Comparison of the Efficacy of Denosumab and Alendronate in Improving Bone Mineral Density in Osteoporosis Patients and High-Risk Populations: A Systematic Review and Meta-Analysis.

To systematically evaluate the effects of Tai Chi on bone mineral density (BMD) in lumbar spine, femoral greater trochanter, Ward's triangle, femoral neck, and calcaneus among middle-aged and older adults through a meta-analysis. A comprehensive literature search was conducted across multiple databases, including CNKI, PubMed, Embase, Web of Science, and Cochrane Library, to identify randomized controlled trials (RCTs) investigating the impact of Tai Chi on BMD in middle-aged and older populations. The literature search covered the period from the establishment of each database to February 25, 2025. EndNote 20 was employed for literature management. The methodological quality of included studies was evaluated using the PEDro (Physiotherapy Evidence Database) scale. Heterogeneity analysis, bias assessment, and sensitivity analysis were performed on extracted data using RevMan 5.4 and Stata SE 15.0 software. 1. Seventeen randomized controlled trials (RCTs) with a total sample size of 1,253 participants (intervention group: n=675; control group: n=578) were included in the final analysis. The methodological quality of the included studies, as assessed by standardized evaluation criteria, demonstrated overall high robustness. The meta-analysis revealed statistically significant improvements in bone mineral density (BMD) at multiple skeletal sites following Tai Chi intervention: lumbar spine (WMD = 0.07, 95% CI: 0.04-0.11,p< 0.00001), greater trochanter (WMD = 0.04, 95% CI: 0.02-0.06,p< 0.00001), Ward's triangle (WMD = 0.03, 95% CI: 0.01-0.05,p= 0.007), femoral neck (WMD = 0.03, 95% CI: 0.02-0.05,p< 0.0001), and calcaneus (WMD = 5.52, 95% CI: 3.87-7.27,p< 0.00001). Regular Tai Chi practice demonstrates significant improvements in bone mineral density (BMD) among middle-aged and older adults, particularly at the lumbar spine. Our meta-analysis suggests Tai Chi may serve as a viable non-pharmacological intervention for mitigating osteoporosis in aging populations. Notably, individuals aged ≥60 years exhibit more pronounced BMD enhancements when adhering to a structured regimen of ≥3 sessions/week over ≥6 months. However, rigorously designed randomized controlled trials (RCTs) are required to validate these observed benefits and systematically explore optimal Tai Chi exercise regimens for skeletal health promotion.

Background:Thyroid hormones affect bone remodeling in patients with thyroid disease by acting directly or indirectly on bone cells. In view of limited information on correlation of thyroid function with bone mineral density (BMD) in euthyroid subjects, we undertook this study to evaluate the correlation between thyroid function with BMD in subjects with normal thyroid function and subclinical hypothyroidism.Material and Methods:A total of 1290 subjects included in this cross sectional study, were divided in Group-1 with normal thyroid function and Group-2 with subclinical hypothyroidism. Fasting blood samples were drawn for the estimation of serum 25(OH)D, intact parathyroid hormone, total and ionized calcium, inorganic phosphorus, and alkaline phosphatase. BMD at lumbar spine, femur, and forearm was measured.Results:BMD at all sites (radius, femur, and spine) were comparable in both groups. There was no difference in BMD when subjects were divided in tertiles of TSH in either group. In group-1, FT4 and TSH were positively associated with BMD at 33% radius whereas FT3 was negatively associated with BMD at femoral neck in multiple regression analysis after adjustment for age, sex, BMI, 25(OH)D and PTH levels. In group-2, there was no association observed between TSH and BMD at any site. Amongst all study subjects FT4 and FT3 were positively correlated with BMD at lumbar spine and radius respectively among all subjects.Conclusion:TSH does not affect BMD in euthyroid subjects and subjects with subclinical hypothyroidism. Thyroid hormones appear to have more pronounced positive effect on cortical than trabecular bone in euthyroid subjects.

