Spine BMD Research Articles

Association of Changes in Relevant Indicators With Cardiovascular Disease and Osteoporosis in Perimenopausal and Postmenopausal Women

ABSTRACTThe essence of menopause is ovarian failure, decreased estrogen volatility, and deficiency leading to multiple related symptoms and an increased risk of metabolic disease in women, such as cardiovascular disease and osteoporosis. This study screened 773 eligible postmenopausal and perimenopausal women from an initial pool of 1187 participants, and various physiological and biochemical indices were measured and analyzed to assess differences across three age groups (40–44 years, 45–49 years, 50–54). We found no significant difference in the rate of cardiovascular disease between postmenopausal and perimenopausal women, while the rate of osteoporosis was higher in postmenopausal women compared to perimenopausal women. The disease of osteoporosis in postmenopausal women was associated with age (p < 0.05). We also found that postmenopausal women and perimenopausal women had significant effects on follicle‐stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), total cholesterol (TC), lumbar spine BMD (T1), femoral neck BMD, The bone density (T2) of the right femur was significantly affected. There are significant differences in FSH, LH, E2, TC, low‐density lipoprotein (LDL), L2–L4, T1, Neck of femur decrease, and T2 in women of different ages. Furthermore, the correlation analysis between age and E2 and metabolic indicators showed that age has a greater impact on the risk of postmenopausal and perimenopausal females. This study can help further understand the mechanisms of cardiovascular disease and osteoporosis in perimenopausal and menopausal women.

La pratique du cyclisme de haut niveau impacte-t-elle la masse osseuse ?

Background : Elite cyclists may be at risk for osteopenia. Many factors can lead to bone loss in cycling, including low energy availability, low grade of inflammation, and a weak mechanical osteogenic stimulus. Thus we wanted to assess bone health in one elite team of professional cyclists, and to identify correlations between BMD and potential risks factors.Methods : Thirty-three adult male cyclists were recruited from one international team. Total body, hip femur and lumbar spine BMD had been measured by DXA and was compared to standard values for a healthy population of same age and sex. Training characteristics, morphometrics, body lean mass, fat mass, history, medication and results of recent blood and stool analysis were collected and compared between the cyclists having low BMD and those with unaltered BMD. Univariate and multivariate correlation analyses were carried out to identify predictive factors for low BMD.Results : Twenty-one (64%) out of 33 cyclists presented a Z score < -1 at one site, and five of them (15%) had densitometric osteoporosis. Lumbar spine was involved every time ‘Z score = -b 1,23 +/- 0,94). Age, history, and training characteristics were significantly and negatively linked to BMD. After multiple regression, no variable had an independent correlation with BMD. No correlation was found with biomarkers or with training characteristics.Conclusion : Our study shows a worrying proposition of low bone mass in our population of young male and otherwise healthy cyclists. Low energy availability, as the missing point of our study, might be the main causal factor. Great attention should be paid in bone status in elite cyclists of any age.

Changes of bone turnover markers and bone mineral density among postmenopausal Thai women with osteoporosis receiving generic risedronate

BackgroundOsteoporosis has been recognized as a significant health issue in Thailand. Pharmacological interventions are important way to prevent fracture. However, one of the main challenges in selecting a medication is high cost, particularly for brand-name drugs. Data on generic bisphosphonate use in Thai are still lacking. Therefore, our study aimed to assess the efficacy and safety of generic risedronate in postmenopausal Thai women with osteoporosis.MethodsThis prospective study was conducted at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, from December 2022 to January 2024. Serum C-terminal cross-linking telopeptide of type I collagen (CTX) and procollagen type I N-propeptide (P1NP) were measured at baseline. All participants subsequently received 35 milligrams of oral risedronate once weekly for 52 weeks. Serum CTX and P1NP were remeasured at different time points. BMD was reevaluated at 52 weeks after risedronate treatment initiation.ResultsA total of 80 participants were included. The mean age was 65.2 ± 6.6 years. The mean body mass index (BMI) was 23.45 ± 3.49 kg/m2. The median (IQR) serum CTX level at 12 weeks was significantly lower than that at baseline (0.28 (0.16–0.46) ng/mL versus 0.44 (0.26–0.64) ng/mL, respectively; p value < 0.01). The suppression of serum CTX was confirmed at 52 weeks after treatment initiation. Compared with those at baseline, the serum P1NP levels were significantly lower at 24 weeks after treatment initiation (30.33 (19.19–39.58) ng/mL versus 41.90 (30.33–68.67) ng/mL, respectively; p value < 0.01). In terms of the BMD assessment at 52 weeks, significant improvements were observed in both areal BMD (g/cm2) and T scores at all measured sites compared with baseline. The lumbar spine, femoral neck, and total hip BMD increased from baseline by 4.76%, 3.84% and 4.54%, respectively.ConclusionPostmenopausal women with osteoporosis who were treated with generic risedronate demonstrated significant suppression of the bone remodelling process at 3, 6, and 12 months after treatment initiation. Additionally, significant improvements in the lumbar spine, femoral neck, and total hip BMD were observed at 12 months of therapy. These findings suggest that generic risedronate could be considered a reasonable and interesting option for treating postmenopausal women with osteoporosis in Thailand.

