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Aydin Ozturk P, Arac E, Ozturk U, Arac S. Estimation of bone mineral density with hounsfield unit measurement. Br J Neurosurg 2024; 38:464-467. [PMID: 33629886 DOI: 10.1080/02688697.2021.1888877] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Although dual-energy x-ray absorptiometry (DXA) remains the gold standard for the measurement of bone mineral density (BMD), degenerative spine and spinal instrumentation yields inaccurate results, warranting the need for optional methods. METHODS Surgical options depend on the BMD of the patients, and to accommodate this need, we compared Hounsfield unit (HU) measurements obtained from computed tomography (CT) scans with the T-scores obtained from DXA scans to inquire whether HU measurements can screen for BMD. In this study, we also evaluated the relationship between body mass index and spontaneous fractures. RESULTS Based on the findings described in this study, we provide evidence that HU measurements obtained from CT scans can predict BMD. CONCLUSIONS This, therefore, allows HU measurements to be used as an effective diagnostic method in lieu of DXA scans when deciding on appropriate management of therapy for patients with spinal instrumentation or degenerative spines.
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Affiliation(s)
- Pınar Aydin Ozturk
- Department of Neurosurgery, University of Health Sciences, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Esref Arac
- Department of Internal Medicine, University of Health Sciences, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Unal Ozturk
- Department of Neurology, University of Health Sciences, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Songul Arac
- Department of Emergency Medicine and First Aid, University of Health Sciences, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
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Ruangnopparut R, Charoensri S, Sribenjalak D, Theerakulpisut D, Pongchaiyakul C. Trabecular Bone Score Improves Fracture Risk Discrimination in Postmenopausal Rheumatoid Arthritis Patients Receiving Glucocorticoids. Int J Gen Med 2024; 17:287-295. [PMID: 38292825 PMCID: PMC10826709 DOI: 10.2147/ijgm.s448659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024] Open
Abstract
Background Bone mineral density (BMD) might not be a sensitive tool for predicting osteoporotic fracture risk among patients with rheumatoid arthritis (RA), especially when receiving glucocorticoids. Trabecular bone score (TBS), which has emerged as a new assessment technique representing bone microarchitecture and strength, may be considered an alternative approach. Materials and Methods In this cross-sectional analytical study, postmenopausal RA patients receiving glucocorticoids were identified from the postmenopause BMD database. The database included clinical data of postmenopausal outpatients who had at least one BMD measurement between January 2014 and December 2017. TBS was calculated from lumbar spine BMD with the microarchitecture assessment software. The presence of osteoporotic fractures, either vertebral or non-vertebral, was identified at the time of BMD measurement. Results A total of 64 postmenopausal RA patients receiving glucocorticoids were included. The TBS values were inversely associated with osteoporotic fractures, with a TBS cut-off of less than 1.24, showing the best accuracy with a sensitivity of 79% and a specificity of 84% in discriminating fractures. This newly proposed TBS threshold combined with a BMD T-score of -2.5 or less demonstrated a greater area under receiver operating characteristic curve in identifying patients with osteoporotic fractures than the BMD threshold alone (p value = 0.003). Conclusion The reduction in TBS was associated with an osteoporotic fracture in postmenopausal RA patients receiving glucocorticoids. Combining TBS and BMD in these patients incrementally improves fracture risk discrimination and may serve as a supplementary tool in identifying patients at greatest risk of osteoporotic fracture.
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Affiliation(s)
| | - Suranut Charoensri
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Dueanchonnee Sribenjalak
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Daris Theerakulpisut
- Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chatlert Pongchaiyakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Tang IYK, Luk L, Wong V, Pang S, Lao V, So H. Reduced bone mineral density in patients with idiopathic inflammatory myopathies: a case-control study. Ther Adv Musculoskelet Dis 2023; 15:1759720X231181968. [PMID: 37484925 PMCID: PMC10356997 DOI: 10.1177/1759720x231181968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 05/30/2023] [Indexed: 07/25/2023] Open
Abstract
Background Patients with idiopathic inflammatory myopathies (IIMs) are at risk of reduced bone mineral density (BMD). Objectives To compare the prevalence of reduced BMD between patients with IIMs and controls and to determine its risk factors. Design This was a single-center case-control study. Methods BMD was assessed by dual-energy X-ray absorptiometry. The prevalence of reduced BMD in IIM patients and age-and sex-matched non-rheumatological controls was compared. The BMD results of female IIM were also compared to age-matched female rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) patients. Independent factors associated with reduced BMD in IIM patients were identified by multivariate analyses. Results A total of 230 patients (IIM: 65, non-rheumatological controls: 65, RA: 50, SLE: 50) were recruited. The mean age of IIM patients was 58.6 ± 11.0 years and 76.9% were females. Significantly, more IIM patients had reduced BMD (73.8% versus 43.1%, p = 0.043) and osteoporosis (29.2% versus 13.8%, p = 0.033) than non-rheumatological controls. Multivariate analysis confirmed that IIM was independently associated with reduced BMD (OR: 2.12, p = 0.048, 95% CI: 1.01-4.46). The prevalence of reduced BMD was not significantly different between IIM, RA, and SLE patients but the mean hip BMD was the lowest in the IIM group (0.641 ± 0.152 g/cm2versus 0.663 ± 0.102g/cm2 in the RA group versus 0.708 ± 0.132 g/cm2 in the SLE group, p = 0.035). Lower body mass index and more advanced age were independently associated with lower BMD in IIM patients. Conclusion Reduced BMD was more prevalent in IIM patients than in non-rheumatological controls. Hip BMD was lower in patients with IIMs than RA or SLE. Close monitoring and early treatment are encouraged especially in patients with risk factors.
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Affiliation(s)
- Iris Yan Ki Tang
- Division of Rheumatology and Clinical Immunology, Department of Medicine, The University of Hong Kong, Hong Kong
| | - Lucas Luk
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong
| | - Victor Wong
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong
| | - Steve Pang
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong
| | - Virginia Lao
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong
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Schwarz Y, Goldshtein I, Friedman YE, Peltz-Sinvani N, Brodavka M, Kowal D, Vered I, Tripto-Shkolnik L. Bone mineral density of the ultra-distal radius: are we ignoring valuable information? Arch Osteoporos 2023; 18:28. [PMID: 36725758 DOI: 10.1007/s11657-023-01218-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/23/2023] [Indexed: 02/03/2023]
Abstract
The current study explored the possible utilization in dual-X-ray-absorptiometry scanning (DXA) of the ultra-distal radius (UDR). This region of interest is currently unused and mostly unstudied in this context. The study findings suggest UDR as potential useful region of interest in DXA scanning and warrant further study of the site. PURPOSE Bone mineral density (BMD) measurement of a non-dominant arm is not routinely performed during dual-X-ray-absorptiometry (DXA) test, and the possible utility of ultra-distal (UDR) radius BMD is not well-studied. We evaluated in women, correlations of UDR BMD with fracture prevalence, fracture risk prediction by the fracture risk assessment tool (FRAX), and osteoporosis diagnosed by traditional sites. METHODS Women who underwent a routine DXA (including their non-dominant forearm and including UDR BMD) in a tertiary medical center were included. Risk factors relevant to FRAX calculation were assessed via a self-administered questionnaire. Spearman correlations of UDR BMD to 10-year risks of major osteoporotic and hip fractures (assessed by FRAX) were explored. The possible added value of UDR BMD in explaining prevalent osteoporotic fractures was assessed using a multivariable regression model incorporating age and traditional osteoporosis diagnosis. RESULTS The study included 1245 women with a median age of 66 years (interquartile range: 59-73), of whom 298 (24%) had UDR T-score ≤ - 2.5 and 154 (12%) reported prior fractures. UDR BMD was significantly negatively correlated with FRAX risk score for hip and major osteoporotic fractures (R = - 0.5 and R = - 0.41, respectively; P < 0.001). UDR T-score ≤ - 2.5 was associated with higher fracture prevalence (19% vs 10%; P < 0.001) and remained significant after adjusting for traditional BMD and age (OR 1.49, 1.01-2.19; P = 0.043). CONCLUSION UDR BMD correlates both with prior fractures and with predicted fracture risks and might pose added value over traditional DXA sites.
