Predictor Of Bone Loss Research Articles

Prediction of bone loss by MR perfusion imaging and spectroscopy

Prediction of bone loss by MR perfusion imaging and spectroscopy

Predictors of Bone Loss in Revision Total Knee Arthroplasty

Revision total knee arthroplasty (RTKA) requires preoperative planning to enable the reconstruction of bony deficiencies. The objective of this project was to identify predictors of bone loss management at RTKA based on the preoperative failure mode and patient demographics known preoperatively. We retrospectively reviewed 245 consecutive RTKA procedures in which the same revision knee system was utilized. Patient demographic and treatment data were recorded, and locations of bone loss were identified based on the reconstructive management. We identified significant predictors for use of femoral augments at all four positions. Several predictors significantly predisposed to use of a thick (>19 mm) polyethylene; however, no predictors of tibial augments were significant. Although the reconstruction of bone loss is primarily based on the intraoperative assessment, these findings may provide additional information to help the surgeon prepare for difficult revision procedures.

Capacity of endogenous sex steroids to predict bone loss in Japanese men: 10-year follow-up of the Taiji Cohort Study

This prospective cohort study aimed to evaluate the capacity of endogenous sex steroids to predict male osteoporosis (OP) among community-dwelling inhabitants. Among 1,028 male residents aged 40-79 years, 50 men belonging to each age stratum (200 in total) were randomly selected from a resident registration list. In the years 1993, 1996, 2000, and 2003, bone mineral density (BMD) of the lumbar spine and proximal femur was measured by dual-energy X-ray absorptiometry. Serum total estradiol (E(2)) and free testosterone (FT) were measured using samples extracted in 1993. Among the 200 participants at baseline, 153 subjects completed 10-year follow-ups. Mean values of serum E(2) and FT were 22.4 and 9.4 pg/ml, respectively. Rates of change for BMD at the lumbar spine and femoral neck were 0.8% and 0.5% during the first 3 years, 0.0% and 0.5% during 7 years, and 0.8% and -0.3% over 10 years, respectively. According to multivariate regression analysis after adjusting for age and body mass index, mean values of FT were significantly related to the rate of change of BMD at the femoral neck at 3 years (beta = 0.21; r (2) = 0.05; P < 0.01), but not at 7 or 10 years. Serum FT level could offer a useful predictor of bone loss within 3 years.

Prevalence and risk factors associated with decreased bone mineral density in patients with haemophilia

Osteoporosis in adult males is an under-recognized problem. Patients with haemophilia have several predisposing factors for developing decreased bone mineral density (BMD) including prolonged periods of immobility, reduced weight bearing and co-morbidities associated with bone loss. To establish prevalence and risk factors associated with decreased BMD in patients with haemophilia. Adults with moderate or severe haemophilia A or B underwent dual-energy X-ray absorptiometry (DXA). BMD was correlated to laboratory values, joint mobility measurements and physical activity questionnaires. Thirty patients completed evaluations. The median age was 41.5 years (range 18-61). Median lowest T-score by DXA was -1.7 (range: -5.8 to +0.6), with the femoral neck being the site of the lowest T-scores. Based on World Health Organization criteria, 70% of patients had decreased BMD. Twenty-seven per cent of the participants (n = 8) had osteoporosis and 43% (n = 13) had osteopenia. Variables associated with increased bone loss included lower serum 25-hydroxyvitamin D levels (P = 0.03), lower body mass index (P = 0.047), lower activity scores (P = 0.02), decreased joint range of motion (P = 0.046), HIV (P = 0.03), HCV (P = 0.02), history of inhibitor (P = 0.01) and age (P = 0.03). Adults with haemophilia are at increased risk for developing osteoporosis. A history of HCV and HIV infections, decreased joint range-of-motion, decreased activity levels, history of an inhibitor and low body weight predict bone loss and suggest a population to target for screening. A high prevalence of vitamin D insufficiency was observed. Future studies should investigate interventions, including vitamin D supplementation, to prevent bone loss and fractures for this at-risk population.

