Age-Related Changes in Bone Density, Microarchitecture, and Strength in Postmenopausal Black and White Women: The SWAN Longitudinal HR-pQCT Study

Choose your mother wisely: the familial resemblance of bone adaptation

This study demonstrates how complex bone microarchitectural features can be summarized to describe bone adaptations seen with aging in women, which are consistent with the stages of osteoporosis. Additionally, we showed familial resemblance in these bone microarchitectural traits between mothers and daughters that can be used to predict bone adaptations.

INTRODUCTION

Patient-specific characterization of bone quality can reduce complex microarchitectural features to common combinations of bone characteristics, known as bone phenotypes. This study investigated whether there is a general trend in bone phenotype change over time seen with aging in females and whether there is a familial resemblance to phenotype membership between mothers and daughters.

METHODS

Bone phenotype membership was calculated on biological mother and daughter pairs (Participants = 101), scanned using high resolution peripheral quantitative computed tomography, to the three pre-defined phenotypes (healthy, low volume, and low density). The trajectory of bone phenotype with age was explored using all participant's data. Linear regression models were used to assess the familial resemblance of phenotyping in the mother-daughter pairs.

RESULTS

When stratified for age, the trajectory of the phenotype membership transitioned from healthy (20-40 years), to low volume (40-60 years), to low density (60-80 years), which similarly aligns with the stages of osteoporosis observed in females. Familial resemblance (½h2) was observed in the healthy phenotype (β = 0.432, p < 0.01). Predictive modelling showed a significant association in phenotype membership between mothers and daughters in the healthy (R2 = 0.347, p = 0.04) and low volume (R2 = 0.416, p < 0.01) phenotypes, adjusted for age, height, and weight.

CONCLUSION

Our results suggest that phenotype membership in females changes with age in a pattern that is consistent with the stages of osteoporosis. Additionally, we showed familial resemblance in bone phenotype, which can be used to predict bone adaptations between mothers and daughters that are associated with bone loss with aging.

Circulating Baseline CXCR3+Th2 and Th17 Cell Proportions Correlate With Trabecular Bone Loss After 48 Weeks of Biological Treatment in Early Rheumatoid Arthritis

OBJECTIVE

The high prevalence of osteoporosis in rheumatoid arthritis (RA) is due to inflammation that stimulates differentiation of osteoclasts, a process involving circulating monocytes and T cell-derived factors. The aim of this study was to evaluate relations between circulating monocytes, T cell subsets, and changes in bone characteristics before and after treatment with biological disease-modifying antirheumatic drugs (bDMARDs) in RA.

METHODS

Thirty patients with untreated early RA who met the American College of Rheumatology/EULAR 2010 criteria were included. Data were collected before and 48 weeks after treatment with methotrexate (MTX) together with one of three bDMARDs (abatacept, tocilizumab, or certolizumab pegol). Disease activity was measured using the Clinical Disease Activity Index, swollen or tender joint counts, C-reactive protein levels, and erythrocyte sedimentation rates. Proportions of monocyte and CD4+ T cell subsets in blood samples were analyzed by flow cytometry. Bone densitometry was performed using high-resolution peripheral quantitative computed tomography (HR-pQCT).

RESULTS

HR-pQCT revealed an overall decrease in cortical (P = 0.009) and trabecular (P = 0.034) bone mineral density, although a subset of patients showed no bone loss after 48 weeks of treatment. The overall bone loss was not associated with age, body mass index, sex, intraarticular glucocorticoid injections, or baseline disease activity. Loss of trabecular bone volume fraction correlated with high proportions of circulating CXCR3+Th2 cells (r = -0.38, P = 0.04) and CXCR3+Th17 cells (r = -0.36, P = 0.05) at baseline. Similarly, no loss of trabecular bone volume fraction correlated with high proportions of regulatory T cells (r = 0.4, P = 0.03) at baseline. However, the associations were not significant when corrected for confounders and multiple testing.

CONCLUSION

MTX together with bDMARDs efficiently reduce disease activity but only prevent bone loss in a subset of patients with RA after 48 weeks of treatment. The correlations of circulating baseline T helper cell and regulatory T cell populations with trabecular bone changes suggest a potential novel role for these cells in systemic bone homeostasis during early RA.