Meta-analyses conducted >15 years ago reported that improvements in bone mineral density (BMD) were associated with reduction in vertebral and nonvertebral fractures in osteoporosis trials. Numerous studies have been conducted since then, incorporating new therapies with different mechanisms of action and enrolling many more subjects. To extend these prior analyses, we conducted a meta-regression of 38 placebo-controlled trials of 19 therapeutic agents to determine the association between improvements in BMD and reductions in fracture risk. We used a linear model to examine the relationship between mean percent difference in BMD change between treatment and placebo groups and the logarithm of the relative risk. We found that greater improvements in BMD were strongly associated with greater reductions in vertebral and hip fractures but not nonvertebral fractures. For vertebral fracture, the r2 values for total hip, femoral neck, and lumbar spine BMD change were 0.56, 0.54, and 0.63, respectively (p ≤ 0.0002). For a 2% or 6% improvement in total hip BMD, we might expect a 28% or 66% reduction, respectively, in vertebral fracture risk. For hip fracture, the r2 values for total hip, femoral neck, and lumbar spine BMD change were 0.48 (p = 0.01), 0.42 (p = 0.02), and 0.22 (ns), respectively. For a 2% or 6% improvement in total hip BMD, we might expect a 16% or 40% reduction in hip fracture risk. In conclusion, our results extend prior observations that larger improvements in dual-energy X-ray absorptiometry (DXA)-based BMD are associated with greater reductions in fracture risk, particularly for vertebral and hip fractures. Although these results cannot be directly applied to predict the treatment benefit in an individual patient, they provide compelling evidence that improvements in BMD with osteoporosis therapies may be useful surrogate endpoints for fracture in trials of new therapeutic agents. © 2019 American Society for Bone and Mineral Research.

Calcium and vitamin D supplementation is commonly recommended in conjunction with osteoporosis treatment. However, some patients are unable to tolerate or take these supplements due to various factors. This study aims to assess the impact of calcium and vitamin D supplementation on bone mineral density (BMD) changes over a two-year period in patients treated with denosumab, comparing those who received supplements with those who did not. This retrospective study included 344 patients who had received at least four doses of denosumab. Patients were divided into two groups: those who received calcium and vitamin D supplementation and those who did not. BMD was measured annually at the lumbar spine, total hip, and femoral neck, and denosumab efficacy was assessed by calculating the percentage change in BMD from baseline. We also evaluated BMD changes according to patients' prior osteoporosis treatments and history of osteoporotic fractures. In addition, a subgroup analysis was conducted among treatment-naïve patients, comparing those who received denosumab alone with those who received denosumab combined with calcium and vitamin D supplementation. The study cohort consisted of 328 women, with a mean age of 70.50 ± 9.48years. Statistically significant differences were found between the two groups regarding prior osteoporosis treatment (P = 0.004) and baseline lumbar spine BMD (P = 0.027). However, no significant differences were observed in BMD changes at the lumbar spine, total hip, or femoral neck after one and two years of denosumab treatment, regardless of calcium and vitamin D supplementation. The type of prior osteoporosis medication and the presence of low-energy fragility fractures did not significantly affect BMD changes at either time point. In treatment-naïve patients (n = 209), BMD gains did not differ significantly between those with and without supplementation. Notably, none of the patients reported experiencing adverse events such as injection site infections, myalgia, or symptomatic hypocalcemia. The two-year treatment with denosumab resulted in improvements in BMD that were independent of calcium and vitamin D supplementation. These findings suggest that denosumab may increase BMD regardless of supplementation, though further studies are warranted to confirm this relationship.

Physical Exercise and Bone Density in Middle-aged and Older Men

Disclosure: C. Plessias: None. N. Charoenngam: None. T. Rittiphairoj: None. T. Suenghataiphorn: None. T. Srikulmontri: None. P. Wattanachayakul: None. M. Kurt: None. Bone Mineral Density Improvement After Resolution of Endogenous Cushing Syndrome: a Meta-analysis and meta-regression Patients with endogenous Cushing syndrome (eCS) are known to have decreased bone mineral density (BMD) and are prone to fragility fractures. Treatment of eCS have been shown in multiple studies to result in improvement in BMD. However, the degree of BMD improvement after resolution of eCS remains inadequately explored due to limited sample sizes in existing studies. Through systematic review, meta-analysis, and meta-regression techniques, we aimed to identify all available evidence to evaluate BMD improvement after resolution of eCS. Potentially eligible studies were identified from the PubMed and EMBASE databases from inception to February 2024, utilizing a search strategy incorporating terms related to "Bone mineral density" and "Cushing syndrome". Eligible studies must include adult or pediatric patients diagnosed with any form of eCS, encompassing Cushing disease (CD), adrenal adenoma, mild autonomous cortisol secretion or ectopic ACTH-secreting tumors, who received treatment resulting in CS resolution. These studies must either present lumbar spine (LS) or femoral neck (FN) BMD measurements in the form of T-score, Z-score or actual BMD values before and after CS resolution, or report mean differences (MD) of BMD, or provide individual BMD data. Point estimates with corresponding standard errors were extracted from each study and combined using the generic inverse variance method. Meta-regression analysis was utilized to explore the impact of time after resolution of eCS on BMD improvement.A total of 5,085 records were identified from the databases. After systematic review, 14 studies, including a total of 386 patients, were deemed eligible for analysis. The meta-analysis demonstrated that resolution of eCS resulted in statistically significantly improvement of LS BMD (pooled MD: Z-score: +0.76, 95%CI 0.50 – 1.02, I2 76%; T-score: +0.87, 95%CI 0.55 – 1.19, I2 78%; actual BMD: +0.092 g/cm2, 95%CI 0.060 – 0.124, I2 74%) and FN BMD (pooled MD: Z-score: +0.54, 95%CI 0.32 – 0.76, I2 75%; T-score: +0.38, 95%CI 0.25 – 0.51, I2 0%; actual BMD: +0.041 g/cm2, 95%CI 0.021 – 0.062, I2 0%). The meta-regression analysis revealed a statistically significant association between follow-up time and improvements in LS T-score BMD (predicted LS T-score improvement = 0.42 + 0.062 × year, p = 0.027) and FN Z-score BMD (predicted FN Z-score improvement = 0.35 + 0.037 × year, p = 0.003), but not with LS Z-score and FN T-score.In summary, our study presents the extent of improvement in LS and FN BMD following the resolution of eCS based on all available data in the literature. These findings have clinical significance as they offer guidance for management of osteoporosis following the resolution of eCS. Presentation: 6/3/2024