Associations of AMH in mid-reproductive years with bone mineral density and turnover markers in mid-life.

Concentration of circulating anti-Müllerian hormone (AMH) predicts short-term (3-5 years) bone loss around menopause. Whether AMH during mid-reproductive years predicts bone health over a decade later is unknown. To study the association of AMH levels in mid-reproductive years with bone density and turnover biomarkers measured after ∼14 years of follow-up. We assessed plasma AMH in 2003-2006 (mean 37.0 years, SD 5.1) among 450 parous women (71% White) in a US longitudinal cohort, and bone mineral density (BMD; spine, hip, and femoral neck, measured by dual-energy X-ray absorptiometry) in 2017-2021 (mean 51.0 years, SD 5.1). Secondary outcomes were plasma levels of procollagen type I N-propeptide (PINP) and C-terminal telopeptide I (CTX-I). In linear regression models adjusted for demographics and lifestyle, compared to women with AMH >3.5 ng/mL, those with AMH <1.0 ng/mL had lower BMD (g/cm2) at follow-up (beta [95% CI]: spine: -0.06 [-0.10, -0.02]; hip: -0.05 [-0.08, -0.02]; femoral neck: -0.03 [-0.06, 0.00]) and higher bone turnover markers (beta [95% CI]: PINP: 0.36 SD [0.10, 0.63]; CTX-I: 0.34 SD [0.07, 0.60]). The association of AMH with spine BMD was more pronounced among post-menopausal women, in contrast to associations with bone turnover markers which were more pronounced among women who had not yet reached menopause. The associations between AMH and BMD were primarily mediated by menopausal status at follow-up. Lower AMH during mid-reproductive years is associated with lower BMD and higher bone turnover 14 years later. Ovarian reserve during mid-reproductive years may be a valuable predictor of long-term bone health.

7686 A Case Of A 66-Year-Old Male With Systemic Macrocytosis Complicated By Osteoporosis

Abstract Disclosure: J.M. Gri: None. M. Hillhouse: None. P. madhavan: None. Background: Osteoporosis in men is underestimated and warrants investigation for secondary causes of osteoporosis. Systemic mastocytosis is a rare secondary cause of osteoporosis. Clinical Case: This is a 66-year-old male with a past medical history of severe persistent asthma, eczema, hypertension, GERD with esophagitis, basal cell carcinoma, and systemic mastocytosis (diagnosed in 2010). Family history was significant for lung cancer in both of his parents. Patient was first noted to have hyperpigmented skin lesions on his legs, trunk and upper extremities in the early 1990s. The spots were biopsied and he was diagnosed with urticaria pigmentosa in 1998. Due to persistent symptoms of facial flushing and soft stool, he was referred to Hematology and was started on antihistamines. He later underwent a bone marrow biopsy in 2010 which showed multifocal mast cell aggregates but normal trilineage hematopoiesis. He endorsed back pain shortly after his diagnosis and a DXA scan was completed. The DXA scan showed osteopenia of the spine T score of -1.8, BMD 0.999 mg/mm3 and normal bone density in bilateral hips. He had no history of fractures. He was started on alendronate and remained on the medication from 2012 to 2015. It was stopped due to intolerable symptoms of acid reflux and he required proton pump inhibitors. DXA scan in 2017 showed normal bone density of the hips and osteopenia of the lumbar spine (T score -1.2). DXA scan in 2022 showed a decrease in spine BMD by 6% (T score -1.8) from 2017 to 2022 but unchanged from 2010. Hip bone mineral density was normal but decreased by 10% since 2010 and by 6% since 2017. Labs obtained in May 2022 showed normal serum electrophoresis, normal urine calcium and creatinine ratio, calcium and vitamin D level and urine NTX of 41 nM BCE/mM (21-83) and bone specific alkaline phosphatase level of 31.5 U/L (15-41.3). After discussion with the patient, conservative management with calcium, vitamin D and exercise has been implemented along with close follow up. Should the patient’s bone turnover markers increase or fracture risk increase, additional antiresorptive therapy will be initiated. Conclusion: This case study highlights the importance of screening for osteoporosis in patients with systemic macrocytosis. As this patient was diagnosed with osteopenia at age 53, this case also emphasizes the importance of early screening in both women and men with this rare condition. Presentation: 6/3/2024

7217 Impact of INZ-701 on Bone and Mineral Metabolism Biomarkers and Clinical Outcomes in Adults with ENPP1 Deficiency - Results from 48-week Phase 1/2 Open Label Study

