Follow-up Bone Mineral Density Research Articles

Changes in bone mineral density and clinical parameters after stroke in elderly patients with osteopenia.

We aimed to determine the association between changes in bone mineral density (BMD) of the lumbar spine, bilateral femoral necks and clinical parameters in ambulatory older adult patients with stroke who were diagnosed with osteopenia. This retrospective study included ambulatory patients older than 65 years diagnosed with stroke between January 2019 and June 2021. Osteopenia was diagnosed within 1 month after stroke diagnosis. Subsequently, follow-up BMD was performed within 12 to 14 months. The manual muscle test and modified Barthel index were measured as clinical parameters, and bone turnover markers were measured as biochemical markers. The Wilcoxon signed-rank test was used to compare whether a significant difference in the change in BMD was noted at each site measured at 1-year intervals. The BMD of the paretic and non-paretic femoral necks decreased significantly over time, but no significant change was observed in the BMD of the lumbar spine. Bone turnover markers were significantly changed at follow-up. Patients with modified Barthel index of less than 82 had significant bone loss only on the paretic side of the femoral neck. The BMD of the paretic side of the femoral neck was significantly decreased regardless of the strength of the hip and knee extensors. Although older adult patients with stroke and osteopenia can walk independently, more active osteoporosis treatment is needed to prevent bone loss and fractures, including improvement in daily living function and bilateral lower extremity strength training.

Coronary artery calcification is associated with smaller increases in femoral neck bone mineral density with anti-resorptive therapy

Abstract Introduction Patients with osteoporosis are at high cardiovascular risk, partly due to vascular calcification, such as in the coronary vessels. It is uncertain if the presence of coronary artery calcification (CAC) effects bone mineral density (BMD) response to anti-resorptive treatment – first line therapy for osteoporosis. We therefore assessed changes in BMD following initiation of anti-resorptive treatment for osteoporosis in patients with and without evidence of CAC. Methods Individuals dispensed at least one prescription for an anti-resorptive medication (bisphosphonates or denosumab) at Monash Health between 2009-2022 were identified. Unique record numbers for these individuals were then cross-matched against the cardiac CT imaging service at Monash Heart (HREC#73603). CAC was detected using a 320-slice CT coronary angiogram (CTCA). We included only those patients having a baseline BMD measurement within two years of CTCA. The annualised percentage change in femoral neck BMD was calculated and adjusted for age, sex, height, weight, and number of years on anti-resorptive treatment. Results 106 individuals were identified of which 85 (women=70 [85%], median age=73 years [interquartile range 64-79 years]) had a follow-up BMD measurement including 19 with, and 66 without, evidence of CAC. Those with CAC were older (76 years versus 64 years, p<0.001). There were 70 bisphosphonate users and 15 denosumab users. Individuals with evidence of CAC experienced, on average, a 1.2% lower increase [(0.345% (0.343 to 0.348) versus -0.881% (-0.883 to -0.879), mean difference -1.226% (-1.493 to -0.959; p<0.05)] in annualised femoral neck BMD with anti-resorptive therapy after adjusting for important clinical risk factors. Interpretation These preliminary data suggests that CTCA-determined CAC may negatively impact femoral neck BMD increases with anti-resorptive therapy. This is perhaps consistent with existing and evolving hypotheses of dysregulatory processes driving ectopic calcium deposition, which we surmise would partially counter the effects of anti-resorptive therapy and potentially manifest as CAC. Thus, of particular interest will be the comparison of cardiovascular outcomes of patients with known CAC with and without anti-resorptive therapy, with the hypothesis that anti-resorptive therapy may potentially have cardioprotective effects in context of CAC. Analysis of the full cohort is underway.Table 1

THU410 Retrospective Review Of Adults Patients With Suspected Or Confirmed Hypophosphatasia At The Penn Bone Center

