51
|
Ward RJ, Roberts CC, Bencardino JT, Arnold E, Baccei SJ, Cassidy RC, Chang EY, Fox MG, Greenspan BS, Gyftopoulos S, Hochman MG, Mintz DN, Newman JS, Reitman C, Rosenberg ZS, Shah NA, Small KM, Weissman BN. ACR Appropriateness Criteria ® Osteoporosis and Bone Mineral Density. J Am Coll Radiol 2018; 14:S189-S202. [PMID: 28473075 DOI: 10.1016/j.jacr.2017.02.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 01/27/2017] [Accepted: 02/02/2017] [Indexed: 10/19/2022]
Abstract
Osteoporosis is a considerable public health risk, with 50% of women and 20% of men >50 years of age experiencing fracture, with mortality rates of 20% within the first year. Dual x-ray absorptiometry (DXA) is the primary diagnostic modality by which to screen women >65 years of age and men >70 years of age for osteoporosis. In postmenopausal women <65 years of age with additional risk factors for fracture, DXA is recommended. Some patients with bone mineral density above the threshold for treatment may qualify for treatment on the basis of vertebral body fractures detected through a vertebral fracture assessment scan, a lateral spine equivalent generated from a commercial DXA machine. Quantitative CT is useful in patients with advanced degenerative bony changes in their spines. New technologies such as trabecular bone score represent an emerging role for qualitative assessment of bone in clinical practice. It is critical that both radiologists and referring providers consider osteoporosis in their patients, thereby reducing substantial morbidity, mortality, and cost to the health care system. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Collapse
Affiliation(s)
| | - Robert J Ward
- Principal Author, Tufts Medical Center, Boston, Massachusetts.
| | | | - Jenny T Bencardino
- Panel Vice-Chair, New York University School of Medicine, New York, New York
| | - Erin Arnold
- Illinois Bone and Joint Institute, Morton Grove, Illinois; American College of Rheumatology
| | | | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky; American Academy of Orthopaedic Surgeons
| | - Eric Y Chang
- VA San Diego Healthcare System, San Diego, California
| | - Michael G Fox
- University of Virginia Health System, Charlottesville, Virginia
| | | | | | - Mary G Hochman
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | - Charles Reitman
- Medical University of South Carolina, Charleston, South Carolina; North American Spine Society
| | | | - Nehal A Shah
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | | |
Collapse
|
52
|
Hiperparatiroidismo primario. Med Clin (Barc) 2018; 150:226-232. [DOI: 10.1016/j.medcli.2017.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 11/21/2022]
|
53
|
Olsson A, Oturai AB, Søndergaard HB, Sellebjerg F, Oturai PS. Bone microarchitecture and bone mineral density in multiple sclerosis. Acta Neurol Scand 2018; 137:363-369. [PMID: 29270986 DOI: 10.1111/ane.12884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) patients are at increased risk of reduced bone mineral density (BMD) and fractures. The aetiology of bone loss in MS is unclear. Trabecular bone score (TBS) is a novel analytical tool that provides a measurement of the bone microarchitecture. Decreased TBS predicts increased fracture risk independently of BMD. To date, no studies have investigated TBS in MS patients. OBJECTIVES To assess bone quality in MS patients by TBS and to evaluate potential risk factors that may affect BMD and TBS in patients with MS. METHODS Two hundred sixty MS patients were included. TBS was calculated using TBS iNsight software (MediMaps® ). Multivariable regression analyses were performed with information on smoking, alcohol, glucocorticoid (GC) treatment, sun exposure, physical activity, vitamin D and BMI. RESULTS Trabecular bone score was not significantly different from an age-matched reference population. Low TBS was associated with high age (P = .014) and smoking (P = .03). Smoking and physical inactivity were associated with low BMD in spine (P = .034, P = .032). GC treatment was not associated with TBS. CONCLUSION We could not find altered TBS values among MS patients, suggesting that BMD alone, and not the bone microarchitecture, is affected in MS. However, larger studies are needed to verify these findings and to establish the role of TBS in MS. As in the background population, physical activity and non-smoking habits are associated with better bone health in MS.
Collapse
Affiliation(s)
- A. Olsson
- Department of Neurology; Danish Multiple Sclerosis Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - A. B. Oturai
- Department of Neurology; Danish Multiple Sclerosis Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - H. B. Søndergaard
- Department of Neurology; Danish Multiple Sclerosis Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - F. Sellebjerg
- Department of Neurology; Danish Multiple Sclerosis Center; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - P. S. Oturai
- Department of Clinical Physiology; Nuclear Medicine and PET; Rigshospitalet; Copenhagen Denmark
| |
Collapse
|
54
|
Makras P, Anastasilakis AD. Bone disease in primary hyperparathyroidism. Metabolism 2018; 80:57-65. [PMID: 29051042 DOI: 10.1016/j.metabol.2017.10.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/05/2017] [Accepted: 10/07/2017] [Indexed: 11/16/2022]
Abstract
Primary hyperparathyroidism (PHPT) is a disease of high bone turnover, decreased bone mineral density (BMD) especially at cortical sites, and increased risk of fractures at all skeletal sites. Early diagnosis during the last decades resulted in milder forms of bone involvement. New methods of imaging and validation such as high resolution peripheral quantitative computed tomography and trabecular bone score provide evidence of disturbed bone microarchitecture and explain further the increased risk of fractures at both cortical and trabecular skeletal sites. Parathyroidectomy has a long-term beneficial effect on the skeleton and is probably prudent to refer PHPT patients for surgery in all cases where increased bone fragility is suspected. Bisphosphonates (BPs), mainly alendronate, have been proved as reasonable choices for BMD improvement while cinacalcet has no effect on bone strength in PHPT. Combination of BPs and cinacalcet, is a valid therapeutic approach from a pathophysiological point of view at least in terms of bone health, however, an adequately powered study to prove it is lacking. Adequate dietary calcium intake and vitamin D supplementation is advised as in the general population for the skeletal integrity of PHPT patients albeit with a close monitoring of serum and urinary calcium levels.
Collapse
Affiliation(s)
- Polyzois Makras
- Department of Endocrinology and Diabetes, 251 Hellenic Air Force & VA General Hospital, Athens, Greece
| | | |
Collapse
|
55
|
Tay D, Cremers S, Bilezikian JP. Optimal dosing and delivery of parathyroid hormone and its analogues for osteoporosis and hypoparathyroidism - translating the pharmacology. Br J Clin Pharmacol 2018; 84:252-267. [PMID: 29049872 PMCID: PMC5777439 DOI: 10.1111/bcp.13455] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 09/30/2017] [Accepted: 10/08/2017] [Indexed: 12/14/2022] Open
Abstract
In primary hyperparathyroidism (PHPT), bone loss results from the resorptive effects of excess parathyroid hormone (PTH). Under physiological conditions, PTH has actions that are more targeted to homeostasis and to bone accrual. The predominant action of PTH, either catabolic, anabolic or homeostatic, can be understood in molecular and pharmacokinetic terms. When administered intermittently, PTH increases bone mass, but when present continuously and in excess (e.g. PHPT), bone loss ensues. This dual effect of PTH depends not only on the dosing regimen, continuous or intermittent, but also on how the PTH molecule interacts with various states of its receptor (PTH/PTHrP receptor) influencing downstream signalling pathways differentially. Altering the amino-terminal end of PTH or PTHrP could emphasize the state of the receptor that is linked to an osteoanabolic outcome. This concept led to the development of a PTHrP analogue that interacts preferentially with the transiently linked state of the receptor, emphasizing an osteoanabolic effect. However, designing PTH or PTHrP analogues with prolonged state of binding to the receptor would be expected to be linked to a homeostatic action associated with the tonic secretory state of the parathyroid glands that is advantageous in treating hypoparathyroidism. Ideally, further development of a drug delivery system that mimics the physiological tonic, circadian, and pulsatile profile of PTH would be optimal. This review discusses basic, translational and clinical studies that may well lead to newer approaches to the treatment of osteoporosis as well as to different PTH molecules that could become more advantageous in treating hypoparathyroidism.
Collapse
Affiliation(s)
- Donovan Tay
- Department of Medicine, College of Physicians and SurgeonsColumbia UniversityNew YorkNY10032USA
- Department of MedicineSengkang HealthSingapore
- Osteoporosis and Bone Metabolism Unit, Department of EndocrinologySingapore General HospitalSingapore
| | - Serge Cremers
- Department of Medicine, College of Physicians and SurgeonsColumbia UniversityNew YorkNY10032USA
- Department of Pathology and Cell BiologyColumbia University Medical CenterNew YorkNY10032USA
- Irving Institute for Clinical and Translational ResearchColumbia University Medical CenterNew YorkNY10032USA
| | - John P. Bilezikian
- Department of Medicine, College of Physicians and SurgeonsColumbia UniversityNew YorkNY10032USA
| |
Collapse
|
56
|
Eller-Vainicher C, Palmieri S, Cairoli E, Goggi G, Scillitani A, Arosio M, Falchetti A, Chiodini I. Protective Effect of Denosumab on Bone in Older Women with Primary Hyperparathyroidism. J Am Geriatr Soc 2018; 66:518-524. [DOI: 10.1111/jgs.15250] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
| | - Serena Palmieri
- Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - Elisa Cairoli
- Unit of Endocrinology; Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico; Milan Italy
- Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - Giovanni Goggi
- Unit of Endocrinology; ‘Casa Sollievo della Sofferenza,’ IRCCS, San Giovanni Rotondo; Foggia Italy
| | - Alfredo Scillitani
- Unit of Endocrinology; ‘Casa Sollievo della Sofferenza,’ IRCCS, San Giovanni Rotondo; Foggia Italy
| | - Maura Arosio
- Unit of Endocrinology; Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico; Milan Italy
- Department of Clinical Sciences and Community Health; University of Milan; Milan Italy
| | - Alberto Falchetti
- Villa Alba Hospital; Villa Maria Group; Bologna Italy
- EndOsMet; Villa Donatello, Private Hospital; Florence Italy
| | - Iacopo Chiodini
- Unit of Endocrinology; Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico; Milan Italy
| |
Collapse
|
57
|
Lewiecki EM, Bilezikian JP, Carey JJ, Dell RM, Gordon CM, Harris ST, McClung MR, Miller PD, Rosenblatt M. Proceedings of the 2017 Santa Fe Bone Symposium: Insights and Emerging Concepts in the Management of Osteoporosis. J Clin Densitom 2018; 21:3-21. [PMID: 29229501 DOI: 10.1016/j.jocd.2017.10.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 10/31/2017] [Indexed: 11/28/2022]
Abstract
The 18th Annual Santa Fe Bone Symposium was held on August 4-5, 2017, in Santa Fe, New Mexico, USA. The symposium convenes health-care providers and clinical researchers to present and discuss clinical applications of recent advances in research of skeletal diseases. The program includes lectures, oral presentations by endocrinology fellows, case-based panel discussions, and breakout sessions on topics of interest, with emphasis on participation and interaction of all participants. Topics included the evaluation and treatment of adult survivors with pediatric bone diseases, risk assessment and management of atypical femur fractures, nonpharmacologic strategies in the care of osteoporosis, and skeletal effects of parathyroid hormone with opportunities for therapeutic intervention. Management of skeletal complications of rheumatic diseases was discussed. Insights into sequential and combined use of antiresorptive agents were presented. Individualization of patient treatment decisions when clinical practice guidelines may not be applicable was covered. Challenges and opportunities with osteoporosis drug development were discussed. There was an update on progress of Bone Health TeleECHO (Bone Health Extension for Community Healthcare Outcomes), a teleconferencing strategy for sharing knowledge and expanding capacity to deliver best-practice skeletal health care.
