Bone Mineral Density Percentage Research Articles

Effectiveness of bisphosphonates on bone mineral density in osteopenic postmenopausal women: A systematic review and network meta-analysis of randomized controlled trials.

Background:Various bisphosphonate agents have been proven to be effective in preventing bone loss and fracture in osteopenic postmenopausal women. This study was designed to compare the effectiveness of various BPs on preventing the loss of bone mineral density (BMD) for postmenopausal women with osteopenia.Methods:PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were screened up to identify randomized controlled trails comparing effectiveness of BPs or placebo on the BMD of postmenopausal women with osteopenia. Network meta-analysis and standard pair-wise meta-analyses were performed. The main outcomes include the percentage changes of 6-, 12-, 24-, and 36-month BMD at lumbar, total hip and femoral neck, and frequencies of new fractures and severe adverse events.Results:Fourteen randomized controlled trials were eligible, involving 11,540 participants. No significant difference was presented among the available interventions for the 6-month BMD at 3 different sites, but the magnitudes of differences among the treatment regimens became gradually increased along with the extending of follow-up periods. Daily aledronate of more than 5 mg provided the maximal percentage increase on BMD of femoral neck and lumbar spine, while zoledronate provided maximal change on BMD of total hip, at different follow-up periods. This network meta-analysis also demonstrated similar frequencies of new clinical fractures and severe adverse events among different interventions.Conclusions:A ranking spectrum depicting the effectiveness on BMD percentage change following interventions with different bisphosphonate regimens was provided. Generally, regimens with zoledronate and aledronate were found to be the most effective interventions in the 3 sites at different end points.

Characteristics Of Bone Mineral Density In College Students With Low/Normal Weight Obesity

PURPOSE: Investigate the bone mineral density(BMD) of college students, and analyze the characteristics of the BMD of low/normal obese college students. METHODS: The subjects of the study were 519 low/normal-weight students(18-23 years old), including 383 women and 136 men. The dual-energy X-ray test method was used to detect the percentage of body fat and BMD of college students. The BMD of obese people with low/normal weight was compared with those of non-obese people. Partial correlation analysis was used to analyze the relationship between body mass index(BMI), body fat percentage(BF%) and BMD. RESULTS: 1)Among the low-weight male college students, the whole body BMD, T-value and Z-value of the low weight obese students were lower than those of the low weight non-obese students (2.01 ± 0.22 vs 1.82 ± 0.04 g/cm2; -0.02 ± 0.15 vs -1.10 ± 0.24;-0.01 ± 0.43 vs -0.94 ± 0.64,P < 0.01);2)Among low-weight male college students, the BMD of the upper limbs, thighs, ribs, and pelvis of the low weight obese students was lower than that of the low weight non-obese students (0.68 ± 0.03 vs 0.57 ± 0.01; 1.20 ± 0.04 vs 0.96 ± 0.02;0.87 ± 0.04 vs 0.79 ± 0.06;0.78 ± 0.02 vs 0.69 ± 0.04; 0.91 ± 0.06 vs 0.77 ± 0.06 g/cm2,P < 0.01);3)Among low-weight female college students, the body BMD of the low weight obese students was lower than that of the low weight non-obese students (1.31 ± 0.29 vs 1.13 ± 0.48 g/cm2; P < 0.05);4)Among low-weight female college students, the BMD of the head, upper limbs, thighs, and trunk of the low weight obese students was lower than that of the low weight non-obese students (1.48 ± 0.57 vs 1.23 ± 0.72; 0.74 ± 0.13 vs 0.65 ± 0.20;1.07 ± 0.10 vs 1.02 ± 0.11;0.86 ± 0.07 vs 0.82 ± 0.07 g/cm2,P < 0.05); 5)In male college students, BMI was positively correlated with BMD, T-value and Z value (r = 0.694; 0.676; 0.612,P < 0.01), while BF% was negatively correlated with BMD, T-value and Z value (r = -0.523; -0.509; -0.488,P < 0.01); 6)In female college students, BMI was positively correlated with T-value and Z-value(r = 0.455; 0.261,P < 0.01), and BF% was negatively correlated with T-value and Z-value(r = -0.224; -0.225,P < 0.01). CONCLUSIONS: Low/Normal weight obese college students have poorer bone mineral density. Intervention to promote BMD in this population is of great significance for the prevention of osteoporosis.

Efficacy and Safety of Postmenopausal Osteoporosis Treatments: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.