Relationship between Bone Turnover and Bone Density at the Proximal Femur in Stroke Patients

To investigate the relationship between the rate of bone turnover and bone loss at the proximal femur in stroke patients. This study was performed between January 1, 2005 and August 31, 2006 at the Stroke Rehabilitation Unit, Istanbul Physical Medicine and Rehabilitation Training Hospital, Istanbul, Turkey. One hundred six patients who had a stroke for the first time were included in the study. The control group consisted of 33 age- and gender-matched healthy subjects. Bone mineral density (BMD) was measured at the proximal hip region by dual energy X-ray absorptiometry (DXA). Serum osteocalcin (OC) and C telopeptide of type 1 collagen (CTX) levels were measured. Barthel Index (BI) was used for the evaluation of daily activities. Ambulation status of the patients was recorded. Mean age was 65.1 +/- 9.8 years in the patient group and 51% were male. Mean disease duration was 16.9 +/- 9.1 months. Mean BI score was 60.5 +/- 25.8 on admission. Femoral neck BMD values were 0.873 +/- 0.95 g/cm(2) and 0.816 +/- 0.180 g/cm(2) for control subjects and hemiplegic sides of the patient group, respectively. Femur total BMD values were 0.948 +/- 0.119 g/cm(2) and 0.872 +/- 0.187 g/cm(2) for control group and hemiplegic sides of the patients, respectively. Femoral neck and femur total BMD values in the hemiplegic side were lower than those of controls' (P < .05). There was no statistically significant difference between the proximal femur BMD values of the intact and hemiplegic sides. Negative correlation was found between the proximal femur BMD values of both the intact and hemiplegic sides, and serum OC and CTX levels. Bone resorption rate was higher among the patients with stroke; however, bone formation rate was normal in this group. Serum CTX levels showed correlation with ambulation status. Femoral neck BMD values on the intact side were lower in the patient group with disease duration of more than 1 year compared to those with shorter disease duration. As a result of this study bone turnover was inversely correlated with bone density at the hip of both hemiplegic and intact sides in stroke patients. Evaluation of bone turnover might be helpful to predict bone loss and to find out the stroke patients with bone loss who can not be decided to begin antiresorptive treatment with bone density measurement.

Bone-specific alkaline phosphatase (BSAP) and serum N-telopeptide (sNTX) as predictors of bone loss in postmenopausal women with early breast cancer receiving letrozole as adjuvant therapy: a 5-year study (Z-FAST).

Abstract Abstract #2067 Background: Changes in biochemical markers of bone turnover are expected to be predictors of long-term changes in bone mineral density (BMD). We studied the potential of bone-specific alkaline phosphatase (BSAP) and serum N-telopeptide (sNTX) at 6 and 12 months (mo) in predicting BMD of the lumber spine (LS) and total hip (TH) at 48 mo in Z-FAST study.&amp;#x2028; Methods: Postmenopausal women with ER+ and/or PR+ early stage breast cancer were randomized 1:1 into Up-front (U) or Delayed (D) arms (N=301 in each). Patients (pts) in U received zoledronic acid (ZOL) 4 mg IV q6 mo starting at baseline; pts in D started ZOL q6 mo when their LS or TH T-score fell below -2. All pts started Letrozole 2.5 mg/day for 5 years. Levels of BSAP and sNTX were assessed at screening and every 6 mo on a subset of pts. LS and TH BMD were assessed by dual-energy x-ray absorptiometry (DEXA) at screening, 6 mo and every 12 mo thereafter for all available pts. This is an exploratory analysis to investigate the correlation between short-term % changes from baseline in BSAP and sNTX and long-term % changes from baseline in BMD. Pearson correlations and Receiver Operating Characteristics (ROC) analysis were performed. We report the results based on 48 mo data.&amp;#x2028; Results: The Pearson correlations between % change in BSAP at 6 mo and LS BMD at 48 mo were -0.13 [(N=38, not significant (NS)] and -0.17 (N=39, NS) in arms U and D respectively. The correlations between % change in BSAP at 12 mo and LS BMD at 48 mo were -0.15 (N=39, NS) in U and -0.43 (N=38, p=0.0077) in D. Very similar correlations were obtained for % change in sNTX at 6, 12 mo and LS BMD at 48 mo in D, but in U the correlations were smaller and positive. The correlations between % change of both markers at 6, 12 mo and TH BMD at 48 mo were all NS at 0.05. ROC analysis showed that at best performance (maximum of sensitivity plus specificity), for any increase in sNTX at 12 mo, the sensitivity (SE), specificity (SP), positive predictive value (PPV) and negative predictive value (NPV) to predict LS BMD loss at 48 mo was 74%, 77%, 85% and 63% in D. For BSAP change of 3%, the four ROC parameters were 71%, 71%, 81% and 59% respectively. For prediction of TH BMD loss, the SE, SP and NPV were lower for both markers with higher PPV. In U, the SE, SP and PPV were all much lower with very high NPV for both markers and BMD loss.&amp;#x2028; Conclusion: Interim results of Z-FAST data show that short-term changes in BSAP and sNTX have the potential for predicting long-term bone loss. The weaker correlations in U also suggest that zoledronic acid may have a direct preventive effect on bone loss independent of changes in the markers. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2067.

