Bisphosphonates prevents the bone mineral loss in lymphoma patients treated with glucocorticoids: a prospective, randomized controlled phase 3 trial in China

Background Glucocorticoids-containing regimens are the standard first line treatment for most lymphoma patients, however, as the improvement of overall survival in these cases, glucocorticoids related osteopenia or osteoporosis attracted attention in clinical administration. We aim to investigate the efficacy of bisphosphonates in prevention bone mineral loss in glucocorticoids-treated lymphoma patients. Methods This is a prospective, randomized controlled phase 3 trial. Eligible lymphoma adults from China with first line glucocorticoids involved treatment, were randomly assigned 1:1 to receive either Zoledronic acid (ZA) for twice infusion or not. All patients received daily oral calcium and vitamin D3 for one year. The primary endpoint, alternations of bone mineral loss from enrollment to the twelfth month at the lumbar spine (L1-L4), left hip and left femoral neck, measured by the dual-energy, x-ray absorptiometry scanners, recorded as T score; and new bone fractures during the first year, were analyzed by intent-to-treat. This trial was registered with www.Chictr.org, number ChiCTR-INR-17010771. Results Between May, 2016 to July, 2019, 84 patients were randomly assigned to both Zoledronic acid and control groups, 29 patients completed the study and were on follow-up. We found a marked improvement of T score in ZA group compared with the control in a year at lumbar spine, T score changes of L1-4 in ZA group and control group were as following: L1, 0.14±0.61 vs. -0.33±0.40, p=0.009; L2, 0.28±0.41 vs. -0.35±0.54, p=0.003; L3, 0.23±0.42 vs. -0.23±0.66, p=0.020; L4, 0.28±0.44 vs. -0.35±0.54, p=0.020. Meanwhile, no severe adverse event was observed on both groups. Conclusions Glucocorticoids-treatment lymphoma patients that prophylactic ZA infusion could relieve BMD loss to prevent osteoporosis without increasing severe adverse effects in Chinese population, providing reference for clinicians to consider ZA application in this situation.

Radiographic predictors for bone mineral loss

Objectives Researchers continue to seek easier ways to evaluate the quality of bone and screen for osteoporosis and osteopenia. Until recently, radiographic images of various parts of the body, except the distal femur, have been reappraised in the light of dual-energy X-ray absorptiometry (DXA) findings. The incidence of osteoporotic fractures around the knee joint in the elderly continues to increase. The aim of this study was to propose two new radiographic parameters of the distal femur for the assessment of bone quality. Methods Anteroposterior radiographs of the knee and bone mineral density (BMD) and T-scores from DXA scans of 361 healthy patients were prospectively analyzed. The mean cortical bone thickness (CBTavg) and the distal femoral cortex index (DFCI) were the two parameters that were proposed and measured. Intra- and interobserver reliabilities were assessed. Correlations between the BMD and T-score and these parameters were investigated and their value in the diagnosis of osteoporosis and osteopenia was evaluated. Results The DFCI, as a ratio, had higher reliability than the CBTavg. Both showed significant correlation with BMD and T-score. When compared with DFCI, CBTavg showed better correlation and was better for predicting osteoporosis and osteopenia. Conclusion The CBTavg and DFCI are simple and reliable screening tools for the prediction of osteoporosis and osteopenia. The CBTavg is more accurate but the DFCI is easier to use in clinical practice. Cite this article: Q-F. He, H. Sun, L-Y. Shu, Y. Zhu, X-T. Xie, Y. Zhan, C-F. Luo. Radiographic predictors for bone mineral loss: Cortical thickness and index of the distal femur. Bone Joint Res 2018;7:468–475. DOI: 10.1302/2046-3758.77.BJR-2017-0332.R1.

Prevalence of osteoporosis in hysterectomised as compared to non-hysterectomized women in 7th decade of life

Background: Osteoporosis is considered as a major public health issue with fragility fractures of the hip, vertebrae and distal radius being the most important consequences. It has been said to be an age-related degenerative process. However, postmenopausal women develop this disease due to age-related bone mineral loss as well as due to declining levels of estrogen in the body following menopause leading to increased risk of fractures. Objectives of this study were to find out the prevalence of osteoporosis in hysterectomised and non-hysterectomised postmenopausal women in 7th decade of life.Methods: Descriptive cross-sectional study done on a total of 66 postmenopausal women who were in their 7th decade of life. They were divided into two groups, one consisting of 36 women who underwent natural menopause and the other group of 30 women who had surgical menopause. The bone mineral density of both the groups was measured using DEXA scan and comparison was done between these study groups.Results: Out of 30 hysterectomised subjects, 24 (80%) were found to be having osteoporosis, 6 (20%) had osteopenia and none had normal BMD. While out of 36 subjects in the non-hysterectomised group, 14 (38.88%) had osteoporosis, 16 (44.44%) had osteopenia and 6 (16.66%) subjects had normal BMD. Significant relation (p-value 0.001) was found on comparison of the study groups. In addition, significant positive correlation was between BMD and BMI whereas negative correlation was seen between BMD and parity.Conclusions: Hysterectomy was found to increase the incidence of osteoporosis. Obesity was found to have protective effect against bone mineral loss while increasing parity had a negative relation with BMD.