Journal of Clinical Densitometry

2009 Santa Fe Bone Symposium

2010-01-01

Abstract: Osteoporosis is a common skeletal disease with serious clinical consequences because of fractures. Despite the availability of clinical tools to diagnose osteoporosis and assess fracture risk, and drugs proven to reduce fracture risk, it remains a disease that is underdiagnosed and undertreated. When treatment is started, it is commonly not taken correctly or long enough to be effective. Recent advances in understanding of the regulators and mediators of bone remodeling have led to new therapeutic targets and the development of drugs that may offer advantages over current agents in reducing the burden of osteoporotic fractures. Many genetic factors that play a role in the pathogenesis of osteoporosis and metabolic bone disease have now been identified. At the 2009 Santa Fe Bone Symposium, held in Santa Fe, New Mexico, USA, the links between advances in genetics, basic bone science, recent clinical trials, and new and emerging therapeutic agents were presented and explored. Socioeconomic challenges and opportunities in the care of osteoporosis were discussed. This is a collection of medical essays based on key presentations at the 2009 Santa Fe Bone Symposium.

Slight Abduction/Adduction Deviations in Femur Positioning for Dual-Energy X-Ray Absorptiometry are Inconsequential

Byram H. Ozer, Diane Krueger, Neil Binkley — 2009-11-30

Abstract: Straight femur alignment during dual-energy X-ray absorptiometry (DXA) acquisition is assumed to help ensure accurate bone mineral density (BMD) measurement. Use of bilateral femur positioners may not result in straight femur alignment. To assess the effect of a bilateral femur positioner on DXA results, we compared a standard fixed-width bilateral femur positioner with an adjustable-width positioner that allowed for straight femur alignment. BMD values obtained from the adjustable-width bilateral femur positioner were highly correlated (R2=0.98–0.99) with those obtained using a fixed-width positioner. The mean bias in BMD between the fixed- and adjustable-width positioner was low (−0.001 to +0.006g/cm2) at all proximal femur regions of interest. In this study, the use of a fixed-width bilateral femur positioner and associated deviations in femur alignment have little consequence on BMD measurement.

Is a Fixed Value for the Least Significant Change Appropriate?

Lisa Nelson, Karen Y. Gulenchyn, Mark Atthey, Colin E. Webber — 2010-01-01

Abstract: The least significant change (LSC) represents the smallest difference between successive measurements of bone mineral density (BMD) that can be considered to be a real change and not attributable to chance. The LSC is derived from same-day in vivo BMD precision measurements. Our first objective was to determine if the LSC differs between technologists. Our second objective was to determine if patient body size influenced the LSC. Each of 8 technologists measured same-day precision in groups of 30 patients for the lumbar spine and the total trochanter and neck regions of the proximal femur. At the spine, precision ranged from 0.008 to 0.011g/cm2 and did not differ between technologists. Precision for the total region of the left proximal femur ranged from 0.006 to 0.016g/cm2 and did differ between technologists. For the trochanter and neck regions, precision ranged from 0.008 to 0.013g/cm2 for the former and from 0.010 to 0.020g/cm2 for the latter, again, with inter-technologist differences. The LSC for the lumbar spine increased linearly from 0.022 to 0.031g/cm2 when body mass index (BMI) increased from 19.5 to 31.3kg/m2. In contrast, there was no discernable impact of BMI on the LSC for any of the proximal femur regions. The LSC at the spine is determined by the patient, whereas the LSC at the femur is determined by the technologist. Use of a single value for the LSC will lead to misinterpretations of the significance of BMD changes at both the spine and the proximal femur.

Discordance in Femoral Neck Bone Density in Subjects With Unilateral Hip Osteoarthritis

2010-01-01

Abstract: Osteoarthritis (OA) is a common disease that increases in incidence with age and currently affects an estimated 27 million Americans. To determine whether site-specific hip bone mineral density (BMD) measures are confounded by the presence of OA, we measured bilateral hip BMD by dual X-ray absorptiometry in 34 subjects (19 women and 15 men) scheduled for hip replacement for confirmed advanced unilateral hip OA. The femoral neck (FN) BMD (p=0.035) and T-score (p=0.017) for the hip with OA was higher than those of the contralateral hip. There was a difference in osteoporosis classification depending on which hip was considered: for 11 of the 34 subjects (32%), the FN T-score was normal for OA hip, but the contralateral hip was classified as osteopenic (T-score between −1.0 and −2.5). For 1 subject, the FN T-score was normal for OA hip, but the contralateral hip was classified as osteoporotic (T-score below −2.5). Discordance was also present for trochanter values and not for total hip values. These data indicate that advanced hip OA can be associated with a higher bone density at the FN and trochanter but not at total hip and that the discrepancy between hips at the FN may have an impact on patient treatment decisions.

Some Physical and Clinical Factors Influencing the Measurement of Precision Error, Least Significant Change, and Bone Mineral Density in Dual-Energy X-Ray Absorptiometry

Jeffrey Frimeth, Eduardo Galiano, Dave Webster — 2009-11-26

Abstract: Dual-energy X-ray absorptiometry (DXA) is the standard method of measuring bone mineral density (BMD) at highly trabecular bone, which can be statistically linked to the risk of fracture. For DXA, precision error (PE) and phantom-based accuracy studies are among the most important routine quality control procedures. A precision study was performed at our institution using International Society for Clinical Densitometry guidelines. Comparing our results with those reported by other investigators, we draw the following general conclusions: the PE was higher for the spine than the hip, which we attribute to the better geometric reproducibility at the hip. The hypothesis that the DXA calculates BMD relative to water was validated. Whether follow-up measurements are performed by the same technologist on the same day—or different technologists on subsequent days—does not appear to have a clinically significant impact on PE or least significant change (LSC). Mixing beam types (i.e., fan and pencil) may affect lumbar PE and LSC measurements more significantly than those of the hip. The use of a single technologist may reduce the PE for the lumbar spine but appears to increase it for the hip. Restricting the patient population to the female gender has the apparent effect of narrowing the gap between lumbar and hip PEs. Finally, the degree of BMD measurement accuracy can be affected by the type of phantom being used (e.g., European Spine Phantom vs Lunar phantom) and the faults in specific DXA edge detection algorithms.

How Activity of Inflammatory Bowel Disease Influences Bone Loss

2010-01-01

Abstract: Bone loss is a common problem for individuals with inflammatory bowel disease (IBD). The aim of our study was to assess bone mineral density (BMD) in patients with IBD and to investigate the role of corticosteroid (CS) use and duration and activity of disease on BMD. Ninety-two patients (56 men and 36 women) with IBD, of whom 32 had ulcerative colitis (UC) and 60 had Crohn's disease (CD), underwent clinical assessment. Lumbar and femoral neck BMDs were measured by dual-energy X-ray absorptiometry. Osteopenia was observed in 14 patients (43%) with UC and in 24 patients (40%) with CD (p=0.187). Four patients (12%) with UC and 7 patients (11%) with CD had osteoporosis (p=0.308). Femoral BMD decreased in patients with long duration of CS use and correlated inversely with disease activity. Multiple regression analysis of BMD showed that statistically significant risk factors were duration of active disease and body mass index as well. Based on our results, it is necessary to take into account the risk of decreased BMD in patients with IBD. It is most important to achieve disease remission as soon as possible in addition to nutritional support.

Diet, Body Composition, and Bone Mass in Well-Trained Cyclists

2009-11-30

Abstract: Cycling is believed to be associated with low bone mass. In this study, we investigate food intake, body composition, and bone mass in well-trained young adult cyclists compared with those in sedentary controls. Four-day estimated diet records were used to study dietary intake in 31 cyclists and 28 sedentary controls (all male, 24yr old on average), together with maximal oxygen uptake (VO2max), body composition, and bone mass measurements (dual-energy X-ray absorptiometry). The VO2max values were twice as high as those in the cyclists, whereas no significant difference in bone mass was observed between cyclists and controls. A total of 10 cyclists and 9 controls had low bone mass. Total-body lean mass and appendicular skeletal muscle mass were higher in cyclists (p<0.001), whereas percentage of body fat was lower (p<0.001) compared with that of the controls. Energy and macro- and micronutrient intake was higher in the cyclists than in the controls (p<0.01). Energy consumption was considered adequate in the cyclists, whereas lipid and protein intake was higher than the American College of Sports Medicine recommendation. Lipid consumption negatively correlated with bone mass in the athletes. Our results demonstrate that cycling was associated with greater aerobic conditioning and lean mass without significant association with bone mass compared with sedentary controls.

Application of FRAX Model to Sri Lankan Postmenopausal Women

Sarath Lekamwasam — 2009-11-19

Abstract: The FRAX software developed by the World Health Organization provides a method to estimate fracture probability of old men and women based on their bone mineral density (BMD) and clinical risk factors (CRFs). The validity of 4 selected ethnic-specific FRAX tools in determining prevalent fracture or treatment decisions in a group of postmenopausal women from Sri Lanka was examined. Women with a history of fragility fracture/s and those who were detected to have femoral neck T-score<2.5 were considered eligible for specific osteoporosis treatment. Ten-year all osteoporotic fracture (vertebral and nonvertebral) probability (10y-AOFP) of 481 postmenopausal women were estimated on US Caucasian, US Asian, Japanese, and Chinese FRAX tools, first using CRFs alone and then combining with femoral neck T-scores. At 20% 10y-AOFP, Chinese tool showed a very low sensitivity in detecting prevalent fracture or detecting women needing intervention (1.3%). Sensitivities observed with US Asian and Japanese tools ranged from 33% to 42%, showing their limitations in predicting prevalent fracture in this group of women. The US Caucasian tool, either with CRFs alone or with BMD incorporated, showed a relatively higher sensitivity in detecting fractures or identifying those needing interventions (71% and 76%, respectively). Furthermore, the US Caucasian tool showed a relatively high specificity (ranging from 70% to 87%). In conclusion, this analysis showed the limitations of the current FRAX tools in predicting fractures when applied to a different ethnic group. Until a separate FRAX tool is developed, the US Caucasian tool can be used to predict fractures in Sri Lankan postmenopausal women.

Risedronate on 2 Consecutive Days a Month Reduced Vertebral Fracture Risk at 1Year Compared With Historical Placebo

Nelson B. Watts, Jacques P. Brown, Gary Cline — 2009-11-30

Abstract: The use of historical controls may be a viable alternative for comparing antifracture efficacy in osteoporosis fracture endpoint trials that do not have a placebo control group. The risedronate 2 consecutive days a month (2CDM) study showed that risedronate 75mg on 2 consecutive days had similar increases in bone mineral density compared with risedronate 5mg/d. To assess the antifracture efficacy of this regimen, data collected in the 2CDM study were analyzed using historical control data matched for key clinical characteristics from 2 placebo-controlled trials. Fracture rates in historical groups were compared with those of the 2CDM study treatment groups. At 12mo, vertebral fractures occurred in 5.1% and 1.0% of the placebo and 5-mg risedronate historical patients, respectively. In the risedronate 5mg/d and 75mg 2CDM groups, fracture incidence was 1.5% and 1.1%, respectively. Based on comparisons with the historical control group, risedronate 75mg 2CDM appears as effective as the 5-mg/d dose in reducing the risk of new vertebral fractures in the first year of treatment. The use of appropriate historical control data may provide an alternative design to assess fracture effects in osteoporosis trials for which simultaneous placebo-controlled data are unavailable.

