Osteopenic Patients Research Articles

Effect of Physical Exercise on Bone Density and Remodeling in Egyptian Type 1 Diabetic Osteopenic Adolescents

BackgroundThe study was planned to assess effect of physical exercise on bone remodeling in type I diabetics with osteopenia.MethodsTwenty-four type I diabetes mellitus (DM1) with osteopenia (10 females and 14 males) were compared to thirty-eight age- and sex-matched healthy control individuals (20 females and 18 males) for biochemical and radiologic parameters of bone mass. Laboratory investigations included serum and urinary calcium, inorganic phosphorus, alkaline phosphatase, and serum "procollagen type 1 N-terminal propeptide (P1NP). Bone densitometry was assessed at neck femur using Dual Energy X-ray Absorptiometry (DEXA). Serum P1NP and DEXA were reevaluated after a planned exercise program.ResultsPatients and controls were comparable with respect to serum as well as urinary biochemical parameters of bone mass namely; calcium, phosphorus and total serum alkaline phosphatase. Osteopenic DM1 patients displayed lower mean serum P1NP than control group (20.11 ± 6.72 ug\\dL versus 64.96 ± 34.89 ug\\dL; p < 0.05). A significant correlation was observed between BMD and degree of glycemic control reflected by serum glycated hemoglobin (r = -0.44, p, 0.030). Bone densitometry correlated with serum P1NP (r = -0.508, p, 0.011). After a planned regular exercise for 3 months, serum P1NP and BMD levels increased with percentage change of 40.88 ± 31.73 and 3.36 ± 2.94, respectively. Five patients resumed normal densitometry and they were all males.ConclusionDiabetic osteopenic patients displayed lower serum levels of procollagen type 1 N-terminal propeptide which reflects poor bone formation. A 3-months planned exercise program was associated with improvement of bone densitometry and significant increment of serum P1NP.

Hip Structural Changes and Fracture Risk in Osteopenia and Osteoporosis

Although bone mineral density (BMD) is an important predictor of hip fracture, there is a large overlap of BMD values between those who fracture their hips and those who do not. The aim of this study was to evaluate differences in the structural parameters of the hip in patients with osteopenia and osteoporosis in the hip region and to assess their relationship with osteoporotic fracture risk, age and gender. In this observational retrospective study, 150 patients with osteopenia (100 postmenopausal women and 50 men ≥50 years of age) and 125 patients with osteoporosis in the hip (100 postmenopaussal women and 25 men ≥50 years of age) were included. In addition to densitometry measurements by DEXA (Dual Energy X-ray Absorbimetry), structural variables were determined using the Hip Strength Analysis program (HSA). In logistic regression analyses, the femoral neck BMD (odds ratio (OR), 2.6; 95% Confidence Interval (CI) 1.8-3.8), age (OR per 10 years 1.4; 95% CI, 1.1-1.9), femoral neck shaft angle (NSA) (OR 1.5; 95% CI, 1.2-2.1), Femur Strength Index (FSI) (OR 1.6; 95% CI 1.3-2.2), and Cross sectional area (CSA) (OR 1.6; 95% CI 1.2-2.1) were all associated with osteoporotic fractures in women and men. Osteopenic patients had smaller femoral neck-shaft angles (NSA) compared to osteoporotic patients (p<0.05). This angle was larger in women (p<0.05); and women had decreased (FSI) (p<0.001) and CSA (p<0.05), which cause increased fracture risk. Spatial distribution of bone tissue is a useful determinant of fracture risk.

Fracture Assessment Tool Risk Scores in Bone Density Reports Do Not Change Physician Prescribing Behavior for Osteoporosis

