Underwent Bone Mineral Density Testing Research Articles

Challenges of fracture risk assessment in Asian and Black women.

Bone mineral density (BMD) and fracture risk calculators (eg, the Fracture Risk Assessment Tool [FRAX]) guide primary prevention care in postmenopausal women. BMD scores use non-Hispanic White (NHW) reference data for T-score classification, whereas FRAX incorporates BMD, clinical risk factors, and population differences when calculating risk. This study compares findings among Asian, Black, and NHW women who underwent osteoporosis screening in a US health care system. Retrospective cross-sectional study. Asian, Black, and NHW women aged 65 to 75 years who underwent BMD testing (with no recent fracture, osteoporosis therapy, metastatic cancer, multiple myeloma, metabolic bone disorders, or kidney replacement therapy) were compared across the following measures: femoral neck BMD (FN-BMD) T-score (normal ≥ -1, osteoporosis ≤ -2.5), high FRAX 10-year hip fracture risk (FRAX-Hip ≥ 3%), FRAX risk factors, and diabetes status. Among 3640 Asian women, 23.8% had osteoporosis and 8.7% had FRAX-Hip scores of at least 3% (34.5% among those with osteoporosis). Among 11,711 NHW women, 12.3% had osteoporosis and 17.2% had FRAX-Hip scores of at least 3% (84.8% among those with osteoporosis). Among 1711 Black women, 68.1% had normal FN-BMD, 4.1% had BMD-defined osteoporosis, and 1.8% had FRAX-Hip scores of at least 3% (32.4% among those with osteoporosis). Fracture risk factors differed by group. Diabetes was 2-fold more prevalent in Black and Asian (35% and 36%, respectively) vs NHW (16%) women. A large subset of Asian women have discordant BMD and FRAX scores, presenting challenges in osteoporosis management. Furthermore, FN-BMD and especially FRAX scores identified few Black women at high fracture risk warranting treatment. Studies should examine whether fracture risk assessment can be optimized in understudied racial minority populations, particularly when findings are discordant.

Bone Health Evaluations and Secondary Fragility Fractures in Hip Fracture Patients.

This study sought to examine the utilization of bone health evaluations in geriatric hip fracture patients and identify risk factors for the development of future fragility fractures. A consecutive series of patients ≥55 years who underwent surgical management of a hip fracture between September 2015 and July 2019 were identified. Chart review was performed to evaluate post-injury follow-up, performance of a bone health evaluation, and use of osteoporosis-related diagnostic and pharmacologic treatment. A total of 832 patients were included. The mean age of the patients was 81.2±9.9 years. Approximately 21% of patients underwent a comprehensive bone health evaluation. Of this cohort, 64.7% were started on pharmacologic therapy, and 73 patients underwent bone mineral density testing. Following discharge from the hospital, 70.3% of the patients followed-up on an outpatient basis with 95.7% seeing orthopedic surgery for post-fracture care. Overall, 102 patients (12.3%) sustained additional fragility fractures within two years, and 31 of these patients (3.7%) sustained a second hip fracture. There was no difference in the rate of second hip fractures or other additional fragility fractures based on the use of osteoporosis medications. Management of osteoporosis in geriatric hip fracture patients could be improved. Outpatient follow-up post-hip fracture is almost 70%, yet a minority of patients were started on osteoporosis medications and many sustained additional fragility fractures. The findings of this study indicate that orthopedic surgeons have an opportunity to lead the charge in treatment of osteoporosis in the post-fracture setting.

Bone Health Screening Prior to Medicare Eligibility—Osteoporosis Screening and Fracture Prevention After Distal Radius Fractures in Patients Aged 50–59

Current guidelines recommend bone mineral density (BMD) testing after fragility fractures in patients aged 50 years or older. This study aimed to assess BMD testing and subsequent fragility fractures after low-energy distal radius fractures (DRFs) among patients aged 50-59 years. We used the 2010-2020 MarketScan dataset to identify patients with initial DRFs with ages ranging between 50 and 59 years. We assessed the 1-year BMD testing rate and 3-year non-DRF fragility fracture rate. We created Kaplan-Meier plots to depict fragility fracture-free probabilities over time and used log-rank tests to compare the Kaplan-Meier curves. Among 78,389 patients aged 50-59 years with DRFs, 24,589 patients met our inclusion criteria, and most patients were women (N= 17,580, 71.5%). The BMD testing rate within 1 year after the initial DRF was 12.7% (95% CI, 12.3% to 13.2%). In addition, 1-year BMD testing rates for the age groups of 50-54 and 55-59 years were 10.4% (95% CI, 9.9% to 11.0%) and 14.9% (95% CI, 14.2% to 15.6%), respectively. Only 1.8% (95% CI, 1.5% to 2.1%) of men, compared with 17.1% (95% CI, 16.5% to 17.7%) of women, underwent BMD testing within 1 year after the initial fracture. The overall 3-year fragility fracture rate was 6.0% (95% CI, 5.6% to 6.3%). The subsequent fragility fracture rate was lower for those with any BMD testing (4.4%; 95% CI, 3.7% to 5.2%), compared with those without BMD testing (6.2%; 95% CI, 5.9% to 6.6%; P < .05). We report a low BMD testing rate for patients aged between 50 and 59 years after initial isolated DRFs, especially for men and patients aged between 50 and 54 years. Patients who received BMD testing had a lower rate of subsequent fracture within 3 years. We recommend that providers follow published guidelines and initiate an osteoporosis work-up for patients with low-energy DRFs to ensure early diagnosis. This provides an opportunity to initiate treatment that may prevent subsequent fractures. Prognosis II.

