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Antonini S, Pedersini R, Birtolo MF, Baruch NL, Carrone F, Jaafar S, Ciafardini A, Cosentini D, Laganà M, Torrisi R, Farina D, Leonardi L, Balzarini L, Vena W, Bossi AC, Zambelli A, Lania AG, Berruti A, Mazziotti G. Denosumab improves trabecular bone score in relationship with decrease in fracture risk of women exposed to aromatase inhibitors. J Endocrinol Invest 2024; 47:433-442. [PMID: 37592052 DOI: 10.1007/s40618-023-02174-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE Trabecular bone score (TBS) is a gray-level textural metric that has shown to correlate with risk of fractures in several forms of osteoporosis. The value of TBS in predicting fractures and the effects of bone-active drugs on TBS in aromatase inhibitors (AIs)-induced osteoporosis are still largely unknown. The primary objective of this retrospective study was to assess the effects of denosumab and bisphosphonates (BPs) on TBS and vertebral fractures (VFs) in women exposed to AIs. METHODS 241 consecutive women (median age 58 years) with early breast cancer undergoing treatment with AIs were evaluated for TBS, bone mineral density (BMD) and morphometric VFs at baseline and after 18-24 months of follow-up. During the study period, 139 women (57.7%) received denosumab 60 mg every 6 months, 53 (22.0%) BPs, whereas 49 women (20.3%) were not treated with bone-active drugs. RESULTS Denosumab significantly increased TBS values (from 1.270 to 1.323; P < 0.001) accompanied by a significant decrease in risk of VFs (odds ratio 0.282; P = 0.021). During treatment with BPs, TBS did not significantly change (P = 0.849) and incidence of VFs was not significantly different from women untreated with bone-active drugs (P = 0.427). In the whole population, women with incident VFs showed higher decrease in TBS vs. non-fractured women (P = 0.003), without significant differences in changes of BMD at any skeletal site. CONCLUSIONS TBS variation predicts fracture risk in AIs treated women. Denosumab is effective to induce early increase of TBS and reduction in risk of VFs.
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Affiliation(s)
- S Antonini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - R Pedersini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - M F Birtolo
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - N L Baruch
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - F Carrone
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - S Jaafar
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - A Ciafardini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - D Cosentini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - M Laganà
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - R Torrisi
- Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - D Farina
- Radiology Unit 2, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - L Leonardi
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - L Balzarini
- Department of Radiology, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - W Vena
- Endocrinology, Humanitas Gavazzeni-Castelli, Bergamo, Italy
| | - A C Bossi
- Endocrinology, Humanitas Gavazzeni-Castelli, Bergamo, Italy
| | - A Zambelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
- Cancer Center, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy
| | - A G Lania
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy.
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
| | - A Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Brescia, Italy
| | - G Mazziotti
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy.
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy.
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Shevroja E, Reginster JY, Lamy O, Al-Daghri N, Chandran M, Demoux-Baiada AL, Kohlmeier L, Lecart MP, Messina D, Camargos BM, Payer J, Tuzun S, Veronese N, Cooper C, McCloskey EV, Harvey NC. Update on the clinical use of trabecular bone score (TBS) in the management of osteoporosis: results of an expert group meeting organized by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO), and the International Osteoporosis Foundation (IOF) under the auspices of WHO Collaborating Center for Epidemiology of Musculoskeletal Health and Aging. Osteoporos Int 2023; 34:1501-1529. [PMID: 37393412 PMCID: PMC10427549 DOI: 10.1007/s00198-023-06817-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/31/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE Trabecular bone score (TBS) is a grey-level textural measurement acquired from dual-energy X-ray absorptiometry lumbar spine images and is a validated index of bone microarchitecture. In 2015, a Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) published a review of the TBS literature, concluding that TBS predicts hip and major osteoporotic fracture, at least partly independent of bone mineral density (BMD) and clinical risk factors. It was also concluded that TBS is potentially amenable to change as a result of pharmacological therapy. Further evidence on the utility of TBS has since accumulated in both primary and secondary osteoporosis, and the introduction of FRAX and BMD T-score adjustment for TBS has accelerated adoption. This position paper therefore presents a review of the updated scientific literature and provides expert consensus statements and corresponding operational guidelines for the use of TBS. METHODS An Expert Working Group was convened by the ESCEO and a systematic review of the evidence undertaken, with defined search strategies for four key topics with respect to the potential use of TBS: (1) fracture prediction in men and women; (2) initiating and monitoring treatment in postmenopausal osteoporosis; (3) fracture prediction in secondary osteoporosis; and (4) treatment monitoring in secondary osteoporosis. Statements to guide the clinical use of TBS were derived from the review and graded by consensus using the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. RESULTS A total of 96 articles were reviewed and included data on the use of TBS for fracture prediction in men and women, from over 20 countries. The updated evidence shows that TBS enhances fracture risk prediction in both primary and secondary osteoporosis, and can, when taken with BMD and clinical risk factors, inform treatment initiation and the choice of antiosteoporosis treatment. Evidence also indicates that TBS provides useful adjunctive information in monitoring treatment with long-term denosumab and anabolic agents. All expert consensus statements were voted as strongly recommended. CONCLUSION The addition of TBS assessment to FRAX and/or BMD enhances fracture risk prediction in primary and secondary osteoporosis, adding useful information for treatment decision-making and monitoring. The expert consensus statements provided in this paper can be used to guide the integration of TBS in clinical practice for the assessment and management of osteoporosis. An example of an operational approach is provided in the appendix. This position paper presents an up-to-date review of the evidence base, synthesised through expert consensus statements, which informs the implementation of Trabecular Bone Score in clinical practice.
