.99 � 0.32 versus 0.94 � 0.31; p = 0.019) BMD decreased. In group A, compared to baseline, OPG (6.37 � 3.04 versus 5.02 � 1.12; p = 0.041), spine (1.03 � 0.15 versus 0.89 � 0.15; p = 0.0003) and hip (0.82 � 0.18 versus 0.75 � 0.17; p = 0.003) BMD decreased. Osteoporosis is prevalent among hormone-na�ve PCa patients. Estrogens are associated with an increase of serum OPG, while anti-androgens with a decrease of serum OPG. Irrespective of ADT type, BMD still decreases in primary PCa patients.

2018 ◽  
Vol 20 (2) ◽  
pp. 129
Author(s):  
Rezwana Haque ◽  
Raihan Hussain ◽  
Shamim MF Begum

<p><strong><em>Objective:</em></strong><strong> </strong>Bone loss is a major complication of primary hyperparathyroidism (PHPT), and the extent of bone loss is an important factor for parathyroidectomy. Studies focused on this issue of bone loss in subjects with PHPT are quite rare in our country. This study will help the physicians to take proper action by giving an exact reflection of bone condition in subjects with PHPT. The purpose of this study was to evaluate the bone condition by measuring Bone Mineral Density (BMD), in subjects with PHPT using Dual Energy X-ray Absorptiometry (DEXA) and compare these findings with individuals without PHPT.</p><p><strong><em>Patients and Methods:</em></strong><strong> </strong>It was an analytic cross sectional study (group comparison) carried out at National Institute of Nuclear Medicine and Allied Sciences (NINMAS) BSMMU campus, Dhaka from July 2015-December 2016. Subjects of PHPT diagnosed by biochemical evaluation (increased serum calcium and parathyroid hormone concentrations), between age ranges 15-45 years were selected as group-A. Individuals without biochemical evidence of PHPT or other major illness causing bone loss were selected as comparison group or as group-B. The subjects underwent BMD test by DEXA at lumbar spines from L1-L4 vertebra and the left femoral neck using Norland XR-46 densitometer. BMD was classified according to WHO criteria. Data presented on categorical form were analyzed using chi-squared test. While the data presented on continuous scale were analyzed using student’s t-test. In each analysis, level of significance was 5% and P value &lt;0.05 was considered significant. Data were processed and analyzed with the help of computer software SPSS, version 20.</p><p><strong><em>Results:</em></strong><strong> </strong>Total number of 90 subjects were selected for this study, 45 subjects with PHPT were in group-A and equal number of subjects without PHPT were in group-B. The findings derived from data analysis showed, a significantly more male participants in group-A. The mean age of group-A and group-B was 37.24 ± 8.03 years and 38.20 ± 5.74 years respectively. Mean BMI of group-A was 25.10 ± 4.35 kg/m<sup>2  </sup>in compare to 29.43 ± 5.17 kg/m<sup>2</sup> in group-B. Higher BMI was noted in both groups. PHPT subjects with high BMI had low BMD. BMD expressed in absolute value (gm/cm<sup>2</sup>) and T score. BMD was significantly low in group-A (with PHPT) than in group-B (without PHPT), (p&lt;0.0001). In group-A, prevalence of low BMD was 62.2% (osteopenia 37.8%  and osteoporosis 24.4%)  at lumbar spine and 84.5% (osteopenia 35.6% and osteoporosis 48.9%) at femoral neck. PHPT subjects had significant difference in both T score and BMD between lumbar spine and femoral neck.</p><p><strong><em>Conclusion:</em></strong><strong> </strong>Primary hyperparathyroidism (PHPT) is shown to be associated with significantly reduced BMD especially at femoral neck. Thus, an increased fracture risk should consider if it is left untreated.</p><p>Bangladesh J. Nuclear Med. 20(2): 129-135, July 2017</p>