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Affiliation(s)
- Yair Schwarz
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Inbal Goldshtein
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | - Yehudit Eden Friedman
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Naama Peltz-Sinvani
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Brodavka
- Rheumatology Unit, Sheba Medical Center, Tel Hashomer, Israel
| | - David Kowal
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Israel
| | - Iris Vered
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liana Tripto-Shkolnik
- Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel Hashomer, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Osteoporosis Screening: Applied Methods and Technological Trends. Med Eng Phys 2022; 108:103887. [DOI: 10.1016/j.medengphy.2022.103887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/15/2022]
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Yu H, Zhou W, Zhong Z, Qiu R, Chen G, Zhang P. High-mobility group box chromosomal protein-1 deletion alleviates osteoporosis in OVX rat model via suppressing the osteoclastogenesis and inflammation. J Orthop Surg Res 2022; 17:232. [PMID: 35414033 PMCID: PMC9004163 DOI: 10.1186/s13018-022-03110-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Osteoporosis is a skeletal metabolic disease that constitutes a great threaten to human health. However, there is currently no gold standard for its treatment. High-mobility group box chromosomal protein-1 (HMGB-1) has been reported to play an important role in various orthopedic diseases. Till now, its role in osteoporosis remains elusive. Methods Rats underwent ovariectomy (OVX) were used to construct a postmenopausal model of osteoporosis. Then, rats were divided into sham groups without OVX surgery, OVX model group, HMGB-1 knockdown (HMGB-1 KD) OVX model groups. The expression of HMGB1 was evaluated by qRT-PCR and western blotting. Subsequently, the changes of trabeculae were evaluated by micro-computed tomography (CT) assay. Skeletal necrosis and metabolism were further analyzed by hematoxylin–eosin (HE) staining, Alcian blue staining and Masson’s trichrome staining. The contents of serum alkaline phosphatase (ALP) and osteocalcin were detected by ELISA assay. Expression of osteoclast-associated receptor (OSCAR) and tartrate-resistant acid phosphatase (TRAP) were determined to investigate the effects of HMGB-1 loss on osteoclastogenesis. Results Single HMGB-1 deletion exerted no significant effect on rat trabeculae, serum ALP and osteocalcin. Noticeably, HMGB1 knockdown dramatically ameliorated OVX-induced changes in above indexes. Trabeculae structures of OVX rats were sparse with disorder arrangement, which were greatly recovered after HMGB-1 deletion. Enhanced osteoclastogenesis was observed in OVX rats by increasing number of TRAP + cells and expression of TRAP and OSCAR, and loss of HMGB1 ameliorated osteoclastogenesis in OVA rats. Moreover, HMGB-1 deletion antagonized OVX-evoked downregulation of osteoblast activity markers osterix (OSX), collagen type I alpha 1(COL1A1) and distal-less homeobox 2 (DLX2) protein. Furthermore, loss of HMGB-1 attenuated fluctuation of inflammatory factors in OVX rats. Additionally, HMGB-1 deficiency inhibited OVX-evoked activation of the Toll-like receptor (TLR) 4/NF-κB signaling pathway. Moreover, reactivating the TLR4 signaling further aggravated OVX-induced osteoporosis, which was reversed by HMGB1 knockdown. Conclusion HMGB-1 deletion alleviated OVX-triggered osteoporosis by suppressing osteoclastogenesis and inflammatory disorder via the inhibition of the TLR4 signaling. Therefore, HMGB-1 may be a promising therapeutic target for osteoporosis.
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Affiliation(s)
- Haotao Yu
- Department of Orthopedics, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510000, Guangdong, China
| | - Wei Zhou
- Department of Orthopedics, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510000, Guangdong, China
| | - Zhihong Zhong
- Department of Orthopedics, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510000, Guangdong, China
| | - Ruixin Qiu
- Department of Orthopedics, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510000, Guangdong, China
| | - Guoquan Chen
- Department of Orthopedics, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510000, Guangdong, China
| | - Ping Zhang
- Department of Orthopedics, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Liwan District, Guangzhou, 510000, Guangdong, China.
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Ran B, Wei F, Gong J, Xu H. Application and prospect of trabecular bone score in differentiated thyroid cancer patients receiving thyrotropin suppression therapy. Front Endocrinol (Lausanne) 2022; 13:1004962. [PMID: 36313757 PMCID: PMC9596913 DOI: 10.3389/fendo.2022.1004962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Thyroid-stimulating hormone (TSH) suppression therapy is one of the common treatments for most patients with differentiated thyroid cancer (DTC). Unfortunately, its detrimental effects on bone health are receiving increasing attention. It may increase the risk of osteoporosis and osteoporotic fractures. The trabecular bone score (TBS) is a relatively new gray-scale texture measurement parameter that reflects bone microarchitecture and bone strength and has been shown to independently predict fracture risk. We reviewed for the first time the scientific literature on the use of TBS in DTC patients on TSH suppression therapy and aim to analyze and compare the utility of TBS with bone mass strength (BMD) in the management of skeletal health and prediction of fracture risk. We screened a total of seven relevant publications, four of which were for postmenopausal female patients and three for all female patients. Overall, postmenopausal female patients with DTC had lower TBS and a significant reduction in TBS after receiving TSH suppression therapy, but their BMD did not appear to change significantly. In addition, TBS was also found to be an independent predictor of osteoporotic fracture risk in postmenopausal women with DTC receiving TSH suppression therapy. However, due to limitations in the number of studies and study populations, this evidence is not sufficient to fully demonstrate the adverse effects of TSH suppression therapy on patients' TBS or BMD and the efficacy of TBS, and subsequent larger and more case-cohort studies are needed to further investigate the relationship and application of TBS to TSH suppression therapy in terms of skeletal health impairment and fracture risk in DTC patients.