Abstract Disclosure: K. Gunter: Employee; Self; Inozyme Pharma. Stock Owner; Self; Inozyme Pharma. R.A. Wermers: Research Investigator; Self; Inozyme Pharma. R. Fuhr: Employee; Self; Parexel GmbH. Research Investigator; Self; Inozyme Pharma. D. Schnabel: Research Investigator; Self; Inozyme Pharma. A. Besancon: Research Investigator; Self; Inozyme Pharma. M.A. Nour: Research Investigator; Self; Inozyme Pharma. D. Wenkert: Stock Owner; Self; Inozyme Pharma. Y. Sabbagh: Employee; Self; Inozyme Pharma. Stock Owner; Self; Inozyme Pharma. Background: ENPP1 Deficiency is a rare disorder due to inactivating mutations in the ENPP1 gene that result in low levels of inorganic pyrophosphate (PPi), a critical regulator of mineralization. Subsequent pathologic soft tissue calcification results in severe vascular calcification and ∼50% infant mortality. By early adolescence the majority of survivors develop FGF-23 mediated hypophosphatemic rickets, characterized by bone deformities, short stature, joint/ligament calcification and musculoskeletal pain. No targeted therapy exists for this disease. INZ-701 is a recombinant ENPP1-Fc investigational product. Purpose: To describe the safety, tolerability, immunogenicity, and exploratory efficacy (bone and mineral metabolism biomarkers and clinical outcomes) of INZ-701 in adults with ENPP1 Deficiency through the end of the phase 2 study period (week 48). Methods: Phase 1/2, multicenter, open-label, multiple ascending dose study including three adults in each of three dose cohorts (0.2, 0.6 and 1.8 mg/kg, total N=9) with genetic variants in ENPP1 and PPi &amp;lt;1300 nM (NCT04686175). Participants were dosed subcutaneously on Day 1, then twice weekly from Day 8 to end of study. Data through wk 48 as of July 6, 2023 are included; topline wk 48 data will be presented. Per protocol, participants may continue to receive INZ-701 beyond wk 48. Results: Rapid increase in mean PPi from baseline of 426±407 nM was noted in all patients, reaching the healthy volunteer range within 6 hrs of the first dose with sustained elevation through wk 48. Mean PPi across the 0.2, 0.6 and 1.8 mg/kg dose cohorts from day 32 to wk 48 was 1299±131 nM, 1356±136 nM, and 1282±81 nM, respectively. There were improvements from baseline to wk 48 in mean pooled FGF-23 (-22 pg/mL) and serum phosphate (+0.18 mg/dL), with dose-dependent changes in bone specific alkaline phosphatase consistent with bone healing. DEXA revealed improvements in spine BMD and BMC. There were trends towards improvement in mean % predicted change in 6MWT from baseline to wk 48: cohort 1, 76.7% (SE 10.5) to 85.0% (SE 3.0); cohort 2, 52.2% (SE 10.9 ) to 79.0% (SE 2.9); cohort 3, wk 48 data not available. Improvements were also observed in physician and patient global impression of change score (with no patients deteriorating) and PROMIS pain intensity score. INZ-701 was well tolerated with no drug-related serious or severe (&amp;gt; grade 2) adverse events. Low titers of non-neutralizing anti-drug antibodies (≤160) were observed in 7/9 patients. Long half-life of approximately 126 hours suggests the potential for once-weekly dosing. Conclusions: In adults with ENPP1 Deficiency, INZ-701 was well tolerated with no related serious or severe adverse events. INZ-701 demonstrated a rapid and sustained increase in PPi levels from baseline to week 48 with corresponding improvements in bone mineral biomarkers, functional performance, and patient and physician-reported outcomes. Presentation: 6/3/2024

7863 Polycystic Ovary Syndrome in Relation to Clinical, Biochemical, and Functional Musculoskeletal Health Outcomes During Midlife: A Longitudinal Cohort Study