2008 ◽  
Vol 93 (6) ◽  
pp. 2181-2187 ◽  
Author(s):  
Dennis T. Villareal ◽  
Krupa Shah ◽  
Marian R. Banks ◽  
David R. Sinacore ◽  
Samuel Klein

Abstract Background: Although weight loss and exercise ameliorates frailty and improves cardiac risk factors in obese older adults, the long-term effect of lifestyle intervention on bone metabolism and mass is unknown. Objective: The objective was to evaluate the effects of diet-induced weight loss in conjunction with exercise on bone metabolism and mass in obese older adults. Design and Setting: We conducted a one-year randomized, controlled clinical trial in a university-based research center. Participants: Twenty-seven frail, obese (body mass index = 39 ± 5 kg/m2), older (age 70 ± 5 yr) adults participated in the study. Intervention: Participants were randomly assigned to diet and exercise (treatment group; n = 17) or no therapy (control group; n = 10). Outcome Measures: Body weight decreased in the treatment group but not in the control group (−10 ± 2 vs. +1 ± 1%, P &lt; 0.001). Compared with the control group, the treatment group had greater changes in bone mass, bone markers, and hormones, including 1) bone mineral density (BMD) in total hip (0.1 ± 2.1 vs. −2.4 ± 2.5%), trochanter (0.2 ± 3.3 vs. −3.3 ± 3.1%), and intertrochanter (0.3 ± 2.7 vs. −2.7 ± .3.0%); 2) C-terminal telopeptide (12 ± 35 vs. 101 ± 79%) and osteocalcin (−5 ± 15 vs. 66 ± 61%); and 3) leptin (2 ± 12 vs. −30 ± 25%) and estradiol (0.1 ± 14% vs. −14 ± 21%) (all P &lt; 0.05). Changes in weight (r = 0.55), bone markers (r = −0.54), and leptin (r = 0.61) correlated with changes in hip BMD (all P &lt; 0.05). Conclusion: Weight loss, even when combined with exercise, decreases hip BMD in obese older adults. It is not known whether the beneficial effects of weight loss and exercise on physical function lower the overall risk of falls and fractures, despite the decline in hip BMD.


Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4672-4672
Author(s):  
Nicola Martinelli ◽  
Michela Traglia ◽  
Fabiana Busti ◽  
Marcella Sirtori ◽  
Natascia Campostrini ◽  
...  

Background and Aims Osteoporosis is a multifactorial major health problem affecting over 200 million people worldwide. It is long known as a complication of marked iron overload, both primary (i.e. genetic hemochromatosis) and secondary (i.e. transfusional iron overload), but only recently cellular and animal models have shed some light on the pathogenetic link between iron and bone metabolism. Iron has been shown to activate osteoclasts (Ishii KA, Nat Med 2009) and to inhibit osteoblasts (Yamasaki K, Toxicol Lett 2009), which express ferroportin regulated by hepcidin (Xu Y, Inflammation 2012). A murine model has shown that iron overload causes bone loss through induction of Reactive Oxygen Species (ROS) (Tsay J, Blood 2010). Of note, a recent longitudinal study in a Korean population has demonstrated that serum ferritin, even at concentrations generally not considered as “iron overload”, is an independent predictor of bone mass deterioration and incident vertebral fractures (Kim BJ, J Bone Miner Res 2012), an effect most prominent in women ≥ 45 years of age (Kim BJ, Osteoporos Int 2013). Taking advantage from the recently completed iron section of the Val Borbera Study (Traglia M, J Med Genet 2011), this study aimed to evaluate for the first time the association between iron status (including serum hepcidin levels) and bone mass in a Caucasian population. Subjects and Methods This survey included 921 subjects (564 females, 357 males) aged 53.8 ± 16.3 years for whom complete data regarding bone mass (measured by transportable Quantitative Ultrasonography, QUS-based approach) and iron status (including serum hepcidin-25 levels measured by Mass Spectrometry) were available. Subjects with known inflammatory and renal disorders, as well as hereditary hemochromatosis had been previously excluded. Analyses were performed separately in males and females, due to known gender-related differences in either iron or bone metabolism. Main Results No significant association was found in males, while in females both ferritin (r= -0.42, P<0.001) and hepcidin (r= -0.30, P<0.001) were inversely correlated with T-score at univariate analyses. However, after including both ferritin and hepcidin in an age-adjusted linear regression model, only ferritin remained a significant predictor of T-score variability (beta coefficient= -0.115, P=0.042). Subsequent regression models adjusted for age, BMI, and C-Reactive Protein highlighted ferritin levels as independent predictors of T-score in females. After stratification for age and ferritin categories, T-score decreased linearly with increasing ferritin levels especially in females aged 50-75 years (n=293), i.e. the age known to be at major risk of accelerated bone loss (P<0.001 – Figure 1). Conclusions This study confirms that iron status significantly associates with bone loss at population level even in Caucasians, particularly in post-menopausal women. Increasing iron stores, even not clearly “pathologic”, may influence bone metabolism through increased ROS and/or hepcidin-mediated altered iron handling of osteoblasts and osteoclasts. Disclosures: No relevant conflicts of interest to declare.