Although a range of pharmacological interventions is available, it remains uncertain which treatment for osteoporosis is more effective. This network meta-analysis study aimed to compare different drug efficacy and safety in randomized controlled trials (RCTs) for the treatment of postmenopausal osteoporosis. PubMed, EMBASE, MEDLINE, Clinicaltrial.gov, Cochrane library, Google scholar were searched up to 31 October 2020. Randomized placebo-controlled trials that reported measures of bone mineral density (BMD) percentage change and/or numbers of adverse events of postmenopausal osteoporosis patients were included. Network meta-analysis was conducted using frequentist approach. Ninety-four RCTs comprising 15,776 postmenopausal osteoporosis females were included in the network meta-analysis. Compared with placebo, most interventions showed increase in BMD change. According to surfaces under the cumulative ranking curves (SUCRAs), strontium ranelate, fluoride, and hormone replacement therapy were most effective in increasing total hip, lumbar spine, and distal radius BMD, respectively. Parathyroid hormone (PTH) was most effective in preventing new hip fracture. When taking into account all anatomic sites, bisphosphonate (BP), monoclonal antibody (mAb), and fluoride have a balanced efficacy in increasing BMD at all sites. Considering both the effectiveness of increasing BMD and preventing hip fracture, mAb, BP, and PTH are more favorable among all interventions. The treatment effects of different medications on BMD percentage change are anatomic site-dependent. After weighing anti-osteoporosis treatment efficacy against risk of complications, BP and mAb are the more favorable interventions to increase BMD at all sites and reduce the risks of hip fracture and death.

Real-time assessment of guided bone regeneration in critical size mandibular bone defects in rats using collagen membranes with adjunct fibroblast growth factor-2

Background/purposeFibroblast growth factor-2 (FGF-2) regulates bone formation. The concept of guided bone regeneration using a resorbable collagen membrane (RCM) is generally accepted in implant dentistry. This study aimed to investigate the bone healing pattern in rat mandibular bone defects in real-time with and without RCM containing FGF-2 (RCM/FGF-2). Materials and methodsCritical-size circular bone defects (4.0 mm diameter) were created on both sides of the rat mandibular bone. The defects were randomly divided into the following groups: control, RCM alone, RCM containing low (0.5 μg) or high (2.0 μg) concentration of FGF-2. We performed real-time in vivo micro-computerized tomography scans at the baseline and at 2, 4, and 6 weeks, and measured the volume of newly formed bone (NFB), bone mineral density (BMD) of NFB, and the closure percentage of the NFB area. At 6 weeks, the mandibular specimens were assessed histologically and histomorphometrically to evaluate the area of new bone regeneration. ResultsReal-time assessment revealed a significant increase in the volume, BMD, and closure percentage of the NFB area in the RCM/FGF-2-treated groups than that in the control and RCM groups. In the H-FGF-2 group, the volume and BMD of NFB exhibited a significant increase at 6 weeks than that at the baseline. Histological evaluation revealed the presence of osteoblasts, osteocytes, and blood vessels within the NFB. ConclusionThe real-time in vivo experiment demonstrated that RCM/FGF-2 effectively promoted bone regeneration within the critical-size mandibular defects in rats and verified new bone formation starting in the early postoperative phase.

Effect of Tibolone on Bone Mineral Density in Postmenopausal Women: Systematic Review and Meta-Analysis.

Simple SummaryLow bone mineral density (osteoporosis) is associated with vertebral and nonvertebral fractures in postmenopausal women. Tibolone is a low-risk hormone replacement therapy alternative to estrogen therapy, effective in the treatment of menopausal symptoms and prevention of bone loss, but the evidence is controversial. This systematic review with meta-analysis summarizes the clinical trials of the tibolone effect on percentage change of bone mineral density in the lumbar spine, femoral neck, and total hip in postmenopausal women. The results show that tibolone 2.5 mg dose increases the percent change in bone mineral density compared with non-active controls at 24 months in lumbar spine and femoral neck, regardless of the scanner used to evaluate the bone mineral density. No difference was observed when 2.5 mg tibolone dose was compared with estrogen therapy at 24 months, and both treatments have a positive effect on the bone mineral density. In conclusion, tibolone increases bone mineral density compared to non-active controls, and there was no difference when it is compared to estrogenic therapy; thus, tibolone is an alternative treatment for menopausal symptoms and bone protection.Low bone mineral density (BMD) on postmenopausal women causes bone fragility and fracture risk. Tibolone seems to prevent bone loss. Therefore, this systematic review with meta-analysis synthesizes the tibolone effect on BMD percent change in lumbar spine (LS), femoral neck (FN), and total hip (TH) in postmenopausal women. Controlled trials that provided tibolone evidence on the efficacy of tibolone in preventing loss of BMD were included. Regarding the included studies, a pooled mean difference (MD) with 95% confidence intervals (95%CI) was estimated to determine the BMD percentage change. Eleven studies were identified and eight were included in the quantitative analysis. Tibolone at a dose of 2.5 mg increased BMD compared with non-active controls at 24 months in LS (MD 4.87%, 95%CI: 4.16–5.57, and MD 7.35%, 95%CI: 2.68–12.01); and FN (MD 4.85%, 95%CI: 1.55–8.15, and 4.21%, 95%CI: 2.99–5.42), with Hologic and Lunar scanners, respectively. No difference was observed when tibolone 2.5 mg dose was compared with estrogen therapy (ET) at 24 months, LS (MD −0.58%, 95%CI: −3.77–2.60), FN (MD −0.29%, 95%CI: −1.37–0.79), and TH (MD −0.12%, 95%CI: −2.28–2.53). Therefore, tibolone increases BMD in LS and FN compared to non-active controls, and there was no showed difference with ET.