Utilize polygenic risk score to enhance fracture risk estimation and improve the performance of FRAX in patients with osteoporosis.

Osteoporosis and fragility fractures are multifactorial, with contributions from both clinical and genetic determinants. However, whether using polygenic risk scores (PGS) may enhance the risk estimation of osteoporotic fracture in addition to Fracture Risk Assessment Tool (FRAX) remains unknown. This study investigated the collective association of PGS and FRAX with fragility fracture. We conducted a cohort study from the Taiwan Precision Medicine Initiative (TPMI) at Taichung Veterans General Hospital, Taiwan. Genotyping was performed to compute PGS associated with bone mineral density (BMD). Phenome-wide association studies were executed to pinpoint phenotypes correlated with the PGS. Logistic regression analysis was conducted to ascertain factors associated with osteoporotic fractures. Among all 57,257 TPMI participants, 3744 (904 men and 2840 women, with a mean age of 66.7) individuals had BMD testing, with 540 (14.42%) presenting with fractures. The 3744 individuals who underwent BMD testing were categorized into four quartiles (Q1-Q4) based on PGS; 540 (14.42%) presented with fractures. Individuals with PGS-Q1 exhibited lower BMD, a higher prevalence of major fractures, and elevated FRAX-major and FRAX-hip than those with PGS-Q4. PGS was associated with major fractures after adjusting age, sex, and FRAX scores. Notably, the risk of major fractures (PGS-Q1 vs. Q4) was significantly higher in the subgroups of FRAX-major scores < 10% and 10-20%, but not in participants with a FRAX-major score ≧ 20%. Our study highlights the potential of PGS to augment fracture risk estimation in conjunction with FRAX, particularly in individuals with middle to low risks. Incorporating genetic testing could empower physicians to tailor personalized preventive strategies for osteoporosis.

THU421 Utility Of Forearm DXA As A Tool For Identification Of Osteoporosis: A Cleveland Clinic Experience

Abstract Disclosure: A.F. Ishola: None. K. Alsibai: None. A. Iqbal: None. A. Elsherif: None. P. Rao: None. L.Z. Khan: None. Background: Osteoporosis is a preventable and treatable condition with a significant impact on the quality of life. According to the National Osteoporosis Foundation, 10.2 million Americans have osteoporosis. In addition, more than 2 million osteoporosis-related fractures occur annually in the US and &amp;gt;70% of these occur in women. Unfortunately, most individuals at risk do not undergo appropriate assessment or treatment. Clinically osteoporosis may be diagnosed if there is a fragility fracture, independent of bone mineral density (BMD) T-score value. Diagnosis based on BMD can also be made with a T-score of − 2.5 or below in the lumbar spine, femoral neck, total proximal femur, or distal 1/3 radius. Due to the limitations in interpreting BMD values in patients with degenerative joint disease (DJD), using the forearm (distal 33% radius) as an alternative skeletal site could serve as a more sensitive screening test. Our study primary aims were to assess the frequency at which females age ≥ 65 undergoing BMD testing had DJD of the spine, to determine the frequency at which BMD testing of the forearm was performed in patients with DJD of the spine, and to assess skeletal site-specific rates of osteoporosis. Methods: This is a large, single-center, retrospective, IRB- approved study conducted at Cleveland Clinic Foundation. Postmenopausal female patients above the age of 65 who underwent DXA scans between January 2018 and December 2019 were identified. Manual chart reviews were performed. Patients receiving osteoporosis treatment and those with hyperparathyroidism were excluded. Results: 195 patients were eligible for the study. The mean age was 73.4 ± 8.2 years. DJD of spine and osteoarthritis were present in 74.5% and 58.2% of patients respectively. Forearm BMD testing was only performed in 18.9% of patients with DJD of the spine. Osteoporosis was diagnosed in 39.1 % at the femoral neck, 35.4% of patients at the lumbar spine, 9.3 % at the distal 1/3 radius, and 6.8% at the total hip. Conclusion: DJD of the spine and hip osteoarthritis often lead to falsely elevated T-scores resulting in under-diagnosis and under-treatment of osteoporosis. Although there is a higher sensitivity of using forearm BMD values to diagnose osteoporosis in patients with DJD of spine and/or osteoporosis, our preliminary data show that the forearm DXA scan is an under-utilized clinical tool in cases of DJD of spine, osteoarthritis, and hip replacement. Presentation: Thursday, June 15, 2023