Abstract Disclosure: R. Tran: None. C. Hvisdas: None. M. Riordan: None. L. Novotny: None. S. Kallish: None. K. Patel: None. M. Al Mukaddam: None. Abstract: Hypophosphatasia (HPP) is a rare inherited genetic disorder that affects the mineralization of bones and teeth. HPP is the result of a pathogenic variant involving the tissue nonspecific alkaline phosphatase (ALPL) gene. The clinical presentations of HPP greatly vary from serious perinatal manifestations (respiratory failure, seizures, and death) to mild manifestations in adulthood. In adults, hallmark signs and symptoms include early loss of primary or secondary teeth, osteoporosis, osteomalacia, recurring metatarsal stress fractures, and abnormal laboratory values, such as low alkaline phosphatase (ALP), elevated phosphoethanolamine, and elevated vitamin B6.The treatment and follow up of adults with HPP are not clearly described. This retrospective study characterizes 43 patients referred to the Penn Bone Center for suspected HPP. Twelve of the 43 patients had a confirmed HPP diagnosis based on both clinical presentations and evidence of variant in the ALPL gene. The twelve patients consisted of both female and male adults between the ages of 24 to 74. In addition, the patients had abnormal ALP levels, ranging between less than 5 to 38 units per liter (normal range: 38 to 126 U/L). Six of these patients had previous or current use of asfotase alfa with variable treatment response. Two patients decided to stop treatment due to lack of clinical benefit or worsening of symptoms while on asfotase alfa therapy. Biochemical and bone mineral density follow-up while on therapy has not been shown to be helpful in monitoring treatment response. Asfotase alfa is a subcutaneously administered synthetic human alkaline phosphatase that was approved by the Federal Drug Administration (FDA) in 2015 for treatment of perinatal/infantile- and juvenile-onset hypophosphatasia. However, the efficacy of treatment in adults remain unclear at this time. Further research is required to better define the natural progression of mild or adult-onset hypophosphatasia and the patients who would benefit from enzyme therapy. Presentation: Thursday, June 15, 2023

Comparison between real-world practice and application of the FRAX algorithm in the treatment of osteoporosis

Background and aimsThe most recent guidelines suggest treating patients whose FRAX 10-year fracture risk scores are ≥ 20%. However, this method of evaluation does not take into account parameters that are nonetheless relevant to the therapeutic choice. Our aim was to compare the therapeutic choices for treatment based on a wider assessment (real-world practice) with those based on FRAX scores, taking 20% as the cut-off score.MethodsWe obtained the medical history, bone mineral density (BMD) values, and the presence of major fragility fractures in a sample of 856 postmenopausal women. The 10-year FRAX risk of major osteoporotic fracture was calculated, and patients were grouped into risk classes (“FRAX < 20%” = low, “FRAX ≥ 20%” = high); we then compared the treated and untreated patients in each class. After an average interval of 2.5 years, changes in lumbar and femoral BMD and appearances of new fragility fractures were recorded.Results83% of high-risk patients and 57% of low-risk patients were treated. The therapeutic decision was based mainly on densitometric values and the presence of vertebral fractures. At the 2.5 year follow-up, lumbar spine and femur BMD had decreased in the untreated group; 9.9% of the treated patients developed new vertebral fragility fractures, compared with 5.3% of the untreated patients.Discussion and conclusionsOur wider assessment designated as at high fracture risk a group of patients who had not been identified by the FRAX assessment. FRAX could underestimate the risk of fracture in older people, for which the therapeutic choice should consider a broader approach, also based on individual patient’s needs.

Dual-energy x-ray absorptiometry scanner mismatch in follow-up bone mineral density testing.

Detecting significant changes in bone mineral density (BMD) with dual-energy x-ray absorptiometry (DXA) scanners relies on the least significant change (LSC). Results from two different DXA scanners can only be compared, albeit with decreased sensitivity for change, if the LSC between the two scanners has been directly determined through cross-calibration. Performing follow-up DXA scans on non-cross-calibrated scanners (scanner mismatch) has safety and economic implications. This study aims to determine the proportion of scanner mismatch occurring at a population level. All patients who completed at least two DXA scans between 1 April 2009 and 31 December 2018 in the province of Alberta, Canada, were identified using population-based health services databases. Scanner mismatch was defined as a follow-up DXA scan completed on a DXA scanner that differed from and was not cross-calibrated to the previous DXA scanner. Multivariate logistic regression models were used to assess predictive factors that may contribute to scanner mismatch. A total of 264,866 patients with 470,641 follow-up DXA scans were identified. Scanner mismatch occurred in 18.9% of follow-up DXA scans; 28.7% of patients experienced at least one scanner mismatch. Longer duration between scans (OR 1.25, 95% CI 1.24-1.26) and major osteoporotic fracture history before index scan (OR 1.06, 95% CI 1.03-1.08) increased risk of scanner mismatch. Osteoporosis medication use before index scan (OR 0.89; 95% CI 0.88-0.91), recency of follow-up scans (OR 0.98, 95% CI 0.73-0.98), female sex (OR 0.97, 95% CI 0.94-1.00), and age at last scan (OR 0.99, 95% CI 0.99-1.00) were associated with lower risk of scanner mismatch. Scanner mismatch is a common problem, occurring in one-in-five follow-up DXA scans and affecting more than a quarter of patients. Interventions to reduce this large proportion of scanner mismatch are necessary.