Abstract Disclosure: M. Kazemi: None. S. Rifas-Shiman: None. E. Yu: None. S. Wang: None. M. Hivert: None. W. Perng: None. V. Fitz: None. J. Shifren: None. E. Oken: None. J. Chavarro: None. Background: Research about musculoskeletal composition and function in women with polycystic ovary syndrome (PCOS) is conflicting and primarily derived from cross-sectional analyses in clinical populations, raising concerns about the generalizability of findings and the temporal relation of observed associations. We tested the hypothesis that PCOS status is associated with adverse musculoskeletal outcomes during the menopausal transition. Methods: We enrolled 405 women in early pregnancy in 1999-2002 and followed them for ∼17y. Women with a PCOS clinical diagnosis were classified as “diagnosed PCOS” (N=26) 3y post-enrollment. In women without a PCOS diagnosis, we defined “probable PCOS” (N=40) as the presence of ≥2 PCOS traits, including ovulatory dysfunction (cycle length&amp;lt;21, ≥35d, or too irregular to determine length), elevated testosterone (&amp;gt;75th%) or elevated anti-Müllerian hormone (&amp;gt;75th%). We classified the remaining women as “no PCOS" (N=339). Musculoskeletal health outcomes (lean body mass [LBM], bone mineral density [BMD], and fat mass by dual-energy X-ray absorptiometry; plasma procollagen type I N-propeptide [PINP] and C-terminal telopeptide of type I collagen [CTX-I]; handgrip strength; and fractures) were assessed at 17y visit. We evaluated associations using linear regression models with log-transformed outcomes adjusted for age (mean [SD] 37 [5]y) and BMI (25.7 [5.4] kg/m2) at 3y visit. Further, we stratified analyses by menopausal status at 17y visit (self-reported amenorrhea for 12mos) to account for known effects of menopause on musculoskeletal health. Results: At the 17y follow-up, women were 51 (5)y; BMI, 27.9 (6.3) kg/m2. Diagnosed and probable PCOS were unrelated to spine (log β [95%CI]: 0.03 [-0.01, 0.07]) and hip (0.02 [-0.01, 0.06]) BMD (g/cm2) vs. no PCOS. However, diagnosed and probable PCOS were associated with increases in lower limbs (0.04 [0.01, 0.06]) and total (0.03 [0.004, 0.05]) BMD (g/cm2), without differences between PCOS groups. Compared to no PCOS, probable (-0.26 [-0.41, -0.11]) but not diagnosed PCOS (0.00 [-0.18, 0.18]) was inversely related to plasma CTX-I (ng/dL); a similar pattern was observed for PINP. In analyses stratified by menopausal status, PCOS was unrelated to BMD in postmenopausal women but remained positively associated with lower limb (0.04 [0.01, 0.06]) BMD (g/cm2) in premenopausal women. Conversely, associations between probable PCOS and plasma CTX-I were stronger in postmenopausal (-0.41 [-0.71, -0.11]) than in premenopausal women (-0.16 [-0.33, 0.01] ng/dL). Similarly, probable PCOS was inversely associated with PINP (-0.40 [-0.78, -0.01] mg/L) in postmenopausal, unlike premenopausal women. Diagnosed and probable PCOS were unrelated to LBM, fat mass, handgrip strength, or fracture risk. Conclusions: Any BMI-independent protective effects of PCOS on BMD may be offset during menopausal transition. Presentation: 6/2/2024

7863 Polycystic Ovary Syndrome in Relation to Clinical, Biochemical, and Functional Musculoskeletal Health Outcomes During Midlife: A Longitudinal Cohort Study

Abstract Disclosure: M. Kazemi: None. S. Rifas-Shiman: None. E. Yu: None. S. Wang: None. M. Hivert: None. W. Perng: None. V. Fitz: None. J. Shifren: None. E. Oken: None. J. Chavarro: None. Background: Research about musculoskeletal composition and function in women with polycystic ovary syndrome (PCOS) is conflicting and primarily derived from cross-sectional analyses in clinical populations, raising concerns about the generalizability of findings and the temporal relation of observed associations. We tested the hypothesis that PCOS status is associated with adverse musculoskeletal outcomes during the menopausal transition. Methods: We enrolled 405 women in early pregnancy in 1999-2002 and followed them for ∼17y. Women with a PCOS clinical diagnosis were classified as “diagnosed PCOS” (N=26) 3y post-enrollment. In women without a PCOS diagnosis, we defined “probable PCOS” (N=40) as the presence of ≥2 PCOS traits, including ovulatory dysfunction (cycle length&amp;lt;21, ≥35d, or too irregular to determine length), elevated testosterone (&amp;gt;75th%) or elevated anti-Müllerian hormone (&amp;gt;75th%). We classified the remaining women as “no PCOS" (N=339). Musculoskeletal health outcomes (lean body mass [LBM], bone mineral density [BMD], and fat mass by dual-energy X-ray absorptiometry; plasma procollagen type I N-propeptide [PINP] and C-terminal telopeptide of type I collagen [CTX-I]; handgrip strength; and fractures) were assessed at 17y visit. We evaluated associations using linear regression models with log-transformed outcomes adjusted for age (mean [SD] 37 [5]y) and BMI (25.7 [5.4] kg/m2) at 3y visit. Further, we stratified analyses by menopausal status at 17y visit (self-reported amenorrhea for 12mos) to account for known effects of menopause on musculoskeletal health. Results: At the 17y follow-up, women were 51 (5)y; BMI, 27.9 (6.3) kg/m2. Diagnosed and probable PCOS were unrelated to spine (log β [95%CI]: 0.03 [-0.01, 0.07]) and hip (0.02 [-0.01, 0.06]) BMD (g/cm2) vs. no PCOS. However, diagnosed and probable PCOS were associated with increases in lower limbs (0.04 [0.01, 0.06]) and total (0.03 [0.004, 0.05]) BMD (g/cm2), without differences between PCOS groups. Compared to no PCOS, probable (-0.26 [-0.41, -0.11]) but not diagnosed PCOS (0.00 [-0.18, 0.18]) was inversely related to plasma CTX-I (ng/dL); a similar pattern was observed for PINP. In analyses stratified by menopausal status, PCOS was unrelated to BMD in postmenopausal women but remained positively associated with lower limb (0.04 [0.01, 0.06]) BMD (g/cm2) in premenopausal women. Conversely, associations between probable PCOS and plasma CTX-I were stronger in postmenopausal (-0.41 [-0.71, -0.11]) than in premenopausal women (-0.16 [-0.33, 0.01] ng/dL). Similarly, probable PCOS was inversely associated with PINP (-0.40 [-0.78, -0.01] mg/L) in postmenopausal, unlike premenopausal women. Diagnosed and probable PCOS were unrelated to LBM, fat mass, handgrip strength, or fracture risk. Conclusions: Any BMI-independent protective effects of PCOS on BMD may be offset during menopausal transition. Presentation: 6/2/2024

Updated reference values for BMD and lean mass measured by DXA in Thai children.