Potential alleviation of bone mineral density loss with Janus kinase inhibitors in rheumatoid arthritis.

Rheumatoid arthritis (RA) is characterized by localized bone loss, general osteoporosis and increased fracture risks. Tumour necrosis factor inhibitors (TNFi), non-tumour necrosis factor inhibitors (non-TNFi) biologic, Janus kinase inhibitors (JAKi) had shown the suppression effects to osteoclast activation and improvement of bone mineral density (BMD). Anti-cyclic citrullinated peptide antibody (ACPA) is associated with osteoclast activation and the resultant bone loss. However, few studies have compared BMD changes among patients with RA treated with targeted therapies that have different mechanisms of action. This retrospective study recruited patients with RA who had undergone BMD testing twice. Changes in the BMD were compared using the generalized estimating equation (GEE) in treatment groups that received conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), TNFi, non-TNFi biologics, and JAKi. In total, 362 patients with RA were enrolled (csDMARDs, n = 153, TNFi, n = 71, non-TNFi biologics, n = 108, JAKi, n = 30). We observed greater changes in femoral BMD (left, 0.06, 95% CI 0.01-0.12, p = 0.016; right, 0.09, 95% CI 0.04-0.15, p = 0.001 by GEE) following JAKi treatment as compared with other treatments. Compared to the ACPA-negative group, patients with ACPA positivity exhibited greater improvement in the femoral BMD (left, 0.09, 95% CI 0.02-0.15, p = 0.008; right, 0.11, 95% CI 0.05-0.18, p = 0.001). Compared to other targeted therapies, JAKi might exert a more potent effect to prevent BMD loss, specifically in ACPA-positive patients with RA, and could be a potential therapeutic option to mitigate generalized bone loss. Key Points •JAKi therapy inhibits systemic bone loss in patients with RA. •ACPA-positive RA patients exhibited a greater BMD improvement than ACPA-negative RA patients. •JAKi might more potently prevent BMD decline than conventional synthetic or biological DMARDs.

Experience in the Morphological Study of Dorsolumbar Spine Deformities in Women over 50 Years

Abstract Introduction Osteoporosis is characterized by a reduction in bone mineral density. Among the factors that can contribute to the onset of osteoporosis we can enumerate alcohol consumption, smoking, glucocorticoid therapy, or the presence of diabetes mellitus. The incidence of osteoporosis increases with age. Materials and Methods A total of 183 women over the age of 50, with a mean age of 67.9 ± 7.74 years, were studied to visualize spinal column alterations. From this cohort, 103 patients underwent bone mineral density testing using dual-energy X-ray absorptiometry (DXA) and dorsolumbar radiography, while 80 patients did not undergo DXA testing. Assessment of the degree of vertebral involvement was performed using the Genant semiquantitative method. Results The highest percentage of vertebral fractures was observed in patients aged &gt;70 years (100%). Within the studied cohort, 28% of patients displayed multiple vertebral fractures associated with age (p = 0.01). The most common site for vertebral involvement was the dorsolumbar region (D11–L2) across all age groups (p = 0.35). No statistically significant correlation (p = 0.22) was identified between DXA values and the presence of vertebral fractures, despite a trend of increased incidence of fractures as the T-score decreased. Conclusion Within the cohort, vertebral fractures were identified both in women with normal values of bone mineral density and in those with osteoporosis. Furthermore, the severity of these vertebral fractures did not correlate with bone mineral density values, highlighting the necessity of using both osteodensitometry and spinal radio-graphs for diagnosis.