MO1011: The Effect of Vitamin D on Bone Mineral Density: A Real-Life Study in Long-Term Kidney Transplant Recipients Never Supplemented

Abstract BACKGROUND AND AIMS Vitamin D insufficiency has been associated with decreased bone mineral density (BMD) in kidney transplant patients (KTRs). However, few data on BMD changes due to vitamin D supplementation in long-term KTRs are available. The purpose of our study is to ascertain the effect of 25-OH-vitamin D (25-OH-D) supplementation on the BMD over a follow-up period of up to 3 years in a real-life cohort of long-term KTRs never supplemented with 25-OH-D and not treated with active vitamin D, bisphosphonate and calciomimetics. METHOD Demographic, clinical and laboratory data were collected. Inclusion criteria were: (1) being a recipient of a kidney from a cadaveric or living donor, (2) age ≥ 18 years and (3) no therapy with inactive vitamin D sterols. Patients with parathyroidectomy and/or history of bone fractures were excluded. BMD was evaluated with standard DEXA, performed at baseline (before vitamin D supplementation) and at the end of the study period. BMD was assessed at lumbar vertebral bodies (LV) and right femoral neck (FN) by a single operator. Bone mineral content (BMC) was calculated in grams (g), bone area in centimetres squared (cm2), and BMD in g/cm2 (BMC divided by the area). According to WHO criteria, results were expressed as T-score [standard deviation (SD) relative to young healthy adults] and Z-score (SD relative to age-matched controls). Osteoporosis and osteopenia were defined as T-score ≤−2.5 SD and T-score &amp;lt;−1 and &amp;gt;−2.5 SD, respectively. According to plasma levels, 25-OH-D was supplemented as recommended for the general population. Linear mixed model analysis was implemented to test the impact of 25-OH-D use on Z-score, T-score and BMD changes (dependent variables) adjusted for sex, age, BMI and presence of diabetes. Z-score, T-score and BMD changes were defined as Z-score, T-score and BMD at follow-up, Z-score, T-score and BMD at study inception. RESULTS A total of 118 KTRs consecutive outpatients never supplemented with 25-OH-D, of whom 69 KTRs were untreated (KTRs-free) and 49 were treated (control group) with bisphosphonate (n = 13) and/or calcio-mimetics (n = 11) and/or active vitamin D (n = 29) were enrolled. Clinical and biochemical characteristics are shown in Table 1. At the basal DEXA, the percentage of osteopenia and osteoporosis was 39.0% and 21.2% at LV; 52.5% and 16.9% at FN, respectively. The mean study-period was 27.7 ± 3.4 months. Basal and follow-up Z-score, T-score and BMD at both measurement sites are reported in Table 2. In linear mixed model analysis, a positive interaction of 25-OH-D supplementation on T-score and Z-score changes at the lumbar vertebral bodies was found (P &amp;lt; .05). At the end of the study, no statistical differences in Z-score, T-score and BMD gains were observed. CONCLUSION Prolonged supplementation with 25-OH-D affects Z-score and T-score at LV in long-term KTRs never supplemented with active or inactive vitamin D.

Effects of non-supervised exercise interventions on bone mineral density in adult women: a systematic review and meta‑analysis.

Mini abstractOsteoporosis is a major health issue worldwide. This study analyzes the effects of non-supervised osteoporosis prevention programs on bone mineral density. Non-supervised exercise increases femoral neck and lumbar spine bone mineral density in adult women. Thus, it might be effective for preventing or treating osteoporosis or osteopenia in this population.IntroductionOsteoporosis is a major health issue worldwide. Social distancing measures due to COVID-19 have hindered the chances to take part in supervised osteoporosis prevention exercise programs. The purpose of the present study is to systematically review and meta-analyze the effects of non-supervised osteoporosis prevention exercise programs on bone mineral density (BMD) in adult women.MethodsA comprehensive search of electronic databases (n = 7) was conducted including (a) prospective randomized controlled trials (RCTs) comparing at least one exercise group vs. a control group with sedentary lifestyle or sham exercises; (b) baseline and follow-up BMD values, or BMD changes from baseline, at any skeletal site; (c) women over 30 years old; and (d) non-supervised exercise programs only. Subgroup analyses were performed for menopausal status, intervention duration, type of exercise, and osteopenia/osteoporosis status.ResultsTen studies were included (n = 668). Random effect analyses showed that unsupervised exercise had beneficial effects on lumbar spine (LS) BMD with standardized mean difference (SMD) = 0.40 (95% confidence interval (CI): 0.03–0.77), and femoral neck (FN) BMD with SMD = 0.51 (95% CI: 0.16–0.85). Unsupervised exercise increased LS (SMD = 0.73 (95% CI: 0.13–1.33)) and FN BMD (SMD = 0.85 (95% CI: 0.33–1.37)) in women with osteopenia/osteoporosis, but not in healthy counterparts.ConclusionNon-supervised exercise improves FN and LS BMD in adult women. Beneficial effects of exercise on FN and LS BMD might be more pronounced in those with poor bone health compared with healthy counterparts. More RCTs prescribing non-supervised, osteogenic exercise are required in this population. It is necessary to investigate the efficacy of remote/assistive technologies for delivering and monitoring non-supervised exercise interventions.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00198-022-06357-3.

