Evaluation Of Osteoporosis Research Articles

Neural EGFL like 1 as a novel gene for Trabecular Bone Score in older adults: The Bushehr Elderly Health (BEH) program.

Neural EGFL like 1 (NELL-1), is a secreted glycoprotein and stimulates osteogenic cell differentiation and bone mineralization. This study aimed to explore the relationship between NELL-1 and Trabecular Bone Score (TBS) as a novel tool for the evaluation of osteoporosis in an elderly population-based cohort study in Iran. A single-locus analysis was performed on TBS using data from 2,071 participants in the Bushehr Elderly Health (BEH) Program. The study investigated 376 independent single nucleotide polymorphisms (SNPs) within the NELL-1 on chromosome 11p15.1. The association between SNPs and the mean TBS L1 to L4 was analyzed through an additive model. Significant variants in the additive model (PFDR<0.05) were further examined within dominant, recessive, over-dominant, and co-dominant models. Multiple linear regression was employed to assess the relationship between the genetic risk score (GRS) derived from significant SNPs and TBS. Three SNPs within the NELL-1 showed a statistically significant association with TBS after adjusting for age and sex. The associations for rs1901945 (β = 0.013, PFDR = 0.0007), rs1584851 (β = -0.011, PFDR = 0.0003), and rs58028601 (β = 0.011, PFDR = 0.0003) were significant in the additive model. Additionally, significant results were observed for rs1901945 and rs58028601 in the dominant model (P<0.05). The GRS showed a statistically significant relationship with TBS, considering adjustments for age, sex, Body Mass Index, type 2 diabetes, and smoking (β = 0.077, P = 1.7×10-5). This study highlights the association of NELL-1 with TBS, underscoring its potential as a candidate for further research and personalized medicine concerning the impact of this gene on bone quality.

[Translated article] Evaluation, differential diagnosis and treatment of vertebral osteoporosis: How to avoid the occurrence of new fractures

Osteoporosis is a highly prevalent and multifactorial disease whose main manifestation is the appearance of fragility or low-impact fractures. The most frequent locations of osteoporotic fractures occur at the vertebrae, femoral, distal end of the radius and humerus. Osteoporotic vertebral fracture deserves special mention among them due to its prevalence, importance as it often goes unnoticed and medium-long term consequences are: pain, deformity, disability and deterioration in quality of life. In this review we will focus on the classification and initial evaluation of the patient with osteoporosis, estimation of risk factors, laboratory and imaging studies for an adequate assessment using simple radiography, dual densitometry and magnetic resonance imaging. We will also address the main aspects of the differential diagnosis, treatment and prevention of vertebral fragility fracture, briefly reviewing the main therapeutic agents currently used for its prevention and treatment.

Osteoporosis Evaluation and Management in Spine Surgery.

Osteoporosis is a global health problem affecting over 200 million people worldwide and 54 million adults in the United States. Approximately half of all postmenopausal women will have an osteoporosis-related fracture during their lifetime. In the United States, the direct medical cost related to osteoporosis is expected to exceed $25 billion by 2025. Management of osteoporosis in vertebral fractures and elective spine surgery is of the utmost concern, given the high prevalence of osteoporosis in the general population and the increased risk of complication in this population. New pharmacologic treatment options such as anabolic medications and diagnostic tools including Hounsfield unit measurements on routine computed tomography scans are available to orthopaedic and spinal surgeons to help best manage this condition. This review serves as an update to diagnosis, management, and treatment of patients with osteoporosis undergoing spinal surgery.

Canal to calcar ratio is associated with lumbar compression fractures

Objective: Osteoporosis is one of the major public health problems. Singh (SI) and Genant indexes are the most well-known osteoporosis evaluation methods. Femoral cortical thickness index (CTI) and femoral canal to calcar ratio (CCR) values have been found to be more informative in the literature. This study aimed to investigate the relationship between SI, CTI, CCR, bone mineral density, and blood tests. Patients and Methods: Hospital digital archives were searched and postmenauposal female patients who underwent bone scanning between 2018 and 2020 were included. Demographic data, blood laboratory and bone mineral densitometry (BMD) test results, and radiographic views were collected. The results were statistically analysed and expressed as mean ± standard deviation. Results: The mean age was 66.14±6.82 years. There were 22 patients with lumbar compression according to Genant criteria. Also, 52 patients had osteoporosis and 35 patients had osteopenia according to the spine or hip BMD T scores. CCR was found to be significantly related to lumbar compression (p=0.04). Conclusion: In this study, no correlation was found between CCR value and T score. However, CCR value was found to be associated with lumbar vertebral compression, which is helpful in the diagnosis of osteoporosis. It may be considered as a parameter that should be studied more in the diagnosis of osteoporosis.