Fragility fracture care gap at a tertiary teaching hospital in Malaysia

This study aimed to investigate the clinical burden and secondary fracture prevention of fragility fractures at a tertiary teaching hospital in Malaysia. Electronic medical records of all patients admitted with fragility fractures between 1 January 2017-31 December 2018 were reviewed. Patients < 50years old, with non-fragility fractures, restricted access to medical records, transferred to another hospital or who passed away during admission were excluded. Descriptive statistics were used to summarise patients' characteristics, frequency of fragility fractures, and secondary fracture prevention details. Binomial logistic regression was performed to analyse predictive factors for post-fracture bone health assessments and treatment initiation. 1030 patients [female (767/1030, 74.5%)] presented with 1071 fractures [hip fractures (378/1071, 35.3%)]. 170/993 (17.1%) patients were initiated on anti-osteoporosis medications (AOMs) and 148/984 (15.0%) had bone mineral density (BMD) performed within 1-year post-fracture. Less than half (42.4%) of the patients remained on treatment at 1-year post-fracture.Older patients [65-74 years old: odds ratio (OR) = 2.18, 95%CI 1.05-4.52, p = 0.04; ≥ 75 years: OR = 3.06, 95%CI 1.54-6.07, p < 0.01], hip fractures (OR = 1.95, 95%CI 1.23-3.11, p < 0.01), Chinese ethnicity (OR = 1.90, 95%CI 1.07-3.35, p = 0.03),previously diagnosed with osteoporosis (OR = 2.65, 95%CI:1.32-5.31, p < 0.01) and a BMD test performed (OR = 12.48, 95%CI 8.04-19.37, p < 0.01) were found to have higher AOM initiation. Patients with past diagnosis of osteoporosis(OR = 4.45, 95%CI 2.25-8.81, p < 0.01) and initiated on AOM (OR = 11.34, 95%CI 7.57-16.97, p < 0.01) had a higherlikelihood to undergo BMD testing. The AOM initiation and BMD testing rates were low. There is a need to address the fragility fracture care gap with strategies such as Fracture Liaison Service.

OR01-3 Lack of Bone Mineral Density Testing in Men with Hypogonadism: A Clinical Conundrum

Abstract Objective Hypogonadism is a known risk factor for decreased bone mineral density (BMD) and increased risk of fractures in men. The 2012 Endocrine Society Clinical Practice Guidelines recommend that men ≥ 50 years of age with a diagnosis of hypogonadism undergo BMD testing.1 The objective of this study was to determine the frequency at which men aged ≥ 50 with a diagnosis of hypogonadism underwent BMD testing, and among those that underwent testing, the percentage of men diagnosed with osteopenia or osteoporosis and subsequently treated with an osteoporosis medication. Methods A retrospective chart review was conducted using the enterprise-wide electronic health record system at our institution. Inclusion requirements were an ICD-9 or -10 code for hypogonadism at any time between 7/1/2012 and 9/30/2020, and at least two subsequent visits with providers from primary care, endocrinology, or urology. Patients with a diagnosis of osteoporosis or who had undergone treatment with an osteoporosis medication, prior to the diagnosis of hypogonadism, were excluded. Patients were followed until the date of BMD assessment or censoring (9/30/2021). The testing results and documentation of treatment with an osteoporosis medication were recorded. Categorical variables and continuous variables were summarized using N (%) and median (IQR) or mean (SD), respectively. Results A total of 10,169 men with hypogonadism were identified. General characteristics included mean age of 63.4 years (±9.2), 85.2% white, 52.7% with history of smoking, 68.2% with hypertension, 36.9% with type 2 diabetes, and mean BMI of 31.3 kg/m2 (±6.0). Median follow-up time was 6.6 years (3.8, 8.5). Of 728 (7.2%) patients who underwent BMD testing, 352 (48.4%) had osteopenia and 87 (12.0%) had osteoporosis. A total of 5,633 (55.4%) men underwent treatment with testosterone replacement therapy. Of the 87 patients identified as having osteoporosis, 50 (57.5%) were treated with an osteoporosis medication. Conclusion Despite a recommendation from the 2012 Endocrine Society for men ≥ 50 years of age with hypogonadism to undergo BMD testing, the rate at which this testing is performed in real-world practice is quite low. The high rate (60.3%) at which low BMD was discovered in hypogonadal men who underwent testing, and further observation of a low rate of treatment with osteoporosis medication when indicated, is alarming and necessitates a call to action for more hypogonadal men to undergo testing and receive appropriate treatment. Further studies are needed to determine the reasons why so few men with hypogonadism undergo BMD assessment and what systems can be put in place to overcome this clinical conundrum. Reference 1. Watts NB, et al. Osteoporosis in Men: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology &amp; Metabolism, Volume 97, Issue 6, 1 June 2012, Pages 1802–1822, https://doi.org/10.1210/jc.2011-304 Presentation: Saturday, June 11, 2022 12:00 p.m. - 12:15 p.m.

Lack of Bone Mineral Density Testing in Men With Hypogonadism: A Clinical Conundrum.

