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Raiser SN, Schroeder AN, Lawley RJ, Tenforde AS. Bone health and the masters runner. PM R 2024; 16:363-373. [PMID: 38532664 DOI: 10.1002/pmrj.13175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/13/2024] [Accepted: 02/25/2024] [Indexed: 03/28/2024]
Abstract
Masters runners are often defined as those ages 35 years and older who train and compete in running events. These runners represent a growing population of the overall running community and experience running-related injuries including bone stress injuries (BSIs). Similar to younger runners, health considerations in masters runners include the goal to optimize bone health with focus on mitigating age-associated loss of bone strength and preventing BSIs through a combination of ensuring appropriate physical activity, optimizing nutrition, and correcting faulty biomechanics. Importantly, BSIs in masters runners may include characteristics of both overuse injury from insufficient recovery and failure of bone weakened by age-related loss of bone (insufficiency fractures). This narrative review covers the limited available research on strategies to optimize bone health in masters runners. Applying knowledge on masters athletes and extrapolating from other populations, we propose strategies on treatment and prevention of BSIs. Finally, the review highlights gaps in knowledge that require further age-specific discoveries to advance treatment and prevention.
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Affiliation(s)
- Sara N Raiser
- Department of Physical Medicine & Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
| | - Allison N Schroeder
- Department of Orthopedics, University Hospitals and Case Western Reserve University, Cleveland, Ohio, USA
| | - Richard J Lawley
- Department of Physical Medicine & Rehabilitation, Loyola University Medical Center, Maywood, Illinois, USA
| | - Adam S Tenforde
- Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, USA
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Bai X, Zhang X, Xiao J, Lin X, Lin R, Zhang R, Deng X, Zhang M, Wei W, Lan B, Weng S, Chen M. Endowing Polyetheretherketone with Anti-Infection and Immunomodulatory Properties through Guanidination Carbon Dots Modification to Promote Osseointegration in Diabetes with MRSA Infection. Adv Healthc Mater 2024; 13:e2302873. [PMID: 38041688 DOI: 10.1002/adhm.202302873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/17/2023] [Indexed: 12/03/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infection and compromised immunity are the severe complications associated with implantation surgery in diabetes mellitus. Enhancing the antibacterial and immunomodulatory properties of implants represents an effective approach to improve the osseointegration of implant in diabetes mellitus. Herein, guanidination carbon dots (GCDs) with antibacterial and immunoregulatory functions are synthesized. The GCDs demonstrate killing effect on MRSA without detectable induced resistance. Additionally, they promote the polarization of macrophages from the M1 to M2 subtype, with the inhibiting pro-inflammatory cytokines and promoting anti-inflammatory factors. Correspondingly, GCDs are immobilized onto sulfonated polyether ether ketone (SP@GCDs) using a polyvinyl butyraldehyde (PVB) coating layer through soaking-drying technique. SP@GCDs maintain stable antibacterial efficacy against MRSA for six consecutive days and retain the immunomodulatory function, while also possessing the long-term storage stability and biocompatibility of more than 6 months. Moreover, SP@GCDs significantly promote the proliferation and mineralization of osteoblasts. SP@GCDs facilitate osteogenesis through immunoregulatory. Additionally, SP@GCDs exert stable antibacterial and immune regulatory functions in implantation site of a diabetes rat, effectively promoting implant osseointegration regardless of the MRSA infection. These findings provide valuable insights into implant modification through designing nanomaterials with multifunction for enhancing osseointegration of diabetes mellitus, suggesting the promising clinical application prospects.
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Affiliation(s)
- Xinxin Bai
- Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, P. R. China
| | - Xintian Zhang
- Department of Pharmaceutical Analysis, School of Pharmacy, Fujian Medical University, Fuzhou, 350122, P. R. China
| | - Jiecheng Xiao
- Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, P. R. China
| | - Xingyu Lin
- Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, P. R. China
| | - Rongjie Lin
- Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, P. R. China
| | - Rui Zhang
- Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, P. R. China
| | - Xiaoqin Deng
- Department of Pharmaceutical Analysis, School of Pharmacy, Fujian Medical University, Fuzhou, 350122, P. R. China
| | - Menghan Zhang
- Department of Pharmaceutical Analysis, School of Pharmacy, Fujian Medical University, Fuzhou, 350122, P. R. China
| | - Wenqin Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, P. R. China
| | - Bin Lan
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350005, P. R. China
| | - Shaohuang Weng
- Department of Pharmaceutical Analysis, School of Pharmacy, Fujian Medical University, Fuzhou, 350122, P. R. China
| | - Min Chen
- Department of Orthopedic Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, P. R. China
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Sone T, Ohnaru K, Sugai T, Yamashita A, Okimoto N, Inoue T, Matsumoto T. The effects of abaloparatide on hip geometry and biomechanical properties in Japanese osteoporotic patients assessed using DXA-based hip structural analysis: results of the Japanese phase 3 ACTIVE-J trial. Arch Osteoporos 2023; 18:146. [PMID: 38030806 PMCID: PMC10687120 DOI: 10.1007/s11657-023-01344-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 11/01/2023] [Indexed: 12/01/2023]
Abstract
Daily subcutaneous injection of 80 μg abaloparatide increased bone mineral density in Japanese patients with osteoporosis at high fracture risk in the ACTIVE-J trial. Dual-energy X-ray absorptiometry-based hip structural analysis from ACTIVE-J data showed improved hip geometry and biomechanical properties with abaloparatide compared with placebo. PURPOSE Abaloparatide (ABL) increased bone mineral density (BMD) in Japanese patients with osteoporosis at high fracture risk in the ACTIVE-J trial. To evaluate the effect of ABL on hip geometry and biomechanical properties, hip structural analysis (HSA) was performed using ACTIVE-J trial data. METHODS Hip dual-energy X-ray absorptiometry scans from postmenopausal women and men (ABL, n = 128; placebo, n = 65) at baseline and up to week 78 were analyzed to extract bone geometric parameters at the narrow neck (NN), intertrochanteric region (IT), and proximal femoral shaft (FS). Computed tomography (CT)-based BMD and HSA indices were compared between baseline and week 78. RESULTS ABL treatment showed increased mean percent change from baseline to week 78 in cortical thickness at the NN (5.3%), IT (5.3%), and FS (2.9%); cross-sectional area at the NN (5.0%), IT (5.0%), and FS (2.6%); cross-sectional moment of inertia at the NN (7.6%), IT (5.1%), and FS (2.5%); section modulus at the NN (7.4%), IT (5.4%), and FS (2.4%); and decreased mean percent change in buckling ratio (BR) at the IT (- 5.0%). ABL treatment showed increased mean percent change in total volumetric BMD (vBMD; 2.7%) and trabecular vBMD (3.2%) at the total hip and decreased mean percent change in BR at femoral neck (- 4.1%) at week 78 vs baseline. All the changes noted here were significant vs placebo (P < 0.050 using t-test). CONCLUSION A 78-week treatment with ABL showed improvement in HSA parameters associated with hip geometry and biomechanical properties vs placebo. TRIAL REGISTRATION JAPIC CTI-173575.
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Affiliation(s)
- Teruki Sone
- Department of Nuclear Medicine, Kawasaki Medical School, 577, Matsushima, Kurashiki, Okayama, 701-0192, Japan.
| | - Kazuhiro Ohnaru
- Department of Orthopedics, Traumatology & Spine Surgery, Kawasaki Medical School, Okayama, Japan
| | - Takumi Sugai
- Division of Pharmaceutical Development and Production, Teijin Pharma Limited, Tokyo, Japan
| | - Akiko Yamashita
- Division of Pharmaceutical Development and Production, Teijin Pharma Limited, Tokyo, Japan
| | | | | | - Toshio Matsumoto
- Fujii Memorial Institute of Medical Sciences, Tokushima University, Tokushima, Japan
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Sheppard AJ, Paravastu SS, Wojnowski NM, Osamor CC, Farhadi F, Collins MT, Saboury B. Emerging Role of 18F-NaF PET/Computed Tomographic Imaging in Osteoporosis: A Potential Upgrade to the Osteoporosis Toolbox. PET Clin 2023; 18:1-20. [PMID: 36442958 PMCID: PMC9773817 DOI: 10.1016/j.cpet.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Osteoporosis is a metabolic bone disorder that leads to a decline in bone microarchitecture, predisposing individuals to catastrophic fractures. The current standard of care relies on detecting bone structural change; however, these methods largely miss the complex biologic forces that drive these structural changes and response to treatment. This review introduces sodium fluoride (18F-NaF) positron emission tomography/computed tomography (PET/CT) as a powerful tool to quantify bone metabolism. Here, we discuss the methods of 18F-NaF PET/CT, with a special focus on dynamic scans to quantify parameters relevant to bone health, and how these markers are relevant to osteoporosis.
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Affiliation(s)
- Aaron J. Sheppard
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Building 30, Room 228, Bethesda, MD 20892-4320, USA
| | - Sriram S. Paravastu
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Building 30, Room 228, Bethesda, MD 20892-4320, USA
| | - Natalia M. Wojnowski
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Building 30, Room 228, Bethesda, MD 20892-4320, USA;,Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago, IL 60611, USA
| | - Charles C. Osamor
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Building 30, Room 228, Bethesda, MD 20892-4320, USA
| | - Faraz Farhadi
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892-4320, USA;,Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, NH 03755, USA
| | - Michael T. Collins
- National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Building 30, Room 228, Bethesda, MD 20892-4320, USA
| | - Babak Saboury
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892-4320, USA;,Corresponding author. 10 Center Drive, Bethesda, MD 20892.
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Winzenrieth R, Humbert L, Boxberger JI, Weiss RJ, Wang Y, Kostenuik P. Abaloparatide Effects on Cortical Volumetric BMD and Estimated Strength Indices of Hip Subregions by 3D-DXA in Women With Postmenopausal Osteoporosis. J Clin Densitom 2022; 25:392-400. [PMID: 35033435 DOI: 10.1016/j.jocd.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
In ACTIVE, abaloparatide increased areal BMD (aBMD) of the hip and femoral neck vs teriparatide and placebo in women with osteoporosis. Previously, 3D-processing of dual X-ray absorptiometry (DXA) scans of a subgroup of ACTIVE subjects showed similar increases in trabecular volumetric BMD (Tb.vBMD) and greater increases in cortical vBMD (Ct.vBMD) of the total hip with abaloparatide vs teriparatide. The current analyses from this subgroup describe 2D- and 3D-DXA data for hip subregions. Randomly selected subjects from ACTIVE (n = 250/treatment group) who received 18 mo of placebo, abaloparatide 80 µg, or open-label teriparatide 20 µg by daily subcutaneous injection underwent hip DXA at baseline, and mo 6 and 18 of treatment. Areal BMD of the femoral neck, trochanter, and femoral shaft was determined using standard 2D-DXA and 3D-SHAPER software to retrospectively evaluate changes from baseline in volumetric parameters of these 3 hip subregions, including trabecular and cortical segmentation. Changes in biomechanical parameters cross-sectional moment of inertia (CSMI), section modulus (Z), and buckling ratio were also evaluated. Femoral neck, trochanter, and shaft aBMD increased in the abaloparatide and teriparatide groups at mo 6 and 18 vs placebo, with greater increases for abaloparatide vs teriparatide at the femoral neck at mo 6 and the shaft at mo 6 and 18. All 3 subregions showed similar significant increases in Tb.vBMD with abaloparatide and teriparatide vs placebo, whereas Ct.vBMD of all 3 subregions showed greater increases after 18 mo of abaloparatide vs teriparatide. Biomechanical parameters improved in all subregions with abaloparatide and teriparatide vs placebo, with greater improvements in CSMI and Z of the femoral neck and lower shaft after 6 and 18 mo of abaloparatide vs teriparatide. Differential femoral neck and shaft Ct.vBMD responses may explain the greater increases in CSMI and Z of those subregions with abaloparatide vs teriparatide.
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Deng Y, Wei W, Tang P. Applications of Calcium-Based Nanomaterials in Osteoporosis Treatment. ACS Biomater Sci Eng 2022; 8:424-443. [PMID: 35080365 DOI: 10.1021/acsbiomaterials.1c01306] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
With rapidly aging populations worldwide, osteoporosis has become a serious global public health problem. Caused by disordered systemic bone remodeling, osteoporosis manifests as progressive loss of bone mass and microarchitectural deterioration of bone tissue, increasing the risk of fractures and eventually leading to osteoporotic fragility fractures. As fracture risk increases, antiosteoporosis treatments transition from nonpharmacological management to pharmacological intervention, and finally to the treatment of fragility fractures. Calcium-based nanomaterials (CBNMs) have unique advantages in osteoporosis treatment because of several characteristics including similarity to natural bone, excellent biocompatibility, easy preparation and functionalization, low pH-responsive disaggregation, and inherent pro-osteogenic properties. By combining additional ingredients, CBNMs can play multiple roles to construct antiosteoporotic biomaterials with different forms. This review covers recent advances in CBNMs for osteoporosis treatment. For ease of understanding, CBNMs for antiosteoporosis treatment can be classified as locally applied CBNMs, such as implant coatings and filling materials for osteoporotic bone regeneration, and systemically administered CBNMs for antiosteoporosis treatment. Locally applied CBNMs for osteoporotic bone regeneration develop faster than the systemically administered CBNMs, an important consideration given the serious outcomes of fragility fractures. Nevertheless, many innovations in construction strategies and preparation methods have been applied to build systemically administered CBNMs. Furthermore, with increasing interest in delaying osteoporosis progression and avoiding fragility fracture occurrence, research into systemic administration of CBNMs for antiosteoporosis treatment will have more development prospects. Deep understanding of the CBNM preparation process and optimizing CBNM properties will allow for increased application of CBNMs in osteoporosis treatments in the future.