Measuring metacarpal cortical bone by digital x-ray radiogrammetry: a step forward?

Changes in metacarpal cortical bone mineral density (BMD) using digital x-ray radiogrammetry were studied in patients with early rheumatoid arthritis. After 1, 2, and 5 years, large BMD losses were found: -1.7%, -2.8%, and -5.6%, respectively. Elevated erythrocyte sedimentation rate and anti-cyclic citrullinated peptide levels were independent predictors of bone loss, indicating that the largest amount of bone loss was found in patients with severe inflammation and high production of auto-antibodies, who are known to be at the highest risk of developing radiological bone damage. Studies are needed about the spatial and time relationship between erosions and juxta-articular and metacarpal bone loss.

Depot medroxyprogesterone acetate use after peak bone mass is associated with increased bone turnover but no decrease in bone mineral density

To ascertain whether increased bone turnover in depot medroxyprogesterone acetate (DMPA) users after peak bone mass is associated with bone mineral loss. Three-year, observational, longitudinal study. General practice and family planning clinics. Women over age 34: established DMPA users (n = 23), discontinuers (n = 14), and controls (n = 27). Change in spine and hip bone mineral density (BMD). Despite increased biochemical markers of bone turnover in DMPA users, there was no decrease in BMD. Bone turnover markers did not correlate with change in BMD. In established DMPA users, after peak bone mass, a single normal BMD measurement could provide reassurance for long-term use. Measurement of bone turnover does not predict bone loss in DMPA users.

Periacetabular Bone Density After Total Hip Arthroplasty: A Postmortem Analysis

To clinically verify the bony response to a press-fit acetabular component, this study assessed 5 postmortem-retrieved pelves with unilateral total hip arthroplasties. Changes in periacetabular bone density between implanted and contralateral bone were assessed with dual energy x-ray absorptiometry and computed tomography. At a mean of 9.1 years postarthroplasty, bone density decreased an average of 1.5% to 7.1% proximal and 12.8% medial to the cup. This supports shorter-term in vivo investigations demonstrating periacetabular stress shielding proximal to press-fit cups as well as computer models predicting bone loss medially, but in much greater magnitudes. Unlike femoral remodeling, the average magnitudes of pelvic bone loss are not extensive; therefore, we question whether periacetabular remodeling should be a primary concern for orthopedic surgeons.

Dynamic simulation of three dimensional architectural and mechanical alterations in human trabecular bone during menopause