ContextThe 2012 Endocrine Society Clinical Practice Guidelines recommend that men aged 50 years or older with a diagnosis of hypogonadism undergo bone mineral density (BMD) testing.ObjectiveThe objective of this study was to determine the frequency at which men aged 50 years or older with a diagnosis of hypogonadism undergo BMD testing, and if found to have low BMD, are subsequently treated with an osteoporosis medication.MethodsA retrospective chart review was conducted at a large academic medical center. Inclusion requirements were an International Classification of Diseases (ICD)-9 or -10 code for hypogonadism at any time between July 1, 2012 and September 30, 2020. Patients were followed until the date of BMD assessment or censoring (September 30, 2021). BMD results and treatment with osteoporosis medication were recorded.ResultsA total of 10 169 men with hypogonadism were identified, of whom the mean age was 63.4 (± 9.2), 86.3% White, mean body mass index 31.3 with prevalence of chronic kidney disease, type 2 diabetes, and hypertension of 20.6%, 36.9%, and 68.2%, respectively. The percentage that underwent BMD testing was 7.2%, of which 352 (48.4%) and 87 (12.0%) had osteopenia and osteoporosis, respectively. Among the 87 patients with osteoporosis, 57.5% were treated with an osteoporosis medication.ConclusionOnly 7.2% of hypogonadal men underwent BMD testing, and among them, 12.0% were found to have osteoporosis. Among those with osteoporosis, 57.5% underwent treatment with osteoporosis medication. Further studies are needed to determine why so few men with hypogonadism undergo BMD assessment and what systems can be put in place to overcome this clinical conundrum.

Prevalence and Factors Associated With Osteoporosis and Bone Mineral Density Testing in Psoriatic Arthritis.

To determine bone mineral density (BMD) in psoriatic arthritis (PsA) patients, factors associated with undergoing BMD testing, and the effect of PsA clinical activity on BMD. Patients attending the University of Toronto PsA Clinic with BMD testing results from cohort inception to January 2019 were included. Descriptive statistics summarized lumbar spine, femoral neck, and total hip T scores. Cox proportional hazards regression identified predictors for BMD testing. Logistic regression analysis determined odds of having normal (T score -1.0 or more) versus osteoporotic-range BMD (T score -2.5 or less). A multistate model determined factors associated with BMD state changes over time. Of the 1,479 patients, 214 had BMD tests performed. The mean ± SD T scores at the lumbar spine, femoral neck, and total hip were -0.30 ± 0.32, -1.10 ± 1.04, and -0.45 ± 0.42, respectively. Osteopenia and osteoporosis occurred in 45.27% and 12.94% of patients. Increasing age, menopause, elevated acute-phase reactants, and biologics, methotrexate, and systemic glucocorticoids use were associated with a higher chance of undergoing BMD testing. Increased body mass index (BMI) and biologics use were associated with a lower chance of having osteoporotic-range BMD test results. In multistate analysis, polyarthritis may portend lower BMD results over time, although this did not achieve statistical significance due to low patient numbers. The prevalence of osteopenia and osteoporosis in the PsA cohort was similar to that of the general population. Clinicians are using osteoporosis risk factors and PsA disease severity markers to select patients for BMD testing. Polyarticular disease may portend worse BMD test results. Biologic use and increased BMI appear to have a protective effect.

20-Year-Old Man With Elevated Liver Tests

20-Year-Old Man With Elevated Liver Tests

Bone-density testing interval and transition to osteoporosis in differentiated thyroid carcinoma patients on TSH suppression therapy.

Thyrotropin (TSH) suppression therapy is a standard treatment after surgery for differentiated thyroid carcinoma (DTC). It may be associated with osteoporosis in postmenopausal women. However, there are no guidelines for bone mineral density (BMD) testing intervals to screen for osteoporosis in these patients. Therefore, we evaluated the timing of repeated BMD testing in DTC patients with TSH suppression according to baseline T-scores. We retrospectively evaluated 658 DTC patients who underwent BMD testing more than twice between January 2007 and January 2020. A 1:3 propensity score matching was conducted to compare the timing of repeated BMD tests between the DTC and non-DTC groups. We stratified the participants into four groups based on their baseline T-scores: normal (-1.00 or higher), mild osteopenia (-1.01 to -1.49), moderate osteopenia (-1.50 to -1.99), and severe osteopenia (-2.00 to -2.49). Additionally, the 10% of patients in each group that transitioned to osteoporosis were analysed. The estimated BMD testing interval for 10% of patients who developed osteoporosis was 85 months for patients with initially mild osteopenia, 65 months for those with moderate osteopenia, and 15 months for those with severe osteopenia in the DTC group. In the non-DTC group, the testing intervals for mild, moderate, and severe osteopenia were 98, 57, and 13 months, respectively. On multivariate analysis, baseline T-score (mild osteopenia: hazard ratio [HR] 5.91, p = .105; moderate osteopenia: HR, 25.27, p = .02; and severe osteopenia: HR, 134.82, p < .001) and duration of TSH suppression (tertile 2: HR, 2.25, p = .005; Tertile 3: 1.78, p = .033) were independent risk factors for osteoporosis in the DTC group. This study provides guidance for the timing of repeated BMD tests in women over 50 years of age with TSH suppression. The rescreening interval for BMD testing can be modified based on the baseline T-score. The appropriate BMD testing intervals in female DTC patients were similar to those in non-DTC females.