Collapse
Affiliation(s)
- E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA.
| | - John P Bilezikian
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Catherine M Gordon
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Steven T Harris
- University of California San Francisco, San Francisco, CA, USA
| | | | - Paul D Miller
- University of Colorado Health Sciences Center, Denver, CO, USA
| | | |
Collapse
|
58
|
Ulivieri FM, Piodi LP, Grossi E, Rinaudo L, Messina C, Tassi AP, Filopanti M, Tirelli A, Sardanelli F. The role of carboxy-terminal cross-linking telopeptide of type I collagen, dual x-ray absorptiometry bone strain and Romberg test in a new osteoporotic fracture risk evaluation: A proposal from an observational study. PLoS One 2018; 13:e0190477. [PMID: 29304151 PMCID: PMC5755772 DOI: 10.1371/journal.pone.0190477] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/17/2017] [Indexed: 02/05/2023] Open
Abstract
The consolidated way of diagnosing and treating osteoporosis in order to prevent fragility fractures has recently been questioned by some papers, which complained of overdiagnosis and consequent overtreatment of this pathology with underestimating other causes of the fragility fractures, like falls. A new clinical approach is proposed for identifying the subgroup of patients prone to fragility fractures. This retrospective observational study was conducted from January to June 2015 at the Nuclear Medicine-Bone Metabolic Unit of the of the Fondazione IRCCS Ca' Granda, Milan, Italy. An Italian population of 125 consecutive postmenopausal women was investigated for bone quantity and bone quality. Patients with neurological diseases regarding balance and vestibular dysfunction, sarcopenia, past or current history of diseases and use of drugs known to affect bone metabolism were excluded. Dual X-ray absorptiometry was used to assess bone quantity (bone mineral density) and bone quality (trabecular bone score and bone strain). Biochemical markers of bone turnover (type I collagen carboxy-terminal telopeptide, alkaline phosphatase, vitamin D) have been measured. Morphometric fractures have been searched by spine radiography. Balance was evaluated by the Romberg test. The data were evaluated with the neural network analysis using the Auto Contractive Map algorithm. The resulting semantic map shows the Minimal Spanning Tree and the Maximally Regular Graph of the interrelations between bone status parameters, balance conditions and fractures of the studied population. A low fracture risk seems to be related to a low carboxy-terminal cross-linking telopeptide of type I collagen level, whereas a positive Romberg test, together with compromised bone trabecular microarchitecture DXA parameters, appears to be strictly connected with fragility fractures. A simple assessment of the risk of fragility fracture is proposed in order to identify those frail patients at risk for osteoporotic fractures, who may have the best benefit from a pharmacological and physiotherapeutic approach.
Collapse
Affiliation(s)
- Fabio M. Ulivieri
- Nuclear Medicine Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
- * E-mail:
| | - Luca P. Piodi
- Gastroenterology and Digestive Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enzo Grossi
- Villa Santa Maria Institute, Tavernerio (CO), Italy
| | | | - Carmelo Messina
- Postgraduation School in Radiodiagnostics, University of Milan, Milan, Italy
| | - Anna P. Tassi
- Physical Medicine and Rehabilitation Physician, A.S.P. I.M.M e S. e P.A.T, Milan, Italy
| | - Marcello Filopanti
- Endocrinology and Metabolic Diseases Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Tirelli
- Clinical Chemistry and Microbiology Laboratory, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | |
Collapse
|
59
|
Hans D, Šteňová E, Lamy O. The Trabecular Bone Score (TBS) Complements DXA and the FRAX as a Fracture Risk Assessment Tool in Routine Clinical Practice. Curr Osteoporos Rep 2017; 15:521-531. [PMID: 28988401 DOI: 10.1007/s11914-017-0410-z] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF THE REVIEW There is an increasing body of evidence that the trabecular bone score (TBS), a surrogate of bone microarchitecture extracted from spine DXA, could play an important role in the management of patients with osteoporosis or at risk of fracture. The current paper reviews this published body of scientific literature on TBS and answers the most relevant clinical questions. RECENT FINDINGS TBS has repeatedly been proven to be predictive of fragility fractures, current and future, and this is largely independent of BMD, CRF, and the FRAX, and when used in conjunction with any one of these measures, it consistently enhances their accuracy. There also is a growing body of evidence indicating that the TBS has particular advantages over BMD for specific causes of increased fracture risk, like chronic corticosteroid excess, type-2 diabetes, and chronic kidney disease, and patients being treated with anti-aromatase and primary hyperparathyroidism, conditions wherein BMD readings are often misleading. TBS enhances performance of the FRAX tool, where its greatest utility appears to lie in its ability to accurately classify those patients whose BMD level lies close to the intervention threshold, aiding in decisions on whether treatment is warranted or not. Furthermore, TBS has also particular advantages over BMD in secondary osteoporosis. While the role of TBS with monitoring could be important as the different molecules impact logically TBS to various degrees, large clinical trials are still needed.
Collapse
Affiliation(s)
- Didier Hans
- Centre of Bone diseases, Bone and Joint Department, Lausanne University Hospital, Avenue Pierre-Decker, 4, CH-1011, Lausanne, Switzerland.
| | - Emőke Šteňová
- 1st Department of Internal Medicine, Comenius University, Faculty of Medicine in Bratislava, University Hospital, Bratislava, Staré Mesto, Bratislava, Slovakia
| | - Olivier Lamy
- Centre of Bone diseases, Bone and Joint Department, Lausanne University Hospital, Avenue Pierre-Decker, 4, CH-1011, Lausanne, Switzerland
- Internal Medicine Unit, Internal Medicine Department, Lausanne University Hospital, Lausanne, Switzerland
| |
Collapse
|
60
|
Martineau P, Silva BC, Leslie WD. Utility of trabecular bone score in the evaluation of osteoporosis. Curr Opin Endocrinol Diabetes Obes 2017; 24:402-410. [PMID: 28857846 DOI: 10.1097/med.0000000000000365] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Trabecular bone score (TBS) is a lumbar spine dual-energy absorptiometry texture index which provides information on skeletal quality partially independent of bone mineral density (BMD). A body of work has emerged demonstrating the relationship between TBS and fracture risk, with lower TBS values associated with increased risk for osteoporotic fracture in postmenopausal women and older men. TBS is derived from standard DXA images; however, the information provided by TBS is complementary to that provided by BMD. In this article, we review the current state of TBS and its evolving role in the assessment and management of osteoporosis, with particular emphasis on the literature of the previous year. RECENT FINDINGS TBS-adjusted The Fracture Risk Assessment tool (FRAX) probabilities enhance fracture risk prediction compared with conventional FRAX predictions. TBS has been found to better categorize fracture risk and assists in FRAX-based treatment decisions, particularly for patients close to an intervention threshold. However, change in lumbar spine TBS while undergoing antiresorptive treatment is not a useful indicator of antifracture effect. SUMMARY Lumbar spine TBS is a recently developed image-based software technique for skeletal assessment, complementary to conventional BMD, which has been shown to be clinically useful as a fracture risk prediction tool.
Collapse
Affiliation(s)
- Patrick Martineau
- aUniversity of Ottawa, Ottawa, Ontario, Canada bUNI-BH, Santa Casa Hospital, Belo Horizonte, Brazil cUniversity of Manitoba, Winnipeg, Manitoba, Canada
| | | | | |
Collapse
|
61
|
Choi YJ, Chung YS, Suh CH, Jung JY, Kim HA. Trabecular bone score as a supplementary tool for the discrimination of osteoporotic fractures in postmenopausal women with rheumatoid arthritis. Medicine (Baltimore) 2017; 96:e8661. [PMID: 29137106 PMCID: PMC5690799 DOI: 10.1097/md.0000000000008661] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Rheumatoid arthritis (RA) is a risk factor for bone fragility, and its effect on fracture risk is independent of bone mineral density (BMD). The trabecular bone score (TBS) is a new indirect parameter of bone quality. In this study, BMD and the TBS were compared between female postmenopausal RA patients with and those without vertebral fractures (VFs).This study had a cross-sectional design. Two hundred seventy-nine postmenopausal women with RA aged 50 years or older were included in this study. TBS measurements were performed on the same vertebrae as those for the BMD measurements.Among the 279 subjects, 34 had VFs (12.5%). There was a significant difference in the TBS (P = .005) but not L-spine BMD (P = .142) between the subjects with and those without VFs. The odds ratio (OR) for the TBS per standard deviation decrease was significant, even after adjusting for confounding factors such as age, height, rheumatoid factor positivity, the disease activity score for 28 joints (DAS28), the cumulative dose of glucocorticoids (GCs), the time since menopause and osteoporosis drug use (OR = 2.86; 95% CI, 1.34-6.09), and L-spine BMD (OR = 2.57; 95% CI, 1.19-5.54). The TBS was negatively correlated with the cumulative dose of GCs, but not with the DAS28 or erythrocyte sedimentation rate. However, the correlation was an L-shaped nonlinear relationship.The TBS could be a supplementary tool for discriminating osteoporotic fractures in postmenopausal women with RA, and it may have a nonlinear relationship with the cumulative dose of GCs, but not with RA disease activity.
Collapse
Affiliation(s)
| | | | - Chang-Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon, South Korea
| | - Ju-Yang Jung
- Department of Rheumatology, Ajou University School of Medicine, Suwon, South Korea
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, South Korea
| |
Collapse
|
62
|
Martineau P, Leslie WD. Trabecular bone score (TBS): Method and applications. Bone 2017; 104:66-72. [PMID: 28159710 DOI: 10.1016/j.bone.2017.01.035] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 01/10/2017] [Accepted: 01/29/2017] [Indexed: 01/14/2023]
Abstract
Trabecular bone score (TBS) is a texture index derived from standard lumbar spine dual energy X-ray absorptiometry (DXA) images and provides information about the underlying bone independent of the bone mineral density (BMD). Several salient observations have emerged. Numerous studies have examined the relationship between TBS and fracture risk and have shown that lower TBS values are associated with increased risk for major osteoporotic fracture in postmenopausal women and older men, with this result being independent of BMD values and other clinical risk factors. Therefore, despite being derived from standard DXA images, the information contained in TBS is independent and complementary to the information provided by BMD and the FRAX® tool. A procedure to generate TBS-adjusted FRAX probabilities has become available with the resultant predicted fracture risks shown to be more accurate than the standard FRAX tool. With these developments, TBS has emerged as a clinical tool for improved fracture risk prediction and guiding decisions regarding treatment initiation, particularly for patients with FRAX probabilities around an intervention threshold. In this article, we review the development, validation, clinical application, and limitations of TBS.