Long-Term Mortality After Osteoporotic Hip Fracture in Chiang Mai, Thailand

2010-01-01

Abstract: The purpose of the study was to investigate 10-yr mortality and associated factors after osteoporotic hip fracture. A prospective cohort study of mortality and associated factors was carried out in patients who sustained hip fracture and were admitted to Chiang Mai University Hospital from 1998 through 2003. Eligibility criteria were defined as age over 50yr, hip fracture caused by simple fall, and Singh index of 3 or less.Mortality rates at 3, 6, 12, 24, 36, 60, 96, and 120mo were 10%, 14%, 18%, 27%, 32%, 45%, 55%, and 68%, respectively. One-year mortality rates were 31% in males and 16% in females. The median survival time was 6yr. Ten-year mortality was 68%. Factors correlated with higher mortality were male gender, age greater than 70yr, and nonoperative treatment. Mortality after osteoporotic hip fracture in Thais was extremely high, especially in the first year. It was about 8 times higher than that in the age-adjusted general population.

Bone Mineral Density According to Age, Bone Age, and Pubertal Stages in Korean Children and Adolescents

2009-11-30

Abstract: To determine whether bone age (BA)–based bone mineral density (BMD) reference values are more accurate than chronological age–based BMD values in predicting the BMD of children who have a discrepancy between their chronological age and BA; we calculated BMD reference values for 514 healthy Korean children (262 girls and 252 boys) aged 5–20yr by dual-energy X-ray absorptiometry. We found that children with BA chronological age discrepancy fitted better to the BA BMD reference curve than to the chronological age BMD reference curve. In contrast, most children without BA–chronological age discrepancy fitted well to both BA and chronological age BMD reference curves, because the 2 reference curves are very similar. In the linear regression analysis, BA–based equations for BMD had a higher R2 value and lower standard error of estimate than chronological age–based equations. These results indicate that BA–based BMD values are more accurate in predicting BMD in children who have a discrepancy between their BA and chronological age.

Quantitative Ultrasound and Dual-Energy X-ray Absorptiometry in Children and Adolescents With Neurofibromatosis of Type 1

2010-01-01

Abstract: Reduced areal bone mineral density (aBMD) is a common feature of neurofibromatosis type 1 (NF1). Moreover, in recent years there has been a growing interest in using quantitative ultrasound (QUS) for the evaluation of bone status. In 55 NF1 subjects (mean age: 9.3±5.4yr) and in 51 age- and sex-matched controls we measured aBMD at lumbar spine, at femoral neck (aBMD-FN), and at total femur (aBMD-T). Apparent volumetric bone mineral density (BMAD) was also calculated. In all subjects, QUS parameters at phalanges were evaluated. In NF1 subjects, the values of aBMD and BMAD were lower than in controls at all skeletal sites, but the difference reached statistical significance only at femoral sites (p<0.05). Both aBMD and QUS parameters were lower in those NF1 subjects with skeletal abnormalities than in those without abnormalities, but the difference was statistically significant (p<0.05) only for aBMD-FN and aBMD-T. Multiple regression analysis showed that the subjects with skeletal abnormalities had a higher risk of having bone transmission time (BTT) Z-score and aBMD Z-score at femoral sites less than −1. In conclusion, our results suggest that aBMD and QUS represent useful tools in evaluating the impairment of bone status in NF1 subjects.

The Evaluation of Consistency Between Body Composition Assessments in Pediatric Population Using Pencil Beam and Fan Beam Dual-Energy X-Ray Absorptiometers

2010-01-01

Abstract: The replacement of the old dual-energy X-ray absorptiometry system with a novel one should be preceded by a cross-calibration procedure. Therefore, the study was aimed at investigating the consistency of bone and body composition measures performed in pediatric population using pencil beam (DPX-L; GE Healthcare, GE Healthcare, Madison, WI) and fan beam (Prodigy; GE Healthcare, GE Healthcare, Madison, WI) densitometers. The study group consisted of 212 healthy children aged 4–18yr. Total body (TB) and lumbar spine (S) (L2–L4) measurements were performed using DPX-L and Prodigy during the same visit. Bland-Altman analysis, linear regressions, and paired t-test were performed to evaluate the consistency of measurements and to establish a cross-calibration equation. The average Prodigy values for TB and lumbar spine bone mineral density (BMD) and content (BMC) were 2.7%, 2.4% and 1.6%, 1.6% higher than those of DPX-L, respectively (p<0.0001). Prodigy-assessed bone area (BA) was lower by 1.4% for TBBA (p<0.0001) and 1.1% for SBA (p<0.001). Lean body mass (LBM) from Prodigy was higher by 6.9% (p<0.0001), whereas fat mass (FM) was lower by 8.4% compared with those from DPX-L (p<0.0001). Bland-Altman analyses revealed the effect of magnitude that was nonlinear (2nd degree polynomial) for TBBMD (r=0.32, p=0.001), TBBMC (r=0.51, p<0.0001), TBBA (r=0.34, p<0.0001), and LBM (r=0.56, p<0.0001), but not for FM (r=0.14, not significant [n.s.]). In contrast, in lumbar spine, the magnitude dependence was linear and significant for SBMC (r=0.46, p<0.0001) and SBA (r=0.34, p<0.0001) but not for SBMD (r=0.12, n.s.). Both skeletal and body composition variables assessed by DPX-L and Prodigy devices were highly correlated, showing R2 values ranging from 0.976 for FM to 0.994 for SBMC. The results of this study document a necessity for implementation of calculated cross-calibration equations to transform DPX-L–based local pediatric references into a novel Prodigy system.

Association Between Lean Mass and Handgrip Strength With Bone Mineral Density in Physically Active Postmenopausal Women

2010-01-01

Abstract: The present study evaluated 117 physically active postmenopausal women (67.8±7.0yr) who performed neuromotor physical tests (strength, balance, and mobility). Body composition (lean mass [g], fat mass [g], and % fat) and bone mineral density (BMD) of lumbar spine (L1–L4), femoral neck, and total body were measured by dual-energy X-ray absorptiometry. Following the World Health Organization criteria, osteoporosis was found in at least 1 analyzed site in 33 volunteers (28.2%): 30 (25.6%) in lumbar spine and 9 (7.7%) in femoral neck. Body weight was strongly and positively related to BMD in all sites, but the most important component of body composition was lean mass, also significantly related to all BMD sites, whereas fat mass was weakly related to the femoral neck BMD. Percent fat did not correlate with any BMD site. Of all the physical tests, the handgrip strength was most importantly related to lumbar spine, femoral neck, and total body (r=0.49, p<0.001; r=0.56, p<0.001; and r=0.52, p<0.001, respectively). The static body balance presented a weak but significant positive correlation only with lumbar spine. Our results suggest that strategies aiming to improve muscle strength and lean mass must contribute to the bone health of physically active postmenopausal women.

Atypical Femoral Diaphyseal Fractures Documented by Serial DXA

Fergus Eoin McKiernan — 2010-01-01

Incomplete lateral and completed femoral diaphyseal fractures have been reported in the context of prolonged antiremodeling therapy. The American Society for Bone and Mineral Research task force has been assembled to define the nature, investigate the cause, and consider management options for these fractures. Illustrated are serial dual-energy X-ray absorptiometry (DXA) images (GE/Lunar, Madison, WI) of a 51-yr-old, steroid-dependent, premenopausal woman who began daily oral alendronate in 2001 to prevent glucocorticoid osteoporosis. In 2006, she developed the insidious onset of bilateral, lateral proximal thigh pain in the absence of trauma or overuse. Radiographs, nuclear scintigraphy, and computed tomography scans were consistent with “atypical, subtrochanteric femoral fractures” recently associated with prolonged antiremodeling therapy. Double tetracycline-labeled iliac crest biopsy showed severe suppression of bone turnover. Alendronate was discontinued in 2006. She remains symptomatic despite protected weight bearing 3yr later. Radiographs in 2009 show neither medial fracture propagation or fracture union. These serial DXA images illustrate the evolution of the typical lateral cortical thickening and “pointing” or “beaking” (arrows) before, during, and after therapy with alendronate. Recognition of these fractures by DXA has not previously been reported. Radiographic surveillance for these unusual fractures would be costly and result in excessive radiation exposure. Vigilance for these findings during serial DXA monitoring may offer a point-of-service means of monitoring for these fractures that is nonintrusive, safe, and inexpensive.

Denosumab Increased BMD of the Lumbar Spine, Total Hip, Femoral Neck, and Trochanter as Measured by QCT in Postmenopausal Women with Osteoporosis

2010-01-01

Background: Denosumab (DMAb), a fully human monoclonal antibody to RANKL, decreases bone turnover, increases DXA areal bone mineral density (aBMD), and reduces fracture risk in postmenopausal women with osteoporosis that participated in the FREEDOM trial (Cummings et al., NEJM 2009;361:756). Here we describe the effect of DMAb on lumbar spine and hip (total hip, femoral neck, and trochanter) BMD as measured by quantitative computed tomography (QCT) in a subset of women that participated in the FREEDOM trial.

Improving Post Hip Fracture Care in Veterans

2010-01-01

Purpose: Despite documented treatment efficacy and comprehensive guidelines, osteoporosis (OP) is inadequately managed following fragility fracture. This retrospective chart review and quality improvement project evaluated care following hip fracture and developed interventions based on these findings.

Older Men With Extended Aortic Calcifications Have More Vertebral Fractures - A Cross-Sectional Study in the Strambo Cohort Using the HOLOGIC VFA Software

Pawel Szulc, Roland Chapurlat — 2010-01-01

Older men with the extended aortic calcifications assessed on lateral spine radiographs with a 24-point score (aortic calcification score, ACS > 6) had an increased risk of fracture (Szulc & al., JBMR, 2008). In this study carried out in 912 men aged 50 and over, we assess the association between prevalent vertebral fractures and ACS identified on the lateral spine scans obtained using the Vertebral Fracture Assessment software on the HOLOGIC Discovery A device. Vertebral fractures were diagnosed in 166 men with the semiquantitative method: Grade 1 (mild, n = 87 including 18 probably osteoporotic fractures), Grade 2 (moderate, n = 59), Grade 3 (severe, n = 21). ACS was assessed using the same 24-point score. Bone mineral density (BMD) at lumbar spine, hip, whole body and radius was measured on the same HOLOGIC device.

Spine-Hip Discordance and Fracture Risk Assessment: A Physician-Friendly FRAX Enhancement

William D. Leslie, Lisa M. Lix — 2010-01-01

Background: The WHO fracture risk assessment (FRAX) tool estimates ten-year probability of fracture based upon multiple clinical risk factors and an optional BMD measurement obtained from the femoral neck. Discordance between lumbar spine (LS) and femoral neck (FN) T-scores is common and a source of clinical confusion since the LS measurement is currently ignored under the FRAX formulation.

Genistein Aglycone is Effective in Reducing Bone Loss and Some Predictors of Cardiovascular Risk in Postmenopausal Women: A 3-Years Study

2010-01-01

Genistein aglycone improves bone metabolism and has received wide attention over the last few years because of its potential preventive role for cardiovascular disease. However, questions about the long-term safety of genistein on reproductive tissues as well as its continued efficacy still remain.