Opportunistic osteoporosis screening using routine computed tomography images to identify bone loss in gynecologic cancer survivors

ObjectiveCancer treatment-induced bone loss is a known side effect of cancer therapy. Computed tomography (CT) bone mineral density screening is a novel tool for identifying bone loss. This study aims...

A randomized trial of alendronate as prophylaxis against loss in bone mineral density following lymphoma treatment

AbstractLymphoma patients often receive high glucocorticoid doses as part of standard therapy. Observational studies have shown a substantial risk of glucocorticoid-induced osteoporosis (GIO) with associated fractures. The aim of the SIESTA trial was to determine if oral alendronate (ALN) is a safe and effective prophylaxis against GIO in lymphoma. SIESTA was a single-center, randomized, double-blinded, phase 2 study of lymphoma patients planned for glucocorticoid-containing chemotherapy. After randomization, patients received weekly ALN 70 mg or placebo for a total of 52 weeks. Bone mineral density (BMD) was assessed at baseline, after completion of chemotherapy (end of treatment [EOT]) (4 to 6 months), and at the end of the study (EOS) (12 months). Vertebral fracture and biomarkers were assessed at baseline and EOS. Patients with baseline BMD assessment and at least 1 follow-up BMD assessment were analyzed for efficacy. The primary endpoint was a change in lumbar spine T-score from baseline to EOS. Of the 59 patients enrolled, 23 of 30 in the ALN arm and 24 of 29 in the placebo arm were analyzed for efficacy. The mean change in T-score from baseline to 12 months at the lumbar spine was +0.15 for ALN and -0.12 for placebo (P = .023). The difference in ΔTEOS between the ALN and placebo groups was larger among females (ALN 0.28; placebo -0.28; P = .01). Biomarker analyses confirmed reduced bone resorption in ALN-treated patients. In conclusion, ALN is a safe and effective primary prophylaxis against loss in BMD following glucocorticoid-containing chemotherapy. Despite reduced BMD loss in the ALN arm, the treatment did not influence fracture risk in this small cohort of patients.

Ranked set sampling in finite populations with bivariate responses: An application to an osteoporosis study.

The majority of the research on rank-based sampling designs in finite populations has been concerned with univariate situations. In this article, we study design-based estimation using a bivariate ranked set sampling (BIRSS) for finite populations when we have bivariate response variables. We derive the first and second-order inclusion probabilities associated with a BIRSS design. We show that the size of a BIRSS sample is random and propose using a conditional Poisson sampling (CPS) design to rectify this problem. We then use calculated inclusion probabilities to obtain design-based estimators of correlation coefficients between the bone mineral density (BMD) levels at the baseline and followup of a longitudinal BMD study in the province of Manitoba in Canada. We also study the problem of estimating the parameters of a regression model between the followup BMD and easy to obtain auxiliary information from the underlying population. Finally, we study the problem of classifying patients as those with or without osteoporosis using BIRSS and various CPS designs. We show that BIRSS designs are very flexible and can be used to obtain more efficient design-based estimators in sample surveys when dealing with response variables that are hard to measure or expensive to obtain.

Feasibility and effects of 6-month home-based digitally supported E-Fit program utilizing high-intensity interval exercises in girls with adolescent idiopathic scoliosis: a randomized controlled pilot study.