Collapse
Affiliation(s)
- P Martineau
- University of Ottawa, Ottawa, Ontario, Canada
| | - W D Leslie
- University of Manitoba, Winnipeg, Manitoba, Canada.
| |
Collapse
|
63
|
Yavropoulou MP, Vaios V, Pikilidou M, Chryssogonidis I, Sachinidou M, Tournis S, Makris K, Kotsa K, Daniilidis M, Haritanti A, Liakopoulos V. Bone Quality Assessment as Measured by Trabecular Bone Score in Patients With End-Stage Renal Disease on Dialysis. J Clin Densitom 2017; 20:490-497. [PMID: 28039046 DOI: 10.1016/j.jocd.2016.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/02/2016] [Accepted: 11/04/2016] [Indexed: 12/18/2022]
Abstract
Patients with end-stage renal disease (ESRD) on maintenance hemodialysis (HD) exhibit osteoporosis and increased fracture risk. Dual-energy X-ray absorptiometry scan measurements and calculation of fracture risk assessment toll score underestimate fracture risk in these patients and do not estimate bone quality. Trabecular bone score (TBS) has been recently proposed as an indirect measure of bone microarchitecture. In this study, we investigated alterations of bone quality in patients with ESRD on HD, using TBS. Fifty patients with ESRD on HD, with a mean age 62 years, and 52 healthy individuals matched for age, body mass index, and gender, were enrolled. All participants had a bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry scan at the lumbar spine, femoral neck, total hip, and 1/3 radius. TBS was evaluated using TBS iNsight. Serum fetuin-A and plasma fibroblast growth factor-23 (FGF-23) (C-terminal) were also measured. Patients on dialysis had significantly lower BMD values at all skeletal sites measured. Plasma FGF-23 levels significantly increased and serum fetuin-Α significantly decreased in patients on dialysis compared with controls. TBS was significantly reduced in patients on dialysis compared with controls (1.11 ± 0.16 vs 1.30 ± 0.13, p < 0.001, respectively) independently of age; BMD; duration of dialysis; and serum levels of alkaline phosphatase, 25-OH-vitamin D, parathyroid hormone, fetuin-A, or plasma FGF-23. Patients on HD who were diagnosed with an osteoporotic vertebral fracture had numerically lower TBS values, albeit without reaching statistical significance, compared with patients on dialysis without a fracture (1.044 ± 0.151 vs 1.124 ± 0.173, respectively, p = 0.079). Bone microarchitecture, as assessed by TBS, is significantly altered in ESRD on patients on HD independently of BMD values and metabolic changes that reflect chronic kidney disease-mineral and bone disorder.
Collapse
Affiliation(s)
- Maria P Yavropoulou
- Division of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Vasilios Vaios
- Nephrology Division, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Maria Pikilidou
- 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | | | - Melina Sachinidou
- Radiology Unit AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Symeon Tournis
- Laboratory of Research of Musculoskeletal System "Th. Garofalidis", Medical School, KAT Hospital, University of Athens, Athens, Greece
| | - Konstantinos Makris
- Laboratory of Research of Musculoskeletal System "Th. Garofalidis", Medical School, KAT Hospital, University of Athens, Athens, Greece
| | - Kalliopi Kotsa
- Division of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Michalis Daniilidis
- 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Afroditi Haritanti
- Radiology Unit AHEPA University Hospital, Aristotle University of Thessaloniki, Greece
| | - Vassilios Liakopoulos
- Nephrology Division, 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
| |
Collapse
|
64
|
Lundstam K, Heck A, Godang K, Mollerup C, Baranowski M, Pernow Y, Aas T, Hessman O, Rosén T, Nordenström J, Jansson S, Hellström M, Bollerslev J. Effect of Surgery Versus Observation: Skeletal 5-Year Outcomes in a Randomized Trial of Patients With Primary HPT (the SIPH Study). J Bone Miner Res 2017; 32:1907-1914. [PMID: 28543873 DOI: 10.1002/jbmr.3177] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 05/15/2017] [Accepted: 05/19/2017] [Indexed: 01/10/2023]
Abstract
Mild primary hyperparathyroidism (PHPT) is known to affect the skeleton, even though patients usually are asymptomatic. Treatment strategies have been widely discussed. However, long-term randomized studies comparing parathyroidectomy to observation are lacking. The objective was to study the effect of parathyroidectomy (PTX) compared with observation (OBS) on bone mineral density (BMD) in g/cm2 and T-scores and on biochemical markers of bone turnover (P1NP and CTX-1) in a prospective randomized controlled study of patients with mild PHPT after 5 years of follow-up. Of 191 patients with mild PHPT randomized to either PTX or OBS, 145 patients remained for analysis after 5 years (110 with validated DXA scans). A significant decrease in P1NP (p < 0.001) and CTX-1 (p < 0.001) was found in the PTX group only. A significant positive treatment effect of surgery compared with observation on BMD (g/cm2 ) was found for the lumbar spine (LS) (p = 0.011), the femoral neck (FN) (p < 0.001), the ultradistal radius (UDR) (p = 0.042), and for the total body (TB) (p < 0.001) but not for the radius 33% (Rad33), where BMD decreased significantly also in the PTX group (p = 0.012). However, compared with baseline values, there was no significant BMD increase in the PTX group, except for the lumbar spine. In the OBS group, there was a significant decrease in BMD (g/cm2 ) for all compartments (FN, p < 0.001; Rad33, p = 0.001; UDR, p = 0.006; TB, p < 0.001) with the exception of the LS, where BMD was stable. In conclusion, parathyroidectomy improves BMD and observation leads to a small but statistically significant decrease in BMD after 5 years. Thus, bone health appears to be a clinical concern with long-term observation in patients with mild PHPT. © 2017 American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Karolina Lundstam
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ansgar Heck
- Section of Specialized Endocrinology, Oslo University Hospital, and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristin Godang
- Section of Specialized Endocrinology, Oslo University Hospital, and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Charlotte Mollerup
- Clinic of Breast and Endocrine Surgery, Center HOC, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Ylva Pernow
- Department of Molecular Medicine and Surgery, Department of Endocrinology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Turid Aas
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
| | - Ola Hessman
- Department of Surgical Sciences, University of Uppsala, Uppsala, Sweden
| | - Thord Rosén
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jörgen Nordenström
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Svante Jansson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Mikael Hellström
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jens Bollerslev
- Section of Specialized Endocrinology, Oslo University Hospital, and Faculty of Medicine, University of Oslo, Oslo, Norway
| | | |
Collapse
|
65
|
Shevroja E, Lamy O, Kohlmeier L, Koromani F, Rivadeneira F, Hans D. Use of Trabecular Bone Score (TBS) as a Complementary Approach to Dual-energy X-ray Absorptiometry (DXA) for Fracture Risk Assessment in Clinical Practice. J Clin Densitom 2017; 20:334-345. [PMID: 28734710 DOI: 10.1016/j.jocd.2017.06.019] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Osteoporosis is a common bone disease characterized by low bone mass and altered bone microarchitecture, resulting in decreased bone strength with an increased risk of fractures. In clinical practice, physicians can assess the risk of fracture for a patient based on several risk factors. Some such as age, weight, and history of fractures after 50 years of age, parental fracture, smoking status, and alcohol intake are incorporated into FRAX, an assessment tool that estimates the 10-year probability of hip fracture and major osteoporotic fractures based on the individual's risk factors profile. The diagnosis of osteoporosis is currently based on bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry scans. Among other widely recognized limitations of BMD is that BMD considers only the density of the bone and fails in measuring bone microarchitecture, for which novel techniques, such as trabecular bone score (TBS), have been developed. TBS is a texture parameter related to bone microarchitecture that may provide skeletal information that is not captured from the standard BMD measurement. Several studies have examined the value of TBS on predicting osteoporotic fractures. Our study aimed to summarize a review of the current scientific literature with focus on fracture risk assessment and to present both its findings and its conclusions regarding how and when TBS should be used. The existing literature indicates that low lumbar spine TBS is associated with a history of fracture and the incidence of new fracture. The effect is largely independent of BMD and of sufficient magnitude to enhance risk stratification with BMD. The TBS effect is also independent of FRAX, with likely greatest utility for those individuals whose BMD levels lie close to an intervention threshold. The clinical and scientific evidence supporting the use of TBS, with the ability of this technology to be seamlessly integrated into a daily workflow, makes TBS an attractive and useful clinical tool for physicians to improve patient management in osteoporosis. Further research is ongoing and necessary to further clarify the role of TBS in additional specific disorders.
Collapse
Affiliation(s)
- Enisa Shevroja
- Center of Bone Diseases, Bone & Joint Department, Lausanne University Hospital, Lausanne, Switzerland; Musculoskeletal Genomics, Departments of Internal Medicine and Epidemiology, Rotterdam, The Netherlands
| | - Olivier Lamy
- Center of Bone Diseases, Bone & Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Lynn Kohlmeier
- Endocrinology and Metabolic Bone, Spokane Osteoporosis, Spokane, WA, USA
| | - Fjorda Koromani
- Musculoskeletal Genomics, Departments of Internal Medicine and Epidemiology, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Musculoskeletal Genomics, Departments of Internal Medicine and Epidemiology, Rotterdam, The Netherlands
| | - Didier Hans
- Center of Bone Diseases, Bone & Joint Department, Lausanne University Hospital, Lausanne, Switzerland.
| |
Collapse
|
66
|
Silva BC, Leslie WD. Trabecular Bone Score: A New DXA-Derived Measurement for Fracture Risk Assessment. Endocrinol Metab Clin North Am 2017; 46:153-180. [PMID: 28131130 DOI: 10.1016/j.ecl.2016.09.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Trabecular bone score (TBS) is a novel method that assesses skeletal texture from spine dual-energy X-ray absorptiometry (DXA) images. TBS improves fracture-risk prediction beyond that provided by DXA bone mineral density (BMD) and clinical risk factors, and can be incorporated to the Word Health Organization Fracture Risk Assessment tool (FRAX®) to enhance fracture prediction. There is insufficient evidence that TBS can be used to monitor treatment with bisphosphonates. TBS may be particularly helpful to assess fracture risk in diabetes. This article reviews technical and clinical aspects of TBS and its potential utility as a clinical tool to predict fracture risk.
