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Warner SE, Kaplan FS, Pignolo RJ, Smith SE, Hsiao EC, De Cunto C, Di Rocco M, Harnett K, Grogan D, Genant HK. Whole-body Computed Tomography Versus Dual Energy X‑ray Absorptiometry for Assessing Heterotopic Ossification in Fibrodysplasia Ossificans Progressiva. Calcif Tissue Int 2021; 109:615-625. [PMID: 34331548 PMCID: PMC8531122 DOI: 10.1007/s00223-021-00877-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/09/2021] [Indexed: 11/24/2022]
Abstract
Fibrodysplasia ossificans progressiva (FOP) is an ultra-rare genetic disorder that leads to heterotopic ossification (HO), resulting in progressive restriction of physical function. In this study, low-dose, whole-body computed tomography (WBCT) and dual energy X-ray absorptiometry (DXA) were evaluated to determine the preferred method for assessing total body burden of HO in patients with FOP. This was a non-interventional, two-part natural history study in patients with FOP (NCT02322255; date of registration: December 2014). In Part A (described here), WBCT and DXA scans were individually assessed for HO presence and severity across 15 anatomical regions. All images were independently reviewed by an expert imaging panel. Ten adult patients were enrolled across four sites. The sensitivity to HO presence and severity varied considerably between the two imaging modalities, with WBCT demonstrating HO in more body regions than DXA (76/138 [55%] versus 47/113 [42%]) evaluable regions). Inability to evaluate HO presence, due to overlapping body regions (positional ambiguity), occurred less frequently by WBCT than by DXA (mean number of non-evaluable regions per scan 1.2 [standard deviation: 1.5] versus 2.4 [1.4]). Based on the increased sensitivity and decreased positional ambiguity of low-dose WBCT versus DXA in measuring HO in patients with FOP, low-dose WBCT was chosen as the preferred imaging for measuring HO. Therefore, low-dose WBCT was carried forward to Part B of the natural history study, which evaluated disease progression over 36 months in a larger population of patients with FOP.
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Affiliation(s)
- Sarah E Warner
- Scientific and Medical Services, PAREXEL International (dba Calyx), Billerica, MA, USA.
| | - Frederick S Kaplan
- Departments of Orthopaedic Surgery & Medicine, The Center for Research in FOP and Related Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Stacy E Smith
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, and The Neil and Elise Wallace STRATUS Center for Medical Simulation, Harvard Medical School, Boston, MA, USA
| | - Edward C Hsiao
- Division of Endocrinology and Metabolism, the UCSF Metabolic Bone Clinic, and the Institute of Human Genetics, Department of Medicine, and the UCSF Program in Craniofacial Biology, University of California-San Francisco, San Francisco, CA, USA
| | - Carmen De Cunto
- Pediatric Rheumatology Section, Department of Pediatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Maja Di Rocco
- Unit of Rare Diseases, Department of Pediatrics, Giannina Gaslini Institute, Genoa, Italy
| | | | | | - Harry K Genant
- Departments of Radiology, Medicine and Orthopaedic Surgery, University of California, San Francisco, CA, USA
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Maugesten Ø, Pedersen SJ, Stoenoiu MS, Kroon F, Mathew AJ, Genant HK, Conaghan PG, Gandjbakhch F, Kloppenburg M, Peterfy C, Østergaard M, Haugen IK. Reliability and agreement of proton density-weighted vs. gadolinium-enhanced T1-weighted MRI in hand osteoarthritis. An OMERACT MRI special interest group reliability exercise. Semin Arthritis Rheum 2021; 51:929-932. [PMID: 34140182 DOI: 10.1016/j.semarthrit.2021.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/12/2021] [Accepted: 05/13/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To compare reliabilities of assessing synovitis in hand osteoarthritis (OA) using Magnetic Resonance Imaging (MRI) with/without gadolinium (Gd). METHODS Three readers scored synovitis on non-enhanced two-dimensional (2D) proton density (PD)-weighted MRI and Gd-enhanced (3D) MRI of hand joints in 20 patients. Inter-reader reliabilities were examined. RESULTS Reliability was good for Gd-enhanced MRI, but poor for non-enhanced PD-weighted MRI (intraclass correlation coefficient 0.83 and 0.21, respectively). Agreement between the two sequences was poor (weighted kappa 0.18). CONCLUSION Gd-enhanced MRI was more reliable than PD-weighted MRI for assessing synovitis. Gd-enhancement, but also resolution and tissue contrast, might have contributed to this.
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Affiliation(s)
- Ø Maugesten
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Box 23 Vinderen, Oslo N-0319, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - S J Pedersen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
| | - M S Stoenoiu
- Department of Rheumatology, Cliniques Universitaires Saint Luc, Brussels, Belgium; Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Belgium
| | - Fpb Kroon
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands; Department of Rheumatology, Zuyderland Medical Center, Heerlen, the Netherlands
| | - A J Mathew
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark
| | - H K Genant
- Department of radiology and biomedical imaging, University of California, San Francisco, United States
| | - P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - F Gandjbakhch
- Department of Rheumatology, Sorbonne University, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - C Peterfy
- Spire Sciences, Inc., Boca Raton, FL 33487, United States
| | - M Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences University of Copenhagen, Copenhagen, Denmark
| | - I K Haugen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Box 23 Vinderen, Oslo N-0319, Norway
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Kuzma M, Vanuga P, Sagova I, Pavai D, Jackuliak P, Killinger Z, Binkley N, Winzenrieth R, Genant HK, Payer J. Vertebral Fractures Occur Regardless of Acromegaly Activity and Are Best Predicted by Proximal Femur Cortical Volumetric Bone Mineral Density. J Endocr Soc 2021. [PMCID: PMC8090376 DOI: 10.1210/jendso/bvab048.1299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction: Vertebral fractures (VFs) in patients with acromegaly are not associated with bone mineral density (BMD) decrease. Previous studies showed impaired trabecular bone parameters among acromegaly patients. However, recent studies suggest that cortical bone could also play a role in VF development. Objective: Evaluate the utility of dual energy x-ray absorptiometry (DXA) BMD and bone structural parameters to determine VF risk among acromegaly patients. Patients and Methods: A single-center two years prospective follow up of acromegaly patients regardless of age, gender, disease activity or associated treatments was conducted. Pituitary hormones, glucose metabolism and bone turnover markers in all subjects were assessed. Each subject had L1-4 spine, femoral neck (FN) and total hip (TH) BMD measured using DXA, and TBS measurement performed ± 7 days from blood sampling. 3D Shaper was used to assess proximal femur trabecular and cortical volumetric (v) BMD, cortical surface (s) BMD and cortical thickness (Cth). VF assessment was performed using the lateral spine imaging IVA™ mode with a Hologic Horizon® densitometer using semi-quantitative approach. Study outcomes were assessed at two time points - baseline and month 24. Results: Seventy subjects (34 M/36F), mean age 55.1 years, including 26 with active disease were studied. After two years a significant decrease in IGF-1 (-30%), osteocalcin (-18%) and TH cortical vBMD (-3%; all p≤0.05) was observed. During follow-up, 13 patients nine of them with controlled disease, developed VF; these patients had greater increase in CTx and decrease in TBS, sBMD, cortical and trabecular vBMD at TH and neck. Multivariate analysis of fracture prediction showed cortical vBMD at TH and neck as best parameters for fracture prediction with AUC 0.766 and 0.774; respectively. TBS was negatively associated with fasting plasma glucose (FPG), HBA1c at each time period. Conclusions: Decrease in cortical vBMD was the most sensitive and specific predictor of incident VF suggesting that cortical bone is involved in fracture development among acromegaly patients. In addition, TBS was strongly negatively associated with glucose metabolism, suggesting glucose intolerance could lead to trabecular bone impairment.
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Affiliation(s)
- Martin Kuzma
- University Hospital Bratislava, Bratislava, Slovakia
| | - Peter Vanuga
- National institute of Endocrinology and Diabetology, Lubochna, Slovakia
| | - Ivana Sagova
- National institute of Endocrinology and Diabetology, Lubochna, Slovakia
| | - Dusan Pavai
- National institute of Endocrinology and Diabetology, Lubochna, Slovakia
| | | | | | | | | | | | - Juraj Payer
- University Hospital Bratislava, Bratislava, Slovakia
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Tanaka Y, Takeuchi T, Soen S, Yamanaka H, Yoneda T, Tanaka S, Nitta T, Okubo N, Genant HK, van der Heijde D. Effects of Denosumab in Japanese Patients With Rheumatoid Arthritis Treated With Conventional Antirheumatic Drugs: 36-month Extension of a Phase III Study. J Rheumatol 2021; 48:1663-1671. [PMID: 33858976 DOI: 10.3899/jrheum.201376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of long-term denosumab 60 mg every 6 months (Q6M) or every 3 months (Q3M) in patients with rheumatoid arthritis (RA). METHODS This 12-month, randomized, double-blind, placebo-controlled, multicenter, phase III trial with an open-label extension period from 12 to 36 months (DESIRABLE) enrolled Japanese patients with RA treated with placebo (P) for 12 months followed by either denosumab Q6M (P/Q6M) or denosumab Q3M (P/Q3M) for 24 months; denosumab Q6M for 36 months (Q6M/Q6M); or denosumab Q3M for 36 months (Q3M/Q3M). Efficacy was assessed by van der Heijde modified total Sharp score (mTSS), bone erosion score (BES), and joint space narrowing ( JSN) score. RESULTS Long-term treatment better maintained mTSS and BES suppression in the P/Q3M and Q3M/ Q3M vs P/Q6M and Q6M/Q6M groups; changes from baseline in total mTSS (standard error) at 36 months were 2.8 (0.4) and 1.7 (0.3) vs 3.0 (0.4) and 2.4 (0.3), respectively, and corresponding changes in BES were 1.3 (0.2) and 0.4 (0.2) vs 1.4 (0.2) and 1.1 (0.2), respectively. No JSN effect was observed. Bone mineral density consistently increased in all groups after denosumab initiation, regardless of concomitant glucocorticoid administration. Serum C-terminal telopeptide of type I collagen decreased rapidly at 1 month postdenosumab administration (in both the initial 12-month [Q3M and Q6M groups] and long-term treatment [P/Q3M and P/Q6M groups] phases). Adverse event incidence leading to study drug discontinuation was similar across treatment groups. CONCLUSION Denosumab treatment maintained inhibition of progression of joint destruction up to 36 months. Based on effects on BES progression, higher dosing frequency at an earlier treatment stage may be needed to optimize treatment. Denosumab was generally well tolerated. (ClinicalTrials.gov: NCT01973569).
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Affiliation(s)
- Yoshiya Tanaka
- This study was funded by Daiichi Sankyo Co., Ltd. Y. Tanaka, MD, PhD, First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; S. Soen, MD, PhD, Department of Orthopedics and Rheumatology, Kindai University Nara Hospital, Ikoma, Japan; H. Yamanaka, MD, PhD, Director of Rheumatology, Sanno Medical Center, Tokyo, Japan; T. Yoneda, DDS, PhD, Department of Biochemistry, Osaka University Graduate School of Dentistry, Osaka, Japan; S. Tanaka, MD, PhD, Orthopedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan; T. Nitta, MS, N. Okubo, PhD, Daiichi Sankyo Co., Ltd, Japan; H.K. Genant, MD, Departments of Radiology, Medicine, and Orthopedic Surgery, University of California, San Francisco, California, USA; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. Y. Tanaka and T. Takeuchi contributed equally to this work. H.K. Genant passed away on January 14, 2021. YT has received speakers bureau fees from Daiichi Sankyo, Eli Lilly, Novartis, YL Biologics, BMS, Eisai, Chugai, AbbVie GK, Astellas, Pfizer, Sanofi, GSK, Mitsubishi Tanabe, Gilead, and Janssen. TT has received grant/research support from Daiichi Sankyo, Takeda, Nippon Kayaku, JCR Pharma, Astellas, Chugai, AbbVie GK, Asahi Kasei Pharma, Mitsubishi Tanabe, UCB Japan, and Eisai, and consulting fees from Astellas, AbbVie GK, Gilead, Daiichi Sankyo, Taisho Pharma, Nippon Kayaku, BMS, GSK, Eli Lilly, Novartis, Mitsubishi Tanabe, and Chugai, and speakers bureau fees from Mitsubishi Tanabe, Pfizer, Astellas, Daiichi Sankyo, Eisai, Sanofi, Novartis, Eli Lilly, Gilead, AbbVie GK, BMS, and Chugai. SS has received grant/ research support from Chugai and Daiichi Sankyo and has served on speakers bureaus for Asahi Kasei Pharma, Astellas, Daiichi Sankyo, Takeda, Chugai, Eisai, Pfizer, Eli Lilly, and Ono. HY has received speakers bureau fees from Pfizer, YL Biologics, Teijin, Astellas, Tanabe Mitsubishi, and BMS. TY has received grants-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (MEXT #17H04377) and has acted as a consultant for Daiichi Sankyo. ST has received grant/research support from Kyocera Corp and Asahi Kasei Corp and consulting fees from Amgen Astellas BioPharma KK, Kyocera Corp, Daiichi Sankyo, and Pfizer, and speakers bureau fees from Asahi Kasei Corp, Astellas, Ayumi, Eisai, Ono, Daiichi Sankyo, Taisho Pharma, Mitsubishi Tanabe, Chugai, Teijin, Eli Lilly, Hisamitsu, Pfizer, and BMS. TN and NO report fulltime employment with Daiichi Sankyo. HG has received consulting fees or other remuneration from Daiichi Sankyo, Amgen, Eli Lilly, Biomarin, Clementia, Agnovos, Regeneron, Medtronic, QED, and Bioclinica. DvdH has acted as a consultant for AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi Sankyo, Eisai, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, and UCB, and is a director at Imaging Rheumatology BV. Address correspondence to Dr. Y. Tanaka, First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. . Accepted for publication April 8, 2021
| | - Tsutomu Takeuchi
- This study was funded by Daiichi Sankyo Co., Ltd. Y. Tanaka, MD, PhD, First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; S. Soen, MD, PhD, Department of Orthopedics and Rheumatology, Kindai University Nara Hospital, Ikoma, Japan; H. Yamanaka, MD, PhD, Director of Rheumatology, Sanno Medical Center, Tokyo, Japan; T. Yoneda, DDS, PhD, Department of Biochemistry, Osaka University Graduate School of Dentistry, Osaka, Japan; S. Tanaka, MD, PhD, Orthopedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan; T. Nitta, MS, N. Okubo, PhD, Daiichi Sankyo Co., Ltd, Japan; H.K. Genant, MD, Departments of Radiology, Medicine, and Orthopedic Surgery, University of California, San Francisco, California, USA; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. Y. Tanaka and T. Takeuchi contributed equally to this work. H.K. Genant passed away on January 14, 2021. YT has received speakers bureau fees from Daiichi Sankyo, Eli Lilly, Novartis, YL Biologics, BMS, Eisai, Chugai, AbbVie GK, Astellas, Pfizer, Sanofi, GSK, Mitsubishi Tanabe, Gilead, and Janssen. TT has received grant/research support from Daiichi Sankyo, Takeda, Nippon Kayaku, JCR Pharma, Astellas, Chugai, AbbVie GK, Asahi Kasei Pharma, Mitsubishi Tanabe, UCB Japan, and Eisai, and consulting fees from Astellas, AbbVie GK, Gilead, Daiichi Sankyo, Taisho Pharma, Nippon Kayaku, BMS, GSK, Eli Lilly, Novartis, Mitsubishi Tanabe, and Chugai, and speakers bureau fees from Mitsubishi Tanabe, Pfizer, Astellas, Daiichi Sankyo, Eisai, Sanofi, Novartis, Eli Lilly, Gilead, AbbVie GK, BMS, and Chugai. SS has received grant/ research support from Chugai and Daiichi Sankyo and has served on speakers bureaus for Asahi Kasei Pharma, Astellas, Daiichi Sankyo, Takeda, Chugai, Eisai, Pfizer, Eli Lilly, and Ono. HY has received speakers bureau fees from Pfizer, YL Biologics, Teijin, Astellas, Tanabe Mitsubishi, and BMS. TY has received grants-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (MEXT #17H04377) and has acted as a consultant for Daiichi Sankyo. ST has received grant/research support from Kyocera Corp and Asahi Kasei Corp and consulting fees from Amgen Astellas BioPharma KK, Kyocera Corp, Daiichi Sankyo, and Pfizer, and speakers bureau fees from Asahi Kasei Corp, Astellas, Ayumi, Eisai, Ono, Daiichi Sankyo, Taisho Pharma, Mitsubishi Tanabe, Chugai, Teijin, Eli Lilly, Hisamitsu, Pfizer, and BMS. TN and NO report fulltime employment with Daiichi Sankyo. HG has received consulting fees or other remuneration from Daiichi Sankyo, Amgen, Eli Lilly, Biomarin, Clementia, Agnovos, Regeneron, Medtronic, QED, and Bioclinica. DvdH has acted as a consultant for AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi Sankyo, Eisai, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, and UCB, and is a director at Imaging Rheumatology BV. Address correspondence to Dr. Y. Tanaka, First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. . Accepted for publication April 8, 2021
| | - Satoshi Soen
- This study was funded by Daiichi Sankyo Co., Ltd. Y. Tanaka, MD, PhD, First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; S. Soen, MD, PhD, Department of Orthopedics and Rheumatology, Kindai University Nara Hospital, Ikoma, Japan; H. Yamanaka, MD, PhD, Director of Rheumatology, Sanno Medical Center, Tokyo, Japan; T. Yoneda, DDS, PhD, Department of Biochemistry, Osaka University Graduate School of Dentistry, Osaka, Japan; S. Tanaka, MD, PhD, Orthopedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan; T. Nitta, MS, N. Okubo, PhD, Daiichi Sankyo Co., Ltd, Japan; H.K. Genant, MD, Departments of Radiology, Medicine, and Orthopedic Surgery, University of California, San Francisco, California, USA; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. Y. Tanaka and T. Takeuchi contributed equally to this work. H.K. Genant passed away on January 14, 2021. YT has received speakers bureau fees from Daiichi Sankyo, Eli Lilly, Novartis, YL Biologics, BMS, Eisai, Chugai, AbbVie GK, Astellas, Pfizer, Sanofi, GSK, Mitsubishi Tanabe, Gilead, and Janssen. TT has received grant/research support from Daiichi Sankyo, Takeda, Nippon Kayaku, JCR Pharma, Astellas, Chugai, AbbVie GK, Asahi Kasei Pharma, Mitsubishi Tanabe, UCB Japan, and Eisai, and consulting fees from Astellas, AbbVie GK, Gilead, Daiichi Sankyo, Taisho Pharma, Nippon Kayaku, BMS, GSK, Eli Lilly, Novartis, Mitsubishi Tanabe, and Chugai, and speakers bureau fees from Mitsubishi Tanabe, Pfizer, Astellas, Daiichi Sankyo, Eisai, Sanofi, Novartis, Eli Lilly, Gilead, AbbVie GK, BMS, and Chugai. SS has received grant/ research support from Chugai and Daiichi Sankyo and has served on speakers bureaus for Asahi Kasei Pharma, Astellas, Daiichi Sankyo, Takeda, Chugai, Eisai, Pfizer, Eli Lilly, and Ono. HY has received speakers bureau fees from Pfizer, YL Biologics, Teijin, Astellas, Tanabe Mitsubishi, and BMS. TY has received grants-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (MEXT #17H04377) and has acted as a consultant for Daiichi Sankyo. ST has received grant/research support from Kyocera Corp and Asahi Kasei Corp and consulting fees from Amgen Astellas BioPharma KK, Kyocera Corp, Daiichi Sankyo, and Pfizer, and speakers bureau fees from Asahi Kasei Corp, Astellas, Ayumi, Eisai, Ono, Daiichi Sankyo, Taisho Pharma, Mitsubishi Tanabe, Chugai, Teijin, Eli Lilly, Hisamitsu, Pfizer, and BMS. TN and NO report fulltime employment with Daiichi Sankyo. HG has received consulting fees or other remuneration from Daiichi Sankyo, Amgen, Eli Lilly, Biomarin, Clementia, Agnovos, Regeneron, Medtronic, QED, and Bioclinica. DvdH has acted as a consultant for AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi Sankyo, Eisai, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, and UCB, and is a director at Imaging Rheumatology BV. Address correspondence to Dr. Y. Tanaka, First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. . Accepted for publication April 8, 2021