A three dimensional (3D) computational simulation of dynamic process of trabecular bone remodeling was developed with all the parameters derived from physiological and clinical data. Contributions of the microstructural bone formation deficits: trabecular plate perforations, trabecular rod breakages, and isolated bone fragments, to the rapid bone loss and disruption of trabecular microarchitecture during menopause were studied. Eighteen human trabecular bone samples from femoral neck (FN) and spine were scanned using a micro computed tomography (μCT) system. Bone resorption and formation were simulated as a computational cycle corresponding to 40-day resorption/160-day formation. Resorption cavities were randomly created over the bone surface according to the activation frequency, which was strictly based on clinical data. Every resorption cavity was refilled during formation unless it caused trabecular plate perforation, trabecular rod breakage or isolated fragments. A 20-year-period starting 5 years before and ending 15 years after menopause was simulated for each specimen. Elastic moduli, standard and individual trabeculae segmentation (ITS)-based morphological parameters were evaluated for each simulated 3D image. For both spine and FN groups, the time courses of predicted bone loss pattern by microstructural bone formation deficits were fairly consistent with the clinical measurements. The percentage of bone loss due to trabecular plate perforation, trabecular rod breakage, and isolated bone fragments were 73.2%, 18.9% and 7.9% at the simulated 15 years after menopause. The ITS-based plate fraction (pBV/BV), mean plate surface area (pTb.S), plate number density (pTb.N), and mean rod thickness (rTb.Th) decreased while rod fraction (rBV/BV) and rod number density (rTb.N) increased after the simulated menopause. The dynamic bone remodeling simulation based on microstructural bone formation deficits predicted the time course of menopausal bone loss pattern of spine and FN. Microstructural plate perforation could be the primary cause of menopausal trabecular bone loss. The combined effect of trabeculae perforation, breakage, and isolated fragments resulted in fewer and smaller trabecular plates and more but thinner trabecular rods.

Circulating Levels of Inflammatory Markers Predict Change in Bone Mineral Density and Resorption in Older Adults: A Longitudinal Study

IL-1, IL-6, and TNF-alpha play an important role in the pathogenesis of osteoporosis in animals; however, evidence that these play a similar role in bone loss in human studies is limited. Our objective was to determine the associations between serum markers of inflammation and changes in bone mineral density (BMD) and urinary pyridinoline (PYR) to creatinine (Cr) ratio over 2.9 yr in older adults. A total of 168 randomly selected subjects (mean 63 yr, range 52-78, 48% female) was studied. BMD was measured by dual-energy x-ray absorptiometry at baseline (mean T score: -0.18 to -0.61) and 2.9 yr later. Serum high-sensitivity (hs) C-reactive protein (CRP), IL-6, TNF-alpha, and the urinary PYR/Cr ratio were measured on both occasions. The mean annual loss of BMD was 0.15, 0.15, and 0.34% at total body, spine, and hip, respectively. Change in total body BMD was associated with baseline hs-CRP, IL-6, and TNF-alpha, as well as change in hs-CRP (beta: -0.41%/U, 95% confidence interval -0.68%, -0.15%) and IL-6 (beta: -0.62%/U, 95% confidence interval -1.01%, -0.23%). If these markers were put in the same predictive model, only IL-6 remained largely unchanged. Changes in other BMD sites were significantly predicted by IL-6 (hip and spine) and TNF-alpha (spine only). Finally, change in the PYR/Cr ratio was positively associated baseline IL-6, hs-CRP, and their changes (all P < 0.05) in women, but not men. Variation within the low levels of inflammatory markers observed in this study, especially IL-6, predicts bone loss and resorption, suggesting that targeted antiinflammatory therapy has potential for the prevention of osteoporosis.

A prospective investigation of the relations among cognitive dietary restraint, subclinical ovulatory disturbances, physical activity, and bone mass in healthy young women

Cognitive dietary restraint (CDR) may mediate subclinical ovulatory disturbances, which may result in loss of bone mineral density (BMD). CDR is associated with greater physical activity, which may modify the effect of CDR and ovulatory disturbances on bone mass. We aimed to investigate the relations among CDR, ovulatory disturbances, and physical activity and their effect on BMD in healthy premenopausal women over a 2-y period. In this prospective cohort study, key explanatory factors, important covariates, and BMD were measured at baseline and at 12 and 24 mo; 225 women completed the baseline assessment, and 189 completed the study. CDR was measured with the Three-Factor Eating Questionnaire, and physical activity was measured with the Baecke scale. An average of 9.8 menstrual cycles in 2 y were monitored by using salivary progesterone measurements and urinary ovulation detection kits. Ovulatory disturbances included anovulatory cycles or short luteal phase lengths of <10 d. BMD at the lumbar spine, femoral neck, and total body was measured by using dual-energy X-ray absorptiometry. General linear mixed modeling was used to determine predictors of change in BMD over time. CDR was not associated with ovulatory disturbances or changes in BMD. The average annual rate of change in lumbar spine BMD was decreased by 0.01 g/cm(2) in women who had experienced > or =3 monitored cycles with ovulatory disturbances (P = 0.02). CDR did not predict bone loss, and there was no relation between CDR and ovulatory disturbances. Ovulatory disturbances had a negative effect on the rate of change at the lumbar spine. The cause of these disturbances is unknown.