Prevention of osteoporotic fractures is desirable to decrease morbidity, mortality and health care costs. The World Health Organization Fracture Assessment Tool (FRAX) enhances physician treatment decisions by combining epidemiologic fracture risk calculations with bone density. The authors sought to determine the effect of reporting FRAX results and treatment recommendations in bone density reports on clinician prescribing behavior. Retrospective review of adherence to treatment recommendations for 368 osteopenic patients at a VA Medical Center 7 months before (pre-FRAX) and after (post-FRAX) inclusion of fracture risk assessment data into the dual energy X-ray absorptiometry. Only osteopenic patients were included (T score: -1.0<T<-2.5). Demographic information, provider type, dual energy X-ray absorptiometry results and the decision to prescribe a Food and Drug Administration-approved drug within 6 months of the report were captured. Data were analyzed using χ test. There were 178 pre-FRAX and 192 post-FRAX patients. In the pre-FRAX group, 14.8% of osteopenic patients were treated based on clinical judgment. In the post-FRAX group, FRAX identified 63 high-risk osteopenic patients for treatment. Of these, only 31.7% were treated. Eleven of the 129 osteopenic patients not recommended for treatment were treated. There was no difference in physician decision to treat or seek subspecialty consultation before and after reporting of FRAX data (14.8% pre-FRAX versus 16.2% post-FRAX; P = 0.682). Despite the potential benefit of using FRAX, the authors found that: (1) prescribing behavior was not influenced by including FRAX in the bone density report and (2) increased education of FRAX fracture risk assessment is needed.

Significant and continuous improvement in bone mineral density among type 1 Gaucher disease patients treated with velaglucerase alfa: 69-month experience, including dose reduction

Since bone pathology is a major concern in type 1 Gaucher disease (GD1), we evaluated bone mineral density (BMD) in adults receiving velaglucerase alfa in the seminal Phase I/II and extension trial. Ten treatment-naïve symptomatic patients with GD1 (four men, six women; median age 35 years, range 18–62 years) were included; of these, four patients were receiving bisphosphonates at enrollment. Using WHO criteria to classify the lumbar spine (LS) and femoral neck (FN) BMD T-scores, respectively, one (10%) and four (40%) patients had osteoporosis; eight (80%) and five (50%) had osteopenia; and one each (10%) was in the normal range, at baseline. By Month 69, two LS and one FN osteopenic patients normalized and one FN osteoporotic patient became osteopenic; change was seen only in patients not receiving bisphosphonates. Significant improvements in BMD Z-scores were seen at the LS by Month 24 and at the FN by Month 33 and were continuous thereafter. In linear mixed models, Z-scores were significantly lower than the reference population at baseline and improved significantly with treatment (LS and FN both P < 0.01); analysis of the subgroup of patients not receiving bisphosphonates showed similar results. In conclusion, in this small cohort, velaglucerase alfa was associated with clinically meaningful and statistically significant LS and FN BMD improvements as early as Month 24 (LS) and 33 (FN), despite dose reduction and significant baseline skeletal pathology. These results suggest that velaglucerase alfa may hold promise in the management of skeletal pathology associated with GD1.

Insulin-like growth factor-1 in correlation with bone mineral density among Egyptian adolescents with type 1 diabetes mellitus

Diabetes is associated with alterations in bone health in children and adolescents. The natural history and etiopathogenesis of osteoporosis in type 1 diabetes is not clear. This study was designed primarily to estimate the prevalence of osteoporosis in a sample of type 1 diabetic adolescents and to asses the level of IGF-I and its association with bone mineral density. A total of 60 type 1 diabetic patients and 40 healthy controls aged 13 to 18 years participated in the study. DEXA scan was performed in patients, serum IGF-I, urinary albumin excretion, serum calcium, phosphorus and serum alkaline phosphatase were assessed in both patients and controls. Our results revealed that 50% of our patients have impaired BMD Z score (−2.10 to −1.20), diabetic cases showed significantly lower mean IGF-I when compared to control group (P < 0.0001) and there was positive correlation between BMD and serum level of IGF-I (r = 0.66, P < 0.0001) and not with disease duration, insulin dose, HbA1c and serum metabolic bone markers. Diabetic osteopenic patients had significantly lower mean weight, height and BMI than diabetic non-osteopenic patients (P < 0.0001, P < 0.0001, P < 0.001 respectively). Moreover, age at menarche in diabetic osteopenic females is significantly delayed than non-osteopenic (P = 0.02), a higher frequency of smoking in diabetic osteopenic was observed (p < 0.0001). Impairment of bone mineral density was identified in Egyptian adolescences with T1DM. Lower serum IGF-I levels correlates with decreased mineralization, which suggests its prominent role in the pathophysiology of osteoporosis.

Analysis of the risk of fracture in an unselected cohort of patients undergoing androgen deprivation.