| | - Hisashi Yamanaka
- This study was funded by Daiichi Sankyo Co., Ltd. Y. Tanaka, MD, PhD, First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; S. Soen, MD, PhD, Department of Orthopedics and Rheumatology, Kindai University Nara Hospital, Ikoma, Japan; H. Yamanaka, MD, PhD, Director of Rheumatology, Sanno Medical Center, Tokyo, Japan; T. Yoneda, DDS, PhD, Department of Biochemistry, Osaka University Graduate School of Dentistry, Osaka, Japan; S. Tanaka, MD, PhD, Orthopedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan; T. Nitta, MS, N. Okubo, PhD, Daiichi Sankyo Co., Ltd, Japan; H.K. Genant, MD, Departments of Radiology, Medicine, and Orthopedic Surgery, University of California, San Francisco, California, USA; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. Y. Tanaka and T. Takeuchi contributed equally to this work. H.K. Genant passed away on January 14, 2021. YT has received speakers bureau fees from Daiichi Sankyo, Eli Lilly, Novartis, YL Biologics, BMS, Eisai, Chugai, AbbVie GK, Astellas, Pfizer, Sanofi, GSK, Mitsubishi Tanabe, Gilead, and Janssen. TT has received grant/research support from Daiichi Sankyo, Takeda, Nippon Kayaku, JCR Pharma, Astellas, Chugai, AbbVie GK, Asahi Kasei Pharma, Mitsubishi Tanabe, UCB Japan, and Eisai, and consulting fees from Astellas, AbbVie GK, Gilead, Daiichi Sankyo, Taisho Pharma, Nippon Kayaku, BMS, GSK, Eli Lilly, Novartis, Mitsubishi Tanabe, and Chugai, and speakers bureau fees from Mitsubishi Tanabe, Pfizer, Astellas, Daiichi Sankyo, Eisai, Sanofi, Novartis, Eli Lilly, Gilead, AbbVie GK, BMS, and Chugai. SS has received grant/ research support from Chugai and Daiichi Sankyo and has served on speakers bureaus for Asahi Kasei Pharma, Astellas, Daiichi Sankyo, Takeda, Chugai, Eisai, Pfizer, Eli Lilly, and Ono. HY has received speakers bureau fees from Pfizer, YL Biologics, Teijin, Astellas, Tanabe Mitsubishi, and BMS. TY has received grants-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (MEXT #17H04377) and has acted as a consultant for Daiichi Sankyo. ST has received grant/research support from Kyocera Corp and Asahi Kasei Corp and consulting fees from Amgen Astellas BioPharma KK, Kyocera Corp, Daiichi Sankyo, and Pfizer, and speakers bureau fees from Asahi Kasei Corp, Astellas, Ayumi, Eisai, Ono, Daiichi Sankyo, Taisho Pharma, Mitsubishi Tanabe, Chugai, Teijin, Eli Lilly, Hisamitsu, Pfizer, and BMS. TN and NO report fulltime employment with Daiichi Sankyo. HG has received consulting fees or other remuneration from Daiichi Sankyo, Amgen, Eli Lilly, Biomarin, Clementia, Agnovos, Regeneron, Medtronic, QED, and Bioclinica. DvdH has acted as a consultant for AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi Sankyo, Eisai, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, and UCB, and is a director at Imaging Rheumatology BV. Address correspondence to Dr. Y. Tanaka, First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. . Accepted for publication April 8, 2021
| | - Toshiyuki Yoneda
- This study was funded by Daiichi Sankyo Co., Ltd. Y. Tanaka, MD, PhD, First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; S. Soen, MD, PhD, Department of Orthopedics and Rheumatology, Kindai University Nara Hospital, Ikoma, Japan; H. Yamanaka, MD, PhD, Director of Rheumatology, Sanno Medical Center, Tokyo, Japan; T. Yoneda, DDS, PhD, Department of Biochemistry, Osaka University Graduate School of Dentistry, Osaka, Japan; S. Tanaka, MD, PhD, Orthopedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan; T. Nitta, MS, N. Okubo, PhD, Daiichi Sankyo Co., Ltd, Japan; H.K. Genant, MD, Departments of Radiology, Medicine, and Orthopedic Surgery, University of California, San Francisco, California, USA; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. Y. Tanaka and T. Takeuchi contributed equally to this work. H.K. Genant passed away on January 14, 2021. YT has received speakers bureau fees from Daiichi Sankyo, Eli Lilly, Novartis, YL Biologics, BMS, Eisai, Chugai, AbbVie GK, Astellas, Pfizer, Sanofi, GSK, Mitsubishi Tanabe, Gilead, and Janssen. TT has received grant/research support from Daiichi Sankyo, Takeda, Nippon Kayaku, JCR Pharma, Astellas, Chugai, AbbVie GK, Asahi Kasei Pharma, Mitsubishi Tanabe, UCB Japan, and Eisai, and consulting fees from Astellas, AbbVie GK, Gilead, Daiichi Sankyo, Taisho Pharma, Nippon Kayaku, BMS, GSK, Eli Lilly, Novartis, Mitsubishi Tanabe, and Chugai, and speakers bureau fees from Mitsubishi Tanabe, Pfizer, Astellas, Daiichi Sankyo, Eisai, Sanofi, Novartis, Eli Lilly, Gilead, AbbVie GK, BMS, and Chugai. SS has received grant/ research support from Chugai and Daiichi Sankyo and has served on speakers bureaus for Asahi Kasei Pharma, Astellas, Daiichi Sankyo, Takeda, Chugai, Eisai, Pfizer, Eli Lilly, and Ono. HY has received speakers bureau fees from Pfizer, YL Biologics, Teijin, Astellas, Tanabe Mitsubishi, and BMS. TY has received grants-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (MEXT #17H04377) and has acted as a consultant for Daiichi Sankyo. ST has received grant/research support from Kyocera Corp and Asahi Kasei Corp and consulting fees from Amgen Astellas BioPharma KK, Kyocera Corp, Daiichi Sankyo, and Pfizer, and speakers bureau fees from Asahi Kasei Corp, Astellas, Ayumi, Eisai, Ono, Daiichi Sankyo, Taisho Pharma, Mitsubishi Tanabe, Chugai, Teijin, Eli Lilly, Hisamitsu, Pfizer, and BMS. TN and NO report fulltime employment with Daiichi Sankyo. HG has received consulting fees or other remuneration from Daiichi Sankyo, Amgen, Eli Lilly, Biomarin, Clementia, Agnovos, Regeneron, Medtronic, QED, and Bioclinica. DvdH has acted as a consultant for AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi Sankyo, Eisai, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, and UCB, and is a director at Imaging Rheumatology BV. Address correspondence to Dr. Y. Tanaka, First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. . Accepted for publication April 8, 2021
| | - Sakae Tanaka
- This study was funded by Daiichi Sankyo Co., Ltd. Y. Tanaka, MD, PhD, First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; S. Soen, MD, PhD, Department of Orthopedics and Rheumatology, Kindai University Nara Hospital, Ikoma, Japan; H. Yamanaka, MD, PhD, Director of Rheumatology, Sanno Medical Center, Tokyo, Japan; T. Yoneda, DDS, PhD, Department of Biochemistry, Osaka University Graduate School of Dentistry, Osaka, Japan; S. Tanaka, MD, PhD, Orthopedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan; T. Nitta, MS, N. Okubo, PhD, Daiichi Sankyo Co., Ltd, Japan; H.K. Genant, MD, Departments of Radiology, Medicine, and Orthopedic Surgery, University of California, San Francisco, California, USA; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. Y. Tanaka and T. Takeuchi contributed equally to this work. H.K. Genant passed away on January 14, 2021. YT has received speakers bureau fees from Daiichi Sankyo, Eli Lilly, Novartis, YL Biologics, BMS, Eisai, Chugai, AbbVie GK, Astellas, Pfizer, Sanofi, GSK, Mitsubishi Tanabe, Gilead, and Janssen. TT has received grant/research support from Daiichi Sankyo, Takeda, Nippon Kayaku, JCR Pharma, Astellas, Chugai, AbbVie GK, Asahi Kasei Pharma, Mitsubishi Tanabe, UCB Japan, and Eisai, and consulting fees from Astellas, AbbVie GK, Gilead, Daiichi Sankyo, Taisho Pharma, Nippon Kayaku, BMS, GSK, Eli Lilly, Novartis, Mitsubishi Tanabe, and Chugai, and speakers bureau fees from Mitsubishi Tanabe, Pfizer, Astellas, Daiichi Sankyo, Eisai, Sanofi, Novartis, Eli Lilly, Gilead, AbbVie GK, BMS, and Chugai. SS has received grant/ research support from Chugai and Daiichi Sankyo and has served on speakers bureaus for Asahi Kasei Pharma, Astellas, Daiichi Sankyo, Takeda, Chugai, Eisai, Pfizer, Eli Lilly, and Ono. HY has received speakers bureau fees from Pfizer, YL Biologics, Teijin, Astellas, Tanabe Mitsubishi, and BMS. TY has received grants-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (MEXT #17H04377) and has acted as a consultant for Daiichi Sankyo. ST has received grant/research support from Kyocera Corp and Asahi Kasei Corp and consulting fees from Amgen Astellas BioPharma KK, Kyocera Corp, Daiichi Sankyo, and Pfizer, and speakers bureau fees from Asahi Kasei Corp, Astellas, Ayumi, Eisai, Ono, Daiichi Sankyo, Taisho Pharma, Mitsubishi Tanabe, Chugai, Teijin, Eli Lilly, Hisamitsu, Pfizer, and BMS. TN and NO report fulltime employment with Daiichi Sankyo. HG has received consulting fees or other remuneration from Daiichi Sankyo, Amgen, Eli Lilly, Biomarin, Clementia, Agnovos, Regeneron, Medtronic, QED, and Bioclinica. DvdH has acted as a consultant for AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi Sankyo, Eisai, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, and UCB, and is a director at Imaging Rheumatology BV. Address correspondence to Dr. Y. Tanaka, First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. . Accepted for publication April 8, 2021
| | - Takaya Nitta
- This study was funded by Daiichi Sankyo Co., Ltd. Y. Tanaka, MD, PhD, First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; S. Soen, MD, PhD, Department of Orthopedics and Rheumatology, Kindai University Nara Hospital, Ikoma, Japan; H. Yamanaka, MD, PhD, Director of Rheumatology, Sanno Medical Center, Tokyo, Japan; T. Yoneda, DDS, PhD, Department of Biochemistry, Osaka University Graduate School of Dentistry, Osaka, Japan; S. Tanaka, MD, PhD, Orthopedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan; T. Nitta, MS, N. Okubo, PhD, Daiichi Sankyo Co., Ltd, Japan; H.K. Genant, MD, Departments of Radiology, Medicine, and Orthopedic Surgery, University of California, San Francisco, California, USA; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. Y. Tanaka and T. Takeuchi contributed equally to this work. H.K. Genant passed away on January 14, 2021. YT has received speakers bureau fees from Daiichi Sankyo, Eli Lilly, Novartis, YL Biologics, BMS, Eisai, Chugai, AbbVie GK, Astellas, Pfizer, Sanofi, GSK, Mitsubishi Tanabe, Gilead, and Janssen. TT has received grant/research support from Daiichi Sankyo, Takeda, Nippon Kayaku, JCR Pharma, Astellas, Chugai, AbbVie GK, Asahi Kasei Pharma, Mitsubishi Tanabe, UCB Japan, and Eisai, and consulting fees from Astellas, AbbVie GK, Gilead, Daiichi Sankyo, Taisho Pharma, Nippon Kayaku, BMS, GSK, Eli Lilly, Novartis, Mitsubishi Tanabe, and Chugai, and speakers bureau fees from Mitsubishi Tanabe, Pfizer, Astellas, Daiichi Sankyo, Eisai, Sanofi, Novartis, Eli Lilly, Gilead, AbbVie GK, BMS, and Chugai. SS has received grant/ research support from Chugai and Daiichi Sankyo and has served on speakers bureaus for Asahi Kasei Pharma, Astellas, Daiichi Sankyo, Takeda, Chugai, Eisai, Pfizer, Eli Lilly, and Ono. HY has received speakers bureau fees from Pfizer, YL Biologics, Teijin, Astellas, Tanabe Mitsubishi, and BMS. TY has received grants-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (MEXT #17H04377) and has acted as a consultant for Daiichi Sankyo. ST has received grant/research support from Kyocera Corp and Asahi Kasei Corp and consulting fees from Amgen Astellas BioPharma KK, Kyocera Corp, Daiichi Sankyo, and Pfizer, and speakers bureau fees from Asahi Kasei Corp, Astellas, Ayumi, Eisai, Ono, Daiichi Sankyo, Taisho Pharma, Mitsubishi Tanabe, Chugai, Teijin, Eli Lilly, Hisamitsu, Pfizer, and BMS. TN and NO report fulltime employment with Daiichi Sankyo. HG has received consulting fees or other remuneration from Daiichi Sankyo, Amgen, Eli Lilly, Biomarin, Clementia, Agnovos, Regeneron, Medtronic, QED, and Bioclinica. DvdH has acted as a consultant for AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi Sankyo, Eisai, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, and UCB, and is a director at Imaging Rheumatology BV. Address correspondence to Dr. Y. Tanaka, First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. . Accepted for publication April 8, 2021
| | - Naoki Okubo
- This study was funded by Daiichi Sankyo Co., Ltd. Y. Tanaka, MD, PhD, First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; S. Soen, MD, PhD, Department of Orthopedics and Rheumatology, Kindai University Nara Hospital, Ikoma, Japan; H. Yamanaka, MD, PhD, Director of Rheumatology, Sanno Medical Center, Tokyo, Japan; T. Yoneda, DDS, PhD, Department of Biochemistry, Osaka University Graduate School of Dentistry, Osaka, Japan; S. Tanaka, MD, PhD, Orthopedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan; T. Nitta, MS, N. Okubo, PhD, Daiichi Sankyo Co., Ltd, Japan; H.K. Genant, MD, Departments of Radiology, Medicine, and Orthopedic Surgery, University of California, San Francisco, California, USA; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. Y. Tanaka and T. Takeuchi contributed equally to this work. H.K. Genant passed away on January 14, 2021. YT has received speakers bureau fees from Daiichi Sankyo, Eli Lilly, Novartis, YL Biologics, BMS, Eisai, Chugai, AbbVie GK, Astellas, Pfizer, Sanofi, GSK, Mitsubishi Tanabe, Gilead, and Janssen. TT has received grant/research support from Daiichi Sankyo, Takeda, Nippon Kayaku, JCR Pharma, Astellas, Chugai, AbbVie GK, Asahi Kasei Pharma, Mitsubishi Tanabe, UCB Japan, and Eisai, and consulting fees from Astellas, AbbVie GK, Gilead, Daiichi Sankyo, Taisho Pharma, Nippon Kayaku, BMS, GSK, Eli Lilly, Novartis, Mitsubishi Tanabe, and Chugai, and speakers bureau fees from Mitsubishi Tanabe, Pfizer, Astellas, Daiichi Sankyo, Eisai, Sanofi, Novartis, Eli Lilly, Gilead, AbbVie GK, BMS, and Chugai. SS has received grant/ research support from Chugai and Daiichi Sankyo and has served on speakers bureaus for Asahi Kasei Pharma, Astellas, Daiichi Sankyo, Takeda, Chugai, Eisai, Pfizer, Eli Lilly, and Ono. HY has received speakers bureau fees from Pfizer, YL Biologics, Teijin, Astellas, Tanabe Mitsubishi, and BMS. TY has received grants-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (MEXT #17H04377) and has acted as a consultant for Daiichi Sankyo. ST has received grant/research support from Kyocera Corp and Asahi Kasei Corp and consulting fees from Amgen Astellas BioPharma KK, Kyocera Corp, Daiichi Sankyo, and Pfizer, and speakers bureau fees from Asahi Kasei Corp, Astellas, Ayumi, Eisai, Ono, Daiichi Sankyo, Taisho Pharma, Mitsubishi Tanabe, Chugai, Teijin, Eli Lilly, Hisamitsu, Pfizer, and BMS. TN and NO report fulltime employment with Daiichi Sankyo. HG has received consulting fees or other remuneration from Daiichi Sankyo, Amgen, Eli Lilly, Biomarin, Clementia, Agnovos, Regeneron, Medtronic, QED, and Bioclinica. DvdH has acted as a consultant for AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi Sankyo, Eisai, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, and UCB, and is a director at Imaging Rheumatology BV. Address correspondence to Dr. Y. Tanaka, First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. . Accepted for publication April 8, 2021
| | - Harry K Genant
- This study was funded by Daiichi Sankyo Co., Ltd. Y. Tanaka, MD, PhD, First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; S. Soen, MD, PhD, Department of Orthopedics and Rheumatology, Kindai University Nara Hospital, Ikoma, Japan; H. Yamanaka, MD, PhD, Director of Rheumatology, Sanno Medical Center, Tokyo, Japan; T. Yoneda, DDS, PhD, Department of Biochemistry, Osaka University Graduate School of Dentistry, Osaka, Japan; S. Tanaka, MD, PhD, Orthopedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan; T. Nitta, MS, N. Okubo, PhD, Daiichi Sankyo Co., Ltd, Japan; H.K. Genant, MD, Departments of Radiology, Medicine, and Orthopedic Surgery, University of California, San Francisco, California, USA; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. Y. Tanaka and T. Takeuchi contributed equally to this work. H.K. Genant passed away on January 14, 2021. YT has received speakers bureau fees from Daiichi Sankyo, Eli Lilly, Novartis, YL Biologics, BMS, Eisai, Chugai, AbbVie GK, Astellas, Pfizer, Sanofi, GSK, Mitsubishi Tanabe, Gilead, and Janssen. TT has received grant/research support from Daiichi Sankyo, Takeda, Nippon Kayaku, JCR Pharma, Astellas, Chugai, AbbVie GK, Asahi Kasei Pharma, Mitsubishi Tanabe, UCB Japan, and Eisai, and consulting fees from Astellas, AbbVie GK, Gilead, Daiichi Sankyo, Taisho Pharma, Nippon Kayaku, BMS, GSK, Eli Lilly, Novartis, Mitsubishi Tanabe, and Chugai, and speakers bureau fees from Mitsubishi Tanabe, Pfizer, Astellas, Daiichi Sankyo, Eisai, Sanofi, Novartis, Eli Lilly, Gilead, AbbVie GK, BMS, and Chugai. SS has received grant/ research support from Chugai and Daiichi Sankyo and has served on speakers bureaus for Asahi Kasei Pharma, Astellas, Daiichi Sankyo, Takeda, Chugai, Eisai, Pfizer, Eli Lilly, and Ono. HY has received speakers bureau fees from Pfizer, YL Biologics, Teijin, Astellas, Tanabe Mitsubishi, and BMS. TY has received grants-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (MEXT #17H04377) and has acted as a consultant for Daiichi Sankyo. ST has received grant/research support from Kyocera Corp and Asahi Kasei Corp and consulting fees from Amgen Astellas BioPharma KK, Kyocera Corp, Daiichi Sankyo, and Pfizer, and speakers bureau fees from Asahi Kasei Corp, Astellas, Ayumi, Eisai, Ono, Daiichi Sankyo, Taisho Pharma, Mitsubishi Tanabe, Chugai, Teijin, Eli Lilly, Hisamitsu, Pfizer, and BMS. TN and NO report fulltime employment with Daiichi Sankyo. HG has received consulting fees or other remuneration from Daiichi Sankyo, Amgen, Eli Lilly, Biomarin, Clementia, Agnovos, Regeneron, Medtronic, QED, and Bioclinica. DvdH has acted as a consultant for AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi Sankyo, Eisai, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, and UCB, and is a director at Imaging Rheumatology BV. Address correspondence to Dr. Y. Tanaka, First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. . Accepted for publication April 8, 2021
