Added Value of Impact Microindentation in the Evaluation of Bone Fragility: A Systematic Review of the Literature

Schoeb, Manuela; Hamdy, Neveen A. T.; Malgo, F.; Winter, Elizabeth M.; Appelman‐Dijkstra, Natasha M.

doi:10.3389/fendo.2020.00015

Cited by 34 publications

(33 citation statements)

References 76 publications

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“…Additionally, advances in impact microindentation (IMI) technology have enabled in vivo assessment of bone material strength index (BMSi), at the tibial diaphysis, reflecting primarily cortical bone properties. A systematic review including 38 studies showed that IMI is a promising tool for identification of individuals with primary osteoporosis and fractures, and with secondary osteoporosis due to various underlying systemic disorders 9 Accumulation of advanced glycation end products (AGEs) have been proposed to affect bone quality in subjects with diabetes 3,10 . Pentosidine is a biomarker for AGEs that has been reported to increase over the course of diabetes 11 , and serum levels correlate with prevalent fractures in those with T1D 12,13 .…”

Section: Introductionmentioning

confidence: 99%

Evidence of impaired bone quality in men with type 1 diabetes: a cross-sectional study

Syversen

Mosti

Mynarek

et al. 2021

Endocrine Connections

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Objective: Type 1 diabetes (T1D) is associated with a substantial fracture risk. Bone mineral density (BMD) is, however, only modestly reduced, suggesting impaired bone microarchitecture and/or bone material properties. Yet, the skeletal abnormalities have, however, not been uncovered. Men with TID seem to experience a more pronounced bone loss than their female counterparts. Hence, we aimed to examine different aspects of bone quality in men with T1D. Design and Methods: In this cross-sectional study, men with T1D and healthy, male controls were enrolled. BMD (femoral neck, total hip, lumbar spine, whole body), and spine trabecular bone score (TBS) were measured by dual x-ray absorptiometry, and bone material strength index (BMSi) by in vivo impact microindentation. HbA1c and bone turnover markers were analyzed. Results: Altogether, 33 men with T1D (43 ± 12 yrs) and 28 healthy male controls (42 ± 12 yrs) were included. Subjects with T1D exhibited lower whole body BMD than controls (p=0.04). TBS and BMSi were attenuated in men with T1D vs. controls (p=0.016 and p=0.004, respectively), and T1D subjects also had lower bone turnover. vs. controls. The bone parameters did not differ between subjects with or without diabetic complications. Duration of disease correlated negatively with femoral neck BMD, but not with TBS or BMSi. Conclusions: This study revealed compromised bone material strength and microarchitecture in men with T1D. Moreover, we confirm previous studies showing a modest decrease in BMD and low bone turnover in subjects with T1D, underscoring that bone should be recognized as a target of diabetic complications.

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Section: Introductionmentioning

confidence: 99%

Evidence of impaired bone quality in men with type 1 diabetes: a cross-sectional study

Syversen

Mosti

Mynarek

et al. 2021

Endocrine Connections

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“…However, baseline characteristics of patients who had a baseline measurement but were not included in the study did not differ from those of patients reported here and treatment protocols were the same. Moreover, all measurements were performed by two experienced investigators that minimized intra-and interobserver variability, a known limitation of the application of IMI technique [1,2,6].…”

Section: Discussionmentioning

confidence: 99%

“…Impact microindentation (IMI), a method to assess tissue-level properties of cortical bone in vivo [1,2], is being increasingly used in studies evaluating the contribution of such properties to bone fragility in humans [3][4][5][6]. The resistance of cortical bone to indentation, measured as bone material strength index (BMSi), was decreased in individuals with fragility fractures compared with appropriate controls in several studies [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Treatments of osteoporosis increase bone material strength index in patients with low bone mass