Promoting Perimenopausal Bone Health: What's Theory Got To Do With It?

Ann C.F. Olson — 2010-01-01

Background: Although bone mineral density (BMD) loss accelerates during perimenopause, current guidelines do not support BMD testing to determine individualized osteoporosis risk before menopause. Most primary health care providers rely on updated information as an educational intervention to promote modifiable bone health behaviors, but few experimental studies are conducted to explore and compare the immediate effects of this information on prevention intentions.

Appropriateness of Referrals to a Tertiary Referral Centre for BMD Testing

2010-01-01

Introduction: Evidence-based guidelines for who should have a DXA scan are well established. Much attention has appropriately focussed on increasing the proportion of persons at high risk for fracture being referred for such investigation, as many studies show current practice is suboptimal. Waiting times for DXA scans have increased substantially in some tertiary referral centres such as ours because of 1) increased awareness among referring-providers, 2) cutbacks in DXA resources and 3) at times patients or physicians with some knowledge of osteoporosis pressurising the service for a ‘screening’ test. Screening scans and diagnostic criteria for younger persons (such as premenopausal women) are controversial. Studies show several thousand women would need a DXA test at age 50 compared to 70 years to prevent a single fracture. Little literature exists on the extent of inappropriate requests for DXA.

Community Based Osteoporosis Screening and Education of Ethnically Diverse Populations by Pharmacy Students

Tasneem Sheikh, Thu Huynh, Bryan Coleman, Cynthia L. Lieu, Kathleen Besinque — 2010-01-01

Background: Pharmacy students are an effective and underutilized resource for identifying women at risk for osteoporosis through bone mineral density (BMD) screenings and for providing osteoporosis prevention education.

Genistein Aglycone Demonstrates a Protective and Reversible Effect on the Development of Steroid-Induced Secondary Osteoporosis and Increases Bone Breaking Strength in Vivo

2010-01-01

Genistein aglycone has been shown in several studies to increase bone mineral density (BMD) at the lumbar spine and femoral neck in osteopenic, postmenopausal women with no clinically significant adverse effects on the breast and uterus. In order to clarify the efficacy of genistein aglycone in the management of the underlying metabolic processes of glucocorticoid-induced osteoporosis (GIO), the following studies were conducted. The first study was carried out to assess the effectiveness of genistein aglycone in the preventive management of GIO-induced bone loss and osteonecrosis of the femoral head. In addition to a steady decrease in bone formation, a rapid weakening of bone architecture and an increase in fracture risk, chronic administration of glucocorticoids also cause avasuclar necrosis. A Sprague-Dawley rat model of GIO was used in this study, in which 28 female rats received injections of 30 mg/kg methylprednisolone (MP), MP + genistein (5 mg/kg, equivalent to 54 mg/day in humans), genistein alone or vehicle for 60 days. At the end of treatment, genistein was found to not only maintain but also increase BMD and bone mineral content (BMC). Serum levels of the bone formation marker, bone-alkaline phosphatase (b-ALP) were increased in the genistein group, while levels of carboxy-terminal collagen cross links (CTX), a bone resorption maker were reduced. Administration of genistein succeeded in preserving femoral breaking strength and prevented osteonecrosis, bone erosion and maintained a normal bone architecture equivalent to the vehicle group. A second study aimed to assess how genistein aglycone compared in effectiveness with alendronate. A similar animal model was used, in which GIO was induced by daily injections of MP (30 mg/kg) followed by treatment with genistein (5 mg/kg), alendronate (0.03 mg/kg) or vehicle for an additional 60 days. The genistein group demonstrated a greater increase in BMD, BMC, and in breaking strength compared to animals treated with alendronate. As seen in the previous study, the genistein treated animals also had significantly increased b-ALP serum levels and CTX levels. Genistein showed positive histological evidence of reducing bone and cartilage erosion and was able to reverse GIO more effectively than alendronate. Collectively, these results suggest that naturally derived isoflavones like genistein aglycone might be a potential new therapy for the prevention of GIO, the most important secondary cause of osteoporosis in humans. Genistein aglycone may also prevent necrotic deterioration of the femoral head caused by glucocorticoid use and could represent a unique therapy that combines powerful bone-forming as well as anti-resorptive activity. Human clinical trials are needed to assess these possibilities.

Quantitative CT (QCT) can Survey Bone Density During PET-CT Studies of Oncology Patients - The First 100 Studies

Alexander L. Acevedo, Lionel S. Zuckier — 2010-01-01

Background: Oncology patients are at increased risk of osteoporosis but are infrequently screened. We report our method of capturing bone density during routine performance of oncologic PET-CT studies.

The Prevalence of Osteoporosis in an Iranian Population

2010-01-01

Background: The present study was designed to determine the prevalence of osteoporosis in a representative group of healthy Iranian population. Methods- The study population comprised of apparently healthy subjects who participated in the Iranian Multi-centric Osteoporosis Study (IMOS), a cross-sectional study carried out in urban areas of five great cities to assess the bone health in the country. Bone mineral density (BMD) values for the lumbar spine (L2-L4), the femoral neck and total hip were measured with a Lunar DPXMD densitometer (Lunar 7164, GE, Madison, WI) and used to identify the osteoporotic and osteopenic cases based on WHO categorization.

Association Between Different Domains of Physical Activity and Fractures

2010-01-01

Background: Epidemiological studies suggest for an inverse relationship between physical activity and risk of fractures. However, it is unclear how this association varies according to the domain of life in which the activity is undertaken.

Prevalence and Correlates of Osteoporosis in US Men

Lei Chen, David R. Nelson, Evgeniya Antonova, Joseph Johnston — 2010-01-01

While male osteoporosis has recently received attention as a growing public health concern, widely discrepant estimates of its prevalence exist, and relatively little is known about the characteristics of men with osteoporosis. The objectives of this study were to determine the prevalence of osteoporosis in US men using alternative definitions, and to describe correlates of low bone mass in men.

Distribution of T-Scores and Z-Scores in a University Cohort with an Emphasis on Elevated Bone Mineral Density (BMD)

Sarah L. Morgan, Frederick Peace, Robert Lopez-Ben, Naomi Fineberg — 2010-01-01

Introduction: Elevated BMD is currently not defined by the ISCD with a specific Z-score cutoff, however it has been suggested that a Z-score ≥ 2.5 is not normal. Methods: IRB approval was obtained. We evaluated a University DXA database i over 24 months to define T-score and Z-score distributions. A Z-score of equal to or greater than 2.5 was selected as the outcome event of interest in a logistic regression for adjusted odds ratio. The covariates were: height, weight, gender, menopausal status, use of female hormones, presence of insufficiency fractures after age 50, previous fractures, previous surgeries (back surgeries, vertebroplasty, or kyphoplasty), transplant history, presence of long term chronic conditions (asthma, lupus, rheumatoid arthritis, or cystic fibrosis), eating disorder, current use of glucocorticoids, smoking status, along with current and past usage of osteoporosis pharmacological therapies.

Coordinate Regulation of Bone Biomechanical Performance and Bone Size in Mice

Robert D. Blank, Neema Saless, Suzanne J. Litscher, Peter Demant, Ray Vanderby — 2010-01-01

Background: While DXA is the single best clinical tool for predicting fracture risk, it fails to reflect all aspects of biomechanical performance. These can't be studied systematically in the clinical setting since fractures are unique, unpredictable, and therefore unrecorded events. Animal models therefore offer the best approach to studying bones under load conditions similar to those that cause fractures.

Body Weight Determines Directly Bone Mineral Density in an Irish Referral Population

Malachi J. McKenna, Susan van der Kamp, Oliver FitzGerald — 2010-01-01

Background: Obesity moderates the effect of osteoporosis by a number of ways: bone strength is augmented by an increase in bone mineral density (BMD) and by more robust bone geometry; padding at site of trauma dissipates the energy reducing fracture liklihood; but, lower level of activities lead to trauma and obese persons have more falls and higher impact of fall. We sought to evaluate the influence of age, gender, height, weight, and dietary calcium intake on BMD at spine and hip.

Impact of Smoking on Bone Mineral Density in Elderly Men: The Fujiwara-kyo Osteoporosis Risk in Men (Formen) Study

2010-01-01

Background: The impact of smoking on bone status in men has not been conclusively established. Methods: We examined how smoking and its cessation influence bone status in men. We analyzed 1,576 men among a baseline survey of Japanese men aged ≥ 65 years, the Fujiwara-kyo Osteoporosis Risk in Men Study, conducted during 2007-2008.

LDL Cholesterol Level Correlate with Urinary Deoxypyridinoline in Pre-Menopausal Japanese Women

Yukiko Kihara, Jun Kitagawa, Mizuho Nagata, Naonobu Takahira — 2010-01-01

Background: Many studies have investigated the association between bone mineral density and serum lipids; however, their findings have been discordant. Moreover, almost all the studies examined post-menopausal women and the elderly. Therefore, the objective of this study was to investigate whether serum lipid levels are associated with osteo-sono index (OSI) and bone turnover markers in pre-menopausal Japanese women.

Calcidiol and iPTH Serum Level in Postmenopausal Women Treated with Ergocalciferol

Daniel A. Salica, Clelia Salica Biologist — 2010-01-01

Background: The therapeutic administration of Vitamin D is usually determined by empirical bases ruled by clinical criterion and not by seric dosage. The PTH response, in cases of low seric levels of calcidiol, can have a negative effect on bone health.

Optimizing Separation of Bone Marker Quadrants in Osteoporosis Patients Treated with Teriparatide

Xiaohai Wan, John H. Krege, Xinming Hao — 2010-01-01

Background: Osteoporosis is a metabolic bone disease characterized by reduced bone mineral density (BMD), deterioration in bone architecture, and increased risk of fracture. In postmenopausal women, this disease arises because of an imbalance between bone formation and resorption resulting in loss of BMD. Bone markers offer a means to assess bone metabolism and include both formation (F) and resorption (R) markers. While changes in bone markers have been correlated with changes in BMD, errors in the measurement of bone markers as well as BMD has limited the strength of the correlations. We propose a new way to use bone markers to assess later changes in BMD using a novel analytic approach called generalized boosted regression modeling (GBM).

Hand Dominance and Bone Microarchitecture at the Distal Radius by High-Resolution Magnetic Resonance Imaging - Updated Data

Xiaohai Wan, Pamela Seaman, Mayme Wong, Kelly Krohn, Michael Kleerekoper — 2010-01-01

Background: Bone mineral density as measured using dual-energy X-ray absorptiometry has been found to be significantly higher in the hand, forearm, and calcaneus on the dominant side compared with the nondominant side. Whether hand dominance influences bone microarchitecture is unknown.