Collapse
Affiliation(s)
- Barbara C Silva
- Department of Medicine, UNI-BH, Santa Casa Hospital, Uberaba, 370/705, Belo Horizonte, MG 30180-010, Brazil.
| | - William D Leslie
- Department of Medicine, University of Manitoba, (C5121) 409 Tache Avenue, Winnipeg, MB R2H 2A6, Canada
| |
Collapse
|
67
|
Cipriani C, Abraham A, Silva BC, Cusano NE, Rubin MR, McMahon DJ, Zhang C, Hans D, Silverberg SJ, Bilezikian JP. Skeletal changes after restoration of the euparathyroid state in patients with hypoparathyroidism and primary hyperparathyroidism. Endocrine 2017; 55:591-598. [PMID: 27757772 PMCID: PMC5407087 DOI: 10.1007/s12020-016-1101-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 08/22/2016] [Indexed: 12/30/2022]
Abstract
Restoration of the euparathyroid state is associated with improvement of bone dynamics both in hypoparathyroidism and primary hyperparathyroidism. To date, no study has directly compared these two groups following correction of parathyroid hormone excess or deficiency. The study was designed to investigate changes in bone mineral density and trabecular bone score with restoration of the euparathyroid state by parathyroidectomy in primary hyperparathyroidism or recombinant parathyroid hormone [rhPTH(1-84)] replacement in hypoparathyroidism. This was a 2-year prospective intervention study in which we evaluated areal bone mineral density by DXA and trabecular bone score in 52 hypoparathyroid patients on rhPTH(1-84) replacement and 27 patients with primary hyperparathyroidism who underwent parathyroidectomy. We evaluated changes in areal bone mineral density by DXA and trabecular bone score at baseline, 6, 12, 18, and 24 months. After parathyroidectomy, areal bone mineral density increased from baseline at the lumbar spine and total hip at 6 months and at the femoral neck at 12 months, while there were no changes at the distal 1/3 radius. Treatment with rhPTH(1-84) was associated with significant increases in lumbar spine and decreases in distal 1/3 radius areal bone mineral density by 18 months in hypoparathyroid patients. At this time point, hypoparathyroid subjects demonstrated a significant increase in trabecular bone score from baseline, while there were no significant changes in trabecular bone score following parathyroidectomy. Bone mineral density increases both with administration of parathyroid hormone in a state of parathyroid hormone deficiency or removal of parathyroid hormone in a state of parathyroid hormone excess. However, only hypoparathyroid patients on rhPTH(1-84) appeared to have improvements in micro-architectural pattern as assessed by trabecular bone score.
Collapse
Affiliation(s)
- Cristiana Cipriani
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA
- Department of Internal Medicine and Medical Disciplines, Sapienza University of Rome, Rome, Italy
| | - Alice Abraham
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA
| | - Barbara C Silva
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA
- Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Natalie E Cusano
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA
| | - Mishaela R Rubin
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA
| | - Donald J McMahon
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA
| | - Chengchen Zhang
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA
| | - Didier Hans
- Center of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Shonni J Silverberg
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA
| | - John P Bilezikian
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, USA.
| |
Collapse
|
68
|
Khan AA, Hanley DA, Rizzoli R, Bollerslev J, Young JEM, Rejnmark L, Thakker R, D'Amour P, Paul T, Van Uum S, Shrayyef MZ, Goltzman D, Kaiser S, Cusano NE, Bouillon R, Mosekilde L, Kung AW, Rao SD, Bhadada SK, Clarke BL, Liu J, Duh Q, Lewiecki EM, Bandeira F, Eastell R, Marcocci C, Silverberg SJ, Udelsman R, Davison KS, Potts JT, Brandi ML, Bilezikian JP. Primary hyperparathyroidism: review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus. Osteoporos Int 2017; 28:1-19. [PMID: 27613721 PMCID: PMC5206263 DOI: 10.1007/s00198-016-3716-2] [Citation(s) in RCA: 265] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 07/20/2016] [Indexed: 01/02/2023]
Abstract
The purpose of this review is to assess the most recent evidence in the management of primary hyperparathyroidism (PHPT) and provide updated recommendations for its evaluation, diagnosis and treatment. A Medline search of "Hyperparathyroidism. Primary" was conducted and the literature with the highest levels of evidence were reviewed and used to formulate recommendations. PHPT is a common endocrine disorder usually discovered by routine biochemical screening. PHPT is defined as hypercalcemia with increased or inappropriately normal plasma parathyroid hormone (PTH). It is most commonly seen after the age of 50 years, with women predominating by three to fourfold. In countries with routine multichannel screening, PHPT is identified earlier and may be asymptomatic. Where biochemical testing is not routine, PHPT is more likely to present with skeletal complications, or nephrolithiasis. Parathyroidectomy (PTx) is indicated for those with symptomatic disease. For asymptomatic patients, recent guidelines have recommended criteria for surgery, however PTx can also be considered in those who do not meet criteria, and prefer surgery. Non-surgical therapies are available when surgery is not appropriate. This review presents the current state of the art in the diagnosis and management of PHPT and updates the Canadian Position paper on PHPT. An overview of the impact of PHPT on the skeleton and other target organs is presented with international consensus. Differences in the international presentation of this condition are also summarized.
Collapse
Affiliation(s)
- A A Khan
- McMaster University, Hamilton, Canada.
- Bone Research and Education Center, 223-3075 Hospital Gate, Oakville, ON, Canada.
| | | | - R Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | | | - L Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - T Paul
- Western University, London, ON, Canada
| | - S Van Uum
- Western University, London, ON, Canada
| | - M Zakaria Shrayyef
- Division of Endocrinology, University of Toronto, Mississauga, ON, Canada
| | | | - S Kaiser
- Dalhousie University, Halifax, Canada
| | - N E Cusano
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | | | - A W Kung
- University of Hong Kong, Hong Kong, China
| | - S D Rao
- Henry Ford Hospital, Detroit, MI, USA
| | - S K Bhadada
- Postgraduate Institute of Medical Education and Research, Chandigarth, India
| | | | - J Liu
- Rui-Jin Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Q Duh
- University of California, San Francisco, CA, USA
| | - E Michael Lewiecki
- New Mexico Clinical Research and Osteoporosis Center, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - F Bandeira
- Division of Endocrinology, Diabetes and Metabolic Bone Diseases, Agamenon Magalhaes Hospital, Brazilian Ministry of Health, University of Pernambuco Medical School, Recife, Brazil
| | - R Eastell
- Department of Human Metabolism, University of Sheffield, Sheffield, UK
| | - C Marcocci
- Department for Clinical and Experimental Medicine, University of Pisa, Endocrine Unit 2, University Hospital of Pisa, Pisa, Italy
| | - S J Silverberg
- Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - R Udelsman
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | | | - J T Potts
- Massachusetts General Hospital, Harvard University, Boston, MA, USA
| | | | - J P Bilezikian
- Division of Endocrinology, Columbia University College of Physicians and Surgeons, New York, NY, USA
| |
Collapse
|
69
|
Oei L, Koromani F, Rivadeneira F, Zillikens MC, Oei EHG. Quantitative imaging methods in osteoporosis. Quant Imaging Med Surg 2016; 6:680-698. [PMID: 28090446 DOI: 10.21037/qims.2016.12.13] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Osteoporosis is characterized by a decreased bone mass and quality resulting in an increased fracture risk. Quantitative imaging methods are critical in the diagnosis and follow-up of treatment effects in osteoporosis. Prior radiographic vertebral fractures and bone mineral density (BMD) as a quantitative parameter derived from dual-energy X-ray absorptiometry (DXA) are among the strongest known predictors of future osteoporotic fractures. Therefore, current clinical decision making relies heavily on accurate assessment of these imaging features. Further, novel quantitative techniques are being developed to appraise additional characteristics of osteoporosis including three-dimensional bone architecture with quantitative computed tomography (QCT). Dedicated high-resolution (HR) CT equipment is available to enhance image quality. At the other end of the spectrum, by utilizing post-processing techniques such as the trabecular bone score (TBS) information on three-dimensional architecture can be derived from DXA images. Further developments in magnetic resonance imaging (MRI) seem promising to not only capture bone micro-architecture but also characterize processes at the molecular level. This review provides an overview of various quantitative imaging techniques based on different radiological modalities utilized in clinical osteoporosis care and research.
Collapse
Affiliation(s)
- Ling Oei
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Fjorda Koromani
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
70
|
Eller-Vainicher C, Bassotti A, Imeraj A, Cairoli E, Ulivieri FM, Cortini F, Dubini M, Marinelli B, Spada A, Chiodini I. Bone involvement in adult patients affected with Ehlers-Danlos syndrome. Osteoporos Int 2016; 27:2525-31. [PMID: 27084695 DOI: 10.1007/s00198-016-3562-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 03/07/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED The Ehlers-Danlos syndrome is characterized by abnormal connective tissue but bone involvement is debated. We found a reduced BMD and bone quality and increased prevalence of asymptomatic vertebral fractures in eugonadal patients with Ehlers-Danlos syndrome. These findings suggest the need of a bone health evaluation in these patients. INTRODUCTION The Ehlers-Danlos (EDS) syndrome is characterized by abnormalities of the connective tissue leading to ligamentous laxity and skin and tissue fragility. We evaluated the bone metabolism, bone mineral density (BMD) and bone quality (measured by trabecular bone score, TBS), and the prevalence of vertebral fractures (VFx) in a group of eugonadal adult EDS patients. METHODS Fifty consecutive Caucasian patients, aged 30-50 years (36 females, 14 males) with classical or hypermobility EDS and 50 age-, gender-, and body mass index (BMI)-matched control subjects were enrolled. In all subjects' calcium-phosphorous metabolism, bone turnover, BMD at the lumbar spine (LS) and femur (femoral neck, FN and total femur, FT) and TBS by dual-energy X-ray absorptiometry, and the VFx presence by spine radiograph were assessed. RESULTS Patients showed reduced BMD (Z-scores LS -0.45 ± 1.00, FN -0.56 ± 1.01, FT -0.58 ± 0.92) and TBS (1.299 ± 0.111) and increased prevalence of morphometric VFx (32 %) than controls (Z-scores LS 0.09 ± 1.22, FN 0.01 ± 0.97, FT 0.08 ± 0.89; TBS 1.382 ± 0.176; VFx 8 %, p <0.05 for all comparisons), while vitamin D levels, calcium-phosphorous metabolism, and bone turnover were comparable. Fractured EDS patients showed lower TBS values than non-fractured ones (1.245 ± 0.138 vs 1.325 ± 0.086, p < 0.05), despite comparable BMD. In EDS patients, the VFx presence was significantly associated with TBS even after adjusting for sex, age, BMD, EDS type, and falls frequency. CONCLUSIONS EDS patients have reduced BMD and bone quality (as measured by TBS) and increased prevalence of VFx.
Collapse
Affiliation(s)
- C Eller-Vainicher
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - A Bassotti
- Unit of Occupational Medicine, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - A Imeraj
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - E Cairoli
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - F M Ulivieri
- Nuclear medicine, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - F Cortini
- Unit of Occupational Medicine, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - M Dubini
- Unit of Occupational Medicine, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - B Marinelli
- Unit of Occupational Medicine, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - A Spada
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
- Department of Medical Sciences and Community Health, University of Milan, Milan, Italy
| | - I Chiodini
- Unit of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
| |
Collapse
|
71
|
Abstract
PURPOSE OF REVIEW In the 8 years since the launch of the FRAX tool, it has continued to grow with the addition of new country or territory models. Although the core of the fracture risk algorithm remains unchanged, there is growing evidence of possible additional independent clinical variables that might modulate the interpretation of the FRAX outputs. There is also an expanding number of international guidelines that incorporate FRAX assessments, leading to discussions on the use of FRAX in treated patients and the determination of intervention thresholds. RECENT FINDINGS This review encompasses recent information on the use of FRAX in immigrant populations and the potential influence of skeletal and extraskeletal risk factors on FRAX estimations. For example, trabecular bone score and falls risk appear to be promising additional factors in individual risk assessment. FRAX appears to remain accurate in those on osteoporosis treatments, but FRAX is not a suitable tool for use in treat-to-target strategies. SUMMARY The assessment of fracture risk in immigrants is probably more accurate with the use of the FRAX tool for the country of origin, if available. The impact of additional risk variables will need evaluation of the impact of these on recharacterizing patients by moving them across intervention thresholds.