2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5052-5052 ◽  
Author(s):  
J. Mardiak ◽  
D. Ondrus ◽  
B. Spanikova ◽  
B. Ostatnikova

5052 Background: Improved survival of testicular cancer (TC) patients leads to rising of interest on late toxicity. Treatment-related bone loss is well recognized in breast and prostate cancer, but there has been little information in long-term survivors from other tumors. The aim of the study was to assign the damage of bone metabolism in TC patients. Materials: Bone mineral density (BMD) was measured by dual energy photon x-ray absorptiometry in the lumbar spine and hips. BMD was classified as osteopenia (T score ranging from -1 to -2,5) and osteoporosis (T score less -2,5). C-terminal cross-linked telopeptides of type I collagen (CTX) were measured using ELISA. Additionally serum total testosterone was measured. Comparison was made with matched control data. Relationships between baseline characteristics (age, treatment type and time from orchiectomy) and BMD were assessed using univariate and multivariate analysis tools. Results: We included 257 patients in the study (17 - 72 yrs old, median: 36 yrs) who were treated for GCT since 1982. 29 (11%) of them had bilateral orchiectomy (OE) due to bilateral TC. 23% of pts were treated by OE alone, 17% by subsequent radiotherapy of para-aortic field and 59% by subsequent chemotherapy. Median time since the OE was 4 years (1–36 yrs). Pts after bilateral OE had significantly lower BMD comparing with pts with unilateral OE. We didn’t find any differences between TC pts and matched control data regarding incidence of osteopenia and CTX, but the incidence of osteoporosis was considerably higher in TC pts. The incidence of osteoporosis appeared to increase with age and slightly correlated with time since OE, particularly after 10 years after OE. Type of therapy did not prove to have significant impact on the appearance of osteoporosis. Serum testosterone level did not correlate with BMD. Conclusion: The long term survivors from GCP have significantly higher risk of osteoporosis than healthy matched population. No significant financial relationships to disclose.


2019 ◽  
Vol 51 (05) ◽  
pp. 302-308
Author(s):  
Antonio Mancini ◽  
Edoardo Vergani ◽  
Carmine Bruno ◽  
Angelina Barini ◽  
Andrea Silvestrini ◽  
...  