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Ho CS, Chen YP, Fan TY, Kuo CF, Yen TY, Liu YC, Pei YC. Application of deep learning neural network in predicting bone mineral density from plain X-ray radiography. Arch Osteoporos 2021; 16:153. [PMID: 34626252 DOI: 10.1007/s11657-021-00985-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 08/02/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED DeepDXA is a deep learning model designed to infer bone mineral density data from plain pelvis X-ray, and it can achieve good predicted value for clinical use. PURPOSE Osteoporosis is defined as a systemic disease of the bone characterized by a decrease in bone strength and deterioration of bone structure at the microscopic level, leading to bone fragility and increased risk of fracture. Bone mineral density (BMD) is the preferred method for the diagnosis of osteoporosis, and dual-energy x-ray absorptiometry (DXA) is the gold standard for diagnosing osteoporosis. Conventional radiography is more suited for the screening of osteoporosis rather than diagnosis, and osteoporosis can be detected on radiographs by experienced physicians only. This study explored the possibility of predicting BMD relative to DXA using patient radiographs. METHODS A deep learning algorithm of convolutional neural network (CNN) was used for the purpose. The method includes image segmentation, CNN learning, and a convolution-based regression model (DeepDXA) that links the isolated images of the femur bone to predict BMD value. Data were obtained in a single medical center from 2006 to 2018, with a total amount of 3472 pairs of pelvis X-ray and DXA examination within 1 year. RESULTS The proposed workflow successfully predicted BMD values of the femur bone with the correlation coefficient (R) of 0.85 (P < 0.001) and the accuracy of 0.88 for prediction osteoporosis, a finding that could be reliably ready for further clinical use. CONCLUSION When suspicious osteoporosis is seen on plain films using the deep learning method we developed, further referral to DXA for the definite diagnosis of osteoporosis is indicated.
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Affiliation(s)
- Chan-Shien Ho
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Yueh-Peng Chen
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan.
- Department of Industrial Design, College of Management, Chang Gung University, Taoyuan, Taiwan.
| | - Tzuo-Yau Fan
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Chang-Fu Kuo
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Tzu-Yun Yen
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan
- Department of Education, Chang Gung Memorial Hospital at Linkou, No.5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
| | - Yuan-Chang Liu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan
- College of Medicine, Institute for Radiologic Research, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan
| | - Yu-Cheng Pei
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan.
- School of Medicine, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan.
- Center of Vascularized Tissue Allograft, Gung Memorial Hospital at Linkou, No. 5, Fuxing St., Guishan Dist., Taoyuan City, 333, Taiwan.
- Healthy Aging Research Center, Chang Gung University, No. 259, Wenhua 1st Rd., Guishan Dist., Taoyuan City, 33302, Taiwan.
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Sousa BÉCA, Silva BC, de Oliveira Guidotti T, Pires MC, Soares MMS, Kakehasi AM. Trabecular bone score in women with differentiated thyroid cancer on long-term TSH-suppressive therapy. J Endocrinol Invest 2021; 44:2295-2305. [PMID: 33730348 DOI: 10.1007/s40618-021-01537-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/15/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Thyrotropin stimulating hormone (TSH) suppression in patients with differentiated thyroid cancer (DTC) aims to decrease the growth and proliferation of thyroid cancer cells. However, the effect of TSH-suppressive therapy on bone microarchitecture remains undefined. METHODS Cross-sectional study including 43 women with DTC undergoing TSH-suppressive therapy (sTSH) compared to 20 women also on levothyroxine (LT4) therapy but with TSH in the low-normal range (nTSH) since the thyroid surgery. Bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA), and trabecular bone score (TBS) was evaluated using the TBS iNsigth software. Fracture risk assessed by FRAX, with and without TBS, was calculated. The relationship between suppressive therapy-related parameters and bone parameters was investigated. RESULTS The TBS mean values were not significantly different in the sTSH and nTSH groups (1.273 ± 0.12 vs 1.307 ± 0.14, p = 0.7197). In both groups, postmenopausal women had degraded microarchitecture (TBS 1.216 ± 0.11 vs 1.213 ± 0.09, p = 0.9333), while premenopausal women had normal microarchitecture (1.328 ± 0.11 vs 1.401 ± 0.12, p = 0.195). The percentage of all postmenopausal women with degraded TBS was 54.7%, while the percentage of osteoporosis diagnoses was 16.1%. The TBS-adjusted FRAX-probability of fracture was similar in sTSH and nTSH groups. Body mass index (BMI) and menopausal status were the only variables associated with TBS and BMD. CONCLUSION Trabecular microarchitecture assessed by TBS was similar between women on long-term suppressive therapy in DTC and those on LT4 replacement therapy aiming at a TSH level within the low-normal reference range. Low TBS values were observed in postmenopausal women of both groups, suggesting that not only suppressed TSH levels but also a low-normal TSH is associated with deteriorated bone microarchitecture in postmenopausal women following total thyroidectomy.
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Affiliation(s)
- B É C A Sousa
- Graduate Program in Sciences Applied To Adult Health Care, Federal University of Minas Gerais - UFMG, Belo Horizonte, Minas Gerais State, Brazil.
| | - B C Silva
- School of Medicine, University Center of Belo Horizonte - UNI-BH, Belo Horizonte, Brazil
- Division of Endocrinology, Felício Rocho Hospital, Belo Horizonte, Brazil
- Division of Endocrinology, Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
| | - T de Oliveira Guidotti
- Physiotherapy Academic, Federal University of Minas Gerais - UFMG, Belo Horizonte, Brazil
| | - M C Pires
- Statistics Department, Federal University of Minas Gerais - UFMG, Belo Horizonte, Brazil
| | - M M S Soares
- Graduate Program in Sciences Applied To Adult Health Care, Federal University of Minas Gerais - UFMG, Belo Horizonte, Minas Gerais State, Brazil
- Division of Endocrinology, Felício Rocho Hospital, Belo Horizonte, Brazil
- Department of Internal Medicine and Endocrinology, Federal University of Minas Gerais - UFMG, Belo Horizonte, Brazil
| | - A M Kakehasi
- Graduate Program in Sciences Applied To Adult Health Care, Federal University of Minas Gerais - UFMG, Belo Horizonte, Minas Gerais State, Brazil
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Utility of fragility fracture prediction tools in a group of postmenopausal women. Reumatologia 2021; 59:230-236. [PMID: 34538953 PMCID: PMC8436788 DOI: 10.5114/reum.2021.108631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/16/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives Fractures are a common complication of osteoporosis. The main aim of our study was to assess the relation between fractures identified as low energy fractures (fragility), bone mineral density (BMD), trabecular bone score (TBS), and handgrip in a group of postmenopausal women. An additional aim was to determine the relation between fragility fractures and age, height loss, and falls (reported in the last 12 months and 5 years). Material and methods The study was conducted in a group of 120 (mean age 69 years; 59-81, SD 5.3) postmenopausal patients who were referred to the Medical Centre for an osteoporosis screening appointment by their general practitioner. All patients were interviewed (with a questionnaire containing questions on fracture risk factors and highest height), had their anthropometric measures taken (current height and weight) as well as TBS analysis following their DXA (dual-energy X-ray absorptiometry) scan and handgrip measure. Results Sixty patients from the study group had a history of fractures (with a total of 92 fractures), of whom 39 women (76 fractures) were identified as those with a low-energy fracture. Fragility fractures were more likely to be reported in older patients (Me 71 vs. 68 years, p < 0.05). Differences observed between TBS, handgrip and BMD in reference to fragility fractures were not statistically significant. Analysis showed significant correlations between BMD (neck and L1-L4) and TBS fracture risk categories. Falls reported in the last 5 years and height loss were factors which correlated with fragility fractures (p < 0.05). Conclusions Risk of fragility fractures increases with age. Bone mineral density is insufficient as a fracture risk assessment tool. Information on falls and height loss may provide additional data on fracture risk assessment.