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Affiliation(s)
- Yuan Deng
- Department of Orthopedics, Fourth Medical Center, General Hospital of Chinese PLA, Beijing 100000, China
| | - Wei Wei
- State Key Laboratory of Biochemical Engineering Institute of Process Engineering Chinese Academy of Sciences No. 1 Bei-Er-Tiao, Beijing 100190, P. R. China
| | - Peifu Tang
- Department of Orthopedics, Fourth Medical Center, General Hospital of Chinese PLA, Beijing 100000, China
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Eriksen EF, Chapurlat R, Boyce RW, Shi Y, Brown JP, Horlait S, Betah D, Libanati C, Chavassieux P. Modeling-Based Bone Formation After 2 Months of Romosozumab Treatment: Results From the FRAME Clinical Trial. J Bone Miner Res 2022; 37:36-40. [PMID: 34633116 DOI: 10.1002/jbmr.4457] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 09/20/2021] [Accepted: 10/03/2021] [Indexed: 11/11/2022]
Abstract
The bone-forming agent romosozumab is a monoclonal antibody that inhibits sclerostin, leading to increased bone formation and decreased resorption. The highest levels of bone formation markers in human patients are observed in the first 2 months of treatment. Histomorphometric analysis of bone biopsies from the phase 3 FRAME trial (NCT01575834) showed an early significant increase in bone formation with concomitant decreased resorption. Preclinical studies demonstrated that most new bone formation after romosozumab treatment was modeling-based bone formation (MBBF). Here we analyzed bone biopsies from FRAME to assess the effect of 2 months of romosozumab versus placebo on the surface extent of MBBF and remodeling-based bone formation (RBBF). In FRAME, postmenopausal women aged ≥55 years with osteoporosis were randomized 1:1 to 210 mg romosozumab or placebo sc every month for 12 months, followed by 60 mg denosumab sc every 6 months for 12 months. Participants in the bone biopsy substudy received quadruple tetracycline labeling and underwent transiliac biopsies at month 2. A total of 29 biopsies were suitable for histomorphometry. Using fluorescence microscopy, bone formation at cancellous, endocortical, and periosteal envelopes was classified based on the appearance of underlying cement lines as modeling (smooth) or remodeling (scalloped). Data were compared using the Wilcoxon rank-sum test, without multiplicity adjustment. After 2 months, the median percentage of MBBF referent to the total bone surface was significantly increased with romosozumab versus placebo on cancellous (18.0% versus 3.8%; p = 0.005) and endocortical (36.7% versus 3.0%; p = 0.001), but not on periosteal (5.0% versus 2.0%; p = 0.37) surfaces, with no significant difference in the surface extent of RBBF on all three bone surfaces. These data show that stimulation of bone formation in the first 2 months of romosozumab treatment in postmenopausal women with osteoporosis is predominately due to increased MBBF on endocortical and cancellous surfaces. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Erik F Eriksen
- Institute of Clinical Dentistry, University of Oslo, Oslo, Norway.,Spesialistsenteret Pilestredet Park, Oslo, Norway
| | - Roland Chapurlat
- INSERM UMR 1033, Université de Lyon, Hospices Civils de Lyon, Lyon, France
| | | | | | - Jacques P Brown
- CHU de Québec Research Centre and Laval University, Quebec City, Canada
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Fang Y, Morse LR, Nguyen N, Battaglino RA, Goldstein RF, Troy KL. Functional electrical stimulation (FES)-assisted rowing combined with zoledronic acid, but not alone, preserves distal femur strength and stiffness in people with chronic spinal cord injury. Osteoporos Int 2021; 32:549-558. [PMID: 32888047 DOI: 10.1007/s00198-020-05610-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/25/2020] [Indexed: 01/04/2023]
Abstract
UNLABELLED We investigated the effect of 12 months of functional electrical stimulation-assisted rowing with and without zoledronic acid (ZA) on computationally estimated bone strength and stiffness in individuals with spinal cord injury. We found that rowing with ZA, but not rowing alone, improved stiffness at the distal femur, but not the proximal tibia. INTRODUCTION People with spinal cord injury (SCI) have high fracture risk at the knee after the injury. Therapies that prevent bone loss or stimulate an anabolic response in bone have been proposed to reduce fractures. Zoledronic acid (ZA) is a potent bisphosphonate that inhibits osteoclastic resorption. Functional electrical stimulation (FES)-assisted rowing is a potentially osteogenic exercise involving mechanical stimulation to the lower extremities. Here, we investigated the effect of FES-assisted rowing with and without ZA on bone strength and stiffness in individuals with SCI. METHODS Twenty individuals from a cohort of adults with SCI who participated in a clinical trial were included in the study. CT scans of their knees before and after the intervention were converted to finite element models. Bone failure strength (Tult) and stiffness were calculated at the proximal tibia and distal femur. RESULTS Tult at the distal femur increased 4.6% among people who received rowing + ZA and decreased 13.9% among those with rowing only (p < 0.05 for group). Torsional and compressive stiffness at the femur metaphysis increased in people with rowing + ZA (+ 3 to +4%) and decreased in people with rowing only (- 7 to -8%; p < 0.05). Tult in the proximal tibia decreased in everyone, but the loss was attenuated in the rowing + ZA group. People with initially stronger bone tended to lose more strength. CONCLUSION Overall, we observed increases in bone strength at the distal femur but not the proximal tibia, with FES-assisted rowing combined with ZA treatment. Rowing alone did not significantly prevent bone loss at either site, which might be attributed to insufficient mechanical loading.
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Affiliation(s)
- Y Fang
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, USA
| | - L R Morse
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - N Nguyen
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - R A Battaglino
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
| | - R F Goldstein
- Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA, USA
| | - K L Troy
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA.
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Flanigan PM, Mikula AL, Peters PA, Oushy S, Fogelson JL, Bydon M, Freedman BA, Sebastian AS, Currier BL, Nassr A, Kennel KA, Anderson PA, Polly DW, Elder BD. Regional improvements in lumbosacropelvic Hounsfield units following teriparatide treatment. Neurosurg Focus 2020; 49:E11. [DOI: 10.3171/2020.5.focus20273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/13/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVEOpportunistic Hounsfield unit (HU) determination from CT imaging has been increasingly used to estimate bone mineral density (BMD) in conjunction with assessments from dual energy x-ray absorptiometry (DXA). The authors sought to compare the effect of teriparatide on HUs across different regions in the pelvis, sacrum, and lumbar spine, as a surrogate measure for the effects of teriparatide on lumbosacropelvic instrumentation.METHODSA single-institution retrospective review of patients who had been treated with at least 6 months of teriparatide was performed. All patients had at least baseline DXA as well as pre- and post-teriparatide CT imaging. HUs were measured in the pedicle, lamina, and vertebral body of the lumbar spine, in the sciatic notch, and at the S1 and S2 levels at three different points (ilium, sacral body, and sacral ala).RESULTSForty patients with an average age of 67 years underwent a mean of 20 months of teriparatide therapy. Mean HUs of the lumbar lamina, pedicles, and vertebral body were significantly different from each other before teriparatide treatment: 343 ± 114, 219 ± 89.2, and 111 ± 48.1, respectively (p < 0.001). Mean HUs at the S1 level for the ilium, sacral ala, and sacral body were also significantly different from each other: 124 ± 90.1, −10.7 ± 61.9, and 99.1 ± 72.1, respectively (p < 0.001). The mean HUs at the S2 level for the ilium and sacral body were not significantly different from each other, although the mean HU at the sacral ala (−11.9 ± 52.6) was significantly lower than those at the ilium and sacral body (p = 0.003 and 0.006, respectively). HU improvement occurred in most regions following teriparatide treatment. In the lumbar spine, the mean lamina HU increased from 343 to 400 (p < 0.001), the mean pedicle HU increased from 219 to 242 (p = 0.04), and the mean vertebral body HU increased from 111 to 134 (p < 0.001). There were also significant increases in the S1 sacral body (99.1 to 130, p < 0.05), S1 ilium (124 vs 165, p = 0.01), S1 sacral ala (−10.7 vs 3.68, p = 0.04), and S2 sacral body (168 vs 189, p < 0.05).CONCLUSIONSThere was significant regional variation in lumbar and sacropelvic HUs, with most regions significantly increasing following teriparatide treatment. The sacropelvic area had lower HU values than the lumbar spine, more regional variation, and a higher degree of correlation with BMD as measured on DXA. While teriparatide treatment resulted in HUs > 110 in the majority of the lumbosacral spine, the HUs in the sacral ala remained suggestive of severe osteoporosis, which may limit the effectiveness of fixation in this region.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Kurt A. Kennel
- 3Division of Endocrinology, Department of Internal Medicine, Mayo Clinic, Rochester
| | - Paul A. Anderson
- 4Department of Orthopedics and Rehabilitative Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - David W. Polly
- 5Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota; and
| | - Benjamin D. Elder
- Departments of 1Neurologic Surgery,
- 2Orthopedic Surgery, and
- 6Biomedical Engineering, Mayo Clinic, Rochester
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Rhodes S, Batzdorf A, Sorci O, Peng M, Jankelovits A, Hornyak J, An J, Noël PB, Høilund-Carlsen PF, Alavi A, Rajapakse CS. Assessment of femoral neck bone metabolism using 18F-sodium fluoride PET/CT imaging. Bone 2020; 136:115351. [PMID: 32276154 PMCID: PMC7246165 DOI: 10.1016/j.bone.2020.115351] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/26/2020] [Accepted: 03/30/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Standard of care metabolic bone disease assessment relies on changes to bone quantity, which can only be detected after structural changes occur. PURPOSE To investigate the usefulness of Bone Metabolism Score (BMS), derived from fluorine 18 labeled sodium fluoride (18F-NaF) PET/CT imaging as a biomarker of localized metabolic changes at the femoral neck. METHODS In this retrospective study, 139 participants (68 females and 71 males, ages 21-75 years) that had undergone 18F-NaF PET/CT were included. BMS was calculated as the ratio of standard uptake value (SUV) in the bone region to that of the total region. Correlations and linear regressions of BMS with age, CT-derived bone mineral density (BMD), body mass index (BMI), height, and weight were conducted. Differences in BMS between women younger and older than the age of 50 years were assessed. Inter- and intra-operator reproducibility was evaluated by coefficient of variation (CV) and intra-class correlation coefficient (ICC). RESULTS Among females, age was negatively correlated with left and right whole BMS (5.61% and 4.90% drop in BMS per decade of life) and left and right cortical BMS (10.50% and 10.09% drop in BMS per decade of life). BMS of women older than 50 years was lower than BMS of women younger than 50 years (P < .0001). Among males, age was negatively correlated with left and right whole BMS (4.29% and 4.25% drop in BMS per decade of life) and left and right cortical BMS (9.13% and 10.30% drop in BMS per decade of life). BMD was positively correlated with whole (r = 0.80, P < .0001) and cortical (r = 0.92, P < .0001) BMS. CONCLUSIONS BMS could provide functional insight regarding bone metabolism in the femoral neck to complement bone health status assessed through conventional structural imaging. The methodology described herein could be potentially useful for assessing hip fracture risk in individuals when BMD tests provide borderline determination of bone disease.
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Affiliation(s)
- Sylvia Rhodes
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Alexandra Batzdorf
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Olivia Sorci
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Matthew Peng
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Amanda Jankelovits
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Julia Hornyak
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jongyun An
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter B Noël
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Abass Alavi
- Division of Nuclear Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Chamith S Rajapakse
- Departments of Radiology, University of Pennsylvania, Philadelphia, PA, USA; Departments of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA.
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11
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Roberts BC, Arredondo Carrera HM, Zanjani-Pour S, Boudiffa M, Wang N, Gartland A, Dall'Ara E. PTH(1-34) treatment and/or mechanical loading have different osteogenic effects on the trabecular and cortical bone in the ovariectomized C57BL/6 mouse. Sci Rep 2020; 10:8889. [PMID: 32483372 PMCID: PMC7264307 DOI: 10.1038/s41598-020-65921-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/12/2020] [Indexed: 12/18/2022] Open
Abstract
In preclinical mouse models, a synergistic anabolic response to PTH(1–34) and tibia loading was shown. Whether combined treatment improves bone properties with oestrogen deficiency, a cardinal feature of osteoporosis, remains unknown. This study quantified the individual and combined longitudinal effects of PTH(1–34) and loading on the bone morphometric and densitometric properties in ovariectomised mice. C57BL/6 mice were ovariectomised at 14-weeks-old and treated either with injections of PTH(1–34); compressive loading of the right tibia; both interventions concurrently; or both interventions on alternating weeks. Right tibiae were microCT-scanned from 14 until 24-weeks-old. Trabecular metaphyseal and cortical midshaft morphometric properties, and bone mineral content (BMC) in 40 different regions of the tibia were measured. Mice treated only with loading showed the highest trabecular bone volume fraction at week 22. Cortical thickness was higher with co-treatment than in the mice treated with PTH alone. In the mid-diaphysis, increases in BMC were significantly higher with loading than PTH. In ovariectomised mice, the osteogenic benefits of co-treatment on the trabecular bone were lower than loading alone. However, combined interventions had increased, albeit regionally-dependent, benefits to cortical bone. Increased benefits were largest in the mid-diaphysis and postero-laterally, regions subjected to higher strains under compressive loads.
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Affiliation(s)
- Bryant C Roberts
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom. .,Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom.
| | - Hector M Arredondo Carrera
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom.,MRC Arthritis Research UK, Centre for Integrated Research into Musculoskeletal Ageing (CIMA), University of Sheffield, Sheffield, United Kingdom
| | - Sahand Zanjani-Pour
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom.,Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom
| | - Maya Boudiffa
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom.,MRC Arthritis Research UK, Centre for Integrated Research into Musculoskeletal Ageing (CIMA), University of Sheffield, Sheffield, United Kingdom
| | - Ning Wang
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom.,MRC Arthritis Research UK, Centre for Integrated Research into Musculoskeletal Ageing (CIMA), University of Sheffield, Sheffield, United Kingdom
| | - Alison Gartland
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom.,MRC Arthritis Research UK, Centre for Integrated Research into Musculoskeletal Ageing (CIMA), University of Sheffield, Sheffield, United Kingdom
| | - Enrico Dall'Ara
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom.,Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, United Kingdom.,MRC Arthritis Research UK, Centre for Integrated Research into Musculoskeletal Ageing (CIMA), University of Sheffield, Sheffield, United Kingdom
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12
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Liu Y, Wang L, Su Y, Brown K, Yang R, Zhang Y, Duanmu Y, Guo Z, Zhang W, Yan C, Yan D, Cheng X. CTXA hip: the effect of partial volume correction on volumetric bone mineral density data for cortical and trabecular bone. Arch Osteoporos 2020; 15:50. [PMID: 32193671 DOI: 10.1007/s11657-020-00721-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 02/25/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study compares the results of computed tomography X-ray absorptiometry (CTXA) hip volumetric BMD (vBMD) analyses of cortical and trabecular bone with and without partial volume correction. For cortical bone in some circumstances, corrected cortical volumes were negative and corrected vBMD was very high. For trabecular bone, the correction effects are smaller. CTXA volumetric data should be interpreted with caution. PURPOSE Previous studies have reported concerns about the reliability of CTXA hip cortical vBMD measurements generated using partial volume (PV) correction (the "default" analysis, with cortical PV correction). To date, no studies have examined the results of the alternative ("new") analysis (with trabecular PV correction). This study presents in vivo and phantom data comparing the corrected and uncorrected data for cortical and trabecular bone respectively. METHODS We used the commercial QCTPro CTXA software to analyze CT scans of 129 elderly Chinese men and women and an anthropomorphic European Proximal Femur phantom (EPFP) and accessed data for two alternative scan analyses using the database dump utility. The CTXA software gives the user two methods of performing the PV correction: (1) a default analysis in which only cortical bone results are corrected; (2) a new analysis in which only trabecular bone results are corrected. Both methods are based on a numerical recalculation of vBMD values without any change in volume of interest (VOI) placement. RESULT In vivo, the results of the two analyses for integral bone were the same while cortical and trabecular results were different. PV correction of cortical bone led to a decrease of cortical volume for all four VOIs: total hip (TH), femoral neck (FN), trochanter (TR), and intertrochanter (IT) volumes were reduced on average by 7.8 cm3, 0.9 cm3, 2.5 cm3, and 4.3 cm3 respectively. For TR, where cortex was thinnest, average corrected cortical volume was negative (- 0.4± 1.3 cm3). Corrected cortical vBMD values were much larger than uncorrected ones for TH, FN, and IT. Scatter plots of corrected cortical vBMD against cortical bone thickness showed that elevated results correlated with thinner cortices. When trabecular bone was corrected for the PV effect, trabecular volumes of TH, FN, TR, and IT were reduced on average by 7.9 cm3, 0.8 cm3, 2.6 cm3, and 4.4 cm3 respectively, while vBMD measurements were increased correspondingly. The trabecular volume and vBMD measurements of the two datasets both had highly positive correlations. For the EPFP, the PV-corrected FN data deviated from the nominal phantom value, but was closer for the TR and IT VOIs. Both corrected and uncorrected data overestimated trabecular vBMD, with the corrected results showing greater deviation from nominal values. CONCLUSION The default and new CTXA analyses for volumetric data generate different results, both for cortical and trabecular bone. For cortical bone, the uncorrected results are subject to partial volume effects but the correction method of the default analysis overcorrects the effect leading to in part unreasonable results for cortical bone volume and BMD. For trabecular bone, the correction effects are smaller. CTXA volumetric data should be interpreted with caution.