| | - Désirée van der Heijde
- This study was funded by Daiichi Sankyo Co., Ltd. Y. Tanaka, MD, PhD, First Department of Internal Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan; T. Takeuchi, MD, PhD, Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan; S. Soen, MD, PhD, Department of Orthopedics and Rheumatology, Kindai University Nara Hospital, Ikoma, Japan; H. Yamanaka, MD, PhD, Director of Rheumatology, Sanno Medical Center, Tokyo, Japan; T. Yoneda, DDS, PhD, Department of Biochemistry, Osaka University Graduate School of Dentistry, Osaka, Japan; S. Tanaka, MD, PhD, Orthopedic Surgery and Spinal Surgery, The University of Tokyo, Tokyo, Japan; T. Nitta, MS, N. Okubo, PhD, Daiichi Sankyo Co., Ltd, Japan; H.K. Genant, MD, Departments of Radiology, Medicine, and Orthopedic Surgery, University of California, San Francisco, California, USA; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands. Y. Tanaka and T. Takeuchi contributed equally to this work. H.K. Genant passed away on January 14, 2021. YT has received speakers bureau fees from Daiichi Sankyo, Eli Lilly, Novartis, YL Biologics, BMS, Eisai, Chugai, AbbVie GK, Astellas, Pfizer, Sanofi, GSK, Mitsubishi Tanabe, Gilead, and Janssen. TT has received grant/research support from Daiichi Sankyo, Takeda, Nippon Kayaku, JCR Pharma, Astellas, Chugai, AbbVie GK, Asahi Kasei Pharma, Mitsubishi Tanabe, UCB Japan, and Eisai, and consulting fees from Astellas, AbbVie GK, Gilead, Daiichi Sankyo, Taisho Pharma, Nippon Kayaku, BMS, GSK, Eli Lilly, Novartis, Mitsubishi Tanabe, and Chugai, and speakers bureau fees from Mitsubishi Tanabe, Pfizer, Astellas, Daiichi Sankyo, Eisai, Sanofi, Novartis, Eli Lilly, Gilead, AbbVie GK, BMS, and Chugai. SS has received grant/ research support from Chugai and Daiichi Sankyo and has served on speakers bureaus for Asahi Kasei Pharma, Astellas, Daiichi Sankyo, Takeda, Chugai, Eisai, Pfizer, Eli Lilly, and Ono. HY has received speakers bureau fees from Pfizer, YL Biologics, Teijin, Astellas, Tanabe Mitsubishi, and BMS. TY has received grants-in-aid for scientific research from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (MEXT #17H04377) and has acted as a consultant for Daiichi Sankyo. ST has received grant/research support from Kyocera Corp and Asahi Kasei Corp and consulting fees from Amgen Astellas BioPharma KK, Kyocera Corp, Daiichi Sankyo, and Pfizer, and speakers bureau fees from Asahi Kasei Corp, Astellas, Ayumi, Eisai, Ono, Daiichi Sankyo, Taisho Pharma, Mitsubishi Tanabe, Chugai, Teijin, Eli Lilly, Hisamitsu, Pfizer, and BMS. TN and NO report fulltime employment with Daiichi Sankyo. HG has received consulting fees or other remuneration from Daiichi Sankyo, Amgen, Eli Lilly, Biomarin, Clementia, Agnovos, Regeneron, Medtronic, QED, and Bioclinica. DvdH has acted as a consultant for AbbVie, Amgen, Astellas, AstraZeneca, BMS, Boehringer Ingelheim, Celgene, Cyxone, Daiichi Sankyo, Eisai, Eli Lilly, Galapagos, Gilead, GSK, Janssen, Merck, Novartis, Pfizer, Regeneron, Roche, Sanofi, Takeda, and UCB, and is a director at Imaging Rheumatology BV. Address correspondence to Dr. Y. Tanaka, First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. . Accepted for publication April 8, 2021
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Watts NB, Chesnut CH, Genant HK, Harris ST, Jackson RD, Licata AA, Miller PD, Mysiw WJ, Richmond B, Valent D. History of etidronate. Bone 2020; 134:115222. [PMID: 31911206 DOI: 10.1016/j.bone.2020.115222] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/19/2019] [Accepted: 01/02/2020] [Indexed: 11/20/2022]
Abstract
Etidronate is a non-nitrogen-containing bisphosphonate. Because it binds with calcium and inhibits crystal formation and dissolution, it was considered by Procter & Gamble as an additive to toothpaste (to prevent build-up of tartar) and detergent (to bind calcium and increase sudsing in "hard" water). The first clinical use (1968) was for fibrodysplasia ossificans progressiva. The first approved clinical use (1977) was for treatment of Paget's disease of bone. Other approved indications are hypercalcemia of malignancy and heterotopic ossification, with a host of off-label uses (including fibrous dysplasia, periodontal disease, multiple myeloma, neuropathic arthropathy, pulmonary microlithiasis, diabetic retinopathy, bone metastases, melorheostosis, urinary stone disease, periodontal disease, etc.). Unique among bisphosphonates, etidronate (oral therapy) results in hyperphosphatemia, increased tubular reabsorption of phosphorus and increased levels of 1,25-dihydroxyvitamin D. The dose that reduces bone resorption is close to the dose that impairs mineralization; prolonged high-dose use can result in osteomalacia and bone fractures. Intermittent cyclic etidronate for osteoporosis resulted in favorable changes in bone density and histomorphometry (no mineralization defect) as well as a decrease in vertebral fracture rates in postmenopausal women with osteoporosis. Later studies showed similar effects in men with osteoporosis and patients with glucocorticoid-induced osteoporosis. Although its use for osteoporosis has given way to newer bisphosphonates and other agents, because of its unique properties, it remains the bisphosphonate of choice for treatment of heterotopic ossification.
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Affiliation(s)
- Nelson B Watts
- Mercy Health Osteoporosis and Bone Health Services, 4760 E. Galbraith Rd, Suite 212, Cincinnati, OH 45236, USA.
| | - Charles H Chesnut
- Departments of Radiology and Medicine, University of Washington Medical Center, Seattle, Washington USA 98195; Department of Medicine, University of Washington Medical Center, Seattle, WA 98195, USA.
| | - Harry K Genant
- Departments of Radiology, Medicine and Orthopedic Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Orthopedic Surgery, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Steven T Harris
- Department of Medicine, University of California, San Francisco, 1635 Divisadero St., Suite 525, San Francisco, CA 94115-3044, USA.
| | - Rebecca D Jackson
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, The Ohio State University, 376 West Tenth Ave, Suite 260 Prior Hall, Columbus, OH 43210, USA.
| | - Angelo A Licata
- Department of Endocrinology, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA.
| | | | - W Jerry Mysiw
- Department of Physical Medicine and Rehabilitation, 480 Medical Center Drive, 1018 Dodd Hall, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
| | - Bradford Richmond
- Department of Radiology, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44194, USA.
| | - David Valent
- Procter & Gamble Pharmaceuticals, 8700 Mason Montgomery Road, Mason, OH 45040, USA.
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Howe JG, Hill RS, Stroncek JD, Shaul JL, Favell D, Cheng RR, Engelke K, Genant HK, Lee DC, Keaveny TM, Bouxsein ML, Huber B. Treatment of bone loss in proximal femurs of postmenopausal osteoporotic women with AGN1 local osteo-enhancement procedure (LOEP) increases hip bone mineral density and hip strength: a long-term prospective cohort study. Osteoporos Int 2020; 31:921-929. [PMID: 31802158 PMCID: PMC7170985 DOI: 10.1007/s00198-019-05230-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 11/07/2019] [Indexed: 12/14/2022]
Abstract
UNLABELLED This first-in-human study of AGN1 LOEP demonstrated that this minimally-invasive treatment durably increased aBMD in femurs of osteoporotic postmenopausal women. AGN1 resorption was coupled with new bone formation by 12 weeks and that new bone was maintained for at least 5-7 years resulting in substantially increased FEA-estimated femoral strength. INTRODUCTION This first-in-human study evaluated feasibility, safety, and in vivo response to treating proximal femurs of postmenopausal osteoporotic women with a minimally-invasive local osteo-enhancement procedure (LOEP) to inject a resorbable triphasic osteoconductive implant material (AGN1). METHODS This prospective cohort study enrolled 12 postmenopausal osteoporotic (femoral neck T-score ≤ - 2.5) women aged 56 to 89 years. AGN1 LOEP was performed on left femurs; right femurs were untreated controls. Subjects were followed-up for 5-7 years. Outcomes included adverse events, proximal femur areal bone mineral density (aBMD), AGN1 resorption, and replacement with bone by X-ray and CT, and finite element analysis (FEA) estimated hip strength. RESULTS Baseline treated and control femoral neck aBMD was equivalent. Treated femoral neck aBMD increased by 68 ± 22%, 59 ± 24%, and 58 ± 27% over control at 12 and 24 weeks and 5-7 years, respectively (p < 0.001, all time points). Using conservative assumptions, FEA-estimated femoral strength increased by 41%, 37%, and 22% at 12 and 24 weeks and 5-7 years, respectively (p < 0.01, all time points). Qualitative analysis of X-ray and CT scans demonstrated that AGN1 resorption and replacement with bone was nearly complete by 24 weeks. By 5-7 years, AGN1 appeared to be fully resorbed and replaced with bone integrated with surrounding trabecular and cortical bone. No procedure- or device-related serious adverse events (SAEs) occurred. CONCLUSIONS Treating femurs of postmenopausal osteoporotic women with AGN1 LOEP results in a rapid, durable increase in aBMD and femoral strength. These results support the use and further clinical study of this approach in osteoporotic patients at high risk of hip fracture.
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Affiliation(s)
- J G Howe
- AgNovos Healthcare LLC, Rockville, MD, USA
| | - R S Hill
- AgNovos Healthcare LLC, Rockville, MD, USA.
| | | | - J L Shaul
- AgNovos Healthcare LLC, Rockville, MD, USA
| | - D Favell
- AgNovos Healthcare LLC, Rockville, MD, USA
| | - R R Cheng
- AgNovos Healthcare LLC, Rockville, MD, USA
| | - K Engelke
- Bioclinica-Synarc, Inc., Hamburg, Germany
- FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - H K Genant
- University of California San Francisco, San Francisco, CA, USA
- Bioclinica-Synarc, Inc., Newark, CA, USA
| | - D C Lee
- O.N. Diagnostics, Berkeley, CA, USA
| | - T M Keaveny
- University of California Berkeley, Berkley, CA, USA
| | - M L Bouxsein
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - B Huber
- Mansfield Orthopedics, Morrisville, VT, USA
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Ishiguro N, Tanaka Y, Yamanaka H, Yoneda T, Ohira T, Okubo N, Genant HK, van der Heijde D, Takeuchi T. Efficacy of denosumab with regard to bone destruction in prognostic subgroups of Japanese rheumatoid arthritis patients from the phase II DRIVE study. Rheumatology (Oxford) 2020; 58:997-1005. [PMID: 30602032 PMCID: PMC6532444 DOI: 10.1093/rheumatology/key416] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/14/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To evaluate the efficacy of denosumab for progressive bone erosion in risk factor subgroups of Japanese RA patients. METHODS This study included 340 RA patients on MTX from the dose-response study of Denosumab in patients with RheumatoId arthritis on methotrexate to Validate inhibitory effect on bone Erosion (DRIVE study-a 12-month, multicentre, randomized, double-blind, placebo-controlled, phase II study). The patients were randomized to receive placebo or denosumab 60 mg every 6 months, 3 months or 2 months. Subgroup analyses involved baseline RF, ACPA, swollen joint count, CRP level, RA duration, ESR and glucocorticoid use. RESULTS Patients with risk factor positivity generally showed consistent results for the primary endpoint of the change in the modified Sharp erosion score at 12 months from baseline. In the placebo, every 6 months, every 3 months and every 2 months groups, the mean changes in the erosion score, according to the RF status (RF-positive vs -negative subgroups), were 1.18 vs 0.59, 0.25 (P = 0.0601 vs placebo) vs 0.31 (P = 0.0827), 0.21 (P = 0.0422) vs -0.02 (P = 0.0631) and 0.15 (P = 0.0010) vs -0.05 (P = 0.0332), respectively, while the mean changes in the erosion score, according to the ACPA status (ACPA-positive vs -negative subgroups), were 1.30 vs 0.07, 0.26 (P = 0.0142) vs 0.33 (P = 0.2748), 0.16 (P = 0.0058) vs 0.08 (P = 0.7166) and 0.09 (P < 0.0001) vs 0.08 (P = 0.8939), respectively. CONCLUSION Denosumab is a potentially useful treatment option for RA patients who are positive for RF, ACPA and other possible risk factors. TRIAL REGISTRATION JAPIC Clinical Trials Information, http://www.clinicaltrials.jp/user/cteSearch_e.jsp, JapicCTI-101263.
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Affiliation(s)
- Naoki Ishiguro
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, Nagoya, Aichi
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu
| | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo
| | - Toshiyuki Yoneda
- Department of Biochemistry, Osaka University Graduate School of Dentistry, Osaka
| | | | | | - Harry K Genant
- Departments of Radiology, Medicine and Orthopaedic Surgery, University of California, San Francisco, CA, USA
| | | | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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LeBlanc ES, Rosales AG, Genant HK, Dell RM, Friess DM, Boardman DL, Santora AC, Bauer DC, de Papp AE, Black DM, Orwoll ES. Radiological criteria for atypical features of femur fractures: what we can learn when applied in a clinical study setting. Osteoporos Int 2019; 30:1287-1295. [PMID: 30809724 DOI: 10.1007/s00198-019-04869-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
Abstract
UNLABELLED The paper focuses on the identification of atypical fractures (AFFs). This paper examines the concordance between objective classification and expert subjective review. We believe the paper adds critical information about how to apply the American Society of Bone and Mineral Research (ASBMR) criteria to diagnose AFFs and is of high interest to the field. INTRODUCTION Assess American Society of Bone and Mineral Research (ASBMR) criteria for identifying atypical femoral fractures (AFFs). METHODS Two orthopedic surgeons independently evaluated radiographs of 372 fractures, applying ASBMR criteria. We assessed ease of applying ASBMR criteria and whether criteria-based assessment matched qualitative expert assessment. RESULTS There was up to 27% uncertainty about how to classify specific features. 84% of films were classified similarly for the presence of AFF according to ASBMR criteria; agreement increased to 94% after consensus meeting. Of 37 fractures categorized as AFFs based on ASBMR criteria, 23 (62.2%) were considered AFFs according to expert assessment (not relying on criteria). Only one (0.5%) femoral shaft fracture that did not meet ASBMR criteria was considered an AFF per expert assessment. The number of major ASBMR features present (four vs five) and whether there was periosteal or endosteal thickening ("beaking" or "flaring") played major roles in the discrepancies between ASBMR criteria-based and expert-based determinations. CONCLUSIONS ASBMR AFF criteria were useful for reviewers but several features were difficult to interpret. Expert assessments did not agree with the ASBMR classification in almost one-third of cases, but rarely identified an AFF when a femoral shaft fracture did not meet ASBMR AFF criteria. Experts identified lateral cortical transverse fracture line and associated new-bone formation along with no or minimal comminution as crucial features necessary for the definition of atypical femoral fractures.
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Affiliation(s)
- E S LeBlanc
- Kaiser Permanente Center for Health Research NW, 3800 N. Interstate Ave, Portland, OR, 97227, USA.
| | - A G Rosales
- Kaiser Permanente Center for Health Research NW, 3800 N. Interstate Ave, Portland, OR, 97227, USA
| | - H K Genant
- University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - R M Dell
- Kaiser Permanente Southern California, Cypress, CA, USA
| | - D M Friess
- Oregon Health & Science University (OHSU), Portland, OR, USA
| | | | - A C Santora
- Merck & Co., Inc, Kenilworth, NJ, Kenilworth, NJ, USA
| | - D C Bauer
- University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - A E de Papp
- Merck & Co., Inc, Kenilworth, NJ, Kenilworth, NJ, USA
| | - D M Black
- University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - E S Orwoll
- Oregon Health & Science University (OHSU), Portland, OR, USA
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9
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Takeuchi T, Tanaka Y, Soen S, Yamanaka H, Yoneda T, Tanaka S, Nitta T, Okubo N, Genant HK, van der Heijde D. Effects of the anti-RANKL antibody denosumab on joint structural damage in patients with rheumatoid arthritis treated with conventional synthetic disease-modifying antirheumatic drugs (DESIRABLE study): a randomised, double-blind, placebo-controlled phase 3 trial. Ann Rheum Dis 2019; 78:899-907. [PMID: 31036625 PMCID: PMC6585575 DOI: 10.1136/annrheumdis-2018-214827] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 01/30/2023]
Abstract
Objective To evaluate the efficacy of denosumab in suppressing joint destruction when added to conventional synthetic disease-modifying antirheumatic drug (csDMARD) therapy in patients with rheumatoid arthritis (RA). Methods This was a multi-centre, randomised, double-blind, parallel-group, placebo-controlled phase 3 study in Japan. Patients with RA aged ≥20 years receiving csDMARDs were randomly assigned (1:1:1) to denosumab 60 mg every 3 months (Q3M), denosumab 60 mg every 6 months (Q6M) or placebo. The change in the modified total Sharp score (mTSS) and effect on bone mineral density (BMD) at 12 months was evaluated. Results In total, 654 patients received the trial drugs. Denosumab groups showed significantly less progression of joint destruction. The mean changes in the mTSS at 12 months were 1.49 (95% CI 0.99 to 1.99) in the placebo group, 0.99 (95% CI 0.49 to 1.49) in the Q6M group (p=0.0235) and 0.72 (95% CI 0.41 to 1.03) in the Q3M group (p=0.0055). The mean changes in bone erosion score were 0.98 (95% CI 0.65 to 1.31) in the placebo group, 0.51 (95% CI 0.22 to 0.80) in the Q6M group (p=0.0104) and 0.22 (95% CI 0.09 to 0.34) in the Q3M group (p=0.0001). No significant between-group difference was observed in the joint space narrowing score. The per cent change in lumbar spine (L1–L4) BMD in the placebo, Q6M and Q3M groups were −1.03%, 3.99% (p<0.0001) and 4.88% (p<0.0001). No major differences were observed among safety profiles. Conclusions Denosumab inhibits the progression of joint destruction, increases BMD and is well tolerated in patients with RA taking csDMARD.