Adolescent idiopathic scoliosis (AIS) patients have lower physical activities when compared with healthy controls, and are associated with lower bone mineral density (BMD), muscle strength and poorer quality of life (QoL). We aimed to assess the feasibility and effects of 6-month home-based digitally supported E-Fit comprised of high-intensity interval exercises for AIS patients. 40 AIS girls aged 11-14 were randomly assigned to E-Fit or control group. E-Fit group participated in an online 6-month home-based exercise program. At baseline, 6-months and 12-months follow-up, BMD using dual-energy X-ray absorptiometry, muscle functions, physical activity using Modified Baecke Questionnaire (MBQ), and QoL using Scoliosis Research Society-22 (SRS-22r) and feedback questionnaire were investigated. 14 in E-Fit and 16 in control group completed the study. Both groups had similar baseline characteristics. At 6-months, E-Fit group showed better improvement and significant interaction effect in left femoral neck bone mineral content (p=0.021) and isometric curl up test (p=0.04). Left arm lean mass showed better improvement between 6-months and 12-months follow-up (p=0.046) and whole-body areal BMD had significant interaction effect at 12-months follow-up (p=0.077). Improvement on self-image, work and sports participation were noted in E-Fit group across time. 70% of E-Fit participants were positive towards domestic application via online platform. E-Fit showed some benefits on bone health, muscle functions, physical activity and QoL measures. Current study indicated some potential physical and psychological benefits of E-Fit for AIS girls. E-Fit was feasible to conduct online at home and might have value of promoting exercise habits among relatively inactive AIS girls.

The Predictive Value of Vitamin D Serum Concentration for Osteopenia and Fractures in Children with Hematological Malignancies

Background -Impaired bone mineral density (BMD) is a frequently reported side-effect of patients with childhood cancer. Vitamin D deficiency is suggested to be a risk factor for diminished BMD and fractures during and after cessation of treatment of childhood hematological malignancies.Objective - The aim of our study was to assess the predictive value of a deficient vitamin D serum concentrations for osteopenia and fractures in children with hematological malignancies during and after cessation of treatment.Methods - An extensive literature search was conducted in PubMed, Embase and Cochrane databases. Studies with a prospective study design and written in English, Dutch, French or German, addressing children with hematological malignancies were considered eligible if vitamin D and bone mineral density and/or fractures were measured at baseline and during/after cessation of treatment.Results - A total of 923 articles were identified. After screening and critical appraisal, ten articles (n=16-43, mean/ median age 3.9-11.2 years) were eligible for quantitative analysis. Five studies showed deficient 25-OHD and/or 1,25(OH)2D levels, ranging from 8.5-46 ng/ml and 12.3-75 pg/ml, respectively. In all these cases, levels were already deficient at baseline.No studies adressed the predicitive value of vitamin D on fracture risk. All studies except one investigating BMD found decreased BMD Z-scores both at baseline and at follow-up, ranging from 0.70- -2.3 and -0.21- -2.4. Only four studies assessed the relation between vitamin D status and low BMD, of which just two corrected for possible confounders. Of these studies, one reported a positive correlation of serum 25-OHD at follow-up and subtotal body BMD (R=0.39-0.42, p<0.03), whereas the others found no relation.Conclusion - Based on the available evidence consisting of small studies, deficient vitamin D serum concentration cannot be conceived to be a predictor of impaired BMD and fractures during and after cessation of treatment in children with hematological malignancies. However, one studie reported a positive correlation and both vitamin D levels and BMD were often decreased, implying a relation. Larger studies addressing vitamin D as an independent risk factor should be conducted. DisclosuresNo relevant conflicts of interest to declare.

Association of vitamin D nutritional status with calcaneal bone mineral density in school-age children: a prospective cohort study

Objective: To investigate the relationships between vitamin D nutritional status and the calcaneal bone mineral density (BMD) in children. Methods: Data were obtained from School-based Cardiovascular and Bone Health Promotion Program. In 2017, a total of 15 391 children aged 6-16 years in Beijing selected through stratified cluster sampling were included in the baseline survey. A follow-up investigation was conducted in 2019. The questionnaire survey, detection of serum 25-hydroxyvitamin D [25(OH)D] level and ultrasound measurement of calcaneal BMD were conducted. Multivariable linear and logistic regression models were used to analyze the relationships between baseline vitamin D nutritional status and the follow-up calcaneal BMD. Results: A total of 10 914 children aged (11.5±3.3) years (boys accounting for 49.6%) were included in the analysis. The average 25(OH)D level was (35.4±12.0) nmol/L, and the deficiency rate was 36.1%. After the adjustment for age, gender, body mass index, smoking status, alcohol use status, dairy products intake, vitamin D supplement, calcium supplement, physical activity, pubertal development, and baseline calcaneal BMD Z-score, for per 10 nmol/L increase in 25(OH)D, the follow-up calcaneal BMD Z-score increased by 0.01(P=0.041), and the OR(95%CI) of decreased calcaneal BMD Z-score after 2 years was 0.96 (0.93-1.00)(P=0.030). Compared with vitamin D adequacy, the follow-up calcaneal BMD Z-score of children with vitamin D insufficiency and deficiency decreased by 0.03(P=0.307) and 0.06 (P=0.046), and the risk of decreased calcaneal BMD Z-score after 2 years increased by 15%(P=0.037) and 21%(P=0.006), respectively (P for trend<0.05). Conclusions: Vitamin D nutritional status was closely related to calcaneal BMD, and children with adequate vitamin D nutritional status tended to obtain higher BMD. Children and adolescents are encouraged to maintain sufficient vitamin D levels, strengthen nutrition and exercise to promote bone health.