Effects of 12-week power training on bone in mobility-limited older adults: randomised controlled trial

This study examines how power training affects estimated bone strength, revealing that females benefit more than males, especially in the upper limbs (radius). These findings highlight the importance of designing sex-specific exercise programs to enhance bone health. Further research is needed to optimize training duration and address site-specific differences.

PURPOSE

This study aimed to compare the effects of 12-week of power training (PWT), an explosive form of strength training, on bone microarchitecture, estimated bone strength, and markers in mobility-limited (gait speed < 0.9 m/s) older adults.

METHODS

Fifty-seven older adults (83 ± 5 years) were randomly assigned to either a training group (TRAIN, n = 28, 15 females, 13 males) performing high-intensity PWT or a control group (CTRL, n = 29, 22 females, 7 males) maintaining their usual lifestyle. High-resolution peripheral quantitative computed tomography (HR-pQCT) assessed bone geometry, densities, microarchitecture (e.g. trabecular number (Tb.N) and thickness (Tb.Th)), and estimated bone strength (stiffness and failure load) at the tibia and radius. Blood markers for bone metabolism (PINP and CTX-1) and muscle strength (handgrip and leg press) were also measured.

RESULTS

Baseline sex differences showed females having lower stiffness (- 37.5%) and failure load (- 38%) at the radius compared with males. After PWT, females in the TRAIN group exhibited declines in Tb.N (- 4.4%) and improvements in Tb.Th (+ 6.0%), stiffness (+ 2.7%), and failure load (+ 2.4%) at the radius (p < 0.05). A time x group interaction indicated increases in leg press strength for the whole TRAIN group (+ 23%), and within females (+ 29%) and males (+ 19%) (p < 0.001). Baseline handgrip strength correlated with stiffness (r = 0.577) and failure load (r = 0.612) at the radius (p < 0.001). Females in the TRAIN group showed a reduction in PINP (- 25%), while males showed an increase in CTX-1 (+ 18%).

CONCLUSION

A 12-week PWT may enhance estimated bone strength in mobility-limited older adults, especially at sites less accustomed to daily loading (i.e. radius).

CLINICAL TRIAL REGISTRATION

NCT02051725.

Age-related Differences in Volumetric Bone Mineral Density, Structure, and Bone Strength of Surgical Neck of Humerus in Postmenopausal Women

OBJECTIVE

Postmenopausal changes in bone mass and structure compromise the mechanical properties of proximal humerus, predisposing it to low-energy fractures with complex morphology. The aim of the study is to investigate associations of bone quality and estimated bone strength of the surgical neck with age after menopause.

METHODS

A total of 122 healthy postmenopausal women were recruited from December 2016 to December 2022 and assigned to three groups: the 50-59 years group, the 60-69 years group, and the older than 70 years group. Bone properties of the surgical neck, including volumetric bone mineral density (vBMD), cortical thickness (CTh), the periosteal and medullary size, and estimated indices of bone strength were evaluated by quantitative computed tomography.

RESULTS

Compared to the 50-59 years group, postmenopausal women aged over 70 years were characterized by lower cortical thickness (13.9%) and vBMD (6.65%), as well as reduced strength indices including the minimum and maximum section modulus (Zmin 18.11%, Zmax 21.71%), polar section modulus (Zpol 20.21%), and the minimum and maximum second moments of area (Imax 21.01%, Imin 21.43%). Meanwhile, the difference in periosteal diameter and perimeter, total area in three groups did not reach statistical significance. Both cortical thickness and vBMD value were inversely associated with age, showing 10.56% and 23.92% decline. Imax showed the greatest age-related decrease between age of 54 and 86 years (39.08%), followed by Zmax (-35.77%), Imin (-35.73%), Zpol (-34.90%) and Imin (-23.92%).The strength indices had stronger correlations with cortical thickness than with bone size or density.

CONCLUSION

In postmenopausal women, aging is associated with a significant decline in cortical bone thickness and mechanical strength of the proximal humerus, especially over the age of 70 years.