Stretchable Ultrasound Metalens for Biomedical Zoom Imaging and Bone Quality Assessment with Subwavelength Resolution.

Ultrasound imaging is extensively used in biomedical science and clinical practice. Imaging resolution and tunability of imaging plane are key performance indicators, but both remain challenging to be improved due to the longer wavelength compared with light and the lack of zoom lens for ultrasound. Here, the ultrasound zoom imaging based on a stretchable planar metalens that simultaneously achieves the subwavelength imaging resolution and dynamic control of the imaging plane is reported. The proposed zoom imaging ultrasonography enables precise bone fracture diagnosis and comprehensive osteoporosis assessment. Millimeter-scale microarchitectures of the cortical bones at different depths can be selectively imaged with a 0.6-wavelength resolution. The morphological features of bone fractures, including the shape, size and position, are accurately detected. Based on the extracted ultrasound information of cancellous bones with healthy matrix, osteopenia and osteoporosis, a multi-index osteoporosis evaluation method is developed. Furthermore, it provides additional biological information in aspects of bone elasticity and attenuation to access the comprehensive osteoporosis assessment. The soft metalens also features flexibility and biocompatibility for preferable applications on wearable devices. This work provides a strategy for the development of high-resolution ultrasound biomedical zoom imaging and comprehensive bone quality diagnosis system.

Radiofrequency echographic multi-spectrometry-based measurement of bone mineral density in patients with severe motor and intellectual disability: An opportunity for patients with severe scoliosis and hip dislocation

PurposeRadiofrequency echographic multi-spectrometry (REMS) is an ultrasound technology currently used for the densitometric evaluation of osteoporosis and has been validated against dual-energy X-ray absorptiometry. However, the use of REMS for bone densitometry in patients with severe motor and intellectual disabilities (SMID) remains to be reported. This study aimed to investigate whether REMS technology can be used for densitometric evaluation of osteoporosis in patients with SMID with hip dislocation and severe scoliosis. MethodsSixty-five patients with SMID, who resided in a long-term care facility and received comprehensive medical and rehabilitation care, underwent REMS scans of the femoral neck and/or lumbar spine. Data regarding anthropometric parameters (height and weight), bone mineral density (BMD), clinical diagnostic classification, physical ability, presence of scoliosis and hip dislocation, and frontal radiographs of both hip joints were obtained. ResultsWe included 29 men and 34 women (mean age: 52.6 years). All patients underwent successful scanning at either the femoral neck (82.5 %) or lumbar spine (95.2 %). BMD measurements obtained using REMS revealed low values, with a mean BMD, T-score, and Z-score of 0.67 g/cm2, −2.39 standard deviation (SD), and − 1.38 SD, respectively, at the femoral neck and 0.66 g/cm2, −2.70 SD, and − 1.87 SD, respectively, at the lumbar spine. The average Cobb angle of the lumbar spine was 34.0°; furthermore, dislocation rates did not significantly differ between those with and without successful BMD measurements (p = 0.073). Lumbar BMD T-scores were significantly correlated with femoral neck BMD T-scores (p < 0.001, r = 0.530). ConclusionAll patients with SMID were able to undergo measurements of either spinal or femoral neck BMD; furthermore, 77.7 % of the patients underwent measurements at both the lumbar spine and femur. Our data suggest that REMS is useful for measuring BMD in patients with SMID who are residing in institutions.

Develop a bone mineral density T-score distribution nomograms based on osteoporosis risk factors for middle-aged and older adults

PurposeThis study aimed to understand how age, health status, and lifestyle impact bone mineral density (BMD) in middle-aged and older adults, focusing on predicting osteoporosis risk. MethodsThis study included 2836 participants aged 50–88 from the Health Improvement Program of Bone (HOPE) conducted from 2021 to 2023. We used logistic regression to make a prediction tool. Then checked its accuracy and reliability using receiver operating characteristic (ROC) and calibration curves. ResultsFactors like age, body weight, prior fractures, and smoking were independently found to affect BMD T-score distribution in men. In women, age and body weight were identified as independent factors influencing BMD T-score distribution. A nomogram was created to visually illustrate these predictive relationships. ConclusionsThe nomogram proved highly accurate in identifying men aged 50 and above and postmenopausal women based on their BMD T-score distribution, improving clinical decision-making and patient care in osteoporosis evaluation and treatment.

