Relationship between bone mineral density, trabecular bone score and uric acid level in postmenopausal women with rheumatoid arthritis

Aging is associated with a decrease in bone mass and quality. This community-based prospective cohort study investigated longitudinal changes in bone phenotype in Korean adults. We analyzed data from a prospective community-based cohort study, the Korean Genome and Epidemiology Study. Postmenopausal women and men who underwent dual-energy X-ray absorptiometry at least twice from 2007 to 2014 were included. Longitudinal changes in bone mineral density (BMD) and trabecular bone score (TBS) over 6years were analyzed by sex, age, and body mass index. A total of 1895 subjects were enrolled (men 965; postmenopausal women 929). The femoral neck (FN) BMD, total hip (TH) BMD, and lumbar spine (LS) TBS decreased significantly over time, but the LS BMD increased significantly. In men, the average annual changes were 0.3% in LS BMD (p< 0.001), - 0.33% in FN BMD (p< 0.001), - 0.26% in TH BMD (p= 0.001), and - 0.27% in LS TBS (p< 0.001). In women, the average annual changes were 0.27% in LS BMD (p< 0.001), - 0.67% in FN BMD (p< 0.001), - 0.66% in TH BMD (p< 0.001), and - 0.27% in LS TBS (p< 0.001). The longitudinal decrease in TH BMD over time was significantly greater in women (versus men) and those who were older (versus younger). The FN and TH BMDs decreased with aging. But, the LS BMD was inappropriate to evaluate longitudinal changes of bone loss. The LS TBS could be alterative.

The aim – to assess bone mineral density (BMD) and microarchitecture, as well as the risk of fractures in postmenopausal women with rheumatoid arthritis (RA). Materials and methods: 95 postmenopausal women (mean age 62.3±8.1 years) with a confirmed RA were included. All patients underwent a questionnaire, clinical and laboratory examination, dual-energy X-ray absorptiometry (DXA) of the lumbar spine (L1–L4), proximal femur, and trabecular bone score (TBS) assessment. The 10-year probability of osteoporotic fracture was calculated using the FRAX tool without including femoral neck (FN) BMD (BMD–), with FN BMD (BMD +) and additionally adjustment for TBS (BMD + TBS). Results. Osteoporosis (OP) was found in 41 (43.2%) patients: in L1–L4 – in 26,3%, in FN – in 22.1%, and in the total hip (TH) – in 11.6% persons. Degraded microarchitecture according to TBS was found in 38.9% of patients, partially degraded – in 25.3%, and normal – in 35.8% of women with RA. A high risk of fracture according to FRAX BMD– was detected in 49.5% of patients. TBS correlated with age (r=–0.30; p=0.003), duration of postmenopausal period (r=–0.26; p=0.014), cumulative dose of glucocorticoids (GCs) (r=–0.34; p=0.045), FRAX BMD– (r=–0.24; p&lt;0.05) and FRAX BMD+ (r=–0.21; p&lt;0.05); L1–L4 BMD (r=0.43; p&lt;0.001), FN BMD (r=0.21; p=0.038), TH BMD (r=0.23; p=0.02). Low TBS was significantly more often detected in people with a history of fractures compared to people without them (p&lt;0.05). Among RA patients with normal L1–L4 BMD 9.5% of persons had degraded microarchitecture of bone tissue according to TBS. The inclusion of TBS in FRAX increased the risk of fractures to high in 9.5% of patients and reduced it to low in 7.4% of women, due to which the total number of people with RA who had a high risk of fractures became 54.7%. Conclusion. OP was diagnosed in 43.2%, and degraded microarchitecture of bone tissue according to TBS – in 38.9% of postmenopausal women with RA. A high risk of fractures according to FRAX was found in 49.5%. TBS negatively correlated with age, duration of postmenopause, cumulative GCs dose, FRAX fracture risk, and positively correlated with BMD in all measurement sites. The FRAX adjustment by TBS redistributed patients in risk groups, as a result of which 54.7% of RA patients needed anti-osteoporotic treatment.