193 Background: Androgen deprivation therapy (ADT) is a therapeutic approach for men with various prostate cancer disease states. Treatment related side effects of ADT include rapid bone loss. A large 2005 NEJM study found that the bone loss related to ADT leads to the development of fractures. Methods: This is a retrospective cohort study of patients treated with ADT in a radiation oncology (RDE) and medical oncology (SC) practice at an urban academic medical center from 1998-2010. Patients with evidence of bone metastases responsive to ADT were included. Those with androgen independent prostate cancer were excluded. Results: 130 patients met the criteria for inclusion and had the characteristics listed in the table. Among the 130 only 3 fractures occurred during 373 patient years of follow up, all within 5 months of ADT initiation. The fracture free survival (FFS) rate at 3 years for all was 97.7%. Excluding fractures occurring within 6 months of ADT initiation the FFS rate was 100% at 3 years. No significant difference was demonstrated in those screened with a pretreatment DEXA scan; there was no relationship between the number of AD cycles, recovery of testosterone to normal or total time on AD. Those with any baseline risk factor of osteoporosis had a trend to an increased risk of fractures (p=0.065); older patients, surprisingly, had a lower risk (p=0.054). Patients with normal BMD had a FFS of 93.8% at 3 yrs, osteopenic patients had 94.7%, and patients with osteoporosis and hormone responsive metastases had 100%. Conclusions: The prevalence of fracture among this group is significantly less than what has previously been reported for men receiving ADT, potentially suggesting an overstatement of risk. Further prospective study with a larger sample size is needed. [Table: see text] No significant financial relationships to disclose.

Improvement in hematological, visceral, and skeletal manifestations of Gaucher disease type 1 with oral eliglustat tartrate (Genz-112638) treatment: 2-year results of a phase 2 study

AbstractEliglustat tartrate is an investigational oral substrate reduction therapy for Gaucher disease type 1 that is pharmacologically distinct from intravenous enzyme replacement therapy. Eliglustat tartrate improved clinical manifestations in patients who received 50 or 100 mg twice daily for 1 year during an open-label phase 2 study (Blood. 2010;116(6):893-899). We report further improvements after 2 years of treatment in 20 patients (11 females, 9 males; mean age, 33 years) with baseline splenomegaly and thrombocytopenia and/or anemia. Statistically significant (P < .001) percentage improvements from baseline occurred in platelet count (mean ± SD, 81% ± 56%), hemoglobin level (20% ± 15%), spleen volume (−52% ± 11%), and liver volume (−24% ± 13%). Mean platelet count increased ∼ 50 000/mm3. Mean hemoglobin level increased 2.1 g/dL overall and 3.1 g/dL in 10 patients with baseline anemia. Organ volume reductions were greatest in patients with severe baseline organomegaly. Seventeen (85%) patients met established therapeutic goals for ≥ 3 of the 4 parameters. Lumbar spine bone mineral density increased 7.8% ± 10.6% (P = .01) and T-score 0.6 ± 0.8 (P = .012), with major gains in osteoporotic and osteopenic patients. Magnetic resonance imaging assessment showed that bone marrow infiltration by Gaucher cells was decreased (8/18 patients) or stable (10/18 patients). No safety-related trends emerged during 2 years of treatment. This multisite, open-label, single-arm phase 2 study is registered at www.clinicaltrials.gov as NCT00358150.

Prolonged anti-resorptive activity of zoledronic acid: evidence from postmenopausal osteopenic women and patients with Paget’s disease of bone

Prolonged anti-resorptive activity of zoledronic acid: evidence from postmenopausal osteopenic women and patients with Paget’s disease of bone

The value of lateral vertebral assessment in patients receiving glucocorticoids referred for dual x-ray absorptiometry (DXA)