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Affiliation(s)
- Y Liu
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - L Wang
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - Y Su
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - K Brown
- Mindways Software, Austin, 78704, TX, USA
| | - R Yang
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - Y Zhang
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - Y Duanmu
- Department of Radiology, The First Affiliated Hospital of USTC South District, Hefei, 230036, China
| | - Z Guo
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - W Zhang
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - C Yan
- Department of Radiology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - D Yan
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China
| | - X Cheng
- Department of Radiology, Beijing Jishuitan Hospital, 31 Xinjiekou East Street, Beijing, 100035, China.
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13
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Morita A, Kobayashi N, Choe H, Ike H, Tezuka T, Higashihira S, Inaba Y. Effect of switching administration of alendronate after teriparatide for the prevention of BMD loss around the implant after total hip arthroplasty, 2-year follow-up: a randomized controlled trial. J Orthop Surg Res 2020; 15:17. [PMID: 31948455 PMCID: PMC6966791 DOI: 10.1186/s13018-020-1547-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 01/06/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Stress shielding after total hip arthroplasty (THA) can induce bone mineral density (BMD) loss around the femoral implant. Several studies using drug have described methods to prevent BMD loss around implants following THA. Switching from teriparatide to alendronate was reported to increase lumbar BMD; on the other hands, it is unclear whether switching from teriparatide to alendronate is effective around the implant. The aim of this study is that changes in BMD is compared in patients switched from teriparatide to alendronate, in patients treated with alendronate alone, and in control patients without medication after total hip arthroplasty. PATIENTS AND METHODS Patients were randomized into three groups, those switched to alendronate after teriparatide (switch: n = 17), those receiving continuous alendronate (ALD: n = 15), and control untreated patients (control: n = 16) and followed up for 2 years after THA. Baseline periprosthetic BMD was measured by dual-energy X-ray absorptiometry (DEXA) 1 week after THA, followed by subsequent measurements at 1 and 2 years postoperatively. Lumbar BMD was also evaluated at preoperatively, 1 and 2 years postoperatively. RESULTS Two years after surgery, BMD (%) at zone 1 was significantly higher in the switch group than in the control group (P = 0.02). BMD (%) at zone 7 was significantly higher in the switch and ALD groups than in the control group (P = 0.01, P = 0.03). Lumbar BMD (%) anterior-posterior (AP) side was significantly higher in the switch group than in the ALD and control groups 2 years after surgery. On the other hand, lumbar BMD (%) lateral side was significantly higher in the switch and ALD groups than control group 2 years after surgery. CONCLUSIONS Switching therapy had a significant effect on BMD of the lumbar spine and zones 1 and 7 at 2 years postoperatively. At zone 1 in particular, it was found to be more effective than ALD alone. TRIAL REGISTRATION UMIN, registry number UMIN000016158. Registered 8 January 2015.
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Affiliation(s)
- Akira Morita
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Naomi Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
| | - Hyonmin Choe
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Hiroyuki Ike
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Taro Tezuka
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Shota Higashihira
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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14
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Fujihara R, Mashiba T, Yoshitake S, Komatsubara S, Iwata K, Takao-Kawabata R, Yamamoto T. Weekly teriparatide treatment increases vertebral body strength by improving cortical shell architecture in ovariectomized cynomolgus monkeys. Bone 2019; 121:80-88. [PMID: 30630124 DOI: 10.1016/j.bone.2019.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/21/2018] [Accepted: 01/07/2019] [Indexed: 11/30/2022]
Abstract
Weekly teriparatide treatment is reported to reduce the incidence of osteoporotic vertebral fractures. However, the effect of weekly teriparatide on cortical bone has not been clarified. This study aimed to examine the effects of weekly teriparatide treatment on bone mass, intracortical structure, and remodeling of the lumbar vertebral cortical shell and its relation to mechanical properties in ovariectomized cynomolgus monkeys. Female monkeys, aged 9 to 15 years, were divided into four groups: (1) SHAM group, (2) ovariectomized group (OVX group), (3) OVX with 1.2 μg/kg once-weekly teriparatide group (LOW group), (4) OVX with 6.0 μg/kg once-weekly teriparatide group (HIGH group). After 18 months, all animals were double-labeled with calcein, and lumbar vertebrae were analyzed with histomorphometry and compressive mechanical tests. Following ovariectomy, we found reductions in the anterior cortical shell area of the vertebrae and reductions in nearly all of the tested vertebral mechanical properties. Weekly teriparatide significantly preserved the anterior cortical shell area and the energy absorption capacity of the lumbar vertebrae in a dose-dependent manner. Multiple regression analyses indicated that improved mechanical properties were more associated with the increased anterior cortical shell area rather than the cancellous bone volume. The intracortical structure of the Haversian canals was also preserved following teriparatide treatment after ovariectomy. These findings suggest the importance of the cortical shell as a therapeutic target in the treatment of osteoporosis. Weekly teriparatide treatment increases the compressive mechanical strength of the lumbar vertebrae by thickening the anterior cortical shell.
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Affiliation(s)
- Ryuji Fujihara
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Tasuku Mashiba
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan.
| | - Shingo Yoshitake
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Satoshi Komatsubara
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Ken Iwata
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
| | - Ryoko Takao-Kawabata
- Pharmaceutical Research Center, Asahi Kasei Pharma Corporation, 632-1 Mifuku, Izunokuni, Shizuoka 410-2321, Japan
| | - Tetsuji Yamamoto
- Department of Orthopedic Surgery, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793, Japan
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15
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Díez-Pérez A, Marin F, Eriksen EF, Kendler DL, Krege JH, Delgado-Rodríguez M. Effects of teriparatide on hip and upper limb fractures in patients with osteoporosis: A systematic review and meta-analysis. Bone 2019; 120:1-8. [PMID: 30268814 DOI: 10.1016/j.bone.2018.09.020] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 09/18/2018] [Accepted: 09/24/2018] [Indexed: 02/07/2023]
Abstract
In randomized clinical trials (RCTs) with teriparatide, the number of patients with incident hip fractures was small and insufficiently powered to show statistically significant differences between groups. We, therefore, conducted a systematic review and meta-analysis of the efficacy of teriparatide in the reduction of hip and upper limb fractures in women and men with osteoporosis. A comprehensive search of databases until 22 November 2017 was conducted for RCTs of at least 6-month duration that reported non-spine fractures (hip, humerus, forearm, wrist), either as an efficacy or safety endpoint. Only RCTs that included patients with the approved treatment indications and dose for use of teriparatide were included; trials with off-label use of teriparatide were excluded. Two independent reviewers performed study selection and data extraction. Statistical procedures included Peto's method and Mantel-Haenszel with empirical correction, as most of the RCTs reported zero events in at least one of the treatment arms. Study results are expressed as odds ratios (OR) with 95% confidence intervals (CI). Publication bias and heterogeneity were evaluated with standard statistical tests. Twenty-three RCTs were included, 19 with an active-controlled arm (representing 64.9% of the patients included in the control group) and 11 double-blind, representing data on 8644 subjects, 3893 of them treated with teriparatide. Mean age (SD) was 67.0 (4.5) years, median treatment duration 18 months (range: 6 to 24 months). A total of 34 incident hip, 31 humerus, 31 forearm, and 62 wrist fractures were included. Meta-analysis results showed an OR (95% CI) for hip fractures of 0.44 (0.22-0.87; p = 0.019) in patients treated with teriparatide compared with controls. The effects on the risk of humerus [1.02 (0.50-2.08)], forearm [0.53 (0.26-1.08)] and wrist fractures [1.21 (0.72-2.04)] were not statistically significant (p > 0.05). This meta-analysis provides evidence of efficacy of teriparatide in reducing hip fractures by 56% in patients with osteoporosis.
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Affiliation(s)
- Adolfo Díez-Pérez
- Hospital del Mar-IMIM-UAB, Department of Internal Medicine, Barcelona, Spain; CIBERFES, Institute Carlos III, Barcelona, Spain.
| | | | - Erik F Eriksen
- Department of Clinical Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Norway
| | | | | | - Miguel Delgado-Rodríguez
- Department of Preventive Medicine and Public Health, University of Jaén, Spain; CIBERESP, Institute Carlos III, Madrid, Spain
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16
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Wang L, Museyko O, Su Y, Brown K, Yang R, Zhang Y, Duanmu Y, Guo Z, Zhang W, Yan D, Cheng X, Engelke K. QCT of the femur: Comparison between QCTPro CTXA and MIAF Femur. Bone 2019; 120:262-270. [PMID: 30342226 DOI: 10.1016/j.bone.2018.10.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/15/2018] [Accepted: 10/16/2018] [Indexed: 11/30/2022]
Abstract
QCT is commonly employed in research studies and clinical trials to measure BMD at the proximal femur. In this study we compared two analysis software options, QCTPro CTXA and MIAF-Femur, using CT scans of the semi-anthropometric European Proximal Femur Phantom (EPFP) and in vivo data from 130 Chinese elderly men and women aged 60-80 years. Integral (Int), cortical (Cort) and trabecular (Trab) vBMD, volume, and BMC of the neck (FN), trochanter (TR), inter-trochanter (IT), and total hip (TH) VOIs were compared. Accuracy was determined in the 5 mm wide central portion of the femoral neck of the EPFP. Nominal values were: cross-sectional area (CSA) 4.9 cm2, cortical thickness (C.Th) 2 mm, CortBMD 723 mg/cm3 and TrabBMD 100 mg/cm3. In MIAF the so-called peeled trabecular VOI was analyzed, which excludes subcortical bone to avoid partial volume artefacts at the endocortical border that artificially increase TrabBMD. For CTXA uncorrected, so called raw cortical values were used for the analysis. QCTPro and MIAF phantom results were: CSA 5.9 cm2 versus 5.1 cm2; C.Th 1.68 mm versus 1.92 mm; CortBMD 578 mg/cm3 versus 569 mg/cm3; and TrabBMD 154 mg/cm3 versus 104 mg/cm3. In vivo correlations (R2) of integral and trabecular bone parameters ranged from 0.63 to 0.96. Bland-Altman analysis for TH and FN TrabBMD showed that lower mean values were associated with higher differences, which means that TrabBMD differences between MIAF and CTXA are larger for osteoporotic than for normal patients, which can be largely explained by the inclusion of subcortical BMD in the trabecular VOI analyzed by CTXA in combination with fixed thresholds used to separate cortical from trabecular bone compartments. Correlations between CTXA corrected CortBMD and MIAF were negative, whereas raw data correlated positively with MIAF measurements for all VOIs questioning the validity of the CTXA corrections. The EPFP results demonstrated higher MIAF accuracy of cortical thickness and TrabBMD. Integral and trabecular bone parameters were highly correlated between CTXA and MIAF. Partial volume artefacts at the endocortical border artificially increased trabecular BMD by CTXA, especially for osteoporosis patients. With respect to volumetric cortical measurements with CTXA, the use raw data is recommended, because corrected data cause a negative correlation with MIAF CortBMD.
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Affiliation(s)
- Ling Wang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China; Institute of Medical Physics, University of Erlangen, Erlangen, Germany
| | - Oleg Museyko
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany
| | - Yongbin Su
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | | | - Ruopei Yang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Yong Zhang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Yangyang Duanmu
- Department of Radiology, Anhui Provincial Hospital, Anhui, China
| | - Zhe Guo
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Wei Zhang
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Dong Yan
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China
| | - Xiaoguang Cheng
- Department of Radiology, Beijing Jishuitan Hospital, Beijing, China.
| | - Klaus Engelke
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany; Dept of Medicine 3, University Hospital Erlangen, Germany.
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17
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Abstract
Fractures resulting from osteoporosis become increasingly common in women after age 55 years and men after age 65 years, resulting in substantial bone-associated morbidities, and increased mortality and health-care costs. Research advances have led to a more accurate assessment of fracture risk and have increased the range of therapeutic options available to prevent fractures. Fracture risk algorithms that combine clinical risk factors and bone mineral density are now widely used in clinical practice to target high-risk individuals for treatment. The discovery of key pathways regulating bone resorption and formation has identified new approaches to treatment with distinctive mechanisms of action. Osteoporosis is a chronic condition and long-term, sometimes lifelong, management is required. In individuals at high risk of fracture, the benefit versus risk profile is likely to be favourable for up to 10 years of treatment with bisphosphonates or denosumab. In people at a very high or imminent risk of fracture, therapy with teriparatide or abaloparatide should be considered; however, since treatment duration with these drugs is restricted to 18-24 months, treatment should be continued with an antiresorptive drug. Individuals at high risk of fractures do not receive adequate treatment and strategies to address this treatment gap-eg, widespread implementation of Fracture Liaison Services and improvement of adherence to therapy-are important challenges for the future.
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Affiliation(s)
| | - Michael R McClung
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA; Mary MacKillop Institute for Health, Australian Catholic University, Melbourne, VIC, Australia
| | - William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
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18
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Paschalis EP, Krege JH, Gamsjaeger S, Eriksen EF, Burr DB, Disch DP, Stepan JJ, Fahrleitner-Pammer A, Klaushofer K, Marin F, Pavo I. Teriparatide Treatment Increases Mineral Content and Volume in Cortical and Trabecular Bone of Iliac Crest: A Comparison of Infrared Imaging With X-Ray-Based Bone Assessment Techniques. J Bone Miner Res 2018; 33:2230-2235. [PMID: 30102789 DOI: 10.1002/jbmr.3565] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 07/25/2018] [Accepted: 08/05/2018] [Indexed: 11/11/2022]
Abstract
Teriparatide increases bone mass primarily through remodeling of older or damaged bone and abundant replacement with new mineralizing bone. This post hoc analysis investigated whether dual-energy X-ray absorptiometric (DXA) areal bone mineral density (aBMD) measurement adequately reflects changes of mineral and organic matrix content in cortical and trabecular bone. Paired biopsies and aBMD measurements were obtained before and at end of 2 years of teriparatide treatment from postmenopausal women with osteoporosis who were either alendronate pretreated (mean, 57.5 months) or osteoporosis-treatment naive. Biopsies were assessed by micro-computed tomography (μCT) to calculate mean cortical width (Ct.Wi), cortical area (Ct.Ar), and trabecular bone volume fraction (BV/TV). Fourier transformed infrared imaging (pixel size ∼6.3 × 6.3 μm2 ) was utilized to calculate mineral and organic matrix density (mean absorption/pixel), as well as total mineral and organic contents of cortical and cancellous compartments (sum of all pixels in the compartment). Effect of pretreatment over time was analyzed using mixed model repeated measures. μCT derived Ct.Wi and BV/TV increased, accompanied by similar increases in the overall mineral contents of their respective bone compartments. Mineral density did not change. Marked increases in the total content of both mineral and organic matrix associated with volumetric growth in both compartments consistently exceeded those of aBMD. Increases in organic matrix exceeded increases in mineral content in both cortical and trabecular compartments. For percent changes, only change in Ct.Wi correlated to change in femoral neck aBMD (r = .38, p = 0.043), whereas no other significant correlations of Ct.Wi or BV/TV with lumbar spine, total hip, or femoral neck aBMD were demonstrable. These data indicate that 2 years of teriparatide treatment leads to an increased bone organic matrix and mineral content in the iliac crest. The magnitude of these increases in the iliac crest were not detected with conventional aBMD measurements at other skeletal sites. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Eleftherios P Paschalis
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of Wiener Gebietskrankenkasse (WGKK), Allgemeine Unfallversicherungsanstalt (AUVA) Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | | | - Sonja Gamsjaeger
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of Wiener Gebietskrankenkasse (WGKK), Allgemeine Unfallversicherungsanstalt (AUVA) Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | - Erik F Eriksen
- Department of Clinical Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Insititute of Clinical Medicine, Oslo University, Oslo, Norway
| | - David B Burr
- Department of Anatomy and Cell Biology, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Jan J Stepan
- Institute of Rheumatology and Faculty of Medicine 1, Charles University, Prague, Czech Republic
| | - Astrid Fahrleitner-Pammer
- Department of Internal Medicine, Division of Endocrinology and Diabetes, Medical University of Graz, Graz, Austria
| | - Klaus Klaushofer
- Ludwig Boltzmann Institute of Osteology, Hanusch Hospital of Wiener Gebietskrankenkasse (WGKK), Allgemeine Unfallversicherungsanstalt (AUVA) Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria
| | | | - Imre Pavo
- Eli Lilly and Company, Indianapolis, IN, USA
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19
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Winzenrieth R, Humbert L, Di Gregorio S, Bonel E, García M, Del Rio L. Effects of osteoporosis drug treatments on cortical and trabecular bone in the femur using DXA-based 3D modeling. Osteoporos Int 2018; 29:2323-2333. [PMID: 29974136 DOI: 10.1007/s00198-018-4624-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/27/2018] [Indexed: 12/11/2022]
Abstract
UNLABELLED Effects of osteoporosis drugs on proximal femur cortical and trabecular bone were studied using dual-energy x-ray absorptiometry (DXA)-based 3D modeling method. Changes observed in this head-to-head study were consistent with those obtained using computed tomography in the literature. INTRODUCTION The aim of the present study was to assess the effects of osteoporosis drugs on cortical and trabecular bone at the proximal femur using DXA-based 3D modeling. METHODS We retrospectively analyzed 155 patients stratified by treatments: naive of treatment (NAIVE), alendronate (AL), denosumab (DMAB), and teriparatide (TPTD). DXA scans were performed at baseline and after treatment, and areal bone mineral density at spine and femur were measured. A software algorithm (3D-SHAPER) was used to derive 3D models from hip DXA scans and compute: trabecular and cortical volumetric BMD (vBMD), cortical thickness (Cth), and cortical surface BMD (cortical sBMD). Changes from baseline were normalized at 24 months and evaluated in terms or percentage. RESULTS After 24 months, a non-significant decrease was observed for trabecular vBMD, Cortical sBMD, Cth, and cortical vBMD (- 2.3, - 0.8, - 0.3, and - 0.5%) in the NAIVE group. Under AL and DMAB, significant increases were observed in trabecular vBMD (3.8 and 7.3%), cortical vBMD (1.4 and 2.0%), and cortical sBMD (1.5 and 3.6%). An increase in Cth was observed in patients under DMAB (1.8%). Under TPTD, a significant increase in Trabecular vBMD was observed (5.9%) associated with a non-significant increase of Cth (+ 1%) concomitant with a decrease in cortical vBMD (- 1.1%). CONCLUSION Results obtained in this head-to-head study are consistent with those obtained using computed tomography in the literature. DXA-based modeling techniques could complement standard DXA examination to monitor treatment effects on trabecular and cortical compartments.