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Holloway-Kew KL, Betson AG, Anderson KB, Gaston J, Kotowicz MA, Liao WH, Henneberg M, Pasco JA. Association between bone measures and use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Arch Osteoporos 2021; 16:137. [PMID: 34536130 DOI: 10.1007/s11657-021-01004-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 09/13/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Angiotensin-converting enzyme inhibitor use in women was associated with lower femoral neck and lumbar spine bone mineral density as well as trabecular bone score compared to non-users. No differences were identified for men or for those who used ARB medications. PURPOSE Many individuals at high fracture risk use medications such as angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARB) that could affect bone; thus, this study aimed to investigate whether there are any differences in bone mineral density (BMD) and trabecular bone score (TBS) between ACEI users, ARB users, and non-users. METHODS Participants (685 men, 573 women) were from the Geelong Osteoporosis Study. Current medication use was self-reported. BMD at the femoral neck (FNBMD) and lumbar spine (LSBMD) were measured using DXA. TBS was calculated using TBS iNsight software. Linear regression models were used to investigate associations between ACEI or ARB use and bone measures, adjusting for other potential confounders. Due to interaction terms, data were stratified by age. RESULTS There were 88 (12.8%) men and 41 (7.2%) women taking an ACEI medication, and 71 (10.4%) men and 76 (13.3%) women taking an ARB medication. Compared to non-users, ACEI use was associated with lower FNBMD (- 7.2%), LSBMD (- 12.2%), and TBS (- 9.0%) for women aged < 65 years. Lower TBS was also observed for women aged ≥ 65 years (- 17.3%). No differences were identified for ARB use. CONCLUSIONS Women who used an ACEI medication had lower values for FNBMD, LSBMD and TBS compared to non-users. No differences were identified for men or for those who used ARB medications.
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Affiliation(s)
- Kara L Holloway-Kew
- Epi-Centre for Healthy Ageing (ECHA), School of Medicine, Health Education and Research Building, IMPACT Institute, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia.
| | - Amelia G Betson
- Epi-Centre for Healthy Ageing (ECHA), School of Medicine, Health Education and Research Building, IMPACT Institute, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
| | - Kara B Anderson
- Epi-Centre for Healthy Ageing (ECHA), School of Medicine, Health Education and Research Building, IMPACT Institute, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
| | - James Gaston
- Epi-Centre for Healthy Ageing (ECHA), School of Medicine, Health Education and Research Building, IMPACT Institute, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia
| | - Mark A Kotowicz
- Epi-Centre for Healthy Ageing (ECHA), School of Medicine, Health Education and Research Building, IMPACT Institute, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia.,Barwon Health, Geelong, Australia.,Department of Medicine, The University of Melbourne-Western Health, St Albans, Australia
| | - Wan-Hui Liao
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Maciej Henneberg
- Biological and Comparative Anatomy Research Unit, Adelaide Medical School, University of Adelaide, Adelaide, Australia.,Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland.,Department of Archaeology, Flinders University, Adelaide, Australia
| | - Julie A Pasco
- Epi-Centre for Healthy Ageing (ECHA), School of Medicine, Health Education and Research Building, IMPACT Institute, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, VIC, 3220, Australia.,Barwon Health, Geelong, Australia.,Department of Medicine, The University of Melbourne-Western Health, St Albans, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Australia
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12
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Gao Y, Wang O, Guan W, Wu X, Mao J, Wang X, Yu W, Nie M. Bone mineral density and trabecular bone score in patients with 21-hydroxylase deficiency after glucocorticoid treatment. Clin Endocrinol (Oxf) 2021; 94:765-773. [PMID: 33301636 DOI: 10.1111/cen.14391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 11/28/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Patients with 21-hydroxylase deficiency (21-OHD) are at risk of reduced bone mineral density (BMD) and fracture due to long-term glucocorticoid treatment. Trabecular bone score (TBS) is complementary to conventional BMD as a marker for bone quality in patients with glucocorticoid-induced osteoporosis. The purpose of this study is to evaluate the BMD and TBS in a cohort of patients with 21-OHD and analyse factors related to TBS. DESIGN An observational study. PATIENTS A total of 46 21-OHD adult patients treated with glucocorticoid for over 10 years who visited Peking Union Medical College Hospital between 2015 and 2019 were recruited. Eight male patients included in this study were all under 50 years old, and 38 female patients were all premenopausal. MEASUREMENTS Diagnosis was confirmed by multiplex ligation-dependent probe amplification combined with sequencing. Data were collected on physical characteristics, serum hormones and glucocorticoid treatment. Skeletal quality was evaluated by BMD and TBS, and factors related to TBS were analysed. RESULTS Among the 46 patients, 2 (4.3%) had low BMD (Z-score ≤ -2), while 11 (23.9%) patients had low TBS (degraded or partially degraded microarchitecture). The proportion of bone abnormality evaluated by TBS was higher than that by BMD (p < .001). Patients with lower TBS had significantly higher daily hydrocortisone dosage (p = .009 for males; p = .019 for females). TBS value was negatively correlated with daily hydrocortisone dosage (r = -.317, p = .026), and positively correlated with BMI in female patients (r = .345, p = .034). And there was a negative correlation between TBS value and the current age in male patients (r = -.741, p = .036). The distribution of genotypes (p = 1.000 for male; p = .567 for female) or phenotypes (p = .486 for male; p = .075 for female) had no statistical difference in patients with normal or abnormal TBS. CONCLUSIONS Approximately 24% of patients with 21-OHD had abnormal microarchitecture of their bone in our study, and TBS score was negatively correlated with daily glucocorticoid dosage in patients. TBS may be used alongside conventional BMD as a complementary marker for bone evaluation in 21-OHD patients.
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Affiliation(s)
- Yinjie Gao
- NHC Key Laboratory of Endocrinology (Peking Union Medical College Hospital), Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ou Wang
- NHC Key Laboratory of Endocrinology (Peking Union Medical College Hospital), Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Wenmin Guan
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xueyan Wu
- NHC Key Laboratory of Endocrinology (Peking Union Medical College Hospital), Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiangfeng Mao
- NHC Key Laboratory of Endocrinology (Peking Union Medical College Hospital), Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xi Wang
- NHC Key Laboratory of Endocrinology (Peking Union Medical College Hospital), Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Min Nie
- NHC Key Laboratory of Endocrinology (Peking Union Medical College Hospital), Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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13
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Lui DTW, Lee CH, Chau VWK, Fong CHY, Yeung KMY, Lam JKY, Lee ACH, Chow WS, Tan KCB, Woo YC, Lam KSL. Potential role of fibroblast growth factor 21 in the deterioration of bone quality in impaired glucose tolerance. J Endocrinol Invest 2021; 44:523-530. [PMID: 32602078 DOI: 10.1007/s40618-020-01337-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/14/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Findings on trabecular bone score (TBS), an index of bone quality, have been reported in prediabetes defined by impaired fasting glucose or HbA1c. Here, we assessed the bone mineral density (BMD) and TBS in prediabetes individuals with impaired glucose tolerance (IGT), and investigated the association of these bone parameters with serum levels of fibroblast growth factor 21 (FGF21), a hormone implicated in bone metabolism and with higher levels in IGT. METHODS Chinese postmenopausal women aged 55-80 years, without diabetes, were recruited from the Hong Kong Cardiovascular Risk Factor Prevalence Study in 2016-2018. Normal glucose tolerance (NGT) was defined by fasting glucose < 5.6 mmol/L and 2-h plasma glucose (2hG) < 7.8 mmol/L, and IGT by 2hG 7.8-11 mmol/L. Serum levels of FGF21 and other bone metabolism regulators were measured. Insulin sensitivity was assessed by the Matsuda index. Independent determinants of TBS were evaluated using multivariable stepwise linear regression. RESULTS 173 individuals with NGT and 73 with IGT were included. TBS was lower in those with IGT compared to those with NGT, while BMD was comparable. Individuals with IGT had significantly higher serum FGF21 levels, which in turn showed an independent inverse relationship with TBS, attenuated after inclusion of the Matsuda index. Serum FGF21 levels, however, did not correlate with BMD. CONCLUSION Among Chinese postmenopausal women, bone quality was worse in IGT, despite comparable bone density. FGF21 levels showed a significant independent inverse relationship with TBS, partly attributed to insulin resistance. Whether FGF21 contributes to the impaired bone quality in IGT remains speculative.