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Affiliation(s)
- Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Satoshi Soen
- Department of Orthopedics and Rheumatology, Kindai University Nara Hospital, Ikoma, Japan
| | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshiyuki Yoneda
- Department of Biochemistry, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Sakae Tanaka
- Department of Orthopedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takaya Nitta
- Clinical Development Department, Daiichi Sankyo Co., Ltd, Shinagawa-ku, Tokyo, Japan
| | - Naoki Okubo
- Biostatistics & Data Management Department, Daiichi Sankyo Co., Ltd, Shinagawa-ku, Tokyo, Japan
| | - Harry K Genant
- Department of Radiology, Medicine and Orthopedic Surgery, University of California, San Francisco, California, USA
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10
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Kužma M, Vaňuga P, Ságová I, Pávai D, Jackuliak P, Killinger Z, Binkley NC, Winzenrieth R, Genant HK, Payer J. Non-invasive DXA-derived bone structure assessment of acromegaly patients: a cross-sectional study. Eur J Endocrinol 2019; 180:201-211. [PMID: 30566903 DOI: 10.1530/eje-18-0881] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 12/19/2018] [Indexed: 11/08/2022]
Abstract
Introduction Impaired bone microarchitecture is involved in vertebral fracture (VF) development among acromegaly patients. Aim of the study Comparison of DXA-derived bone parameters, areal BMD (aBMD), trabecular bone score (TBS) and 3D-SHAPER parameters in acromegaly patients with healthy controls. Methods This cross-sectional study evaluated acromegaly patients and a control group of healthy subjects. In all subjects, a single measurement of pituitary axis hormone levels, bone turnover markers, aBMD, (total hip (TH) and lumbar spine (LS)), TBS and 3D-SHAPER of the proximal femur region was performed. All subjects underwent DXA assessment of VF using the semiquantitative approach. Results One hundred six patients with acromegaly (mean age 56.6 years, BMI 30.2 kg/m2) and 104 control subjects (mean age 54.06 years, 28.4 BMI kg/m2) were included. After adjustment for weight, LS aBMD, TBS and TH trabecular volumetric BMD (vBMD) remained lower (P = 0.0048, <0.0001 and <0.0001, respectively) while cortical thickness (Cth) at TH and neck remained thicker (P = 0.006) in acromegaly patients compared with controls. The best multivariate model (model 1) discriminating patients with and without acromegaly included TBS, TH trabecular vBMD and TH Cth parameters (all P < 0.05). Twenty-two VFs (13 acromegaly subjects) were recognized. In these subjects after adjustment for age, FN aBMD, TH cortical sBMD and TH cortical vBMD remained significantly associated with the prevalent VF (OR = 2.69 (1.07-6.78), 2.84 (1.24-6.51) and 2.38 (1.11-5.10) for neck aBMD, TH cortical sBMD and TH cortical vBMD respectively)). The AUCs were similar for each parameter in this model. Conclusions Acromegaly patients, regardless of VF presence, have lower trabecular bone quantitative parameters, but those with VFs had decreased cortical density.
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Affiliation(s)
- Martin Kužma
- Comenius University Faculty of Medicine, 5th Department of Internal Medicine, University Hospital Bratislava, Bratislava, Slovakia
| | - Peter Vaňuga
- National Institute of Endocrinology and Diabetology, Lubochna, Slovakia
| | - Ivana Ságová
- Comenius University Jessenius Faculty of Medicine, th Department of Internal Medicine, University Hospital Martin, Martin, Slovakia
| | - Dušan Pávai
- National Institute of Endocrinology and Diabetology, Lubochna, Slovakia
| | - Peter Jackuliak
- Comenius University Faculty of Medicine, 5th Department of Internal Medicine, University Hospital Bratislava, Bratislava, Slovakia
| | - Zdenko Killinger
- Comenius University Faculty of Medicine, 5th Department of Internal Medicine, University Hospital Bratislava, Bratislava, Slovakia
| | - Neil C Binkley
- Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | | | - Harry K Genant
- University of California San Francisco, San Francisco, California, USA
| | - Juraj Payer
- Comenius University Faculty of Medicine, 5th Department of Internal Medicine, University Hospital Bratislava, Bratislava, Slovakia
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11
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Engelke K, Stampa B, Steiger P, Fuerst T, Genant HK. Automated quantitative morphometry of vertebral heights on spinal radiographs: comparison of a clinical workflow tool with standard 6-point morphometry. Arch Osteoporos 2019; 14:18. [PMID: 30741350 DOI: 10.1007/s11657-019-0577-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 01/31/2019] [Indexed: 02/03/2023]
Abstract
UNLABELLED A workflow tool for measurements of vertebral heights on lateral spine radiographs based on automated placements of 6 points per vertebra was evaluated. The tool helps to standardize point placement among operators. Its success rate is very good in normal vertebrae but lower in vertebrae with more severe fractures. Manual corrections were required in 192 of 1257 analyzed vertebrae. INTRODUCTION To evaluate a new workflow tool (SA) for the automated measurements of vertebral heights on lateral spine radiographs. METHODOLOGY Lateral radiographs from 200 postmenopausal women were evaluated at two visits. Genant's semi-quantitative fracture assessment (SQ) and manual quantitative morphometry (QM) results were available from prior analyses. Vertebral heights from point placements using SA were compared with manual 6-point placement QM. Differences were quantified as RMS coefficient of variations (rmsCV) and standard deviations (rmsSD). RESULTS AND CONCLUSIONS SA required manual corrections in 192 of 1257 vertebrae. SA heights were larger than QM ones by 2.2-3.6%. Correlations (r2 > 0.92) between SA and QM were very high. Differences between QM and SA were higher for fractured (SQ = 2; rmsCV% 14.5%) than for unfractured vertebrae (rmsCV% 4.2-4.7%). rmsCV% for QM varied between 3 and 6% and for SA between 2.5 and 7.5%. For SA, highest rmsCV% was obtained for T4 and L4. Manual correction mostly affected the end vertebrae T4 and L4. SA helps to standardize point placement among operators. The algorithm success rate is very good in normal vertebrae but lower in vertebrae with more severe fractures, which are of greater clinical interest but are more readily recognized without morphometric measurements.
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Affiliation(s)
- Klaus Engelke
- Institute of Medical Physics, University of Erlangen, Erlangen, Germany. .,Bioclinica Inc., Kaiser-Wilhelm-Strasse 89, D-20355, Hamburg, Germany. .,Department of Medicine, University Hospital, University of Erlangen-Nürnberg, Erlangen, Germany.
| | - B Stampa
- Bioclinica Inc., Kaiser-Wilhelm-Strasse 89, D-20355, Hamburg, Germany
| | - P Steiger
- PAREXEL International, Waltham, MA, USA
| | - T Fuerst
- Department of Medicine, University Hospital, University of Erlangen-Nürnberg, Erlangen, Germany
| | - H K Genant
- Department of Radiology, University of California, San Francisco, CA, USA
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12
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Kroon FP, van Beest S, Gandjbakhch F, Peterfy CG, Chen S, Conaghan PG, Eshed I, Foltz V, Genant HK, Haugen IK, Medema JK, Østergaard M, Zhang L, Levesque MC, Kloppenburg M. Longitudinal Reliability of the OMERACT Thumb Base Osteoarthritis Magnetic Resonance Imaging Scoring System (TOMS). J Rheumatol 2018; 46:1228-1231. [DOI: 10.3899/jrheum.180949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2018] [Indexed: 11/22/2022]
Abstract
Objective.To assess the longitudinal reliability of the Outcome Measures in Rheumatology (OMERACT) Thumb base Osteoarthritis Magnetic resonance imaging (MRI) Scoring system (TOMS).Methods.Paired MRI of patients with hand osteoarthritis were scored in 2 exercises (6-mo and 2-yr followup) for synovitis, subchondral bone defects (SBD), osteophytes, cartilage assessment, bone marrow lesions (BML), and subluxation. Interreader reliability of delta scores was assessed.Results.Little change occurred. Average-measure intraclass correlation coefficients were good-excellent (≥ 0.71), except synovitis (0.55–0.83) and carpometacarpal-1 osteophytes/cartilage assessment (0.47/0.39). Percentage exact/close agreement was 52–92%/68–100%, except BML in 2 years (28%/64–76%). Smallest detectable change was below the scoring increment, except in SBD and BML.Conclusion.TOMS longitudinal reliability was moderate-good. Limited change hampered assessment.
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Genant HK. Editorial for the clinical paper "Therapeutic effects analysis of percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A multicentre study Huilin Yang et al.". J Orthop Translat 2018; 11:A1. [PMID: 29662772 PMCID: PMC5866405 DOI: 10.1016/j.jot.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Harry K Genant
- Departments of Radiology and Orthopaedic Surgery, University of California at San Francisco (UCSF), San Francisco, CA, USA
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14
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Kroon FPB, Peterfy CG, Conaghan PG, Foltz V, Gandjbakhch F, Eshed I, Genant HK, Østergaard M, Reijnierse M, Bloem JL, Haugen IK, Kloppenburg M. Atlas for the OMERACT thumb base osteoarthritis MRI scoring system (TOMS). RMD Open 2018. [PMID: 29531783 PMCID: PMC5845431 DOI: 10.1136/rmdopen-2017-000583] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This paper presents an atlas for the Outcome Measures in Rheumatology Clinical Trials (OMERACT) thumb base osteoarthritis MRI scoring system (TOMS). The atlas includes reference images of each grade of each feature that is assessed in TOMS (synovitis grade 0–3, subchondral bone defects grade 0–3, osteophytes grade 0–3, cartilage assessment grade 0–3, subluxation and bone marrow lesions grade 0–3) in the first carpometacarpal and scapho-trapezio-trapezoid joint. The presented reference images can be used to guide scoring of thumb base MRIs in patients with hand osteoarthritis according to the OMERACT TOMS.
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Affiliation(s)
- Féline P B Kroon
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and National Institute for Health Research, Leeds Biomedical Research Centre, Leeds, UK
| | - Violaine Foltz
- Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie, Paris, France
| | - Frédérique Gandjbakhch
- Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie, Paris, France
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - Harry K Genant
- Department of Radiology, University of California San Francisco, San Francisco, California, USA.,Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Qin L, Chen CH, Genant HK, Guo XD, Li G, O'Keefe R, Richards RG, Tang TT, Chan KM. The impact of translational orthopaedic research: Journal of Orthopaedic Translation indexed in Science Citation Index Expanded. J Orthop Translat 2018; 12:A1-A2. [PMID: 29662783 PMCID: PMC5866495 DOI: 10.1016/j.jot.2018.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Ling Qin
- Department of Orthopaedics and Traumatology, Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China.,Department of Orthopedics, Taipei Medical University Hospital, College of Medicine, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.,Departments of Radiology, Medicine and Orthopaedic Surgery, University of California at San Francisco (UCSF), San Francisco, CA, USA.,Department of Orthopaedic Surgery, University of California at San Francisco (UCSF), San Francisco, CA, USA.,Biomedical Engineering, Columbia University, New York, NY, USA.,Department of Orthopaedics and Traumatology, Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China.,Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA.,AO Research Institute Davos, Davos, Switzerland.,Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Orthopaedics and Traumatology, Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Chih-Hwa Chen
- Department of Orthopedics, Taipei Medical University Hospital, College of Medicine, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.,Departments of Radiology, Medicine and Orthopaedic Surgery, University of California at San Francisco (UCSF), San Francisco, CA, USA.,Department of Orthopaedic Surgery, University of California at San Francisco (UCSF), San Francisco, CA, USA.,Biomedical Engineering, Columbia University, New York, NY, USA.,Department of Orthopaedics and Traumatology, Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China.,Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA.,AO Research Institute Davos, Davos, Switzerland.,Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Orthopaedics and Traumatology, Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Harry K Genant
- Departments of Radiology, Medicine and Orthopaedic Surgery, University of California at San Francisco (UCSF), San Francisco, CA, USA.,Department of Orthopaedic Surgery, University of California at San Francisco (UCSF), San Francisco, CA, USA.,Biomedical Engineering, Columbia University, New York, NY, USA.,Department of Orthopaedics and Traumatology, Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China.,Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA.,AO Research Institute Davos, Davos, Switzerland.,Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Orthopaedics and Traumatology, Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Xiang-Dong Guo
- Biomedical Engineering, Columbia University, New York, NY, USA.,Department of Orthopaedics and Traumatology, Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China.,Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA.,AO Research Institute Davos, Davos, Switzerland.,Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Orthopaedics and Traumatology, Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Gang Li
- Department of Orthopaedics and Traumatology, Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China.,Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA.,AO Research Institute Davos, Davos, Switzerland.,Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Orthopaedics and Traumatology, Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Regis O'Keefe
- Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA.,AO Research Institute Davos, Davos, Switzerland.,Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Orthopaedics and Traumatology, Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - R Geoff Richards
- AO Research Institute Davos, Davos, Switzerland.,Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Orthopaedics and Traumatology, Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Ting-Ting Tang
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Orthopaedics and Traumatology, Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Kai-Ming Chan
- Department of Orthopaedics and Traumatology, Innovative Orthopaedic Biomaterial and Drug Translational Research Laboratory, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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16
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LeBlanc ES, Rosales AG, Black DM, Genant HK, Dell RM, Friess DM, Boardman DL, Bauer DC, de Papp A, Santora AC, Orwoll ES. Evaluating Atypical Features of Femur Fractures: How Change in Radiological Criteria Influenced Incidence and Demography of Atypical Femur Fractures in a Community Setting. J Bone Miner Res 2017; 32:2304-2314. [PMID: 28731209 DOI: 10.1002/jbmr.3221] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 07/11/2017] [Accepted: 07/13/2017] [Indexed: 11/11/2022]
Abstract
Identification of atypical femoral fractures (AFFs) can be challenging. To assist in the radiological assessment, an American Society for Bone and Mineral Research (ASBMR) Task Force developed a case definition for AFFs in 2010, revising it in 2013. How the revised definition performs in a community setting compared with the 2010 definition is unknown. We applied the 2013 criteria to 372 femoral fractures that occurred between January 1, 1996, and June 30, 2009, employing two independent expert physician reviewers. We used radiographs that had been categorized in a previous study on the incidence of atypical fractures using 2010 ASMBR criteria (BEAK1). In this follow-up study (BEAK2), the same reviewers reviewed all previously identified femoral shaft fractures (FSFs) (n = 197) and distal femur fractures (n = 131) plus a 15% random sample of intertrochanteric fractures (n = 49). After initial review, agreement between the two reviewers ranged from 63% to 100% for specific features, and 84% of radiographs received the same overall classification. Fewer fractures met the 2013 compared with 2010 ASMBR case definition of AFFs (37 per 2013 criteria versus 74 per 2010 criteria). Forty-three radiographs (58%) categorized as AFFs according to 2010 criteria were no longer AFFs when 2013 criteria were applied, and an additional 12 non-atypical FSFs according to 2010 criteria were reclassified as AFFs according to 2013 criteria. The major cause of AFF reclassification was the change in the definition of transverse configuration. The modification of the comminution, non-traumatic, and periosteal/endosteal thickness criteria resulted in the reclassification of non-atypical FSFs to AFFs. Incidence rate of AFFs according to 2013 ASBMR criteria was lower overall during the 13 years of observation than when the 2010 ASBMR criteria were applied, although we saw a slight increase starting in 2000. As in BEAK1, we found that those with AFFs were younger, more often female, and had a higher exposure rate to bisphosphonates than those with non-atypical FSFs. As we continue to unravel the demographics of those who suffer from AFFs, our study adds information about how the change in criteria influences epidemiological work. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Erin S LeBlanc
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - Dennis M Black
- University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Harry K Genant
- University of California San Francisco (UCSF), San Francisco, CA, USA
| | | | - Darin M Friess
- Oregon Health & Science University (OHSU), Portland, OR, USA
| | | | - Douglas C Bauer
- University of California San Francisco (UCSF), San Francisco, CA, USA
| | | | | | - Eric S Orwoll
- Oregon Health & Science University (OHSU), Portland, OR, USA
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17
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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: 245] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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19
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Østergaard M, Peterfy CG, Bird P, Gandjbakhch F, Glinatsi D, Eshed I, Haavardsholm EA, Lillegraven S, Bøyesen P, Ejbjerg B, Foltz V, Emery P, Genant HK, Conaghan PG. The OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging (MRI) Scoring System: Updated Recommendations by the OMERACT MRI in Arthritis Working Group. J Rheumatol 2017; 44:1706-1712. [DOI: 10.3899/jrheum.161433] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2017] [Indexed: 02/08/2023]
Abstract
Objective.The Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis (RA) Magnetic Resonance Imaging (MRI) scoring system (RAMRIS), evaluating bone erosion, bone marrow edema/osteitis, and synovitis, was introduced in 2002, and is now the standard method of objectively quantifying inflammation and damage by MRI in RA trials. The objective of this paper was to identify subsequent advances and based on them, to provide updated recommendations for the RAMRIS.Methods.MRI studies relevant for RAMRIS and technical and scientific advances were analyzed by the OMERACT MRI in Arthritis Working Group, which used these data to provide updated considerations on image acquisition, RAMRIS definitions, and scoring systems for the original and new RA pathologies. Further, a research agenda was outlined.Results.Since 2002, longitudinal studies and clinical trials have documented RAMRIS variables to have face, construct, and criterion validity; high reliability and sensitivity to change; and the ability to discriminate between therapies. This has enabled RAMRIS to demonstrate inhibition of structural damage progression with fewer patients and shorter followup times than has been possible with conventional radiography. Technical improvements, including higher field strengths and improved pulse sequences, allow higher image resolution and contrast-to-noise ratio. These have facilitated development and validation of scoring methods of new pathologies: joint space narrowing and tenosynovitis. These have high reproducibility and moderate sensitivity to change, and can be added to RAMRIS. Combined scores of inflammation or joint damage may increase sensitivity to change and discriminative power. However, this requires further research.Conclusion.Updated 2016 RAMRIS recommendations and a research agenda were developed.
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20
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Cosman F, Krege JH, Looker AC, Schousboe JT, Fan B, Sarafrazi Isfahani N, Shepherd JA, Krohn KD, Steiger P, Wilson KE, Genant HK. Spine fracture prevalence in a nationally representative sample of US women and men aged ≥40 years: results from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. Osteoporos Int 2017; 28:1857-1866. [PMID: 28175980 PMCID: PMC7422504 DOI: 10.1007/s00198-017-3948-9] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/26/2017] [Indexed: 12/13/2022]
Abstract
UNLABELLED Spine fracture prevalence is similar in men and women, increasing from <5 % in those <60 to 11 % in those 70-79 and 18 % in those ≥80 years. Prevalence was higher with age, lower bone mineral density (BMD), and in those meeting criteria for spine imaging. Most subjects with spine fractures were unaware of them. INTRODUCTION Spine fractures have substantial medical significance but are seldom recognized. This study collected contemporary nationally representative spine fracture prevalence data. METHODS Cross-sectional analysis of 3330 US adults aged ≥40 years participating in NHANES 2013-2014 with evaluable Vertebral Fracture Assessment (VFA). VFA was graded by semiquantitative measurement. BMD and an osteoporosis questionnaire were collected. RESULTS Overall spine fracture prevalence was 5.4 % and similar in men and women. Prevalence increased with age from <5 % in those <60 to 11 % in those 70-79 and 18 % in those ≥80 years. Fractures were more common in non-Hispanic whites and in people with lower body mass index and BMD. Among subjects with spine fracture, 26 % met BMD criteria for osteoporosis. Prevalence was higher in subjects who met National Osteoporosis Foundation (NOF) criteria for spine imaging (14 vs 4.7 %, P < 0.001). Only 8 % of people with a spine fracture diagnosed by VFA had a self-reported fracture, and among those who self-reported a spine fracture, only 21 % were diagnosed with fracture by VFA. CONCLUSION Spine fracture prevalence is similar in women and men and increases with age and lower BMD, although most subjects with spine fracture do not meet BMD criteria for osteoporosis. Since most (>90 %) individuals were unaware of their spine fractures, lateral spine imaging is needed to identify these women and men. Spine fracture prevalence was threefold higher in individuals meeting NOF criteria for spine imaging (∼1 in 7 undergoing VFA). Identifying spine fractures as part of comprehensive risk assessment may improve clinical decision making.
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Affiliation(s)
- F Cosman
- Regional Bone Center, Helen Hayes Hospital, Route 9W, West Haverstraw, NY, 10993, USA.