Potential cause affecting bone quality in Saudi Arabia: New insights

Background:Osteoporosis (OP) is a silent systemic disease characterized by decrements in bone mineral density (BMD) and bone microstructure. This study aimed to determine the status of bone quality as well as to investigate the relationship between the glycaemic; lipid; bone profiles; and the BMD.Methods:A retrospective study was conducted at KFHU, Al Khobar, Saudi Arabia analysis of patients who underwent BMD testing between the periods of 2016 to 2018. Based on the T scores, patients were classified as follows: normal (>−1.0), osteopenic (−1.0 to −2.5), or osteoporotic (≤−2.5). Details about medical and demographic information as well as metabolic and bone profiles (fasting blood glucose [FBG], glycated haemoglobin [HbA1c], cholesterol [Chol], high-density lipoprotein [HDL], low-density lipoprotein [LDL], triglycerides [TG], calcium [Ca], phosphorus [Ph], alkaline phosphatase [ALP], vitamin D 25OHD [Vit D]) were extracted from the medical records system.Results:Out of 4838 extracted profiles, there were 4196 females (85.1%). The mean glycaemic variables of patients showed an abnormal profile (FBG 118 ± 49 and HbA1c 6.6 ± 2). The mean T score showed that the majority of patients had either osteopenic (40%) or osteoporotic (24%) changed. Significant increase in mean HbA1c (7.6 ± 1.7) was obvious among the osteopenic patients when judged against the normal (7.5 ± 1.6; P < 0.033) and osteoporotic (7.4 ± 1.8; P < 0.037). Meanwhile, the mean serum ALP was significantly lower (81 ± 26) in the normal group than in the osteopenic (86 ± 33; P < 0.006) and osteoporotic groups (90 ± 40; P < 0.001). Finally, a linear, logistic regression analysis was found that Ca and ALP levels were significant predictors.Conclusion:This study finds that the main cause that affects bone quality in Saudi Arabia is diabetes mellitus and/or its related metabolic alteration. These results suggest that bone health is clinically significant and should be carefully assessed in diabetes patients.

Effect of type 2 diabetes mellitus on bone mineral density in patients with rheumatoid arthritis

Background: RA affection of bone manifests as low bone mineral density (BMD), generalised osteoporosis and increased risk of fragility fractures. Whereas, Type 2 Diabetes Mellitus (T2DM) produces many micro and macro vascular complications, its effects on bone and bone density is not very clear. The effect of coexistent RA and T2DM on BMD has not been well studied. Objective: The aim of this study was to investigate the effect of T2DM on BMD in patients with newly diagnosed RA. Methods: Patients diagnosed as RA were assigned to undergo BMD testing. Patients with T2DM were gathered from this population and formed a separate group. Healthy controls were drawn from subjects who came for a check-up. BMD was done with the GE Lunar DPX machine. Mean T Scores at spine, femur neck and total femur were recorded. Multivariate analysis was performed to compare T scores at various sites in the 3 groups. Age, gender, and steroid use were checked as confounding factors. Results: A total of 449 patients were diagnosed as RA during the period of 48 months. Of these, 337 (M-56, F-321) diagnosed as RA who had their BMD examined were enrolled in the study. Five hundred and one (M-248, F-253) healthy controls were enrolled. The mean T score values at femur neck, femur total and spine were -1.2+0.9, -0.8+1, -1.2+1.3 for controls, -2.4+0.8, -2.2+0.9, -2.9+0.9 for patients with RA and -1.7+1, -1.3+1, -1.7+1.2 for patients with RA+T2DM. The T scores at all sites in patients with additional T2DM were significantly better than those with only RA but significantly less than compared to controls. Similar results were obtained when separate analyses were done for males and females. Conclusion: Coexisting T2DM partly negates the low BMD measures and present with significantly higher values as compared to RA alone. In patients with this co morbidity, the BMD measures should be read with caution. With increasing evidence of diabetics having higher fragility fracture risk, measures other than the standard BMD need to be investigated which can quantify the exact fracture risk in patients with RA and T2DM.