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Affiliation(s)
- D T W Lui
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - C H Lee
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - V W K Chau
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - C H Y Fong
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - K M Y Yeung
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - J K Y Lam
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - A C H Lee
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - W S Chow
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - K C B Tan
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Y C Woo
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
| | - K S L Lam
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.
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14
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Sandru F, Carsote M, Dumitrascu MC, Albu SE, Valea A. Glucocorticoids and Trabecular Bone Score. J Med Life 2021; 13:449-453. [PMID: 33456590 PMCID: PMC7803323 DOI: 10.25122/jml-2019-0131] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
TBS (Trabecular Bone Score) is the latest tool for clinicians to evaluate bone micro-architecture based on a pixel greyscale, which is provided by lumbar dual-energy X-ray absorptiometry (DXA). Its use enhances fracture prediction in addition to DXA-BMD (Bone Mineral Density). This is independent of fracture risk assessment (FRAX) and DXA results. We present a narrative review regarding the connection between TBS and Glucocorticoids (GC), either as a drug used for different conditions or as a tumor-produced endogenous excess. TBS is a better discriminator for GC-induced vertebral fractures compared to DXA-BMD. This aspect is similarly available for patients with osteoporosis diagnosed by DXA. TBS is inversely correlated with the cumulative dose of GC (systemic or inhaled), with disease duration, and positively correlated with respiratory function in patients with asthma. Low TBS values are found in females with a T-score at the hip within the osteoporosis range, with diabetes mellitus, or who use GC. Lumbar TBS is a screening tool in menopausal women with type 2 diabetes mellitus. TBS is an independent parameter that provides information regarding skeleton deterioration in diabetic patients receiving GC therapy in a manner complementary to DXA-BMD. TBS might become an essential step regarding the adrenalectomy decision in patients with adrenal incidentaloma in whom autonomous cortisol secretion might damage bone micro-architecture. TBS currently represents a standard tool of fracture risk evaluation in patients receiving GC therapy or with endogenous Cushing’s syndrome, a tool easy to be applied by different practitioners since GCs are largely used
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Affiliation(s)
- Florica Sandru
- Department of Dermatology, Elias Emergency University Hospital, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Mara Carsote
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Endocrinology, C.I.Parhon National Institute of Endocrinology, Bucharest, Romania
| | - Mihai Cristian Dumitrascu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Gynecology, Emergency University Hospital, Bucharest, Romania
| | - Simona Elena Albu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Gynecology, Emergency University Hospital, Bucharest, Romania
| | - Ana Valea
- Department of Endocrinology, Clinical County Hospital, Cluj-Napoca, Romania.,"Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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15
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Ulivieri FM, Rinaudo L. Beyond Bone Mineral Density: A New Dual X-Ray Absorptiometry Index of Bone Strength to Predict Fragility Fractures, the Bone Strain Index. Front Med (Lausanne) 2021; 7:590139. [PMID: 33521014 PMCID: PMC7843921 DOI: 10.3389/fmed.2020.590139] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/17/2020] [Indexed: 12/12/2022] Open
Abstract
For a proper assessment of osteoporotic fragility fracture prediction, all aspects regarding bone mineral density, bone texture, geometry and information about strength are necessary, particularly in endocrinological and rheumatological diseases, where bone quality impairment is relevant. Data regarding bone quantity (density) and, partially, bone quality (structure and geometry) are obtained by the gold standard method of dual X-ray absorptiometry (DXA). Data about bone strength are not yet readily available. To evaluate bone resistance to strain, a new DXA-derived index based on the Finite Element Analysis (FEA) of a greyscale of density distribution measured on spine and femoral scan, namely Bone Strain Index (BSI), has recently been developed. Bone Strain Index includes local information on density distribution, bone geometry and loadings and it differs from bone mineral density (BMD) and other variables of bone quality like trabecular bone score (TBS), which are all based on the quantification of bone mass and distribution averaged over the scanned region. This state of the art review illustrates the methodology of BSI calculation, the findings of its in reproducibility and the preliminary data about its capability to predict fragility fracture and to monitor the follow up of the pharmacological treatment for osteoporosis.
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Affiliation(s)
- Fabio Massimo Ulivieri
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda Ospedale Maggiore Policlinico, Unità Operativa (UO) Medicina Nucleare, Milan, Italy
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16
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Lui DTW, Fung MMH, Lee CH, Fong CHY, Loong CHN, Lam AHK, Tan KCB, Woo YC, Lang BHH. The Potential Role of Preoperative Trabecular Bone Score in Predicting Changes in Bone Mineral Density After Parathyroidectomy. World J Surg 2020; 45:522-530. [PMID: 33104831 DOI: 10.1007/s00268-020-05842-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND The skeletal indication for parathyroidectomy for primary hyperparathyroidism (PHPT) is based on bone mineral density (BMD) T-score < - 2.5. Whether trabecular bone score (TBS) additionally identifies patients who benefit from parathyroidectomy in terms of bone health is unknown. We aimed to study changes in BMD and TBS among Chinese who underwent curative parathyroidectomy for PHPT, in relation to their preoperative parameters, especially in those with worst site BMD T-score ≥ - 2.5 (non-osteoporotic range). METHODS We included consecutive Chinese individuals who underwent curative parathyroidectomy during 2002-2015 for PHPT and completed preoperative and postoperative BMD and TBS measurements in Queen Mary Hospital. Correlations between preoperative parameters and changes in densitometric parameters were studied. RESULTS 45 Chinese individuals (13 men, 32 women) were included (mean age 62.0 ± 10.0 years and BMI 24.6 ± 4.7 kg/m2). After parathyroidectomy, BMD at lumbar spine (LS) improved by 6.7% (p < 0.001) while TBS did not change. Among women, peak preoperative parathyroid hormone and calcium levels independently predicted LS BMD gain. Among women with BMD in non-osteoporotic range, LS BMD also improved after parathyroidectomy, where preoperative TBS was the only significant variable inversely correlating with percentage change in LS BMD (ρ - 0.775, p = 0.005). Particularly, those with preoperative TBS ≤ 1.25 gained 7.1% LS BMD post-parathyroidectomy (p = 0.003). CONCLUSIONS LS BMD, but not TBS, improved after parathyroidectomy. Among non-osteoporotic PHPT women, preoperative TBS inversely correlated with postoperative BMD improvement. Hence, low preoperative TBS may be an additional indication for surgical benefit with parathyroidectomy in non-osteoporotic PHPT women, as those with worse preoperative TBS tend to benefit more from surgery.
