Relationship of bone turnover to density and fractures

relationship of bone turnover to density and fractures

Bone turnover, bone mineral density, and fracture risk in acromegaly: P relationship with male gender, hypogonadism, and. Abstract We analyzed the relationships between bone mineral density (BMD) or bone turnover marker (BTM) changes and vertebral fracture. Relationship between Bone Mineral Density Changes and Fracture Risk Reduction The Journal of Clinical Endocrinology & Metabolism, Volume 92, Issue 8.

The design and methodology of these two studies were fully described in previous reports 9 Briefly, postmenopausal outpatients were recruited in 11 European countries and in Australia in two prospective, randomized, double-blind, placebo-controlled trials, i.

Relationship of bone turnover to bone density and fractures.

Women were eligible for the SOTI study if they were at least 50 yr old, had been postmenopausal for at least 5 yr, had at least one prevalent vertebral fracture confirmed by spinal radiography, and had a lumbar spine BMD of 0.

Calcium and vitamin D supplementation was prescribed throughout the studies with the dosage determined during a run-in period. All participants gave written informed consent before enrollment, and the appropriate institutional review boards approved these two studies. All the scans were analyzed centrally, and the femoral neck, total proximal femur, and spine BMD T-scores were calculated according to the centralized European normative data D. A quality control program including daily quality controls was conducted throughout the studies Coefficients of variation for in vivo DXA measurements were 1.

relationship of bone turnover to density and fractures

Vertebral fractures were assessed by the same team in a central facility throughout the 3-yr studies C. Fetchenbaum, Paris, Franceusing a semiquantitative visual assessment of each vertebra, from T4 to L4 21 L5 vertebra was assessed as fractured or not fractured The semiquantitative grading scale was as follows: A new fracture was defined by a change in the score of a vertebra from grade 0 to grade 1 or more.

A clinical vertebral fracture was defined as a new fracture semiquantitative assessment with either the presence of back pain or a body height loss of at least 1 cm.

Only documented nonvertebral fractures were taken into account in the statistical analysis. Fractures of the coccyx, skull, jaw, face, phalanx fingers and toesand ankle were not regarded as being related to osteoporosis and were not considered.

Statistical analysis Patients were included in this particular analysis only if they had vertebral x-rays and spine BMD performed at baseline and after 1 yr and 3 yr, independent of drug compliance.

Bone turnover, bone mineral density, and fracture risk in acromegaly: a meta-analysis.

A total of patients from the strontium ranelate group and from the placebo group met these inclusion criteria. The association between changes in BMD and fracture incidence vertebral and nonvertebral was assessed only in the strontium ranelate-treated patients through a logistic regression analysis with age, body mass index, number of prevalent vertebral fractures, and baseline BMD as covariates.

The Mann-Whitney test was used to compare the changes in BMD after strontium ranelate treatment in patients with and without new fractures. We also assessed the risk of sustaining at least one new fracture in different groups stratified for different BMD changes i.

Bone turnover, bone mineral density, and fracture risk in acromegaly: a meta-analysis.

We also performed the analysis with the absolute changes in BMD, using the individual smallest detectable difference as a reference Acromegaly patients had higher bone formation SMD, 1. Patients with acromegaly had high frequency of vertebral fractures odds ratio, 8. Limitations included heterogeneous study protocols with possible variability in the assessment of skeletal end-points.

relationship of bone turnover to density and fractures

Skeletal fragility is an emerging complication of acromegaly. GH and IGF-I are important anabolic hormones for bone because they enhance the differentiated function of osteoblasts and stimulate bone formation 1. Both GH deficiency and acromegaly are traditionally considered to cause abnormalities of bone remodeling. Patients with GH deficiency have low bone turnover osteoporosis 2whereas patients with acromegaly were shown to have an increase in bone turnover and negative calcium balance 13.

After the first evidence that acromegaly may cause abnormalities of calcium homeostasis and bone remodeling 4subsequent histomorphometrical investigations confirmed that GH excess may stimulate bone turnover, but the consequences in terms of skeletal fragility have long been uncertain 56.

In fact, data on bone mineral density BMD were conflicting because some studies reported increased BMD in patients with acromegaly 7 — 9some observed reduced BMD 1011and others did not find any difference in BMD between acromegaly patients and healthy subjects 12 — As a matter of fact, some authors hypothesized a possible protective effect of GH excess on the skeleton 5 However, in recent years, several studies provided convincing evidence that patients with acromegaly may have skeletal fragility with high prevalence and incidence of vertebral fractures 16 — 26even in patients with normal BMD 171820 This latter finding was similar to that observed in other forms of secondary osteoporosis Indeed, the current guidelines recommend investigating the presence of vertebral fractures by a spine x-ray, whereas the clinical relevance of BMD measures in this clinical setting have been critically revisited 28 — Limitations of all studies so far published in the field concern the study design mainly cross-sectionalthe number of patients enrolled, and the differences in study protocols all the parameters of bone health such as bone turnover, BMD, and fractures were rarely assessed together in the same patient.

relationship of bone turnover to density and fractures

To overcome the above-mentioned limitations, we have conducted a systematic review and meta-analysis of clinical studies examining the effects of acromegaly on relevant parameters of bone health. As a secondary objective, we evaluated the effects of sex, gonadal status, and disease activity in terms of skeletal fragility in acromegaly patients.

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Materials and Methods Types of studies The searches were designed to select studies with a prospective or retrospective design conducted in patients with acromegaly and reporting at least one of the following determinants of skeletal fragility: Bone turnover measures of formation serum osteocalcin, bone-specific alkaline phosphatase, and procollagen type 1 amino-terminal propeptide and resorption C-terminal telopeptide of type 1 collagen, urinary hydroxyproline, pyridinoline, and deoxypyridinoline.