Bone resorption and dietary calcium in pregnancy-a window to future maternal bone health.

Pregnancy is characterized by increased bone turnover and reversible loss of bone mineral density (BMD) to meet fetal calcium demands. The long-term effect of bone turnover and maternal diet in pregnancy on maternal bone is not well established. We aimed to determine if an association exists between [1] bone resorption, [2] dietary calcium, and [3] serum 25-hydroxyvitamin D in pregnancy with maternal BMD 5-year postpartum. This is a prospective, longitudinal study of 107 women recruited to the ROLO low glycemic index dietary intervention trial in pregnancy and followed-up at 13, 28, and 34weeks' gestation and 5years' postpartum. At 13 and 28weeks' gestation, a biomarker of bone resorption, urine cross-linked N-telopeptide of type I collagen (uNTX), was measured. At the 5-year follow-up BMD was measured using dual-energy X-ray absorptiometry. Anthropometry, dietary intakes, and serum 25-hydroxyvitamin D were measured in pregnancy and at 5years. Multiple linear regression, controlling for confounders, was used for analysis. Mean BMD at 5years was 1.208g/cm2. In pregnancy, 24-34% reported dietary calcium intakes <800mg/day. Vitamin D deficiency (< 30nmol/L) was observed in 38-41% of women in pregnancy and in 29% of women at the 5-year follow-up. At 13 and 28weeks' gestation, uNTX levels greater than the median were associated with 0.060 and 0.050g/cm2 lower BMD 5years later, respectively. Dietary calcium <800mg/day in trimester 3 was associated with 0.072g/cm2 lower BMD 5years later. Vitamin D deficiency at 5years, but not in pregnancy, was associated with lower BMD. Higher bone resorption and low dietary calcium in pregnancy were associated with lower BMD 5years later. These findings could enable the identification of women at risk of declining of BMD in later life, but further research is needed. Adequate dietary calcium should be advised in the antenatal setting to promote lifelong maternal bone health.

The Importance of Careful Patient Selection in the Use of Follow-up Bone Mineral Density Testing

The Importance of Careful Patient Selection in the Use of Follow-up Bone Mineral Density Testing

Bone mineral density improves during 2 years of treatment with bisphosphonates in patients with ankylosing spondylitis.

AimsTo evaluate whether 2 years of treatment with bisphosphonates in combination with calcium/vitamin D supplements has an effect on lumbar spine and hip bone mineral density (BMD) in ankylosing spondylitis (AS) patients starting tumour necrosis factor‐α inhibitors or receiving conventional treatment. Secondly, to explore the development of radiographic vertebral fractures.MethodsPatients from the Groningen Leeuwarden AS cohort receiving bisphosphonates based on clinical indication and available 2‐year follow‐up BMD measurements were included. BMD of lumbar spine (L1–L4) and hip (total proximal femur) were measured using dual‐energy X‐ray absorptiometry. Spinal radiographs (Th4–L4) were scored for vertebral fractures according to the Genant method.ResultsIn the 20 included patients (median 52 years, 14 males), lumbar spine and hip BMD Z‐scores increased significantly; median from −1.5 (interquartile range [IQR] −2.2 to 0.4) to 0.1 (IQR −1.5 to 1.0); P < .001 and median from −1.0 (IQR −1.6 to −0.7) to −0.8 (IQR −1.2 to 0.0); P = .006 over 2 years, respectively. In patients also treated with tumour necrosis factor‐α inhibitors (n = 11), lumbar spine and hip BMD increased significantly (median 2‐year change +8.6% [IQR 2.4 to 19.6; P = .009] and +3.6% [IQR 0.7–9.0; P = .007]). In patients on conventional treatment (n = 9), lumbar spine BMD increased significantly (median 2‐year change +3.6%; IQR 0.7 to 9.0; P = .011) and no improvement was seen in hip BMD (median −0.6%; IQR −3.1 to 5.1; P = .61). Overall, younger AS males with limited spinal radiographic damage showed most improvement in lumbar spine BMD. Four mild radiographic vertebral fractures developed in 3 patients and 1 fracture increased from mild to moderate over 2 years in postmenopausal women and middle‐aged men.ConclusionThis explorative observational cohort study in AS showed that 2 years of treatment with bisphosphonates in combination with calcium/vitamin D supplements significantly improves lumbar spine BMD. Mild radiographic vertebral fractures still occurred.