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Affiliation(s)
- David Tak Wai Lui
- Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Matrix Man Him Fung
- Department of Surgery, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Chi Ho Lee
- Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Carol Ho Yi Fong
- Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Connie Hong Nin Loong
- Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Allan Hoi Kin Lam
- Department of Surgery, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Kathryn Choon Beng Tan
- Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yu Cho Woo
- Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Brian Hung Hin Lang
- Department of Surgery, the University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
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17
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Abstract
Thyroid hormones stimulate bone turnover in adults by increasing osteoclastic bone resorption. TSH suppressive therapy is usually applied in patients with differentiated thyroid cancer (DTC) to improve the disease outcome. Over the last decades several authors have closely monitored the potential harm suffered by the skeletal system. Several studies and meta-analyses have shown that chronic TSH suppressive therapy is safe in premenopausal women and men. Conversely, in postmenopausal women TSH suppressive therapy is associated with a decrease of bone mineral density, deterioration of bone architecture (quantitative CT, QCT; trabecular bone score, TBS), and, possibly, an increased risk of fractures. The TSH receptor is expressed in bone cells and the results of experimental studies in TSH receptor knockout mice and humans on whether low TSH levels, as opposed to solely high thyroid hormone levels, might contribute to bone loss in endogenous or exogenous thyrotoxicosis remain controversial. Recent guidelines on the use of TSH suppressive therapy in patients with DTC give value not only to its benefit on the outcome of the disease, but also to the risks associated with exogenous thyrotoxicosis, namely menopause, osteopenia or osteoporosis, age >60 years, and history of atrial fibrillation. Bone health (BMD and/or preferably TBS) should be evaluated in postmenopausal women under chronic TSH suppressive therapy or in those patients planning to be treated for several years. Antiresorptive therapy could also be considered in selected cases (increased risk of fracture or significant decline of BMD/TBS during therapy) to prevent bone loss.
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Affiliation(s)
- Alessandro Brancatella
- Endocrine Unit 1, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudio Marcocci
- Endocrine Unit 2, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Correspondence should be addressed to C Marcocci:
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18
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Guebeli A, Platz EA, Paller CJ, McGlynn KA, Rohrmann S. Relationship of sex steroid hormones with bone mineral density of the lumbar spine in adult men. Bone Joint Res 2020; 9:139-145. [PMID: 32435466 PMCID: PMC7229310 DOI: 10.1302/2046-3758.93.bjr-2019-0141.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Aims To examine the relationship of sex steroid hormones with osteopenia in a nationally representative sample of men in the USA. Methods Data on bone mineral density (BMD), serum sex hormones, dairy consumption, smoking status, and body composition were available for 806 adult male participants of the cross-sectional National Health and Nutrition Examination Survey (NHANES, 1999-2004). We estimated associations between quartiles of total and estimated free oestradiol (E2) and testosterone (T) and osteopenia (defined as 1 to 2.5 SD below the mean BMD for healthy 20- to 29-year-old men) by applying sampling weights and using multivariate-adjusted logistic regression. We then estimated the association between serum hormone concentrations and osteopenia by percentage of body fat, frequency of dairy intake, cigarette smoking status, age, and race/ethnicity. Results Men in the lowest quartile of total E2 concentrations (< 21.52 pg/ml) had greater odds of osteopenia compared with men in the highest quartile (odds ratio (OR) 2.29, 95% confidence interval (CI) 1.11 to 4.73; p-trend = 0.030). Total and free T were not associated with osteopenia. Low total E2 concentrations were associated with greater odds of osteopenia among non-daily dairy consumers (p-trend = 0.046), current or former smokers (p-trend = 0.032), and younger men (p-trend = 0.031). No differences were observed by race/ethnicity and obesity. Conclusion In this nationally representative study of the USA, men with lower total E2 were more likely to have osteopenia, which was particularly evident among younger men, men with less-than-daily dairy consumption, and current or former smokers. Cite this article:Bone Joint Res. 2020;9(3):139–145.
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Affiliation(s)
- Alissa Guebeli
- Department of Orthopaedic Surgery, Cantonal Hospital of Baselland, Liestal, Switzerland
| | - Elizabeth A Platz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health; James Buchanan Brady Urological Institute, and Department of Urology, Johns Hopkins University School of Medicine, and the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | - Channing J Paller
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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19
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Colia R, Corrado A, Cantatore FP. Postmenopausal women presenting with spinal fractures and the importance of primary care: A case-series. Aten Primaria 2020; 52:796-797. [PMID: 32362457 PMCID: PMC8054291 DOI: 10.1016/j.aprim.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 11/26/2019] [Indexed: 11/05/2022] Open
Affiliation(s)
- Ripalta Colia
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
| | - Addolorata Corrado
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Francesco Paolo Cantatore
- Rheumatology Clinic, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
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20
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Narla RR, Ott SM. Structural and Metabolic Assessment of Bone. Handb Exp Pharmacol 2020; 262:369-396. [PMID: 32885312 DOI: 10.1007/164_2020_376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The assessment of bone structure and metabolism should focus on the bone strength. Many factors are involved, and although bone density is an important component, it is not the same as bone strength. Other aspects of bone quality include bone volume, micro-architecture, material composition, and ability to repair damage. This chapter briefly reviews some of the methods that can be used to assess both density and quality of bone. Non-invasive measurements of density or structure include dual X-ray absorptiometry (DXA), quantitative computed tomography, ultrasound, and magnetic resonance imaging. DXA is most widely used and has advantages of safety and accessibility, but there are limitations in the interpretation of the results, and in clinical practice positioning errors are frequently seen. Invasive methods are used primarily for research. Samples of bone can be used to measure structure by histology as well as micro-computed tomography and infra-red spectroscopy or backscattered electron microscopy. Force can be directly applied to bone samples to measure the bones strength. Impact microindentation is a new minimally invasive technique that measures bone hardness. Metabolic assessment includes blood and urine tests that reflect diseases that cause bone loss, particularly problems with mineral metabolism. Tetracycline-labelled bone biopsies are the standard for measuring bone formation. Non-invasive biochemical tests of bone formation and resorption can evaluate a patient's skeletal physiology.
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Affiliation(s)
- Radhika R Narla
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Susan M Ott
- Department of Medicine, University of Washington, Seattle, WA, USA.
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21
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Messina C, Piodi LP, Rinaudo L, Buonomenna C, Sconfienza LM, Vergani L, Ulivieri FM. Reproducibility of DXA-based bone strain index and the influence of body mass: an in vivo study. Radiol Med 2019; 125:313-318. [PMID: 31883053 DOI: 10.1007/s11547-019-01118-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/28/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Bone strain index (BSI) is a dual-energy X-ray absorptiometry (DXA)-derived index of bone strength obtained from lumbar densitometric scan. We estimated the reproducibility of BSI in healthy women with different body mass index. METHODS We enrolled postmenopausal women (mean age ± SD: 66 ± 10 years) divided into three groups (A, B and C) according to body mass index (BMI: < 25; 25-29.9; ≥ 30 kg/m2) and two groups (D and E) according to waist circumference (WC: ≤ 88; > 88 cm), each of 30 subjects. They underwent two DXA examinations with in-between repositioning, according to the International Society for Clinical Densitometry guidelines for precision estimation. Bone mineral density (BMD) and BSI were expressed as g/cm2 and absolute value, respectively. The coefficient of variation (CoV) was calculated as the ratio between root-mean-square standard deviation and mean; least significant change percentage (LSC%) as 2.77 × CoV; reproducibility as the complement to 100% LSC. RESULTS BSI increased proportionally to BMI and WC and significantly in group C compared to B and A (p = 0.032 and 0.006, respectively). BSI was significantly higher in E compared to D (p = 0.017), whereas no differences were observed in BMD. Although BSI reproducibility was slightly lower in group C (89%), the differences were not significant between all groups. BMD reproducibility did not significantly differ between all groups. CONCLUSIONS BSI reproducibility was significantly lower than that of BMD and decreased proportionally to BMI and WC increase. This reduction of BSI reproducibility was more pronounced in patients with BMI ≥ 30 and WC > 88, as expected, being BSI a parameter sensible to weight.