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Affiliation(s)
- R Winzenrieth
- Musculoskeletal Unit, Galgo Medical, Carrer del Comte d'Urgell, 143, 08036, Barcelona, Spain.
- Department of Urology, Hospital Universitario de Bellvitge, l'Hospitalet, Spain.
| | - L Humbert
- Musculoskeletal Unit, Galgo Medical, Carrer del Comte d'Urgell, 143, 08036, Barcelona, Spain
- Department of Urology, Hospital Universitario de Bellvitge, l'Hospitalet, Spain
| | - S Di Gregorio
- Department of Urology, Hospital Universitario de Bellvitge, l'Hospitalet, Spain
- Cetir Grup Mèdic, Barcelona, Spain
| | - E Bonel
- Department of Urology, Hospital Universitario de Bellvitge, l'Hospitalet, Spain
- Cetir Grup Mèdic, Barcelona, Spain
| | - M García
- Department of Urology, Hospital Universitario de Bellvitge, l'Hospitalet, Spain
- Cetir Grup Mèdic, Barcelona, Spain
| | - L Del Rio
- Department of Urology, Hospital Universitario de Bellvitge, l'Hospitalet, Spain
- Cetir Grup Mèdic, Barcelona, Spain
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Paggiosi MA, Yang L, Blackwell D, Walsh JS, McCloskey E, Peel N, Eastell R. Teriparatide treatment exerts differential effects on the central and peripheral skeleton: results from the MOAT study. Osteoporos Int 2018. [PMID: 29520607 DOI: 10.1007/s00198-018-4445-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
UNLABELLED The central and peripheral skeleton was characterised using imaging techniques during 104 weeks of teriparatide treatment. Teriparatide exerts differential effects on the central and the peripheral skeleton. Overall, we did not observe a change in total body bone mineral. Our conclusions are constrained by the study limitations. INTRODUCTION Teriparatide stimulates bone formation and resorption and therefore can cause bone gain and loss. We simultaneously characterised the central and peripheral skeleton using imaging techniques to better understand the mechanism of action of teriparatide. METHODS Postmenopausal, osteoporotic women (n = 20, 65.4 ± 5.5 years) were recruited into a 104-week study of teriparatide. Imaging techniques included DXA, quantitative computed tomography (QCT), and high-resolution peripheral quantitative computed tomography (HR-pQCT). RESULTS Total lumbar spine areal bone mineral content (aBMC) (+ 11.2%), total lumbar spine areal bone mineral density (aBMD) (+ 8.1%), subregional thoracic spine aBMD (+ 7.5%), lumbar spine aBMC (+ 23.5%), lumbar spine aBMD (+ 11.9%), pelvis aBMC (+ 9.3%), and pelvis aBMD (+ 4.3%) increased. However, skull aBMC (- 5.0%), arms aBMC (- 5.1%), legs aBMC (- 2.9%), and legs aBMD (- 2.5%) decreased. Overall, we did not observe a change in total body bone mineral. Increases in L1-L3 volumetric BMD (vBMD) (+ 28.5%) occurred but there was no change in total proximal femur vBMD. Radius and tibia cortical vBMD (- 3.3 and - 3.4%) and tissue mineral density (- 3.2 and - 3.8%) decreased and there was an increase in porosity (+ 21.2 and + 10.3%). Tibia, but not radius, trabecular inhomogeneity (+ 3.2%), and failure load (+ 0.2%) increased, but cortical thickness (- 3.1%), area (- 2.9%), and pore volume (- 1.6%) decreased. CONCLUSIONS Teriparatide exerts differential effects on the central and the peripheral skeleton. Central trabecular vBMD (L1-L3) is improved, but there is a concomitant decrease in peripheral cortical vBMD and an increase in porosity. Overall, we did not observe a change in total body bone mineral. We acknowledge that our conclusions may be speculative and are constrained by the technical limitations of the imaging techniques used, the lack of a control group, and the small sample size studied.
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Affiliation(s)
- M A Paggiosi
- The Mellanby Centre for Bone Research, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK.
| | - L Yang
- The Mellanby Centre for Bone Research, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - D Blackwell
- The Mellanby Centre for Bone Research, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - J S Walsh
- The Mellanby Centre for Bone Research, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- The MRC-Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA), University of Liverpool, Liverpool, UK
| | - E McCloskey
- The Mellanby Centre for Bone Research, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- The MRC-Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA), University of Liverpool, Liverpool, UK
| | - N Peel
- Metabolic Bone Centre (Sorby Wing), Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - R Eastell
- The Mellanby Centre for Bone Research, Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
- The MRC-Arthritis Research UK Centre for Integrated Research into Musculoskeletal Ageing (CIMA), University of Liverpool, Liverpool, UK
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21
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Effect of osteoporosis treatment agents on the cortical bone osteocyte microenvironment in adult estrogen-deficient, osteopenic rats. Bone Rep 2018; 8:115-124. [PMID: 29955630 PMCID: PMC6020081 DOI: 10.1016/j.bonr.2018.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 01/18/2018] [Accepted: 02/23/2018] [Indexed: 11/21/2022] Open
Abstract
Though osteoporosis is a significant cause of disability worldwide, treatment with pharmacologic agents decreases risk of fragility fracture. Though these treatments act through the bone remodeling system to improve bone mass, it is unclear if they alter the response of bone to mechanical loading at the level of the osteocyte. This pre-clinical study determined the relationship between microstructural bone tissue properties and osteocyte lacunar size and density to strain around osteocytes with standard osteoporosis treatment or sequential therapies. Six-month-old female ovariectomized (OVX) Sprague-Dawley rats were cycled through various sequences of pharmacological treatments [alendronate (Aln), raloxifene (Ral) and human parathyroid hormone-1,34 (PTH)] for three month intervals, over nine months. Linear nanoindentation mapping was used to determine Young's modulus in perilacunar and bone matrix regions around cortical bone osteocyte lacunae. Measurements of lacunar diameter and density were completed. Treatment-related differences in Young's modulus in the perilacunar and bone matrix regions were not observed. We confirmed previous data that showed that the bone matrix region was stiffer than the perilacunar matrix region. Whole bone material properties were correlated to perilacunar matrix stiffness. Finite element models predicted a range of mechanical strain amplification factors estimated at the osteocyte across treatment groups. In summary, though the perilacunar matrix near cortical osteocyte lacuna is not as stiff as bone matrix further away, osteoporosis treatment agents do not affect the stiffness of bone tissue near osteocyte lacunae. Monotherapy with osteoporosis treatment agents does not affect the stiffness of bone tissue around osteocyte lacunae. Sequential use of osteoporosis treatment agents does not affect bone tissue stiffness around osteocyte lacunae. Perilacunar cortical bone tissue is not as stiff as bone matrix further from osteocyte lacunae. Whole bone material properties are negatively correlated to the stiffness of perilacunar bone tissue.
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Ito M, Sone T, Shiraki M, Tanaka S, Irie C, Ota Y, Nakamura T. The effect of once-yearly zoledronic acid on hip structural and biomechanical properties derived using computed tomography (CT) in Japanese women with osteoporosis. Bone 2018; 106:179-186. [PMID: 29033381 DOI: 10.1016/j.bone.2017.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
The effects of zoledronic acid on hip structural and biomechanical properties were evaluated in Japanese patients with osteoporosis by computed tomography (CT). The subjects included in this study were a subset of female subjects (zoledronic acid group, 49 subjects; placebo group, 53 subjects) in the phase 3 trial (ZONE study) who were available for multi-detector row CT (MDCT) scanning. Eligible subjects were those diagnosed with primary osteoporosis based on the Diagnostic Criteria for Primary Osteoporosis (2000) by the Japanese Society for Bone and Mineral Research and who had between one and four fractured vertebrae located between the fourth thoracic vertebra and the fourth lumbar vertebra. The subjects received a once-yearly intravenous infusion of zoledronic acid 5mg or placebo for two years. CT data were obtained at baseline and at 12 and 24months later and analyzed under blinded conditions. The results demonstrated that once-yearly intravenous infusion of zoledronic acid improved volumetric bone mineral density (vBMD), cortical bone geometry parameters, and CT-derived biomechanical parameters at the femoral neck, intertrochanteric region, and shaft; particularly at the intertrochanteric region, significant improvements in cortical bone geometry parameters and CT-derived biomechanical parameters, compared with those in the placebo group, were detectable early, at 12months. The present data suggest that zoledronic acid has a possibility to reduce the risk of hip fractures in Japanese patients with osteoporosis.
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Affiliation(s)
- Masako Ito
- Center for Diversity and Inclusion, Nagasaki University, 1-14 Bunkyo-machi, Nagasaki City, Nagasaki 852-8521, Japan.
| | - Teruki Sone
- Department of Nuclear Medicine, Kawasaki Medical School, 577 Matsushima, Kurashiki City, Okayama 701-0192, Japan
| | - Masataka Shiraki
- Research Institute and Practice for Involutional Diseases, 1610-1 Meisei, Misato, Azumino, Nagano 399-8101, Japan
| | - Satoshi Tanaka
- Asahi Kasei Pharma Corporation, 1-105 Jinbocho, Kanda, Chiyoda-ku, Tokyo 101-8101, Japan
| | - Chika Irie
- Asahi Kasei Pharma Corporation, 1-105 Jinbocho, Kanda, Chiyoda-ku, Tokyo 101-8101, Japan
| | - Yuri Ota
- Asahi Kasei Pharma Corporation, 1-105 Jinbocho, Kanda, Chiyoda-ku, Tokyo 101-8101, Japan
| | - Toshitaka Nakamura
- Japan Osteoporosis Foundation, 2-14 Odenma-cho, Nihonbashi Chuo-ku, Tokyo, Japan
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Abstract
Teriparatide is a safe and effective anabolic treatment for osteoporosis. In postmenopausal women, it increases BMD and decreases vertebral fractures by about 70% and non-vertebral fractures by about 45% (although there is no evidence that it prevents hip fractures). The current evidence indicates that it should be administered for a single course of 24 months, and followed with an anti-resorptive agent to maintain the BMD gain. There is no clear benefit to repeated or cyclical treatment. Combination treatment, particularly with denosumab achieves greater BMD increase than either agent alone, but there are no available fracture data for combination treatment. There are some unknowns; most fundamentally why daily PTH administration is anabolic to bone when continuous high PTH is catabolic. Also, a better understanding of why the anabolic action declines with time and why there is a poor response to repeated treatment may help us to use teriparatide more effectively, and increase our understanding of bone biology and osteoporosis pathophysiology.
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Affiliation(s)
- Richard Eastell
- Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, UK (R.E., T.V.)
| | - Jennifer S Walsh
- Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, UK (R.E., T.V.)
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24
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Langdahl BL, Libanati C, Crittenden DB, Bolognese MA, Brown JP, Daizadeh NS, Dokoupilova E, Engelke K, Finkelstein JS, Genant HK, Goemaere S, Hyldstrup L, Jodar-Gimeno E, Keaveny TM, Kendler D, Lakatos P, Maddox J, Malouf J, Massari FE, Molina JF, Ulla MR, Grauer A. Romosozumab (sclerostin monoclonal antibody) versus teriparatide in postmenopausal women with osteoporosis transitioning from oral bisphosphonate therapy: a randomised, open-label, phase 3 trial. Lancet 2017; 390:1585-1594. [PMID: 28755782 DOI: 10.1016/s0140-6736(17)31613-6] [Citation(s) in RCA: 264] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 05/08/2017] [Accepted: 05/18/2017] [Indexed: 01/07/2023]
Abstract
BACKGROUND Previous bisphosphonate treatment attenuates the bone-forming effect of teriparatide. We compared the effects of 12 months of romosozumab (AMG 785), a sclerostin monoclonal antibody, versus teriparatide on bone mineral density (BMD) in women with postmenopausal osteoporosis transitioning from bisphosphonate therapy. METHODS This randomised, phase 3, open-label, active-controlled study was done at 46 sites in North America, Latin America, and Europe. We enrolled women (aged ≥55 to ≤90 years) with postmenopausal osteoporosis who had taken an oral bisphosphonate for at least 3 years before screening and alendronate the year before screening; an areal BMD T score of -2·5 or lower at the total hip, femoral neck, or lumbar spine; and a history of fracture. Patients were randomly assigned (1:1) via an interactive voice response system to receive subcutaneous romosozumab (210 mg once monthly) or subcutaneous teriparatide (20 μg once daily). The primary endpoint was percentage change from baseline in areal BMD by dual-energy x-ray absorptiometry at the total hip through month 12 (mean of months 6 and 12), which used a linear mixed effects model for repeated measures and represented the mean treatment effect at months 6 and 12. All randomised patients with a baseline measurement and at least one post-baseline measurement were included in the efficacy analysis. This trial is registered with ClinicalTrials.gov, number NCT01796301. FINDINGS Between Jan 31, 2013, and April 29, 2014, 436 patients were randomly assigned to romosozumab (n=218) or teriparatide (n=218). 206 patients in the romosozumab group and 209 in the teriparatide group were included in the primary efficacy analysis. Through 12 months, the mean percentage change from baseline in total hip areal BMD was 2·6% (95% CI 2·2 to 3·0) in the romosozumab group and -0·6% (-1·0 to -0·2) in the teriparatide group; difference 3·2% (95% CI 2·7 to 3·8; p<0·0001). The frequency of adverse events was generally balanced between treatment groups. The most frequently reported adverse events were nasopharyngitis (28 [13%] of 218 in the romosozumab group vs 22 [10%] of 214 in the teriparatide group), hypercalcaemia (two [<1%] vs 22 [10%]), and arthralgia (22 [10%] vs 13 [6%]). Serious adverse events were reported in 17 (8%) patients on romosozumab and in 23 (11%) on teriparatide; none were judged treatment related. There were six (3%) patients in the romosozumab group compared with 12 (6%) in the teriparatide group with adverse events leading to investigational product withdrawal. INTERPRETATION Transition to a bone-forming agent is common practice in patients treated with bisphosphonates, such as those who fracture while on therapy. In such patients, romosozumab led to gains in hip BMD that were not observed with teriparatide. These data could inform clinical decisions for patients at high risk of fracture. FUNDING Amgen, Astellas, and UCB Pharma.