Collapse
Affiliation(s)
- Eugene V McCloskey
- aCentre for Metabolic Bone Diseases bCentre for Integrated Research Musculoskeletal Ageing, Mellanby Centre for Bone Research, University of Sheffield, Sheffield cMRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | | | | | | |
Collapse
|
72
|
|
73
|
Díaz-Soto G, de Luis Román D, Jauregui OI, Briongo L, Romero E, Pérez-Castrillón JL. TRABECULAR BONE SCORE IN PATIENTS WITH NORMOCALCEMIC HYPERPARATHYROIDISM. Endocr Pract 2016; 22:703-7. [PMID: 26866705 DOI: 10.4158/ep151055.or] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The effects of normocalcemic hyperparathyroidism (NHPT) on bone remain unclear. The objective of this study was to evaluate differences in the trabecular bone score (TBS) of NHPT patients and asymptomatic hypercalcemic hyperparathyroidism (HHPT) patients. METHODS We performed a prospective study that enrolled consecutive patients with asymptomatic hyperparathyroidism (NHPT and HHPT) with a follow-up ≥1 year at the University Hospital of Valladolid, Spain. Metabolic phosphocalcium plasma and urine parameters were evaluated in ≥2 determinations during follow-up to classify patients as NHPT patients or asymptomatic HHPT patients. A control group was enrolled during the same period. TBS and bone mineral density (BMD) were evaluated. RESULTS Thirty-nine patients with asymptomatic HPT (24 with NHPT and 15 with HHPT) and 24 controls were recruited. NHPT patients and HHPT patients had a similar mean age, vitamin D level, TBS, and areal BMD (all sites). Compared to controls, symptomatic HPT patients had significantly higher parathyroid hormone (PTH) and calcium levels and significantly lower TBS and areal BMD at all sites (all P<.05). A significant negative relationship between TBS and PTH was found in asymptomatic HPT patients (r = -0.320, P = .043), which remained significant after adjustment for age, sex, and body mass index. CONCLUSION There was no difference in the TBS between NHPT and HHPT patients. However, there was a reduction in the TBS of patients with asymptomatic HPT that was related to PTH levels but had no repercussion on bone mass. Higher levels of PTH seem to be responsible for this alteration in microarchitecture texture. ABBREVIATIONS aBMD = areal bone mineral density BMD = bone mineral density BMI = body mass index DXA = dual-energy X-ray absorptiometry HHPT = hypercalcemic hyperparathyroidism HPT = hyperparathyroidism HR-MRI = high-resolution magnetic resonance HR-pQcT = high-resolution peripheral quantitative computed tomography NHPT = normocalcemic hyper-parathyroidism PTH = parathyroid hormone TBS = trabecular bone score 25vitD = 25-hydroxyvitamin D.
Collapse
|
74
|
Oei L, Zillikens MC, Rivadeneira F, Oei EHG. Osteoporotic Vertebral Fractures as Part of Systemic Disease. J Clin Densitom 2016; 19:70-80. [PMID: 26376171 DOI: 10.1016/j.jocd.2015.08.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 08/13/2015] [Indexed: 12/31/2022]
Abstract
Our understanding of the genetic control of skeletogenesis and bone remodeling is expanding, and normally, bone resorption and bone formation are well balanced through regulation by hormones, growth factors, and cytokines. Osteoporosis is considered a systemic disease characterized by low bone mass and microarchitectural deterioration of bone tissue. Consequent increased bone fragility results in higher fracture risk. The most common osteoporotic fractures are located in the spine, and they form a significant health issue. A large variety of systemic diseases are associated with risk of osteoporotic vertebral fractures, illustrating its multifactorial etiology. Prevalences of these conditions vary from common to extremely rare, and incidence peaks differ according to etiology. This review appreciates different aspects of osteoporotic vertebral fractures as part of systemic disease, including genetic, immunologic, inflammatory, metabolic, and endocrine pathways. It seems impossible to be all-comprehensive on this topic; nevertheless, we hope to provide a reasonably thorough overview. Plenty remains to be elucidated in this field, identifying even more associated diseases and further exposing pathophysiological mechanisms underlying osteoporotic vertebral fractures.
Collapse
Affiliation(s)
- Ling Oei
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, The Netherlands; Department of Internal Medicine, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, The Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, The Netherlands
| | - Edwin H G Oei
- Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
| |
Collapse
|
75
|
Leib ES, Winzenrieth R. Bone status in glucocorticoid-treated men and women. Osteoporos Int 2016; 27:39-48. [PMID: 26252975 DOI: 10.1007/s00198-015-3211-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 06/12/2015] [Indexed: 01/01/2023]
Abstract
UNLABELLED We recorded the results of areal bone mineral density (aBMD) and microarchitecture of the bone measured by trabecular bone score (TBS) in 416 glucocorticoid-treated men and women aged 40 years and older with or without fracture to 1104 controls. TBS better discriminated those with fracture compared to aBMD. These differences were the greatest in men. INTRODUCTION The aim of this study is to evaluate glucocorticoid (GC)-induced effects on areal bone mineral density (aBMD) and bone microarchitectural texture measured by trabecular bone score (TBS). METHODS TBS and aBMD were evaluated at L1-L4 postero-anterior (PA) spine by dual X-ray absorptiometry (DXA) in 1520 men and women aged 40 years and over. Four hundred sixteen subjects who received GCs (≥5 mg/day, for ≥3 months) were matched with 1104 sex-, age-, and BMI-matched control subjects. Clinical data, osteoporotic fractures (OPF), and dietary habits were documented in the medical report. RESULTS GC-treated patients were characterized by a significant decrease of TBS (1.267 vs. 1.298, p < 0.001) compared with control-matched subjects while no change in BMD was observed at any sites. These decreases were even more pronounced when fracture status was taken into account (1.222 vs. 1.298, p < 0.001). The odds ratio (OR) for TBS was 1.44 (1.095-1.89) for OPF, whereas no association was found for BMD at any sites (all p > 0.3). A similar effect on microarchitecture measured by TBS was seen by the presence of fracture as by the use of glucocorticoids. An influence on TBS by sex was also noted with a decrease in TBS of greater magnitude in men. CONCLUSIONS GC-treated individuals have a significant deterioration of bone microarchitectural texture as assessed by TBS which is more marked in those with OPF and in men. TBS seems to be more sensitive than aBMD for GC-related fracture detection and should be a good surrogate indicator of bone health in such secondary osteoporosis.
Collapse
Affiliation(s)
- E S Leib
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - R Winzenrieth
- R & D Department, Med-Imaps, 5 rue Henri Becquerel, Merignac, 33700, Bordeaux, France.
| |
Collapse
|
76
|
|
77
|
Zhukouskaya VV, Eller-Vainicher C, Gaudio A, Privitera F, Cairoli E, Ulivieri FM, Palmieri S, Morelli V, Grancini V, Orsi E, Masserini B, Spada AM, Fiore CE, Chiodini I. The utility of lumbar spine trabecular bone score and femoral neck bone mineral density for identifying asymptomatic vertebral fractures in well-compensated type 2 diabetic patients. Osteoporos Int 2016; 27:49-56. [PMID: 26138582 DOI: 10.1007/s00198-015-3212-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 06/12/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED The objective of the study was to evaluate the usefulness of trabecular bone score (TBS) and bone mineral density (BMD) for identifying vertebral fractures (VFx) in well-compensated type 2 diabetic (T2D) patients. TBS and femoral neck BMD below certain cutoffs may be useful for identifying VFx in well-compensated T2D patients. INTRODUCTION In T2D, the prevalence of VFx is increased, especially in poorly compensated and complicated diabetic patients. The possibility of predicting the fracture risk in T2D patients by measuring BMD and TBS, an indirect parameter of bone quality, is under debate. Therefore, the objective was to evaluate the usefulness of TBS and BMD for identifying VFx in well-compensated T2D patients. METHODS Ninety-nine T2D postmenopausal women in good metabolic control (glycosylated haemoglobin 6.8 ± 0.7 %) and 107 control subjects without T2D were evaluated. In all subjects, we evaluated the following: the BMD at the lumbar spine (LS) and the femoral neck (FN); the TBS by dual X-ray absorptiometry; and VFx by radiography. In T2D subjects, the presence of diabetic retinopathy, neuropathy, and nephropathy was evaluated. RESULTS T2D subjects had increased VFx prevalence (34.3 %) as compared to controls (18.7 %) (p = 0.01). T2D subjects presented higher BMD (LS -0.8 ± 1.44, FN -1.06 ± 1.08), as compared to controls (LS -1.39 ± 1.28, p = 0.002; FN -1.45 ± 0.91, p = 0.006, respectively). TBS was not different between diabetics and controls. In fractured T2D patients, LS-BMD, FN-BMD, and TBS were reduced (-1.2 ± 1.44; -1.44 ± 1.04; 1.072 ± 0.15) and the prevalence of retinopathy (15.4 %) was increased than in nonfractured T2D subjects (-0.59 ± 1.4, p = 0.035; -0.87 ± 1.05, p = 0.005; 1.159 ± 0.15, p = 0.006; 1.8 %, p = 0.04, respectively). The combination of TBS ≤1.130 and FN-BMD less than -1.0 had the best diagnostic accuracy for detecting T2D fractured patients (SP 73.8 %, SN 63.6 %, NPV 78.9 %, PPV 56.8 %). CONCLUSIONS TBS and FN-BMD below certain cutoffs may be useful for identifying VFx in well-compensated T2D patients.