Independent Risk Factors of Proximal Junctional Kyphosis with Vertebral Fracture After Spinal Long Fusion: Survivorship Analysis of Adult Spinal Deformity Surgery Patients

ObjectiveThis study aimed to identify risk factors for postoperative proximal junctional kyphosis (PJK) with vertebral fracture in adult spinal deformity (ASD) patients. We performed a survival analysis considering various factors, including osteoporosis. MethodsThis single-center retrospective study included 101 ASD patients (mean age: 67.2 years, mean follow-up: 8.1 years). We included patients aged ≥ 50 years with abnormal radiographic variables undergoing corrective long spinal fusion. The main outcome measure was PJK with vertebral fracture, analyzed based on patient data, radiographic measurements, sagittal parameters, bone mineral density, and osteoporosis medication. ResultsPJK occurred in 37.6% of patients, with vertebral fracture type 2 accounting for 65% of these cases. Kaplan-Meier analysis indicated a median PJK-free survival time of 60.7 months. Existing vertebral fracture (grade 1 or higher or grade 2 or higher) was a significant risk factor for PJK with vertebral fracture, with hazard ratios of 4.58 and 5.61, respectively. The onset time of PJK with vertebral fracture was 1.5 months postoperatively, with 44% of these cases occurring within 1 month and 64% within 2 months. ConclusionsPJK with vertebral fracture affected 25% of ASD patients, emphasizing the importance of osteoporosis evaluation. Existing vertebral fracture emerged as a significant independent risk factor, surpassing bone mineral density. This study provides valuable insights for spine surgeons, highlighting the need to provide osteoporosis treatment and emphasize potential postoperative complications during discussions with patients.

Development of Transdermal Formulation Based on Nanotechnology and Elucidation of Its Drug Delivery Pathways

Transdermal drug delivery is a formulation in which the drug is absorbed through the skin for systemic action. Its advantages include avoidance of first-pass effects, sustained drug supply, and ease of administration and discontinuation. Drugs administered transdermally transfer into the blood circulation through the stratum corneum, epidermis, and dermis. The stratum corneum on the skin surface plays a barrier function in skin absorption. Therefore, developing of transdermal drug delivery systems requires innovations that overcome the barrier function of the stratum corneum and improve skin permeation. This review examines the usefulness of transdermal formulations based on solid nanoparticles using raloxifene. Milled raloxifene was gelled with (mRal-NPs) or without menthol (Ral-NPs) using Carbopol. The drug release and transdermal penetration were measured using a Franz diffusion cell, and the therapeutic evaluation of osteoporosis was determined in an ovariectomized rat model. Although the raloxifene released from Ral-NPs remained in the nanoparticle state, the skin penetration of raloxifene nanoparticles was prevented by the stratum corneum in rat. The inclusion of menthol in the formulation attenuated the barrier function of the stratum corneum and permitted raloxifene nanoparticles to penetrate through the skin. Moreover, macropinocytosis relates to the formulation's skin penetration, including menthol (mRal-NPs). Applying mRal-NPs attenuated the decreases in calcium level and stiffness of bones of ovariectomized rats. This information can support future studies aimed at designing novel transdermal formulations.