Biochemical markers of bone turnover predict bone loss in perimenopausal women but not in postmenopausal women-the Japanese Population-based Osteoporosis (JPOS) Cohort Study

The predictive value of biochemical markers of bone turnover for subsequent change in bone density in a population sample of healthy women with a wide range of ages has not been fully established. We followed 1,283 women aged 15-79 years at baseline selected randomly from the inhabitants of three areas in Japan for 6 years, and examined 1,130 subjects with no disease or administration of drugs affecting bone metabolism. The annual change in bone density at the spine, total hip, and distal one third of the radius was determined during the follow-up period by dual x-ray absorptiometry and was compared among the groups using different levels of biochemical markers at baseline, including serum osteocalcin (OC) and bone-specific alkaline phosphatase (bone ALP), free and total (tDPD) forms of immunoreactive deoxypyridinoline, and type I collagen crosslinked C-terminal telopeptide (CTX) in urine. Premenopausal women aged 45 years or older with elevated levels of OC, bone ALP, CTX, or tDPD showed significantly greater bone loss at most skeletal sites during the follow-up period than those with lower levels, after adjustment for the effects of age, height, weight, dietary calcium intake, regular exercise, and current smoking. The greatest coefficient of determination of the model was observed in the association between CTX and bone loss at the hip during the first 3 years of follow-up (42.8%). These subjects were pooled with perimenopausal women at baseline, and those who still menstruated at follow-up in this pooled group showed significant but more modest associations, whereas those who entered menopause during the follow-up period showed clear associations. However, early postmenopausal women with less than 5 or 10 years since menopause showed an association that was limited mostly to the distal radius, and other postmenopausal groups had virtually no association. Biochemical markers of bone turnover may predict bone loss in women undergoing menopausal transition but may not predict bone loss in postmenopausal women.

Radiographic Prediction of Intraoperative Bone Loss in Knee Arthroplasty Revision

A key challenge for orthopaedic surgeons performing revision total knee arthroplasty is the management of bone loss. The goal of our study was to test the validity of predicting bone loss from preoperative radiographs using two commonly utilized bone loss assessments: the Anderson Orthopaedic Research Institute and University of Pennsylvania systems and secondarily to assess the frequency and severity of bone loss in a prospective study of total knee arthroplasty revisions. Ninety-eight total knee arthroplasty revision patients were assessed and bone loss was detected in 76 (77.6%) patients preoperatively and intraoperatively. The validity of both systems was established. Agreement between preoperative and intraoperative Anderson Orthopaedic Research Institute classification was fair for the femur and good for the tibia. All University of Pennsylvania preoperative measures were correlated with intraoperative measures. Establishing valid and reliable preoperative systems of measuring bone loss facilitates planning of total knee arthroplasty revision and rehabilitation and meaningful comparisons between different series of patients and treatment protocols. Diagnostic study, level I (prospective testing of previously developed diagnostic criteria on consecutive patients [with universally applied reference "gold" standard]). See Author Guidelines for a complete description of levels of evidence.