Bone Turnover Markers and Fracture Risk in African American Kidney Transplant Recipients with Hypovitaminosis D and Hyperparthyroidism

Mariana Markell, Sima Terebelo — 2010-01-01

The recommendation has been made that the majority of kidney transplant recipients would benefit from prophylactic bisphosphonate therapy, with the assumption that they are at increased risk for high turnover bone disease due to multiple factors, including corticosteroid therapy and hyperparathyroidism (hPTH). Few studies have looked at bone markers or actual fracture risk in this population, especially in African Americans, who make up an increasing number of pts due to their high prevalence of kidney disease. We studied bone markers and risk for osteoporosis through FRAX score in 26 African American and 2 Hispanic KTR's all of whom had preserved kidney function (creatinine < 2.5 mg/dl) hyperparathyroidism and hypovitaminosis D. There were 14 men and 14 women in the cohort, and by t-test they did not differ for any parameters so the entire group was used for analysis. Mean age was 52.7+/−12.2 yrs, BMI 32.9+/−9.0, mean time since transplant 54.6+/−48.1 mos, months on dialysis 55.6+/-56.7, prednisone dose 7.5+/−2.3mg, creatinine 1.6+/− 0.4 mg/dl. Mean 25-OH Vit D was 15.9+/− 4.3 ng/dl, iPTH was 190.3+/−62.9. Bone markers were not elevated in the majority of pts, w mean osteocalcin 30.5+/−14.7, bone alkaline phosphatase (BAP)17.9+/−8.1 and c-telopeptide (C-tx) 459.6+/−247.2. C-tx was highly correlated with osteocalcin (r = 0.72, p < 0.0001) and BAP (r = 0.5, p < 0.05), and was directly correlated with time on dialysis (r = 0.5, p = 0.011), and cigarette smoking (r = 0.6, p = 0.003). Both BAP and C-tx were inversely correlated with 25-OH vitamin D levels (r = -0.47, p = 0.014),but osteocalcin was not. There was no correlation of any bone marker with iPTH level, prednisone dose, age, gender, dose or level of tacrolimus, serum calcium, phosphorous or creatinine, or use of a diuretic. Of note, FRAX scores were low for the population as a whole (3.00+/−2.7). No pts reported a history of fracture, despite age, persistent hPTH and hypoD, dose of prednisone, length of time since transplant (on prednisone) and length of time on dialysis.

Estrogen Withdrawal

Bahaa Abu Bakr, Nathan Bolton, Lillian Yau, Brandy Panunti, Alan Burshell — 2010-01-01

Background: Estrogen withdraw (EW) is associated with both increased fracture risk and decreased BMD.WHI published results in October 2002 suggested that the risks of hormonal therapy were greater than the benefits; hence many women discontinued hormonal therapy. The objective of this study was to follow BMD changes that occur after estrogen cessation, the period between the three scan varied, thus results were expressed as BMD % change/year.

Z - Score an Important Clue to Diagnosis of Co-Morbidities and Fracture Risk

John A. Goldman — 2010-01-01

Background: Z - scores are related to age matched relationships of Bone Mineral Density and can be used to suggest possible secondary causes of low bone density. This study reviews the presence of low Z - scores and relevance to diagnosis, risk of fracture and therapeutic implications for evaluation of patients in a solo rheumatology practice.

High Prevalence of Non-Hip Non-Spine Fractures Among Post Menopausal Women with Rheumatoid Arthritis

Maria Rell-Bakalarska, Edward Franek, Krzysztof Rell, Dariusz Gozdowskibachelor — 2010-01-01

Purpose: This study aimed to assess a prevalence of non-hip non-spine fractures in rheumatoid arthritis (RA) patients. Methods: Into this cross-sectional study 534 consecutive rheumatoid arthritis patients from Outpatients Department of the Institute of Rheumatology in Warsaw were included. Mean age of the patients was 64.1 ± 9.4 years, BMI 26.5 ± 4.4 kg/m2, RA duration 13.7 ± 9.9 years. In all patients prevalence of clinical low-energy fracture was assessed. Only fractures sustained after RA diagnosis were included. In case of clinical spine fractures a radiogram was required for diagnosis.

Secondary Causes of Osteoporosis in 869 Patients Treated for Osteoporosis in Romania

2010-01-01

Aim of the study: To evaluate the prevalence of secondary causes of osteoporosis among patients treated for osteoporosis. Materials and methods: 869 women with osteoporosis (age between 36 and 86, mean 64.7), treated through National Programe of Osteoporosis in 2008-2009 in two endocrine departments from Bucharest, Romania. They were diagnosed with osteoporosis according to WHO criteria and medical records contained also clinical and endocrine evaluation at the baseline. We retrospectively analyzed their medical records for secondary causes of osteoporosis and fractures.

Screening for Osteoporosis - A Missed Opportunity?

Gregor Freystaetter, Kapil Sharma, Deepu Thomas, Sunita Trivedi, Nitin Trivedi — 2010-01-01

Background: Osteoporosis is a common skeletal disease characterized by low bone mineral density (BMD) predisposing an individual to fragility fractures. Osteoporosis can be diagnosed with dual-energy x-ray absorptiometry (DXA). Pharmacotherapy for osteoporosis reduces the incidence of fragility fractures. Osteoporosis is clinically silent unless complicated by fracture; therefore, it is generally overlooked, particularly in an underserved population. The National Osteoporosis Foundation (NOF) recommends BMD-measurement in all women and men older than 65 years and 70 years respectively. The main objective of our study was to assess rates of osteoporosis screening in eligible patients in our resident run ambulatory clinic. In addition, charts were reviewed to determine whether the osteoporosis risk factors were assessed in these patients. Moreover, osteoporosis screening was compared to screening rates of other common diseases, such as colon, breast, cervix and prostate cancer.

Use of the FRAX Tool: A New Approach to the Diagnosis and Risk Assessment of Osteoporosis in A Greek Rural Area

2010-01-01

Background: Osteoporosis is recognized as a major Health Problem worldwide. NOF recommends a comprehensive approach to the diagnosis and management of osteoporosis to establish the individual patients fracture risk with the use of medical history and examination together with BMD measurement, incorporated in the use of FRAX tool, released by WHO in February 2008.

Improvement of Treatment Decisions in Epileptic Patients by Performing Lateral Vertebral Assessment (LVA)

Antonio A. Lazzari, Philip Dussault, Samuel Davis — 2010-01-01

Purpose: The WHO fracture risk algorithm (FRAX™) is a tool developed to assist clinicians in making treatment decisions for patients at risk for developing osteoporotic fragility fractures. The National Osteoporosis Foundation suggests that patients with a vertebral fracture or with a low bone mass and a FRAX™ calculated 10-year probability of fracture ≥ 3% for hip fracture or ≥ 20% for major osteoporotic fracture are at a high risk and should be considered for treatment. The FRAX™ algorithm is validated based on femoral neck bone mass as determined by bone mass densitometry (BMD) by dual-energy X-ray absorptiometry (DXA). The FRAX™ is considered to be most useful in patients with low hip bone mass and of less predictive value in patients with relatively normal BMD at the hip and low BMD at the spine. Epileptic patients have a 50% higher risk for developing osteoporotic fractures compared to non-epileptic patients. Newer generations of DXA instruments, allow lateral vertebral assessment (LVA) and vertebral fracture assessment (VFA). Presence of compression vertebral fractures is considered to be a strong predictor of future vertebral and non-vertebral fractures. The purpose of this study is to report our experience comparing the FRAX™ calculator and VFA findings in a cohort of epileptic patients.

Characteristics of A Population with BMD Defined Osteoporosis but Low Fracture Risk

Eman Ramses Boulis, Robert McMurray, John Jenkins — 2010-01-01

Purpose of Study: To examine the characteristics of patients with osteoporosis (T-score ≤-2.5) who cannot be identified by FRAX as high fracture risk patients. Methods Used: A retrospective chart review was performed on consecutive DXA scans collecting data on patients age 50 and older with a BMD indicating osteoporosis (T-score ≤-2.5 at any site). Individuals were separated into high FRAX (group A) and low FRAX (group B) groups, where high FRAX was > 3% hip or > 20% major osteoporotic 10 yr fracture risk and low FRAX included patients with ≤ 3% hip and ≤ 20% major osteoporotic 10 yr fracture risk. FRAX was calculated without BMD included in the FRAX calculation.

Medical Home Care Model Improves Quality and Efficacy of Bone Care of Our Patients at SCPMG/Riverside Medical Center

2010-01-01

Context: Osteoporosis is a common and costly disease that is associated with high morbidity and mortality. Given the availability of efficacious anti-fracture medication, screening with BMD testing for osteoporosis is recommended in women aged ≥65 years and in men aged ≥70 year. Recently, it is also recommended that clinicians consider using Fracture Risk Assessment tool to evaluate absolute fracture risk to determine appropriate osteoporosis therapies. Our Electronic Medical Record integrated Medical Home care Model has made it possible for our Primary Care Physician to implement this recommendation promptly and effectively.

The Ten Year Probability of Hip Fracture in Thai Population By WHO Fracture Risk Assessment Tool

2010-01-01

Background: The WHO Collaboration Center has identified a clinical risk factors which are including sex, age, body mass index, history of previous fracture etc, that call the FRAX® tool. The FRAX® algorithms give the 10-year probability of fracture. The output is a 10-year probability of hip fracture and major osteoporotic fracture to predict probability of fracture. It is considerable use to health care professionals, particularly in places where there are few DXA machines. But this tool limit number of country is not represented of references. The aim to determine the FRAX® tool (10-year probability of hip fracture) in Thai peoples ages over 50 years who have fragile fracture around hip as a diagnosis test.

FRAX Contribution to the Management of Patients with Fracture Risk. Results from the First 19 Months Since Its Implementation in Our Clinical Practice

2010-01-01

Introduction: Using the WHO DXA-based T-score diagnostic criteria of osteoporosis to initiate treatment lacks sufficient sensitivity and specificity. FRAX was designed to identify patients with osteopenia and high fracture risk. Shortly after its introduction, it was suggested that FRAX should be used to “screen” patients for DXA. Nineteen months after its implementation in our clinical practice we evaluated the impact of FRAX on patient management.

Fracture Risk Evaluation Through FRAX® Model Using BMI Only Is Significantly Underestimated Comparing to the Use of Femoral Neck BMD

2010-01-01

Background: FRAX® model offers the possibility to use either femoral neck BMD or BMI alone to evaluate fracture risk. Our aim was to evaluate the impact of using femoral neck BMD or BMI only on the fracture risk assessment based on this model.

Assessing Fracture Risk with DXA: Comparing 2008 to 1998 NOF Guidelines - The Influence of FRAX

Thomas P. Olenginski, Sorina Dancea, Eric D. Newman, William T. Ayoub — 2010-01-01

Background: In February 2008, the NOF published new guidelines for fracture risk assessment. We sought to evaluate how these guidelines performed versus the previous 1998 guidelines.

Is a 10-Year Major Osteoporotic Fracture Risk Assessment an Effective Complement To a Densitometry Evaluation

Tom V. Sanchez, George J. Ekker, Chad A. Dudzek, Kathy M. Dudzek — 2010-01-01

Control Number: 09-A-226-NOF The WHO 10-year Fracture Risk Assessment is now being applied by many densitometrists with the hope that a 10-year Femur Neck Fracture Risk or a 10-year Major Osteoporotic Fracture Risk Assessment might significantly complement the clinical review of the Femur Neck T-score Assessment. The current study examined if the clinical risk profile and Femur Neck T-score generated different results in the 10-year Femur Neck and 10-year Major Osteoporotic Fracture Risk Assessment.

Wellness with Spinal Cord Injury: Can Osteoporosis Be Improved Through Orthotic Driven Ambulation?