413 Evaluation of Osteoporosis in the Lumbar Spine in Multiple Myeloma Patients Using 18F-NaF PET/CT

INTRODUCTION: Multiple myeloma (MM) is a plasma cell malignancy that structurally damages and weakens the bone, most commonly in the spine, by inducing osteoporosis, osteolytic lesions and pathological fractures. Detecting molecular changes in bone metabolism, such as reduced osteoblastic activity and bone remodeling associated with MM, would allow for early diagnosis of osteoporosis in the lumbar spine and reduce risk for surgical spinal interventions. One such imaging candidate is 18F-NaF PET/CT, a molecular imaging technique sensitive to bone formation. METHODS: The FULIMA clinical trial (NCT02187731) was conducted with 70 newly diagnosed MM patients, with exclusion criteria leaving 33 patients for analysis (9 females, 24 males; mean age 66.6y). Patients’ trabecular body of the L1-L4 vertebrae was analyzed using 18F-NaF PET/CT scans to calculate and evaluate the linear associations among mean standardized NaF uptake value (SUVmean), mean Hounsfield unit (HU) values, and age. Receiver-operating characteristic (ROC) curve analysis with area under the curve (AUC) using the Wilson/Brown method assessed the predictive value of NaF uptake via SUVmean for osteoporosis determined by HU threshold. RESULTS: There was significant positive correlation between HU value and SUVmean (r = 0.64, p &lt; 0.0001) and negative correlations between age and both HU value (r = -0.59, p &lt; 0.0003) and SUVmean (r = -0.53, p = 0.002). Additionally, on average, there was a 29.1% difference in the NaF uptake of MM patients with osteoporosis (SUVmean = 7.0 ± 1.48) compared to normal MM patients (SUVmean = 4.96 ± 1.46). Predictive value of NaF per AUC analysis was 0.857 with p = 0.002. CONCLUSIONS: 18F-NaF PET/CT detects the decreased osteoblastic activity of osteoporosis in the lumbar spine with high precision and accuracy in MM patients, facilitating timely interventions and reducing risk for invasive procedures.

Evaluation of Osteoporosis Among Epileptic Patients on Monotherapy

Epilepsy is a common chronic neurological disorder that affects almost 50 million people worldwide. Most patients require long-term, and sometimes lifelong therapy with antiseizure medications (ASMs), our case control study evaluates the long-term effect of carbamazepine (CBZ) and valproate (VPA) on bone mineral density and bone health biochemical markers. 50 patients with newly diagnosed epilepsy who had no history of antiseizure medications (ASMs) intake prior were divided into 2 groups. In the first group, 25 patients started carbamazepine (CBZ) monotherapy, while the second group included 25 patients who started receiving valproate (VPA) monotherapy. Another 25 healthy individuals were considered as a control group. The primary outcome of our study is to evaluate the percentage of osteoporosis compared to the duration of ASM therapy measured by the T score at two different sites in the body at baseline, after 3 and 6 months of therapy, while measurements of bone biomarker variables are considered secondary outcomes. We found that CBZ and VPA significantly decreased the level of vitamin D3, Ca, P, the L3-L5, and right femoral neck T score with prolonged treatment duration, while the level of ALP increased with increasing duration of treatment in patients treated with CBZ but not in the VPA group. Furthermore, CBZ significantly decreased bone health biomarkers and T score before VPA and the control group, as well as there were no significant differences between the two sexes who received CBZ or VPA therapy on bone biomarkers. In conclusion, valproate will not affect bone biomarkers earlier, but with a longer duration of therapy, they may have the same effect as carbamazepine which requires the prescription of supportive vitamin D and Ca along with ASMs.

The yield of routine laboratory examination in osteoporosis evaluation in primary care

SummaryThis study evaluated the yield of routine laboratory examination in a large population of older women in primary care. The prevalence of laboratory abnormalities was low and the clinical consequences in follow-up were limited. There was a weak association of laboratory abnormalities with osteoporosis but no association with vertebral fractures and recent fractures.PurposeMost osteoporosis guidelines advice routine laboratory examination. We have investigated the yield of laboratory examinations in facture risk evaluation of elderly women in primary care.MethodsWe assessed the prevalence of laboratory abnormalities and their association with risk factors for fractures, recent fractures, low bone mineral density (BMD), and prevalent vertebral fracture in 8996 women ≥ 65 years of age participating in a primary care fracture risk screening study. In a sample of 2208 of these participants, we also evaluated the medical consequences in the medical records during a follow-up period of ≥ 1 year.ResultsVitamin D deficiency (< 30 nmol/L) was present in 13% and insufficiency (< 50 nmol/L) in 43% of the study sample. The prevalence of other laboratory abnormalities (ESR, calcium, creatinine, FT4) was 4.6% in women with risk factors for fractures, 6.1% in women with low BMD (T-score ≤ − 2.5), 6.0% after a prevalent vertebral fracture, 5.2% after a recent fracture and 2.6% in the absence of important risk factors for fractures. Laboratory abnormalities other than vitamin D were associated with low BMD (OR 1.4, 95%CI 1.1–1.8) but not with prevalent vertebral fractures nor recent fractures. Low BMD was associated with renal failure (OR 2.0, 95%CI 1.3–3.4), vitamin D insufficiency (OR 1.2, 95%CI 1.0–1.3) and deficiency (OR 1.3, 95%CI 1.1–.5). In the follow-up period, 82% of the laboratory abnormalities did not result in a new diagnosis or treatment reported in the medical records.ConclusionsWe identified a low prevalence of laboratory abnormalities in a primary care population of older women and the majority of these findings had no medical consequences.