Glucocorticoids are widely used to treat a number of medical disorders. Prolonged steroid use can cause osteoporosis can lead to a significant increase in fracture risk of the hip and spine. Vertebral fractures can indicate higher risk of both subsequent vertebral and non-vertebral fractures. Lateral vertebral assessment (LVA) can highlight patients who have asymptomatic vertebral fractures.A retrospective audit of patients referred for DXA who have been taking oral glucocorticoids for >3 months. DXA was performed and included total hip, femoral neck, lumbar spine and LVA.657 patients on glucocorticoids for >3 months were reviewed. Overall, vertebral fractures were present in 19.3%. Mean age 59.8 (±18) yrs with 72.3% patients being female. Common reasons for being on glucocorticoids included rheumatoid arthritis (47.1%), COPD (25.1%), gastrointestinal disorder (14.7%), bone marrow and renal transplants (7.5%) and inflammatory disorders (5.6%). 44.7% of patients had osteoporosis with the spine being the most likely site to be affected (35.5%). 31.2% of these patients were on treatment on referral. Patients who had vertebral were older and had more severe osteoporosis (p<0.001). 7.3% of overall fractures occured in the osteopenic group.Vertebral fractures were present in almost 1/5 osteopenic patients. LVA identifed osteopenic patients who would be an increased risk of subsequent fracture. As substantial bone loss occurs in the first 6 months of glucocorticoid treatment, these high-risk patients should be prioritised for osteoporosis treatment. Disclosure of Interest: None declared

Use of the plasma CTX for assessing the bone activity of the mandible among osteopenic and osteoporotic patients

The aim of this study was to determine whether the plasma CTX bone remodeling marker is useful for indicating the bone metabolic activity level of the mandible. Thirty-six patients were selected; all were postmenopausal and aged 50 years or over. In accordance with the WHO criteria for osteoporosis, a control group was set up (n = 10) in which the T-score was greater than -1 and a diseased group with T-score less than -1. Using MDP-(99m)Tc samples, the radioisotope uptake in the femoral neck (R(2)) and mandibular body (R(1)) was analyzed. A third examination was performed using the plasma CTX biochemical bone-modeling marker. The inferential results for the diseased group showed that Ln(R(1)) presented a statistically significant linear relationship with Ln(CTx) (p = 0.067) and with the T-score (p = 0.018). The plasma CTX bone remodeling marker is useful for monitoring the bone metabolic activity of the mandible.

Pharmacological therapy of osteoporosis

Osteoporosis is a disease associated with an increased risk of fractures. Vertebral and hip fractures are associated with high mortality or loss of autonomy. The aim of this review is to explore the scientific evidence for current therapies for postmenopausal osteoporosis and fractures and to establish how to treat osteoporosis in clinical practice without risk for patients. We performed research by the use of pubmed of all randomized controlled trials on osteoporosis therapy. The key works used were “osteoporosis therapy”; “postmenopausal osteoporosis” and “osteoporosis trial”. Efficacious pharmacological therapy include alendronate, risedronate, hormone replacement therapy, strontium ranelate, that are successful agents for femoral and vertebral sites. All osteoporosis patients may take calcium and vitamin D supplementation often not recommended by the physicians. Treatment of Osteopenic patients need further evidence. Early diagnosis and treatment can help to reduce the complications such as fractures but adverse effects may be monitoring and need particular knowledge in this setting [1-4].

496 MANAGEMENT OF BONE LOSS ASSOCIATED WITH ANDROGEN DEPRIVATION THERAPY FOR PROSTATE CANCER: A STUDY OF CURRENT PRACTICE PATTERNS IN A CENTER WITH UNIVERSAL ACCESS TO CARE