AbstractReduced bone mineral density (BMD) in Functional Hypothalamic Amenorrhea (FHA) is mainly related to hypoestrogenism, but other hormonal derangement (reduced conversion of T4–T3 and GH resistance) can play a role. These hormones are involved in antioxidant systems regulation. We evaluated the impact of hormonal alterations, with special focus on low T3 and IGF-1 levels, on antioxidant systems as a link with osteoporosis in FHA. Forty-three FHA patients, 15–34 years, with BMI range 17.3–23.4 kg/m2, were divided in 2 groups according to fT3 levels; group A (n=22), low fT3 (<2.4 pg/ml) and group B (n=21), normal fT3 (≥ 2.4 pg/ml). We evaluated hormonal parameters (fT3, fT4, TSH, IGF-1, FSH, LH, estradiol, DHEAS, testosterone, cortisol), bone metabolism (calcium, phosphorus, 25-OH Vitamin D, PTH, β-crosslaps, bone alkaline phosphatase) and total antioxidant capacity (TAC), expressed as LAG (latency time in radical species appearance using spectrophotometric method). BMD was assessed by DEXA. Group A patients exhibited significantly lower levels of IGF-1 (159.76±14.79 vs. 220.05±15.25 ng/ml) and osteocalcin (17.51±1.14 vs. 21.49±1.56 ng/ml); LAG values were significantly higher in A (66.33±1.74 s) vs. B (54.62±1.74 s). A significant direct correlation was found between both IGF-1 and fT3 with osteocalcin (r²=0.22, p=0.0049 and r²=0.34, p=0.0001, respectively). No difference in LAG between groups according to IGF-1 were found. These data show a correlation between altered bone turnover and low fT3, which is highly prevalent in FHA. Low fT3 levels may contribute to reduced BMD. Oxidative stress could be the link underlying different bone turnover pattern and endocrine dysfunction in FHA.


2020 ◽  
Vol 28 (5) ◽  
pp. 953-973 ◽  
Author(s):  
S.M. Nazia Fathima ◽  
R. Tamilselvi ◽  
M. Parisa Beham ◽  
D. Sabarinathan

BACKGROUND: Osteoporosis, a silent killing disease of fracture risk, is normally determined based on the bone mineral density (BMD) and T-score values measured in bone. However, development of standard algorithms for accurate segmentation and BMD measurement from X-ray images is a challenge in the medical field. OBJECTIVE: The purpose of this work is to more accurately measure BMD from X-ray images, which can overcome the limitations of the current standard technique to measure BMD using Dual Energy X-ray Absorptiometry (DEXA) such as non-availability and inaccessibility of DEXA machines in developing countries. In addition, this work also attempts to analyze the DEXA scan images for better segmentation and measurement of BMD. METHODS: This work employs a modified U-Net with Attention unit for accurate segmentation of bone region from X-Ray and DEXA images. A linear regression model is developed to compute BMD and T-score. Based on the value of T-score, the images are then classified as normal, osteopenia or osteoporosis. RESULTS: The proposed network is experimented with the two internally collected datasets namely, DEXSIT and XSITRAY, comprised of DEXA and X-ray images, respectively. The proposed method achieved an accuracy of 88% on both datasets. The Dice score on DEXSIT and XSITRAY is 0.94 and 0.92, respectively. CONCLUSION: Our modified U-Net with attention unit achieves significantly higher results in terms of Dice score and classification accuracy. The computed BMD and T-score values of the proposed method are also compared with the respective clinical reports for validation. Hence, using the digitized X-Ray images can be used to detect osteoporosis efficiently and accurately.


Author(s):  
J. Pepe ◽  
G. Della Grotta ◽  
R. Santori ◽  
V. De Martino ◽  
M. Occhiuto ◽  
...  