Prevalence and predictive factors of undernutrition and low bone mineral density in children with chronic pancreatitis

BackgroundMalnutrition and bone disease are common in adults with chronic pancreatitis (CP). We studied the nutritional status and bone mineral density (BMD) of children with CP and the factors predicting them. MethodsCP children were prospectively evaluated with a detailed questionnaire, anthropometry, 25-hydroxy vitamin D, fecal elastase and BMD [total body less head (TBLH), spine and hip] by dual energy x-ray absorptiometry. Body mass index (BMI) Z score of −1 to −1.9, −2 to −2.9 and <-3 was taken as mild, moderate and severe malnutrition respectively. Low BMD and osteoporosis were defined as per International Society for Clinical Densitometry. Results83 children (46 boys, 14[4.3–21]years) with CP were enrolled. Majority had Cambridge IV (51,62.2%) or III (15,18.3%) changes. 34(41%) had undernutrition (mild-37.3%, moderate-2.4%, severe-1.2%). Overweight and obesity were present in 3.6% and 1.2% cases. BMI had a significant correlation with haemoglobin, serum albumin, percentage body fat and BMD. A majority had low fecal elastase (69 [84.1%], <100 μg/g) and vitamin D deficiency (70[84.3%],<20 ng/ml). 9 cases had a history of fractures. 14/75(18.6%) cases had low TBLH-BMD and this group had a lower BMI (−1.3[-1.9 to 0.34] vs 0.8 [-2.1 to 5.50; p = 0.03) than patients with normal BMD. There was no difference in age, disease duration, vitamin D, fecal elastase and Cambridge grade between normal and low BMD. Conclusions41% CP children have undernutrition with a majority having mild undernutrition. Nearly 20% have low BMD, with osteoporosis in none. Subjects with low BMI have lower BMD and percentage body fat.

The Effect of Neck Flexion on Measurement of Spinal Bone Mineral Density and the Need to Apply Head Positioners During Dual-Energy X-Ray Absorptiometry.

Our purpose was to investigate any potential effect of neck flexion on measurement of spinal bone mineral density (BMD) through further reduction of spinal lordosis and whether it is necessary to apply a head positioner, in addition to a leg positioner, during dual-energy x-ray absorptiometry. Methods: Fifty-nine patients with no significant history of spinal disorders were recruited. A bone densitometry scan of the spine was obtained for all patients using a standard leg positioner in the supine position. Then, another scan of the spine was conducted using a small subnuchal cushion to flex the neck and, thus, straighten and minimize the lumbar lordosis. Parameters including the area, bone mineral content, BMD, and T and z scores for each lumbar vertebra (L1-L4) and for the total spine were extracted from the 2 scans and compared. Results: The mean age of the patients was 55.53 y (±11.86 y); 53 (89.83%) were female and 6 (10.17%) male. A statistically significant difference was found between corresponding values for area, BMD in L4, and total spine. The percentage change from a scan without a cushion to one with a cushion was 1.20% for L4 and 0.58% for the total spine. The percentage BMD change was -0.64% for L4 and -0.34% for the total spine. A change in diagnosis-from normal to osteopenia-occurred for only 1 patient. Conclusion: Use of a head positioner to flex the neck and thus minimize lumbar lordosis in dual-energy x-ray absorptiometry does not significantly affect the diagnosis or densitometric measurements from a clinical standpoint.