Radiographic measure of aorta calcification is a site‐specific predictor of bone loss and fracture risk at the hip

To investigate whether aorta calcification (AC) - a surrogate marker of atherosclerosis - is an independent indicator of low bone mass density (BMD), accelerated bone loss, and risk of future fractures in postmenopausal women. A prospective epidemiological study. Follow-up period was 7.5 years. Community-based sample followed by a research institute. A total of 2662 generally healthy postmenopausal women with a mean age of 65.0 +/- 7.1 years at baseline. Annual rate of changes in BMD (DEXA) and AC (X-rays), vertebral fractures (X-rays), hip fractures (questionnaire). Advanced AC at baseline was significantly associated with lower BMD and accelerated bone loss from the proximal femur. In a multivariate logistic regression model, age (OR 1.1, 95% CI 1.0-1.2, P = 0.02), body mass index (BMI; OR 0.9, 95% CI 0.8-1.0, P = 0.03) and the severity of AC (OR 2.3, 95% CI 1.1-4.8, P = 0.03) were independent predictors of hip fractures. Adjusted OR for vertebral fracture was 1.2 (95% CI 1.0-1.5, P = 0.12). Aorta calcification seems to independently contribute to the development of osteoporosis in the proximal femur. Further studies are needed to clarify whether effective atherosclerosis prevention lowers hip fracture risk.

Prospective Study of Changes in Bone Mineral Density and Turnover in Children after Hematopoietic Cell Transplantation

Osteoporosis is common in adults after hematopoietic cell transplantation (HCT). The data on bone mineral density (BMD) in children after HCT are limited. The objective of the study was to determine the incidence, timing, magnitude, and possible predictors of bone loss in children after HCT. The study population included 49 patients (age 5-18 yr) who were eligible to receive HCT at the University of Minnesota. The patients were evaluated at baseline, 100 d, 6 months, and 1 yr after HCT. Lumbar BMD (LBMD) was assessed by dual-energy x-ray absorptiometry. The number of patients with osteopenia increased from 18% at baseline to 33% 1 yr after HCT, and with osteoporosis from 16-19%. Mean areal LBMD z-score decreased from -0.56 to -1.1 by 6 months (n = 27) and at 1 yr was -0.94 (n = 21), which was significant compared with standard normal distribution (P = 0.004 and P = 0.022, respectively). The absolute loss of bone mineral corresponded to a 5.3% reduction in areal LBMD and a 4.8% reduction in volumetric LBMD. The level of bone-specific alkaline phosphatase decreased by 30% by d 100 (P = 0.009), followed by recovery toward baseline by 6 months. The level of osteocalcin greater than 6.5 ng/ml at d 100 predicted recovery from the initial bone loss by 1 yr. A reduction in LBMD at 6 months correlated with a cumulative dose of glucocorticoids. This study demonstrates that bone loss is common in children after HCT and is primarily due to suppression of bone formation. Further studies are necessary to validate osteocalcin as a predictive biomarker.

Prospective Study of Changes in Bone Mineral Density and Turnover in Children after Hematopoietic Cell Transplantation.

Osteoporosis is common in adults after hematopoietic cell transplantation (HCT). The data on bone mineral density (BMD) in children after HCT are limited. The goals of this prospective study were to determine the incidence, timing, magnitude and possible predictors of bone loss in children following HCT. The study population included 49 patients (age 5–18 years) who were eligible to receive HCT at the University of Minnesota. The patients were evaluated at baseline, 100 days, 6 months, and 1 year after HCT. Lumbar BMD (BMDL) was assessed by dual-energy x-ray absorptiometry. The number of patients with osteopenia increased from 18% at baseline to 33% one year after HCT, and with osteoporosis from 16% to 19%. Mean areal BMDL z-score decreased from −0.56 to −1.1 by 6 months and at 1 year was −0.94, which was significant compared to standard normal distribution (p=0.004 and p=0.022, respectively). The absolute loss of bone mineral corresponded to 5.3% reduction in areal BMDL and 4.8% reduction in volumetric BMDL. The level of bone-specific alkaline phosphatase decreased by 30% by day 100 (p=0.009), followed by recovery toward baseline by 6 months. The level of osteocalcin >6.5 ng/mL at day 100 predicted recovery from the initial bone loss by 1 year. A reduction in BMDL at 6 months correlated with a cumulative dose of glucocorticoids. In conclusion, this study demonstrates that bone loss is common in children after HCT and is primarily due to suppression of bone formation. Further studies are necessary to validate osteocalcin as a predictive biomarker.