ObjectiveWe aimed to determine whether the concomitant combination therapy of anabolic agents and bisphosphonates produces more effects on bone mineral density (BMD) than anabolic agents alone in patients with osteoporosis.MethodsWe...

ObjectiveTo evaluate three Tai Chi (TC) exercise programs as intervention measures to compare their effects on improving rate of change in bone mineral density (BMD) in elderly individuals with osteoporosis (OP) and to propose the optimal exercise duration.MethodsA randomized controlled trial (RCT) was conducted to identify study participants based on inclusion and exclusion criteria. Due to subject attrition, the number of participants analyzed decreased from 60 to 49. These participants were divided into four groups: 24-style TC Chuan group (24TCCG) (n = 13, 7 males/6 females), TC Kung Fu Fan group (TCKFFG) (n = 12, 5 males/7 females), TC Softball group (TCSBG) (n = 11, 6 males/5 females), and a control group (CG) (n = 13, 6 males/7 females). Except for the control group, each group received different TC exercise programs four times a week for 60 min per session, lasting for 16 weeks. BMD was measured using dual-energy X-ray absorptiometry (DXA) at the L2-L4 lumbar vertebrae, Ward's triangle, femoral neck, and greater trochanter. The rate of change of BMD was calculated using the formula.ResultsCompared with CG, all three TC groups showed significant improvements in BMD changes (P < 0.05), but their effects on the improvement of femoral neck and greater tuberosity BMD change rates were similar (P > 0.05). In addition, compared to the other exercise regimens, 24TCCG demonstrated more significant improvements in BMD at the L2-L4 lumbar vertebrae region and exhibited a more pronounced improvement in Ward's triangle BMD after only 8 weeks (P < 0.05). Short-term (≤ 4 weeks) TCKFFG was more effective than TCSBG in enhancing femoral neck BMD (P < 0.05). However, statistical significance was not found (P > 0.05) in all other cases.ConclusionThese three TC exercise programs have similar positive effects on the BMD of the femoral neck and greater trochanter. However, compared with other exercise schemes, 24TCC showed a more significant improvement in BMD of the L2-L4 lumbar vertebrae region after just 8 weeks, as well as a more pronounced improvement in BMD of Ward's triangle. In terms of improving femoral neck BMD, TCKFF was found to be more effective than TCSB in less than 4 weeks. This study provides evidence for the effectiveness of TC exercise in improving BMD and preventing OP in the middle-aged and elderly high-risk population.

BackgroundOsteoporosis is one of the major comorbidity in patients with rheumatoid arthritis (RA). A low bone mineral density (BMD), especially in the femoral neck, was associated with the presence of...

Low bone mass is an important feature of adolescent idiopathic scoliosis (AIS), which is a complex 3D spinal deformity that affects girls during puberty. However, no clinical imaging modality is suitable for regular monitoring on their spinal bone qualities in rapid growth period. Therefore, we investigated whether bone mineral density (BMD) and bone microstructure at non-spinal sites correlated with BMD and mechanical property in the spine in AIS patients. Thirty-two AIS girls (16.7 ± 3.5years old with mean Cobb angle of 67 ± 11°) who underwent pre-operative spine CT examination for navigation surgery were recruited. Volumetric BMD (vBMD) of lumbar spine (LS) was measured by quantitative computed tomography (QCT), vBMD and bone microstructure of distal radius (DR) by high-resolution peripheral QCT (HR-pQCT) and areal BMDs of total hip (TH) and femoral necks (FN) by dual-energy X-ray absorptiometry (DXA). Biomechanical properties of the DR and LS were estimated by finite element analysis (FEA). Pearson correlation was performed to study the correlation between bone parameters at these three sites. LS vBMD correlated significantly with both FN and TH aBMD (R = 0.663-0.725, both p< 0.01) and with DR microstructural parameters (R = 0.380-0.576, all p < 0.05). Mechanical properties of LS and DR were also correlated (R = 0.398, p= 0.039). Bone measurement at proximal femur and distal radius could provide an additional predictive power in estimating the bone changes at spine, which is the primary site of deformity in AIS patients. Our result indicated that DXA and HR-pQCT could provide a valid surrogate for spine bone measurements in AIS patients.