This study established normative references for total body less head (TBLH) BMD, lumbar spine (L1-L4) BMD, and both total and appendicular lean mass (LM) in Thai children and adolescents (aged 5-18years) using DXA. This work expands upon 2014 normative data for Thai children, which included L2-L4 BMD, total body BMD (head included), and total LM. We reanalyzed total body and lumbar spine DXA scans (Lunar Prodigy Pro, GE Healthcare; enCORE version 7.53) from 174 boys and 193 girls, using upgraded software (enCORE version 17SP2) for TBLH BMD, L1-L4 BMD, and LM analysis. The "enhanced" mode was applied for TBLH BMD and LM. Adjustments for total and appendicular LM were made relative to squared height (m2) to account for body size variability. Normative data stratified by sex and Tanner stage were generated for TBLH BMD, L1-L4 BMD, and LM indices. Weight and Tanner stage significantly determined BMD and LM. Adolescent girls exhibited higher LSBMD values due to earlier pubertal onset. Boys showed higher LM indices with more rapid gains during growth spurts. This study provides updated normative reference values for BMD (TBLH and L1-L4) and LM (total and appendicular) in Thai children and adolescents, measured via DXA. These references will enhance the assessment of low bone mass and LM deficits in Thai pediatric populations, particularly in those with chronic illnesses.

MENOPAUSE AND PARITY ARE ASSOCIATED WITH LUMBAR SPINE CURVATURE

BackgroundLateral lumbar spine statistical shape models (SSM) have been used previously to describe associations with osteoarthritis and back pain. However, associations with factors such as osteoporosis, menopause and parity have not been explored.Methods and ResultsA 143-point SSM, describing L1 to the top of L5, was applied to lateral spine iDXA scans from UK Biobank. Associations with self-reported osteoporosis, menopause, parity and back pain and the first 10 modes of variation were examined using adjusted binary logistic regression or linear regression (adjusted for age, height, weight and total spine BMD). We report odds ratios with 95% confidence intervals for each standard deviation change in mode.Complete data were available for 2494 women. Mean age was 61.5 (± 7.4) years. 1369 women reported going through menopause, 96 women self-reported osteoporosis and 339 women reported chronic back pain. 80% of women reported at least 1 live birth.Lumbar spine shape was not associated with back pain in this cohort. Two modes were associated with menopause (modes 1 &amp; 2), 1 mode with parity (mode 1) and 2 modes with osteoporosis (modes 3 &amp; 5). Mode 1 (43.6% total variation), describing lumbar curvature was positively associated with both menopause [OR 1.15 95% CI 1.00–1.33, p=0.05] and parity [OR 1.058 95% CI 1.03–1.0, p=0.01]. Mode 3, describing decreased vertebral height was positively associated with osteoporosis [OR 1.40 95% CI 1.14–1.73, p=0.001].ConclusionMenopause and parity were associated with a curvier lumbar spine and osteoporosis with decreased vertebral height. Shape was not associated with back pain.No conflicts of interest Sources of fundingWellcome Trust collaborative award ref 209233

Efficacy and Safety of Anti-Osteoporotic Agents across CKD Stages: A Meta-Analysis of Randomized Clinical Trials.

Osteoporosis poses a significant health concern, especially for individuals with chronic kidney disease (CKD). CKD disrupts mineral and bone metabolism, heightening the risk of fractures and complicating the management of osteoporosis. While anti-osteoporotic interventions aim to address bone health in CKD patients, ongoing research is essential to understand the comparative efficacy and safety of these medications, particularly in different CKD stages, notably in stages 4 and 5. We searched PubMed/MEDLINE, EMBASE, and the Cochrane CENTRAL for randomized controlled trials assessing the efficacy and safety of osteoporosis interventions in CKD up to June 15, 2024. The analysis utilized the pooled odds ratio (OR) along with the corresponding 95% confidence interval (CI), employing Comprehensive Meta-Analysis software, version 3.0. To assess heterogeneity in the results of individual studies, we used Cochran's Q statistic and the I2 statistic. We analyzed 12 randomized controlled trials involving 31,027 participants, revealing a significantly lower risk of vertebral fractures with anti-osteoporotic agents (teriparatide, denosumab, romosozumab, raloxifene) compared to placebo (pooled OR, 0.28 [95% CI, 0.22-0.36]). Stratification by CKD stages showed a lower risk in Stages 1-3 but no significant reduction in stages 4 and 5. Teriparatide, denosumab, and romosozumab were effective in lowering fracture risk, whereas Raloxifene showed no significant effect. The lumbar spine, femoral neck, and total hip BMD showed no significant differences between anti-osteoporotic agents (denosumab, raloxifene, risedronate, alendronate, teriparatide) and placebo. However, romosozumab demonstrated a significantly greater BMD change in all kidney function categories. No reported side effects were observed in CKD stages 1-5 across the trials. Our meta-analysis highlights the effectiveness of anti-osteoporotic agents in lowering vertebral fracture risk in CKD patients, particularly in stages 1-3. However, this benefit is not apparent in stages 4 and 5, necessitating further research. Despite the absence of reported side effects in CKD patients, clinicians should carefully assess the suitability of these medications, considering individual risks and benefits.