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA.
| | - J H Krege
- Eli Lilly and Company, Indianapolis, IN, USA
| | - A C Looker
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA
| | - J T Schousboe
- HealthPartners Institute and Park Nicollet Clinic, HealthPartners, Minneapolis, MN, USA
| | - B Fan
- Department of Radiology, University of California, San Francisco, CA, USA
| | - N Sarafrazi Isfahani
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA
| | - J A Shepherd
- Department of Radiology, University of California, San Francisco, CA, USA
| | - K D Krohn
- Eli Lilly and Company, Indianapolis, IN, USA
| | - P Steiger
- Parexel International, Waltham, MA, USA
| | | | - H K Genant
- Department of Radiology, University of California, San Francisco, CA, USA
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21
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Kroon FPB, Conaghan PG, Foltz V, Gandjbakhch F, Peterfy C, Eshed I, Genant HK, Østergaard M, Kloppenburg M, Haugen IK. Development and Reliability of the OMERACT Thumb Base Osteoarthritis Magnetic Resonance Imaging Scoring System. J Rheumatol 2017; 44:1694-1698. [PMID: 28250145 DOI: 10.3899/jrheum.161099] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To develop the Outcome Measures in Rheumatology (OMERACT) thumb base osteoarthritis (OA) magnetic resonance imaging (MRI) scoring system (TOMS) for the assessment of inflammatory and structural abnormalities in this hand OA subset, and test its cross-sectional reliability. METHODS Included features and their scaling were agreed upon by members of the OMERACT MRI Task Force using the Hand OA MRI scoring system as a template. A reliability exercise was performed in which 3 readers participated, using a preliminary atlas with examples to facilitate reading. Each reader independently scored a set of 20 MRI (coronal and axial T1- and T2-weighted fat-suppressed images, of which 5 included T1-weighted fat-suppressed post-Gadolinium images). Intra- and inter-reader reliability were assessed using ICC, percentage exact agreement (PEA), and percentage close agreement (PCA). RESULTS The TOMS assessed the first carpometacarpal (CMC-1) and scaphotrapeziotrapezoid (STT) joints for synovitis, subchondral bone defects (including erosions, cysts, and bone attrition), osteophytes, cartilage, and bone marrow lesions on a 0-3 scale (normal to severe). Subluxation was evaluated only in the CMC-1 joint (absent/present). Reliability of scoring for both joints was comparable. Interreader ICC were good for all features (0.77-0.99 and 0.74-0.96 for CMC-1 and STT joints, respectively). Intrareader reliability analyses gave similar results. PCA was ≥ 65% for all features. PEA was low to moderate, with better performance for subchondral bone defects, subluxation, and bone marrow lesions. CONCLUSION A thumb base OA MRI scoring system has been developed. The OMERACT TOMS demonstrated good intrareader and interreader reliability. Longitudinal studies are warranted to investigate reliability of change scores and responsiveness.
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Affiliation(s)
- Féline P B Kroon
- From the Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie, Paris, France; Spire Sciences Inc., Boca Raton, Florida, USA; Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Departments of Radiology and Medicine, University of California San Francisco, San Francisco, California, USA; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. .,F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit; V. Foltz, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; F. Gandjbakhch, MD, Practicing Rheumatologist; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; C. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; I. Eshed, MD, Associate Professor of Radiology, Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University; H.K. Genant, MD, FACR, FRCR, Professor Emeritus of Radiology, Medicine and Orthopedics, Departments of Radiology and Medicine, University of California San Francisco; M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, and Department of Clinical Medicine, University of Copenhagen; M. Kloppenburg, MD, PhD, Professor of Rheumatology, Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center; I.K. Haugen, MD, PhD, Postdoctoral Researcher; Department of Rheumatology, Diakonhjemmet Hospital.
| | - Philip G Conaghan
- From the Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie, Paris, France; Spire Sciences Inc., Boca Raton, Florida, USA; Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Departments of Radiology and Medicine, University of California San Francisco, San Francisco, California, USA; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit; V. Foltz, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; F. Gandjbakhch, MD, Practicing Rheumatologist; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; C. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; I. Eshed, MD, Associate Professor of Radiology, Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University; H.K. Genant, MD, FACR, FRCR, Professor Emeritus of Radiology, Medicine and Orthopedics, Departments of Radiology and Medicine, University of California San Francisco; M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, and Department of Clinical Medicine, University of Copenhagen; M. Kloppenburg, MD, PhD, Professor of Rheumatology, Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center; I.K. Haugen, MD, PhD, Postdoctoral Researcher; Department of Rheumatology, Diakonhjemmet Hospital
| | - Violaine Foltz
- From the Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie, Paris, France; Spire Sciences Inc., Boca Raton, Florida, USA; Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Departments of Radiology and Medicine, University of California San Francisco, San Francisco, California, USA; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit; V. Foltz, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; F. Gandjbakhch, MD, Practicing Rheumatologist; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; C. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; I. Eshed, MD, Associate Professor of Radiology, Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University; H.K. Genant, MD, FACR, FRCR, Professor Emeritus of Radiology, Medicine and Orthopedics, Departments of Radiology and Medicine, University of California San Francisco; M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, and Department of Clinical Medicine, University of Copenhagen; M. Kloppenburg, MD, PhD, Professor of Rheumatology, Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center; I.K. Haugen, MD, PhD, Postdoctoral Researcher; Department of Rheumatology, Diakonhjemmet Hospital
| | - Frédérique Gandjbakhch
- From the Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie, Paris, France; Spire Sciences Inc., Boca Raton, Florida, USA; Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Departments of Radiology and Medicine, University of California San Francisco, San Francisco, California, USA; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit; V. Foltz, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; F. Gandjbakhch, MD, Practicing Rheumatologist; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; C. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; I. Eshed, MD, Associate Professor of Radiology, Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University; H.K. Genant, MD, FACR, FRCR, Professor Emeritus of Radiology, Medicine and Orthopedics, Departments of Radiology and Medicine, University of California San Francisco; M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, and Department of Clinical Medicine, University of Copenhagen; M. Kloppenburg, MD, PhD, Professor of Rheumatology, Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center; I.K. Haugen, MD, PhD, Postdoctoral Researcher; Department of Rheumatology, Diakonhjemmet Hospital
| | - Charles Peterfy
- From the Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie, Paris, France; Spire Sciences Inc., Boca Raton, Florida, USA; Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Departments of Radiology and Medicine, University of California San Francisco, San Francisco, California, USA; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit; V. Foltz, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; F. Gandjbakhch, MD, Practicing Rheumatologist; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; C. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; I. Eshed, MD, Associate Professor of Radiology, Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University; H.K. Genant, MD, FACR, FRCR, Professor Emeritus of Radiology, Medicine and Orthopedics, Departments of Radiology and Medicine, University of California San Francisco; M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, and Department of Clinical Medicine, University of Copenhagen; M. Kloppenburg, MD, PhD, Professor of Rheumatology, Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center; I.K. Haugen, MD, PhD, Postdoctoral Researcher; Department of Rheumatology, Diakonhjemmet Hospital
| | - Iris Eshed
- From the Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie, Paris, France; Spire Sciences Inc., Boca Raton, Florida, USA; Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Departments of Radiology and Medicine, University of California San Francisco, San Francisco, California, USA; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit; V. Foltz, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; F. Gandjbakhch, MD, Practicing Rheumatologist; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; C. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; I. Eshed, MD, Associate Professor of Radiology, Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University; H.K. Genant, MD, FACR, FRCR, Professor Emeritus of Radiology, Medicine and Orthopedics, Departments of Radiology and Medicine, University of California San Francisco; M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, and Department of Clinical Medicine, University of Copenhagen; M. Kloppenburg, MD, PhD, Professor of Rheumatology, Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center; I.K. Haugen, MD, PhD, Postdoctoral Researcher; Department of Rheumatology, Diakonhjemmet Hospital
| | - Harry K Genant
- From the Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie, Paris, France; Spire Sciences Inc., Boca Raton, Florida, USA; Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Departments of Radiology and Medicine, University of California San Francisco, San Francisco, California, USA; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit; V. Foltz, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; F. Gandjbakhch, MD, Practicing Rheumatologist; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; C. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; I. Eshed, MD, Associate Professor of Radiology, Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University; H.K. Genant, MD, FACR, FRCR, Professor Emeritus of Radiology, Medicine and Orthopedics, Departments of Radiology and Medicine, University of California San Francisco; M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, and Department of Clinical Medicine, University of Copenhagen; M. Kloppenburg, MD, PhD, Professor of Rheumatology, Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center; I.K. Haugen, MD, PhD, Postdoctoral Researcher; Department of Rheumatology, Diakonhjemmet Hospital
| | - Mikkel Østergaard
- From the Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie, Paris, France; Spire Sciences Inc., Boca Raton, Florida, USA; Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Departments of Radiology and Medicine, University of California San Francisco, San Francisco, California, USA; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit; V. Foltz, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; F. Gandjbakhch, MD, Practicing Rheumatologist; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; C. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; I. Eshed, MD, Associate Professor of Radiology, Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University; H.K. Genant, MD, FACR, FRCR, Professor Emeritus of Radiology, Medicine and Orthopedics, Departments of Radiology and Medicine, University of California San Francisco; M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, and Department of Clinical Medicine, University of Copenhagen; M. Kloppenburg, MD, PhD, Professor of Rheumatology, Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center; I.K. Haugen, MD, PhD, Postdoctoral Researcher; Department of Rheumatology, Diakonhjemmet Hospital
| | - Margreet Kloppenburg
- From the Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie, Paris, France; Spire Sciences Inc., Boca Raton, Florida, USA; Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Departments of Radiology and Medicine, University of California San Francisco, San Francisco, California, USA; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit; V. Foltz, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; F. Gandjbakhch, MD, Practicing Rheumatologist; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; C. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; I. Eshed, MD, Associate Professor of Radiology, Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University; H.K. Genant, MD, FACR, FRCR, Professor Emeritus of Radiology, Medicine and Orthopedics, Departments of Radiology and Medicine, University of California San Francisco; M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, and Department of Clinical Medicine, University of Copenhagen; M. Kloppenburg, MD, PhD, Professor of Rheumatology, Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center; I.K. Haugen, MD, PhD, Postdoctoral Researcher; Department of Rheumatology, Diakonhjemmet Hospital
| | - Ida K Haugen
- From the Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie, Paris, France; Spire Sciences Inc., Boca Raton, Florida, USA; Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Departments of Radiology and Medicine, University of California San Francisco, San Francisco, California, USA; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,F.P. Kroon, MD, Department of Rheumatology, Leiden University Medical Center; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and National Institute for Health Research, Leeds Musculoskeletal Biomedical Research Unit; V. Foltz, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; F. Gandjbakhch, MD, Practicing Rheumatologist; Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Pierre et Marie Curie; C. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; I. Eshed, MD, Associate Professor of Radiology, Department of Diagnostic Imaging, Sheba Medical Center, Tel Aviv University; H.K. Genant, MD, FACR, FRCR, Professor Emeritus of Radiology, Medicine and Orthopedics, Departments of Radiology and Medicine, University of California San Francisco; M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, and Department of Clinical Medicine, University of Copenhagen; M. Kloppenburg, MD, PhD, Professor of Rheumatology, Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center; I.K. Haugen, MD, PhD, Postdoctoral Researcher; Department of Rheumatology, Diakonhjemmet Hospital
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Genant HK, Engelke K, Bolognese MA, Mautalen C, Brown JP, Recknor C, Goemaere S, Fuerst T, Yang YC, Grauer A, Libanati C. Effects of Romosozumab Compared With Teriparatide on Bone Density and Mass at the Spine and Hip in Postmenopausal Women With Low Bone Mass. J Bone Miner Res 2017; 32:181-187. [PMID: 27487526 DOI: 10.1002/jbmr.2932] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/20/2016] [Accepted: 07/31/2016] [Indexed: 01/17/2023]
Abstract
Romosozumab, a monoclonal antibody that binds sclerostin, has a dual effect on bone by increasing bone formation and reducing bone resorption, and thus has favorable effects in both aspects of bone volume regulation. In a phase 2 study, romosozumab increased areal BMD at the lumbar spine and total hip as measured by DXA compared with placebo, alendronate, and teriparatide in postmenopausal women with low bone mass. In additional analyses from this international, randomized study, we now describe the effect of romosozumab on lumbar spine and hip volumetric BMD (vBMD) and BMC at month 12 as assessed by QCT in the subset of participants receiving placebo, s.c. teriparatide (20 µg once daily), and s.c. romosozumab (210 mg once monthly). QCT measurements were performed at the lumbar spine (mean of L1 and L2 entire vertebral bodies, excluding posterior processes) and hip. One year of treatment with romosozumab significantly increased integral vBMD and BMC at the lumbar spine and total hip from baseline, and compared with placebo and teriparatide (all p < 0.05). Trabecular vertebral vBMD improved significantly and similarly from baseline (p < 0.05) with both romosozumab (18.3%) and teriparatide (20.1%), whereas cortical vertebral vBMD gains were larger with romosozumab compared with teriparatide (13.7% versus 5.7%, p < 0.0001). Trabecular hip vBMD gains were significantly larger with romosozumab than with teriparatide (10.8% versus 4.2%, p = 0.01), but were similar for cortical vBMD (1.1% versus -0.9%, p = 0.12). Cortical BMC gains were larger with romosozumab compared with teriparatide at both the spine (23.3% versus 10.9%, p < 0.0001) and hip (3.4% versus 0.0%, p = 0.03). These improvements are expected to result in strength gains and support the continued clinical investigation of romosozumab as a potential therapy to rapidly reduce fracture risk in ongoing phase 3 studies. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Harry K Genant
- University of California, San Francisco (UCSF), San Francisco, CA, USA.,BioClinica-Synarc, San Francisco, CA, USA
| | - Klaus Engelke
- BioClinica, Hamburg, Germany.,Institute of Medical Physics, University of Erlangen, Erlangen, Germany
| | | | | | - Jacques P Brown
- CHU de Québec Research Centre and Laval University, Québec, QC, Canada
| | | | - Stefan Goemaere
- Department of Endocrinology and Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
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Mohr A, Heiss C, Bergmann I, Schrader C, Roemer FW, Lynch JA, Muhle C, Genant HK, Heller M. Value of micro-CT as an investigative tool for osteochondritis dissecans: A preliminary study with comparison to histology. Acta Radiol 2016; 44:532-7. [PMID: 14510761 DOI: 10.1080/j.1600-0455.2003.00113.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Purpose: To evaluate micro computed tomography (micro-CT) for the assessment of osteochondritis dissecans in comparison with histology. Material and Methods: Osteochondritis dissecans lesions of 3 patients were evaluated using micro-CT (0.125 mA, 40 keV, 60 μm slice thickness, 60 μm isotropic resolution, entire sample) and light microscopy (toluidine blue, 3–5 μm slice thickness). The methods were compared regarding preparation time, detectability of tissue types and morphologic features of bone and cartilage. Results: Non-destructive micro-CT imaging of the entire sample was faster than histologic preparation of a single slice for light microscopy. Morphologic features of bone and cartilage could be imaged in a comparable way to histology. It was not possible to image cells or different tissue types of bone and cartilage with micro-CT. Conclusion: Micro-CT is a fast, non-destructive tool that may be a supplement or, if detailed histologic information is not necessary, an alternative to light microscopy for the investigation of osteochondritis dissecans.
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Affiliation(s)
- A Mohr
- Department of Diagnostic Radiology, Christian-Albrechts-University, Kiel, Germany.
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24
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Takeuchi T, Tanaka Y, Ishiguro N, Yamanaka H, Yoneda T, Ohira T, Okubo N, Genant HK, van der Heijde D. Response to: 'Denosumab, cortical bone and bone erosion in rheumatoid arthritis' by Rossini et al. Ann Rheum Dis 2016; 75:e71. [PMID: 27553215 DOI: 10.1136/annrheumdis-2016-210027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshiyuki Yoneda
- Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | - Harry K Genant
- Departments of Radiology, Medicine and Orthopaedic Surgery, University of California, San Francisco, California, USA
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Jin H, Lu Y, Harris ST, Black DM, Stone K, Hochberg MC, Genant HK. Classification Algorithms for Hip Fracture Prediction Based on Recursive Partitioning Methods. Med Decis Making 2016; 24:386-98. [PMID: 15271277 DOI: 10.1177/0272989x04267009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article presents 2modifications to the classification and regression tree. The authors improved the robustness of a split in the test sample approach and developed a cost-saving classification algorithm by selecting noninferior to the optimum splits from variables with lower cost or being used in parent splits. The new algorithmwas illustrated by 43 predictive variables for 5-year hip fracture previously documented in the Study of Osteoporotic Fractures. The authors generated the robust optimum classification rule without consideration of classification variable costs and then generated an alternative cost-saving rulewith equivalent diagnostic utility. A6-fold cross-validation study proved that the cost-saving alternative classification is statistically noninferior to the optimal one. Their modified classification and regression tree algorithm can be useful in clinical applications. A dual X-ray absorptiometry hip scan and information from clinical examinations can identify subjects with elevated 5-year hip fracture risk without loss of efficiency to more costly and complicated algorithms.
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Affiliation(s)
- Hua Jin
- Department of Radiology University of California, San Francisco 94143-0946, USA
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26
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Zysset P, Pahr D, Engelke K, Genant HK, McClung MR, Kendler DL, Recknor C, Kinzl M, Schwiedrzik J, Museyko O, Wang A, Libanati C. Comparison of proximal femur and vertebral body strength improvements in the FREEDOM trial using an alternative finite element methodology. Bone 2015; 81:122-130. [PMID: 26141837 DOI: 10.1016/j.bone.2015.06.025] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 06/23/2015] [Accepted: 06/29/2015] [Indexed: 01/15/2023]
Abstract
Denosumab reduced the incidence of new fractures in postmenopausal women with osteoporosis by 68% at the spine and 40% at the hip over 36 months compared with placebo in the FREEDOM study. This efficacy was supported by improvements from baseline in vertebral (18.2%) strength in axial compression and femoral (8.6%) strength in sideways fall configuration at 36 months, estimated in Newtons by an established voxel-based finite element (FE) methodology. Since FE analyses rely on the choice of meshes, material properties, and boundary conditions, the aim of this study was to independently confirm and compare the effects of denosumab on vertebral and femoral strength during the FREEDOM trial using an alternative smooth FE methodology. Unlike the previous FE study, effects on femoral strength in physiological stance configuration were also examined. QCT data for the proximal femur and two lumbar vertebrae were analyzed by smooth FE methodology at baseline, 12, 24, and 36 months for 51 treated (denosumab) and 47 control (placebo) subjects. QCT images were segmented and converted into smooth FE models to compute bone strength. L1 and L2 vertebral bodies were virtually loaded in axial compression and the proximal femora in both fall and stance configurations. Denosumab increased vertebral body strength by 10.8%, 14.0%, and 17.4% from baseline at 12, 24, and 36 months, respectively (p<0.0001). Denosumab also increased femoral strength in the fall configuration by 4.3%, 5.1%, and 7.2% from baseline at 12, 24, and 36 months, respectively (p<0.0001). Similar improvements were observed in the stance configuration with increases of 4.2%, 5.2%, and 5.2% from baseline (p≤0.0007). Differences between the increasing strengths with denosumab and the decreasing strengths with placebo were significant starting at 12 months (vertebral and femoral fall) or 24 months (femoral stance). Using an alternative smooth FE methodology, we confirmed the significant improvements in vertebral body and proximal femur strength previously observed with denosumab. Estimated increases in strength with denosumab and decreases with placebo were highly consistent between both FE techniques.