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Affiliation(s)
| | | | | | | | - Jacques P Brown
- Laval University and CHU de Québec (CHUL) Research Centre, Quebec City, QC, Canada
| | | | | | - Klaus Engelke
- BioClinica, Hamburg, Germany; Institute of Medical Physics, University of Erlangen, Erlangen, Germany
| | | | - Harry K Genant
- Department of Radiology, University of California, San Francisco, CA, USA
| | | | | | - Esteban Jodar-Gimeno
- Servicio de Endocrinología, Hospital Universitario Quirón Salud, Universidad Europea de Madrid, Madrid, Spain
| | | | - David Kendler
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Peter Lakatos
- Department of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Jorge Malouf
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fabio E Massari
- Instituto de Investigaciones Metabólicas, Buenos Aires, Argentina
| | | | - Maria Rosa Ulla
- Instituto Latinoamericano de Investigaciones Médicas, Córdoba, Argentina
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25
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Keaveny TM, Crittenden DB, Bolognese MA, Genant HK, Engelke K, Oliveri B, Brown JP, Langdahl BL, Yan C, Grauer A, Libanati C. Greater Gains in Spine and Hip Strength for Romosozumab Compared With Teriparatide in Postmenopausal Women With Low Bone Mass. J Bone Miner Res 2017; 32:1956-1962. [PMID: 28543940 DOI: 10.1002/jbmr.3176] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/09/2017] [Accepted: 05/22/2017] [Indexed: 12/18/2022]
Abstract
Romosozumab is a monoclonal antibody that inhibits sclerostin and has been shown to reduce the risk of fractures within 12 months. In a phase II, randomized, placebo-controlled clinical trial of treatment-naïve postmenopausal women with low bone mass, romosozumab increased bone mineral density (BMD) at the hip and spine by the dual effect of increasing bone formation and decreasing bone resorption. In a substudy of that trial, which included placebo and teriparatide arms, here we investigated whether those observed increases in BMD also resulted in improvements in estimated strength, as assessed by finite element analysis. Participants received blinded romosozumab s.c. (210 mg monthly) or placebo, or open-label teriparatide (20 μg daily) for 12 months. CT scans, obtained at the lumbar spine (n = 82) and proximal femur (n = 46) at baseline and month 12, were analyzed with finite element software (VirtuOst, O.N. Diagnostics) to estimate strength for a simulated compression overload for the spine (L1 vertebral body) and a sideways fall for the proximal femur, all blinded to treatment assignment. We found that, at month 12, vertebral strength increased more for romosozumab compared with both teriparatide (27.3% versus 18.5%; p = 0.005) and placebo (27.3% versus -3.9%; p < 0.0001); changes in femoral strength for romosozumab showed similar but smaller changes, increasing more with romosozumab versus teriparatide (3.6% versus -0.7%; p = 0.027), and trending higher versus placebo (3.6% versus -0.1%; p = 0.059). Compartmental analysis revealed that the bone-strengthening effects for romosozumab were associated with positive contributions from both the cortical and trabecular bone compartments at both the lumbar spine and hip. Taken together, these findings suggest that romosozumab may offer patients with osteoporosis a new bone-forming therapeutic option that increases both vertebral and femoral strength within 12 months. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
| | | | | | | | - Klaus Engelke
- Bioclinica, Hamburg, Germany, and Institute of Medical Physics, University of Erlangen, Erlangen, Germany
| | | | - Jacques P Brown
- CHU de Québec Research Centre and Laval University, Québec City, QC, Canada
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Cosman F, Nieves JW, Dempster DW. Response to Letter to the Editor of JBMR: Treatment Sequence Matters. J Bone Miner Res 2017; 32:1148-1150. [PMID: 28294411 DOI: 10.1002/jbmr.3126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Felicia Cosman
- Professor of Medicine at Columbia University College of Physicians and Surgeons, Osteoporosis Specialist/Endocrinologist Helen Hayes Hospital Co-Editor in Chief, Osteoporosis International
| | - Jeri W Nieves
- Associate Professor of Clinical Epidemiology at Columbia University Mailman School of Public Health, Senior Research Scientist, Helen Hayes Hospital Associate Editor, Osteoporosis International
| | - David W Dempster
- Professor of Clinical Pathology and Cell Biology at Columbia University College of Physicians and Surgeons, Senior Research Scientist, Helen Hayes Hospital Associate Editor, Osteoporosis International
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27
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Miller CG, Bogado CC, Nino AJ, Northcutt AR, Yu HJ, Lewiecki EM, Paul G, Cobitz AR, Wooddell MJ, Bilezikian JP, Fitzpatrick LA. Evaluation of Quantitative Computed Tomography Cortical Hip Quadrant in a Clinical Trial With Rosiglitazone: A Potential New Study Endpoint. J Clin Densitom 2016; 19:485-491. [PMID: 27052635 DOI: 10.1016/j.jocd.2016.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED Quantitative computed tomography (QCT) measurements have been used extensively to ascertain information about bone quality and density due to the 3-dimensional information provided and the ability to segment out trabecular and cortical bones. QCT imaging helps to improve our understanding of the role that each bone compartment plays in the pathogenesis and prognosis of fracture. This study was conducted to explore longitudinal changes in femoral neck (FN) cortical bone structure using both volumetric bone mineral density (vBMD) and cortical shell thickness assessments via QCT in a double-blind, randomized, multicenter clinical trial in postmenopausal women with type 2 diabetes mellitus. This study also examined whether treatment-associated changes in the cortical bone vBMD and thickness in femoral neck quadrants could be evaluated. Subjects were randomized to rosiglitazone (RSG) or metformin (MET) for 52 wk followed by 24 wk of open-label MET. A subset of 87 subjects underwent QCT scans of the hip at baseline, after 52 wk of double-blind treatment, and after 24 wk of treatment with MET using standard full-body computed tomography scanners. All scans were evaluated and analyzed centrally. Cortical vBMD at the FN was precisely segmented from trabecular bone and used to assess a possible therapeutic effect on this bone compartment. QCT analysis showed reductions in adjusted mean percentage change in vBMD and in absolute cortical thickness occurred with RSG treatment from baseline to week 52, whereas changes with MET were generally minimal. The reductions observed during RSG treatment for 1 yr appeared to partially reverse during the open-label MET phase from weeks 52 to 76. The femoral neck quadrant may provide utility as a potential endpoint in clinical trials for the understanding of the therapeutic effect of new entities on cortical bone vs trabecular bone; however, further clinical validation is needed. TRIAL REGISTRATION The protocol (GSK study number AVD111179) was registered on ClinicalTrials.gov as NCT00679939.
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Affiliation(s)
| | - Cesar C Bogado
- Instituto Investigaciones Metabolicas, Buenos Aires, Argentina
| | - Antonio J Nino
- Research and Development, GlaxoSmithKline, King of Prussia, PA, USA.
| | | | - Hui Jing Yu
- Medical Affairs, BioClinica Inc., Princeton, NJ, USA
| | - E Michael Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - G Paul
- Research and Development, GlaxoSmithKline, King of Prussia, PA, USA
| | | | | | - John P Bilezikian
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
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28
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Adami G, Orsolini G, Adami S, Viapiana O, Idolazzi L, Gatti D, Rossini M. Effects of TNF Inhibitors on Parathyroid Hormone and Wnt Signaling Antagonists in Rheumatoid Arthritis. Calcif Tissue Int 2016; 99:360-4. [PMID: 27307275 DOI: 10.1007/s00223-016-0161-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/06/2016] [Indexed: 01/01/2023]
Abstract
Tumor necrosis factor α inhibitors (TNFi) are the major class of biologic drug used for the treatment of Rheumatoid arthritis (RA). Their effects on inflammation and disease control are well established, but this is not true also for bone metabolism, especially for key factors as parathyroid hormone and Wnt pathway. Those two pathways are gaining importance in the pathogenesis RA bone damage, both systemic and local, but how the new treatment affects them is still largely unknown. We studied 54 RA patients who were starting an anti-TNFα treatment due to the failure of the conventional synthetic disease-modifying antirheumatic drugs. Serum levels of Wnt/βcatenin pathway inhibitors (Dickkopf-related protein 1, Dkk1, and Sclerostin), Parathyroid hormone (PTH), vitamin D, and bone turnover markers were measured at baseline in the morning after fasting and after 6 months of therapy. We found a significant percentage increase in serum PTH (+32 ± 55 %; p = 0.002) and a decrease in Dkk1 mean serum levels (-2.9 ± 12.1; p = 0.05). PTH percentage changes were positively correlated both with C-terminal telopeptide of type I collagen and Dkk1 percentage changes. Sclerostin serum levels showed no significant difference. TNFi treatment provokes in the short term a rise in PTH levels and a decrease in Dkk1 serum levels. The increase of PTH might promote bone resorption and blunt the normalization of Dkk1 serum levels in RA. Those data give a new insight into TNFi metabolic effects on bone and suggest new strategies to achieve better results in terms of prevention of bone erosions and osteoporosis with TNFi treatment in RA.
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Affiliation(s)
- Giovanni Adami
- Rheumatology Section, Department of Medicine, University of Verona, Policlinico G.B Rossi, Piazzale Ludovico Scuro, 10, 37134, Verona, Italy.
| | - Giovanni Orsolini
- Rheumatology Section, Department of Medicine, University of Verona, Policlinico G.B Rossi, Piazzale Ludovico Scuro, 10, 37134, Verona, Italy
| | - Silvano Adami
- Rheumatology Section, Department of Medicine, University of Verona, Policlinico G.B Rossi, Piazzale Ludovico Scuro, 10, 37134, Verona, Italy
| | - Ombretta Viapiana
- Rheumatology Section, Department of Medicine, University of Verona, Policlinico G.B Rossi, Piazzale Ludovico Scuro, 10, 37134, Verona, Italy
| | - Luca Idolazzi
- Rheumatology Section, Department of Medicine, University of Verona, Policlinico G.B Rossi, Piazzale Ludovico Scuro, 10, 37134, Verona, Italy
| | - Davide Gatti
- Rheumatology Section, Department of Medicine, University of Verona, Policlinico G.B Rossi, Piazzale Ludovico Scuro, 10, 37134, Verona, Italy
| | - Maurizio Rossini
- Rheumatology Section, Department of Medicine, University of Verona, Policlinico G.B Rossi, Piazzale Ludovico Scuro, 10, 37134, Verona, Italy
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Niimi R, Kono T, Nishihara A, Hasegawa M, Kono T, Sudo A. A retrospective analysis of nonresponse to daily teriparatide treatment. Osteoporos Int 2016; 27:2845-2853. [PMID: 27055464 DOI: 10.1007/s00198-016-3581-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/22/2016] [Indexed: 11/26/2022]
Abstract
UNLABELLED Some patients with osteoporosis do not respond to teriparatide treatment. Prior bisphosphonate use, lower bone turnover marker (BTMs) concentrations, and lower early increases in BTMs were significantly associated with a blunted lumbar spine (LS) bone mineral density (BMD) response to daily treatment with teriparatide, although the impact was limited. INTRODUCTION Some osteoporosis patients do not respond to teriparatide treatment. To better understand the factors underlying treatment nonresponses, we compared nonresponders' and responders' characteristics. METHODS We retrospectively analyzed 354 male and female patients with osteoporosis who were administered teriparatide (20 μg/day) for 24 months. The patients were categorized as responders (≥3 % lumber spine (LS) bone mineral density (BMD) increase) or nonresponders (<3 % LS BMD increase), and the groups were compared. RESULTS The univariate analyses determined that prior bisphosphonate use, a lower baseline procollagen type I N-terminal propeptide (PINP) concentration and a lower urinary N-telopeptide of type I collagen (uNTX) concentration at baseline were significantly associated with teriparatide nonresponses, but these factors were not significant following multivariate analysis. Diminished early increases in the bone turnover markers (BTMs) were also related to nonresponses after teriparatide treatment began. In the nonresponders, the mean (standard deviation (SD)) absolute LS and femoral neck (FN) BMD changes were -0.002 g/cm(2) (0.032) and -0.010 g/cm(2) (0.045), respectively. In the responders, the mean (SD) absolute LS and FN BMD changes were 0.118 g/cm(2) (0.056) and 0.021 g/cm(2) (0.046), respectively. The serum PINP and uNTX levels increased rapidly in both groups, but the responders showed higher early absolute serum PINP and uNTX increases. CONCLUSIONS The factors associated with nonresponses were prior bisphosphonate use, lower baseline BTM levels, and lower early increases in the BTMs after starting teriparatide treatment, but the impact of these factors on achieving a ≥3 % LS BMD increase at 24 months was limited.