HIV infection and antiretroviral therapy (ART) have been associated with decreased bone mineral density (BMD). This study aims to evaluate long-term changes in trabecular bone score (TBS), a novel index that estimates bone microarchitecture, and BMD among Chinese persons with HIV (PWH) treated with ART. We conducted a retrospective chart review of adult PWH at a large tertiary care hospital in China. Patients who had a DXA scan prior to ART and at least one follow-up DXA after ART initiation were included. Subgroup analyses examined the TBS and BMD changes in patients who switch from a non-TDF-containing regimen to one containing TDF, as compared to those who did not switch. Four hundred fifty-nine PWH were included. Among 68 patients ≥ 50 years, 13 patients (19.1%) had a normal BMD but partially degraded or degraded TBS. The mean percent decrease in lumbar spine (LS) BMD nadired at 48 weeks after ART initiation and then gradually improved. Percent decrease in femoral neck (FN) and total hip (TH) BMD nadired at 96 weeks and remained stably low thereafter. After switch to a TDF-containing regimen, only percent change in TH BMD was significant (-3.2%, p = 0.006). In the regression analyses, switch to a TDF-containing regimen was not associated with long-term change in TBS or BMD. This is the first study among PWH to evaluate the long-term impact of ART on TBS and BMD. At baseline, approximately 20% of patients had a normal BMD but impaired bone microstructure based upon TBS. For patients with 5 years of exposure to ART, there is a stabilization of TBS and BMD after initial nadir in the first 144 weeks. However, FN BMD, TH BMD, and TBS remained low at 5 years relative to baseline.

Identification of Rheumatoid Arthritis Patients With Vertebral Fractures Using Bone Mineral Density and Trabecular Bone Score

BackgroundIn patients with axial spondyloarthritis, vertebral fracture risk is elevated and not always correlated with bone mineral density (BMD). Trabecular bone score (TBS) may offer some advantages in the assessment of vertebral fracture risk in these patients. The primary objective of this study was to compare TBS and BMD between axial spondyloarthritis patients depending on their vertebral fracture status. Secondary objectives were to estimate the prevalence of morphometric vertebral fractures, and to explore factors associated with fracture, as well as the interference of syndesmophytes on BMD and TBS.MethodsA cross-sectional study was conducted. Data were collected on demographic and clinical characteristics, lab results, imaging findings and treatment. Statistical analysis was performed using SPSS v.13 statistical software.ResultsEighty-four patients (60 men and 24 women; mean age of 59 years) were included. Nearly half (47.6%) of them had lumbar syndesmophytes. The rate of morphometric fracture was 11.9%. TBS showed a higher area under the curve (0.89) than total hip, femoral neck and lumbar BMD (0.80, 0.78, and 0.70 respectively) for classifying patients regarding their fracture status. Nonetheless, the differences did not reach statistical significance.Syndesmophytes affected lumbar spine BMD (p < 0.001), but not hip BMD or TBS. Fractures were associated with TBS, total hip BMD, erythrocyte sedimentation rate and C-reactive protein levels.ConclusionsWe identified decreased TBS and total hip BMD, as well as increased erythrocyte sedimentation rate and C-reactive protein levels as factors associated with morphometric vertebral fractures. Unlike lumbar spine BMD, TBS is not affected by the presence of syndesmophytes.

Aim: to study the association between bone mineral density (BMD) and uric acid (UA) level in postmenopausal women. Materials and methods. 263 women were examined (median age 62 [56; 67] years). A clinical examination and assessment of UA level were performed. Dual-energy X-ray absorptiometry was done to assess BMD in standard regions of interest (ROI): lumbar spine (L1-L4), femoral neck (FB) and total hip (TH) and trabecular bone score (TBS). Results. The frequency of hyperuricemia in postmenopausal women was 12.5 %, and in persons with osteoporosis (OP) – 10.1 %. UA correlated significantly with BMD and T-score in L1-L4 (r = 0.20 and r = 0.19, respectively) and TH (r = 0.18 and r = 0.16, respectively). No correlation was found between UA and TBS value (p &gt; 0.05). Linear regression analysis adjusted for age showed a significant association between UA and BMD in all ROI (b*L1-L4 = 0.21, p = 0.001; b*FN = 0.14, p = 0.024; b*TH = 0.20, p = 0.002). In women with UA level ≥ 200 mmol/l, the BMD and T-score in all ROI were significantly higher, and the frequency of OP was lower compared with women with UA &lt; 200 mmol/l (p &lt; 0.05 for all comparison). Conclusion. Hyperuricemia was found in 12.5 % of postmenopausal women, and in 10.1 % of patients with OP. Significant differences in BMD, T-score, and OP frequency were found in all ROI, depending on the UA level. The mean value of TBS and the frequency of degraded bone microarchitecture did not differ depending on the UA level.