et al. 2020

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Effects on bone material properties of two-year antiosteoporotic treatment were assessed using in vivo impact microindentation (IMI) in patients with low bone mineral density (BMD) values. Antiresorptive treatment, in contrast to vitamin D ± calcium treatment alone, induced BMD-independent increases in bone material strength index, measured by IMI, the magnitude of which depended on pretreatment values. Introduction Bone material strength index (BMSi), measured by IMI in vivo, is reduced in patients with fragility fractures, but there is no information about changes in values during long-term therapy. In the present study, we assessed changes in BMSi in patients receiving antiosteoporotic treatments for periods longer than 12 months. Methods We included treatment-naive patients with low bone mass who had a BMSi measurement with OsteoProbe® at presentation and consented to a repeat measurement after treatment. Results We studied 54 patients (34 women), median age 58 years, of whom 30 were treated with bisphosphonates or denosumab (treatment group) and 24 with vitamin D ± calcium alone (control group). There were no differences in clinical characteristics between the two groups with the exception of a higher number of previous fragility fractures in the treatment group. Baseline hip BMD and BMSi values were lower in the treatment group. After 23.1 ± 6.6 months, BMSi increased significantly in the treatment group (82.4 ± 4.3 vs 79.3 ± 4.1; p < 0.001), but did not change in the control group (81.5 ± 5.2 vs 82.2 ± 4.1; p = 0.35). Changes in BMSi with antiresorptives were inversely related with baseline values (r = − 0.43; p = 0.02) but not with changes in BMD. Two patients in the control group with large decreases in BMSi values sustained incident fractures. Conclusion In patients at increased fracture risk, antiresorptive treatments induced BMD-independent increases in BMSi values, the magnitude of which depended on pretreatment values.

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“…These time-varying risk factors include bone mineral density (including initiation of medications that may lower BMD) and fall risk (including initiation of medications that may increase fall risk) [ 55 , 57 ]. In general, we lack validated predictive markers of fracture risk for treated patients, yet biochemical markers currently being explored to predict fracture risk that may be extrapolated to those on a drug holiday include high-resolution peripheral quantitative computerized tomography, trabecular bone scores, and impact microindentation [ 58 ].…”

Section: Bisphosphonate Drug Holiday Duration: Considerationsmentioning

confidence: 99%

Duration of Bisphosphonate Drug Holidays in Osteoporosis Patients: A Narrative Review of the Evidence and Considerations for Decision-Making

Hayes

Winter

Cadarette

et al. 2021

JCM

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Bisphosphonates are first-line therapy for osteoporosis, with alendronate, risedronate, and zoledronate as the main treatments used globally. After one year of therapy, bisphosphonates are retained in bone for extended periods with extended anti-fracture effects after discontinuation. Due to this continued fracture protection and the potential for rare adverse events associated with long-term use (atypical femoral fractures and osteonecrosis of the jaw), a drug holiday of two to three years is recommended for most patients after long-term bisphosphonate therapy. The recommendation for a drug holiday up to three years is derived primarily from extensions of pivotal trials with alendronate and zoledronate and select surrogate marker studies. However, certain factors may modify the duration of bisphosphonate effects on a drug holiday and warrant consideration when determining an appropriate time off-therapy. In this narrative review, we recall what is currently known about drug holidays and discuss what we believe to be the primary considerations and areas for future research regarding drug holiday duration: total bisphosphonate exposure, type of bisphosphonate used, bone mineral density and falls risk, and patient sex and body weight.

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Added Value of Impact Microindentation in the Evaluation of Bone Fragility: A Systematic Review of the Literature

Cited by 34 publications

References 76 publications

Evidence of impaired bone quality in men with type 1 diabetes: a cross-sectional study

Evidence of impaired bone quality in men with type 1 diabetes: a cross-sectional study

Treatments of osteoporosis increase bone material strength index in patients with low bone mass

Duration of Bisphosphonate Drug Holidays in Osteoporosis Patients: A Narrative Review of the Evidence and Considerations for Decision-Making

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