Osteopenic Bone Mineral Density Research Articles

Physical tests for patient selection for bone mineral density measurements in postmenopausal women

IntroductionThere is a need for cost-effective clinical methods to select women for bone densitometry. The aim of the present study was to determine whether relatively simple and clinically applicable physical tests could be useful in prediction of bone density in postmenopausal women. MethodsA total of 606 women (age range 66–71 years) taking part in the population based OSTPRE Fracture Prevention Study were investigated. Spinal and femoral bone mineral density (BMD) was measured by Dual X-ray Absorptiometry (DXA). Physical tests included the standing-on-one-foot (SOOF), grip strength (GS), leg extension strength, ability to squat down, standing 10 s eyes closed, chair rising, regular walk for 10 m and tandem walk for 6 m. All linear regression models were adjusted for age, body mass index, years on hormone therapy, years since menopause, current smoking and use of oral glucocorticoids. ResultsThe SOOF was associated with lumbar spine BMD (r2=0.16, p=0.004) and the femoral regions (r2 values from 0.17 to 0.23 and p-values all<0.001). The GS was associated with lumbar spine BMD (r2=0.16, p=0.011) and the femoral regions (r2 values from 0.16 to 0.21 and p-values from <0.001 to 0.004). The ability to squat down on the floor was associated with the femoral regions (r2 values from 0.15 to 0.21 and p-values from 0.028 to 0.040). In addition, functional capacity was decreased in women with femoral neck osteoporosis (WHO classification) compared to women with normal or osteopenic BMD: SOOF −39% (p=0.001), GS −18% (p<0.001), leg extension strength −19% (p=0.007) and ability to squat down on the floor −40% (p=0.004). For osteoporosis prediction (ROC analysis) a threshold of a 22 kg in GS would yield a true-positive rate (sensitivity) of about 58% and a true-negative rate (specificity) of 86% (AUC 0.76). ConclusionsWe suggest that grip strength could be used in medical decision making to identify those women who would benefit from BMD measurements albeit alone it may not provide accurate enough tool for osteoporosis screening.

Bone health in postmenopausal women (PMW) with hormone-sensitive breast cancer (HSBC) receiving adjuvant aromatase inhibitor (AI) therapy

11556 Background: AIs are approved for PMW with HSBC. The near complete reduction in estrogen synthesis with AIs exacerbates the risk for bone loss, osteoporosis, and bone fractures. Methods: Incidence of fracture and osteoporosis, bone mineral density (BMD), and bone turnover markers were evaluated in adjuvant AI trials (ATAC, BIG 1–98, ALIQUOT, IES, LEAP, MA.17). Results: In healthy PMW, all AIs (steroidal or nonsteroidal) are associated with increased bone turnover markers. In PMW with HSBC, any AI (anastrozole [ANA], exemestane [EXE], or letrozole [LET]) decreases BMD and increases fracture and osteoporosis rate vs either placebo (PLA) or tamoxifen (TAM) regardless of treatment setting (Table). After 5 years of ANA, PMW shifted from normal to osteopenic BMD and lost about 8% BMD at the spine and hip. In IES, increased bone turnover was seen in PMW who switched to EXE following prior TAM. Similar findings were seen in PMW who had prior TAM in ALIQUOT. AI-associated bone loss stabilizes with completion of therapy and is attenuated when zoledronic acid (ZOL) is added to the treatment regimen in either pre- or PMW. Conclusions: Irrespective of setting and class, all AIs decrease BMD and increase bone turnover markers, resulting in increased risk for osteoporosis and bone fractures. Concomitant use of ZOL can attenuate these risks. Current guidelines rely solely on the presence of osteoporosis (BMD < -2.5) to guide bisphosphonate intervention. As 80% of fractures occur in osteopenic women, this threshold appears inadequate for averting fractures in PMW with HSBC. It would be prudent to give ZOL 4 mg twice yearly to PMW who are taking AIs and have a T-score < -2.0, and those with any 2 following risk factors: T-score < - 1.5, age >65 years, family history of hip fracture, personal history of fragility fracture after age 50, smoking, or oral corticosteroid use >6 months. Setting Trial N FU (mo) Lumbar BMD (%) Fracture rate (%) Ref Upfront ATAC bone substudy 167 60 − 6.1 ANA +2.8 TAM Coleman 2006 ASCO abs 511 ATAC 6241 68 11.0 ANA* 7.7 TAM Howell 2005 Lancet BIG 1–98 8010 25.6 NR NR 5.7 LET* 4.0 TAM Thürlimann 2005 NEJM Switch IES bone substudy 206 24 −4.0* EXE −0.6 TAM Coleman 2007 Lancet Oncol IES 4724 58 7.0 EXE* 5.0 TAM Coleman 2007 Lancet Oncol Extended MA.17B 226 24 −5.4 LET* −0.7 PLA Perez 2006 JCO MA.17 5187 30 5.3 LET 4.6 PLA Goss 2005 JNCI *P<0.01; NR=not reported. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Expert Testimony Other Remuneration AstraZeneca, Elly Lilly, GlaxoSmithKline, Novartis, Novo Nordisk, Pfizer, Roche, Schering, Solvay, Wyeth