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Cost Effectiveness II1 Apr 2010496 MANAGEMENT OF BONE LOSS ASSOCIATED WITH ANDROGEN DEPRIVATION THERAPY FOR PROSTATE CANCER: A STUDY OF CURRENT PRACTICE PATTERNS IN A CENTER WITH UNIVERSAL ACCESS TO CARE Matthew Christman, Sean Stroup, Preston Gable, Daniel Cooper, Brian Auge, and James L'Esperance Matthew ChristmanMatthew Christman More articles by this author , Sean StroupSean Stroup More articles by this author , Preston GablePreston Gable More articles by this author , Daniel CooperDaniel Cooper More articles by this author , Brian AugeBrian Auge More articles by this author , and James L'EsperanceJames L'Esperance More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.571AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent attention has been given to bone loss associated with androgen deprivation therapy (ADT) in prostate cancer (PCa) patients. We aimed to assess the practices of screening and treating bone loss within a population with universal access to health care. METHODS Patients who received ADT for PCa between OCT2004 and SEP2007 were identified. Data pertaining to demographics, Dual Energy X-ray Absorptiometry (DEXA) results, prescribed medications, fracture incidence, and cause of death (if applicable) were analyzed. Statistical analysis was performed using a two-tailed Fisher′s exact test for categorical variables and a t-test or ANOVA for continuous variables. Significance was set at p≤0.05. RESULTS A total of 272 patients received ADT for management of prostate cancer. The mean age of the group was 75.8±10.2 years. Of these patients, 44.9% (122/272) underwent DEXA scans with findings of normal in 24%, osteopenia in 41%, and osteoporosis in 35%. A total of 32.7% (89/272) of the cohort received some form of pharmacologic treatment for bone loss, either preventatively or therapeutically. Fractures occurred in 10.7% (29/272) and directly contributed to death in 2.2% (6/272). Death related fractures occurred in 9% (4/43) of those with osteoporosis, which trended towards significance (p=0.059). Overall treatment rates were similar for normal, osteopenic, and osteoporotic patients (48%, 44%, 58%, respectively; p=0.410). The occurrence of a fracture did not result in significant differences in treatment rate (p=0.092) or bisphosphonate use (p=0.303). CONCLUSIONS Despite universal access to care, the majority of our population was not screened for bone loss. A minority received preventative or therapeutic medications of any kind. Those diagnosed with bone loss were undertreated, despite the known morbidity and mortality related to fractures. Strides in management of this issue have been made, however opportunities to provide more optimal care remain. San Diego, CA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e196 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Christman More articles by this author Sean Stroup More articles by this author Preston Gable More articles by this author Daniel Cooper More articles by this author Brian Auge More articles by this author James L'Esperance More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Efficacy of low doses of pamidronate in osteopenic patients administered in the early post-renal transplant

This study evaluates the efficacy of low doses of pamidronate after renal transplantation to prevent bone loss in osteopenic patients. Results show that pamidronate is safe and significantly reduced spinal bone loss when administered immediately after renal transplantation. The purpose of this work is to evaluate the efficacy of two intravenous infusions of pamidronate in the immediate post-transplant period in a renal transplant (RT) population. In this 12-month, randomized, double-blind, multicenter trial, 39 kidney recipients with diagnosed osteopenia received two doses of 30mg of disodium pamidronate (n = 24) or placebo (n = 15), at surgery and 3months post-RT. All patients received calcium and vitamin D. Bone density of the lumbar spine and total femur was measured by dual-energy X-ray absorptiometry (DXA) and X-rays were performed at RT, 6 and 12months post-RT. Biochemical and hormonal determinations were performed before and after treatment. Pamidronate significantly reduced spinal bone loss, but no significant benefit was found for the incidence of fractures. Elevated baseline intact parathyroid hormone (iPTH) and bone remodeling markers returned to normal levels 3months post-RT. However, normal procollagen type I N propeptide (PINP) concentrations were only maintained in the pamidronate group. After RT, a comparable graft function was observed in both groups according to creatinine values, 25-hydroxyvitamin-D (25-OH-D) levels were improved, and serum calcium levels normalized after a transient fall during the first 3months. A low dose of pamidronate prevents bone loss in osteopenic patients when administered immediately after RT.

Physical approach for prevention and treatment of osteoporosis

Osteoporosis and its consequent fractures are a major problem in public health. To complement the conventional pharmacological treatment for this metabolic disease, non-pharmacological treatment options have been developed in the last decades. Several studies demonstrate that physical exercise programs including impact exercises, specific strength training, balance and coordination training may maintain or increase spine and hip bone mineral density as well as decrease the frequency of falls among osteoporotic and osteopenic patients. Furthermore, some physical agents such as vibratory platforms, low intensity electrical stimulation, laser therapy and ultrasound show positive effects on osteoporotic tissue as well. Consequently, while planning treatment for an osteoporotic patient, non-pharmacological management options should be considered and integrated to the conventional treatment in order to maximize its effects and improve the quality of life of these patients.