Übergewicht und Osteoporose

Atherosclerosis is a chronic inflammatory disease associated with an elevation of inflammatory markers such as CRP -- a robust predictor of cardiovascular events. Inflammation also plays a pivotal role in the pathogenesis of osteoporosis. IL-6 proved to be the most important predictor of bone loss in the proximal femur. Adipocyte-produced inflammatory cytokines are the pathogenetic link between obesity and its metabolic consequences. The different components of the metabolic syndrome are at the same time well-established risk factors for osteoporosis. Physical training, weight loss, and a Mediterranean-style diet all have a proven cytokine-lowering effect. Contrary to muscle mass, adipose tissue if at all contributes only marginally to the preservation of bone. As a consequence, increasing lean body mass while reducing fat mass seems to be the most effective way to prevent both atherosclerosis and osteoporosis.

Zinc intakes and plasma concentrations in men with osteoporosis: the Rancho Bernardo Study

Low zinc intakes and reduced blood zinc concentrations have been reported to be associated with osteoporosis in women. The objective was to examine the independent association between dietary zinc and plasma zinc and the association of each with bone mineral density (BMD) and 4-y bone loss in community-dwelling older men. Of the original Rancho Bernardo Study subjects, 396 men (age: 45-92 y) completed BMD measurements at baseline in 1988-1992 and 4 y later. Osteoporosis was defined as a BMD > or = 2.5 SDs below the mean for young women (a T-score < or = -2.5). At baseline, dietary intake data were collected by using a standard food-frequency questionnaire, and plasma zinc concentrations were measured by using inductively coupled plasma spectroscopy. The mean dietary zinc intake was 11.2 mg, and the mean plasma zinc concentration was 12.7 micromol/L. Plasma zinc was correlated with total zinc intake (diet plus supplements). Dietary zinc intake and plasma zinc concentrations were lower in men with osteoporosis at the hip and spine than in men without osteoporosis at those locations. BMDs for the hip, spine, and distal wrist were significantly lower in men in the lowest plasma zinc quartile (<11.3 micromol/L) than in men with higher plasma zinc concentrations. The association between plasma zinc and BMD was cross-sectional, longitudinal, and independent of age or body mass index. However, plasma zinc did not predict bone loss during the 4-y interval. Dietary zinc intake and plasma zinc each have a positive association with BMD in men.

Age, body mass index, and serum prostate-specific antigen correlate with bone loss in men with prostate cancer not receiving androgen deprivation therapy

Objectives Preexisting osteopenia and osteoporosis in men with prostate cancer are of concern due to accelerated bone loss during androgen deprivation therapy (ADT). We sought to identify risk factors for osteoporosis in men with prostate cancer who have not received ADT to help determine which patients may need bone mineral density (BMD) testing prior to ADT. Methods Lumbar spine and hip BMD testing were performed using dual-energy x-ray absorptiometry in 34 men with nonmetastatic prostate cancer who were not receiving ADT. The demographic, health status, lifestyle, and disease variables (Gleason score, clinical stage, and prostate-specific antigen level) were obtained and analyzed using univariate and multivariate methods for their role in spine and hip BMD levels. Results Of the 34 men, 73.5% had osteopenia (55.9%) or osteoporosis (17.6%) of the spine and/or hip. On univariate analysis, aging, lower body mass index, and elevated prostate-specific antigen level correlated significantly with bone loss in the spine and hip. Regression models showed age independently predicted bone loss in the spine ( R 2 = 0.14). Prostate-specific antigen was an independent predictor of low BMD in the trochanter ( R 2 = 0.18), and body mass index independently predicted low BMD in the femoral neck ( R 2 = 0.19). Compared with men younger than 70 years old, men 70 years old or older had less BMD in the spine ( P = 0.017), femoral neck ( P = 0.047), and trochanter ( P = 0.030). Conclusions A high prevalence of osteopenia or osteoporosis was found in men with prostate cancer not receiving ADT. Consideration should be given to performing BMD studies in men older than 70 years and with slender stature before initiating ADT.