Diabetes and osteoporotic fractures

In a recent study of bone mineral density and fracture burden in postmenopausal women, Ann Cranney and colleagues reported that most of the fractures in their study population occurred in women with normal or osteopenic bone mineral density.[1][1] The authors suggested that factors other than bone

Elevated arterial stiffness in postmenopausal women with osteoporosis

Objectives Osteoporosis and increased pulse wave velocity (PWV) are cardiovascular risk factors. We investigated the relationship between PWV and bone mass in the lumbar spine in postmenopausal women. Methods We studied the PWV in 95 women; 38 postmenopausal women with normal spinal bone mineral density (BMD), 32 osteopenic postmenopausal women, and 25 osteoporotic postmenopausal women. The brachial-ankle PWV (baPWV) was measured using an automated device. The BMD of the lumbar spine (L2–L4) was measured using dual-energy X-ray absorptiometry. Results After adjusting for age and years since menopause, women with osteoporosis had a significantly higher baPWV than those with normal BMD (1500 ± 220 cm/s versus 1340 ± 215 cm/s; P < 0.05), but no significant differences in baPWV were seen between the osteoporotic and osteopenic groups or between the osteopenic and normal BMD groups. In univariate regression analysis, the baPWV was significantly negatively correlated with BMD ( r = −0.450, P < 0.01), and significantly positively correlated with age ( r = 0.601, P < 0.01), years since menopause ( r = 0.577, P < 0.01), systolic blood pressure ( r = 0.295, P < 0.01), and diastolic blood pressure ( r = 0.264, P < 0.05), but was not with other variables. In multivariate regression analysis, the baPWV was significantly correlated with BMD ( P < 0.05), but not with other variables. Conclusions Postmenopausal women with osteoporosis may have elevated arterial stiffness, suggesting that osteoporotic postmenopausal women may have a higher risk of cardiovascular disease.

Age-related and menopause-related changes of urinary excretion of C- and N-terminal cross-linked telopeptides of type I collagen and the relationships thereof with menopause-related bone loss