Influence of Pregnancy on Bone Mass in Sickle Cell Anemia

Sickle cell disease (SCD) causes osteopenia and osteoporosis, This osteopenia may be further influenced by pregnancy. To find out the effect of pregnancy on bone skeleton density in patients with SCD. Consecutive adult female SCA patients who were treated at the out-patients clinics of King Fahd University Hospital Al-Khobar, Saudi Arabia, between January and July 2007, were the cases of study. Patient's age, number of pregnancies and duration after pregnancy were documented. Weight and height were recorded to calculate body mass index (BMI). Blood was collected for haematology and biochemistry purposes. Bone mineral density (BMD) measurement was done using dual energy X-ray absorbtiometry (DEXA) at upper femur and lumbar spine. Thirty-eight patients were evaluated. There were 20 (52.6%) patients who were delivered in (Group A) and 18 (47.4%) who were nulliparous in Group B. The average age in group A was 27.55 +/- 4.9 years while group B was 26.30 +/- 2.1 years. Thirteen (65%) of the patients in group A were osteoporotic when compared to five (27.7%) in group B (p=0.01). Osteopenic patients in group B were seven (38.9%) versus four (20%) in group A (p=0.2). Osteoporosis in both groups was highest at lumbar spine compared to the hip region (P=0.001). BMD was lower in parous women when compared to the nulliparous women. There was no significant difference in haematological parameters which included the percentage of sickle hemoglobin, hemoglobin level between normal, osteopenic and osteoporotic patient. This study shows that SCA female patients suffer from low bone mass in young age. Pregnancy predisposes the SCA patients to further osteopenia and osteoporosis.

Bisphosphonates in osteoporosis: Where do we stand in 2009?

Bisphosphonates were discovered 40 years ago and remain the market leader in the field of osteoporosis. Bisphosphonates are classified as inhibitors of bone resorption and they act by inhibiting the mevalonate pathway to inhibit protein prenylation with resultant inhibition of osteoclastic activity. There are three ethical bisphosphonates as well as generic alendronate that have been approved for the treatment of osteoporosis in South Africa. These drugs offer a wide range of variations in dose, frequency of administration and method of administration. The wide choice in method of administration may lead to improved individual compliance to treatment protocols. There is strong evidence to support antifracture efficacy at vertebral and hip sites in patients treated for up to three years but long-term data as well as prospective data in osteopenic patients are lacking. Gastrointestinal side-effects are common, but can often be avoided by taking medication in the prescribed fashion. The acute phase response to intravenous administration can be prevented by co-administration of oral paracetamol or ibuprofen. Bisphosphonates can cause bone pain. The Food and Drug Administration (FDA) has accepted evidence that bisphosphonates do not cause atrial fibrillation. Osteonecrosis of the jaw is a rare complication of oral bisphosphonates as used in osteoporosis but may be associated with high dose intravenous treatment in cancer patients. Atypical low energy femur shaft fractures have been associated with long-term usage of the bisphosphonates. A large national observational register-based study reported that these fractures share the same epidemiology and treatment response as classical hip fractures and are best classified as osteoporotic fractures. The cost-effectiveness and treatment options of the bisphosphonates will ensure that they remain significant players in years to come.

Zoledronic Acid Can Prevent Bone Loss In Osteopenic and Hip Fracture Patients

Zoledronic Acid Can Prevent Bone Loss In Osteopenic and Hip Fracture Patients

Accuracy of volumetric bone mineral density measurement in high-resolution peripheral quantitative computed tomography

Accurate bone mineral density (BMD) quantification is critical in clinical assessment of fracture risk and in the research of age-, disease-, and treatment-related musculoskeletal changes. The development of high-resolution peripheral quantitative computed tomography (HR-pQCT) imaging has made possible in vivo assessment of compartmental volumetric BMD (vBMD) and bone micro-architecture in the distal radius and tibia. HR-pQCT imaging relies on a polychromatic X-ray source and therefore is subject to beam hardening as well as scatter artifacts. In light of these limitations, we hypothesize that the accuracy of HR-pQCT vBMD measurement in the trabecular compartment (vBMD trab) is not independent of bone density and geometry, but rather influenced by variations in trabecular bone volume fraction and cortical thickness. The goal of this study, therefore, was to evaluate the accuracy of HR-pQCT vBMD trab measurement in the radius and tibia, and to determine the dependence of this measurement on geometric and densitometric parameters. Our approach was to use a series of idealized hydroxyapatite (HA) phantoms with varying densities and geometries to quantify the accuracy of HR-pQCT analysis. Two sets of custom-made HA phantoms designed to mimic the distal tibia and distal radius were manufactured. Geometric and densitometric specifications were based on a dataset of healthy volunteers and osteopenic patients. Multiple beam hardening correction (BHC) algorithms were implemented and evaluated in their ability to reduce measurement error. Substantial errors in measured vBMD trab were found. Overestimation of vBMD trab increased proportional to cortical shell thickness and decreased proportional to insert density. The most pronounced vBMD trab overestimation therefore occurred in the phantoms with the lowest insert densities and highest shell thickness, where error was as high as 20 mg HA/cm 3 (33%) in the radius phantom and 25 mg HA/cm 3 (41%) in the tibia phantom. Error in vBMD trab propagates to the calculation of micro-architectural measures; 41% error in vBMD trab will produce 41% error in volume fraction (BV/TV) and trabecular thickness (Tb.Th), and 5% error in trabecular separation (Tb.Sp). BHC algorithms supplied by the manufacturer failed to eliminate these errors. Our results confirm that geometric and densitometric variations influence the accuracy of HR-pQCT vBMD trab measurements, and must be considered when interpreting data across populations or time-points.