A Randomized Controlled Trial on the Effect of Luseogliflozin on Bone Microarchitecture Evaluated Using HR-pQCT in Elderly Type 2 Diabetes

INTRODUCTION

Bone fragility is a critical issue in the treatment of elderly people with type 2 diabetes (T2D). In the Canagliflozin Cardiovascular Assessment Study, the subjects with T2D who were treated with canagliflozin showed a significant increase in fracture events compared to a placebo group as early as 12 weeks post-initiation. In addition, it has been unclear whether sodium-glucose co-transporter 2 (SGLT2) inhibitors promote bone fragility. We used high-resolution peripheral quantitative computed tomography (HR-pQCT) to prospectively evaluate the short-term effect of the SGLT2 inhibitor luseogliflozin on bone strength and microarchitecture in elderly people with T2D.

METHODS

This was a single-center, randomized, open-label, active-controlled pilot trial for ≥ 60-year-old Japanese individuals with T2D without osteoporosis. A total of 22 subjects (seven women and 15 men) were randomly assigned to a Lusefi group (added luseogliflozin 2.5 mg) or a control group (added metformin 500 mg) and treated for 48 weeks. We used the second-generation HR-pQCT (Xtreme CT II®, Scanco Medical, Brüttisellen, Switzerland) before and 48 weeks after the treatment to evaluate the subjects' bone microarchitecture and estimate their bone strength.

RESULTS

Twenty subjects (Lusefi group, n = 9; control group, n = 11) completed the study, with no fracture events. As the primary outcome, the 48-week changes in the bone strength (stiffness and failure load) estimated by micro-finite element analysis were not significantly different between the groups. As the secondary outcome, the changes in all of the cortical/trabecular microarchitectural parameters at the radius and tibia from baseline to 48 weeks were not significantly different between the groups.

CONCLUSIONS

In the pilot trial, we observed no negative effect of 48-week luseogliflozin treatment on bone microarchitecture or bone strength in elderly people with T2D.

TRIAL REGISTRATION

UMIN-CTR no. 000036202 and jRCT 071180061.

Ageing-related bone and immunity changes: insights into the complex interplay between the skeleton and the immune system

Ageing as a natural irreversible process inherently results in the functional deterioration of numerous organ systems and tissues, including the skeletal and immune systems. Recent studies have elucidated the intricate bidirectional interactions between these two systems. In this review, we provide a comprehensive synthesis of molecular mechanisms of cell ageing. We further discuss how age-related skeletal changes influence the immune system and the consequent impact of immune system alterations on the skeletal system. Finally, we highlight the clinical implications of these findings and propose potential strategies to promote healthy ageing and reduce pathologic deterioration of both the skeletal and immune systems.

Deficits in volumetric bone mineral density, bone microarchitecture, and estimated bone strength in women with atypical anorexia nervosa compared to healthy controls

OBJECTIVE

Anorexia nervosa is associated with low bone mineral density (BMD) and deficits in bone microarchitecture and strength. Low BMD is common in atypical anorexia nervosa, in which criteria for anorexia nervosa are met except for low weight. We investigated whether women with atypical anorexia nervosa have deficits in bone microarchitecture and estimated strength at the peripheral skeleton.

METHOD

Measures of BMD and microarchitecture were obtained in 28 women with atypical anorexia nervosa and 27 controls, aged 21-46 years.

RESULTS

Mean tibial volumetric BMD, cortical thickness, and failure load were lower, and radial trabecular number and separation impaired, in atypical anorexia nervosa versus controls (p < .05). Adjusting for weight, deficits in tibial cortical bone variables persisted (p < .05). Women with atypical anorexia nervosa and amenorrhea had lower volumetric BMD and deficits in microarchitecture and failure load versus those with eumenorrhea and controls. Those with a history of overweight/obesity or fracture had deficits in bone microarchitecture versus controls. Tibial deficits were particularly marked. Less lean mass and longer disease duration were associated with deficits in high-resolution peripheral quantitative computed tomography (HR-pQCT) variables in atypical anorexia nervosa.