Study of Relation between Advanced Oxidation Protein Product and Bone Mass Density in Type 2 Diabetic Patient

Abstract Background Many disorders associated with diabetes, such as oxidative stress, hyperglycemia, and body weight, can be considered to be involved in the pathogenesis of diabetic bone disorder. Among them, oxidative stress may be a candidate, since it is increased under diabetic conditions and is known to induce cellular dysfunction in a wide variety of cell types. Reactive oxygen species (ROS) generated by high glucose concentrations are also considered to be a causal link between hyperglycemia and other metabolic abnormalities in the development of many diabetic complications. Aim of the Work This study evaluated the relation between advanced oxidation protein product and bone mass density in type2 diabetic patient. Patients and Methods This cross sectional study was conducted on 90 postmenopausal female patients aged from 50-60 years old, selected from endocrine outpatient clinic of Ain shams university hospitals for 12 months in a period from May 2019 to May 2020. Results AOPP was significantly higher in group I (diabetic patients) than group II. There were significant correlations between AOPP and (BMI, HbA1c, forearm, femur, spine T-SCORE) in group I and both groups but there were no significant correlations between AOPP and (menopause duration, age, creatinine, urea, eGFR, Ca level, phosphate level and PTH). Conclusion From the results of current study we can conclude that: AOPP is significantly higher in diabetic patient’s more than non-diabetic patients. Higher AOPP levels were associated with lower BMD. BMD of spine was significantly decreased in diabetic patients than other bony parts. AOPP was significantly increased with high BMI, HbA1c level

618-P: Development of a New Index Based on 24-Hour Urinary Creatinine to Predict Improvement of Lumbar Spine BMD after One Year of Zoledronic Acid Treatment for Osteoporosis

618-P: Development of a New Index Based on 24-Hour Urinary Creatinine to Predict Improvement of Lumbar Spine BMD after One Year of Zoledronic Acid Treatment for Osteoporosis

Limosilactobacillus reuteri 6475 and Prevention of Early Postmenopausal Bone Loss

Daily supplementation with the probiotic Limosilactobacillus reuteri ATCC PTA 6475 (L reuteri) vs placebo has previously been demonstrated to reduce bone loss in an estrogen deficiency mice model and older women, although the magnitude of the effect was small. We hypothesized that long-term treatment with L reuteri could result in clinically relevant skeletal benefits in postmenopausal osteoporosis. To evaluate whether daily supplementation with L reuteri vs placebo could reduce early postmenopausal bone loss and whether the effects remained or increased over time during 2 years of treatment. A double-blind, randomized, placebo-controlled clinical trial was conducted between December 4, 2019, and October 6, 2022, at a single center in Gothenburg, southwestern Sweden. Participants were recruited by online advertisements, and letters were sent to 10 062 women aged 50 to 60 years. Responding women (n = 752) underwent telephone screening, resulting in 292 women being invited to a screening visit. Of those who were screened, 239 women met all inclusion criteria and had no exclusion criteria. Capsules with L reuteri in 2 doses, 5 × 108 (low dose) or 5 × 109 (high dose) colony-forming units, taken twice daily or placebo were administered. All capsules also included cholecalciferol, 200 IU. The primary outcome was the relative change in tibia total volumetric bone mineral density (vBMD) over 2 years. Secondary outcomes included relative change in areal BMD of the lumbar spine and total hip, bone turnover markers C-terminal telopeptide cross-links of collagen type I and type I procollagen intact N-terminal propeptide, as well as tibia trabecular bone volume fraction and cortical vBMD. Both intention-to-treat and per-protocol analyses were conducted. A total of 239 postmenopausal women (median age, 55 [IQR, 53-56] years) were included. Tibia vBMD (primary outcome), hip and spine vBMD, and tibia cortical area and BMD decreased significantly in all groups, with no group-to-group differences (percent change tibia vBMD high dose vs placebo least-squares means, -0.08 [95 CI, -0.85 to 0.69] and low dose vs placebo least-squares means, -0.22 [95% CI, -0.99 to 0.55]). There were no significant treatment effects on any other predefined outcomes. A prespecified sensitivity analysis found a significant interaction between body mass index (BMI) and treatment effect at 2 years. No significant adverse effects were observed. In this randomized clinical trial of 239 early postmenopausal women, supplementation with L reuteri had no effect on bone loss or bone turnover over 2 years. The observed interaction between BMI and treatment effect warrants further investigation. ClinicalTrials.gov Identifier: NCT04169789.