Treatment-related changes in bone mineral density as a surrogate biomarker for fracture risk reduction: meta-regression analyses of individual patient data from multiple randomised controlled trials

The validation of bone mineral density (BMD) as a surrogate outcome for fracture would allow the size of future randomised controlled osteoporosis registration trials to be reduced. We aimed to determine the association between treatment-related changes in BMD, assessed by dual-energy x-ray absorptiometry, and fracture outcomes, including the proportion of treatment effect explained by BMD changes. We did a pooled analysis of individual patient data from multiple randomised placebo-controlled clinical trials. We included data from multicentre, randomised, placebo-controlled, double-blind trials of osteoporosis medications that included women and men at increased osteoporotic fracture risk. Using individual patient data for each trial we calculated mean 24-month BMD percent change together with fracture reductions and did a meta-regression of the association between treatment-related differences in BMD changes (percentage difference, active minus placebo) and fracture risk reduction. We also used individual patient data to determine the proportion of anti-fracture treatment effect explained by BMD changes and the BMD change needed in future trials to ensure fracture reduction efficacy. Individual patient data from 91 779 participants of 23 randomised, placebo-controlled trials were included. The trials had 1-9 years of follow-up and included 12 trials of bisphosphonate, one of odanacatib, two of hormone therapy (one of conjugated equine oestrogen and one of conjugated equine oestrogen plus medroxyprogesterone acetate), three of PTH receptor agonists, one of denosumab, and four of selective oestrogen receptor modulator trials. The meta-regression revealed significant associations between treatment-related changes in hip, femoral neck, and spine BMD and reductions in vertebral (r2 0·73, p<0·0001; 0·59, p=0·0005; 0·61, p=0·0003), hip (0·41, p=0·014; 0·41, p=0·0074; 0·34, p=0·023) and non-vertebral fractures (0·53, p=0·0021; 0·65, p<0·0001; 0·51, p=0·0019). Minimum 24-month percentage changes in total hip BMD providing almost certain fracture reductions in future trials ranged from 1·42% to 3·18%, depending on fracture site. Hip BMD changes explained substantial proportions (44-67%) of treatment-related fracture risk reduction. Treatment-related BMD changes are strongly associated with fracture reductions across randomised trials of osteoporosis therapies with differing mechanisms of action. These analyses support BMD as a surrogate outcome for fracture outcomes in future randomised trials of new osteoporosis therapies and provide an important demonstration of the value of public access to individual patient data from multiple trials. Foundation for National Institutes of Health.

Bone Safety of Dolutegravir-Containing Regimens in People Living with HIV: Results from a Real-World Cohort.

ObjectiveFew data exist about the effect of dolutegravir (DTG) on bone mineral density (BMD) in real life. The aim of this study was to determine rates of change in BMD over time in people living with HIV (PLWH) treated with DTG.DesignThe SCOLTA project is a multicenter observational study enrolling HIV-infected people who start newly commercialized drugs prospectively, with the aim of identifying toxicities and adverse events (AE) in a real-life setting.MethodsDual-energy X-ray absorptiometry at the femoral neck (FN) and lumbar spine (LS) was performed at study entry (baseline, BL) and after 96 weeks. Percentage BMD change from BL was evaluated using a general linear model, including factors potentially associated with bone loss.ResultsOne hundred and sixty PLWH were enrolled (26.3% female, mean age 49.9 ± 11.2 years) from April 2015 to April 2017. Overall, we could calculate BMD change from baseline, for at least one site, in 133 subjects (83.1%). After a median of 102 weeks (IQR: 90–110), mean FN BMD increased, but not significantly, whereas LS BMD showed a significant mean increase of 13.1 (95% confidence interval, CI: 1.7–24.6) mg/cm3 (+1.6%, 95% CI: 0.3%, 2.8%) after a median time of 102 weeks (IQR: 84–110). As regards LS BMD, patients with osteopenia/osteoporosis at study entry experienced a high increase from baseline (20.6, 95% CI: 3.1, 38.1 mg/cm3), as well as experienced subjects (16.9, 95% CI: 4.7, 29.2 mg/cm3) and those on vitamin D supplementation (26.8, 95% CI: 7.7, 45.9 mg/cm3).ConclusionDolutegravir-containing regimens could reduce the negative impact of antiretroviral therapy on bone, especially in patients with low BMD.

Assessment of baseline bone turnover marker levels and response to risedronate treatment: Data from a Japanese phase III trial