Collapse
Affiliation(s)
- V V Zhukouskaya
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy.
| | - C Eller-Vainicher
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - A Gaudio
- Department of Internal Medicine, University of Catania, Catania, Italy
| | - F Privitera
- Department of Internal Medicine, University of Catania, Catania, Italy
| | - E Cairoli
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - F M Ulivieri
- Units of Nuclear Medicine, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - S Palmieri
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - V Morelli
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - V Grancini
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - E Orsi
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - B Masserini
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - A M Spada
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - C E Fiore
- Department of Internal Medicine, University of Catania, Catania, Italy
| | - I Chiodini
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| |
Collapse
|
78
|
Belaya ZE, Hans D, Rozhinskaya LY, Dragunova NV, Sasonova NI, Solodovnikov AG, Tsoriev TT, Dzeranova LK, Melnichenko GA, Dedov II. The risk factors for fractures and trabecular bone-score value in patients with endogenous Cushing's syndrome. Arch Osteoporos 2015; 10:44. [PMID: 26608406 DOI: 10.1007/s11657-015-0244-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/22/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED In a cohort study of 182 consecutive patients with active endogenous Cushing's syndrome, the only predictor of fracture occurrence after adjustment for age, gender bone mineral density (BMD) and trabecular bone score (TBS) was 24-h urinary free cortisol (24hUFC) levels with a threshold of 1472 nmol/24 h (odds ratio, 3.00 (95% confidence interval (CI), 1.52-5.92); p = 0.002). INTRODUCTION The aim was to estimate the risk factors for fracture in subjects with endogenous Cushing's syndrome (CS) and to evaluate the value of the TBS in these patients. METHODS All enrolled patients with CS (n = 182) were interviewed in relation to low-traumatic fractures and underwent lateral X-ray imaging from T4 to L5. BMD measurements were performed using a DXA Prodigy device (GEHC Lunar, Madison, Wisconsin, USA). The TBS was derived retrospectively from existing BMD scans, blinded to clinical outcome, using TBS iNsight software v2.1 (Medimaps, Merignac, France). Urinary free cortisol (24hUFC) was measured by immunochemiluminescence assay (reference range, 60-413 nmol/24 h). RESULTS Among enrolled patients with CS (149 females; 33 males; mean age, 37.8 years (95% confidence interval, 34.2-39.1); 24hUFC, 2370 nmol/24 h (2087-2632), fractures were confirmed in 81 (44.5%) patients, with 70 suffering from vertebral fractures, which were multiple in 53 cases; 24 patients reported non-vertebral fractures. The mean spine TBS was 1.207 (1.187-1.228), and TBS Z-score was -1.86 (-2.07 to -1.65); area under the curve (AUC) was used to predict fracture (mean spine TBS) = 0.548 (95% CI, 0.454-0.641)). In the final regression model, the only predictor of fracture occurrence was 24hUFC levels (p = 0.001), with an increase of 1.041 (95% CI, 1.019-1.063), calculated for every 100 nmol/24-h cortisol elevation (AUC (24hUFC) = 0.705 (95% CI, 0.629-0.782)). CONCLUSIONS Young patients with CS have a low TBS. However, the only predictor of low traumatic fracture is the severity of the disease itself, indicated by high 24hUFC levels.
Collapse
Affiliation(s)
- Zhanna E Belaya
- The National Research Center for Endocrinology, 11, Dmitria Uljanova Str., Moscow, 117036, Russia.
| | - Didier Hans
- Center of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Liudmila Y Rozhinskaya
- The National Research Center for Endocrinology, 11, Dmitria Uljanova Str., Moscow, 117036, Russia
| | - Natalia V Dragunova
- The National Research Center for Endocrinology, 11, Dmitria Uljanova Str., Moscow, 117036, Russia
| | - Natalia I Sasonova
- The National Research Center for Endocrinology, 11, Dmitria Uljanova Str., Moscow, 117036, Russia
| | | | - Timur T Tsoriev
- The National Research Center for Endocrinology, 11, Dmitria Uljanova Str., Moscow, 117036, Russia
| | - Larisa K Dzeranova
- The National Research Center for Endocrinology, 11, Dmitria Uljanova Str., Moscow, 117036, Russia
| | - Galina A Melnichenko
- The National Research Center for Endocrinology, 11, Dmitria Uljanova Str., Moscow, 117036, Russia
| | - Ivan I Dedov
- The National Research Center for Endocrinology, 11, Dmitria Uljanova Str., Moscow, 117036, Russia
| |
Collapse
|
79
|
Trabecular Bone Score: Where are we now? Joint Bone Spine 2015; 82:320-5. [DOI: 10.1016/j.jbspin.2015.02.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 02/04/2015] [Indexed: 11/21/2022]
|
80
|
Harvey NC, Glüer CC, Binkley N, McCloskey EV, Brandi ML, Cooper C, Kendler D, Lamy O, Laslop A, Camargos BM, Reginster JY, Rizzoli R, Kanis JA. Trabecular bone score (TBS) as a new complementary approach for osteoporosis evaluation in clinical practice. Bone 2015; 78:216-24. [PMID: 25988660 PMCID: PMC4538791 DOI: 10.1016/j.bone.2015.05.016] [Citation(s) in RCA: 298] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/12/2015] [Indexed: 12/21/2022]
Abstract
Trabecular bone score (TBS) is a recently-developed analytical tool that performs novel grey-level texture measurements on lumbar spine dual X-ray absorptiometry (DXA) images, and thereby captures information relating to trabecular microarchitecture. In order for TBS to usefully add to bone mineral density (BMD) and clinical risk factors in osteoporosis risk stratification, it must be independently associated with fracture risk, readily obtainable, and ideally, present a risk which is amenable to osteoporosis treatment. This paper summarizes a review of the scientific literature performed by a Working Group of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis. Low TBS is consistently associated with an increase in both prevalent and incident fractures that is partly independent of both clinical risk factors and areal BMD (aBMD) at the lumbar spine and proximal femur. More recently, TBS has been shown to have predictive value for fracture independent of fracture probabilities using the FRAX® algorithm. Although TBS changes with osteoporosis treatment, the magnitude is less than that of aBMD of the spine, and it is not clear how change in TBS relates to fracture risk reduction. TBS may also have a role in the assessment of fracture risk in some causes of secondary osteoporosis (e.g., diabetes, hyperparathyroidism and glucocorticoid-induced osteoporosis). In conclusion, there is a role for TBS in fracture risk assessment in combination with both aBMD and FRAX.
Collapse
Affiliation(s)
- N C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - C C Glüer
- Sektion Biomedizinische Bildgebung, Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - N Binkley
- Osteoporosis Clinical Research Program, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - E V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - M-L Brandi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Southampton Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - D Kendler
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - O Lamy
- Bone Unit, University Hospital, Lausanne, Switzerland
| | - A Laslop
- Scientific Office, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - B M Camargos
- Unidade de Densitometria Óssea, Densimater Rede Materdei de Saúde, Belo Horizonte, MG, Brazil
| | - J-Y Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liege, Liege, Belgium
| | - R Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - J A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
| |
Collapse
|
81
|
Silva BC, Broy SB, Boutroy S, Schousboe JT, Shepherd JA, Leslie WD. Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 2: Trabecular Bone Score. J Clin Densitom 2015; 18:309-30. [PMID: 26277849 DOI: 10.1016/j.jocd.2015.06.008] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 12/29/2022]
Abstract
Bone mineral density (BMD) as measured by dual-energy X-ray absorptiometry (DXA) is the gold standard for the diagnosis and management of osteoporosis. However, BMD explains only 60%-80% of bone strength, and a number of skeletal features other than BMD contribute to bone strength and fracture risk. Advanced imaging modalities can assess some of these skeletal features, but compared to standard DXA, these techniques have higher costs and limited accessibility. A major challenge, therefore, has been to incorporate in clinical practice a readily available, noninvasive technology that permits improvement in fracture-risk prediction beyond that provided by the combination of standard DXA measurements and clinical risk factors. To this end, trabecular bone score (TBS), a gray-level textural index derived from the lumbar spine DXA image, has been investigated. The purpose of this International Society for Clinical Densitometry task force was to review the evidence and develop recommendations on how to incorporate TBS in clinical practice. Clinical applications of TBS for fracture risk assessment, treatment initiation, monitoring of treatment, and use of TBS in special conditions related to greater fracture risk, were addressed. We present the official positions approved by an expert panel following careful review of the recommendations and evidence presented by the TBS task force.
Collapse
Affiliation(s)
- Barbara C Silva
- Endocrinology Division, Department of Medicine, Santa Casa and Felicio Rocho Hospital, and UNI-BH, Belo Horizonte, Minas Gerais, Brazil.
| | - Susan B Broy
- Department of Medicine, Rosalind Franklin School of Medicine, Chicago Medical School, North Chicago, IL, USA
| | | | - John T Schousboe
- Park Nicollet Clinic, HealthPartners, Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - John A Shepherd
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, San Francisco, CA, USA
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Radiology, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
82
|
|
83
|
Macfarlane DP, Yu N, Leese GP. Asymptomatic and mild primary hyperparathyroidism. ANNALES D'ENDOCRINOLOGIE 2015; 76:120-7. [DOI: 10.1016/j.ando.2015.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
|
84
|
Koumakis E, Avouac J, Winzenrieth R, Toth E, Payet J, Kahan A, Allanore Y, Cormier C. Trabecular bone score in female patients with systemic sclerosis: comparison with rheumatoid arthritis and influence of glucocorticoid exposure. J Rheumatol 2014; 42:228-35. [PMID: 25448793 DOI: 10.3899/jrheum.140752] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is associated with an increased risk of osteoporosis and fractures. To date, the etiology of bone loss in SSc is unclear. Trabecular bone score (TBS) provides an indirect measurement of bone microarchitecture, independent of areal bone mineral density (aBMD). The aims were to assess bone involvement in SSc using TBS in comparison with a "high-risk" population with rheumatoid arthritis (RA) and controls, and to investigate the determinants of a low TBS. METHODS This was a cross-sectional study of 65 women with SSc, 138 age-matched female patients with RA, and 227 age-matched female controls. Spine and hip aBMD were assessed using dual-energy X-ray absorptiometry. TBS was calculated from the anteroposterior image of the spine aBMD. RESULTS TBS was significantly lower in SSc compared to controls (p < 0.0001) and did not differ from RA (p = 0.128), despite lower cumulative and daily glucocorticoid (GC) dose (p < 0.0001). Further, patients with SSc receiving GC ≥ 5 mg/day had a significantly lower TBS than those receiving GC < 5 mg/day (p = 0.001). Multivariate analysis revealed that a low TBS was independently associated with daily GC dose (OR 5.6, 95% CI 1.7-19.2) and a T score ≤ -2.5 SD (OR 5.0, 95% CI 1.5-7.0) in SSc. No association between GC and TBS was found in RA. CONCLUSION Our results support the development of a combined approach using both TBS and aBMD for the assessment of bone microarchitecture in inflammatory rheumatic diseases. Our study showed that SSc-related bone involvement is characterized by an impairment in bone quality in addition to reduced bone quantity, and highlights that TBS can identify the negative effect of GC on bone microarchitecture.