Abstract Purpose Osteoporosis and atherosclerosis share common risk factors. Aim of this study was to test if FRAX (which is an algorithm that can identify subjects at risk of fracture), without or with BMD values, also adjusted for trabecular bone score (TBS) was able to identify subclinical atherosclerosis, evaluated by measurement of carotid intima media thickness (cIMT ≥ 0.9 mm) as compared to DXA values. Methods Ninety postmenopausal women underwent DXA measurement and cIMT evaluation. For each patient, the FRAX algorithm for major osteoporotic fracture (M) and for hip fracture (H) without BMD was computed, together with FRAX with BMD and TBS-adjusted FRAX. Serum levels of osteoprotegerin, sRANKL, and interleukin-6 were also measured. Results There were no differences in anthropometric parameters and cardiovascular risk factors between subjects with cIMT ≥ 0.9 mm (35% of subjects, group A) compared to those with cIMT < 0.9 mm (group B). The prevalence of osteoporosis and FRAX BMD, TBS-adjusted FRAX both for M and H were higher in group A compared to group B. The best ROC curves to identify subjects with a cIMT ≥ 0.9 mm were: lumbar spine T-score, with a threshold of − 2.5 SD (area under the curve, AUC 0.64; p = 0.02) with a sensibility of 50% and a specificity of 76%; TBS-adjusted FRAX H with a sensibility of 50% and a specificity of 72% (AUC 0.64; p = 0.01 with a threshold of 3%). Interleukin-6 positively correlated with FRAX BMD H and M. Conclusions FRAX without BMD does not identify subclinical carotid atherosclerosis, while lumbar spine T-score and TBS-adjusted FRAX H similarly detected it with higher specificity for T-score.


2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1193.2-1194
Author(s):  
N. Kirilov ◽  
S. Todorov ◽  
N. Nikolov ◽  
M. Nikolov

Background:Osteoporosis is known to be a risk factor for fragility fractures [4, 5]. On one hand, vertebral body fragility fractures often lead to additional spine deformity [2]. On the other hand, it was found that with the progression of the spinal curvature in osteoporotic patients, the fragility fractures develop more frequently. The increased incidence of these fractures could be explained with a predominance of the mechanical forces on the one side of the already weakened osteoporotic vertebrae [3].Objectives:The aim of this study is to compare the fracture risk (FRAX) for major osteoporotic fractures (MOF) and for hip fractures (HF) in women with and without scoliosis through dual-energy X-ray absorptiomentry (DXA)Methods:In the current study, 59 women underwent DXA scans. Scoliosis was defined as Cobb’s angle ≥ 5◦ according to the Chaklin’s classification [6, 7]. Cobb’s angle was measured from DXA images with DICOM software. We evaluated the following risk factors: previous fractures, parental hip fractures, secondary osteoporosis, rheumatoid arthritis, use of corticosteroids, current smoking and alcohol consumption more than 3 units daily. We estimated FRAX MOF and FRAX HF on the basis of these risk factors and on the basis of the femoral neck bone mineral density (BMD). The calculations were done through FRAX tool published on the website of the University of Sheffield [1].Results:The mean age of the women was 63 years (yrs.) ± 10 yrs. (range 43 yrs. – 89 yrs.). Subjects with scoliosis were significantly older (67 yrs.) than those without scoliosis (59 yrs.), (p = 0.004). Mean weight and height didn’t differ between the groups with- and without scoliosis. Mean lumbar spine BMD and T-score differed significantly between the groups, (p = 0.02). Women with scoliosis had lower mean BMD (0.786 g/cm2) and lower mean T-score (-2.1 standard deviations (SDs)) compared to those without scoliosis (mean BMD: 0.912 g/cm2 and mean T-score: 0.9 SDs). The mean FRAX MOF (19.3%) and FRAX HF (5.9%) of the subjects with scoliosis were significantly higher than those of the women without scoliosis (FRAX MOF: 14.9% and FRAX HF: 3.1%), (p = 0.004 for FRAX MOF and p = 0.010 for FRAX HF).Conclusion:Women with scoliosis showed significantly higher fracture risk for major osteoporotic fractures and for hip fractures compared to those without scoliosis.References:[1]https://www.sheffield.ac.uk/FRAX/index.aspx[2]Mao YF, Zhang Y, Li K, et al. Discrimination of vertebral fragility fracture with lumbar spine bone mineral density measured by quantitative computed tomography. J Orthop Translat. 2018;16:33–39. Published 2018 Oct 10. doi:10.1016/j.jot.2018.08.007.[3]Sabo A, Hatgis J, Granville M, Jacobson RE. Multilevel Contiguous Osteoporotic Lumbar Compression Fractures: The Relationship of Scoliosis to the Development of Cascading Fractures. Cureus. 2017;9(12):e1962. Published 2017 Dec 19. doi:10.7759/cureus.1962.[4]Kirilova E, Cherkezov D, Gonchev B, Zheleva Z. OSIRIS Index for the assessment of the risk for osteoporosis in menopausal women, National conference with international participation, 6-7 october 2019, Kardzhali “Science and society 2019”, RKR print OOD ISSN 1314-3425[5]Madzharova R, Kirilova E, Petranova T, Nikolova M. Assessment of the activity for self care in women with osteoporosis, Science and TechnologieVolume VIII, 2018, Number 1: MEDICAL BIOLOGY STUDIES, CLINICAL STUDIES, SOCIAL MEDICINE AND HEALTH CARE,1-6.[6]Chaklin VD, Orthopedy - Moscow: Medgiz – 1965 – C. 209[7]Chaklin VD. Pathology, clinical manifestation and treatment of the scoliosis, 1stcongress of the union of the orthopedists and traumatologists, Moscow: Medgiz, 1957 – T.2. – p 798Disclosure of Interests:None declared