Special emphasis on bone health management in prostate cancer patients: a prospective longitudinal study.

ABSTRACTIntroduction:Use of androgen deprivation therapy (ADT) in carcinoma prostate (CaP) has deleterious effect on bone mineral density (BMD) leading to increase incidence of osteoporosis and skeletal-related events. We evaluated bone health status and impact of bone-directed therapy (BDT) and ADT on BMD in these patients from Jan 2015-Dec 2018.Materials and Method:Baseline bone health was assessed using Tc-99 MDP Bone scan/ DEXA scan for patients on ADT. Monthly zoledronic acid (ZA) was given to high-risk candidates (T-score ≤2.5 or previous hip/vertebral fracture) or Skel et al. metastatic patients who were receiving ADT. Baseline and follow-up (at 12-months) BMD using DEXA scan at various sites (spine, femur total, femur neck and radius) and subjective improvement in bony pain using Numeric Pain Rating Score after administration of ZA were compared.Results:A total of 96-patients of locally advanced and metastatic prostate cancer receiving ADT with or without BDT were included in the study cohort. Mean age of presentation was 68.4±15.61 years. Median serum PSA was 32.2±13.1ng/mL. There was significant improvement in mean BMD (T-score) in 64-patients post ZA therapy at 12-months (at femoral total, femoral neck and spine; 0.95, 0.79 and 0.68, respectively) (p <0.05) while there was significant deterioration in mean BMD at 12-months (at spine, femoral neck and femoral total; −0.77, −0.55 and −0.66, respectively) in 32 patients who did not receive ZA and were on ADT (p <0.05). Pain scores significantly decreased in patients after 12-months of ZA use (−2.92±2.16, p <0.01).Conclusion:Bone-directed therapy (Zoledronic acid) leads to both subjective and objective improvement in bone health of prostate cancer patients on ADT.

Weight loss since early adulthood, later life risk of fracture hospitalizations, and bone mineral density: a prospective cohort study of 0.5 million Chinese adults

SummaryIn a Chinese population from both urban and rural areas, weight loss of ≥ 5 kg from early adulthood to midlife was associated with a higher risk of hip fracture and lower BMD in later life.IntroductionThis study investigates the association of the long-term weight loss from young adulthood through the middle ages with the subsequent 10-year risk of hospitalized fracture and calcaneus bone mineral density (BMD).MethodsChina Kadoorie Biobank (CKB) was established during 2004–2008 in ten areas across China. Weight at age 25 years was self-reported at baseline, and weight at baseline and resurvey was measured by the calibrated equipment. Outcomes were hospitalized fracture during follow-up and calcaneus BMD measured at resurvey. Analysis for fracture risk included 411,812 participants who were free of fracture in the last 5 years before baseline, cancer, or stroke at any time before baseline. Analysis for BMD included 21,453 participants who participated in the resurvey of 2013–2014 with the same exclusion criteria as above.ResultsThe mean age was 50.8 at baseline and 58.4 at resurvey. Median weight change from age 25 to baseline was 4.4 kg, with 20.7% losing weight and 58.5% gaining weight. During a median follow-up of 10.1 years, we documented 13,065 cases of first diagnosed fracture hospitalizations, including 1222 hip fracture. Compared with participants whose weight was stable (± 2.4 kg), the adjusted hazard ratios (95% CIs) for those with weight loss of ≥ 5.0 kg from age 25 to baseline was 1.39 (1.17 to 1.66) for hip fracture. Weight loss was not associated with fracture risk at other sites. Those with weight loss from age 25 to resurvey had the lowest BMD measures, with β (95% CIs) of − 4.52 (− 5.08 to − 3.96) for broadband ultrasound attenuation (BUA), − 4.83 (− 6.98, − 2.67) for speed of sound (SOS), and − 4.36 (− 5.22, − 3.49) for stiffness index (SI).ConclusionsWeight loss from early adulthood to midlife was associated with a higher risk of hip fracture and lower BMD in later life.