BackgroundRisedronate increases bone mineral density (BMD) and reduces fracture risk, but treatment response may depend on the baseline state of bone turnover. Data regarding the selection of therapeutic drugs or the prediction of therapeutic effects with baseline levels of bone turnover markers (BTMs) as a reference are insufficient. We hypothesized that when the baseline levels of BTMs are higher, baseline BMD might be lower, changes in BMD at 12 months after risedronate treatment might be higher, and the reduction of fracture incidence might be greater. This study aimed to analyze the data of a phase III clinical trial of risedronate from Japan to investigate the relationships between baseline BTM levels and (1) baseline BMD, (2) changes in BMD at 12 months after the start of treatment, and (3) the incidence of new vertebral fractures. MethodsThis post-hoc analysis included 788 postmenopausal women with osteoporosis whose baseline BTM levels as well as baseline and endpoint BMDs were measured. Relationships between baseline BTM levels and BMD at baseline and 12 months after risedronate treatment and new vertebral fractures were examined. One-way analysis of variance, two-tailed Student's t-test, and Fisher's exact test were used to analyze the data. ResultsBaseline BMD showed a significant upward trend when baseline BTM levels were lower in the analysis by tertiles. New vertebral fractures tended to occur in patients with prevalent vertebral fractures, but the relationship between new fractures and BTM levels was not statistically significant. Regardless of BTM types, BMD percentage increments (%) and increments (g/cm2) with the 12-month treatment were high when pretreatment BTM levels were high (P < 0.0001), and a >5.0% increase in BMD was observed even if baseline BTM levels were within the normal range. A new vertebral fracture occurred in only six patients (0.77%), and there was not enough statistical power to clarify the relationship between baseline BTM levels and fracture risk reduction. ConclusionsWhen pretreatment BTM levels increased, baseline BMD tended to be lower and the increase in BMD with 12-month risedronate treatment was higher. However, BMD could still be increased even if the baseline BTM levels are within the normal range. Combined with available evidence, baseline BTMs may not have an important role in deciding the optimal therapy. To elucidate the relationship between baseline BTM levels and long-term fracture risk, it will be necessary to conduct more large-scale studies with a longer follow-up period in severe osteoporotic patients with a high fracture risk. Mini abstractWe evaluated the significance of baseline bone turnover markers in the response to risedronate treatment. The increase in the bone mineral density (BMD) with the 12-month treatment may be higher when the state of bone turnover at baseline is higher, and BMD could still be increased even if the baseline bone turnover is within the normal range.

Improvement in Bone Mineral Density after a Distal Weight-Bearing Implant in a Series of 13 Cases

ABSTRACT Introduction The amputation of lower limbs and the subsequent use of a prosthesis require the adoption of new biomechanical patterns of load and gait by the patient, which may favor the onset of local or generalized bone mineral density loss. Osseo-anchored implants that allow distal weight bearing of the residuum may be able to mitigate bone mineral density loss related to amputation. The objective of this study is to determine the effect of the use of a distal weight-bearing implant on the bone mineral density of the amputated limb in relation to the nonamputated limb. Materials and Methods An interrupted time series clinical trial carried out in the Outpatient Department of Rehabilitation of the five participant hospitals. Thirteen patients with previous transfemoral amputations of traumatic, oncologic, and vascular etiology were enrolled. These patients underwent surgical implantation of an osseo-anchored implant with a distal spacer that allows a direct load on the residuum over the distal surface of the socket. Patients were followed for a 14-month period and assessed presurgically and postsurgically using dual-energy x-ray absorptiometry of the femur neck. Results The mean increase in bone mineral density for the amputated limb was 0.020 g/cm2, which represented a mean percentage increase of 3.0%. For the nonamputated limb, the mean increase in bone mineral density was 0.005 g/cm2 and the mean percentage increase was 0.5%, with eight patients showing improvements in bone mineral density. The mean percentage of bone mineral density of the amputated limb in comparison with the nonamputated limb was 70.6% preimplantation and 73.2% postimplantation, with an average increase of 2.6%. Conclusions The results of this study show an improvement in bone mineral density in individuals with transfemoral amputation 14 months after having received a distal weight-bearing implant.

Association of Bone Metabolism with Fatty Liver Disease in the Elderly in Japan: A Community-based Study.

Objective With the aging of society, both osteoporosis and fatty liver disease (FLD) are becoming important issues. However, the relationship between osteoporosis and FLD remains controversial. We investigated the association between bone metabolism and FLD in a Japanese community in a cross-sectional study. Methods A total of 1,020 participants were enrolled in a health survey. FLD was diagnosed by ultrasonography. Bone metabolism was evaluated based on bone mineral density (BMD), which was assessed using dual-energy X-ray absorptiometry, and with the bone formation index (total type I procollagen N-terminal propeptide/bone-alkaline phosphatase ratio; P1NP/BAP ratio) and the bone resorption index (crosslinked N-telopeptide of type I collagen/tartrate-resistant acid phosphatase-5b ratio; NTx/TRACP-5b ratio) calculated from serum bone turnover markers. Results The BMD (percentage of the young adult mean) was the same level in both male and female participants with and without FLD. Both men and women showed an age-dependent decrease in their bone formation index and bone resorption index values. Men of ≥70 years of age and women of 60-69 years of age with FLD had significantly lower bone formation index values and higher bone resorption index values. However, similar findings were not seen in women of ≥70 years of age. Conclusion Although the BMD levels were the same, regardless of the presence or absence of FLD, elderly participants with FLD showed decreased bone formation and increased bone resorption, with sex differences. Because our results suggest that FLD in elderly individuals is detrimental for bone metabolism, and that it leads to bone loss and osteoporosis, further studies using a cohort population are warranted.