IntroductionType 2 Diabetes (T2D) is associated with fractures, despite preserved Bone Mineral Density (BMD). This study aimed to evaluate the relationship between BMD and trabecular bone score (TBS) with the reallocation of fat within muscle in individuals with eutrophy, obesity, and T2D. MethodsThe subjects were divided into three groups: eutrophic controls paired by age and sex with the T2D group (n = 23), controls diagnosed with obesity paired by age, sex, and body mass index with the T2D group (n = 27), and the T2D group (n = 29). BMD and body fat percentage were determined using dual-energy X-Ray absorptiometry. TBS was determined using TBS iNsight software. Intra and extramyocellular lipids in the soleus were measured using proton magnetic resonance spectroscopy. ResultsTBS was lower in the T2D group than in the other two groups. Glycated hemoglobin (A1c) was negatively associated with TBS. Body fat percentage was negatively associated with TBS and Total Hip (TH) BMD. TH BMD was positively associated with intramuscular lipids. A trend of negative association was observed between intramuscular lipids and TBS. ConclusionThis study showed for the first time that the reallocation of lipids within muscle has a negative association with TBS. Moreover, these results are consistent with previous studies showing a negative association between a parameter related to insulin resistance (intramuscular lipids) and TBS.

Objective: To explore bone mass changes in patients with SAPHO syndrome, utilizing bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) and vertebral bone quality (VBQ) scores measured by MRI. Methods: Thirty-six patients with SAPHO syndrome at Peking Union Medical College Hospital from February 2014 to February 2024 were retrospectively collected with 36 age- and gender-matched healthy controls. DXA assessed BMD, corresponding T-score and Z-score of the lumbar spine (LS), femoral neck (FN), total hip (TH), and trabecular bone score (TBS). LS MRI T1-weighted imaging (T1WI) measured the VBQ scores. Correlations between BMD, TBS, and VBQ scores were analyzed using Pearson correlation. The predictive efficacy of VBQ scores for low bone mass and impaired bone microarchitecture in patients with SAPHO syndrome was assessed using receiver operating characteristic (ROC) curves, with the area under the curve (AUC), optimal diagnostic cut-off values, sensitivity, and specificity documented. Results: The mean age of patients with SAPHO syndrome was (44.8±9.5) years, with 8 (22.2%) males. There were 36 subjects in the control group with a mean age of (44.8±9.5) years and 8(22.2%) males. Compared to the controls, the case group had lower FN BMD, TH BMD, corresponding T-score and Z-score, TBS, and higher VBQ scores (all P<0.05). Compared to the controls, female patients in the case group had lower LS BMD, FN BMD, TH BMD, corresponding T-score and Z-score, TBS, and higher VBQ scores (all P<0.05), whereas only male patients in the case group had higher VBQ scores (P=0.028). Ten cases (27.8%) in the case group had low bone mass and 19 cases (52.8%) had impaired bone microarchitecture, higher than the 3 cases (8.3%) and 9 cases (25.0%) in controls respectively (both P<0.05). VBQ scores in the case group were negatively correlated with FN BMD, FN T-score, TH BMD, TH T-score, and TBS (r=-0.375, -0.391, -0.368, -0.361, and -0.389, respectively, all P<0.05). The AUCs of VBQ scores for predicting ROC curves of low bone mass and impaired bone microarchitecture in patients with SAPHO syndrome were 0.796 (95%CI: 0.649-0.944) and 0.694 (95%CI: 0.521-0.866), with a sensitivity of 100.0% and 47.4%, and a specificity of 53.9% and 88.2%, respectively. Conclusions: Patients with SAPHO syndrome present with low bone mass and impaired bone microarchitecture. VBQ score has a high sensitivity for predicting low bone mass and a high specificity for predicting impaired bone microarchitectural in patients with SAPHO syndrome.

The aims of the study were to determine the mean trabecular bone score (TBS) of postmenopausal Taiwanese women and to analyze the value of TBS in predicting osteoporosis. A total of 1,915 postmenopausal women with lumbar spine and hip bone mineral density (BMD) and spine TBS were enrolled from a single medical center into this study. The women's BMD and TBS were measured using dual x-ray absorptiometry (Discovery Wi; Hologic, Bedford, Mass) and iNsight software (Med-Imaps SASU, Merignac, France), respectively. The women's demographic characteristics; lumbar spine, total hip, and femoral neck BMD; and lumbar spine TBS were recorded, and correlations among the parameters were identified using a 2-tailed Pearson test, in which a P value less than 0.05 was considered statistically significant. We developed simple linear regression models to represent changes related to TBS and performed an analysis of variance on the selected variables. The average age of the women was 62.5 ± 9.1 years (range, 25.7-93.7 years). The mean TBS was 1.300 ± 0.086 (range, 1.015-1.596). The TBS was weakly and negatively correlated with body mass index ( r = -0.078) and moderately and positively correlated with the lumbar spine BMD ( r = 0.619). The patients' lowest BMD values among those measured at multiple sites revealed a higher rate of osteoporosis (32.5%) than those measured at individual sites. Degraded TBS were noted in 21.2% of the participants, and a combination of BMD and TBS results predicted more individuals (7.8%) at a high risk of fracture than did the BMD result only. The rates of both osteoporosis and degraded TBS increased with age. Bone mineral density and TBS can be used in combination to predict osteoporosis in a greater number of postmenopausal Taiwanese women. Because the incidence of osteoporosis is the highest among older women, clinicians should pay careful attention to TBS degradation among older patients without low BMD.