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Affiliation(s)
- R Niimi
- Department of Orthopaedic Surgery, Tomidahama Hospital, 26-14, Tomidahamacho, Yokkaichi, Mie, 510-8008, Japan.
| | - T Kono
- Department of Orthopaedic Surgery, Tomidahama Hospital, 26-14, Tomidahamacho, Yokkaichi, Mie, 510-8008, Japan
| | - A Nishihara
- Department of Orthopaedic Surgery, Tomidahama Hospital, 26-14, Tomidahamacho, Yokkaichi, Mie, 510-8008, Japan
| | - M Hasegawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
| | - T Kono
- Department of Orthopaedic Surgery, Tomidahama Hospital, 26-14, Tomidahamacho, Yokkaichi, Mie, 510-8008, Japan
| | - A Sudo
- Department of Orthopaedic Surgery, Graduate School of Medicine, Mie University, Tsu, Japan
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Borggrefe J, de Buhr T, Shrestha S, Marshall LM, Orwoll E, Peters K, Black DM, Glüer CC. Association of 3D Geometric Measures Derived From Quantitative Computed Tomography With Hip Fracture Risk in Older Men. J Bone Miner Res 2016; 31:1550-8. [PMID: 26916713 PMCID: PMC7676812 DOI: 10.1002/jbmr.2821] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 02/18/2016] [Accepted: 02/20/2016] [Indexed: 12/13/2022]
Abstract
We investigated the associations of 3D geometric measures and volumetric bone mineral density (vBMD) of the proximal femur assessed by quantitative computed tomography (QCT) with hip fracture risk among elderly men. This study was a prospective case-cohort design nested within the Osteoporotic Fractures in Men Study (MrOS) cohort. QCT scans of 230 men (65 with confirmed hip fractures) were evaluated with Mindways' QCTPRO-BIT software. Measures that are indicative of bone strength for the femoral neck (FN) and for the trochanteric region (TR) were defined. Bending strength measures were estimated by minimum section modulus, buckling strength by buckling ratio, and a local thinning index (LTI). Integral and trabecular vBMD measures were also derived. Areal BMD (aBMD) of the total proximal femur from dual-energy X-ray absorptiometry (DXA) is presented for comparison. Associations of skeletal measures with incident hip fracture were estimated with hazard ratios (HR) per standard deviation and their 95% confidence intervals (CI) from Cox proportional hazard regression models with adjustment for age, body mass index (BMI), site, and aBMD. Men with hip fractures were older than men without fracture (77.1 ± 6.0 years versus 73.3 ± 5.7 years, p < 0.01). Age, BMI, and site-adjusted HRs were significant for all measures except TR_LTI. Total femural BMD by DXA (HR = 4.9, 95% CI 2.5-9.9) and QCT (HR = 5.5, 95% CI 2.5-11.7) showed the strongest association followed by QCT FN integral vBMD (HR = 3.6, 95% CI 1.8-6.9). In models that additionally included aBMD, FN buckling ratio (HR = 1.9, 95% CI 1.1-3.2) and trabecular vBMD of the TR (HR = 2.0, 95% CI 1.2-3.4) remained associated with hip fracture risk, independent of aBMD. QCT-derived 3D geometric indices of instability of the proximal femur were significantly associated with incident hip fractures, independent of DXA aBMD. Buckling of the FN is a relevant failure mode not entirely captured by DXA. Further research to study these relationships in women is warranted. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Jan Borggrefe
- Sektion Biomedizinische Bildgebung, Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,Institut und Poliklinik für Diagnostische Radiologie, Uniklinik Köln, Germany
| | - Timm de Buhr
- Sektion Biomedizinische Bildgebung, Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Smriti Shrestha
- Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA
| | - Lynn M Marshall
- Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA.,Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Eric Orwoll
- Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA
| | - Kathy Peters
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Dennis M Black
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Claus C Glüer
- Sektion Biomedizinische Bildgebung, Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
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Lindsay R, Krege JH, Marin F, Jin L, Stepan JJ. Teriparatide for osteoporosis: importance of the full course. Osteoporos Int 2016; 27:2395-410. [PMID: 26902094 PMCID: PMC4947115 DOI: 10.1007/s00198-016-3534-6] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 02/09/2016] [Indexed: 11/01/2022]
Abstract
Teriparatide (TPTD) is the only currently available therapeutic agent that increases the formation of new bone tissue and can provide some remediation of the architectural defects in the osteoporotic skeleton. The use of teriparatide clinically is limited to 24 months. We review clinical findings during daily teriparatide treatment over time. Teriparatide appears to increase bone formation more than bone resorption as determined biochemically and histologically. Teriparatide exerts its positive effects on bone formation in two distinct fashions. The first is direct stimulation of bone formation that occurs within active remodeling sites (remodeling-based bone formation) and on surfaces of bone previously inactive (modeling-based bone formation). The second is an increase in the initiation of new remodeling sites. Both processes contribute to the final increase in bone density observed by non-invasive tools such as DXA. Remodeling is the repair process by which skeletal tissue is maintained in a young healthy state, and when stimulated by TPTD is associated with a positive bone balance within each remodeling cavity. It seems likely therefore that this component will contribute to the anti-fracture efficacy of TPTD. Teriparatide reduces the risk of fracture, and this effect appears to increase with longer duration of therapy. The use of novel treatment regimens, including shorter courses, should be held in abeyance until controlled clinical trials are completed to define the relative fracture benefits of such approaches in comparison to the 24-month daily use of the agent. Summary In patients with osteoporosis at high risk for fracture, the full continuous 24-month course with teriparatide results in improved skeletal health and outcomes than shorter time periods.
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Affiliation(s)
- R Lindsay
- Helen Hayes Hospital, West Haverstraw, NY, USA
| | - J H Krege
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA.
| | - F Marin
- Lilly Research Centre, Eli Lilly and Company, Windlesham, Surrey, UK
| | - L Jin
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN, USA
| | - J J Stepan
- Institute of Rheumatology, Faculty of Medicine 1, Charles University, Prague, Czech Republic
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Seno T, Yamamoto A, Kukida Y, Hirano A, Kida T, Nakabayashi A, Fujioka K, Nagahara H, Fujii W, Murakami K, Oda R, Fujiwara H, Kohno M, Kawahito Y. Once-weekly teriparatide improves glucocorticoid-induced osteoporosis in patients with inadequate response to bisphosphonates. SPRINGERPLUS 2016; 5:1056. [PMID: 27462504 PMCID: PMC4940355 DOI: 10.1186/s40064-016-2704-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 06/28/2016] [Indexed: 01/01/2023]
Abstract
Background Patients with glucocorticoid-induced osteoporosis (GIOP) are at very high risk of fracture, and patients with severe GIOP often experience fractures during treatment with bisphosphonates. Teriparatide (TPTD) is the only currently available anabolic agent expected to be effective for GIOP. Once-weekly TPTD decreased bone resorption marker with primary osteoporosis different from daily TPTD, but it has not yet been tested with GIOP. Objectives To evaluate the efficacy of once-weekly TPTD for patients with GIOP and inadequate response to bisphosphonates. Methods Patients with GIOP and collagen diseases treated with prednisolone for at least 6 months with inadequate responses to bisphosphonates were administered once-weekly TPTD. Bone density of the lumbar spine and femoral neck, measured as percent young adult mean (YAM); serum concentrations of cross-linked N-terminal telopeptides of type I collagen (NTx), bone alkaline phosphatase (BAP), and calcium; and FRAX were measured at baseline and 6, 12 and 18 months after starting TPTD. Results Of the 12 GIOP patients with collagen diseases enrolled, nine (seven females, two males; mean age 57.4 ± 11.1 years) completed treatment, including six with systemic lupus erythematosus, two with rheumatoid arthritis, and one with adult onset still disease. Only one new fracture event, a lumbar compression fracture, occurred during the study period, although seven patients experienced eight fracture events within 18 months before starting TPTD (p = 0.04). Lumbar spine YAM significantly improved at 18 months (p = 0.04), whereas femoral neck YAM did not (p = 0.477). Serum NTx, BAP, Ca, and FRAX were not significantly affected by TPTD treatment. Conclusions Once-weekly TPTD reduces fracture events and increases bone density of the lumbar spine of GIOP patients with inadequate response to bisphosphonates.
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Affiliation(s)
- Takahiro Seno
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| | - Aihiro Yamamoto
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| | - Yuji Kukida
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| | - Aiko Hirano
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| | - Takashi Kida
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| | - Amane Nakabayashi
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| | - Kazuki Fujioka
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| | - Hidetake Nagahara
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| | - Wataru Fujii
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| | - Ken Murakami
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| | - Ryo Oda
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| | - Hiroyoshi Fujiwara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| | - Masataka Kohno
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
| | - Yutaka Kawahito
- Inflammation and Immunology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566 Japan
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Peña JA, Thomsen F, Damm T, Campbell GM, Bastgen J, Barkmann R, Glüer CC. Bone-marrow densitometry: Assessment of marrow space of human vertebrae by single energy high resolution-quantitative computed tomography. Med Phys 2016; 43:4174. [DOI: 10.1118/1.4950874] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Orsolini G, Adami G, Adami S, Viapiana O, Idolazzi L, Gatti D, Rossini M. Short-Term Effects of TNF Inhibitors on Bone Turnover Markers and Bone Mineral Density in Rheumatoid Arthritis. Calcif Tissue Int 2016; 98:580-5. [PMID: 26887973 DOI: 10.1007/s00223-016-0114-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 01/27/2016] [Indexed: 12/11/2022]
Abstract
TNFα inhibitors (TNFαI) exert positive effects on disease activity in rheumatoid arthritis (RA). Bone involvement is a major determinant of functional impairment in this disease. Here we investigated the short-term effects of TNFαI therapy on bone metabolism and density. We studied 54 patients with RA starting a TNFαI biologic drug, in whom any factor known to interfere with bone metabolism was excluded or rigorously accounted for. We measured at baseline and after 6-month therapy bone turnover markers: N-propeptide of type I collagen (P1NP), and bone alkaline phosphates for bone formation and serum C-terminal telopeptide of type I collagen (CTX) for bone resorption. We also evaluated bone mineral density (BMD) at hip and lumbar by dual-energy X-ray absorptiometry. All bone markers rose significantly and these changes were not dependent on steroid dosage. A significant decrease in femoral neck BMD was also observed. These results indicate that TNFαI therapy in RA over 6 months is associated with an early increase in bone turnover and a decline in hip BMD.
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Affiliation(s)
- Giovanni Orsolini
- Rheumatology Section, Department of Medicine, University of Verona, Piazzale Ludovico Scuro, Policlinico G.B Rossi, 37134, Verona, Italy.
| | - Giovanni Adami
- Rheumatology Section, Department of Medicine, University of Verona, Piazzale Ludovico Scuro, Policlinico G.B Rossi, 37134, Verona, Italy
| | - Silvano Adami
- Rheumatology Section, Department of Medicine, University of Verona, Piazzale Ludovico Scuro, Policlinico G.B Rossi, 37134, Verona, Italy
| | - Ombretta Viapiana
- Rheumatology Section, Department of Medicine, University of Verona, Piazzale Ludovico Scuro, Policlinico G.B Rossi, 37134, Verona, Italy
| | - Luca Idolazzi
- Rheumatology Section, Department of Medicine, University of Verona, Piazzale Ludovico Scuro, Policlinico G.B Rossi, 37134, Verona, Italy
| | - Davide Gatti
- Rheumatology Section, Department of Medicine, University of Verona, Piazzale Ludovico Scuro, Policlinico G.B Rossi, 37134, Verona, Italy
| | - Maurizio Rossini
- Rheumatology Section, Department of Medicine, University of Verona, Piazzale Ludovico Scuro, Policlinico G.B Rossi, 37134, Verona, Italy
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Whitmarsh T, Treece GM, Gee AH, Poole KES. The Effects on the Femoral Cortex of a 24 Month Treatment Compared to an 18 Month Treatment with Teriparatide: A Multi-Trial Retrospective Analysis. PLoS One 2016; 11:e0147722. [PMID: 26859142 PMCID: PMC4747533 DOI: 10.1371/journal.pone.0147722] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 01/07/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Teriparatide (TPTD) is an anabolic agent indicated for the treatment of severely osteoporotic patients who are at high risk of fragility fractures. The originally approved duration of TPTD treatment in several regions, including Europe, was 18 months. However, studies of areal bone mineral density (aBMD) showed additional benefit when treatment is continued beyond 18 months, and the drug is currently licenced for 24 months. Improvements in cortical structure at the proximal femur have already been shown in patients given TPTD for 24 months using quantitative computed tomography (QCT). Here, we investigate whether cortical and endocortical trabecular changes differ between an 18- and 24-month treatment. METHODS Since an 18- versus 24-month TPTD study using QCT has not been conducted, we studied combined QCT data from four previous clinical trials. Combined femoral QCT data from three 18-month TPTD studies ('18-month group') were compared with data from a fourth 24-month trial ('24-month group'). Cortical parameters were measured over the entire proximal femur which allowed for a comparison of the mean changes as well as a visual comparison of the colour maps of changes after 18 and 24 months TPTD. RESULTS For both the combined 18-month group and the 24-month group, overall cortical thickness and endocortical trabecular density increased, while overall cortical bone mineral density decreased. While the changes in the 24-month group were of greater magnitude compared to the 18-month group, the differences were only significant for the endocortical trabecular density (ECTD), corrected for age, weight, femoral neck T-score, total hip T-score and the baseline mean ECTD. CONCLUSION Although the combination of data from different clinical trials is not optimal, these data support the concept that the duration of TPTD in the 18-24 month phase is of clinical relevance when considering improvement in hip structure.
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Affiliation(s)
- Tristan Whitmarsh
- University of Cambridge, Department of Engineering, Trumpington Street, Cambridge, CB2 1PZ, United Kingdom
| | - Graham M. Treece
- University of Cambridge, Department of Engineering, Trumpington Street, Cambridge, CB2 1PZ, United Kingdom
| | - Andrew H. Gee
- University of Cambridge, Department of Engineering, Trumpington Street, Cambridge, CB2 1PZ, United Kingdom
| | - Kenneth E. S. Poole
- University of Cambridge, Department of Medicine, Addenbrooke’s Hospital, Cambridge, CB2 0QQ, United Kingdom
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Compston J. Emerging therapeutic concepts for muscle and bone preservation/building. Bone 2015; 80:150-156. [PMID: 26453503 DOI: 10.1016/j.bone.2015.04.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 03/24/2015] [Accepted: 04/07/2015] [Indexed: 01/16/2023]
Abstract
Loss of muscle or bone mass occurs with ageing, immobility and in association with a variety of systemic diseases. The interaction of these two processes is most evident in the major contribution of falls to the risk of fractures in the elderly population. Exercise and nutrition are key common physiological variables that allow for preservation or formation of greater muscle or bone mass. However, although several pharmacological approaches have the potential to benefit both muscle and bone health, for example vitamin D, selective androgen receptor modulators and ghrelin mimetics, clinical trials with appropriate primary outcomes are lacking. Conventional approaches to address muscle loss are being extended to include stem cell biology and conserved molecular mechanisms of atrophy/hypertrophy. Pharmacological interventions to reduce fracture risk are exploring new mechanisms of action, in particular the uncoupling of bone resorption and formation. Emerging key issues for clinical trial design include adequate phenotyping of patients (personalised medicine), optimisation of the physiological background (multimodal approach) and the use of meaningful and robust outcomes relevant to daily clinical practice. At present, effective treatments that combine beneficial effects on both muscle and bone are lacking, although this is an important target for the future. This review therefore considers current and developing strategies to improve muscle function and bone strength in separate sections.
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Affiliation(s)
- Juliet Compston
- University of Cambridge School of Clinical Medicine, Department of Medicine, Addenbrooke's Hospital, Hills Road, Cambridge UK CB2 0QQ.
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Carballido-Gamio J, Bonaretti S, Saeed I, Harnish R, Recker R, Burghardt AJ, Keyak JH, Harris T, Khosla S, Lang TF. Automatic multi-parametric quantification of the proximal femur with quantitative computed tomography. Quant Imaging Med Surg 2015; 5:552-68. [PMID: 26435919 DOI: 10.3978/j.issn.2223-4292.2015.08.02] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Quantitative computed tomography (QCT) imaging is the basis for multiple assessments of bone quality in the proximal femur, including volumetric bone mineral density (vBMD), tissue volume, estimation of bone strength using finite element modeling (FEM), cortical bone thickness, and computational-anatomy-based morphometry assessments. METHODS Here, we present an automatic framework to perform a multi-parametric QCT quantification of the proximal femur. In this framework, the proximal femur is cropped from the bilateral hip scans, segmented using a multi-atlas based segmentation approach, and then assigned volumes of interest through the registration of a proximal femoral template. The proximal femur is then subjected to compartmental vBMD, compartmental tissue volume, FEM bone strength, compartmental surface-based cortical bone thickness, compartmental surface-based vBMD, local surface-based cortical bone thickness, and local surface-based cortical vBMD computations. Consequently, the template registrations together with vBMD and surface-based cortical bone parametric maps enable computational anatomy studies. The accuracy of the segmentation was validated against manual segmentations of 80 scans from two clinical facilities, while the multi-parametric reproducibility was evaluated using repeat scans with repositioning from 22 subjects obtained on CT imaging systems from two manufacturers. RESULTS Accuracy results yielded a mean dice similarity coefficient of 0.976±0.006, and a modified Haussdorf distance of 0.219±0.071 mm. Reproducibility of QCT-derived parameters yielded root mean square coefficients of variation (CVRMS) between 0.89-1.66% for compartmental vBMD; 0.20-1.82% for compartmental tissue volume; 3.51-3.59% for FEM bone strength; 1.89-2.69% for compartmental surface-based cortical bone thickness; and 1.08-2.19% for compartmental surface-based cortical vBMD. For local surface-based assessments, mean CVRMS were between 3.45-3.91% and 2.74-3.15% for cortical bone thickness and vBMD, respectively. CONCLUSIONS The automatic framework presented here enables accurate and reproducible QCT multi-parametric analyses of the proximal femur. Our subjects were elderly, with scans obtained across multiple clinical sites and manufacturers, thus documenting its value for clinical trials and other multi-site studies.