DISCUSSION

Women with atypical anorexia nervosa have lower volumetric BMD and deficits in bone microarchitecture and strength at the peripheral skeleton versus controls, independent of weight, and particularly at the tibia. Women with atypical anorexia nervosa and amenorrhea, less lean mass, longer disease duration, history of overweight/obesity, or fracture history may be at higher risk. This is salient as deficits in HR-pQCT variables are associated with increased fracture risk.

PUBLIC SIGNIFICANCE

Atypical anorexia nervosa is a psychiatric disorder in which psychological criteria for anorexia nervosa are met despite weight being in the normal range. We demonstrate that despite weight in the normal range, women with atypical anorexia nervosa have impaired bone density, structure, and strength compared to healthy controls. Whether this translates to an increased risk of incident fracture in this population requires further investigation.

Causal relationship between glycemic traits and bone mineral density in different age groups and skeletal sites: a Mendelian randomization analysis

INTRODUCTION

Previous research has confirmed that patients with type 2 diabetes mellitus tend to have higher bone mineral density (BMD), but it is unknown whether this pattern holds true for individuals without diabetes. This Mendelian randomization (MR) study aims to investigate the potential causal relationship between various glycemic trait (including fasting glucose, fasting insulin, 2-h postprandial glucose, and glycated hemoglobin) and BMD in non-diabetic individuals. The investigation focuses on different age groups (15-30, 30-45, 45-60, and 60 + years) and various skeletal sites (forearm, lumbar spine, and hip).

MATERIALS AND METHODS

We utilized genome-wide association study data from large population-based cohorts to identify robust instrumental variables for each glycemic traits parameter. Our primary analysis employed the inverse-variance weighted method, with sensitivity analyses conducted using MR-Egger, weighted median, MR-PRESSO, and multivariable MR methods to assess the robustness and potential horizontal pleiotropy of the study results.

RESULTS

Fasting insulin showed a negative modulating relationship on both lumbar spine and forearm. However, these associations were only nominally significant. No significant causal association was observed between blood glucose traits and BMD across the different age groups. The direction of fasting insulin's causal effects on BMD showed inconsistency between genders, with potentially decreased BMD in women with high fasting insulin levels and an increasing trend in BMD in men.

CONCLUSIONS

In the non-diabetic population, currently available evidence does not support a causal relationship between glycemic traits and BMD. However, further investigation is warranted considering the observed gender differences.

Strontium Ranelate and Strontium Chloride Supplementation Influence on Bone Microarchitecture and Bone Turnover Markers-A Preliminary Study

Despite strontium ranelate use in osteoporosis management being one of the promising concepts in disease treatment, there is no clear evidence that strontium organic compounds are more effective than inorganic ones. The aim of this study was to compare strontium chlorate and strontium ranelate influence on the mice bone microarchitecture. We investigated whether strontium chlorate (7.532 mmol/L) and strontium ranelate (7.78 mmol/L) solutions fed to healthy SWISS growing mice (n = 42) had an influence on the percent of bone volume (BV/TV), trabecular thickness (Tb.Th), number of trabeculae (Tb.N), and separation between each trabecula (Tb.Sp) in the chosen ROI (region of interest) in the distal metaphysis of the left femurs. The cortical bone surface was examined close to the ROI proximal scan. There was an increase in each examined parameter compared with the control group. There were no statistical differences between strontium ranelate and strontium chlorate parameters. Our study indicates that organic and inorganic strontium compounds similarly affect the bone microarchitecture and strength.

Racial/Ethnic Differences in Bone Mineral Density for Osteoporosis

PURPOSE OF REVIEW

We primarily aim to review differences in bone mineral density (BMD) for osteoporosis among different racial/ethnic groups and to highlight the magnitude of racial/ethnic differences in obesity and diabetes. We also explore the factors contributing to the BMD differences among various subgroups. In addition, we investigate the existing disparities in research, educational initiatives, screening practices, and treatment options for osteoporosis and discuss these findings' clinical and public health implications.