Iron Overload Associated Endocrine Dysfunction Leading to Lower Bone Mineral Density in Thalassemia Major.

Patients with thalassemia major (TM) have a lower bone mineral density (BMD) and higher risk of fracture than the general population. The possible mechanisms include anemia, iron overload, malnutrition, and hormonal deficiency, but these have not been thoroughly investigated. To identify major mineral and hormonal factors related to BMD in adult TM patients to provide human evidence for the proposed mechanisms. Retrospective study. Referral center. Twenty-nine patients with β-TM, aged 23 to 44 years who were followed-up during 2017 to 2018 were enrolled. Endocrine profiles, including thyroid, parathyroid, and pituitary function, glucose, vitamin D, calcium, phosphate, and fibroblast growth factor 23 (FGF23) were obtained. The relationships among the above parameters, body height, fractures, and BMD were analyzed. Abnormal BMD was observed in 42.9% of women and 23.1% of men. The mean final heights of women and men were 3.7 cm and 7.3 cm lower than the mean expected values, respectively. Fracture history was recorded in 26.7% of women and 35.7% of men. BMD was negatively correlated with parathyroid hormone, FGF23, thyrotropin, and glycated hemoglobin (HbA1c) levels, and positively correlated with testosterone, IGF-1, and corticotropin levels (all P < .05). Moreover, hypothyroidism was associated with lower BMD in both the lumbar spine (P = .024) and the femoral neck (P = .004). Patients with hypothyroidism had a higher percentage of abnormal BMD (P = .016). Hypothyroidism, higher HbA1c, and lower adrenocorticotropin were predictors of abnormal BMD in patients with β-TM. Whether the correction of these factors improves BMD warrants further research.

Delayed Denosumab Injections and Bone Mineral Density Response: An Electronic Health Record-based Study.

Discontinuation of denosumab leads to a rapid reversal of its therapeutic effect. However, there are no data regarding how unintended delays or missed injections of denosumab impact bone mineral density (BMD) response. We examined the association of delays in injections of denosumab with BMD change. We used electronic medical records from two academic hospitals from 2010 to 2017. Patients older than 45 years of age and used at least 2 doses of 60 mg denosumab. Denosumab adherence was evaluated by the medication coverage ratio (MCR). Good adherence corresponds to a dosing interval ≤7 months (defined by MCR ≥93%), moderate adherence corresponds to an interval of 7 to 10 months (MCR 75%-93%), and poor adherence corresponds to an interval ≥10 months (MCR ≤75%). Annualized percent BMD change from baseline at the lumbar spine, total hip, and femoral neck. We identified 938 denosumab injections among 151 patients; the mean (SD) age was 69 (10) years, and 95% were female. Patients with good adherence had an annualized BMD increase of 3.9% at the lumbar spine, compared with patients with moderate (3.0%) or poor adherence (1.4%, P for trend .002). Patients with good adherence had an annualized BMD increase of 2.1% at the total hip, compared with patients with moderate (1.3%) or poor adherence (0.6%, P for trend .002). A longer interval between denosumab injections is associated with suboptimal BMD response at both spine and total hip. Strategies to improve the timely administration of denosumab in real-world settings are needed.

Efficacy of zoledronic acid in older prostate cancer patients undergoing androgen deprivation therapy

ObjectivesThe purpose of this study is to evaluate the efficacy of annual zoledronic acid treatment in Japanese patients with nonmetastatic prostate cancer during androgen deprivation therapy (ADT). MethodsThis is a single institution 12-month study. Between 2016 and 2019, patients aged 70 years or older on ADT for nonmetastatic prostate cancer had bone mineral density (BMD) measured and 10-year probability of fracture calculated using fracture risk assessment tool (FRAX). Patients who showed osteopenia or had a 10-year hip fracture risk ≥ 3% or a 10-year probability of major osteoporotic fracture ≥ 20% were offered treatment with zoledronic acid 5 mg intravenously (ZA group). The patients who did not receive treatment were set as the control group. Lumbar and hip BMD were measured 6 and 12 months after treatment in the ZA group and 12 months after baseline in the control group. The yearly BMD change of both groups was compared. ResultsThe mean ages of the ZA group (n = 26) and control group (n = 12) were 80.5 ± 9.1 and 76.1 ± 6.7 years, respectively. In the ZA group, lumbar and hip BMD changes at 12 months were +2.1% and +0.8%, respectively. In the control group, lumbar and hip BMD changes were −0.9% and −4.9%, respectively. There were statistically significant differences between the 2 groups in BMD percent changes (P < 0.05). ConclusionsWithout intervention, BMD tends to continue to decrease during ADT. Our findings suggest that administration of zoledronic acid enables maintenance of BMD in the older adults.