DWI of the Spine: A Review and Update

The utility of DWI in the spine has been established and continues to grow in clinical practice. DWI raises the MR imaging sensitivity of lesion detection and improves the conspicuity of many spinal pathologies. Applications include evaluation of spinal cord infarction, bone marrow lesions, infection, degenerative disease, trauma, osteoporosis, malignancy, and response to therapy. In this article, we provide a case-based review to illustrate and discuss these uses. We also highlight DWI acquisition techniques and challenges. We provide protocol optimization tips that help to overcome these challenges and permit incorporation of DWI into the workflow.Learning Objective: To emphasize the role of DWI in the spine and discuss technical tips and considerations for protocol optimization

Cone-Beam Computed Tomography to evaluate changes in trabecular lower jawbone microstructure caused by bone loss and antiresorptive treatment.

The aim of this preliminary report is to evaluate the usefulness of CBCT to assess trabecular mandible microstructural properties in normal ewes and to compare the quantitative changes associated with ovariectomy and antiresorptive treatment. Twelve adult Corriedale ewes (n=4/group) aged 3-4 years were divided into 3 groups and studied for 28 months. Eight ewes were ovariectomized (OVX) and divided into OVX and OVX+ZOL groups (n=4/group) which were treated as follows, by jugular injection: OVX received saline solution and OVX+ZOL received zoledronate (Zol) (Gador SA, CABA, Argentina) (4 mg/month). Another four ewes were subjected to sham surgery (SHAM group) and received saline solution. Densitometry showed that jaw mineral content (BMC) and density (BMD) were significantly lower in OVX than in SHAM and OVX+ZOL ewes; no difference was observed between OVX+ ZOL and SHAM groups. CBCT analysis showed that bone volume (BV/TV%); trabecular thickness (TbTh); connectivity density (CD) and anisotropy degree (AD) were significantly lower, and trabecular spacing (TbSp), significantly higher in OVX than in SHAM ewes. AD was significantly higher and TbSp significantly lower in OVX+ZOL than in OVX groups. BV/TV%, TbTh and CD showed a clear tendency to being higher in OVX+ZOL than in OVX groups. No statistical difference was observed between OVX+ZOL and SHAM ewes. CBCT in a nondestructive, fast, very precise procedure for measuring bone morphometric indices without biopsies, which are not indicated for morphometric evaluation in osteoporosis. The current study demonstrated the potential of the high-resolution CBCT imaging to assess in vivo quantitative bone morphometry and bone quality of lower jaw cancellous bone under normal conditions and to differentiate changes associated with excessive bone loss induced by estrogen withdrawal and antiresorptive intervention.

Spinal Sagittal Imbalance is Associated with Vertebral Fracture without a Definite History of Falls: Cross-Sectional, Comparative Study of Cohort with and without a Distal Radius Fracture

Background: Treating osteoporosis in patients with a distal radius fracture (DRF) became paramount at the Fracture Liaison Service. Spinal sagittal imbalance emerged as a risk factor for subsequent fractures. Therefore, here we investigated the spinal profile of patients with DRF to investigate its association with a history of falls and prevalent vertebral fractures.Methods: We reviewed the cases of 162 women presenting with DRF and 162 age-matched women without fracture who underwent an osteoporosis evaluation including bone mineral density (BMD) and lateral spine imaging. We compared the incidence of prevalent vertebral fracture and sagittal vertical axis (SVA) to measure spinal sagittal imbalance. We also performed a regression analysis of the risks of prevalent vertebral fracture, such as age, body mass index (BMI), BMD, and SVA.Results: The SVA was significantly smaller (indicating more stable sagittal balance) in patients with a DRF versus controls (16 mm vs. 34 mm, respectively; &lt;i&gt;p&lt;/i&gt;&lt;0.001). The incidence of a prevalent vertebral fracture was similar between groups (12% vs. 15%, respectively; &lt;i&gt;p&lt;/i&gt;=0.332). In both groups, the SVA was significantly greater in those with versus without a vertebral fracture. The vertebral fracture was significantly associated with age and SVA but not BMI or spinal BMD.Conclusions: Spinal sagittal balance was superior in DRF patients, yet the frequency of prevalent vertebral fractures was similar. The identification of this unique spinal profile in patients with DRF may increase our understanding of osteoporotic fractures.