Effect of T12 Mislabeling as L1 on the Diagnosis of Low BMD at Lumbar Spine

Mislabeling of T12 vertebra as L1 has been shown to reduce L1-L4 bone mineral density (BMD). However, the effect of such mislabeling on the L1-L4 BMD and prevalence of osteoporosis and/or osteopenia in a clinical setting is not known. The study aimed to the effect of mislabelling of T12 as L1 on the L1-L4 BMD and diagnosis of osteoporosis and/or osteopenia. It is a retrospective study done at a tertiary health care center in South India. Database of dual X-ray absorptiometry machine at our center was reviewed and BMD data of men aged more than 50 years and postmenopausal women who underwent BMD during the last 3.5 years were included in the analysis. A total of 570 subjects had undergone BMD testing at the lumbar spine of whom images of the T12 and lower part of the T11 were available for 293 subjects. Six of these with ≤1 eligible vertebra for the calculation of L1-L4 BMD were further excluded from the analysis. The BMD data of the remaining 287 subjects were noted. Later T12 was labeled as L1 and a new set of BMD data was obtained. Using the WHO classification, BMD status was classified as normal BMD, osteopenia, and osteoporosis for both the analyses. L1-L4 BMD (0.916 ± 0.163 vs 0.937 ± 0.170, p < 0.0001) and T-scores of L1-L4 (-2.23 ± 1.37 vs -2.06 ± 1.43, p < 0.0001) with mislabeling were significantly lower than those measured with correct labeling. BMD status was misclassified by T12 mislabelling as L1 in a total of 30 (10.4%) individuals. Inter-rater agreement between the 2 scenarios for the diagnosis of osteoporosis, osteopenia, and normal BMD was substantial (weighted Kappa: 0.87 [95%CI: 0.83-0.91]). To conclude, mislabeling of T12 as L1 significantly reduces L1-L4 BMD. However, the diagnosis of BMD status by mislabeling has a substantial agreement with that obtained with correct labeling.

Contemporary Population-Based Analysis of Bone Mineral Density Testing in Men Initiating Androgen Deprivation Therapy for Prostate Cancer.

Androgen deprivation therapy (ADT) is a cornerstone of treatment for advanced prostate cancer (PCa); however, it accelerates the loss of bone mineral density (BMD), which increases fracture risk. Guidelines recommend BMD testing when initiating ADT to assess baseline fracture risk properly. The objective of this study was to examine the proportion of BMD testing in men initiating ADT in Quebec and to identify factors associated with receipt of this testing. The study cohort consisted of men extracted from Quebec public healthcare insurance administrative databases who initiated continuous ADT from 2000 to 2015 for >12 months. The primary study outcome was receipt of BMD testing in the period from 6 months before through 12 months after ADT initiation. Multivariable generalized linear mixed regression modeling with a logit link was performed to identify variables associated with BMD testing. We identified 22,033 patients, of whom 3,910 (17.8%) underwent BMD testing. Rates of BMD testing increased from 4.1% in 2000 to 23.4% in 2015. After multivariable analyses, prior history of osteoporosis (odds ratio [OR], 1.84; 95% CI, 1.32-2.57; P<.001), rheumatoid arthritis (OR, 1.64; 95% CI, 1.15-2.34; P=.006), use of bisphosphonates (OR, 1.47; 95% CI, 1.25-1.73; P<.001), and long-term corticosteroid use (OR, 1.63; 95% CI, 1.15-2.31; P=.006) were associated with higher odds of BMD testing. Patient age >80 years (OR, 0.67; 95% CI, 0.59-0.76; P<.001), metastases (OR, 0.79; 95% CI, 0.70-0.89; P<.001), higher Charlson comorbidity score (OR, 0.65; 95% CI, 0.51-0.81; P<.001), and rural residence (OR, 0.77; 95% CI, 0.68-0.87; P<.001) were associated with lower odds of BMD testing. In our study population, BMD testing rates in men initiating ADT were low, although they increased over the years especially in the years after the publication of recommendations for BMD testing in these patients. Potential gaps identified include being older, more comorbid, and rural areas. Overall, additional efforts emphasizing the importance of BMD testing in PCa guidelines may be needed.

Brief Report: Low Sensitivity of the Fracture Risk Assessment Tool in Young HIV-Infected Patients: Time to Revise Our Screening Strategy.