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Affiliation(s)
| | - Dieter Pahr
- Vienna University of Technology, Vienna, Austria
| | - Klaus Engelke
- University of Erlangen, Erlangen, Germany and Synarc Germany, Hamburg, Germany
| | | | | | | | | | | | | | - Oleg Museyko
- University of Erlangen-Nuremberg, Erlangen-Nuremberg, Germany
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Takeuchi T, Tanaka Y, Ishiguro N, Yamanaka H, Yoneda T, Ohira T, Okubo N, Genant HK, van der Heijde D. Effect of denosumab on Japanese patients with rheumatoid arthritis: a dose-response study of AMG 162 (Denosumab) in patients with RheumatoId arthritis on methotrexate to Validate inhibitory effect on bone Erosion (DRIVE)-a 12-month, multicentre, randomised, double-blind, placebo-controlled, phase II clinical trial. Ann Rheum Dis 2015; 75:983-90. [PMID: 26585988 PMCID: PMC4893103 DOI: 10.1136/annrheumdis-2015-208052] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/27/2015] [Indexed: 01/27/2023]
Abstract
Objectives To evaluate efficacy and safety of three different regimens of denosumab, a fully human monoclonal antibody to receptor activator of nuclear factor kappa B (RANK) ligand (RANKL), for Japanese patients with rheumatoid arthritis (RA). Methods In this multicentre, randomised, placebo-controlled phase II study, 350 Japanese patients with RA between 6 months and <5 years, stratified by glucocorticoid use and rheumatoid factor status, were randomly assigned to subcutaneous injections of placebo or denosumab 60 mg every 6 months (Q6M), every 3 months (Q3M) or every 2 months (Q2M). All patients basically continued methotrexate treatment and had a supplement of calcium and vitamin D throughout the study. The primary endpoint was change in the modified Sharp erosion score from baseline to 12 months. Results Denosumab significantly inhibited the progression of bone erosion at 12 months compared with the placebo, and the mean changes of the modified Sharp erosion score at 12 months from baseline were 0.99, 0.27 (compared with placebo, p=0.0082), 0.14 (p=0.0036) and 0.09 (p<0.0001) in the placebo, Q6M, Q3M and Q2M, respectively. Secondary endpoint analysis revealed that denosumab also significantly inhibited the increase of the modified total Sharp score compared with the placebo, with no obvious evidence of an effect on joint space narrowing for denosumab. As shown in previous studies, denosumab increased bone mineral density. No apparent difference was observed in the safety profiles of denosumab and placebo. Conclusions Addition of denosumab to methotrexate has potential as a new therapeutic option for patients with RA with risk factors of joint destruction. Trial registration number JapicCTI-101263.
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Affiliation(s)
- Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Naoki Ishiguro
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshiyuki Yoneda
- Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | | | - Harry K Genant
- Departments of Radiology, Medicine and Orthopaedic Surgery, University of California, San Francisco, California, USA
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Haugen IK, Eshed I, Gandjbakhch F, Foltz V, Østergaard M, Bøyesen P, Bird P, Genant HK, Peterfy CG, Conaghan PG. The Longitudinal Reliability and Responsiveness of the OMERACT Hand Osteoarthritis Magnetic Resonance Imaging Scoring System (HOAMRIS). J Rheumatol 2015; 42:2486-91. [DOI: 10.3899/jrheum.140983] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To evaluate the interreader reliability of change scores and the responsiveness of the OMERACT Hand Osteoarthritis (OA) Magnetic Resonance Image (MRI) Scoring System (HOAMRIS).Methods.Paired MRI (baseline and 5-yr followup) from 20 patients with hand OA were scored with known time sequence by 3 readers according to the HOAMRIS: Synovitis, erosive damage, cysts, osteophytes, cartilage space loss, malalignment, and bone marrow lesions (BML; 0–3 scales with 0.5 increments for synovitis, erosive damage, and BML). Interreader reliability for status and change scores were assessed by intraclass correlation coefficients (ICC), percentage exact agreement and percentage close agreement (PEA/PCA), and smallest detectable change (SDC). Responsiveness was assessed by standardized response means (SRM).Results.Cross-sectional interreader ICC were good to very good (≥ 0.74) for all features except synovitis, cysts, and malalignment (ICC 0.50–0.58). The range of change values was small, leading to low ICC for change scores. The SDC values for sum scores (total range 0–24) varied between 1.97–3.05 (except 1.08 for malalignment). For status scores, PEA/PCA on scores in individual joints across the readers were 8.1–50.0 and 43.8–78.1, respectively. Similarly, PEA/PCA for change scores were 20.6–63.8 and 66.3–93.1, respectively. All features except cysts and BML demonstrated good responsiveness with higher SRM for sum scores (range 0.46–1.62) than for scores in individual joints (range 0.24–0.73).Conclusion.Good to very good interreader ICC values were found for cross-sectional readings, whereas the longitudinal reliability was lower because of a smaller range of change scores. All features, except cysts and BML, showed good responsiveness.
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Østergaard M, Bird P, Gandjbakhch F, Eshed I, Haugen IK, Haavardsholm EA, Lillegraven S, Foltz V, Glinatsi D, Peterfy C, Ejbjerg B, Bøyesen P, Mease PJ, Hermann KG, Emery P, Genant HK, Conaghan PG. The OMERACT MRI in Arthritis Working Group - Update on Status and Future Research Priorities. J Rheumatol 2015; 42:2470-2. [PMID: 25684771 DOI: 10.3899/jrheum.141248] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To provide an update on the status and future research priorities of the Outcome Measures in Rheumatology (OMERACT) magnetic resonance imaging (MRI) in arthritis working group. METHODS A summary is provided of the activities of the group within rheumatoid arthritis (RA), psoriatic arthritis (PsA), and osteoarthritis (OA), and its research priorities. RESULTS The OMERACT RA MRI score (RAMRIS) evaluating bone erosion, bone edema (osteitis), and synovitis is now the standard method of quantifying articular pathology in RA trials. Cartilage loss is another important part of joint damage, and at the OMERACT 12 conference, we provided longitudinal data demonstrating reliability and sensitivity to change of the RAMRIS JSN component score, supporting its use in future clinical trials. The MRI group has previously developed a PsA MRI score (PsAMRIS). At OMERACT 12, PsAMRIS was evaluated in a randomized placebo-controlled trial of patients with PsA, demonstrating the responsiveness and discriminatory ability of applying the PsAMRIS to hands and feet. A hand OA MRI score (HOAMRIS) was introduced at OMERACT 11, and has subsequently been further validated. At OMERACT 12, good cross-sectional interreader reliability, but variable reliability of change scores, were reported. Potential future research areas were identified at the MRI session at OMERACT 12 including assessment of tenosynovitis in RA and enthesitis in PsA and focusing on alternative MRI techniques. CONCLUSION MRI has been further developed and validated as an outcome measure in RA, PsA, and OA. The group will continue its efforts to optimize the value of MRI as a robust biomarker in rheumatology clinical trials.
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Affiliation(s)
- Mikkel Østergaard
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; University of New South Wales, Sydney, Australia; Department of Rheumatology, Pitié-Salpêtrière Hospital, APHP, Université Paris 6-UPMC, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences, Boca Raton, Florida, USA; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark; Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine; and Seattle Rheumatology Associates, Seattle, Washington, USA; Department of Radiology, Charité University Hospital, Berlin, Germany; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; University of California, San Francisco, and Synarc Inc., San Francisco, California, USA. M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital and Department of Clinical Medicine, University of Copenhagen; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Senior Lecturer, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié-Salpêtrière, APHP, Université Paris 6-UPMC; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; I.K. Haugen, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; V. Foltz, MD, Practicing Rheumatologist,
| | - Paul Bird
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; University of New South Wales, Sydney, Australia; Department of Rheumatology, Pitié-Salpêtrière Hospital, APHP, Université Paris 6-UPMC, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences, Boca Raton, Florida, USA; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark; Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine; and Seattle Rheumatology Associates, Seattle, Washington, USA; Department of Radiology, Charité University Hospital, Berlin, Germany; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; University of California, San Francisco, and Synarc Inc., San Francisco, California, USA. M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital and Department of Clinical Medicine, University of Copenhagen; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Senior Lecturer, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié-Salpêtrière, APHP, Université Paris 6-UPMC; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; I.K. Haugen, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; V. Foltz, MD, Practicing Rheumatologist,
| | - Frédérique Gandjbakhch
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; University of New South Wales, Sydney, Australia; Department of Rheumatology, Pitié-Salpêtrière Hospital, APHP, Université Paris 6-UPMC, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences, Boca Raton, Florida, USA; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark; Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine; and Seattle Rheumatology Associates, Seattle, Washington, USA; Department of Radiology, Charité University Hospital, Berlin, Germany; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; University of California, San Francisco, and Synarc Inc., San Francisco, California, USA. M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital and Department of Clinical Medicine, University of Copenhagen; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Senior Lecturer, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié-Salpêtrière, APHP, Université Paris 6-UPMC; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; I.K. Haugen, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; V. Foltz, MD, Practicing Rheumatologist,
| | - Iris Eshed
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; University of New South Wales, Sydney, Australia; Department of Rheumatology, Pitié-Salpêtrière Hospital, APHP, Université Paris 6-UPMC, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences, Boca Raton, Florida, USA; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark; Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine; and Seattle Rheumatology Associates, Seattle, Washington, USA; Department of Radiology, Charité University Hospital, Berlin, Germany; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; University of California, San Francisco, and Synarc Inc., San Francisco, California, USA. M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital and Department of Clinical Medicine, University of Copenhagen; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Senior Lecturer, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié-Salpêtrière, APHP, Université Paris 6-UPMC; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; I.K. Haugen, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; V. Foltz, MD, Practicing Rheumatologist,
| | - Ida K Haugen
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; University of New South Wales, Sydney, Australia; Department of Rheumatology, Pitié-Salpêtrière Hospital, APHP, Université Paris 6-UPMC, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences, Boca Raton, Florida, USA; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark; Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine; and Seattle Rheumatology Associates, Seattle, Washington, USA; Department of Radiology, Charité University Hospital, Berlin, Germany; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; University of California, San Francisco, and Synarc Inc., San Francisco, California, USA. M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital and Department of Clinical Medicine, University of Copenhagen; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Senior Lecturer, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié-Salpêtrière, APHP, Université Paris 6-UPMC; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; I.K. Haugen, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; V. Foltz, MD, Practicing Rheumatologist,
| | - Espen A Haavardsholm
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; University of New South Wales, Sydney, Australia; Department of Rheumatology, Pitié-Salpêtrière Hospital, APHP, Université Paris 6-UPMC, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences, Boca Raton, Florida, USA; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark; Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine; and Seattle Rheumatology Associates, Seattle, Washington, USA; Department of Radiology, Charité University Hospital, Berlin, Germany; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; University of California, San Francisco, and Synarc Inc., San Francisco, California, USA. M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital and Department of Clinical Medicine, University of Copenhagen; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Senior Lecturer, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié-Salpêtrière, APHP, Université Paris 6-UPMC; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; I.K. Haugen, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; V. Foltz, MD, Practicing Rheumatologist,
| | - Siri Lillegraven
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; University of New South Wales, Sydney, Australia; Department of Rheumatology, Pitié-Salpêtrière Hospital, APHP, Université Paris 6-UPMC, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences, Boca Raton, Florida, USA; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark; Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine; and Seattle Rheumatology Associates, Seattle, Washington, USA; Department of Radiology, Charité University Hospital, Berlin, Germany; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; University of California, San Francisco, and Synarc Inc., San Francisco, California, USA. M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital and Department of Clinical Medicine, University of Copenhagen; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Senior Lecturer, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié-Salpêtrière, APHP, Université Paris 6-UPMC; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; I.K. Haugen, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; V. Foltz, MD, Practicing Rheumatologist,
| | - Violaine Foltz
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; University of New South Wales, Sydney, Australia; Department of Rheumatology, Pitié-Salpêtrière Hospital, APHP, Université Paris 6-UPMC, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences, Boca Raton, Florida, USA; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark; Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine; and Seattle Rheumatology Associates, Seattle, Washington, USA; Department of Radiology, Charité University Hospital, Berlin, Germany; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; University of California, San Francisco, and Synarc Inc., San Francisco, California, USA. M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital and Department of Clinical Medicine, University of Copenhagen; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Senior Lecturer, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié-Salpêtrière, APHP, Université Paris 6-UPMC; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; I.K. Haugen, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; V. Foltz, MD, Practicing Rheumatologist,
| | - Daniel Glinatsi
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; University of New South Wales, Sydney, Australia; Department of Rheumatology, Pitié-Salpêtrière Hospital, APHP, Université Paris 6-UPMC, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences, Boca Raton, Florida, USA; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark; Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine; and Seattle Rheumatology Associates, Seattle, Washington, USA; Department of Radiology, Charité University Hospital, Berlin, Germany; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; University of California, San Francisco, and Synarc Inc., San Francisco, California, USA. M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital and Department of Clinical Medicine, University of Copenhagen; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Senior Lecturer, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié-Salpêtrière, APHP, Université Paris 6-UPMC; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; I.K. Haugen, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; V. Foltz, MD, Practicing Rheumatologist,
| | - Charles Peterfy
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; University of New South Wales, Sydney, Australia; Department of Rheumatology, Pitié-Salpêtrière Hospital, APHP, Université Paris 6-UPMC, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences, Boca Raton, Florida, USA; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark; Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine; and Seattle Rheumatology Associates, Seattle, Washington, USA; Department of Radiology, Charité University Hospital, Berlin, Germany; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; University of California, San Francisco, and Synarc Inc., San Francisco, California, USA. M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital and Department of Clinical Medicine, University of Copenhagen; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Senior Lecturer, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié-Salpêtrière, APHP, Université Paris 6-UPMC; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; I.K. Haugen, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; V. Foltz, MD, Practicing Rheumatologist,
| | - Bo Ejbjerg
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; University of New South Wales, Sydney, Australia; Department of Rheumatology, Pitié-Salpêtrière Hospital, APHP, Université Paris 6-UPMC, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences, Boca Raton, Florida, USA; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark; Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine; and Seattle Rheumatology Associates, Seattle, Washington, USA; Department of Radiology, Charité University Hospital, Berlin, Germany; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; University of California, San Francisco, and Synarc Inc., San Francisco, California, USA. M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital and Department of Clinical Medicine, University of Copenhagen; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Senior Lecturer, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié-Salpêtrière, APHP, Université Paris 6-UPMC; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; I.K. Haugen, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; V. Foltz, MD, Practicing Rheumatologist,
| | - Pernille Bøyesen
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; University of New South Wales, Sydney, Australia; Department of Rheumatology, Pitié-Salpêtrière Hospital, APHP, Université Paris 6-UPMC, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences, Boca Raton, Florida, USA; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark; Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine; and Seattle Rheumatology Associates, Seattle, Washington, USA; Department of Radiology, Charité University Hospital, Berlin, Germany; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; University of California, San Francisco, and Synarc Inc., San Francisco, California, USA. M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital and Department of Clinical Medicine, University of Copenhagen; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Senior Lecturer, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié-Salpêtrière, APHP, Université Paris 6-UPMC; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; I.K. Haugen, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; V. Foltz, MD, Practicing Rheumatologist,
| | - Philip J Mease
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; University of New South Wales, Sydney, Australia; Department of Rheumatology, Pitié-Salpêtrière Hospital, APHP, Université Paris 6-UPMC, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences, Boca Raton, Florida, USA; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark; Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine; and Seattle Rheumatology Associates, Seattle, Washington, USA; Department of Radiology, Charité University Hospital, Berlin, Germany; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; University of California, San Francisco, and Synarc Inc., San Francisco, California, USA. M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital and Department of Clinical Medicine, University of Copenhagen; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Senior Lecturer, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié-Salpêtrière, APHP, Université Paris 6-UPMC; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; I.K. Haugen, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; V. Foltz, MD, Practicing Rheumatologist,
| | - Kay-Geert Hermann
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; University of New South Wales, Sydney, Australia; Department of Rheumatology, Pitié-Salpêtrière Hospital, APHP, Université Paris 6-UPMC, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences, Boca Raton, Florida, USA; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark; Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine; and Seattle Rheumatology Associates, Seattle, Washington, USA; Department of Radiology, Charité University Hospital, Berlin, Germany; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; University of California, San Francisco, and Synarc Inc., San Francisco, California, USA. M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital and Department of Clinical Medicine, University of Copenhagen; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Senior Lecturer, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié-Salpêtrière, APHP, Université Paris 6-UPMC; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; I.K. Haugen, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; V. Foltz, MD, Practicing Rheumatologist,
| | - Paul Emery
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; University of New South Wales, Sydney, Australia; Department of Rheumatology, Pitié-Salpêtrière Hospital, APHP, Université Paris 6-UPMC, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences, Boca Raton, Florida, USA; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark; Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine; and Seattle Rheumatology Associates, Seattle, Washington, USA; Department of Radiology, Charité University Hospital, Berlin, Germany; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; University of California, San Francisco, and Synarc Inc., San Francisco, California, USA. M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital and Department of Clinical Medicine, University of Copenhagen; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Senior Lecturer, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié-Salpêtrière, APHP, Université Paris 6-UPMC; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; I.K. Haugen, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; V. Foltz, MD, Practicing Rheumatologist,
| | - Harry K Genant
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; University of New South Wales, Sydney, Australia; Department of Rheumatology, Pitié-Salpêtrière Hospital, APHP, Université Paris 6-UPMC, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences, Boca Raton, Florida, USA; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark; Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine; and Seattle Rheumatology Associates, Seattle, Washington, USA; Department of Radiology, Charité University Hospital, Berlin, Germany; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; University of California, San Francisco, and Synarc Inc., San Francisco, California, USA. M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital and Department of Clinical Medicine, University of Copenhagen; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Senior Lecturer, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié-Salpêtrière, APHP, Université Paris 6-UPMC; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; I.K. Haugen, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; V. Foltz, MD, Practicing Rheumatologist,
| | - Philip G Conaghan
- From the Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; University of New South Wales, Sydney, Australia; Department of Rheumatology, Pitié-Salpêtrière Hospital, APHP, Université Paris 6-UPMC, Paris, France; Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences, Boca Raton, Florida, USA; Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark; Division of Rheumatology Research, Swedish Medical Center, University of Washington School of Medicine; and Seattle Rheumatology Associates, Seattle, Washington, USA; Department of Radiology, Charité University Hospital, Berlin, Germany; Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK; University of California, San Francisco, and Synarc Inc., San Francisco, California, USA. M. Østergaard, MD, PhD, DMSc, Professor of Rheumatology, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Glostrup Hospital and Department of Clinical Medicine, University of Copenhagen; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Senior Lecturer, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Department of Rheumatology, Pitié-Salpêtrière, APHP, Université Paris 6-UPMC; I. Eshed, MD, Professor of Radiology, Sheba Medical Center, Tel Aviv University; I.K. Haugen, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; S. Lillegraven, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital, University of Oslo; V. Foltz, MD, Practicing Rheumatologist,
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Glinatsi D, Lillegraven S, Haavardsholm EA, Eshed I, Conaghan PG, Peterfy C, Gandjbakhch F, Bird P, Bøyesen P, Døhn UM, Genant HK, Østergaard M. Validation of the OMERACT Magnetic Resonance Imaging Joint Space Narrowing Score for the Wrist in a Multireader Longitudinal Trial. J Rheumatol 2015; 42:2480-5. [DOI: 10.3899/jrheum.141009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To assess the intrareader and interreader agreement and sensitivity to change of the Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis Magnetic Resonance Imaging Joint Space Narrowing (RAMRIS-JSN) score in the rheumatoid arthritis (RA) wrist in a longitudinal multireader exercise.MethodsCoronal T1-weighted MR image sets of 1 wrist from 20 patients with early RA were assessed twice for JSN at 17 sites at baseline and after 36 or 60 months by 4 readers blinded to patient data but not time order. The joints were scored 0–4 according to the OMERACT RAMRIS-JSN score. Intraclass correlation coefficients (ICC), smallest detectable change (SDC), percentage exact/close agreement (PEA/PCA), and standardized response mean (SRM) were calculated.Results.Median baseline and change score was 10.3 and 1.9, respectively. Intrareader ICC for baseline and change scores was good (≥ 0.50) to very good (≥ 0.80) for all and 3 of 4 readers, respectively. Interreader ICC was very good for change (0.93), while poor for baseline score if all 4 readers were included (0.36), but very good if 1 reader was excluded (0.87). Intrareader and interreader SDC was low (2.34–3.18), except for the intrareader SDC for 1 reader (6.75). The mean PEA/PCA was high for baseline and change scores both within and between the readers (51.5–99.2), except for interreader baseline PEA (14.4). SRM was moderate for all readers (0.55–0.77).Conclusion.The OMERACT RAMRIS-JSN score showed high overall intrareader and interreader reliability, and moderate sensitivity to change, supporting inclusion of the measure as part of the OMERACT RAMRIS system.