FRI452 A Rare Case of Klinefelter Syndrome, 48XXYY

Abstract Disclosure: P. Kachhadia: None. S. Khan: None. S. Aldasouqi: None. A. Abu Limon: None. Introduction: Klinefelter Syndrome (KS), 47XXY, is the most commonly seen chromosomal abnormality causing infertility, or primary hypogonadism. Other chromosomal variants are rare. We present a very rare case of nondisjunction of the sex chromosome resulting in a 48XXYY KS variant. Case Presentation: The patient is a 45-year-old male was referred to our clinic for evaluation of early onset osteoporosis. The patient was accompanied by his sister, given his cognitive delay. On initial physical exam, there was a concern about acromegaly with signs of frontal bossing, increased hand size, increased ring size and increased shoe size. More recent pictures of the patient showed significant changes in his facial appearance from few years prior. Other symptoms included night sweats. Physical exam revealed decreased testicular volume (less than 3mL bilaterally). Pituitary labs showed elevated prolactin, elevated LH, FSH and low free and total testosterone. GH, IGF-1 levels were within normal range. Chromosomal analysis showed an unexpected pattern of 48XXYY. In addition, MRI of the pituitary was done which showed increased infundibular stalk and increase in size of the pituitary gland which was thought to be secondary to pituitary microadenoma. DEXA scan confirmed osteoporosis. Patient was treated with testosterone injections and alendronate. The rationale for alendronate therapy was considered as a bridge to prevent fractures while the bone density would expectedly improve with androgen therapy, over time. Discussion: Although KS is commonly seen at a frequency of 1:500-1:1000 males, less common and variable phenotypical presentations can occur and can lead to a delayed diagnosis. The reason for the delay of diagnosis in these rare KS variants is the cognitive impairment which leads to delayed evaluation of fertility or hypogonadism, as contrasted to patients with the common variant, KS 47XXY. Additionally, unlike the classic KS variant, these rare variants are often associated with learning disabilities and gross bony features. Conclusion: Clinicians should be familiar with different clinical presentations of the less common KS genetic variants, in contrast to classical KS variants. Patients with classical KS typically present early in view of recognizable complaints of infertility, while patients with the less common KS variants may not present early on due to cognitive delay. Thus, familiarity with the additional manifestations of the less common KS variants (e.g., gross bony features) can help clinicians to suspect the possibility of these variants, prompting chromosomal analysis for further evaluation in such patients. Presentation Date: Friday, June 16, 2023

THU448 Multiple Non-traumatic Vertebral Fractures After Discontinuation Of Denosumab

Abstract Disclosure: S. Riahi: None. A.R. Crawford: None. U. Gruntmanis: None. Background: In multiple studies, including a post-hoc analysis of the FREEDOM trial1, an increased risk of vertebral fractures has been demonstrated in patients after discontinuation of denosumab. Clinical Case: A 65-year-old female presented to the endocrinology clinic for evaluation of severe osteoporosis. She was diagnosed with osteoporosis in 2017 after a DXA scan demonstrated a lumbar spine T-score of −3.5. She was started on denosumab therapy by her primary care provider to treat her osteoporosis and received a total of 10 injections over 5 years, during which time she experienced no fractures. Her lumbar spine T-score improved to −2.6 in March of 2021. She received her last injection of denosumab in December of 2021 and was told that she no longer needed denosumab therapy. She began to develop severe pain in her back in October of 2022 and noticed a 3-inch height loss. X-rays done in November of 2022 demonstrated a new compression fracture in L2. Due to persistent debilitating pain, patient had repeat X-rays performed 1 week later which demonstrated multiple age indeterminate compression fractures which MRI was able to confirm at T5, T7, and T9-T12. Repeat DXA scan in December of 2022 demonstrated a lumbar spine T-score of −3.1. Serum C-Telopeptide (CTX) was 1060pg/mL. Patient had adequate calcium and vitamin D intake, and secondary causes of osteoporosis were excluded. Conclusion: This case report highlights the rapid reversibility of the beneficial effects of denosumab on bone density and bone remodeling after discontinuation of the drug (evidenced by the significantly elevated CTX), the importance of close follow up, and the use of transition therapy in patients after discontinuation of denosumab to attenuate the risks associated with stopping the medication. It also places import on the use of MRI imaging, especially in the cases of rebound associated vertebral fractures secondary to denosumab discontinuation2 for those patients in whom you have high suspicion to better characterize compression fractures when x-ray findings are not felt to be sufficient.