The burden of reduced bone mineral density (BMD) is high among HIV-infected patients. As a screening strategy, current guidelines recommend calculating a Fracture Risk Assessment Tool (FRAX) score in patients aged 40-49 years. Patients with a 10-year risk of a major osteoporotic fracture ≥10% should undergo dual-energy x-ray absorptiometry (DXA) to assess BMD. The aim of this study was to establish the sensitivity of this threshold to identify patients with risk of osteoporosis in this age category-as a surrogate marker for high fracture risk. The study group consisted of patients aged 50-59 years and living with HIV for at least 10 years who recently underwent dual-energy x-ray absorptiometry (DXA). A clinical risk factor-based FRAX score was calculated using patient characteristics from 10 years earlier. In this way, we assessed which patients would have undergone DXA while they were 40-49 year old. The cohort consisted of 126 patients; 23 patients (18.3%) had osteoporosis. Ten years before the DXA, none of them met the guideline threshold of a 10-year major osteoporotic fracture probability of ≥10%, resulting in a sensitivity of 0% in this cohort. There was no difference between the median FRAX score between patients who developed osteoporosis and those who did not (3.3% vs. 3.4%. P = 0.55). FRAX lacks sensitivity to determine which HIV-infected patients aged 40-49 years should undergo BMD testing to identify reduced BMD. Its role should be limited to treatment decisions.

Management of Fragility Hip Fractures: Our Institutional Experience.

Introduction:Approximately 320 000 fragility hip fractures are sustained in the United States annually, resulting in substantial morbidity and mortality as well as significant economic burden on the health-care system. Nevertheless, a majority of these patients are not screened and do not receive treatment for osteoporosis. The objective of this study was to evaluate rates of osteoporosis screening and treatment in our institution and compare them to those reported in the literature.Methods:This was a retrospective cohort study of 191 patients ages 50 and older who sustained osteoporotic hip fractures. Primary outcome measures were percentage of patients who (1) underwent bone health laboratory workup during admission, (2) were started on vitamin D, calcium, and/or a bisphosphonate, (3) received bone mineral density testing, and (4) followed up with a primary care doctor or endocrinologist. Secondary outcomes measures were (1) whether gender, race, or age influenced our primary outcomes and (2) whether obtaining in-hospital laboratory workup led to increased rates of further screening and treatment.Results:Fifty-six (29.3%) patients received full laboratory workup, 48 (25.1%) were prescribed vitamin D and calcium, 11 (5.7%) were prescribed a bisphosphonate, 13 (6.8%) underwent bone mineral density testing, and 41 (21.5%) followed up with primary care or endocrinology.Discussion:Women were more likely to be treated with vitamin D and calcium. Outcomes were similar regardless of race. Younger patients were more likely to undergo laboratory testing, bisphosphonate therapy, and bone mineral density testing. Initiating workup during admission did not lead to increased rates of outpatient treatment.Conclusion:Despite nationwide efforts to improve, rates of osteoporosis screening and treatment following hip fracture are suboptimal. Rates at our institution are similar to those reported in previous studies. There were disparities between gender and age groups. Future studies are needed to evaluate whether more recently implemented policies lead to better osteoporosis screening and management.

Bone Turnover Markers for Osteoporosis Status Assessment at Baseline in Postmenopausal Pakistani Females.

To assess bone turnover status in osteopenic and osteoporotic postmenopausal females. Cross-sectional analytical study. The Aga Khan University Hospital, Karachi, from January to December 2013. Across-sectional study was conducted on 203 postmenopausal females undergoing bone mineral density testing (BMD) by DXAscan. Patients with clinical history of any disorder or medications affecting bone turnover were excluded. Bone turnover was assessed with osteocalcin and β-CTx. Data was analyzed by SPSS version 19. Mean age of the participants was 54 ±4.66 years with a mean BMI of 28.7 ±5.5 kg/m2. Mean β-CTx (0.28 ±0.24 ng/ml) and osteocalcin (21.5 ±10.6 ng/ml) levels were within the normal reference range. Subjects were grouped into normal (26.6%), osteopenic (44.8%), and osteoporotic (28.6%) based on the t-scores. Serum levels of osteocalcin and β-CTx between normal, osteopenic, and osteoporotic groups were not significantly different. β-CTx was negatively and significantly associated with only lumber spine BMD (r = -0.13, p=0.04). Positive association (< 0.0001) was noted between both markers in normal, osteopenic, and osteoporotic females. However, association of these markers with BMD in the 3 groups were not found. Multivariate linear regression showed a positive and significant effect of BMI on BMD (β= 0.332, p= < 0.0001). β-CTx had negative but significant effect on BMD (β= -0.155, p= 0.018) of postmenopausal women. Association between baseline levels of BTM and rate of bone loss is variable and site dependent. β-CTx correlates better with BMD. However, role of osteocalcin in postmenopausal osteoporosis is uncertain and needs further investigation.