Bone mineral density is not associated with incident high-intensity back pain: a 10-year cohort study in men.

Although patients believe that osteoporosis is a painful condition, health professionals assume it is painless unless a fracture occurs. The association between BMD and back pain has not been examined longitudinally in community-based adults in an unbiased population using gold-standard measures. This study aimed to examine the association between BMD and incident high-intensity back pain and/or high disability over 10years in Australian men without high-intensity symptoms at baseline. Men with no high-intensity back pain and/or high disability attending the Geelong Osteoporosis Study at the 5-year visit (occurring between 2006-2010) (considered the baseline for the current study) were followed for 10years (reassessed between 2016-2021). Back pain and disability were assessed using the Graded Chronic Pain Scale at both time points. At baseline, DXA was used to measure lumbar spine and total hip BMD and spinal artefacts. The relationships between BMD and incident high-intensity pain and/or high disability at follow-up were examined using binary logistic regression, adjusted for age, body mass index, depression, education, smoking, mobility, and spinal artefacts. A total of 679 participants had no to low-intensity pain and/or no to low disability at baseline. A total of 441 attended follow-up, providing back pain and disability data. Thirty-seven men developed high-intensity pain and/or high disability. No association of BMD at any site was seen with incident high-intensity pain and/or high disability. BMD was not associated with incident high-intensity pain or disability in community-based men. These data provide evidence to dispel the erroneous community-held belief that low BMD is related to back pain and disability.

LONG-TERM SPORT OR EXERCISE COMMENCED BEFORE 16 YEARS OF AGE REDUCES ADVERSE BODY COMPOSITION OUTCOMES IN CEREBRAL PALSY

INTRODUCTION &amp; AIMS Bone mineral density (BMD) and appendicular lean mass (ALM) deficits are common in people with cerebral palsy (CP), increasing sarcopenia and osteoporosis risk, while sport/exercise participation before age 16 improves adult peak bone mass accretion. This study investigated the effects of high-level sport/exercise participation commenced before 16 years of age on body composition in ambulatory adults with CP. METHODS Body composition was measured via dual-energy X-ray absorptiometry in a cross-sectional observational pilot study of 26 adults (m=19; f=7; GMFCS I-III) grouped via self-reported activity level into Low (&amp;lt;150 minutes moderate-vigorous activity weekly; n=10), Post-16 (active but commenced participation after 16; n=6), and Pre-16 (active and commenced participation before 16; n=10). Between-group Z-score differences were assessed via Kruskal-Wallis one-way ANOVA, with post-hoc comparisons via Mann-Whitney U-test. RESULTS Whole body, spine and hip BMD Z-scores were significantly higher in Pre-16 (1.020 (0.639), 1.210 (1.102), and 0.450 (1.325), respectively) versus Low (-0.500 (0.715), -0.840 (0.957), and -1.020 (1.059), respectively) (p&amp;lt;0.001-0.008). Thirteen participants, including four competitive athletes, had low BMD, and 15, including eight athletes, had moderate-significant ALM deficits, versus age- and sex-specific reference populations. CONCLUSION Ambulatory adults with CP who exceed physical activity guidelines and commenced participation before 16 years of age have higher BMD than those who are sedentary or commenced participation after 16 years. Sport and exercise across the lifespan are critical to ameliorate adverse body composition outcomes common in CP, however, some athletes remain at-risk and require targeted combined resistance training and dietary interventions in addition to sport training to address low ALM and BMD.

Sex-specific association of serum dehydroepiandrosterone and its sulfate levels with osteoporosis in type 2 diabetes.

This study is to investigate the relation between serum dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) levels and the risk of osteoporosis in patients with T2DM. This cross-sectional study involved 938 hospitalized patients with T2DM. Linear regression models were used to explore the relationship between DHEA and DHEAS and the BMD at different skeletal sites. Multinominal logistic regression models and the restricted cubic spline (RCS) were used to evaluate the associations of DHEA and DHEAS with the risks of osteopenia and/or osteoporosis. In postmenopausal women with T2DM, after adjustment for confounders including testosterone and estradiol, DHEA showed a significant positive correlation with lumbar spine BMD (P = 0.013). Moreover, DHEAS exhibited significant positive correlations with BMD at three skeletal sites: including femoral neck, total hip, and lumbar spine (all P < 0.05). Low DHEA and DHEAS levels were associated with increased risk of osteopenia and/or osteoporosis (all P < 0.05) and the risk of osteoporosis gradually decreased with increasing DHEAS levels (P overall = 0.018, P-nonlinear = 0.559). However, DHEA and DHEAS levels in men over the age of 50 with T2DM were not associated with any of above outcomes. In patients with T2DM, independent of testosterone and estradiol, higher DHEA and DHEAS levels are associated with higher BMD and lower risk of osteopenia/osteoporosis in postmenopausal women but not men over the age of 50.