Trabecular Bone Score Change Differs with Regard to 25(OH)D Levels in Patients Treated for Adult-Onset Growth Hormone Deficiency

Background: Inconsistent epidemiological evidence between uric acid (UA) and bone mineral density (BMD) has been observed. Therefore, we evaluated the association between UA and BMD in Mexican adults. Methods: This analysis was conducted on 1423 participants from the Health Workers Cohort Study. We explored cross-sectional associations using linear regression and longitudinal associations using fixed-effects linear regression by sex and age groups (<45 and ≥45 years). Results: In females <45 years old, the cross-sectional analysis showed that UA levels were positively associated with total hip BMD. However, in the longitudinal analysis, we observed a negative association with the femoral neck and lumbar spine BMD. In contrast, in males <45 years old, we found an increase in total hip and femoral neck BMD in the groups with high levels of UA in the longitudinal association. On the other hand, in females ≥45 years old, we observed a longitudinal association between UA and loss of BMD at different sites. We did not observe an association between UA levels and BMD in males ≥45 years old. Conclusions: Our results suggest higher serum UA levels are associated with low BMD at different skeletal sites in Mexican females. Further studies are needed to delineate the underlying mechanisms behind this observation.

9075 Background: The primary analysis at 12 months (12M) of the Z-/ZO-FAST studies demonstrated that the loss of bone mineral density (BMD) could be effectively prevented by zoledronic acid (ZA). But there has been few definitive data about aromatase inhibitor (AI)-associated bone loss in Asian women. This study was designed to evaluate an upfront or delayed strategy of bone protection therapy with ZA administered at 4mg every 6Ms in postmenopausal Japanese women with early breast cancer receiving adjuvant letrozole (LET) to compare with results of the Z-/ZO-FAST studies in Western countries. Methods: Postmenopausal women with hormone receptor positive early breast cancer receiving adjuvant LET were randomly assigned to receive either upfront or delayed-start ZA (4mg intravenously every 6Ms). The delayed group received ZA when lumbar spine (L2-L4) BMD decreased to less than young adult mean (YAM) – 2.0 S.D or when a nontraumatic fracture occurred. The primary endpoint of this study was to compare the percent change in L1-L4 BMD at 12M between the groups. Secondary endpoints included percent changes in L2-L4 and total hip (TH) BMD and changes in serum bone turnover markers at 12M. Results: The upfront and delayed groups included 94 and 95 patients, respectively. At 12M, L1-L4, L2-L4, TH BMD significantly decreased by 2.0%, 2.4%, 2.4%, respectively, in the delayed group. L1-L4 BMD was 4.9% higher in the upfront group than in the delayed group (95% CI, 3.9-5.8%; p<0.001). L2-L4 BMD was 5.6% higher (95% CI, 4.5-6.6%; p< 0.001), and TH BMD was 4.4% higher (95% CI, 3.3-5.4%; p<0.001). In the upfront group, mean serum N-telopeptide and bone-specific alkaline phosphatase concentrations decreased by 23.6% (p< 0.001) and 39.4% (p<0.001), respectively, at 12M, whereas concentrations tended to increase in the delayed group by 9.4% (p=0.26) and 10.2% (p= 0.46), respectively. Conclusions: At 12M, upfront ZA therapy prevented bone loss in postmenopausal Japanese women who were receiving adjuvant LET, confirming the Z-/ZO-FAST study results in Western countries.