Collapse
Affiliation(s)
- Eugénie Koumakis
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - Jérôme Avouac
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - Renaud Winzenrieth
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - Emese Toth
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - Judith Payet
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - André Kahan
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - Yannick Allanore
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux
| | - Catherine Cormier
- From the Rheumatology Department A, Cochin Hospital, Assistance Publique-Hôpitaux de Paris (APHP), Paris Descartes University; Institut national de la santé et de la recherche médicale (INSERM), Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité, Paris; Med-Imaps-Plateforme Technologique d'Innovation Biomédicale (PTIB)-Hôpital Xavier Arnozan, CHU Bordeaux, Pessac, France.E. Koumakis, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University, and INSERM, Unité INSERM U845, Centre de Recherche "Croissance et Signalisation," Paris Descartes University, Sorbonne Paris Cité; J. Avouac, MD, PhD; E. Toth, MD; J. Payet, MD; A. Kahan, MD, PhD; Y. Allanore, MD, PhD; Catherine Cormier, MD, Rheumatology Department A, Cochin Hospital, APHP, Paris Descartes University; R. Winzenrieth, PhD, PTIB-Hôpital Xavier Arnozan, CHU Bordeaux.
| |
Collapse
|
85
|
Ulivieri FM, Silva BC, Sardanelli F, Hans D, Bilezikian JP, Caudarella R. Utility of the trabecular bone score (TBS) in secondary osteoporosis. Endocrine 2014; 47:435-48. [PMID: 24853880 DOI: 10.1007/s12020-014-0280-4] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 04/25/2014] [Indexed: 12/17/2022]
Abstract
Altered bone micro-architecture is an important factor in accounting for fragility fractures. Until recently, it has not been possible to gain information about skeletal microstructure in a way that is clinically feasible. Bone biopsy is essentially a research tool. High-resolution peripheral Quantitative Computed Tomography, while non-invasive, is available only sparsely throughout the world. The trabecular bone score (TBS) is an imaging technology adapted directly from the Dual Energy X-Ray Absorptiometry (DXA) image of the lumbar spine. Thus, it is potentially readily and widely available. In recent years, a large number of studies have demonstrated that TBS is significantly associated with direct measurements of bone micro-architecture, predicts current and future fragility fractures in primary osteoporosis, and may be a useful adjunct to BMD for fracture detection and prediction. In this review, we summarize its potential utility in secondary causes of osteoporosis. In some situations, like glucocorticoid-induced osteoporosis and in diabetes mellitus, the TBS appears to out-perform DXA. It also has apparent value in numerous other disorders associated with diminished bone health, including primary hyperparathyroidism, androgen-deficiency, hormone-receptor positive breast cancer treatment, chronic kidney disease, hemochromatosis, and autoimmune disorders like rheumatoid arthritis. Further research is both needed and warranted to more clearly establish the role of TBS in these and other disorders that adversely affect bone.
Collapse
Affiliation(s)
- Fabio M Ulivieri
- Bone Metabolic Unit, Division of Nuclear Medicine, Fondazione Irccs Ca' Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | | | | | | |
Collapse
|
86
|
Silverberg SJ, Clarke BL, Peacock M, Bandeira F, Boutroy S, Cusano NE, Dempster D, Lewiecki EM, Liu JM, Minisola S, Rejnmark L, Silva BC, Walker MD, Bilezikian JP. Current issues in the presentation of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop. J Clin Endocrinol Metab 2014; 99:3580-94. [PMID: 25162667 PMCID: PMC5393491 DOI: 10.1210/jc.2014-1415] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This report summarizes data on traditional and nontraditional manifestations of primary hyperparathyroidism (PHPT) that have been published since the last International Workshop on PHPT. PARTICIPANTS This subgroup was constituted by the Steering Committee to address key questions related to the presentation of PHPT. Consensus was established at a closed meeting of the Expert Panel that followed. EVIDENCE Data from the 5-year period between 2008 and 2013 were presented and discussed to determine whether they support changes in recommendations for surgery or nonsurgical follow-up. CONSENSUS PROCESS Questions were developed by the International Task Force on PHPT. A comprehensive literature search for relevant studies was undertaken. After extensive review and discussion, the subgroup came to agreement on what changes in the recommendations for surgery or nonsurgical follow-up of asymptomatic PHPT should be made to the Expert Panel. CONCLUSIONS 1) There are limited new data available on the natural history of asymptomatic PHPT. Although recognition of normocalcemic PHPT (normal serum calcium with elevated PTH concentrations; no secondary cause for hyperparathyroidism) is increasing, data on the clinical presentation and natural history of this phenotype are limited. 2) Although there are geographic differences in the predominant phenotypes of PHPT (symptomatic, asymptomatic, normocalcemic), they do not justify geography-specific management guidelines. 3) Recent data using newer, higher resolution imaging and analytic methods have revealed that in asymptomatic PHPT, both trabecular bone and cortical bone are affected. 4) Clinically silent nephrolithiasis and nephrocalcinosis can be detected by renal imaging and should be listed as a new criterion for surgery. 5) Current data do not support a cardiovascular evaluation or surgery for the purpose of improving cardiovascular markers, anatomical or functional abnormalities. 6) Some patients with mild PHPT have neuropsychological complaints and cognitive abnormalities, and some of these patients may benefit from surgical intervention. However, it is not possible at this time to predict which patients with neuropsychological complaints or cognitive issues will improve after successful parathyroid surgery.
Collapse
Affiliation(s)
- Shonni J Silverberg
- Columbia University College of Physicians & Surgeons (S.J.S., N.E.C., D.D., M.D.W., J.P.B.) New York, New York 10032; Mayo Clinic (B.L.C.), Rochester, Minnesota 55902; Indiana University School of Medicine (M.P.), Indianapolis, Indiana 46202; University of Pernambuco School of Medicine (F.B.), 52050-450 Recife, Brazil; INSERM UMR 1033, Université de Lyon (S.B.), 69437 Lyon, France; New Mexico Clinical Research and Osteoporosis Center (E.M.L.), University of New Mexico School of Medicine, Albuquerque, New Mexico 87106; Shanghai Jiao-tong University School of Medicine (L.J.-M.), Shanghai 200025, People's Republic of China; Sapienza University of Rome (S.M.), 00161 Rome, Italy; Aarhus University Hospital (L.R.), 8000 Aarhus, Denmark; and Federal University of Minas Gerais (B.C.S.), Belo Horizonte 30.130-100, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
87
|
Crouzeix G, Kerlan V. Hyperparathyroïdie primaire : nouveaux concepts, nouvelles recommandations. ANNALES D'ENDOCRINOLOGIE 2014; 75 Suppl 1:S21-36. [DOI: 10.1016/s0003-4266(14)70024-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
88
|
Eller-Vainicher C, Battista C, Guarnieri V, Muscarella S, Palmieri S, Salcuni AS, Guglielmi G, Corbetta S, Minisola S, Spada A, Hendy GN, Cole DEC, Chiodini I, Scillitani A. Factors associated with vertebral fracture risk in patients with primary hyperparathyroidism. Eur J Endocrinol 2014; 171:399-406. [PMID: 24966175 DOI: 10.1530/eje-14-0343] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To examine factors, in addition to bone mineral density (BMD), such as the common calcium-sensing receptor (CASR) gene polymorphisms, associated with vertebral fracture (VFx) risk in primary hyperparathyroidism (PHPT). DESIGN AND METHODS A cross-sectional analysis of 266 Caucasian PHPT seen as outpatients. Serum calcium (sCa) phosphate metabolism parameters were measured. BMD was assessed by dual-energy X-ray absorptiometry (expressed as Z-score) at lumbar spine (Z-LS) and femoral neck, morphometric VFx by radiograph, and CASR A986S/R990G genotypes by PCR amplification and genomic DNA sequencing. RESULTS Fractured patients (n=100, 37.6%) had lower sCa (10.8±0.7 mg/dl) and Z-LS BMD (-1.0±1.44), higher age (61±10 years), and prevalence (51%) of ≥1 S alleles of the CASR A986S single-nucleotide polymorphism (SNP; AS/SS), than those not fractured (n=166, 11.2±1.0 mg/dl, -0.57±0.97, 58±13 years, and 38% AS/SS, respectively, P<0.05 for all comparisons). Logistic regression, with VFx as dependent variable, showed independent risks associated with increased age (OR 1.03, 95% CI 1.01-1.06, P=0.006), decreased sCa (OR 1.86, 95% CI 1.28-2.7, P=0.001), and Z-LS BMD (OR 1.4, 95% CI 1.12-1.7, P=0.002) and presence of AS/SS (OR 1.8, 95% CI 1.1-2.9, P=0.05). The presence of two out of three factors (age ≥58 years, sCa <10.8 and Z-LS BMD≤-1.0, and AS/SS genotype) gave an overall OR of 4.2 (95% CI 2.25-7.85, P<0.0001). CONCLUSIONS In PHPT, VFx is associated positively with age, negatively with sCa and spinal BMD, and presence of at least one copy of the CASR A986S SNP.