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Affiliation(s)
- Enisa Shevroja
- Interdisciplinary Center for Bone Diseases, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Jean-Yves Reginster
- World Health Organization Collaborating Center for Epidemiology of Musculoskeletal Health and Aging, Liège, Belgium
- Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000 Liège, Belgium
| | - Olivier Lamy
- Interdisciplinary Center for Bone Diseases, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Nasser Al-Daghri
- Biochemistry Department, College of Science, King Saud University, 11451 Riyadh, Kingdom of Saudi Arabia
| | - Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, ACADEMIA, 20, College Road, Singapore, 169856 Singapore
| | | | - Lynn Kohlmeier
- Spokane Strides for Strong Bones, Medical Director, West Coast Bone Health CME TeleECHO, Spokane, WA USA
| | | | - Daniel Messina
- IRO Medical Research Center, Buenos Aires and Rheumatology Section, Cosme Argerich, Buenos Aires, Argentina
| | - Bruno Muzzi Camargos
- Rede Materdei de Saúde - Hospital Santo Agostinho - Densitometry Unit Coordinator, Belo Horizonte, Brazil
| | - Juraj Payer
- 5th Department of Internal Medicine, Comenius University Faculty of Medicine, University Hospital, Bratislava, Slovakia
- Ružinovská 6, 82101 Bratislava, Slovakia
| | - Sansin Tuzun
- Department of Physical Medicine and Rehabilitation, Cerrahpaşa School of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Nicola Veronese
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Eugene V. McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO16 6YD UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Castañeda S, Casas A, González-Del-Alba A, Martínez-Díaz-Guerra G, Nogués X, Ojeda Thies C, Torregrosa Suau Ó, Rodríguez-Lescure Á. Bone loss induced by cancer treatments in breast and prostate cancer patients. CLINICAL & TRANSLATIONAL ONCOLOGY : OFFICIAL PUBLICATION OF THE FEDERATION OF SPANISH ONCOLOGY SOCIETIES AND OF THE NATIONAL CANCER INSTITUTE OF MEXICO 2022; 24:2090-2106. [PMID: 35779210 PMCID: PMC9522722 DOI: 10.1007/s12094-022-02872-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/05/2022] [Indexed: 12/04/2022]
Abstract
Cancer and cancer therapies are a major factor risk for osteoporosis due to bone loss and deterioration of bone microarchitecture. Both factors contribute to a decrease in bone strength and, consequently, increased bone fragility and risk of fracture. Cancer-associated bone loss is a multifactorial process, and optimal interdisciplinary management of skeletal health, accurate assessment of bone density, and early diagnosis are essential when making decisions aimed at reducing bone loss and fracture risk in patients who have received or are receiving treatment for cancer. In this document, a multidisciplinary group of experts collected the latest evidence on the pathophysiology of osteoporosis and its prevention, diagnosis, and treatment with the support of the Spanish scientific society SEOM. The aim was to provide an up-to-date and in-depth view of osteoporotic risk and its consequences, and to present a series of recommendations aimed at optimizing the management of bone health in the context of cancer.