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Affiliation(s)
- Julio Carballido-Gamio
- 1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA ; 2 Department of Endocrinology, Creighton University, Omaha, NE, USA ; 3 Department of Radiological Sciences, Department of Mechanical and Aerospace Engineering, Department of Biomedical Engineering, and Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA ; 4 Intramural Research Program, National Institute on Aging, Bethesda, Maryland, USA ; 5 Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Serena Bonaretti
- 1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA ; 2 Department of Endocrinology, Creighton University, Omaha, NE, USA ; 3 Department of Radiological Sciences, Department of Mechanical and Aerospace Engineering, Department of Biomedical Engineering, and Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA ; 4 Intramural Research Program, National Institute on Aging, Bethesda, Maryland, USA ; 5 Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Isra Saeed
- 1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA ; 2 Department of Endocrinology, Creighton University, Omaha, NE, USA ; 3 Department of Radiological Sciences, Department of Mechanical and Aerospace Engineering, Department of Biomedical Engineering, and Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA ; 4 Intramural Research Program, National Institute on Aging, Bethesda, Maryland, USA ; 5 Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Roy Harnish
- 1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA ; 2 Department of Endocrinology, Creighton University, Omaha, NE, USA ; 3 Department of Radiological Sciences, Department of Mechanical and Aerospace Engineering, Department of Biomedical Engineering, and Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA ; 4 Intramural Research Program, National Institute on Aging, Bethesda, Maryland, USA ; 5 Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Robert Recker
- 1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA ; 2 Department of Endocrinology, Creighton University, Omaha, NE, USA ; 3 Department of Radiological Sciences, Department of Mechanical and Aerospace Engineering, Department of Biomedical Engineering, and Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA ; 4 Intramural Research Program, National Institute on Aging, Bethesda, Maryland, USA ; 5 Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andrew J Burghardt
- 1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA ; 2 Department of Endocrinology, Creighton University, Omaha, NE, USA ; 3 Department of Radiological Sciences, Department of Mechanical and Aerospace Engineering, Department of Biomedical Engineering, and Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA ; 4 Intramural Research Program, National Institute on Aging, Bethesda, Maryland, USA ; 5 Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Joyce H Keyak
- 1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA ; 2 Department of Endocrinology, Creighton University, Omaha, NE, USA ; 3 Department of Radiological Sciences, Department of Mechanical and Aerospace Engineering, Department of Biomedical Engineering, and Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA ; 4 Intramural Research Program, National Institute on Aging, Bethesda, Maryland, USA ; 5 Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Tamara Harris
- 1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA ; 2 Department of Endocrinology, Creighton University, Omaha, NE, USA ; 3 Department of Radiological Sciences, Department of Mechanical and Aerospace Engineering, Department of Biomedical Engineering, and Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA ; 4 Intramural Research Program, National Institute on Aging, Bethesda, Maryland, USA ; 5 Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sundeep Khosla
- 1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA ; 2 Department of Endocrinology, Creighton University, Omaha, NE, USA ; 3 Department of Radiological Sciences, Department of Mechanical and Aerospace Engineering, Department of Biomedical Engineering, and Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA ; 4 Intramural Research Program, National Institute on Aging, Bethesda, Maryland, USA ; 5 Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Thomas F Lang
- 1 Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA ; 2 Department of Endocrinology, Creighton University, Omaha, NE, USA ; 3 Department of Radiological Sciences, Department of Mechanical and Aerospace Engineering, Department of Biomedical Engineering, and Chao Family Comprehensive Cancer Center, University of California, Irvine, Irvine, CA, USA ; 4 Intramural Research Program, National Institute on Aging, Bethesda, Maryland, USA ; 5 Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Internal Medicine, College of Medicine, Mayo Clinic, Rochester, MN, USA
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Geusens P. New insights into treatment of osteoporosis in postmenopausal women. RMD Open 2015; 1:e000051. [PMID: 26557374 PMCID: PMC4632141 DOI: 10.1136/rmdopen-2015-000051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 04/22/2015] [Accepted: 04/24/2015] [Indexed: 01/05/2023] Open
Abstract
For the prevention of fractures, antiresorptive drugs (bisphosphonates and denosumab) that decrease high bone resorption and, secondarily, also bone formation, are the mainstream of therapy. Osteoanabolic drugs, such as teriparatide, increase bone formation more than bone resorption, and are used in severe osteoporosis, including patients treated with antiresorptive drugs who still lose bone and have recurrent fractures. New potential drugs for fracture prevention that uncouple bone resorption from bone formation include odanacatib, a specific inhibitor of cathepsin-K, the enzyme that degrades bone collagen type I, that inhibits bone resorption and only temporarily bone formation, and monoclonal antibodies against sclerostin (romosozumab, blosozumab), that stimulate bone formation and decrease bone resorption.
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Affiliation(s)
- Piet Geusens
- Department of Internal Medicine, Division of Rheumatology , CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center , Maastricht , The Netherlands ; Hasselt University, Biomedical Research Institute, and Transnationale Universiteit Limburg , Hasselt , Belgium
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Ikegami S, Uchiyama S, Nakamura Y, Mukaiyama K, Hirabayashi H, Kamimura M, Nonaka K, Kato H. Factors that characterize bone health with aging in healthy postmenopausal women. J Bone Miner Metab 2015; 33:440-7. [PMID: 25113438 DOI: 10.1007/s00774-014-0608-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 05/25/2014] [Indexed: 01/08/2023]
Abstract
The exponential increase in the incidence of fragility fractures in older people is attributed to attenuation of both bone strength and neuromuscular function. Decrease in bone mineral density (BMD) does not entirely explain this increase. The objective of this study is to investigate the effect of age on various parameters related to bone health with aging, and to identify combinations of factors that collectively express the bone metabolic state in healthy postmenopausal women. Height, weight, and grip strength were measured in 135 healthy postmenopausal volunteer women. Hip BMD, biomechanical indices derived from quantitative computed tomography (QCT), cross-sectional areas of muscle and fat of the proximal thigh, and various biochemical markers of bone metabolism were measured. A smaller group of factors explanatory for bone health was identified using factor analysis and each was newly named. As a result, the factors bone mass, bone turnover, bone structure, and muscle strength had the greatest explanatory power for assessing the bone health of healthy postmenopausal women. Whereas dual X-ray absorptiometry parameters only loaded on the factor bone mass, QCT parameters loaded on both the factors bone mass and bone structure. Most bone turnover markers loaded on the factor bone turnover, but deoxypyridinoline loaded on both bone turnover and muscle strength. Age was negatively correlated with bone mass (r = -0.49, p < 0.001) and muscle strength (r = -0.67, p < 0.001). We conclude that aging is associated as much with muscle weakening as with low BMD. More attention should be paid to the effects of muscle weakening during aging in assessments of bone health.
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Affiliation(s)
- Shota Ikegami
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan,
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Engelke K, Lang T, Khosla S, Qin L, Zysset P, Leslie WD, Shepherd JA, Schousboe JT. Clinical Use of Quantitative Computed Tomography (QCT) of the Hip in the Management of Osteoporosis in Adults: the 2015 ISCD Official Positions-Part I. J Clin Densitom 2015; 18:338-58. [PMID: 26277851 DOI: 10.1016/j.jocd.2015.06.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 11/21/2022]
Abstract
The International Society for Clinical Densitometry (ISCD) has developed new official positions for the clinical use of quantitative computed tomography of the hip. The ISCD task force for quantitative computed tomography reviewed the evidence for clinical applications and presented a report with recommendations at the 2015 ISCD Position Development Conference. Here, we discuss the agreed on ISCD official positions with supporting medical evidence, rationale, controversy, and suggestions for further study. Parts II and III address the advanced techniques of finite element analysis applied to computed tomography scans and the clinical feasibility of existing techniques for opportunistic screening of osteoporosis using computed tomography scans obtained for other diagnosis such as colonography was addressed.
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Affiliation(s)
- Klaus Engelke
- Institute of Medical Physics, University of Erlangen, Germany; Bioclinica, Hamburg, Germany.
| | - Thomas Lang
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, San Francisco, CA, USA
| | - Sundeep Khosla
- Center for Clinical and Translational Science, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Ling Qin
- Bone Quality and Health Center, Department of Orthopedics and Traumatology, The Chinese University of Hong Kong, China
| | - Philippe Zysset
- Institute for Surgical Technology & Biomechanics, University of Bern, Switzerland
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Radiology, University of Manitoba, Winnipeg, Canada
| | - John A Shepherd
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, San Francisco, CA, USA
| | - John T Schousboe
- Park Nicollet Clinic/HealthPartners, Minneapolis, MN, USA; Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
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Whitmarsh T, Treece GM, Gee AH, Poole KES. Mapping Bone Changes at the Proximal Femoral Cortex of Postmenopausal Women in Response to Alendronate and Teriparatide Alone, Combined or Sequentially. J Bone Miner Res 2015; 30:1309-18. [PMID: 25639838 DOI: 10.1002/jbmr.2454] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/16/2014] [Accepted: 01/10/2015] [Indexed: 11/06/2022]
Abstract
Combining antiresorptive and anabolic drugs for osteoporosis may be a useful strategy to prevent hip fractures. Previous studies comparing the effects of alendronate (ALN) and teriparatide (TPTD) alone, combined or sequentially using quantitative computed tomography (QCT) in postmenopausal women have not distinguished cortical bone mineral density (CBMD) from cortical thickness (CTh) effects, nor assessed the distribution and extent of more localized changes. In this study a validated bone mapping technique was used to examine the cortical and endocortical trabecular changes in the proximal femur resulting from an 18-month course of ALN or TPTD. Using QCT data from a different clinical trial, the global and localized changes seen following a switch to TPTD after an 18-month ALN treatment or adding TPTD to the ALN treatment were compared. Ct.Th increased (4.8%, p < 0.01) and CBMD decreased (-4.5%, p < 0.01) in the TPTD group compared to no significant change in the ALN group. A large Ct.Th increase could be seen for the switch group (2.8%, p < 0.01) compared to a significantly smaller increase for the add group (1.5%, p < 0.01). CBMD decreased significantly for the switch group (-3.9%, p < 0.01) and was significantly different from no significant change in the add group. Ct.Th increases were shown to be significantly greater for the switch group compared to the add group at the load bearing regions. This study provides new insights into the effects of ALN and TPTD combination therapies on the cortex of the proximal femur and supports the hypothesis of an increased bone remodeling by TPTD being mitigated by ALN.
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Affiliation(s)
| | - Graham M Treece
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - Andrew H Gee
- Department of Engineering, University of Cambridge, Cambridge, UK
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Ishikawa K, Fukui T, Nagai T, Kuroda T, Hara N, Yamamoto T, Inagaki K, Hirano T. Type 1 diabetes patients have lower strength in femoral bone determined by quantitative computed tomography: A cross-sectional study. J Diabetes Investig 2015; 6:726-33. [PMID: 26543548 PMCID: PMC4627551 DOI: 10.1111/jdi.12372] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 01/16/2023] Open
Abstract
AIMS/INTRODUCTION Previous studies have reported osteoporosis measured by dual-energy X-ray absorptiometry in younger patients with type 1 diabetes. Limitations of 2-D imaging, however, limit the precision of dual-energy X-ray absorptiometry for the measurement of bone mineral density and bone strength. MATERIALS AND METHODS Three-dimensional quantitative computed tomography was used to calculate volumetric-bone mineral density (vBMD) and strength in femoral bone subfractions. A total of 17 male type 1 diabetes patients and 18 sex-matched healthy controls aged from 18 to 49 years were investigated in the present cross-sectional study. Patients with overt nephropathy were excluded. RESULTS Type 1 diabetes patients had significantly lower cortical vBMD in the femoral neck, and significantly lower total vBMD, cortical thickness and cortical cross-sectional area (cortical CSA) in the intertrochanter. Bone strength estimated by the buckling ratio (an index of cortical instability) of the intertrochanter was significantly higher in type 1 diabetes patients. The following serum bone markers were comparable between the two groups: bone-specific alkaline phosphatase, N-terminal propeptide of type 1 procollagen, osteocalcin, pentosidine and homocysteine. Serum insulin-like growth factor-1 values were significantly lower in the type 1 diabetes patients than in controls. Serum insulin-like growth factor-1values were positively correlated with serum bone formation markers, and the total vBMD of the femoral neck and lumbar spine in type 1 diabetes patients. CONCLUSIONS The present study is the first investigation by quantitative computed tomography measurement to show cortical instability and lower vBMD in the intertrochanter of young and middle-aged type 1 diabetes patients. Low insulin-like growth factor-1 might be a causative factor for osteoporosis in type 1 diabetes.
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Affiliation(s)
- Koji Ishikawa
- Department of orthopaedic Surgery, Showa University School of Medicine Tokyo, Japan
| | - Tomoyasu Fukui
- Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University School of Medicine Tokyo, Japan
| | - Takashi Nagai
- Department of orthopaedic Surgery, Showa University School of Medicine Tokyo, Japan
| | - Takuma Kuroda
- Department of orthopaedic Surgery, Showa University School of Medicine Tokyo, Japan
| | - Noriko Hara
- Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University School of Medicine Tokyo, Japan
| | - Takeshi Yamamoto
- Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University School of Medicine Tokyo, Japan
| | - Katsunori Inagaki
- Department of orthopaedic Surgery, Showa University School of Medicine Tokyo, Japan
| | - Tsutomu Hirano
- Department of Medicine, Division of Diabetes, Metabolism and Endocrinology, Showa University School of Medicine Tokyo, Japan
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Ornstrup MJ, Kjær TN, Harsløf T, Stødkilde-Jørgensen H, Hougaard DM, Cohen A, Pedersen SB, Langdahl BL. Adipose tissue, estradiol levels, and bone health in obese men with metabolic syndrome. Eur J Endocrinol 2015; 172:205-16. [PMID: 25416724 DOI: 10.1530/eje-14-0792] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Visceral adipose tissue (VAT) is associated with an increased risk of metabolic syndrome (MetS). Recent studies have suggested that VAT negatively affects bone. However, MetS has also been associated with higher estradiol (E2) levels, which is bone protective. We therefore investigated the impact of VAT and E2 levels on bone density, structural parameters, and strength estimates. DESIGN A cross-sectional study was conducted in 72 obese men with MetS to investigate the impact of VAT and E2 levels on bone. METHODS Bone parameters were assessed by dual-energy X-ray absorptiometry (DXA), quantitative computed tomography (QCT), and high-resolution peripheral QCT (HRpQCT) at lumbar spine, proximal femur, radius, and tibia. VAT volume was measured by magnetic resonance imaging (MRI) and sexual hormones were measured in blood samples. RESULTS Men with high VAT had a lower bone density at the hip (P<0.05), lower cortical thickness, and higher buckling ratio at femoral neck (FN) (P=0.008 and P=0.02), compared with men with low VAT, despite a similar body weight and BMI. Generally, E2 levels were low (median 43 pmol/l), and men with E2 levels below median had reduced bone density at lumbar spine (P=0.04), and impaired structural parameters at radius and tibia, compared with men with E2 levels above median. At the hip, VAT volume and E2 levels affected bone density independently and additively, and 50% of men with high VAT and low E2 levels had osteopenia with significantly lower T-score at FN (P=0.004). CONCLUSIONS High VAT and low E2 negatively affect bone in obese men with MetS. VAT and E2 affect bone density at the hip independently and additively, revealing an unexpected high prevalence of osteopenia in middle-aged men with MetS.