THU429 Improvement Of Osteoporosis Evaluation And Management In Patients Admitted With Hip Fractures At A Tertiary Level Academic Healthcare Institution In Manhattan

Abstract Disclosure: K. Haridas: None. K. Cuan: None. R. Agarwal: None. Objective: Osteoporosis is a widely prevalent disorder responsible for 1.5 million fractures annually resulting in high morbidity, mortality and financial sequelae. We conducted a quality improvement project to improve the diagnosis, evaluation and management of underlying osteoporosis in patients admitted with fragility hip fractures at our healthcare institutions and to understand the barriers to follow-up and thus, in setting up a fracture liaison clinic. Method: Patients admitted with pathological hip fractures were identified and provided educational handouts. Referrals were placed to outpatient Endocrinology for further evaluation and treatment. The status of follow up appointments in Endocrinology and other specialties was noted to evaluate barriers leading to attrition. Relevant steps were taken to address barriers by creating and implementing appropriate strategies. Effectiveness of the strategies was assessed by monitoring rates of outpatient follow up and strategies then permanently instituted or modified as appropriate. Results: 300 patients were included in the study. 278 patients (93%) had follow-up appointments scheduled, while 22 discharged patients did not due to scheduling deficits. Only 56 patients (21%) were present at their follow up appointments. All the patients who were seen at the clinic had appropriate evaluation and treatment of osteoporosis. Of the 79% of patients who cancelled their scheduled appointments, one third of patients (94 patients/ 33%) had a high rate of cancellation or absenteeism to other scheduled appointments as well, while 5 patients attended telehealth appointments only. Discussion: Only 10 to 20% of patients are treated for underlying osteoporosis after a fragility hip fracture. Fracture liaison services are interdisciplinary healthcare models for secondary and tertiary prevention of osteoporosis related complications in a population. Our project was designed to facilitate transition to this model. Despite high rates of designated follow up, significant attrition was noted. Debility due to old age, lack of understanding the need for timely treatment, socio-economic and logistic obstacles contribute to the same. In order to overcome the above barriers, steps proposed include having a designated member of staff meet with the patients during admission to coordinate further follow up for osteoporosis management, and to schedule telemedicine visits to bypass the barriers for physical attendance. In addition, patients will be liable to pay a no-show fee in the event of not attending follow-up appointments without prior notice. We also aim to contact providers in Orthopedics to coordinate referral of patients to Endocrinology during outpatient follow up visits post hospitalization and create a Fragility fracture Order set on Epic, containing a list of first line investigations and nutrient supplementation at discharge. Presentation: Thursday, June 15, 2023

FRI683 Every Dose Counts: Response To Half The Recommended Dose Of Romosozumab

Abstract Disclosure: B.P. Ramchandani: None. F.S. Mirza: None. Introduction: Romosozumab (RSB) is a monoclonal antibody that inhibits sclerostin, increases bone formation and decreases bone resorption. It was approved by FDA in 2019 at a dose of 210 mg monthly for 1 year, followed by an anti-resorptive medication. We present a case of a 76 y.o. female with severe osteoporosis and history of intolerance to multiple medications, who was given half the monthly recommended dose of Romo due to extreme concern about side effects. We hereby report the response of her bone density to the treatment. Case Description: A 76-year-old female with history of primary biliary cirrhosis, Sjogren’s syndrome, hemorrhagic duodenal ulcer, s/p subtotal gastrectomy in 1962 presented for evaluation of severe osteoporosis. Fracture history was significant for T11 compression fracture in 2020 requiring kyphoplasty, and a T10 inferior endplate compression fracture requiring vertebroplasty in 2022. Osteoporosis was first diagnosed in 2005. She was intolerant of teriparatide in 2005 (stopped after six months due to nausea, hypercalcemia, cramps, pain in extremities and fatigue). Zoledronic acid (ZA) was administered in 2006 and 2008. Baseline urine telopeptide cross-links (NTx) was low at 18 which decreased to 10 while on ZA and further infusions were held. She declined denosumab and teriparatide was tried again in 2013 that she did not tolerate. She received ZA again in 2016. BMD did not improve on ZA and she declined further infusions. She was physically active and walked daily and was taking calcium citrate, vitamin D and ursodiol during this time. On examination, she was frail and elderly, with BMI of 16.6 mg/kg2. She had mild kyphoscoliosis of the spine with no spinal or paraspinal tenderness. Remainder of the exam was unremarkable. Laboratory evaluation showed normal serum calcium (9.5 mg/dl), albumin (4.1g/dl), Vit D 25-OH (36 mg/ml), bone specific alkaline phosphatase of 22.7 U/L and urine NTx of 23 nm BCE/mm creatinine. Bone density (BMD) in January 2022 showed lumbar spine (LS) BMD of 0.613 g/cm2 (T-score −4.7) and a total hip BMD of 0.575 g/cm2 (T-score −3.4). She was reluctant to consider any medications due to concern about side effects, but finally agreed to a trial of RSB at half the recommended dose at 105 mg monthly for 12 months. DXA scan a year later showed 17% increase in LS BMD (0.715 g/cm2, T-score -3.9), with stable total hip BMD. She has been transitioned to denosumab, which she was now agreeable to take. Discussion: Our patient showed significant improvement in BMD with half the recommended dose of RSB, comparable to the increase in LS BMD reported in phase 3 trials. She was petite and her weight-based dose was just short of 3 mg/kg body weight. Phase 1 and 2 studies had tried weight based and smaller doses of Romo and showed improvement in BMD. This case highlights the need for additional studies with weight-based dosing of RSB, which may reduce the cost of treatment. Presentation: Friday, June 16, 2023