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Affiliation(s)
- Santos Castañeda
- Department of Rheumatology, Hospital Universitario de La Princesa, IIS-Princesa, Catedra UAM-Roche, EPID-Future, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ana Casas
- Department of Medical Oncology, Hospital Virgen del Rocío, Seville, Spain
| | | | - Guillermo Martínez-Díaz-Guerra
- Department of Endocrinology and Nutrition, Instituto de Investigación imas12, Universidad Complutense, Hospital 12 de Octubre, Madrid, Spain
| | - Xavier Nogués
- Department of Internal Medicine, Hospital del Mar, Hospital del Mar Research Institute (IMIM), Centro de Investigación Biomédica en Red de Fragilidad y Envejecimiento Saludable (CIBERFES), Universidad Pompeu Fabra, Barcelona, Spain
| | - Cristina Ojeda Thies
- Department of Traumatology and Orthopedic Surgery, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - Óscar Torregrosa Suau
- Department of Internal Medicine, Hospital General Universitario de Elche, Alicante, Spain
| | - Álvaro Rodríguez-Lescure
- Department of Medical Oncology, Hospital General Universitario de Elche, Camino de la Almazara, 11, 03202, Alicante, Spain.
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Risedronate complexes with Mg2+, Zn2+, Pb2+, and Cu2+: Species thermodynamics and sequestering ability in NaCl(aq) at different ionic strengths and at T = 298.15 K. J Mol Liq 2021. [DOI: 10.1016/j.molliq.2021.117699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Catalano A, Gaudio A, Morabito N, Basile G, Agostino RM, Xourafa A, Atteritano M, Morini E, Natale G, Lasco A. Quantitative ultrasound and DXA measurements in aromatase inhibitor-treated breast cancer women receiving denosumab. J Endocrinol Invest 2017; 40:851-857. [PMID: 28332172 DOI: 10.1007/s40618-016-0606-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/27/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE Denosumab has been proven to reduce fracture risk in breast cancer (BC) women under aromatase inhibitors (AIs). Quantitative ultrasound (QUS) provides information on the structure and elastic properties of bone. Our aim was to assess bone health by phalangeal QUS and by dual-energy X-ray absorptiometry (DXA), and to evaluate bone turnover in AIs-treated BC women receiving denosumab. METHODS 35 Postmenopausal BC women on AIs were recruited (mean age 61.2 ± 4.5 years) and treated with denosumab 60 mg administered subcutaneously every 6 months. Phalangeal QUS parameters [Amplitude Dependent Speed of Sound (AD-SoS), Ultrasound Bone Profile Index (UBPI), Bone Transmission Time (BTT)] and DXA at lumbar spine and femoral neck were performed. Serum C-telopeptide of type 1 collagen (CTX) and bone-specific alkaline phosphatase (BSAP) were also measured. The main outcomes were compared with a control group not receiving denosumab (n = 39). RESULTS In patients treated with denosumab, differently from controls, QUS and DXA measurements improved after 24 months, and a reduction of CTX and BSAP was detected at 12 and 24 months in comparison to baseline (P < 0.05). The percent changes (Δ) of QUS measurements were significantly associated with ΔBMD at femoral neck, and ΔCTX and ΔBSAP were associated with ΔBMD at lumbar spine (r = -0.39, P = 0.02; r = -0.49, P = 0.01, respectively). CONCLUSIONS Denosumab preserves bone health as assessed by phalangeal QUS and DXA. Since inexpensive and radiation-free, phalangeal QUS may be considered in the follow-up of AIs-treated BC women receiving denosumab.
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Affiliation(s)
- A Catalano
- Department of Clinical and Experimental Medicine, University Hospital of Messina, University Hospital "G. Martino", Via C. Valeria, 98125, Messina, Italy.
| | - A Gaudio
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - N Morabito
- Department of Clinical and Experimental Medicine, University Hospital of Messina, University Hospital "G. Martino", Via C. Valeria, 98125, Messina, Italy
| | - G Basile
- Department of Clinical and Experimental Medicine, University Hospital of Messina, University Hospital "G. Martino", Via C. Valeria, 98125, Messina, Italy
| | - R M Agostino
- Department of Human Pathology, University of Messina, Messina, Italy
| | - A Xourafa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - M Atteritano
- Department of Clinical and Experimental Medicine, University Hospital of Messina, University Hospital "G. Martino", Via C. Valeria, 98125, Messina, Italy
| | - E Morini
- Department of Clinical and Experimental Medicine, University Hospital of Messina, University Hospital "G. Martino", Via C. Valeria, 98125, Messina, Italy
| | - G Natale
- Mineral Metabolism and Nephrology Clinic of Vibo Valentia Hospital, Vibo Valentia, Italy
| | - A Lasco
- Department of Clinical and Experimental Medicine, University Hospital of Messina, University Hospital "G. Martino", Via C. Valeria, 98125, Messina, Italy
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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.
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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
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