Marie A. Vazquez, Morgan, Laura Gehrig — 2010-01-01

Background: Spinal cord injuries (SCI) are catastrophic events that occur predominately in younger individuals, and due to medical advances, survival of injury has increased dramatically with injured individuals living a normal life span. However, there are several secondary physiological complications that can shorten the life span of these individuals and further deteriorate their quality of life. Osteoporosis, which in the uninjured population occurs gradually with age, is exceedingly heightened with SCI placing these individuals at risk for fractures and kidney stones. Although much research has been done in an attempt to attenuate this secondary complication, most of the interventions have been conducted in clinical research laboratories. It is vital to investigate interventions that can provide wellness in this population, which can be done out of the laboratory and in an outpatient setting, where these treatments can be made accessible to all individuals with SCI.

Effect of Alendronate in Postmenopausal Women with Low Bone Mass - 18 Months Results

2010-01-01

Osteoporosis is a chronic disorder that has significant increased morbidity and mortality. It therefore requires a highly effective therapy that archives a rapid onset of action; bisphosphonate treatment is the standard of care in osteoporosis.

Subtrochanteric Fractures Bisphosphonates and Low Turnover Metabolic Disease

Eric O. Eisemon, Travis von Tobel, Edmund Choi, Joseph Feliccia — 2010-01-01

Introduction: Although bisphosphonates have been shown to effectively reduce hip and vertebral fractures in osteoporotic patients, there has been an increasing number of bisphosphonate related subtrochanteric insufficiency fractures reported in the literature following minimal trauma. The specificity of low energy transverse subtrochanteric fracture pattern with medial beaking is 98% for alendronate. Of patients who presented with bisphosphonate related fractures, 76% had prodromal pain.

Bisphosphonate Nonresponders and the Role of Compliance

Maria P. Jofre, Ali D. Askari, Raymond Hong — 2010-01-01

Introduction: Bisphophonates (BP) are the most commonly prescribed medications to treat osteoporosis. Oral BPs confer a vertebral fracture risk reduction of 41-47% compared to placebo. Unfortunately, individuals on therapy are still at risk for fragility fractures. Up to 17% of patients in clinical trials may experience a significant decrease in bone mineral density (BMD), a surrogate marker of BP effectiveness. This nonresponder rate may partially be a consequence of poor patient adherence to the medication regimen or poor medication persistence. We studied the relationship between patient self-reported BP adherence/persistence and medication response as measured by BMD.

Development of a Clinical Examination Tool to Guide Clinician Decisions When Managing Patients with or At Risk for Osteoporosis

Kelly D. McArdle, Risheeta K. Joshi, Maureen Brolly, Janet Buckley — 2010-01-01

Background: In response to the World Health Organization's Women's Health Initiative, physical therapists (PT) at Mercy Catholic Medical Center formed a Women's Health Focus Group (WHFG) to address the unique needs of women across their lifespan. The mission was to review and collaborate on evidence based practice regarding disorders and impairments specific to women (osteoporosis, lymphedema, pelvic floor dysfunction, etc.) and then educate PTs in an effort to improve clinical practice. Osteoporosis was addressed first due to its prevalence among patients (pt's) managed within our health system. There was an observed decrease in the awareness of risk factors, the disease process, and appropriate clinical pathways for examination and intervention by PTs related to osteoporosis. Our purpose is to highlight the process related to the development of a clinical examination tool (CET) to help improve awareness of and management for pt's with or at risk for osteoporosis.

A Preliminary Analysis of Osteoporosis Education and Its Effect on Clinician Treatment Choices

Risheeta K. Joshi, Maureen Brolly, Kelly Duszak McArdle, Janet Buckley — 2010-01-01

Purpose: The Women's Health Focus Group (WHFG) of Mercy Catholic Medical Center was started in response to the 2005 national Women's Health Initiative and was comprised of physical therapists (PT) with varied interests in areas of women's health. In response to observed limitations in staff awareness and proper management of patients (pt) with osteoporosis, the WHFG developed an educational program to improve understanding of women's health issues among PTs. Osteoporosis was chosen as the topic for staff education. An educational series consisting of 7 one-hour lectures / labs was developed and delivered over a 12 week period. The purpose of this study was to assess the impact of staff education on clinician awareness of and intervention choices for pts with and at risk for osteoporosis.

Calcitonin for Treating Acute and Chronic Pain of Recent and Remote Osteoporotic Vertebral Compression Fractures: A Systematic Review and Meta Analysis

Jennifer Knopp-Sihota — 2010-01-01

Background: Vertebral collapse is one of the most common fractures associated with osteoporosis. The subsequent back pain may be severe and often requires medications and bed rest to control pain and improve mobilization. Recent studies have suggested the use of calcitonin as an initial and adjunctive treatment for severe, unrelenting back pain secondary to an osteoporotic vertebral compression fracture (OVCF), as it exhibits known analgesic properties and does not produce the unpleasant side effects associated with narcotics. Therefore, we sought to determine the analgesic efficacy of calcitonin for the treatment of acute or chronic back pain in stable patients sustaining a recent or remote OVCF.

Design of a Phase 3 Trial for Oral Recombinant Salmon Calcitonin

David S. Krause, Kristine Erickson, James Gilligan — 2010-01-01

Background: The choices for treating osteoporosis are expanding, but all currently available products have some limitations. Recombinant salmon calcitonin (rsCT) is safe and effective in increasing lumbar spine bone mineral density in women with postmenopausal osteoporosis, but must be administered by injection or nasal spray. A formulation which could be stored at room temperature and administered orally would improve patient convenience and might increase the use of calcitonin in this population. We have developed an oral formulation of rsCT which provides exposure equivalent to nasal administration of currently marketed rsCT. We have initiated a Phase 3 study in treatment-naïve women with postmenopausal osteoporosis.

Utilization of Zoledronic Acid in the Treatment of Osteoporosis at a Major Inner-City Medical Center

Sobia Hassan — 2010-01-01

Background: There are no specific practice guidelines for selecting the patients with osteoporosis (OP) who should receive zoledronic acid (ZA), except for patients intolerant to oral bisphosphonates (OBP).

Vitamin D Fortification of Food Improves Vitamin D Status but Does Not Assure Adequacy

Neil Binkley, Diane Krueger, Susan Valentine, Jean Engelke, Irina Haller — 2010-01-01

Given 21st century lifestyle of minimal sun exposure, oral vitamin D intake is required for optimal vitamin D status. The only approach likely to succeed on a population level involves widespread food fortification with amounts of vitamin D exceeding those currently utilized. However, provision of larger amounts of vitamin D in food has received little study. Moreover, substantial variability in circulating 25-hydroxyvitamin D [25(OH)D] response to oral vitamin D supplementation has been observed. Factors contributing to this variability remain to be defined. This randomized, double-blind, placebo-controlled trial evaluated serum 25(OH)D response to daily ingestion of D3 fortified food. In this study, 99 women in three age groups (young: 20-30 years, middle aged: 55-65 years and old: 75+ years) were randomly assigned in 1:1 ratio to receive either a low calorie chocolate disk fortified with ∼2,300 IU of D3 or an identical placebo (PBO) disc once daily for four months. Body composition was determined at baseline by total body DXA. Serum calcium and 25(OH)D concentrations and 24-hour urinary calcium excretion were measured at baseline and months 1, 2 and 4. Data were analyzed using t-test and repeated measures ANOVA. As expected, between group differences (p < 0.05) in BMI, creatinine and albumin were observed at baseline; young women had lower weight, creatinine and higher albumin. There were no between group differences in 25(OH)D at baseline. The mean [SEM] baseline 25(OH)D concentration was 31.1 +/− 1.0 ng/ml, however, 45% of these women had low vitamin D status (defined as a 25(OH)D concentration < 30 ng/ml). At four months, 25(OH)D concentration increased (p < 0.0001) by 13.8 ng/ml on average in those receiving the fortified disc, however 11% of those receiving vitamin D remained below 30 ng/ml. Serum and 24-hour urinary calcium were unaffected by intake of vitamin D fortified food. No age-group effect on the 25(OH)D increase was observed. At baseline, total body mass, fat mass and lean mass were negatively correlated (p < 0.05) with 25(OH)D. However, the change in 25(OH)D following four months of vitamin D was unrelated to total body mass, fat mass, lean mass or appendicular lean mass. In conclusion, the increment in 25(OH)D concentration observed with ingestion of fortified food (∼6 ng/1,000 IU vitamin D3 daily) is extremely similar to that reported with use of supplements. Food fortification is a safe and effective approach to increase vitamin D status. Daily vitamin D3 intake will likely need to exceed 2,300 IU to assure adequacy for all women. Further work is required to understand the mechanism(s) underlying the differences in 25(OH)D response to oral vitamin D intake.

Treatment of Presumed Bacterial Overgrowth Normalized Serum 25-Hydroxyvitamin D

Susan E. Williams — 2010-01-01

Purpose: To report a case in which treatment for presumed small intestinal bacterial overgrowth (SIBO) in a Roux-en-Y gastric bypass (RNYGB) patient resulted in normalization of 25-hydroxyvitamin D (25OHD) that had become increasingly resistant to repletion.

A 65 Year Old Woman with A Nonhealing Lesion of the Right Lower Jaw Four Months After Zoledronic Acid Infusion

Elizabeth A. Cogbill, M.E. Csuka, Steven Sewall, Denis Lynch — 2010-01-01

A 65 year old woman with a 10-year history of undifferentiated connective tissue disorder was diagnosed with osteoporosis by bone mineral density DXA. She received one intravenous 5mg dose of zoledronic acid in November 2008. In February 2009 she presented with pain and swelling of the right lower alveolar ridge at the site of multiple tooth extractions and root canals performed in 1972. She was diagnosed with a soft tissue abscess and underwent incision and drainage followed by oral antibiotics. Eight weeks following the procedure she had persistent exposed bone and a diagnosis of bisphosphonate-related osteonecrosis of the jaw was made. At 7 month follow up with her oral surgeon there was some evidence of healing with resolution of the necrotic alveolus and basilar bone. Osteonecrosis of the jaw is a rare complication of bisphosphonate therapy, more common during high-dose therapy for treatment of cancer-related bone metastases. This is the first reported case of osteonecrosis of the jaw secondary to a single infusion of intravenous bisphosphonate.

A Comprehensive Bone Health Center Collaborates with A Specialty Pharmacy to Achieve Teriparatide Persistence

2010-01-01

Background: Fragility fractures associated with low bone mass or osteoporosis are a significant public health concern. Teriparatide is indicated in patients with fragility fractures due to its anabolic action of stimulating new bone formation on trabecular and cortical bone by preferential stimulation of osteoblastic activity. Teriparatide increases bone mineral density over the treatment trajectory period from 3.9% at 3 months to 11.8% at 18 months and reduces risk of vertebral fractures by 65% and nonvertebral fractures by 53%. Treatment persistence is needed to achieve therapeutic benefit and reduce the burden that osteoporosis and secondary fractures place on individuals, society, and the healthcare system.