The Clinical Significance of Bone Mineral Density Changes Following Long Term Androgen Deprivation Therapy in Prostate Cancer Patients Enrolled in the PCS V Trial

Treatment for advanced prostate cancer includes long term androgen deprivation therapy (ADT), which has been associated with decreased bone mineral density (BMD). It is unclear whether this translates to a clinically significant change in bone density status. Some evidence suggests that there is no impact on fracture risk despite a decrease in BMD. We quantified changes in BMD when all patients on ADT were mandated to take Calcium and Vitamin D (CaVitD) in the setting of a phase III randomized clinical trial and compared the findings to historical data. BMD analysis was conducted for high-risk prostate cancer patients enrolled in the PCS V study (NCT01444820), a randomized phase III trial comparing conventional and hypofractionated radiotherapy regimens. Patients received 24 months of ADT and were prescribed CaVitD supplementation (Carbocal D 1 tablet twice daily; 500mg of Calcium + 400 IU of Vitamin D3). Long-course ADT consisted of luteinizing hormone-releasing hormone agonist therapy, with 14 days of bicalutamide (50 mg per day) with the first injection only. BMD reports at baseline and at 30 months of follow-up had the areal density and T-scores (spine, femoral neck, and total femur) extracted and the absolute change calculated. The results were then compared to the BMD decline of CaVitD control groups in bisphosphonate trials. Clinical bone density status (normal, osteopenia, versus osteoporosis) was monitored. In total, BMD reports were obtained from 329 patients. Patient data was further analyzed if a 24-month follow-up BMD data was present for a given site - 226 (spine), 231 (femoral neck), and 173 (total femur). The mean change (standard deviation) in the areal density was -2.65% (5.78), -2.76% (5.59), -4.27% (4.41), respectively. The difference was statistically significant for all three sites (p<0.001). The average decrease in BMD across all three sites was -3.2% after 24 months of ADT, compared to a historical figure of -2.1% following 12 months of ADT. For most patients (n=140, 83%), there was no clinically significant decline in bone density status. Eight patients (5%) with osteopenia prior to ADT became osteoporotic, 18 patients (11%) who had normal BMD became osteopenic, and no patients with normal BMD developed osteoporosis. In comparison to historical data for one year of ADT, our analysis of the prospectively collected BMD data showed minimal further deterioration with two years of ADT. Despite the drop in BMD, the change in bone density status remains low. This is in accordance with data from bisphosphonate trials using CaVitD as a control group, which showed that there is no clinically significant difference in fracture risk despite changes in BMD. As such, mandating patients to take CaVitD alone while on prolonged ADT may suffice, and we propose that steps should be taken to standardize dosing and encourage patient compliance.

Bone Densitometry in Transgender and Gender Non-Conforming (TGNC) Individuals: 2019 ISCD Official Position

The indications for initial and follow-up bone mineral density (BMD) in transgender and gender nonconforming (TGNC) individuals are poorly defined, and the choice of which gender database to use to calculate Z-scores is unclear. Herein, the findings of the Task Force are presented after a detailed review of the literature. As long as a TGNC individual is on standard gender-affirming hormone treatment, BMD should remain stable to increasing, so there is no indication to monitor for bone loss or osteoporosis strictly on the basis of TGNC status. TGNC individuals who experience substantial periods of hypogonadism (>1 yr) might experience bone loss or failure of bone accrual during that time, and should be considered for baseline measurement of BMD. To the extent that this hypogonadism continues over time, follow-up measurements can be appropriate. TGNC individuals who have adequate levels of endogenous or exogenous sex steroids can, of course, suffer from other illnesses that can cause osteoporosis and bone loss, such as hyperparathyroidism and steroid use; they should have measurement of BMD as would be done in the cisgender population. There are no data that TGNC individuals have a fracture risk different from that of cisgender individuals, nor any data to suggest that BMD predicts their fracture risk less well than in the cisgender population. The Z-score in transgender individuals should be calculated using the reference data (mean and standard deviation) of the gender conforming with the individual's gender identity. In gender nonconforming individuals, the reference data for the sex recorded at birth should be used. If the referring provider or the individual requests, a set of “male” and “female” Z-scores can be provided, calculating the Z-score against male and female reference data, respectively.