Dual-Energy X-Ray Absorptiometry Body Composition in NCAA Division I Athletes: Exploration of Mass Distribution.

Body composition assessment is frequently used in sports medicine and athletic performance environments to assess change in response to strength training and nutrition programs. However, to effectively do so requires knowledge regarding expected body composition values relative to sport and sex. Dual-energy x-ray absorptiometry (DXA) is widely used to evaluate body composition, although its utility in relationship to specific sports, performance, or rehabilitation is not clearly defined. Body composition metrics and distribution of National Collegiate Athletic Association Division I collegiate athletes will vary based on sport and sex. Level 4. Cross-sectional study. A convenience sample of 337 athletes (229 men and 108 women) participating in football, wrestling, soccer, hockey, basketball, golf, softball, or volleyball was evaluated. DXA-measured total body composition, including bone mineral density (BMD), % lean mass, % fat, and regional distribution, were compared by sex, sport, and with an age-matched National Health and Nutrition Examination Survey (NHANES) population. Men had higher BMD, lower % fat (16.4% vs 25.2%) and higher % lean mass (79.2% vs 70.6%) (P < 0.001). Regional composition varied by sport and sex, with women having a greater proportion of lean mass at the trunk and men in their arms (P < 0.0001). Leg lean mass was distributed similarly between sexes (35%). Overall, the normative group (NHANES) had lower BMD and higher percentage fat. DXA-measured body composition and lean mass distribution varies by sport and sex in Division I athletes. The observed difference to the NHANES population emphasizes challenges in identifying appropriate comparison populations, reinforcing the need to compare athletes with their own baseline. These findings establish a framework to investigate the relevance of these variances and determine the utility of body composition analysis in elite athletes.

Red wine polyphenols modulate bone loss in the ovariectomized rat model of postmenopausal osteoporosis

The aim of this study was to examine the effect of Red Wine Polyphenols (RWPs) extract on bone mineral density (BMD) in the ovariectomized (OVX) rat model. Thirty-five 10-month-old Wistar rats were separated into controls (CTRL), OVX and OVX plus RWPs in their drinking water (dose, 50 mg/kg body weight per day), starting immediately after OVX for 6 months. Βody and uterine weight, BMD of the tibia at baseline, 3 and 6 months post-OVX, and 3-pointing bending of the femur, were examined. Statistical comparison of the total tibia BMD within groups during the study period showed a significant reduction in the OVX and OVX+RWPs groups both from baseline to 3 and 6 months and from 3 to 6 months, whereas in the CTRL group, there was no significant change. For the proximal tibial metaphysis, comparison of BMD percentage changes from baseline to 3 months and 6 months and from 3 to 6 months revealed highly statistical differences between OVX and OVX+RWPs groups (P = 0.000). OVX induced a significant reduction of biomechanical parameters as expected; the 3-point bending test showed that the maximum force before fracture, energy absorption and fracture stress significantly increased in the OVX group treated with RWPs compared with the nontreated OVX rats (P = 0.048, P = 0.002 and P = 0.003, respectively). Dietary intake of RWPs for 6 months significantly prevented trabecular bone loss and improved bone strength in estrogen-deficient ovariectomized rats.

Impact of Estimated Pre-Exposure Prophylaxis (PrEP) Adherence Patterns on Bone Mineral Density in a Large PrEP Demonstration Project.

Bone mineral density (BMD) declines due to tenofovir-containing pre-exposure prophylaxis (PrEP) have varied among PrEP demonstration projects, potentially related to variable adherence. Characterization of BMD changes in highly adherent individuals, estimated via tenofovir-diphosphate (TFV-DP) levels in dried blood spots (DBS), can assist clinicians when counseling patients. Cisgender men who have sex with men and transwomen in the optional dual-energy X-ray absorptiometry (DXA) substudy of a large, international, open-label PrEP demonstration project, the iPrEx-open-label extension (OLE) study underwent DXA scans and DBS collection every 24 weeks, with average weekly dosing adherence patterns (2, 4, and 7 doses/week) estimated from validated TFV-DP cut-offs. The mean percent BMD change was estimated in strata of average weekly adherence by using a linear mixed-effects model to calculate the BMD decline in highly adherent individuals on PrEP for the first time. DXA/DBS data were available for 254 individuals over a median of 24 weeks in iPrEx-OLE from June 2011 to December 2013. The percent decline in spine BMD was monotonically associated with strata of increasing average weekly adherence (p < .001 trend); the p value for trends using hip BMD measurements was .07. Individuals with estimated daily adherence experienced a 1.2% decrease in spine BMD and a 0.5% drop in hip BMD. In highly adherent PrEP users, we found a lower-than-expected drop in BMD when compared with previous studies. This drop is likely not clinically significant for most PrEP users. However, for those at the highest risk of fracture who plan prolonged PrEP use, alternate PrEP strategies could be considered.