Factors Affecting Vitamin D Status: Evaluation of A Midus Cohort

2010-01-01

The determinants of circulating vitamin D status are complex. Most reports find higher body mass index (BMI) and/or larger amounts of body fat to be associated with lower vitamin D status. Such relationships have led some to postulate that low vitamin D status causes obesity, not that obesity causes low vitamin D status. Clearly, an improved understanding of the relationship between body composition, and other potential variables, with vitamin D status is necessary. As such, the purpose of this report is to investigate relationships between body composition, as determined by total body DXA, parameters of socio-economic status and circulating 25-hydroxyvitamin D {25(OH)D} in a subset of participants in MIDUS (Midlife in the US), a nationally representative cohort study of aging conducted at three US centers. In a MIDUS subset being evaluated at the University of Wisconsin, total body composition was determined using a GE Healthcare Lunar Prodigy densitometer and serum 25(OH)D was measured using HPLC. Data were analyzed by linear regression or factorial ANOVA. In this MIDUS cohort (n = 211; 64% female; 53% Black) the mean (range) age and BMI were 54.1 (38-86 years) 30.8 (17.1-51.6 kg/m2). Mean 25(OH)D concentration was 19.8 (4.0 â€“ 58.7) ng/ml. Vitamin D inadequacy was extremely prevalent; using a cut-point of 30 ng/ml, 86% of this cohort had low vitamin D status. Serum 25(OH)D was lower (p < 0.0001) in Blacks than Caucasians, with no differences by sex. Higher BMI, total soft and lean tissue mass, as measured by DXA, were associated with lower 25(OH)D concentration (p 0.66). Educational level, as a surrogate for socioeconomic status was unrelated to BMI, lean or fat mass. However, serum 25(OH)D was higher in subjects with a college, or greater, education level (p < 0.05). In conclusion, these preliminary analyses suggest that lower vitamin D status is associated with greater amounts of body mass regardless of composition. Additionally, higher levels of education are associated with better vitamin D status. Further work is needed to improve understanding of the complex relationships contributing to an individual's vitamin D status.

Who Can Pass the ISCD Clinician Bone Course Examination? The 8 Years Experience In Taiwan

2010-01-01

Background: The International Society of Clinical Densitometry (ISCD) launched the Professional Certification program in early 1996 and was introduced to Taiwan by the Taiwanese Osteoporosis Association (TOA) in 2002. To disclose the determinants of passing the certification examinations would be valuable for improving the teaching skill of faculties and clinical excellence of professionals.

Estimating Calcium Intake at Time of Dual Energy X-Ray Absorptiometry (DXA) Scan

Susan van der Kamp, Malachi J. McKenna, Oiver FitzGerald — 2010-01-01

Background: Calcium intake, whether from diet or supplementation, is an important determinant of bone mass and an adjunct to all treatments for osteoporosis. Recommended daily allowance for calcium is 800 mg; for patients with osteoporosis on treatment a higher intake of 1200 mg is advocated. As part of our DXA service, we estimate calcium intake from dairy sources, which accounts for about 80% of dietary calcium intake.

A Randomized Controlled Trial to Assess the Effectiveness of An Evidence-Based Guideline for the Prevention of Osteoporosis in Community Health

Etsuko Kajita, Yoshimi Nakatani, Junko Tamaki, Naoko Ito, Masayuki Iki — 2010-01-01

Background: Effectiveness of evidence-based clinical guideline for the prevention of osteoporosis and osteoporotic fracture is not supported by hard evidence. We assessed whether an evidence-based guideline helped public health professionals improve their preventive programs for osteoporosis better than other information.

Improving Adherence to Oral Bisphosphonates through Focused Telephonic Pharmacist Intervention

Amy Steinkellner, Laurie Greenberg, Sandra Eldridge, Lisa Lenzi, Shannon Denison — 2010-01-01

Background: Our study focused on understanding baseline performance levels and improving the adherence to oral bisphosphonates in patients with a history indicating non-adherence. In previously published studies, adherence to chronic medications has been reported to be approximately 50% after one year. For oral bisphosphonates, adherence has been found to be 53% after just 3 months. Our goal was to test the hypothesis that adherence could be improved via telephonic counseling and support by Medco Women's Health Specialist Pharmacists.

More Accurate Weight Based Formula for Vitamin D Replacement

Toufic Abdo, Ajay Chaudhuri — 2010-01-01

Background: Vitamin D deficiency has been recognized in the last decade as a very common problem affecting around one billion people worldwide. In addition to causing osteomalacia and low bone mineral density, it has been associated with muscle weakness, autoimmune disease as well as certain cancers. There is no recommended regiment for replacement of vitamin D deficiency. Doses in previous studies have varied from 800 IU up to 10,000 IU given once, daily, weekly or monthly. But in all of these studies, the achievement of target 25 hydroxyvitamin D (VitD) levels of more than 30 ng/ml (TARGET) was only 50-60%. In this study we compared 4 methods of estimating oral dose needed to achieve the TARGET.

Andragogy-the Missing Gap in Osteoporosis Patient Education

Peter M. Miller — 2010-01-01

The purpose of this paper was to provide a review of the scholarly literature regarding the persistent problem of patient compliance. The importance of patient compliance with medication has been well documented across several chronic disease conditions. These compliance issues have been translated into economic costs as high as 80% of total United States health care costs. Osteoporosis is a chronic disease of measurable and deserved attention for efforts in improving patient compliance. National Osteoporosis Foundation estimates that the cost of osteoporosis fractures will total $25.3 billion in 2025.

A Comparison of Changes in BMD in A Bone Health Plan with Two Different Versions of A Bone Health Supplements

2010-01-01

Background: This study compared BMD changes in a bone health plan with a different bone-health supplement. Method: 274 adults aged 18-25 received a DXA scan, 158 (Grp 1) volunteered to follow a bone-health plan with a supplement containing 680 mg strontium citrate and a plant-sourced 720 mg calcium supplement (AlgaeCal) with 72 mg of magnesium, 800 IU Vit D3, and 1.5 mg Vit K2 as MK-4. Upon completion of the study, a different group of 80 different (Grp 2) subjects followed the same procedure, 51 volunteered to follow the identical plan, but with a modified supplement containing 756 mg calcium, 350 mg magnesium, 1,600 IU Vit D3 and 100mcg of VitK2 as MK-7. Comparisons were made between baseline BMDs in: volunteers vs. non-volunteers, drop-outs vs. completers, and compliant vs. partially compliant subjects. Within-group changes in BMD were assessed in both groups between: baseline/ending, expected changes using national norms, and between compliant and partially compliant subjects. Comparisons of BMD changes between the two study groups were made in baseline/ending BMDs, partially compliant subjects, and compliant subjects. To evaluate safety, within-group comparisons were made between 43 baseline and ending blood chemistries and a self-reported quality of life inventory.

Age-Related Changes in Hip Geometic Parameters in the Japanese Female Population: Cross-Sectional and Longitudinal Data from JPOS Cohort Study

2010-01-01

Background: Hip geometric parameters are expected to improve hip fracture risk assessment conducted solely based on bone mineral density (BMD). However, their basic characteristics including relationship with age, body size and conventional BMD or longitudinal changes are still insufficiently described especially for Japanese.

Effect of Monthly Ibandronate on Hip Structural Geometry in Men With Low Bone Density

2010-01-01

BACKGROUND: Hip fractures can be a devastating consequence of osteoporosis. Bone strength is dependent not only on bone mineral density (BMD) but also on microarchitecture and geometric properties. Hip structural analysis (HSA) of dual-energy X-ray absorptiometry (DXA) images can be used to evaluate changes in hip geometry in patients receiving osteoporosis therapy. The STudy Researching Osteoporosis iN Guys (STRONG) examined the efficacy and safety of 150-mg monthly oral ibandronate in men with low bone density. Men who received monthly ibandronate (n = 85) demonstrated significant increases in lumbar spine and total hip BMD after 1 year compared with placebo (n = 47) (3.52% vs 0.94% [difference 2.58%; P < 0.001], and 1.82% vs -0.31% [difference 2.13%; P < 0.001], respectively).1 To examine the impact of monthly ibandronate on hip bone geometric properties in men with low bone density, we performed HSA on DXA images in a subset of STRONG participants.

Trabecular Architectonic Features in Different Zones of Human Lumbar Vertebrae

Volodymyr Mavrych, Olena Bolgova, Anton Eryomin — 2010-01-01

Background: Recent researches prove that frequency of vertebral injuries had increased in 2-5 times last 30 years, often caused by raising (picking up) insignificant loads. In series of investigative studies it was established that age-associated changes in different parts of vertebra do not occur simultaneously. Detail research of relations in between compact and spongy bones of vertebral body, as well bone marrow filling of intertrabecular spaces will permit to create models of vertebral segments, predict their behavior under different mechanical stresses. That will help to estimate the risks of micro- and macro injuries, to bring better understanding of bone adaptation and remodeling. The purpose of this research was to establish trabecular architectonic features in different zones of human lumbar vertebra bodies.

Establishment and Application of the Rat Tibial Three Dimensional Finite Element Analysis Model Based on the MicroCT Technique

Yong Fang Zhao, Jian Pang, Xiang Wang, Bo Chen Banchlor, Hong Sheng Zhan — 2010-01-01

Background: Primary osteoporosis is the most common metabolic abnormality found in postmenaupausal women. Increasing bone strength and preventing fragility fracture are of great importance. However, there is little of the study on non-invasive bone strength assay. Finite element analysis is a computer aided technique which is based on the scanning images and simulated the bone strength. Thus, we use this FEA model to evaluate the change of bone strength under different physical situation.

Multiparametric Imaging of Bone Architecture: A Cadaveric Study

2010-01-01

Background: Bone architecture is a major determinant of its strength. Currently, assessing trabecular architecture & the effectiveness of osteoporosis therapy by iliac crest biopsies is invasive. Imaging may be useful in such assessment, given that a - correlation between vertebral fractures and strength, and correlations between measures of microarchitectures across different sites in body (vertebrae, distal radii) and vertebral strength are assumed in the osteoporosis literature. This study aims to examine such assumptions.

Spine Osteo-Arthrosis Has No Effect on TBS Assessment: A Site Matched Study with BMD

Renaud Winzenrieth, Remy Dufour, Yana Popova Engineer, Didier Hans — 2010-01-01

In the premenopausal population, spinal BMD predicts the risk of any fracture as well as hip BMD. In later life, however spine measurements are confounded by osteo-arthrosis. The latest guidelines published by the ISCD clearly states in case of osteo-arthrosis, it is accepted to exclude a vertebra when there is more than a 1.0 T-score difference between the vertebra in question and adjacent vertebrae. We know that osteo-arthrosis artificially increases DXA BMD measurement proportionally to its severity. TBS is a grey level texture parameter which characterizes micro-architecture status of bone independently of BMD. The objective of this study is to investigate the effect of the osteo-arthrosis on measurement of A-P lumbar spines TBS values using DXA imaging. We present a cross-sectional study on 390 Caucasian subjects. Study group was composed of 141 cases presenting arthrosis (according to ISCD definition) only at L4 vertebra with mean age and BMI of 66.0 ± 8.3 years and 25.2.8 ± 3.5 Kg/m2 respectively and 249 control subjects free of arthrosis with mean age and BMI of 64.1 ± 6.9 years and 24.5.8 ± 3.4 Kg/m2 respectively. Cases were stratified using severity of arthrosis defined by the differences between L3 and L4 expressed in standard deviation of T-score (severity ranges between 1 to 3.5 T-score). In order to validate control and case groups, a comparison between BMD and TBS data of these groups at L1-L3 was done. In addition, TBS values of control subject were compared with French TBS normative data at L1-L4. BMD and TBS were evaluated at AP Spine (L1-L4) with DXA prodigy (GE-Lunar) and TBS iNsight® (Med-Imaps). Absolute differences in percent between case and control groups at L1-L3 for BMD and TBS were 2.4 and 3.3% respectively. These differences were lower than their respective least significant change and did not show statistical significance. In addition, no significant differences were obtained between TBS values of the study group and French TBS normative data at L1-L3. At L4 vertebral level, differences between case and control groups for BMD and TBS were +19% and -3.2% respectively (see figure below). Difference obtained for TBS was lower than the LSC95 (4%) and statistically non significant. For BMD, highly significant difference was found. Correlations obtained between BMD or TBS and the severity of arthrosis were 0.626 and -0.161 respectively. Arthrosis and its severity had no significant effects on TBS whereas a stronger effect was obtained for BMD measurement. TBS could be used to assess bone microarchitecture even if in presence of arthrosis.