Health-related quality of life in patients with osteopenia or osteoporosis with and without fractures in a geriatric rehabilitation department

Health-related quality of life (HRQOL) is an important aspect in the management of patients with osteoporosis. The objective of this study was to estimate differences in HRQOL in women and men with osteopenia and osteoporosis with and without a fracture history and to assess HRQOL with a generic and disease-specific instrument. Women and men were recruited from a geriatric rehabilitation department. Osteopenia or osteoporosis was diagnosed by Dual X-Ray Energy Absorptiometry (DXA). HRQOL was evaluated with the generic SF-36 questionnaire and the quality of life questionnaire of the International Osteoporosis Foundation (QUALEFFO-41). All subjects were instructed to complete these questionnaires. The level of pain was documented with a VAS (Visual Analogue Scale). 173 women and 49 men at a mean age of 79.3 +/- 8.5 years were enrolled. 85 participants reported a history of vertebral or hip fractures. The QUALEFFO score was 49.8 +/- 19.2 in patients with osteopenia, but significantly higher in osteoporotic patients without fractures (mean 58.1 +/- 13.3; p < 0.05). In osteoporotic patients with a fracture history the mean QUALEFFO score was significantly higher still, i.e. 63.8 +/- 13.6 (p < 0.05). The mean SF-36 summation scores of osteopenic patients and osteoporotic patients without fractures were similar (314 +/- 117 and 312 +/- 99, respectively). Osteoporotic patients with a fracture history showed lower mean scores (276 +/- 88; p < 0.05). VAS scores did not differ significantly. Osteoporosis has a considerably greater impact on HRQOL than osteopenia. Patients with a history of vertebral or hip fractures have a significantly poorer quality of life. These differences should be taken into account when prioritizing health care management.

Management of decreased bone mineral density in men starting androgen‐deprivation therapy for prostate cancer

To determine whether clinicians discuss bone-specific side-effects with patients on androgen-deprivation therapy (ADT) for prostate cancer, or prescribe lifestyle and pharmacological interventions for low bone mineral density (BMD), as decreased BMD is a common side-effect of ADT, leading to increased risk of fracture. Sixty-six men (mean age 70.6 years) with non-metastatic prostate cancer and starting continuous ADT were enrolled in a prospective longitudinal study. BMD was determined by dual X-ray absorptiometry (DXA) at baseline. Patients were interviewed to obtain their medical histories, and charts were reviewed to determine whether clinicians documented potential bone side-effects in clinic notes, and made lifestyle and/or medication recommendations. Both were done at the start of ADT, and 3 and 6 months later. Patients were classified based on DXA T-score as having normal BMD, as osteopenic, or osteoporotic. At baseline, 53% of patients had osteopenia and 5% had osteoporosis. Within 6 months of starting ADT, general side-effects and bone-specific side-effects of ADT were documented as being discussed with 26% and 15%, respectively. Clinicians recommended lifestyle interventions to 11% of patients. Pharmacological interventions (calcium, vitamin D, and/or bisphosphonates) were recommended to 18% of all patients within 6 months of starting ADT, and to 26% and 67% of osteopenic and osteoporotic patients, respectively. A minority of patients is being informed of bone-specific side-effects of ADT. Lifestyle and drug interventions to prevent declines in BMD were recommended uncommonly. Practices around bone health for men starting ADT are suboptimal.