Collapse
Affiliation(s)
- Cristina Eller-Vainicher
- Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, ItalyUnit of Endocrinology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Radiology'Fatebenefratelli and Oftalmico' Hospital, Milan, ItalyUnit of Radiology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology and DiabetologyDepartment of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, ItalyDepartment of Internal Medicine and Medical Disciplines'Sapienza' Rome University, Rome, ItalyDepartments of MedicinePhysiology, and Human Genetics, McGill University, Montreal, Quebec, CanadaDepartments of Laboratory Medicine and PathobiologyMedicine and Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Claudia Battista
- Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, ItalyUnit of Endocrinology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Radiology'Fatebenefratelli and Oftalmico' Hospital, Milan, ItalyUnit of Radiology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology and DiabetologyDepartment of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, ItalyDepartment of Internal Medicine and Medical Disciplines'Sapienza' Rome University, Rome, ItalyDepartments of MedicinePhysiology, and Human Genetics, McGill University, Montreal, Quebec, CanadaDepartments of Laboratory Medicine and PathobiologyMedicine and Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Vito Guarnieri
- Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, ItalyUnit of Endocrinology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Radiology'Fatebenefratelli and Oftalmico' Hospital, Milan, ItalyUnit of Radiology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology and DiabetologyDepartment of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, ItalyDepartment of Internal Medicine and Medical Disciplines'Sapienza' Rome University, Rome, ItalyDepartments of MedicinePhysiology, and Human Genetics, McGill University, Montreal, Quebec, CanadaDepartments of Laboratory Medicine and PathobiologyMedicine and Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Silvana Muscarella
- Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, ItalyUnit of Endocrinology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Radiology'Fatebenefratelli and Oftalmico' Hospital, Milan, ItalyUnit of Radiology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology and DiabetologyDepartment of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, ItalyDepartment of Internal Medicine and Medical Disciplines'Sapienza' Rome University, Rome, ItalyDepartments of MedicinePhysiology, and Human Genetics, McGill University, Montreal, Quebec, CanadaDepartments of Laboratory Medicine and PathobiologyMedicine and Genetics, University of Toronto, Toronto, Ontario, CanadaUnit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, ItalyUnit of Endocrinology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Radiology'Fatebenefratelli and Oftalmico' Hospital, Milan, ItalyUnit of Radiology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology and DiabetologyDepartment of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, ItalyDepartment of Internal Medicine and Medical Disciplines'Sapienza' Rome University, Rome, ItalyDepartments of MedicinePhysiology, and Human Genetics, McGill University, Montreal, Quebec, CanadaDepartments of Laboratory Medicine and PathobiologyMedicine and Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Serena Palmieri
- Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, ItalyUnit of Endocrinology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Radiology'Fatebenefratelli and Oftalmico' Hospital, Milan, ItalyUnit of Radiology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology and DiabetologyDepartment of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, ItalyDepartment of Internal Medicine and Medical Disciplines'Sapienza' Rome University, Rome, ItalyDepartments of MedicinePhysiology, and Human Genetics, McGill University, Montreal, Quebec, CanadaDepartments of Laboratory Medicine and PathobiologyMedicine and Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Stefano Salcuni
- Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, ItalyUnit of Endocrinology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Radiology'Fatebenefratelli and Oftalmico' Hospital, Milan, ItalyUnit of Radiology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology and DiabetologyDepartment of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, ItalyDepartment of Internal Medicine and Medical Disciplines'Sapienza' Rome University, Rome, ItalyDepartments of MedicinePhysiology, and Human Genetics, McGill University, Montreal, Quebec, CanadaDepartments of Laboratory Medicine and PathobiologyMedicine and Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Giuseppe Guglielmi
- Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, ItalyUnit of Endocrinology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Radiology'Fatebenefratelli and Oftalmico' Hospital, Milan, ItalyUnit of Radiology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology and DiabetologyDepartment of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, ItalyDepartment of Internal Medicine and Medical Disciplines'Sapienza' Rome University, Rome, ItalyDepartments of MedicinePhysiology, and Human Genetics, McGill University, Montreal, Quebec, CanadaDepartments of Laboratory Medicine and PathobiologyMedicine and Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Sabrina Corbetta
- Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, ItalyUnit of Endocrinology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Radiology'Fatebenefratelli and Oftalmico' Hospital, Milan, ItalyUnit of Radiology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology and DiabetologyDepartment of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, ItalyDepartment of Internal Medicine and Medical Disciplines'Sapienza' Rome University, Rome, ItalyDepartments of MedicinePhysiology, and Human Genetics, McGill University, Montreal, Quebec, CanadaDepartments of Laboratory Medicine and PathobiologyMedicine and Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Salvatore Minisola
- Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, ItalyUnit of Endocrinology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Radiology'Fatebenefratelli and Oftalmico' Hospital, Milan, ItalyUnit of Radiology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology and DiabetologyDepartment of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, ItalyDepartment of Internal Medicine and Medical Disciplines'Sapienza' Rome University, Rome, ItalyDepartments of MedicinePhysiology, and Human Genetics, McGill University, Montreal, Quebec, CanadaDepartments of Laboratory Medicine and PathobiologyMedicine and Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Anna Spada
- Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, ItalyUnit of Endocrinology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Radiology'Fatebenefratelli and Oftalmico' Hospital, Milan, ItalyUnit of Radiology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology and DiabetologyDepartment of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, ItalyDepartment of Internal Medicine and Medical Disciplines'Sapienza' Rome University, Rome, ItalyDepartments of MedicinePhysiology, and Human Genetics, McGill University, Montreal, Quebec, CanadaDepartments of Laboratory Medicine and PathobiologyMedicine and Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Geoffrey N Hendy
- Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, ItalyUnit of Endocrinology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Radiology'Fatebenefratelli and Oftalmico' Hospital, Milan, ItalyUnit of Radiology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology and DiabetologyDepartment of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, ItalyDepartment of Internal Medicine and Medical Disciplines'Sapienza' Rome University, Rome, ItalyDepartments of MedicinePhysiology, and Human Genetics, McGill University, Montreal, Quebec, CanadaDepartments of Laboratory Medicine and PathobiologyMedicine and Genetics, University of Toronto, Toronto, Ontario, Canada
| | - David E C Cole
- Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, ItalyUnit of Endocrinology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Radiology'Fatebenefratelli and Oftalmico' Hospital, Milan, ItalyUnit of Radiology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology and DiabetologyDepartment of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, ItalyDepartment of Internal Medicine and Medical Disciplines'Sapienza' Rome University, Rome, ItalyDepartments of MedicinePhysiology, and Human Genetics, McGill University, Montreal, Quebec, CanadaDepartments of Laboratory Medicine and PathobiologyMedicine and Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Iacopo Chiodini
- Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, ItalyUnit of Endocrinology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Radiology'Fatebenefratelli and Oftalmico' Hospital, Milan, ItalyUnit of Radiology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology and DiabetologyDepartment of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, ItalyDepartment of Internal Medicine and Medical Disciplines'Sapienza' Rome University, Rome, ItalyDepartments of MedicinePhysiology, and Human Genetics, McGill University, Montreal, Quebec, CanadaDepartments of Laboratory Medicine and PathobiologyMedicine and Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Alfredo Scillitani
- Unit of Endocrinology and Metabolic DiseasesFondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Via Francesco Sforza 35, 20122 Milan, ItalyUnit of Endocrinology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Radiology'Fatebenefratelli and Oftalmico' Hospital, Milan, ItalyUnit of Radiology'Casa Sollievo della Sofferenza', IRCCS, San Giovanni Rotondo, Foggia, ItalyUnit of Endocrinology and DiabetologyDepartment of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milan, San Donato Milanese, Milan, ItalyDepartment of Internal Medicine and Medical Disciplines'Sapienza' Rome University, Rome, ItalyDepartments of MedicinePhysiology, and Human Genetics, McGill University, Montreal, Quebec, CanadaDepartments of Laboratory Medicine and PathobiologyMedicine and Genetics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
89
|
Bandeira F, Cusano NE, Silva BC, Cassibba S, Almeida CB, Machado VCC, Bilezikian JP. Bone disease in primary hyperparathyroidism. ACTA ACUST UNITED AC 2014; 58:553-61. [DOI: 10.1590/0004-2730000003381] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 05/26/2014] [Indexed: 11/22/2022]
Abstract
Bone disease in severe primary hyperparathyroidism (PHPT) is described classically as osteitis fibrosa cystica (OFC). Bone pain, skeletal deformities and pathological fractures are features of OFC. Bone mineral density is usually extremely low in OFC, but it is reversible after surgical cure. The signs and symptoms of severe bone disease include bone pain, pathologic fractures, proximal muscle weakness with hyperreflexia. Bone involvement is typically characterized as salt-and-pepper appearance in the skull, bone erosions and bone resorption of the phalanges, brown tumors and cysts. In the radiography, diffuse demineralization is observed, along with pathological fractures, particularly in the long bones of the extremities. In severe, symptomatic PHPT, marked elevation of the serum calcium and PTH concentrations are seen and renal involvement is manifested by nephrolithiasis and nephrocalcinosis. A new technology, recently approved for clinical use in the United States and Europe, is likely to become more widely available because it is an adaptation of the lumbar spine DXA image. Trabecular bone score (TBS) is a gray-level textural analysis that provides an indirect index of trabecular microarchitecture. Newer technologies, such as high-resolution peripheral quantitative computed tomography (HR-pQCT), have provided further understanding of the microstructural skeletal features in PHPT.
Collapse
|
90
|
Silva BC, Bilezikian JP. Trabecular bone score: perspectives of an imaging technology coming of age. ACTA ACUST UNITED AC 2014; 58:493-503. [DOI: 10.1590/0004-2730000003456] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 05/22/2014] [Indexed: 11/22/2022]
Abstract
The trabecular bone score (TBS) is a new method to describe skeletal microarchitecture from the dual energy X-ray absorptiometry (DXA) image of the lumbar spine. While TBS is not a direct physical measurement of trabecular microarchitecture, it correlates with micro-computed tomography (µCT) measures of bone volume fraction, connectivity density, trabecular number, and trabecular separation, and with vertebral mechanical behavior in ex vivo studies. In human subjects, TBS has been shown to be associated with trabecular microarchitecture and bone strength by high resolution peripheral quantitative computed tomography (HRpQCT). Cross-sectional and prospective studies, involving a large number of subjects, have both shown that TBS is associated with vertebral, femoral neck, and other types of osteoporotic fractures in postmenopausal women. Data in men, while much less extensive, show similar findings. TBS is also associated with fragility fractures in subjects with secondary causes of osteoporosis, and preliminary data suggest that TBS might improve fracture prediction when incorporated in the fracture risk assessment system known as FRAX. In this article, we review recent advances that have helped to establish this new imaging technology.
Collapse
|
91
|
Silva BC, Leslie WD, Resch H, Lamy O, Lesnyak O, Binkley N, McCloskey EV, Kanis JA, Bilezikian JP. Trabecular bone score: a noninvasive analytical method based upon the DXA image. J Bone Miner Res 2014; 29:518-30. [PMID: 24443324 DOI: 10.1002/jbmr.2176] [Citation(s) in RCA: 520] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 01/11/2014] [Accepted: 01/14/2014] [Indexed: 12/16/2022]
Abstract
The trabecular bone score (TBS) is a gray-level textural metric that can be extracted from the two-dimensional lumbar spine dual-energy X-ray absorptiometry (DXA) image. TBS is related to bone microarchitecture and provides skeletal information that is not captured from the standard bone mineral density (BMD) measurement. Based on experimental variograms of the projected DXA image, TBS has the potential to discern differences between DXA scans that show similar BMD measurements. An elevated TBS value correlates with better skeletal microstructure; a low TBS value correlates with weaker skeletal microstructure. Lumbar spine TBS has been evaluated in cross-sectional and longitudinal studies. The following conclusions are based upon publications reviewed in this article: 1) TBS gives lower values in postmenopausal women and in men with previous fragility fractures than their nonfractured counterparts; 2) TBS is complementary to data available by lumbar spine DXA measurements; 3) TBS results are lower in women who have sustained a fragility fracture but in whom DXA does not indicate osteoporosis or even osteopenia; 4) TBS predicts fracture risk as well as lumbar spine BMD measurements in postmenopausal women; 5) efficacious therapies for osteoporosis differ in the extent to which they influence the TBS; 6) TBS is associated with fracture risk in individuals with conditions related to reduced bone mass or bone quality. Based on these data, lumbar spine TBS holds promise as an emerging technology that could well become a valuable clinical tool in the diagnosis of osteoporosis and in fracture risk assessment.
Collapse
Affiliation(s)
- Barbara C Silva
- Metabolic Bone Diseases Unit, Division of Endocrinology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
92
|
Abstract
This review discusses recent findings on the clinical presentation, evaluation, medical and surgical management of primary hyperparathyroidism. Medical management includes the use of cinacalcet and bisphosphonates for bone loss and correction of vitamin D deficiency. Surgical updates reviewed recent studies on the preoperative localization of the disease, specifically, sestamibi scans, 4DCT and MRI. Focused parathyroidectomy continues to be the preferred surgical approach for a select group of patients, guided by intraoperative use of PTH and new technology, such as endoscopic and robotic platforms; however, there appears to be no difference in long-term success compared to the traditional approach.
Collapse
Affiliation(s)
- Zeina Habib
- a Mercy Hospital and Medical Center - Internal Medicine, Section of Endocrinology and Metabolism, 2525 S Michigan Ave, Chicago, IL 60616, USA
| | - Adam Kabaker
- b Loyola University - Surgery, Section of Endocrine Surgery, 2160 S. First Avenue, Maywood, IL 60153, USA
| | - Pauline Camacho
- c Loyola University - Endocrinology and Metabolism, 2160 S. First Avenue, Maywood, IL 60153, USA
| |
Collapse
|