2012 ◽  
Vol 55 (3) ◽  
pp. 133-137 ◽  
Author(s):  
Helena Živná ◽  
Ljiljana Maric ◽  
Iveta Gradošová ◽  
Klára Švejkovská ◽  
Soňa Hubená ◽  
...  

Introduction: We studied influence of mud-bath on bone status in male Wistar rats with subchronic arthritis. Methods: Arthritis was induced by 2 subplantar injections of Freund’s adjuvans with heat-killed Streptoccocus pyogenes into paw. Groups: intact (int) on chippings; (con) arthritis on chippings; (san38) arthritis on hot sand; (mu38) arthritis on hot mud; (mu21) arthritis on mild mud. Bone mineral density (BMD, g/cm2) was measured by dual energy X-ray absorptiometry and femurs were tested biomechanically. Bone markers osteocalcin (OC), PINP and CTX were analysed in bone. Results: BMD of right femur decreased vs. left in san38 (p = 0.030) and mu38 (p = 0.047). Fracture load of right/left femur (N) decreased in experimental groups, significantly in san38 (p = 0.05). Fracture threshold of neck decreased in right vs. left in experimental groups, but significantly in san38 (p = 0.05). OC decreased in mu38 vs. con (1.84 ± 0.14/2.62 ± 0.23). PINP decreased in int vs. san38 (p = 0.005) and mu21 (p < 0.001). CTX decreased in int vs. mu38 (p = 0.006) and mu21 (p = 0.005). Conclusion: The hot bath appears indifferent in relation to osteoporosis, while cold mud-bath shows good effect on bone metabolism. The cold mud-baths help to reduce arthritic inflammation and pain and thereby lead to higher mobility with positive consequence on bone.


2020 ◽  
Vol 2 (37) ◽  
pp. 22-28
Author(s):  
O. A. Nikitinskaya ◽  
N. V. Toroptsova

Dual-energy X-ray absorptiometry is recognized as the ‘gold standard’ for the diagnosis of osteoporosis. This method is used not only for the initial assessment of the state of the IPC, but also for further monitoring of treatment or preventive measures. It allows you to compare the data of a patient with successive measurements during a long observation. However, it is impossible to evaluate the results of studies in dynamics on devices of different manufacturers without standardizing indicators or introducing correction factors. A simple method for recalculating the T-score obtained on a Dexxum 3 apparatus (OsteoSys, South Korea) is presented in order to compare it with a similar indicator of a bone densitometer Lunar Prodigy (GE Healthcare, USA).


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