Effect of Contrast Scaling Mode on Consistency of Vertebral Fracture Assessment with Norland Illuminatus-Based Software

Tom V. Sanchez, Jingmei Wang, Terry W. Schwalenberg, George J. Ekker — 2010-01-01

Because of the wide range of materials encountered by DXA in a vertebral fracture assessment, image contrast scaling is employed to bring out the structural detail in the study and aid in placement of the height cursors on the vertebrae. To establish a vertebral fracture assessment protocol this study examined the consistency of results using four Norland Illuminatus-based contrast scaling modes available to vertebral fracture assessment.

Radiographic Texture Analysis (RTA) During Treatment with Alendronate

Tamara Vokes, Mike Chinander, Maryellen Giger — 2010-01-01

Background: RTA is a method for noninvasive assessment of bone structure through computerized analysis of the pattern of radiographic bone images. We have applied RTA to calcaneal images obtained using a portable densitometer and found that it differentiated subjects with and without vertebral fractures even when controlling for BMD and clinical risk factors. In the present study, we aimed to determine whether alendronate treatment produces changes in RTA that may be clinically useful for monitoring therapy.

Six-Year Safety and Efficacy Data from Denosumab Phase 2 Extension Study

2010-01-01

Denosumab (DMAb) is an investigational, fully human monoclonal antibody that inhibits RANKL, an essential mediator of osteoclast formation, function, and survival. DMAb has been shown to reduce the risk of vertebral, hip, and nonvertebral fractures after 3 years of treatment in the FREEDOM trial (Cummings NEJM 2009;361:756). In a phase 2 study, DMAb increased bone mineral density (BMD) and reduced bone turnover markers (BTM) after 4 years of treatment (Miller Bone 2008;43:222). Here we present the effects of 6 years of DMAb treatment on safety and efficacy with BMD and BTM. In the original phase 2 parent study, postmenopausal women with a DXA T-score between −1.8 and −4.0 (lumbar spine) or −1.8 and −3.5 (total hip or femoral neck) were randomized to receive placebo, alendronate (ALN), or 1 of 7 different doses of DMAb. After 2 years on study, subjects were reallocated to maintain, discontinue, or discontinue and reinitiate DMAb; discontinue ALN; or maintain placebo for 2 more years (Miller et al. Bone 2008). In a 4-year extension phase of this study, all subjects received open-label DMAb 60 mg subcutaneously every 6 months (Q6M). We report interim 2-year safety and efficacy analyses from the extension study, representing up to 6 years of exposure to DMAb.

BMD Response to Delayed-Release Risedronate 35 Mg Once-A-Week Formulation Taken With or Without Breakfast

2010-01-01

Since their introduction, bisphosphonates (BPs) have become the first line treatment for postmenopausal osteoporosis. BPs have to be taken on an empty stomach at least 30 to 60 minutes before first food or drink. Here we present one year efficacy and safety results of a novel delayed release (DR) formulation of risedronate 35 mg once-a-week (OaW) that can be taken with or without breakfast.

Effect of Once-Yearly Zoledronic Acid 5 Mg on A Sub-Set of Six Non-Vertebral Fractures

Dennis M. Black, R. Eastell, F. Cosman, Z. Man, C. Bucci-Rechtweg, P. Mesenbrink — 2010-01-01

Background: Bisphosphonates are widely used in the treatment of osteoporosis and are efficacious in reducing fracture risk. However, assessment of non-vertebral anti-fracture efficacy of bisphosphonates is not consistent in clinical trials due to differences in the definition of a non-vertebral fracture.

Zoledronic Acid Substantially Reduces the Risk of Morphometric Vertebral and Clinical Fractures

E. Seeman, D.M. Black, C. Bucci-Rechtweg, R. Eastell, S. Boonen, P. Mesenbrink — 2010-01-01

Background: HORIZON-Pivotal Fracture Trial (PFT) showed that a once-yearly infusion of zoledronic acid (ZOL 5 mg) during a 3-year period significantly reduced the risk of morphometric vertebral, hip, and all clinical fractures by 70%, 41%, and 33%, respectively.1 As the fracture risk is not abolished and fractures beget more fractures, we sought to determine whether ZOL reduced the increased risk conferred by further fractures. In a pre-planned analysis, we examined the effect of once-yearly i.v. ZOL 5 mg in preventing a second morphometric vertebral fracture over 3 years and the recurrence of clinical fractures.

Odanacatib in the Treatment of Postmenopausal Women with Low Bone Mineral Density: 3-Year Continued Therapy and Resolution of Effect

2010-01-01

Background: The selective cathepsin K inhibitor odanacatib (ODN) progressively increased bone mineral density (BMD) and decreased bone resorption markers during 2 years of treatment in postmenopausal women with low BMD. A 1-year extension of this study assessed the efficacy and safety of ODN and the effects of discontinuing therapy.

Effect of Single Annual Infusion of Zoledronic Acid (5 Mg) on Lumbar Spine Bone Mineral Density versus Daily Oral Risedronate (5 Mg) in Subgroups of Patients Receiving Glucocorticoid Therapy

2010-01-01

Background: Persistent use of glucocorticoid drugs is associated with bone loss and increased fracture risk. Prevention and treatment of glucocorticoid-induced osteoporosis is best established with bisphosphonates.1 This 1-year, randomized, double-blind, study evaluated the effect of a single annual i.v. infusion of zoledronic acid (ZOL 5 mg) compared to daily oral risedronate (RIS 5 mg) on lumbar spine bone mineral density (LS BMD) in different subgroups of patients receiving glucocorticoid therapy.

Efficacy of Oral Ibandronate versus 3 Mg Intravenous Ibandronate

2010-01-01

Background: Ibandronic acid is a potent, nitrogen-containing bisphosphonate used in the treatment of osteoporosis; it is available like 150 mg film-coated tablet for once monthly oral administration and 3 mg intravenously every 3 months. There is strong patient preference for once-monthly regimen and a favourable impact on therapeutic adherence. Intravenous ibandronate formulation is indicated for all patients who are unable to take oral medicine.

Topographic Bone Density of Humeral Head

Sophie Abrassart — 2010-01-01

Purpose: We aimed to provide an anatomical basis for surgical techniques in rotator cuff reinsertion. The purpose of this study was to investigate the 3-dimensional trabecular bone mineral density (BMD) in the humeral head bone and determine areas of low density. Limited information exists for humeral head to understand its mechanical behavior.

Development of An Osteoporosis Screening Clinic at Jefferson County Department of Health: A Pilot Study

Maryam Iranikhah, Roger D. Lander, Dee Dugan — 2010-01-01

Background: Patients in indigent care system often do not receive osteoporosis screening due to lack of insurance coverage for prescribed DEXA scans. Our study population consisted of patients receiving primary care services at the local health department. Our project was designed to provide osteoporosis screening to this patient population. The study objective was to identify patients who have osteopenia or osteoporosis, provide education on the prevention and treatment of osteoporosis, and to refer patients who have osteoporosis to their physicians to receive treatment. Secondary objectives were to create a model for pharmacy based osteoporosis screening at Jefferson County Department of Health (JCDH) and to evaluate bone density characteristics of patients on long term medroxy-progesterone injections.

Longitudinal Study on the Relationship Between Daily Walking Steps and Changes in QUS Parameters in Japanese Female College Students

Akiko Koike, Jun Kitagawa, Yoshibumi Nakahara — 2010-01-01

To increase and maintain the bone mass, it is essential to be physically active. However, there has been a decrease in the number of young Japanese females who exercise on a regular basis.

Case Report: Effect of Silicone Buttock Implant on DXA Scan Evaluation

Nicholas C. Friedman, Erin Grady, Aamna Hassan, Alaleh Mazhari — 2010-01-01

Background: This is a case report of the potential effect a buttock implants on measurement of Bone Mineral Density of the hips. Case Report: A 69 year-old genotypic male underwent a sexual reassignment surgery to become a phenotypic female. The patient, in association with the gender reassignment, started estrogen 5mg PO daily. Baseline DXA of the spine and hips performed on a Lunar Prodigy in 2007 demonstrates osteopenia with a T score of -1.5 in the hips. (Image 1 , upper) . Vitamin D, calcium and parathyroid hormone levels were checked and found to be within normal limits and patient was started on bisphosphonate.

Comparison of DXA Precision by One vs Two Technologists at a DXA Center

Zafar U. Kaleem, Z. Kaleem, I. Shaheen, F. Javed, M. Reid, J. Thornton, L. Allen — 2010-01-01

Objective: To compare the precision of Dual Energy X-ray Absorptiometry (DXA) measurement at the hip and lumbar regions by one technologist with the precision of DXA performed by two different technologists.

Precision and Least Significant Change In Pediatric Measurements of Bone, Body Composition and Mechanostat Parameters by GE Lunar Prodigy

Maciej Jaworski, Pawel Pludowski, Roman S. Lorenc — 2010-01-01

Reproducibility is crucial for characterizing a method and for monitoring therapy. Its derivative, last significant change (LSC), allows a direct comparison of two consecutive measurements and discrimination between “true” and apparent change. The aim of this study was: to assess the reproducibility of bone, body composition and mechanostat parameters in children using GE Lunar Prodigy, and to evaluate impact of measurement mode and subject's age on its reproducibility. Studied group consisted of 70 girls and 77 boys, aged 5-18 yrs (12.6 ± 3.9), recruited from typical patients of Densitometry Lab. Ethical approval was obtained for the study from local Ethics Committee. Measurement mode was automatically set by the software (v.11.4). Total body and PA spine measurements were done twice, with reposition. Total body bone mineral density (TBBMD), total body bone mineral density less head (TBBMDlh), total body bone mineral content (TBBMC), total body bone area (TBBA), fat mass (FM), lean body mass (LBM), spine bone mineral density (SBMD), spine bone mineral content (SBMC), spine bone area (SBA), FM/body weight, LBM/body weight, FM/LBM, TBBMC/LBM and SBMC/LBM were measured. Absolute errors and coefficients of variation (CV%) were calculated for all outcomes for each participant. Nonparametric statistics were used. Reproducibility for whole group was calculated as root mean square (RMS) and then used to calculate LSC. Statistically significant correlations of absolute CV values with age were observed for TBBMC (r = 0.38), TBBA (r = 0.28), FM (r = 0.24), LBM (r = 0.30), SBMD (r = 0.24) and SBMC (r = 0.30) (p < 0.05). In contrast, CV expressed in percentage (CV%) correlated with age only for TBBMD (r = -0.28, p < 0.05). Calculated LSC values were: TBBMD mode thin 2.47%, TBBMD mode standard 2.02%, TBBMDlh 1.91%, TBBMC 3.88%, TBBA 4.40%, SBMD 2.24%, SBMC 5.87%, SBA 5.60%, FM 5.21%, LBM 2.22%, FM/BW 5.21%, LBM/BW 2.22 %, FM/LBM 7.15%, TBBMC/LBM 5.76% and SBMC/LBM 5.68%. Due to stability of CV% values in wide range of age the use of precision error expressed in percentages rather than absolute error seems to be more convenient for calculation of LSC in pediatric population.