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Affiliation(s)
- Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal, 36, 20100, Milan, Italy
| | - Luca Petruccio Piodi
- Gastroenterologia ed Endoscopia Digestiva, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Luca Rinaudo
- TECHNOLOGIC Srl, Lungo Dora Voghera 34/36, 10153, Turin, Italy
| | - Ciriaco Buonomenna
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Pascal, 36, 20100, Milan, Italy
| | - Laura Vergani
- Dipartimento di Ingegneria Meccanica, Politecnico di Milano, Via Giuseppe La Masa 1, 20156, Milan, Italy
| | - Fabio Massimo Ulivieri
- Medicina Nucleare, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
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22
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Diez-Perez A, Brandi ML, Al-Daghri N, Branco JC, Bruyère O, Cavalli L, Cooper C, Cortet B, Dawson-Hughes B, Dimai HP, Gonnelli S, Hadji P, Halbout P, Kaufman JM, Kurth A, Locquet M, Maggi S, Matijevic R, Reginster JY, Rizzoli R, Thierry T. Radiofrequency echographic multi-spectrometry for the in-vivo assessment of bone strength: state of the art-outcomes of an expert consensus meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Aging Clin Exp Res 2019; 31:1375-1389. [PMID: 31422565 PMCID: PMC6763416 DOI: 10.1007/s40520-019-01294-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 07/24/2019] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose of this paper was to review the available approaches for bone strength assessment, osteoporosis diagnosis and fracture risk prediction, and to provide insights into radiofrequency echographic multi spectrometry (REMS), a non-ionizing axial skeleton technique. METHODS A working group convened by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis met to review the current image-based methods for bone strength assessment and fracture risk estimation, and to discuss the clinical perspectives of REMS. RESULTS Areal bone mineral density (BMD) measured by dual-energy X-ray absorptiometry (DXA) is the consolidated indicator for osteoporosis diagnosis and fracture risk assessment. A more reliable fracture risk estimation would actually require an improved assessment of bone strength, integrating also bone quality information. Several different approaches have been proposed, including additional DXA-based parameters, quantitative computed tomography, and quantitative ultrasound. Although each of them showed a somewhat improved clinical performance, none satisfied all the requirements for a widespread routine employment, which was typically hindered by unclear clinical usefulness, radiation doses, limited accessibility, or inapplicability to spine and hip, therefore leaving several clinical needs still unmet. REMS is a clinically available technology for osteoporosis diagnosis and fracture risk assessment through the estimation of BMD on the axial skeleton reference sites. Its automatic processing of unfiltered ultrasound signals provides accurate BMD values in view of fracture risk assessment. CONCLUSIONS New approaches for improved bone strength and fracture risk estimations are needed for a better management of osteoporotic patients. In this context, REMS represents a valuable approach for osteoporosis diagnosis and fracture risk prediction.
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Affiliation(s)
- Adolfo Diez-Perez
- Department of Internal Medicine, Hospital del Mar/IMIM and CIBERFES, Autonomous University of Barcelona, Passeig Maritim 25-29, 08003, Barcelona, Spain.
| | - Maria Luisa Brandi
- FirmoLab Fondazione F.I.R.M.O., Florence, Italy
- Department of Biological, Experimental and Clinical Science, University of Florence, Florence, Italy
| | - Nasser Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Jaime C Branco
- NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Olivier Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, Liège, Belgium
| | - Loredana Cavalli
- FirmoLab Fondazione F.I.R.M.O., Florence, Italy
- Department of Biological, Experimental and Clinical Science, University of Florence, Florence, Italy
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Bernard Cortet
- Department of Rheumatology and EA 4490, University-Hospital of Lille, Lille, France
| | - Bess Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Hans Peter Dimai
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Stefano Gonnelli
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Peyman Hadji
- Frankfurter Hormon und Osteoporose Zentrum, Frankfurt, Germany
| | | | - Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Andreas Kurth
- Department of Orthopaedic Surgery and Osteology, Klinikum Frankfurt, Frankfurt, Germany
- Mayor Teaching Hospital, Charite Medical School, Berlin, Germany
| | - Medea Locquet
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Stefania Maggi
- National Research Council, Aging Program, Institute of Neuroscience, Padua, Italy
| | - Radmila Matijevic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinical Center of Vojvodina, Clinic for Orthopedic Surgery, Novi Sad, Serbia
| | - Jean-Yves Reginster
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, University of Liège, Liège, Belgium
| | - René Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Thomas Thierry
- Department of Rheumatology, Hospital Nord, CHU St Etienne, St Etienne, France
- INSERM 1059, University of Lyon, St Etienne, France
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23
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Messina C, Buonomenna C, Menon G, Magnani S, Albano D, Gitto S, Ulivieri FM, Sconfienza LM. Fat Mass Does Not Increase the Precision Error of Trabecular Bone Score Measurements. J Clin Densitom 2019; 22:359-366. [PMID: 30661747 DOI: 10.1016/j.jocd.2019.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 01/01/2019] [Accepted: 01/02/2019] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Trabecular bone score (TBS) is an indirect index of trabecular microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry. Previous phantom study showed that an increase in soft tissue thickness does not affect TBS reproducibility. We investigated the effect of increasing body mass index (BMI) and waist circumference on TBS precision error on patients, compared to bone mineral density (BMD). METHODOLOGY A population of postmenopausal Caucasian women was distributed in 3 different BMI (normal, overweight, and class I obesity), plus 2 further groups based on waist circumference diameter (≤88 cm and >88 cm, respectively). In vivo precision error was calculated on 30 consecutive subjects that were scanned 2 times, with patient repositioning, using the Hologic QDR-Discovery W densitometer. Coefficient of variation, percent least significant change, and reproducibility were calculated according to the International Society for Clinical Densitometry guidelines. RESULTS Ninety-five women aged 66 ± 10 (mean ± standard deviation) were included. No significant differences were found both for BMD and TBS precision errors, respectively, when comparing BMI groups and waist circumference groups. BMD reproducibility ranged from 95.9% (BMI > 30 kg/m2) to 97.5% (BMI < 25 kg/m2). TBS reproducibility ranged between 95.8% (BMI = 25-29.9 kg/m2, waist circumference > 88 cm) and 96.6% (BMI < 25 kg/m2). With the exception of obese group, a significant difference was found between BMD and TBS reproducibility, being that of TBS slightly lower than BMD. A significant decrease of TBS values was found between normal and obese subjects, as well as between waist circumference groups. CONCLUSIONS TBS precision error is not affected by BMI and waist circumference differences. TBS reproducibility showed to be slightly lower than that of BMD, but this difference was mitigated in obese patients. A negative association was found between the amount of fat mass and TBS mean values.