RECENT FINDINGS

Racial/ethnic differences in BMD for osteoporosis exist in the USA and other countries. There are disparities regarding osteoporosis screening and treatment. Understanding the factors contributing to these differences can help develop targeted interventions and policies to reduce their impact. Clinicians should consider the racial/ethnic differences in BMD when making treatment decisions and providing preventive care. Future research could contribute to developing effective strategies for preventing osteoporosis among different racial/ethnic groups. This review offered a comprehensive examination of differences in BMD across various racial and ethnic groups, elucidating the influence of genetic, lifestyle, and cultural factors on these differences. This review also highlighted the disparities in osteoporosis screening, treatment options, research on medical effectiveness, and educational outreach tailored to each subgroup. Recognizing the importance of addressing these inequalities, we present this review to advocate for targeted interventions to reduce disparities in osteoporosis and improve bone health for all populations.

Male Runners With Lower Energy Availability Have Impaired Skeletal Integrity Compared to Nonathletes

CONTEXT

Female athletes, particularly runners, with insufficient caloric intake for their energy expenditure [low energy availability (EA) or relative energy deficiency] are at risk for impaired skeletal integrity. Data are lacking in male runners.

OBJECTIVE

To determine whether male runners at risk for energy deficit have impaired bone mineral density (BMD), microarchitecture, and estimated strength.

DESIGN

Cross-sectional.

SETTING

Clinical research center.

PARTICIPANTS

39 men (20 runners, 19 controls), ages 16-30 years.

MAIN OUTCOME MEASURES

Areal BMD (dual-energy x-ray absorptiometry); tibia and radius volumetric BMD and microarchitecture (high-resolution peripheral quantitative computed tomography); failure load (microfinite element analysis); serum testosterone, estradiol, leptin; energy availability.

RESULTS

Mean age (24.5 ± 3.8 y), lean mass, testosterone, and estradiol levels were similar; body mass index, percent fat mass, leptin, and lumbar spine BMD Z-score (-1.4 ± 0.8 vs -0.8 ± 0.8) lower (P < .05); and calcium intake and running mileage higher (P ≤ .01) in runners vs controls. Runners with EA

CONCLUSIONS

Despite weight-bearing activity, skeletal integrity is impaired in male runners with lower caloric intake relative to exercise energy expenditure, which may increase bone stress injury risk. Lower estradiol and lean mass are associated with lower tibial strength in runners.

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Key Words

• HR-pQCT
• athletes
• bone density
• energy availability

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MESH Headings

• Humans
• Male
• Female
• Leptin
• Cross-Sectional Studies
• Calcium
• Bone Density
• Absorptiometry, Photon
• Lumbar Vertebrae
• Testosterone
• Estradiol

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Grants

• K23 DK115903 NIDDK NIH HHS
• K24 HD071843 NICHD NIH HHS
• 1UL1TR002541-01 NIH HHS
• K24 HL092902 NHLBI NIH HHS
• Massachusetts General Hospital Executive Committee on Research
• National Institutes of Health
• Department of Defense Research Participation Program
• U.S. Army Research Institute of Environmental Medicine
• Oak Ridge Institute for Science and Education

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Affiliation(s)

Melanie S Haines Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA Harvard Medical School, Boston, MA 02115, USA
Snimarjot Kaur Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA Harvard Medical School, Boston, MA 02115, USA
Geetanjali Scarff Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
Meghan Lauze Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
Anu Gerweck Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
Meghan Slattery Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA
Nicolas M Oreskovic Harvard Medical School, Boston, MA 02115, USA Department of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA 02114, USA
Kathryn E Ackerman Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA Harvard Medical School, Boston, MA 02115, USA Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, Boston, MA 02115, USA
Adam S Tenforde Harvard Medical School, Boston, MA 02115, USA Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Cambridge, MA 02129, USA
Kristin L Popp Harvard Medical School, Boston, MA 02115, USA Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA Military Performance Division, United States Army Research Institute of Environmental Medicine, Natick, MA 01760, USA Department of Energy, Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830, USA
Mary L Bouxsein Harvard Medical School, Boston, MA 02115, USA Endocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA Center for Advanced Orthopedic Studies, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA
Karen K Miller Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA Harvard Medical School, Boston, MA 02115, USA
Madhusmita Misra Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA 02114, USA Harvard Medical School, Boston, MA 02115, USA Division of Pediatric Endocrinology, Massachusetts General Hospital, Boston, MA 02114, USA