THU419 Comprehensive Evaluation Of Osteoporosis And Impaired Bone Micro Architecture In Patients With Transfusion Dependent Beta Thalassemia

Abstract Disclosure: P. Dutta: None. comprehensive evaluation of osteoporosis and impaired bone micro architecture in patients with transfusion dependent beta thalassemia Authors: Pinaki Dutta, Liza Das, Alka Khadwal, Pankaj Malhotra, Sanjay Kumar Bhadada, Vandana Dhiman, Vivek Sharma, Raman Introduction: Thalassemia-related bone disease is an entity that includes low bone mass, fractures and impaired bone microarchitecture. The current study was designed to evaluate the prevalence and determinants of low bone mass, osteoporosis and microarchitectural parameters using high-resolution peripheral quantitative computed tomography (HR-pQCT) in patients with transfusion-dependent thalassemia (TDT). Patients and Methods TDT patients (n=42) and age- and BMI-matched controls (n=40) were recruited. Demographic, biochemical and hormonal parameters were assessed. Bone mineral density (BMD), T- and Z- scores were measured by DEXA using the HOLOGIC Discovery A Viewer 6 machine. Bone microarchitecture was estimated by HR-pQCT (XtremeCT II, Scanco Medical AG, Switzerland). Results: The mean age of thalassemia patients at recruitment was 26.9 ± 6.5 years and that of controls was 28.9 ± 7.9 years. The mean age of transfusion initiation was 7 months (IQR 3-18) and the median number of transfusions required was 24 (15-25) annually. Serum calcium in cases (8.87 ± 0.67mg/dl) was significantly lower than the controls (9.40 ± 0.45mg/dl), with 9 patients having hypocalcemia and 7 of these having hypoparathyroidism. Hypogonadism was present in 40.4% patients. Bone turnover markers (P1NP, β-CTX) were not significantly different between cases and controls, except alkaline phosphatase (ALP) which was higher in the cases (102.6 ± 60.7 U/l) as opposed to controls (78.2 ± 32.1 U/l). There was a significant correlation between ALP and liver dysfunction (alanine transaminase exceeding the upper normal limit) (r = 0.36, p=0.01) and 63.6% of those with elevated ALP had liver dysfunction. Low bone mass (Z ≤−2) was present in significantly greater proportion of patients versus controls at femoral neck (29.3% vs 2.4%) and at lumbar spine (52.4% vs 14.7%). Total, cortical and trabecular volumetric bone mineral density were significantly lower in cases as compared to controls(p&amp;lt;0.05). The trabecular number was significantly lower (p&amp;lt;0.0001) and trabecular separation significantly higher at radius and tibia (p&amp;lt;0.001). Cortical thickness at radius and tibia were also significantly lower in cases than controls (p&amp;lt;0.0001). Conclusion: Patients with transfusion-dependent thalassemia have significantly lower areal and volumetric BMD (both cortical and trabecular). The bone microarchitecture is also significantly impaired in terms of lower number and wider spacing of trabeculae as well as lower cortical thickness at both radius and tibia. Presentation: Thursday, June 15, 2023