Long-Term vs. Short-Term Precision Measurement of Dual-Energy X-Ray Absorptiometry (DXA) Scans and the Impact of Interpreting Change in Bone Mineral Density (BMD) At Follow-Up

Sarah L. Morgan, Gary M. Kiebzak — 2010-01-01

Introduction: DXA measurement precision assessment provides data used to determine if a change in BMD at follow-up is statistically significant. Typically, repeat scans are conducted within minutes in the same scan session. This is termed short-term precision (STP). In clinical practice however, repeat DXA scans are performed after months or years. Therefore, long-term precision (LTP), in which repeat scans are performed on different days, may more accurately reflect true DXA variability. The primary objective of this study was to compare STP and LTP in the same patients.

Which to Use to Evaluate Change in BMD at Follow-Up: RMS-SD or RMS-%CV?

Sarah L. Morgan, Gary M. Kiebzak — 2010-01-01

Introduction: There is bias toward the use of RMS-SD over RMS-%CV to calculate a LSC term that is used to determine if change in BMD at follow-up is statistically significant. In part, this bias is based on the assumption that SD is relatively constant over a wide range of BMD as opposed to %CV, which is assumed to increase as BMD decreases. However, evidence to support these assumptions is scant. The purpose of this project was to determine the frequency of discrepancies in interpretation of follow-up data using a LSC based on RMS-SD (LSC-SD) vs. RMS-%CV (LSC-CV).

The Average Precision Error of Dual Energy X-Ray Absorptiometry Performed by Multiple Bone Densitometry Technologists

2010-01-01

The result of DXA bone density measurement is related to the technologist. Short-term in-vivo precision assessment measures technologist's ability to reproduce technical factors from one scan to next on same patient. The only one way that a physician can know that a real biologic change has occurred is to know if the least significant change (LSC) of the technique has been exceeded. Each technologist should establish their own LSC value. In the case of multiple technologists performing densitometry studies, the values for the precision studies form individual technologists be averaged to determine the precision for the facility. This study was performed to establish the average LSC value of lumbar spine bone mineral density measurements by 3 densitometry technologists. A total of 45 healthy female subjects who ranged from 34 to 47 years old (mean = 39.6 ± 3.8) with normal anatomy, no pregnancy and without taking any medicine which could influence bone metabolism. 45 healthy volunteers’ mean height was 158.1 ± 4.8 cm (mean ± SD), mean weight was 56.5 ± 8.4 kg and mean body mass index (BMI) was 22.6 ± 3.5. The percent coefficient of variation (% CV) of daily quality assurance was 0.394 %. Choosing PA spine scan mode, precision error (group root-mean-square average standard deviation of the error; in g/cm2) and LSC of each technologist were determined in 15 healthy volunteers scanned 3 times each at the lumbar spine (15 patient × 3 scans / patient = 45 scans / technologist × 3 technologists = 135 scans) on Hologic QDR 4500 scanner, with repositioning after each scan. All patients’ L-spine scans for each technologist were done on same day. All precision error and LSC data derived from 3 technologists done within 1 month. The average precision error (RMS SD) in BMD for L1-L4 by 3 technologists was 0.009 g/cm2. An average calculate LSC for the group at the 95% confidence interval was 0.024 g/cm2 ( = 0.009 g/cm2 × 2.77). Precision overall is excellent and these results are consistent with International Society for Clinical Densitometry (ISCD) recommendations (the RMS SD less than 0.020 g/cm2 for spine). As well as the regular scanning of phantoms to check system calibration and patient related factors (artifact, anatomy deformities, patients’ movements, and patient cooperation), the other major quality assurance issue is the training of staff performing bone densitometry investigations to ensure consistency in patient positioning and scan analysis. It is difficult to follow the same positioning and analysis standard for multiple technologists. This study was a very successful experience about establishing an average PE and an average LSC value performed by multiple technologists.

Reviewing Bone Density Images Using Online Reporting System “Bonestation” May Improve the Ability of the Reviewer to Detect Radiographic Abnormalities Compared with Reviewing Images on Paper Printouts

Latarsha G. Whittaker, Alan O. Malabanan, Harold N. Rosen — 2010-01-01

Background: When reporting bone densitometry, any significant radiographic abnormalities that are observed should be mentioned in the final report. However, the ability of the reader to detect radiographic abnormalities in bone densitometry is limited by the resolution of the images produced, and the resolution of the modality on which the bone density is viewed. Our center recently transitioned from a paper-based BMD viewing and reporting systems to a web-based system called BoneStation, which has resulted in substantial savings in cost, space, and manpower (in press, Endocrine Practice). Since this transition we noticed radiographic abnormalities that were clearly present previously, but were not reported when we used to base reports on paper printouts. This observation suggested that a web-based reviewing system might improve image resolution sufficiently to improve sensitivity to detect radiographic abnormalities. We plan to present examples, but thought that it was important to quantify this finding.

Challenges in Establishing a Bone Center in a Midsize Children's Hospital

Sevket Yigit, Donna Steben, Suzanne Czerwinski, Karen Rubin — 2010-01-01

In 2005 Kids’ Center for Bone Health opened in Connecticut Children's Medical Center , Hartford CT with the acquisition of a Lunar Prodigy Advance bone density machine(GE Lunar ,Madison WI).In 2007, we presented the profile of pediatric referrals for DXA for the first year operations of the newly opened pediatric bone center.

Dual-Energy X-Ray Absorptiometry with Serum Ferritin Predict Liver Iron Concentration and Change in Concentration Better Than Ferritin Alone

2010-01-01

Accurate assessment of liver iron concentration (LIC) is critical to prevent iron toxicity in multi-transfused patients. Serum ferritin is the most widely used even though its association to LIC is only modest. We studied if a liver-specific measure using Dual-energy X-ray absorptiometry (DXA) systems could improve LIC estimates over ferritin alone in Thalassemia (Thal) patients. Thirty-seven patients with Thal (18.1 ± 6.4 yrs, 20 Male) were studied and ten had multiple visits. Height, weight, ferritin, whole-body DXA, and hepatic Superconducting Quantum Interference Device (SQUID) were measured within 5 weeks. DXA hepatic density was measured using right rib, whole liver, and multiple sub liver regions. The best agreement to SQUID LIC was found using a combination of ferritin, weight, DXA sub-liver region 3 (R3) BMC, and right rib BMC. DXA with ferritin improved the ferritin alone correlation from R2 = 0.35 to R2 = 0.62. Serial LIC changes using DXA were associated with serial SQUID changes (r = 0.73, p = 0.02). Changes in ferritin alone were not significant (p = 0.06). We conclude that the addition of whole body DXA measures and body weight substantially increased the accuracy of LIC and change in LIC estimates over the use of ferritin alone and could be useful when MRI or SQUID are not available.

The Role of DXA Forearm Analysis in Osteoporosis Clinical Investigation

Claudia B. Maksoud, Henrique Alberto Pasqualette, Yara Leitao — 2010-01-01

Introduction: Osteoporosis is a silent disease and dual energy x-ray (DXA) bone densitometry is still considered the gold standard method for the diagnosis and follow-up. Routine examination includes the study of lumbar spine and hip. The distal forearm acquisition which has a low precision error, is used when one of the previous skeletal sites are not qualified for diagnosis.

Utility and Precision of Body Composition Prediction from Half-Body and Spine/Hip DXA: Comparison of Prodigy with iDXA

Nellie Vallarta-Ast, Diane Krueger, Neil Binkley — 2010-01-01

There is increasing interest in body composition assessment using DXA. Available scan width is a technical limitation in some clinical situations for which half-body analysis appears to be a valid approach. Additionally, given the increasing recognition of sarcopenia as a fracture risk factor, it is plausible that routine spine/hip DXA can provide additional information by estimating lean body mass. As such, the purposes of this study were to compare body composition as obtained by total body DXA with that estimated from half-body and spine/hip measurement with a GE Healthcare Lunar Prodigy and iDXA densitometer. Eighty individuals (38 women/42 men) age 20-85.4 years had lumbar spine, proximal femur and total body measurements performed on both instruments in routine clinical manner by ISCD certified technologists. Precision assessment was conducted in a randomly-selected subset (n = 30). Software versions 9.2 (Prodigy) and 9.3 (iDXA) were used for acquisition, 11 (iDXA), 11.4 (Prodigy) and 12 (both) for analyses. The ISCD precision calculating tool was used to determine precision of total body measurement and half-body estimation. Body composition results were compared by linear regression and Bland-Altman analyses using Analyze-it software. Instrument precision was compared by F-test. Total body bone, fat and lean mass as estimated from half-body analysis was extremely highly correlated with that obtained by actual measurement (r2 = 0.98-1.00) for both instruments. Total body precision (%CV) for bone, fat and lean mass was better (p < 0.0001) with iDXA ( < 1%) than Prodigy (1.2-2.1%). Precision of half-body estimates were good although inferior to direct measurement (Table).

Comparison of the PA and Lateral Spine T- and Z-Scores by Dual Energy X-Ray Absorptiometry in Persons with Spinal Cord Injury

2010-01-01

Background: Bone mineral density (BMD) of the posterior-anterior lumbar spine (PA L-spine) has been reported to be normal by routine DXA in persons with chronic spinal cord injury (SCI). Unlike the extremities and pelvis, several cross-sectional studies have found that the vertebral column does not appear to lose bone mass after paralysis but, rather, tends to gain bone mass with age and/or longer duration of injury (DOI). However, the posterior elements captured by the PA spine scan are rich in cortical bone and prone to extraneous calcification due to degenerative joint disease that may be made worse by paralysis and wheelchair-dependence. As reported in the able-bodied population, the inclusion of extraneous calcification of the posterior elements may underestimate bone loss of the lumbar vertebrae. The objective of this study was to determine if DXA PA L-spine measurements underestimate bone loss compared with those of the LAT L-spine in persons with SCI.

Re: Lazoura et al. Bone Mineral Density Alterations in Upper and Lower Extremities 12 Months After Stroke Measured by Peripheral Quantitative Computed Tomography and DXA (J Clin Densitom 2008;11;511-517)

2010-01-01

After carefully reviewing our paper entitled “Bone Mineral Density Alterations in Upper and Lower Extremities 12 Months After Stroke Measured by Peripheral Quantitative Computed Tomography and DXA” by Lazoura et al (J Clin Densitom 2008;11:511-517), we regretfully admit that parts of the Methods section and a paragraph from the limitations of the study section have been copied from the manuscript entitled “Muscle Weakness Spasticity and Disuse Contribute to Demineralization and Geometric Changes in the Radius Following Chronic Stroke” by Pang et al (Osteoporos Int 2007;18:1243-1252). However, the parts that were copied from Dr. Pang's manuscript do not substantially alter neither the results that were derived by the statistical analysis nor the clinical impact of our study.