To study the age-related and menopause-related changes of urinary excretion of C- and N-terminal cross-linked telopeptides of type I collagen (uCTX/Cr and uNTX/Cr) and the relationships thereof with menopause state, years after menopause, bone mineral density (BMD), and menopause-related bone loss in healthy women. ELISA was used to examine the uCTX/Cr and uNTX/Cr of 659 female volunteers aged 20 - 80 in Changsha. Dual energy X-ray absorptiometry (DXA) was used to measure the BMD of various skeletal sites, including the lumbar vertebrae (L1 - L4) at anteroposterior (AP) position, L(2) - L(4) at lateral (LAT) position, hip, and forearm. 339 postmenopausal women among the 659 subjects were divided into 3 groups, osteoporotic, osteopenic, and normal groups according to the WHO criteria of osteoporosis diagnosis. (1) Both the curves of uCTX/Cr and uNTX/Cr with age were fit the best by regression analysis of cubic equation. The coefficients of determination (R(2)) were 0.139 for uCTX/Cr and 0.149 for uNTX/Cr. The levels of uCTX/Cr and uNTX/Cr of the women aged > 35 increased with age. (2) The values of uCTX/Cr and uNTX/Cr were 253 mg/mol +/- 101 mg/mol Cr and 63 nmol +/- 34 nmol BCE/mmol Cr respectively in the postmenopausal women, remarkably higher than those of the premenopausal women (149 mg/mol +/- 80 mg/mol Cr and 33 nmol +/- 17 nmol BCE/mmol Cr respectively), increased by 69.5% and 93.4% respectively. The annual change rates of uCTX/Cr and uNTX/Cr were the highest within the first 5 years after menopause, and these increases were in agreement with the significant decrease of BMD at most skeletal sites by 10.8% approximately 27.6%. (3) After controlled for age and body weight, both uCTX/Cr and uNTX/Cr showed significant negative correlation with BMD (r = -0.078 to -0.283, P < 0.05 or 0.01), and there was a significant positive correlation between uCTX/Cr and uNTX/Cr. (4) The elevation of the levels of uCTX/Cr and uNTX/Cr in the osteoporotic and osteopenic postmenopausal subgroups were significantly higher than those in the postmenopausal women with normal BMD (P < 0.05 or 0.01). For example, the uCTX/Cr levels of the osteoporotic, osteopenic, and normal BMD subgroups according to the DXA results at the anteroposterior lumbar spine were 189 +/- 87, 272 +/- 108, and 366 +/- 135 mg/mol Cr respectively, while the uNTX/Cr levels were 52 +/- 22, 68 +/- 34 and 108 +/- 41 nmol BCE/mmol Cr respectively. uCTX/Cr and uNTX/Cr can be used as sensitive markers to determine the bone turnover status, which is changeable with age and menopausal status in women. They present a significantly negative correlation with BMD, and increase significantly in the postmenopausal women with osteopenia or osteoporosis, which indicates that measuring uCTX/Cr and uNTX/Cr can predict age-related and menopause-related bone loss in women.

Urinary N-Telopeptide Levels Discriminate Normal, Osteopenic, and Osteoporotic Bone Mineral Density

The level of urinary, type I collagen, crosslinked N-telopeptides (NTX) is a new marker of bone resorption. To our knowledge, no population-based studies of older adults have determined whether this measure can identify individuals with osteoporosis. To measure the levels of NTX in a cross-sectional study of ambulatory, older, white adults and to evaluate whether this measure of bone resorption could identify individuals with osteoporosis. The subjects, aged 50 to 98 years, formed 3 groups: 374 men, 223 women currently using estrogen, and 364 women not currently using estrogen. A standard medical history and validated record of medication use were obtained. Height and weight were measured. Bone mineral density (BMD) was measured at the hip and lumbar spine using dual energy x-ray absorptiometry. The levels of NTX were measured by enzyme-linked immunosorbent assay. Overall, the levels of NTX increased slightly with age in men and in estrogen users and more dramatically in nonestrogen users. In a model adjusted for all major risk factors for osteoporosis, there was a significant decrease in BMD levels by increasing quintiles of NTX levels at the hip and spine in women with and without estrogen use and at the hip in men. Using sex-specific, peak bone mass criteria and age-adjusted analyses, the levels of NTX discriminated between normal (< or = -1.0 SD), osteopenic (> -1.0 and < -2.5 SD), and osteoporotic (> or = -2.5 SD) BMD levels in all groups except the spine in men. The levels of NTX uniquely discriminated between older adults with normal, osteopenic, or osteoporotic BMD levels. If confirmed, these data suggest that NTX levels could be used to predict current osteoporosis in older men and women.