BACKGROUND: Different cytokines could affect bone tissue in patients with rheumatoid arthritis (RA). For formulation clinically significant conclusions about cytokines role in status of bone tissue in RA patients, actual studies are needed to obtain more data.AIM: To study the association of bone mineral density (BMD) with immunological and humoral factors in postmenopausal RA women.MATERIALS AND METHODS: The study included 73 postmenopausal women with RA (median age 63.0 [56.0; 67.0] years). A clinical and laboratory examination was performed including dual-energy X-ray absorptiometry to assess BMD of the lumbar spine (L1–L4), femoral neck (FN) and total hip (TH), level measurement of C-reactive protein (CRP), rheumatoid factor (RF), antibodies to cyclic citrullinated peptide (ACCP), parathyroid hormone (PTH), myostatin, follistatin, interleukin 6 (IL-6), IL-6 receptors, insulin-like growth factor 1, adiponectin, leptin, fibroblast growth factor 23, tumor necrosis factor (TNF) SF12.RESULTS: Persons with osteoporosis (OP) have higher levels of adiponectin (p=0.002), TNF SF12 (p=0.015) and IL-6 receptors (p=0.014) compared to those without OP. L1–L4, FN and TH BMD positively correlated with leptin and IL-6; negative correlation was found between L1–L4 BMD and adiponectin, FN BMD and follistatin, TH BMD and TNF SF12 (p&lt;0.05). Linear regression analysis revealed significant associations between L1–L4 BMD and PTH (β= -0.22), adiponectin (β=-0.36) and leptin (β=0.35); FN BMD with CRP (β=-0.23), ACCP (β=-0.21), PTH (β=-0.35), IL-6 (β=0.37) and leptin (β=0.32); TH BMD with CRP (β=-0.22), AСCP (β=-0.24), PTH (β=-0.30), adiponectin (β=-0.28) and leptin (β=0.42).CONCLUSION: The conducted study showed that BMD in L1-L4, FN and TH is associated with the level of CRP, ACCP, PTH, adiponectin, leptin and IL-6 in postmenopausal women with RA.

Our objective was to compare and contrast predictors of changes in TBS, total hip BMD, and lumbar spine BMD. Our study population was 3969 Osteoporotic Fractures in Men (MrOS) cohort participants (mean age 72.8years) with repeat measures of TBS, lumbar spine and total hip BMD, body mass index (BMI) less than 37kg/m2, and no use of bisphosphonate or glucocorticoid medications. TBS was scored (Med-Imaps Software version 2.1) and BMD measured on Hologic densitometers. One thousand four hundred forty-four men had a TBS decrease >0.04units (estimated least significant change for TBS), 795 men had a TBS increase >0.04units, and 1730 men had TBS change ≤0.04units over mean follow-up of 4.6years. Older age was not associated with TBS change, but was associated with greater decline in lumbar spine and total hip BMD. Compared to stable weight, >10% weight loss was strongly associated with an increase in TBS [effect size =1.24 (95% CI 1.12, 1.36)] and strongly associated with a decrease in total hip BMD [-1.16 (95% CI -1.19, -1.03)]. Other predictors discordant for longitudinal changes of TBS and BMD included baseline BMI, walk speed, and ACE inhibitor use. Predictors of changes in TBS are different from predictors of changes in lumbar spine and total hip BMD. At least when assessed on Hologic densitometers, weight loss is associated with subsequent declines in spine and total hip BMD but subsequent increase in TBS. Faster walk speed may protect against loss of hip BMD, but is not associated with longitudinal changes of TBS.

Despite many studies about local and systemic interactions between bone and muscle, the more dominant interaction remains unclear. We aimed to compare the association of skeletal muscle mass with bone mineral density (BMD) at the femur, which seemed more likely affected by local interaction, and the association of skeletal muscle mass with BMD at the lumbar spine (LS-BMD) and the trabecular bone score (TBS), which seemed more likely affected by systemic interaction. In 279 women, we measured the femoral neck BMD (FN-BMD), total hip BMD (TH-BMD), LS-BMD, and TBS. Appendicular skeletal muscle mass (ASM), lean mass (LM), and other LM (OLM; remaining LM excluding ASM) were measured using bioelectrical impedance analysis. ASM (β = 0.008-0.014, p < 0.001-0.014), OLM (β = 0.006-0.011, p < 0.001-0.044), and LM (β = 0.004-0.007, p < 0.001-0.020) were positively associated with FN-BMD and TH-BMD, but not with LS-BMD or TBS. The positive association of ASM, but not of OLM, was stronger than that of LM (p = 0.023). Odd ratios (ORs) with 95% confidence intervals (95% CIs) for osteoporosis were statistically significant for ASM (OR 0.74, 95% CI 0.59-0.93) and marginally significant for OLM (OR 0.80, 95% CI 0.64-1.01) in the femur, but not in the LS. The direct and indirect (through OLM) effects of ASM on BMD were 69.1-72.2% and 27.8-30.9%, respectively. In the conclusion, ASM was more positively associated with FN-BMD, but not with LS-BMD and TBS, than OLM. This suggests stronger effects of local interaction than systemic interaction between muscle and bone.