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Affiliation(s)
- Marie Juul Ornstrup
- Department of EndocrinologyAarhus University Hospital, Tage-Hansens Gade 2, Entrance 3C, DK-8000 Aarhus C, DenmarkDepartment of Clinical MedicineAarhus University, Nordre Ringgade 1, DK-8000 Aarhus, DenmarkThe MR Research CenterAarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, DenmarkDepartment of Clinical BiochemistryImmunology and Genetics, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark Department of EndocrinologyAarhus University Hospital, Tage-Hansens Gade 2, Entrance 3C, DK-8000 Aarhus C, DenmarkDepartment of Clinical MedicineAarhus University, Nordre Ringgade 1, DK-8000 Aarhus, DenmarkThe MR Research CenterAarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, DenmarkDepartment of Clinical BiochemistryImmunology and Genetics, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
| | - Thomas Nordstrøm Kjær
- Department of EndocrinologyAarhus University Hospital, Tage-Hansens Gade 2, Entrance 3C, DK-8000 Aarhus C, DenmarkDepartment of Clinical MedicineAarhus University, Nordre Ringgade 1, DK-8000 Aarhus, DenmarkThe MR Research CenterAarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, DenmarkDepartment of Clinical BiochemistryImmunology and Genetics, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
| | - Torben Harsløf
- Department of EndocrinologyAarhus University Hospital, Tage-Hansens Gade 2, Entrance 3C, DK-8000 Aarhus C, DenmarkDepartment of Clinical MedicineAarhus University, Nordre Ringgade 1, DK-8000 Aarhus, DenmarkThe MR Research CenterAarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, DenmarkDepartment of Clinical BiochemistryImmunology and Genetics, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
| | - Hans Stødkilde-Jørgensen
- Department of EndocrinologyAarhus University Hospital, Tage-Hansens Gade 2, Entrance 3C, DK-8000 Aarhus C, DenmarkDepartment of Clinical MedicineAarhus University, Nordre Ringgade 1, DK-8000 Aarhus, DenmarkThe MR Research CenterAarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, DenmarkDepartment of Clinical BiochemistryImmunology and Genetics, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
| | - David Michael Hougaard
- Department of EndocrinologyAarhus University Hospital, Tage-Hansens Gade 2, Entrance 3C, DK-8000 Aarhus C, DenmarkDepartment of Clinical MedicineAarhus University, Nordre Ringgade 1, DK-8000 Aarhus, DenmarkThe MR Research CenterAarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, DenmarkDepartment of Clinical BiochemistryImmunology and Genetics, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
| | - Arieh Cohen
- Department of EndocrinologyAarhus University Hospital, Tage-Hansens Gade 2, Entrance 3C, DK-8000 Aarhus C, DenmarkDepartment of Clinical MedicineAarhus University, Nordre Ringgade 1, DK-8000 Aarhus, DenmarkThe MR Research CenterAarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, DenmarkDepartment of Clinical BiochemistryImmunology and Genetics, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
| | - Steen Bønløkke Pedersen
- Department of EndocrinologyAarhus University Hospital, Tage-Hansens Gade 2, Entrance 3C, DK-8000 Aarhus C, DenmarkDepartment of Clinical MedicineAarhus University, Nordre Ringgade 1, DK-8000 Aarhus, DenmarkThe MR Research CenterAarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, DenmarkDepartment of Clinical BiochemistryImmunology and Genetics, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark Department of EndocrinologyAarhus University Hospital, Tage-Hansens Gade 2, Entrance 3C, DK-8000 Aarhus C, DenmarkDepartment of Clinical MedicineAarhus University, Nordre Ringgade 1, DK-8000 Aarhus, DenmarkThe MR Research CenterAarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, DenmarkDepartment of Clinical BiochemistryImmunology and Genetics, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
| | - Bente Lomholt Langdahl
- Department of EndocrinologyAarhus University Hospital, Tage-Hansens Gade 2, Entrance 3C, DK-8000 Aarhus C, DenmarkDepartment of Clinical MedicineAarhus University, Nordre Ringgade 1, DK-8000 Aarhus, DenmarkThe MR Research CenterAarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, DenmarkDepartment of Clinical BiochemistryImmunology and Genetics, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark Department of EndocrinologyAarhus University Hospital, Tage-Hansens Gade 2, Entrance 3C, DK-8000 Aarhus C, DenmarkDepartment of Clinical MedicineAarhus University, Nordre Ringgade 1, DK-8000 Aarhus, DenmarkThe MR Research CenterAarhus University Hospital, Skejby, Brendstrupgaardsvej 100, DK-8200 Aarhus N, DenmarkDepartment of Clinical BiochemistryImmunology and Genetics, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
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Chen JF, Yang KH, Zhang ZL, Chang HC, Chen Y, Sowa H, Gürbüz S. A systematic review on the use of daily subcutaneous administration of teriparatide for treatment of patients with osteoporosis at high risk for fracture in Asia. Osteoporos Int 2015; 26:11-28. [PMID: 25138261 DOI: 10.1007/s00198-014-2838-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 07/31/2014] [Indexed: 12/15/2022]
Abstract
This systematic review aimed to examine the evidence for teriparatide in Asia for osteoporosis with a high fracture risk and for exploratory (unapproved) bone-related indications. MEDLINE (1946+), EMBASE (1966+), and ClinicalTrials.gov (2008+) were searched (16 August 2013); all studies of daily subcutaneous teriparatide 20 μg for bone-related conditions from China, Hong Kong, Japan, Republic of Korea, Philippines, Singapore, and Taiwan were included. Evidence on efficacy/safety was retrieved primarily from randomized controlled trials (10 publications) of postmenopausal women from Japan and China. In these studies, teriparatide was well tolerated; subjects had significantly greater increases in lumbar spine bone mineral density (BMD) from baseline compared with placebo, antiresorptive agents, or elcatonin/calcitonin; bone turnover markers increased from baseline and were sustained at elevated levels during teriparatide treatment. Few studies reported fracture risk, pain, or quality of life; one study showed a lower incidence of new-onset vertebral fracture with teriparatide versus antiresorptive agents. Nonrandomized studies (nine publications, one unpublished trial) conducted mainly in Taiwan, Japan, and the Republic of Korea provided supporting data for efficacy. The exploratory (unapproved) use of teriparatide (17 publications) for fracture healing and osteonecrosis of the jaw was described primarily in case reports. The clinical effectiveness of teriparatide for treatment of postmenopausal women with osteoporosis who are at high risk of fracture in Asia is focused primarily on improvements in BMD and tolerability. Recommended additional studies may include assessment of fracture risk and the effect of teriparatide on pain, quality of life, and mortality in Asia.
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Affiliation(s)
- J F Chen
- Department of Endocrinology and Metabolism, Chang Gung Memorial Hospital, No. 123, Dapi Rd, Niaosong District, Kaohsiung City, 83301, Taiwan
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Poole KES, Treece GM, Gee AH, Brown JP, McClung MR, Wang A, Libanati C. Denosumab rapidly increases cortical bone in key locations of the femur: a 3D bone mapping study in women with osteoporosis. J Bone Miner Res 2015; 30:46-54. [PMID: 25088963 DOI: 10.1002/jbmr.2325] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 07/16/2014] [Accepted: 07/30/2014] [Indexed: 11/05/2022]
Abstract
Women with osteoporosis treated for 36 months with twice-yearly injections of denosumab sustained fewer hip fractures compared with placebo. Treatment might improve femoral bone at locations where fractures typically occur. To test this hypothesis, we used 3D cortical bone mapping of postmenopausal women with osteoporosis to investigate the timing and precise location of denosumab versus placebo effects in the hips. We analyzed clinical computed tomography scans from 80 female participants in FREEDOM, a randomized trial, wherein half of the study participants received subcutaneous denosumab 60 mg twice yearly and the others received placebo. Cortical 3D bone thickness maps of both hips were created from scans at baseline, 12, 24, and 36 months. Cortical mass surface density maps were also created for each visit. After registration of each bone to an average femur shape model followed by statistical parametric mapping, we visualized and quantified statistically significant treatment effects. The technique allowed us to pinpoint systematic differences between denosumab and control and to display the results on a 3D average femur model. Denosumab treatment led to an increase in femoral cortical mass surface density and thickness, already evident by the third injection (12 months). Overall, treatment with denosumab increased femoral cortical mass surface density by 5.4% over 3 years. One-third of the increase came from increasing cortical density, and two-thirds from increasing cortical thickness, relative to placebo. After 36 months, cortical mass surface density and thickness had increased by up to 12% at key locations such as the lateral femoral trochanter versus placebo. Most of the femoral cortex displayed a statistically significant relative difference by 36 months. Osteoporotic cortical bone responds rapidly to denosumab therapy, particularly in the hip trochanteric region. This mechanism may be involved in the robust decrease in hip fractures observed in denosumab-treated women at increased risk of fracture.
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Sugiyama T, Torio T, Sato T, Matsumoto M, Kim YT, Oda H. Improvement of skeletal fragility by teriparatide in adult osteoporosis patients: a novel mechanostat-based hypothesis for bone quality. Front Endocrinol (Lausanne) 2015; 6:6. [PMID: 25688232 PMCID: PMC4311704 DOI: 10.3389/fendo.2015.00006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 01/13/2015] [Indexed: 12/17/2022] Open
Affiliation(s)
- Toshihiro Sugiyama
- Department of Orthopaedic Surgery, Saitama Medical University, Saitama, Japan
- *Correspondence:
| | - Tetsuya Torio
- Department of Orthopaedic Surgery, Saitama Medical University, Saitama, Japan
| | - Tsuyoshi Sato
- Department of Oral and Maxillofacial Surgery, Saitama Medical University, Saitama, Japan
| | - Masahito Matsumoto
- Division of Functional Genomics and Systems Medicine, Research Center for Genomic Medicine, Saitama Medical University, Saitama, Japan
| | - Yoon Taek Kim
- Department of Orthopaedic Surgery, Saitama Medical University, Saitama, Japan
| | - Hiromi Oda
- Department of Orthopaedic Surgery, Saitama Medical University, Saitama, Japan
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Abstract
Odanacatib, a selective cathepsin K inhibitor, decreases bone resorption, whereas osteoclast number increases and bone formation is maintained, perhaps even increased on some cortical surfaces. In a phase 2 clinical trial, post-menopausal women receiving odanacatib presented a sustained reduction of bone resorption markers, whereas procollagen type 1 N-terminal propeptide returned to normal. In turn areal bone mineral density increased continuously at both spine and hip for up to 5 years. Blosozumab and romosozumab are sclerostin neutralizing antibodies that exert potent anabolic effects on both trabecular and cortical compartments. A phase 2 clinical trial has reported areal bone mineral density gains at spine and hip that were greater with romosozumab compared with placebo, but also with teriparatide. It also showed that antagonizing sclerostin results in a transient stimulation of bone formation but progressive inhibition of bone resorption. Other new medical entities that are promising for the treatment of osteoporosis include abaloparatide, a parathyroid hormone-related analogue with improved bone formation-resorption ratio.
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Affiliation(s)
- Serge Ferrari
- Service of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospital and Faculty of Medicine, Switzerland.
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Eriksen EF, Keaveny TM, Gallagher ER, Krege JH. Literature review: The effects of teriparatide therapy at the hip in patients with osteoporosis. Bone 2014; 67:246-56. [PMID: 25053463 DOI: 10.1016/j.bone.2014.07.014] [Citation(s) in RCA: 59] [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: 12/19/2013] [Revised: 06/19/2014] [Accepted: 07/08/2014] [Indexed: 01/24/2023]
Abstract
Teriparatide is a skeletal anabolic treatment for patients with osteoporosis at high risk for fracture. Because adequate clinical trials have not yet been conducted to assess the efficacy of teriparatide for reducing the risk of hip fracture, we review here the literature regarding how treatment with teriparatide affects the hip in patients with osteoporosis. Teriparatide increases cancellous bone volume, improves bone architecture, and - uniquely among osteoporosis treatments - increases cortical thickness and cortical porosity. By bone scan and positron emission tomography, teriparatide increases bone formation throughout the skeleton, including the hip. Consistent with these findings, studies using dual-energy X-ray absorptiometry and quantitative computed tomography for longitudinal assessment of changes at the hip have consistently shown increases in areal and volumetric bone mineral density, cortical thickness, and finite element-estimated hip strength in patients treated with teriparatide. Finally, in clinical fracture-outcome trials, treatment with teriparatide has been shown to reduce the risk of nonvertebral fracture, a composite endpoint that includes hip fracture. Taken together, this body of evidence suggests that teriparatide positively affects the hip in patients with osteoporosis.
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Affiliation(s)
- Erik F Eriksen
- Department of Endocrinology, Oslo University Hospital, Pb 49596 Nydalen, N-0424 Oslo, Norway.
| | - Tony M Keaveny
- University of California, Berkeley, Departments of Mechanical Engineering and Bioengineering, 6175 Etcheverry Hall, MC 1740, Berkeley, CA 94720, USA.
| | - Eileen R Gallagher
- inVentiv Health Clinical, 504 Carnegie Center, Princeton, NJ 08540, USA.
| | - John H Krege
- Lilly USA, LLC, Lilly Technology Center South, Drop Code 5028 Indianapolis, IN 46221, USA.
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Fitzpatrick LA, Wooddell M, Dabrowski CE, Cicconetti G, Gordon DN. Bone mineral density changes following discontinuation of ronacaleret treatment: off-treatment extension of a randomized, dose-finding phase II trial. Bone 2014; 67:104-8. [PMID: 24794093 DOI: 10.1016/j.bone.2014.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 04/21/2014] [Accepted: 04/22/2014] [Indexed: 10/25/2022]
Abstract
CONTEXT Parathyroidectomy in patients with hyperparathyroidism can produce subsequent increases in bone mineral density (BMD). Ronacaleret, a selective calcium-sensing receptor antagonist that stimulates endogenous parathyroid hormone release, induced mild hyperparathyroidism. OBJECTIVE The aim of this study is to evaluate whether BMD changes after cessation of ronacaleret treatment. DESIGN Observational, off-treatment, extension of a randomized, placebo-controlled, dose-ranging phase II trial. SETTING Fifteen academic centers in seven countries. PATIENTS Postmenopausal women with low BMD; 171 out of 569 women in the parent study were enrolled in the extension study. INTERVENTIONS Subjects were treated with ronacaleret 100mg (n=16), 200mg (n=38), 300mg (n=35), or 400mg (n=32) once daily, alendronate 70mg (n=17) once weekly, or matching placebo (n=33) for 10-12months; BMD was measured after discontinuation of ronacaleret or alendronate treatment. MAIN OUTCOME MEASURE Mean percent change in lumbar spine areal BMD by dual-energy X-ray absorptiometry at 6-12months after discontinuing ronacaleret or alendronate compared with the 10- to 12-month BMD measurement of the parent study. RESULTS At the lumbar spine, all doses of ronacaleret resulted in gains in BMD while on treatment. These increases in BMD were maintained or increased after discontinuation of ronacaleret. All doses of ronacaleret caused bone loss at the total hip while on active treatment. However, there was an attenuation of this loss in the off-treatment extension study. CONCLUSION The gain in BMD at the lumbar spine was maintained post-treatment and the loss of BMD at the total hip was attenuated. We hypothesize that there may have been some bone remineralization after cessation of ronacaleret.
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