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Affiliation(s)
- Carmelo Messina
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy.
| | - Ciriaco Buonomenna
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - Giorgia Menon
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Sandro Magnani
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - Domenico Albano
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Salvatore Gitto
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - Fabio Massimo Ulivieri
- Bone Metabolic Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Medicina Nucleare, Milan, Italy
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica ed Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
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24
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Levy-Shraga Y, Tripto-Shkolnik L, David D, Vered I, Stein D, Modan-Moses D. Low trabecular bone score in adolescent female inpatients with anorexia nervosa. Clin Nutr 2019; 38:1166-1170. [DOI: 10.1016/j.clnu.2018.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Revised: 04/17/2018] [Accepted: 04/20/2018] [Indexed: 01/09/2023]
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25
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Filopanti M, Verga U, Ulivieri FM, Giavoli C, Rodari G, Arosio M, Natacci F, Spada A. Trabecular Bone Score (TBS) and Bone Metabolism in Patients Affected with Type 1 Neurofibromatosis (NF1). Calcif Tissue Int 2019; 104:207-213. [PMID: 30421324 DOI: 10.1007/s00223-018-0488-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/16/2018] [Indexed: 12/14/2022]
Abstract
In patients with neurofibromatosis type 1 (NF1), decreased bone mineral density (BMD) and low levels of 25-hydroxy vitamin D3 (25OHD) have been reported. Recently, the trabecular bone score (TBS) measurement has been proposed as index of bone microarchitecture and fracture risk. In 74 NF1 patients (48 females, 26 males, age 41 ± 12), we measured TBS and investigated clinical stage, lifestyle, vitamin D, serum bone turnover markers, vertebral and femoral BMD. A homogenous cohort of 61 healthy subjects was used as control group. TBS was lower in NF1 patients (1.266 ± 0.113 vs. 1.346 ± 0.105) without differences between sexes. No correlations with 25OHD, low exercise, low calcium intake, reduced sun exposure, and number of skin neurofibromas were observed. As expected, hypovitaminosis D was common (98.6%), as well as BMD reduction in hip and spine sites: In NF1 patients, bone texture evaluated by TBS was low in both sexes without any correlation with clinical or metabolic parameters, suggesting a direct role of the fibromin mutation.
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Affiliation(s)
- Marcello Filopanti
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Uberta Verga
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- U.O. Endocrinologia Ospedale Policlinico IRCCS, Via F.Sforza 35, 20121, Milan, Italy.
| | - Fabio Massimo Ulivieri
- Bone Metabolic Unit, Division of Nuclear Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Giavoli
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giulia Rodari
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maura Arosio
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Federica Natacci
- Medical Genetics Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Spada
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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26
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Progressive bone impairment with age and pubertal development in neurofibromatosis type I. Arch Osteoporos 2018; 13:93. [PMID: 30151698 DOI: 10.1007/s11657-018-0507-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 08/14/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED Bone density impairment represents an established complication in adults with neurofibromatosis type 1, while few data exist in the pediatric population. Age- and gender-adjusted bone mass decreases with age and pubertal development, identifying childhood as the best time frame to introduce prevention strategies aiming at peak bone mass achievement. PURPOSE The present study aims at evaluating bone mineral density (BMD) in a population of children with neurofibromatosis type I (NF-1), with particular focus on changes occurring during growth and pubertal development. METHODS Bone metabolic markers and bone status [by dual-energy X-ray absorptiometry scans (DXA) of the total body and lumbar spine with morphometric analysis] were assessed in 50 children (33 males; mean age ± SD, 11.6 ± 4 years). Bone mineral apparent density (BMAD), trabecular bone score (TBS), and bone strain (BS) of the lumbar spine (LS) DXA were also obtained. RESULTS In our cohort areal BMD (aBMD) Z-score was below the mean in 88% of the patients at LS (70% after correction for bone size) and in 86% considering total body (TB) DXA. However, aBMD Z-score was < - 2 in 12% after correction for bone size at LS and TB, respectively. Lumbar spine aBMD Z-score (r = - 0.54, P < 0.0001), LS BMAD Z-score (r = - 0.53, P < 0.0001), and TB Z-score (r = - 0.39, P = 0.005) showed a negative correlation with growth and pubertal development (P = 0.007, P = 0.02, P = 0.01, respectively), suggesting that patients failed to gain as much as expected for age. CONCLUSION Bone density impairment becomes more evident with growth and pubertal development in NF-1 patients, thus identifying childhood as the best time frame to introduce prevention strategies aiming at peak bone mass achievement. TBS and BS, providing bone DXA qualitative information, could be useful during longitudinal follow-up for better characterizing bone impairment in these patients.
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27
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Choksi P, Jepsen KJ, Clines GA. The challenges of diagnosing osteoporosis and the limitations of currently available tools. Clin Diabetes Endocrinol 2018; 4:12. [PMID: 29862042 PMCID: PMC5975657 DOI: 10.1186/s40842-018-0062-7] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 04/27/2018] [Indexed: 02/07/2023] Open
Abstract
Dual-energy X-ray absorptiometry (DXA) was the first imaging tool widely utilized by clinicians to assess fracture risk, especially in postmenopausal women. The development of DXA nearly coincided with the availability of effective osteoporosis medications. Although osteoporosis in adults is diagnosed based on a T-score equal to or below − 2.5 SD, most individuals who sustain fragility fractures are above this arbitrary cutoff. This incongruity poses a challenge to clinicians to identify patients who may benefit from osteoporosis treatments. DXA scanners generate 2 dimensional images of complex 3 dimensional structures, and report bone density as the quotient of the bone mineral content divided by the bone area. An obvious pitfall of this method is that a larger bone will convey superior strength, but may in fact have the same bone density as a smaller bone. Other imaging modalities are available such as peripheral quantitative CT, but are largely research tools. Current osteoporosis medications increase bone density and reduce fracture risk but the mechanisms of these actions vary. Anti-resorptive medications (bisphosphonates and denosumab) primarily increase endocortical bone by bolstering mineralization of endosteal resorption pits and thereby increase cortical thickness and reduce cortical porosity. Anabolic medications (teriparatide and abaloparatide) increase the periosteal and endosteal perimeters without large changes in cortical thickness resulting in a larger more structurally sound bone. Because of the differences in the mechanisms of the various drugs, there are likely benefits of selecting a treatment based on a patient’s unique bone structure and pattern of bone loss. This review retreats to basic principles in order to advance clinical management of fragility fractures by examining how skeletal biomechanics, size, shape, and ultra-structural properties are the ultimate predictors of bone strength. Accurate measurement of these skeletal parameters through the development of better imaging scanners is critical to advancing fracture risk assessment and informing clinicians on the best treatment strategy. With this information, a “treat to target” approach could be employed to tailor current and future therapies to each patient’s unique skeletal characteristics.
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Affiliation(s)
- Palak Choksi
- 1Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
| | - Karl J Jepsen
- 2Departments of Orthopaedic Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI USA
| | - Gregory A Clines
- 1Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA.,Endocrinology Section, Ann Arbor VA Medical Center, 2215 Fuller Road, Research 151, Ann Arbor, MI 48105-2399 USA
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