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Engelke K, Fuerst T, Dardzinski B, Kornak J, Ather S, Genant HK, de Papp A. Odanacatib treatment affects trabecular and cortical bone in the femur of postmenopausal women: results of a two-year placebo-controlled trial. J Bone Miner Res 2015; 30:30-8. [PMID: 24898537 DOI: 10.1002/jbmr.2292] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 05/19/2014] [Accepted: 05/28/2014] [Indexed: 01/28/2023]
Abstract
Odanacatib, a selective cathepsin K inhibitor, increases areal bone mineral density (aBMD) at the spine and hip of postmenopausal women. To gain additional insight into the effects on trabecular and cortical bone, we analyzed quantitative computed tomography (QCT) data of postmenopausal women treated with odanacatib using Medical Image Analysis Framework (MIAF; Institute of Medical Physics, University of Erlangen, Erlangen, Germany). This international, randomized, double-blind, placebo-controlled, 2-year, phase 3 trial enrolled 214 postmenopausal women (mean age 64 years) with low aBMD. Subjects were randomized to odanacatib 50 mg weekly (ODN) or placebo (PBO); all participants received calcium and vitamin D. Hip QCT scans at 24 months were available for 158 women (ODN: n = 78 women; PBO: n = 80 women). There were consistent and significant differential treatment effects (ODN-PBO) for total hip integral (5.4%), trabecular volumetric BMD (vBMD) (12.2%), and cortical vBMD (2.5%) at 24 months. There was no significant differential treatment effect on integral bone volume. Results for bone mineral content (BMC) closely matched those for vBMD for integral and trabecular compartments. However, with small but mostly significant differential increases in cortical volume (1.0% to 1.3%) and thickness (1.4% to 1.9%), the percentage cortical BMC increases were numerically larger than those of vBMD. With a total hip BMC differential treatment effect (ODN-PBO) of nearly 1000 mg, the proportions of BMC attributed to cortical gain were 45%, 44%, 52%, and 40% for the total, neck, trochanter, and intertrochanter subregions, respectively. In postmenopausal women treated for 2 years, odanacatib improved integral, trabecular, and cortical vBMD and BMC at all femur regions relative to placebo when assessed by MIAF. Cortical volume and thickness increased significantly in all regions except the femoral neck. The increase in cortical volume and BMC paralleled the increase in cortical vBMD, demonstrating a consistent effect of ODN on cortical bone. Approximately one-half of the absolute BMC gain occurred in cortical bone.
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Affiliation(s)
- Klaus Engelke
- Synarc Inc., Hamburg, Germany; Institute of Medical Physics, University of Erlangen, Erlangen, Germany
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Karsdal MA, Bay-Jensen AC, Henriksen K, Christiansen C, Genant HK, Chamberlain C, Platt A. Rheumatoid arthritis: a case for personalized health care? Arthritis Care Res (Hoboken) 2014; 66:1273-80. [PMID: 24470057 DOI: 10.1002/acr.22289] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 01/14/2014] [Indexed: 12/29/2022]
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Kremer JM, Peterfy C, Russell AS, Emery P, Abud-Mendoza C, Sibilia J, Becker JC, Westhovens R, Genant HK. Longterm safety, efficacy, and inhibition of structural damage progression over 5 years of treatment with abatacept in patients with rheumatoid arthritis in the abatacept in inadequate responders to methotrexate trial. J Rheumatol 2014; 41:1077-87. [PMID: 24786925 DOI: 10.3899/jrheum.130263] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Evaluate the safety and efficacy of longterm abatacept (ABA) treatment over 5 years in methotrexate (MTX)-refractory patients with rheumatoid arthritis (RA). METHODS Patients from the 1-year, double-blind Abatacept in Inadequate Responders to Methotrexate (AIM) study (NCT00048568) received open-label ABA (∼10 mg/kg) in the longterm extension (LTE). Safety was assessed for patients who received ≥ 1 ABA dose, and efficacy for patients randomized to ABA and treated in the LTE. Radiographs were evaluated for changes in Genant-modified Sharp scores. RESULTS Out of 652 patients, 539 entered the LTE (ABA, n = 378; placebo, n = 161). At Year 5, 72.4% were ongoing; discontinuation rates declined over time. Incidence rates of serious adverse events, serious infections, malignancies, and autoimmune events were 13.87, 2.84, 1.45, and 0.99 events/100 patient-years exposure, respectively. American College of Rheumatology 20 response was 82.3% (n = 373) and 83.6% (n = 268) at years 1 and 5, respectively. Disease Activity Score 28 C-reactive protein (DAS28-CRP) < 2.6 and ≤ 3.2 were achieved by 25.4% and 44.1% of patients at Year 1 (n = 370), and 33.7% and 54.7% at Year 5 (n = 267), respectively. Mean changes in DAS28-CRP and Health Assessment Questionnaire-Disability Index at Year 1 [-2.83 (n = 365) and -0.68 (n = 369)] were maintained at Year 5 [-3.14 (n = 264) and -0.77 (n = 271)] for patients continuing treatment. Of them, 59.5% (n = 291) and 45.1% (n = 235) remained free from radiographic progression at years 1 and 5, respectively. CONCLUSION In MTX-refractory patients with RA, longterm ABA treatment was well tolerated and provided consistent safety and sustained efficacy, with high patient retention. Radiographic progression continued to be inhibited with ongoing treatment.
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Affiliation(s)
- Joel M Kremer
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc.
| | - Charles Peterfy
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Anthony S Russell
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Paul Emery
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Carlos Abud-Mendoza
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Jean Sibilia
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Jean-Claude Becker
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Rene Westhovens
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
| | - Harry K Genant
- From the Center for Rheumatology, Albany Medical College, Albany, New York; Spire Sciences Inc., Boca Raton, Florida, USA; Division of Rheumatology, University of Alberta Hospital, Edmonton, Alberta, Canada; Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust, Leeds, UK; Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí, San Luis Potosí, México; Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre, Strasbourg, France; Bristol-Myers Squibb, Princeton, New Jersey, USA; Department of Rheumatology, Universitaire Ziekenhuizenn Leuven, Leuven, Belgium; UCSF/Synarc, San Francisco, California, USA.Professional medical writing and editorial assistance funded by Bristol-Myers Squibb, Princeton, New Jersey, USA, and provided by Eve Guichard BSc (hons) of Caudex Medical, Oxford, UK.J.M. Kremer, MD, Center for Rheumatology, Albany Medical College; C. Peterfy, MD, PhD, FRCPC, Spire Sciences Inc.; A.S. Russell, FRCP, FRCPC, Division of Rheumatology, University of Alberta Hospital; P. Emery, MA, MD, FRCP, FRCPE, Division of Rheumatic and Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust; C. Abud-Mendoza, MD, Regional Unit of Rheumatology, Faculty of Medicine and Central Hospital, University of San Luis Potosí; J. Sibilia, MD, Service de Rhumatologie, CHU de Strasbourg, Hôpital de Hautepierre; J-C. Becker, MD, Bristol-Myers Squibb*; R. Westhovens, MD, Department of Rheumatology, Universitaire Ziekenhuizenn Leuven; H.K. Genant, MD, UCSF/Synarc
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Engelke K, Nagase S, Fuerst T, Small M, Kuwayama T, Deacon S, Eastell R, Genant HK. The effect of the cathepsin K inhibitor ONO-5334 on trabecular and cortical bone in postmenopausal osteoporosis: the OCEAN study. J Bone Miner Res 2014; 29:629-38. [PMID: 24038152 DOI: 10.1002/jbmr.2080] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/02/2013] [Accepted: 08/15/2013] [Indexed: 11/05/2022]
Abstract
ONO-5334 (Ono Pharmaceutical Co., Ltd., Osaka, Japan) inhibits cathepsin K and has been shown to increase areal bone mineral density (BMD) at the hip and spine in postmenopausal osteoporosis. Quantitative computed tomography (QCT) allows the study of the cortical and trabecular bone separately and provides structural information such as cortical thickness. We investigated the impact of 2 years of cathepsin K inhibition on these different bone compartments with ONO-5334. The clinical study was a randomized, double-blind, placebo, and active controlled parallel group study conducted in 13 centers in six European countries. The original study period of 12 months was extended by another 12 months. A total of 147 subjects (age 55-75 years) of the QCT substudy who participated in the extension period were included. Subjects had been randomized into one of five treatment arms: placebo; ONO-5334 50 mg twice per day (BID); ONO-5334 100 mg once daily (QD); ONO-5334 300 mg QD; or alendronate 70 mg once weekly (QW). QCT was obtained to evaluate bone structure at the lumbar spine and proximal femur. After 24 months ONO-5334 showed statistically significant increases versus placebo for integral, trabecular, and cortical BMD at the spine and the hip (for ONO-5334 300 mg QD, BMD increases were 10.5%, 7.1%, and 13.4% for integral, cortical, and trabecular BMD at the spine, respectively, and 6.2%, 3.4%, and 14.6% for integral, cortical, and trabecular total femur BMD, respectively). Changes in cortical and trabecular BMD in the spine and hip were similar for alendronate as for ONO-5334. Integral volume did not demonstrate statistically significant changes under ONO-5334 treatment, thus there was no evidence of periosteal apposition, neither at the spine nor at the femur. Cortical thickness changes were not statistically significant for ONO-5334 in the spine and hip, with exception of a 2.1% increase after month 24 in the intertrochanter for ONO-5334 300 mg QD. Over 2 years ONO-5334 showed a statistically significant and persistent increase of trabecular and integral BMD at the spine and the hip. Cortical BMD also progressively increased but at a lower rate. Changes in bone size and of periosteal apposition were not observed.
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Affiliation(s)
- Klaus Engelke
- Synarc Inc, Hamburg, Germany; Institute of Medical Physics, University of Erlangen, Germany
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Keaveny TM, McClung MR, Genant HK, Zanchetta JR, Kendler D, Brown JP, Goemaere S, Recknor C, Brandi ML, Eastell R, Kopperdahl DL, Engelke K, Fuerst T, Radcliffe HS, Libanati C. Femoral and vertebral strength improvements in postmenopausal women with osteoporosis treated with denosumab. J Bone Miner Res 2014; 29:158-65. [PMID: 23794225 PMCID: PMC4238810 DOI: 10.1002/jbmr.2024] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/30/2013] [Accepted: 06/10/2013] [Indexed: 01/23/2023]
Abstract
In the randomized, placebo-controlled FREEDOM study of women aged 60 to 90 years with postmenopausal osteoporosis, treatment with denosumab once every 6 months for 36 months significantly reduced hip and new vertebral fracture risk by 40% and 68%, respectively. To gain further insight into this efficacy, we performed a nonlinear finite element analysis (FEA) of hip and spine quantitative computed tomography (QCT) scans to estimate hip and spine strength in a subset of FREEDOM subjects (n = 48 placebo; n = 51 denosumab) at baseline, 12, 24, and 36 months. We found that, compared with baseline, the finite element estimates of hip strength increased from 12 months (5.3%; p < 0.0001) and through 36 months (8.6%; p < 0.0001) in the denosumab group. For the placebo group, hip strength did not change at 12 months and decreased at 36 months (-5.6%; p < 0.0001). Similar changes were observed at the spine: strength increased by 18.2% at 36 months for the denosumab group (p < 0.0001) and decreased by -4.2% for the placebo group (p = 0.002). At 36 months, hip and spine strength increased for the denosumab group compared with the placebo group by 14.3% (p < 0.0001) and 22.4% (p < 0.0001), respectively. Further analysis of the finite element models indicated that strength associated with the trabecular bone was lost at the hip and spine in the placebo group, whereas strength associated with both the trabecular and cortical bone improved in the denosumab group. In conclusion, treatment with denosumab increased hip and spine strength as estimated by FEA of QCT scans compared with both baseline and placebo owing to positive treatment effects in both the trabecular and cortical bone compartments. These findings provide insight into the mechanism by which denosumab reduces fracture risk for postmenopausal women with osteoporosis.
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Affiliation(s)
- Tony M Keaveny
- University of California Berkeley, Berkeley, CA, USA; O.N. Diagnostics, Berkeley, CA, USA
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Shane E, Burr D, Abrahamsen B, Adler RA, Brown TD, Cheung AM, Cosman F, Curtis JR, Dell R, Dempster DW, Ebeling PR, Einhorn TA, Genant HK, Geusens P, Klaushofer K, Lane JM, McKiernan F, McKinney R, Ng A, Nieves J, O'Keefe R, Papapoulos S, Howe TS, van der Meulen MCH, Weinstein RS, Whyte MP. Atypical subtrochanteric and diaphyseal femoral fractures: second report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res 2014; 29:1-23. [PMID: 23712442 DOI: 10.1002/jbmr.1998] [Citation(s) in RCA: 959] [Impact Index Per Article: 95.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 05/11/2013] [Accepted: 05/17/2013] [Indexed: 12/13/2022]
Abstract
Bisphosphonates (BPs) and denosumab reduce the risk of spine and nonspine fractures. Atypical femur fractures (AFFs) located in the subtrochanteric region and diaphysis of the femur have been reported in patients taking BPs and in patients on denosumab, but they also occur in patients with no exposure to these drugs. In this report, we review studies on the epidemiology, pathogenesis, and medical management of AFFs, published since 2010. This newer evidence suggests that AFFs are stress or insufficiency fractures. The original case definition was revised to highlight radiographic features that distinguish AFFs from ordinary osteoporotic femoral diaphyseal fractures and to provide guidance on the importance of their transverse orientation. The requirement that fractures be noncomminuted was relaxed to include minimal comminution. The periosteal stress reaction at the fracture site was changed from a minor to a major feature. The association with specific diseases and drug exposures was removed from the minor features, because it was considered that these associations should be sought rather than be included in the case definition. Studies with radiographic review consistently report significant associations between AFFs and BP use, although the strength of associations and magnitude of effect vary. Although the relative risk of patients with AFFs taking BPs is high, the absolute risk of AFFs in patients on BPs is low, ranging from 3.2 to 50 cases per 100,000 person-years. However, long-term use may be associated with higher risk (∼100 per 100,000 person-years). BPs localize in areas that are developing stress fractures; suppression of targeted intracortical remodeling at the site of an AFF could impair the processes by which stress fractures normally heal. When BPs are stopped, risk of an AFF may decline. Lower limb geometry and Asian ethnicity may contribute to the risk of AFFs. There is inconsistent evidence that teriparatide may advance healing of AFFs.
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Døhn UM, Conaghan PG, Eshed I, Boonen A, Boyesen P, Peterfy CG, Lillegraven S, Ejbjerg B, Gandjbakhch F, Bird P, Foltz V, Genant HK, Haavardsholm E, McQueen FM, Østergaard M. The OMERACT-RAMRIS Rheumatoid Arthritis Magnetic Resonance Imaging Joint Space Narrowing Score: Intrareader and Interreader Reliability and Agreement with Computed Tomography and Conventional Radiography. J Rheumatol 2013; 41:392-7. [DOI: 10.3899/jrheum.131087] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To test the intrareader and interreader reliability of assessment of joint space narrowing (JSN) in rheumatoid arthritis (RA) wrist and metacarpophalangeal (MCP) joints on magnetic resonance imaging (MRI) and computed tomography (CT) using the newly proposed OMERACT-RAMRIS JSN scoring method, and to compare JSN assessment on MRI, CT, and radiography.Methods.After calibration of readers, MRI and CT images of the wrist and second to fifth MCP joints from 14 patients with RA and 1 healthy control were assessed twice for JSN by 3 readers, blinded to clinical and imaging data. Radiographs were scored by the Sharp/van der Heijde method. Intraclass correlation coefficients (ICC) and smallest detectable differences (SDD) were calculated, and the performance of various simplified scores was investigated.Results.Both MRI and CT showed high intrareader (ICC ≥ 0.95) and interreader (ICC ≥ 0.94) reliability for total (wrist + MCP) assessment of JSN. Agreement was generally lower for MCP joints than for wrist joints, particularly for CT. Intrareader SDD for MCP/wrist/MCP + wrist were 1.2/6.1/6.4 JSN units for MRI, while 2.7/8.3/9.9 JSN units for CT. JSN on MRI and CT correlated moderately well with corresponding radiographic JSN scores (MCP 2–5: 0.49 and 0.56; wrist areas assessed by Sharp/van der Heijde: 0.80 and 0.95), and high ICC between scores on MRI and CT were demonstrated (MCP: 0.94; wrist: 0.92; MCP + wrist: 0.92).Conclusion.The OMERACT-RAMRIS MRI JSN scoring system showed high intrareader and interreader reliability, and high correlation with CT scores of JSN. The suggested JSN score may, after further validation in longitudinal studies, become a useful tool in RA clinical trials.
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Genant HK, Libanati C, Engelke K, Zanchetta JR, Høiseth A, Yuen CK, Stonkus S, Bolognese MA, Franek E, Fuerst T, Radcliffe HS, McClung MR. Improvements in hip trabecular, subcortical, and cortical density and mass in postmenopausal women with osteoporosis treated with denosumab. Bone 2013; 56:482-8. [PMID: 23871852 DOI: 10.1016/j.bone.2013.07.011] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 05/31/2013] [Accepted: 07/09/2013] [Indexed: 11/22/2022]
Abstract
In the FREEDOM study, denosumab treatment (60 mg every 6 months) decreased bone resorption, increased bone mineral density (BMD), and reduced new vertebral, nonvertebral, and hip fractures over 36 months in postmenopausal women with osteoporosis. In a subset of these women, hip quantitative computed tomography (QCT) was performed at baseline and months 12, 24, and 36. These scans were analyzed using Medical Image Analysis Framework (MIAF) software, which allowed assessment of total hip integral, trabecular, subcortical, and cortical compartments; the cortical compartment was further divided into 2 areas of interest (outer and inner cortex). This substudy reports changes in BMD and bone mineral content (BMC) from baseline and compared placebo with denosumab over 36 months of treatment (placebo N=26; denosumab N=36). Denosumab treatment resulted in significant improvements in total hip integral volumetric BMD (vBMD) and BMC from baseline at each time point. At month 36, the mean percentage increase from baseline in total hip integral vBMD and BMC was 6.4% and 4.8%, respectively (both p<0.0001). These gains were accounted for by significant increases in vBMD and BMC in the trabecular, subcortical, and cortical compartments. In the placebo group, total hip integral vBMD and BMC decreased at month 36 from baseline by -1.5% and -2.6%, respectively (both p<0.05). The differences between denosumab and placebo were also significant at months 12, 24, and 36 for integral, trabecular, subcortical, and cortical vBMD and BMC (all p<0.05 to <0.0001). While the largest percentage differences occurred in trabecular vBMD and BMC, the largest absolute differences occurred in cortical vBMD and BMC. In summary, denosumab significantly improved both vBMD and BMC from baseline and placebo, assessed by QCT MIAF, in the integral, trabecular, subcortical, and cortical hip compartments, all of which are relevant to bone strength.
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Abstract
Based on spiral 3D tomography a large variety of applications have been developed during the last decade to asses bone mineral density, bone macro and micro structure, and bone strength. Quantitative computed tomography (QCT) using clinical whole body scanners provides separate assessment of trabecular, cortical, and subcortical bone mineral density (BMD) and content (BMC) principally in the spine and hip, although the distal forearm can also be assessed. Further bone macrostructure, for example bone geometry or cortical thickness can be quantified. Special high resolution peripheral CT (hr-pQCT) devices have been introduced to measure bone microstructure for example the trabecular architecture or cortical porosity at the distal forearm or tibia. 3D CT is also the basis for finite element analysis (FEA) to determine bone strength. QCT, hr-pQCT, and FEM are increasingly used in research as well as in clinical trials to complement areal BMD measurements obtained by the standard densitometric technique of dual x-ray absorptiometry (DXA). This review explains technical developments and demonstrates how QCT based techniques advanced our understanding of bone biology.