Bisphosphonates may increase BMD at the femoral neck, lumbar spine, and forearm compared to placebo after two years' therapy. Zinc supplementation probably increases BMD at the lumbar spine and hip after 12 months. Denosumab may make little or no difference to BMD, and we are uncertain about the effect of strontium on BMD. We recommend further long-term RCTs on different bisphosphonates and zinc supplementation therapies in people with beta-thalassaemia-associated osteoporosis.

Objective To systematically assess the efficacy of alendronate in improving bone mineral density (BMD) in postmenopausal women. Methods The databases such as the Cochrane Library, PubMed, EMBASE, CBM, CNKI and VIP were electronically searched for all randomized controlled trials (RCTs), with deadline of September 2013, without language restrictions. Women with postmenopausal osteoporosis were included as the research objects, the RCTs on the efficacy comparison between alendronate (tablets) and placebo were collected, and the quality of clinical trials were evaluated. RevMan5.2 software was used for analysis.Meta regression models were established by using the Stata11.0 software to discuss the source of heterogeneity of primaryindex for assessment of curative effect. Results Twelve studies with 5 466 patients were included. Meta analysis on primary and secondary curative effect index showed that compared with placebo, alendronate (10mg daily/1 year, 10mg daily/2-3 years and 5mg daily/2-3 years) significantly increased BMD at the lumbar spine, total hip, trochanter and femoral neck, and the changes oflumbar BMD were in maximum (WMD=5.39, 7.70 and 5.99, 95%CI: 4.03-6.76; 6.96-8.43; 5.16-6.82; respectively), followed by the trochanter and the femoral neck, and the BMD was increased with the medication time and dosage. Conclusions Alendronate could effectively increase BMD in postmenopausal women, and we recommend that the treatment course of alendronate should be 2-3 years at least. Key words: Alendronate; Bone mineral density; Menopause

Efficacy of zoledronic acid for prevention of bone loss in early-stage breast cancer patients receiving adjuvant therapy: A meta-analysis of 13 randomized controlled trials

Patients with primary hyperparathyroidism (PHPT) have higher bone turnover, lower bone mineral density (BMD), and an increased risk of fractures. They also have a high incidence of low vitamin D levels (25-OH-vitamin D <50 nmol/L) that could worsen the negative effect on the bone. In this double-blinded clinical trial, 150 patients with PHPT were randomized, after successful parathyroidectomy (PTX), to 1-year daily treatment with either cholecalciferol 1600 IU and calcium carbonate 1000 mg (D+) or calcium carbonate alone (D-). BMD was measured in the lumbar spine, femoral neck, total hip, distal and 33% radius using dual-energy X-ray absorptiometry (DXA) before surgery and after 1 year of study medication. Median age was 60 (range 30-80) years and there were 119 (79%) women and 31 (21%) men; 76% had 25-OH-D <50 nmol/L before PTX and 50% had persistent elevated parathyroid hormone (PTH) 6 weeks after PTX. A similar increase in BMD in the lumbar spine, femoral neck, and total hip was observed in both groups (D+ : 3.6%, 3.2%, and 2.7%, p<0.001, respectively; and D-: 3.0%, 2.3%, and 2.1%, respectively, p<0.001). Patients with vitamin D supplementation also increased their BMD in distal radius (median 2.0%; interquartile range, -1.7% to 5.4%; p=0.013). The changes in BMD, especially in the hips, were correlated to the baseline concentrations of PTH, ionized calcium, and bone markers (p<0.001). A benefit from vitamin D substitution was observed among patients with a persistent postoperative PTH elevation, who also improved their BMD at 33% radius and radius ultradistal (p<0.05). In conclusion, except for a minor improvement of radius BMD, our data show no beneficial effect on BMD or bone turnover markers of vitamin D supplementation after PTX. Preoperative PTH seems to have the strongest association with improvement in BMD.

Increased Bone Mineral Density in Male Patients With Idiopathic Hypogonadotropic Hypogonadism Who Undergo Sex Hormone Therapy: Findings From Cross-Sectional and Longitudinal Studies