The Effect of Linzagolix on Bone Mineral Density (BMD): Safety Results From a Dose-Ranging Trial [21J

INTRODUCTION: Linzagolix is a new, non-peptide, GnRH receptor antagonist being developed to treat endometriosis-associated pain (EAP). The EDELWEISS trial is a Phase 2b, double-blind, randomized, placebo-controlled, multicenter, dose-ranging trial in and Europe evaluating oral once daily doses of 50, 75, 100 and 200 mg taken for 24 weeks. Subjects randomized to placebo were crossed-over to 100 mg after 12 weeks. METHODS: IRB approval was obtained. Participants were women with surgically confirmed endometriosis and moderate to severe EAP. Women with a history of osteoporosis or other metabolic bone disease were excluded. BMD of the femoral neck, total hip and lumbar spine was assessed by DXA at baseline and after 12 and 24 weeks of treatment. Reading of DXA scans and monitoring of scan quality, including cross-calibration between sites, was centralized. RESULTS: 327 patients were randomized and treated. Mean percent (95% CI P value) BMD changes for lumbar spine from baseline to week 24 in the 50, 75, 100 and 200 mg dose groups were 0.137% (-0.83, -1.11 P=.777), -0.798% (-1.57, -0.03 P=.042), -1.365% (-2.14, -0.59, P<.001), -2.602% (-3.56, -1.65, P<.001), respectively. BMD of femoral neck and total hip showed a similar pattern but with generally smaller changes from baseline. CONCLUSION: Mean BMD losses at 24 weeks were <1% at doses of 50 and 75 mg and increased with increasing dose up to 2.6% for 200 mg. Long term use of 75 mg daily is not expected to require concomitant estrogen/progestin add-back therapy, while higher doses may require it.

Unacylated ghrelin is correlated with the decline of bone mineral density after Roux-en-Y gastric bypass in obese Chinese with type 2 diabetes

BackgroundBariatric surgery is an effective and therapeutic way for different metabolic diseases. It has become a focus of attention about the effects and molecular mechanisms to bone metabolism. ObjectiveWe aim to assess the changes of bone mineral density (BMD) among Chinese obese individuals with type 2 diabetes who have undergone Roux-en-Y gastric bypass surgery (RYGB). Two ghrelin gene products, namely unacylated ghrelin (UAG) and obestatin, were evaluated the roles in this pathologic process. SettingUniversity-affiliated hospital, China. MethodsThirty patients who had received RYGB were enrolled in the study. Changes in anthropometric parameters, metabolic indexes, and serum UAG and obestatin were assessed preoperatively, 6, 12, and 24 months postoperatively. BMD at lumbar spine (LS), femoral neck (FN), and total hip (TH) were identified. ResultsRYGB resulted in statistical reductions of BMD in 3 different skeletal parts. After the first 6 months, BMD began to reduce and maintained a declining trend until 24 months postoperatively. Comparing to baseline, the maximal reduction of BMD was as high as 10.28% in total hip. The plasma concentration of UAG increased after 6 months (51.61 ± 55.21 versus 71.95 ± 64.91 pg/mL; P < .01), as well as the serum obestatin level (1.65 ± 0.88 versus 1.71 ± 0.99 ng/mL; P > .05). Although there was a slight drop of both peptides in the first year, they were still above the baseline. Notably, in the second year, UAG and obestatin rose to their peak values, respectively (91.90 ± 77.11 pg/mL and 1.74 ± 1.09 ng/mL). There was a negative correlation between UAG and BMD in all sites. Multiple linear regression analysis showed that the UAG level was the independent parameter associated with BMD at baseline (FN: β = -.407, P = .012 and TH: β = -0.396, P = .030 respectively), as well as the changes of UAG that were independently related with reduction percentage of LS BMD after 24 months (β = - .379, P = .046). ConclusionThe reduction of BMD in obese Chinese with type 2 diabetes was observed after RYGB. The pronounced increase of serum UAG acts as an independent risk factor for the decrease of BMD.