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Longitudinal Change in Bone Density, Geometry, and Estimated Bone Strength in Older Men and Women From The Gambia: Findings From the Gambian Bone and Muscle Aging Study (GamBAS)

Musculoskeletal aging in the most resource-limited countries has not been quantified, and longitudinal data are urgently needed to inform policy. The aim of this prospective study was to describe musculoskeletal aging in Gambian adults. A total of 488 participants were recruited stratified by sex and 5-year age band (aged 40 years and older); 386 attended follow-up 1.7 years later. Outcomes were dual-energy X-ray absorptiometry (DXA) (n = 383) total hip areal bone mineral density (aBMD), bone mineral content (BMC), bone area (BA); peripheral quantitative computed tomography (pQCT) diaphyseal and epiphyseal radius and tibia (n = 313) total volumetric BMD (vBMD), trabecular vBMD, estimated bone strength indices (BSIc), cross-sectional area (CSA), BMC, and cortical vBMD. Mean annualized percentage change in bone outcomes was assessed in 10-year age bands and linear trends for age assessed. Bone turnover markers, parathyroid hormone (PTH), and 25-hydroxyvitamin D (25(OH)D) were explored as predictors of change in bone. Bone loss was observed at all sites, with an annual loss of total hip aBMD of 1.2% in women after age 50 years and in men at age 70 years plus. Greater loss in vBMD and BSIc was found at the radius in both men and women; strength was reduced by 4% per year in women and 3% per year in men (p trend 0.02, 0.03, respectively). At cortical sites, reductions in BMC, CSA, and vBMD were observed, being greatest in BMC in women, between 1.4% and 2.0% per annum. Higher CTX and PINP predicted greater loss of trabecular vBMD in women and BMC in men at the radius, and higher 25(OH)D with less loss of tibial trabecular vBMD and CSA in women. The magnitude of bone loss was like those reported in countries where fragility fracture rates are much higher. Given the predicted rise in fracture rates in resource-poor countries such as The Gambia, these data provide important insights into musculoskeletal health in this population. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Denosumab increases spine bone density in women with anorexia nervosa: a randomized clinical trial

Objective

Anorexia nervosa is complicated by high bone resorption, low bone mineral density (BMD), and increased fracture risk. We investigated whether off-label antiresorptive therapy with denosumab increases BMD in women with anorexia nervosa.

Design

Twelve-month, randomized, double-blind, placebo-controlled study.

Methods

Thirty ambulatory women with anorexia nervosa and areal BMD (aBMD) T-score <-1.0 at ≥1 sites were randomized to 12 months of denosumab (60 mg subcutaneously q6 months)(n = 20) or placebo (n = 10). Primary end point was postero-anterior (PA) lumbar spine aBMD by dual-energy x-ray absorptiometry. Secondary end points included femoral neck aBMD, tibia and radius volumetric BMD and bone microarchitecture by high-resolution peripheral quantitative CT, tibia and radius failure load by finite element analysis (FEA), and markers of bone turnover.

Results

Baseline mean (±s.d.) age (29 ± 8 (denosumab) vs 29 ± 7 years (placebo)), BMI (19.0 ± 1.7 vs 18.0 ± 2.0 kg/m2), and aBMD (PA spine Z-score -1.6±1.1 vs -1.7±1.4) were similar between groups. PA lumbar spine aBMD increased in the denosumab vs placebo group over 12 months (P = 0.009). The mean (95% CI) increase in PA lumbar spine aBMD was 5.5 (3.8-7.2)% in the denosumab group and 2.2 (-0.3-4.7)% in the placebo group. The change in femoral neck aBMD was similar between groups. Radial trabecular number increased, radial trabecular separation decreased, and tibial cortical porosity decreased in the denosumab vs placebo group (P ≤ 0.006). Serum C-terminal telopeptide of type I collagen and procollagen type I N-terminal propeptide decreased in the denosumab vs placebo group (P < 0.0001). Denosumab was well tolerated.

Conclusions

Twelve months of antiresorptive therapy with denosumab reduced bone turnover and increased spine aBMD, the skeletal site most severely affected in women with anorexia nervosa.