TBS correlates with bone density and microstructure at trabecular and cortical bone evaluated by HR-pQCT.

Trabecular bone score (TBS) estimates bone microstructure, which is directly measured by high-resolution peripheral quantitative computed tomography (HRpQCT). We evaluated the correlation between these methods and TBS influence on fracture risk assessed by FRAX. We evaluated 129 individuals (82 women, 43 postmenopausal) 20 to 82.3 years without prevalent clinical or non-clinical morphometric vertebral fractures, using DXA (spine and hip), HR-pQCT at distal radius (R) and tibia (T) and TBS which classifies bone microarchitecture as normal (TBS ≥ 1.350), partially degraded (1.200 < TBS < 1.350), or degraded (TBS ≤ 1.200). Spine and hip BMD and HR-pQCT parameters at cortical bone: area (T), density (R,T) thickness (T) and trabecular bone: density (R,T), number (T) and thickness (R) were significantly better in the 78 individuals with normal TBS (group 1) versus the 51 classified as partially degraded (n = 42) or degraded microarchitecture (n = 9) altogether (group 2). TBS values correlated with age (r = -0.55), positively with spine and hip BMD and all cortical and trabecular bone density and microstructure parameters evaluated, p < 0.05 all tests. Binary logistic regression defined age (p = 0.008) and cortical thickness (p = 0.018) as main influences on TBS, while ANCOVA demonstrated that HR-pQCT data corrected for age were not different between TBS groups 1 and 2. TBS adjustment increased FRAX risk for major osteoporotic fractures and hip fractures. We describe significant association between TBS and both trabecular and cortical bone parameters measured by HR-pQCT, consistent with TBS influence on fracture risk estimation by FRAX, including hip fractures, where cortical bone predominates.

Lower risk of low bone mineral density in high vitamin E level in older people: A cross-sectional study

IntroductionOsteoporosis and osteopenia, together known as low bone mineral density (LBMD), are common problems in the elderly. LBMD may cause fragility fractures in the elderly. The relationship between Vitamin E and LBMD in old Americans is still unclear. In this study, we investigated the relationship between serum Vitamin E levels and LBMD in the elderly. MethodsWe utilized data from the National Health and Nutrition Examination Survey (NHANES) 2017-2018 and ultimately included 378 participants aged 50 to 79. Multivariable logistic or linear regression models were applied to examine the associations between serum Vitamin E levels and LBMD, total femur or lumbar spine BMD after adjusting for covariates. ResultsAfter adjusting for all covariates, higher serum Vitamin E levels reduced the risk of LBMD (OR 0.76; 95% CI 0.58-1.00) and were positively associated with total femur BMD (β: 0.02; 95% CI: 0.01-0.03)， after adjusting for all covariates. In the subgroup analysis, for the BMI normal group (BMI<25), the serum Vitamin E levels were positively associated with the total femur (β: 0.03; 95% CI: 0.01-0.05) and lumbar spine BMD (β: 0.04; 95% CI: 0.01-0.07). In the BMI normal group, people with high serum Vitamin E levels have a lower incidence of LBMD (OR:0.43; 95% CI: 0.21-0.88). Though the P for interaction was larger than 0.05. ConclusionThis study found serum Vitamin E levels were negatively associated with LBMD in older Americans. Serum Vitamin E levels were positively associated with femur BMD in older Americans.

Influence of age on the efficacy of pharmacologic treatments on fracture risk reduction and increases in BMD: RCT results from the FNIH-ASBMR-SABRE project.

There is a common belief that antiosteoporosis medications are less effective in older adults. This study used data from randomized controlled trials (RCTs) to determine whether the anti-fracture efficacy of treatments and their effects on BMD differ in people ≥70 compared to those <70yr. We used individual patient data from 23 RCTs of osteoporosis medications collected as part of the FNIH-ASBMR SABRE project. We assessed the following fractures: radiographic vertebral, non-vertebral, hip, all clinical, and all fractures. We used Cox proportional hazard regression to estimate treatment effect for clinical fracture outcomes, logistic regression for the radiographic vertebral fracture outcome, and linear regression to estimate treatment effect on 24-mo change in hip and spine BMD in each age subgroup. The analysis included 123 164 (99% female) participants; 43% being ≥70yr. Treatment with anti-osteoporosis drugs significantly and similarly reduced fractures in both subgroups (eg, odds ratio [OR] = 0.47 and 0.51 for vertebral fractures in those below and above 70yr, interaction P = .19; hazard ratio [HR] for all fractures: 0.72 vs 0.70, interaction P = .20). Results were similar when limited to bisphosphonate trials with the exception of hip fracture risk reduction which was somewhat greater in those <70 (HR = 0.44) vs ≥70 (HR = 0.79) yr (interaction P = .02). Allocation to anti-osteoporotic drugs resulted in significantly greater increases in hip and spine BMD at 24mo in those ≥70 compared to those <70yr. In summary, anti-osteoporotic medications similarly reduced the risk of fractures regardless of age, and the few small differences in fracture risk reduction by age were of uncertain clinical significance.