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Affiliation(s)
- K Engelke
- Institute of Medical Physics, University of Erlangen, Henkestr. 91, 91052, Erlangen, Germany,
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Silva Jr. JR, Hayashi D, Yonenaga T, Fukuda K, Genant HK, Lin C, Rahmouni A, Guermazi A. MRI of bone marrow abnormalities in hematological malignancies. Diagn Interv Radiol 2013; 19:393-9. [DOI: 10.5152/dir.2013.067] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
OBJECTIVE Understanding how knee cartilage is affected by osteoarthritis (OA) is critical in the development of sensitive biomarkers that may be used as surrogate endpoints in clinical trials. The objective of this study was to analyze longitudinal changes in cartilage thickness using detailed change maps and to examine if current methods for subregional analysis are able to capture the underlying cartilage changes. MATERIALS AND METHODS MRI images of 267 knees from 135 participants were acquired at baseline and 21-month follow-up and processed using a fully automatic framework for cartilage segmentation and quantification. The framework provides an anatomical coordinate system that allows for direct comparison across cartilage thickness maps. The reproducibility of this method was evaluated on 37 scan-rescan image pairs. RESULTS In OA knees, an annualized thickness loss of 3.7% was observed in the medial femoral cartilage plate (MF) whereas subregional measurements varied between -9.0% (loss) and 1.6%. The largest changes were observed in the posterior part of the MF. In the medial tibial cartilage plate (MT), a thickness increase of 0.4% was observed whereas subregional measurements varied between -0.8% (loss) and 1.6%. In addition, notable differences in the patterns of cartilage change were observed between genders. CONCLUSIONS This study indicated that the spatial changes, although highly heterogeneous, showed distinct patterns of cartilage thinning and cartilage thickening in both the MF and the MT. These patterns were not accurately reflected when thickness changes were averaged over large, predefined subregions as defined in current methods for subregional analysis.
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Affiliation(s)
- Dan R. Jørgensen
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark,Biomediq A/S, Copenhagen, Denmark
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Marques J, Genant HK, Lillholm M, Dam EB. Diagnosis of osteoarthritis and prognosis of tibial cartilage loss by quantification of tibia trabecular bone from MRI. Magn Reson Med 2012; 70:568-75. [PMID: 22941674 DOI: 10.1002/mrm.24477] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 06/26/2012] [Accepted: 08/08/2012] [Indexed: 11/05/2022]
Abstract
A longitudinal study was used to investigate the quantification of osteoarthritis and prediction of tibial cartilage loss by analysis of the tibia trabecular bone from magnetic resonance images of knees. The Kellgren Lawrence (KL) grades were determined by radiologists and the levels of cartilage loss were assessed by a segmentation process. Aiming to quantify and potentially capture the structure of the trabecular bone anatomy, a machine learning approach used a set of texture features for training a classifier to recognize the trabecular bone of a knee with radiographic osteoarthritis. Using cross-validation, the bone structure marker was used to estimate for each knee both the probability of having radiographic osteoarthritis (KL >1) and the probability of rapid cartilage volume loss. The diagnostic ability reached a median area under the receiver-operator-characteristics curve of 0.92 (P < 0.0001), and the prognosis had odds ratio of 3.9 (95% confidence interval: 2.4-6.5). The medians of cartilage loss of the subjects classified as slow and rapid progressors were 1.1% and 4.9% per year, respectively. A preliminary radiological reading of the high and low risk knees put forward an hypothesis of which pathologies the bone marker could be capturing to define the prognosis of cartilage loss.
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Engelke K, Stampa B, Timm W, Dardzinski B, de Papp AE, Genant HK, Fuerst T. Short-term in vivo precision of BMD and parameters of trabecular architecture at the distal forearm and tibia. Osteoporos Int 2012; 23:2151-8. [PMID: 22143491 DOI: 10.1007/s00198-011-1829-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 10/17/2011] [Indexed: 10/15/2022]
Abstract
UNLABELLED In vivo hr-pQCT precision was determined in 42 postmenopausal women using double baseline measurements from a multicenter trial of odanacatib. Errors, e.g., at the radius below 1.3% for BMD and below 6.3% for trabecular structure, were comparable to single-center results. Motion artifacts remain a challenge, particularly at the forearm. INTRODUCTION The short-term in vivo precision of BMD, trabecular bone structure, cortical thickness and porosity of the forearm and tibia was measured by hr-pQCT. Also the effect of image quality on precision was evaluated. METHODS In 42 postmenopausal women (age 64.4 ± 6.8 years) out of 214 subjects enrolled in a multi center advanced imaging phase III study of odanacatib (DXA spine or hip T-scores between -1.5 and -3.5), double baseline hr-pQCT (XtremeCT) measurements with repositioning were performed. The standard ultradistal location and a second, more proximally located VOI were measured at the radius and tibia to better assess cortical thickness and porosity. Image analysis and quality grading (grades: perfect, slight artifacts, pronounced artifacts, unacceptable) were performed centrally. RESULTS At the radius RMS%CV values varied from 0.7% to 1.3% for BMD and BV/TV and from 5.6% to 6.3% for Tb.Sp, Tb.Th, Tb.N, and cortical porosity. Numerically at the tibia, precision errors were approx. 0.5% lower for BMD and 1% to 2% lower for structural parameters although most differences were insignificant. In the radius but not in the tibia, precision errors for cortical thickness were smaller at the distal compared to the ultradistal location (1% versus 2%). CONCLUSIONS BMD precision errors were lower than those for trabecular architecture and cortical porosity. Motion artifacts remain a challenge, particularly at the forearm. Quality grading remains subjective, and more objective evaluation methods are needed. Precision in the context of a multicenter clinical trial, with centralized training and scan analysis, was comparable to single-center results previously reported.
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Affiliation(s)
- K Engelke
- Synarc Inc., Lübecker Strasse 128, Hamburg, Germany.
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Abstract
Tremendous advances have been made over the past several decades in assessing osteoporosis and its complications. High resolution imaging combined with sophisticated computational techniques now provide a detailed analysis of bone structure and a much more accurate prediction of bone strength. These techniques have shown how different mechanisms of age-related bone weakening exist in males and females. Limitations peculiar to these more advanced imaging techniques currently hinder their adoption into mainstream clinical practice. As such, the ultimate quest remains a readily available, safe, high resolution technique capable of fully predicting bone strength, capable of showing how bone strength is faltering and precisely monitoring treatment effect. Whether this technique will be based on acquisition of spine/hip data or data obtained at peripheral sites reflective of changes happening in the spine and hip regions is still not clear. In the meantime, mainstream imaging will continue to improve the detection of osteoporosis related insufficiency fracture in the clinical setting. We, as clinicians, should aim to increase awareness of this fracture type both as a frequent and varied source of pain in patients with osteoporosis and as the ultimate marker of severely impaired bone strength.
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Affiliation(s)
- James F Griffith
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Conaghan PG, McQueen FM, Bird P, Peterfy CG, Haavardsholm EA, Gandjbakhch F, Bøyesen P, Coates L, Ejbjerg B, Eshed I, Foltz V, Hermann KG, Freeston J, Lillegraven S, Lassere M, Wiell C, Anandarajah A, Duer-Jensen A, O'Connor P, Genant HK, Emery P, Ostergaard M. Update on research and future directions of the OMERACT MRI inflammatory arthritis group. J Rheumatol 2012; 38:2031-3. [PMID: 21885512 DOI: 10.3899/jrheum.110419] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The OMERACT Magnetic Resonance Imaging (MRI) Task Force has developed and evolved the psoriatic arthritis MRI score (PsAMRIS) over the last few years, and at OMERACT 10, presented longitudinal evaluation by multiple readers, using PsA datasets obtained from extremity MRI magnets. Further evaluation of this score will require more PsA imaging datasets. As well, due to improved image resolution since the development of the original rheumatoid arthritis MRI scoring system (RAMRIS), the Task Force has worked on semiquantitative assessment of joint space narrowing, and developed a reliable method as a potential RAMRIS addendum, although responsiveness will need to be evaluated. One of the strengths of MRI is the ability to detect subclinical synovitis, so the group worked on obtaining low disease activity/clinical remission datasets from a number of international centers and presented cross-sectional findings. Subsequent longitudinal evaluation of this unique resource will be a major continuing focus for the group.
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Affiliation(s)
- Philip G Conaghan
- Department of Rheumatology, Pitié Salpetrière Hospital, APHP, Université Paris 6-UPMC, Paris, France.
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Liu CT, Karasik D, Zhou Y, Hsu YH, Genant HK, Broe KE, Lang TF, Samelson EJ, Demissie S, Bouxsein ML, Cupples LA, Kiel DP. Heritability of prevalent vertebral fracture and volumetric bone mineral density and geometry at the lumbar spine in three generations of the Framingham study. J Bone Miner Res 2012; 27:954-8. [PMID: 22222934 PMCID: PMC3375687 DOI: 10.1002/jbmr.1537] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Genetic factors likely contribute to the risk for vertebral fractures; however, there are few studies on the genetic contributions to vertebral fracture (VFrx), vertebral volumetric bone mineral density (vBMD), and geometry. Also, the heritability (h(2)) for VFrx and its genetic correlation with phenotypes contributing to VFrx risk have not been established. This study aims to estimate the h(2) of vertebral fracture, vBMD, and cross-sectional area (CSA) derived from quantitative computed tomography (QCT) scans and to estimate the extent to which they share common genetic association in adults of European ancestry from three generations of Framingham Heart Study (FHS) families. Members of the FHS families were assessed for VFrx by lateral radiographs or QCT lateral scout views at 13 vertebral levels (T(4) to L(4)) using Genant's semiquantitative (SQ) scale (grades 0 to 3). Vertebral fracture was defined as having at least 25% reduction in height of any vertebra. We also analyzed QCT scans at the L(3) level for integral (In.BMD) and trabecular (Tb.BMD) vBMD and CSA. Heritability estimates were calculated, and bivariate genetic correlation analysis was performed, adjusting for various covariates. For VFrx, we analyzed 4099 individuals (148 VFrx cases) including 2082 women and 2017 men from three generations. Estimates of crude and multivariable-adjusted h(2) were 0.43 to 0.69 (p < 1.1 × 10(-2)). A total of 3333 individuals including 1737 men and 1596 women from two generations had VFrx status and QCT-derived vBMD and CSA information. Estimates of crude and multivariable-adjusted h(2) for vBMD and CSA ranged from 0.27 to 0.51. In a bivariate analysis, there was a moderate genetic correlation between VFrx and multivariable-adjusted In.BMD (-0.22) and Tb.BMD (-0.29). Our study suggests vertebral fracture, vertebral vBMD, and CSA in adults of European ancestry are heritable, underscoring the importance of further work to identify the specific variants underlying genetic susceptibility to vertebral fracture, bone density, and geometry.
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Affiliation(s)
- Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
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Zhu HM, Qin L, Garnero P, Genant HK, Zhang G, Dai K, Yao X, Gu G, Hao Y, Li Z, Zhao Y, Li W, Yang J, Zhao X, Shi D, Fuerst T, Lu Y, Li H, Zhang X, Li C, Zhao J, Wu Q, Zhao SJ. The first multicenter and randomized clinical trial of herbal Fufang for treatment of postmenopausal osteoporosis. Osteoporos Int 2012; 23:1317-27. [PMID: 21505910 DOI: 10.1007/s00198-011-1577-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 01/22/2011] [Indexed: 10/18/2022]
Abstract
UNLABELLED This multicenter and randomized clinical trial showed that daily oral herbal formula Xian Ling Gu Bao (XLGB) was safe in postmenopausal women over a 1-year treatment. Those patients (n ∼ 50) treated with XLGB at the conventional dose demonstrated a statistically significant increase in dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD) at lumbar spine at 6 months and a numerically increased BMD at 12 months. INTRODUCTION The aim of this study was to examine the safety and efficacy of a herbal formula XLGB in postmenopausal women (ChiCTR-TRC-00000347). METHODS One hundred eighty healthy postmenopausal women (≥60 years old) with BMD T-score ≤ -2.0 (lumbar spine or femoral neck) were recruited from four clinical centers to receive low-dose (conventional dose) XLGB (L-XLGB group, 3 g/day, n = 61) or high-dose XLGB (H-XLGB group, 6 g/day, n = 58) or placebo (CON group, n = 61). Women received daily calcium (500 mg) and vitamin D (200 IU) supplementation. Primary endpoints were lumbar spine BMD and safety; secondary endpoints were femoral neck BMD and bone turnover markers measured at baseline and at 6 and 12 months. RESULTS Of 180 women recruited, 148 completed the study. The compliance in each group was comparable. Prominent adverse events were not observed in either group. In the L-XLGB group at 6 months, lumbar spine BMD by DXA increased significantly from baseline (+2.11% versus CON +0.58%, p < 0.05), but femoral neck BMD did not; at 12 months, BMD in the L-XLGB group decreased from 6-month levels yet remained higher than baseline, but without difference from the CON group. There was no dose-dependent response. Bone turnover marker levels declined during the first 6 months after XLGB treatment. There was no significant difference in the overall incidence of side effects among treatment and control groups. CONCLUSION XLGB over 1-year treatment at the conventional dose demonstrated safe and only a statistically significant increase in BMD at lumbar spine at 6 months in postmenopausal women.
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Affiliation(s)
- H M Zhu
- Centre of Osteoporosis, Shanghai Hua Dong Hospital, Fu Dan University, Shanghai, China.
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48
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Fitzpatrick LA, Dabrowski CE, Cicconetti G, Gordon DN, Fuerst T, Engelke K, Genant HK. Ronacaleret, a calcium-sensing receptor antagonist, increases trabecular but not cortical bone in postmenopausal women. J Bone Miner Res 2012; 27:255-62. [PMID: 22052452 DOI: 10.1002/jbmr.554] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Intermittent injections of parathyroid hormone have osteoanabolic effects that increase bone mineral density (BMD). Ronacaleret is an orally administered calcium-sensing receptor antagonist that stimulates endogenous parathyroid hormone release from the parathyroid glands. Our objective was to compare the effects of ronacaleret and teriparatide on volumetric BMD (vBMD) measured by quantitative computed tomography (QCT). We conducted a randomized, placebo-controlled, dose-ranging trial at 45 academic centers with 31 sites participating in the substudy. Patients included 569 postmenopausal women with low bone mineral density; vBMD was assessed at the spine and hip in a subset of 314 women. Patients were treated for up to 12 months with open-label teriparatide 20 µg subcutaneously once daily or randomly assigned in a double-blind manner to ronacaleret 100 mg, 200 mg, 300 mg, or 400 mg once daily, alendronate 70 mg once weekly, or matching placebos. Ronacaleret increased spine integral (0.49% to 3.9%) and trabecular (1.8% to 13.3%) vBMD compared with baseline, although the increments were at least twofold lower than that attained with teriparatide (14.8% and 24.4%, respectively) but similar or superior to that attained with alendronate (5.0% and 4.9%, respectively). There were small non-dose-dependent decreases in integral vBMD of the proximal femur with ronacaleret (-0.1 to -0.8%) compared with increases in the teriparatide (3.9%) and alendronate (2.7%) arms. Parathyroid hormone (PTH) elevations with ronacaleret were prolonged relative to that seen historically with teriparatide. Ronacaleret preferentially increased vBMD of trabecular bone that is counterbalanced by small decreases in BMD at cortical sites. The relative preservation of trabecular bone and loss at cortical sites are consistent with the induction of mild hyperparathyroidism with ronacaleret therapy.
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Genant HK, Lewiecki EM, Fuerst T, Fries M. Effect of monthly ibandronate on hip structural geometry in men with low bone density. Osteoporos Int 2012; 23:257-65. [PMID: 21811866 DOI: 10.1007/s00198-011-1732-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 06/07/2011] [Indexed: 12/12/2022]
Abstract
UNLABELLED Hip structural analysis (HSA) performed in a subset of participants from the STudy Researching Osteoporosis iN Guys (STRONG) demonstrated that 1 year of ibandronate treatment was associated with a significant improvement in some but not all parameters of hip geometry relative to placebo in men with low bone density. INTRODUCTION HSA was performed on dual-energy X-ray absorptiometry (DXA) images in a subset of participants from the STRONG to examine the impact of monthly ibandronate on geometric properties of the hip in men with low bone density. METHODS This prespecified subgroup analysis evaluated men in the intent-to-treat population of STRONG with baseline and 12-month DXA data. Cross-sectional geometric parameters of the femoral shaft (FS), intertrochanter region (IT), and narrow neck (NN) were calculated from femoral DXA scans. All analyses were exploratory. Treatment differences were evaluated using analysis of covariance, which adjusted for baseline parameter value, testosterone level, and treatment. RESULTS HSA was performed on DXA scans from 89 men (34 placebo; 55 monthly ibandronate). Significant increases in average cortical thickness and cross-sectional area and decreases (i.e., improvements) in the buckling ratio were observed at the FS and IT at 12 months for ibandronate-treated men compared with placebo-treated men. No significant differences were observed between ibandronate and placebo for any NN HSA parameters. CONCLUSIONS One year of ibandronate treatment was associated with a significant improvement in some but not all parameters of hip geometry relative to placebo in men with low bone density, suggesting that ibandronate may improve resistance to axial compressive forces and bending forces at the hip.
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Affiliation(s)
- H K Genant
- Radiology, Orthopaedic Surgery, Medicine and Epidemiology, University of California San Francisco, San Francisco, CA 94143-1250, USA.
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50
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Kremer JM, Russell AS, Emery P, Abud-Mendoza C, Szechinski J, Westhovens R, Li T, Zhou X, Becker JC, Aranda R, Peterfy C, Genant HK. Long-term safety, efficacy and inhibition of radiographic progression with abatacept treatment in patients with rheumatoid arthritis and an inadequate response to methotrexate: 3-year results from the AIM trial. Ann Rheum Dis 2011; 70:1826-30. [PMID: 21893583 PMCID: PMC3171107 DOI: 10.1136/ard.2010.139345] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective To evaluate abatacept treatment over 3 years in patients with rheumatoid arthritis (RA) refractory to methotrexate (MTX). Methods Patients randomised to abatacept or placebo (+MTX) during the 1-year double-blind period of the Abatacept in Inadequate responders to Methotrexate (AIM) trial received open-label abatacept (+MTX) in the long-term extension (LTE). Safety was assessed for patients who received ≥1 dose of abatacept, regardless of randomisation group. Efficacy was assessed for patients randomised to abatacept who entered the LTE. Results 433 and 219 patients were randomised and treated with abatacept or placebo, respectively; 378 and 161 entered the LTE. At year 3, 440/539 patients were ongoing. No unexpected safety events were observed in the LTE. By year 3, incidence rates of adverse event and serious adverse events were 249.8/100 and 15.1/100 patient-years, respectively. Incidence rates were generally stable over time. At year 3, 84.8%, 63.4% and 37.5% of patients achieved American College of Rheumatology (ACR) criteria of 20, 50 and 70, respectively, compared with 82.3%, 54.3% and 32.4% of patients at year 1. Mean changes in Genant-modified Sharp scores were reduced progressively over 3 years, with significantly greater inhibition during year 3 compared with year 2 (p=0.022 for total score). Conclusion In MTX-inadequate responders with RA, abatacept provided consistent safety and sustained efficacy over 3 years. The data suggest an increasing inhibitory disease-modifying effect on radiographic progression.
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Affiliation(s)
- Joel M Kremer
- Center for Rheumatology, Albany Medical College, 1367 Washington Ave, Albany, NY 12206, USA.
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