Current methods and recent advances in the diagnosis of osteoporosis

Jergas, M.; Genant, Harry K.

doi:10.1002/art.1780361203

Cited by 72 publications

(23 citation statements)

References 117 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…17 DXA permits BMD measurement at sites in the skeleton vulnerable to fractures, such as the lumbar spine, femoral neck, and wrist as well as providing a whole body measurements. It also allows regions of interest to be defined, so that the BMD of focal areas within the skeleton can be assessed 18.…”

Section: Discussionmentioning

confidence: 99%

Changes in bone mineral density in patients with Paget's disease treated with risedronate

Patel

Pearson

Bhallah

et al. 1997

Annals of the Rheumatic Diseases

View full text Add to dashboard Cite

Objectives-To study changes in bone mineral density (BMD) in patients with Paget's disease of bone treated with risedronate. Methods-Whole body dual energy x ray absorptiometry (DXA) scans were carried out on 20 patients with Paget's disease treated with oral risedronate. DXA scanning was carried out at baseline and 11 months. Whole body bone mineral content (BMC) was measured. In addition, regions of interest were drawn around the skull, individual lumbar vertebrae, hemipelvis, femora, and tibiae to obtain BMD for these sites. An uncoupling index was also calculated as the area under the curve for serum alkaline phosphatase (ALP) divided by the area under the curve for hydroxyproline excretion (HYPRO) for the period of treatment. Results-Median whole body BMC increased from 3057 g to 3156 g (p < 0.001) resulting from an increase in pagetic and non-pagetic BMD. From the analysis of regions of interest it was found that pagetic trabecular bone showed the largest increase in BMD. The pretreatment HYPRO and the uncoupling index were significantly related to the change in BMD for all pagetic sites for a patient (r = 0.65 , p < 0.01 and r = 0.57, p < 0.05 respectively). Conclusion-Bisphosphonate treatment of Paget's disease results in an increase in BMD of pagetic bone without redistribution of mineral from non-pagetic bone. The remodelling space and extent of uncoupling are significantly related to increases in BMD at pagetic sites. (Ann Rheum Dis 1997;56:405-409) Bisphosphonates are now widely used in the treatment of a variety of bone diseases.1-3 Current evidence suggests a dual mode of action, with a direct inhibitory eVect on osteoclasts 4 5 as well as an indirect inhibitory eVect via osteoblasts.6 7 As a result of inhibition of osteoclastic activity, both the temporal relation between bone resorption and formation, as well as the volume of the remodelling space, are transiently shifted in favour of formation. These eVects would be expected to increase bone mineral density (BMD), the magnitude of the increase in BMD being related to the change in bone turnover. These mechanisms are the basis of the use of bisphosphonates in the treatment of osteoporosis. 8-10Paget's disease of bone is characterised by increased bone turnover, often at multiple skeletal sites. The primary abnormality is believed to be that of increased osteoclastic resorption with a secondary eVect on bone formation.11 Despite this increased rate of remodelling the normal coupling between bone resorption and formation remains intact, 12 13 although the remodelling space is increased. It would be predicted that bisphosphonate treatment of Paget's disease would increase bone mass by decreasing bone resorption and the resorption space, 13 although there is a surprising lack of data. In this paper we report our measurements of bone density using dual energy x ray absorptiometry (DXA), before and after treatment with risedronate, a new cyclic bisphosphonate. Methods PATIENTS AND STUDY DESIGNTwenty patients with Paget's disease of bone (...

show abstract

Section: Discussionmentioning

confidence: 99%

Changes in bone mineral density in patients with Paget's disease treated with risedronate

Patel

Pearson

Bhallah

et al. 1997

Annals of the Rheumatic Diseases

View full text Add to dashboard Cite

show abstract

“…Dual energy X-ray absorptiometry (DEXA), at lumbar spine, has proved to be very precise and is widely used in CRD patients since the trabecular bone of the spine appears to be most affected by corticosteroid therapy, leading to a high rate of vertebral fractures [22,23].…”

Section: Introductionmentioning

confidence: 99%

Osteoporosis in juvenile systemic lupus erythematosus: a longitudinal study on the effect of steroids on bone mineral density

Trapani

Civinini

Ermini

et al. 1998

Rheumatology International

View full text Add to dashboard Cite

Peak bone mass is an important determinant of future bone mass and of the risk of osteoporosis and subsequent fractures. Although some information concerning bone mineral density (BMD) in adults affected with systemic lupus erythematosus (SLE) is available, few data on children and adolescents have been reported. Many variables, such as duration and activity of the disease, reduced sun exposure, and steroid therapy have been suggested as risk factors in the pathogenesis of osteoporosis in SLE. In this study, we longitudinally evaluated, by dual energy X-ray absorptiometry (DEXA), the BMD of 20 young patients affected with juvenile SLE (JSLE), in order to establish the degree of osteoporosis and the influence of steroid treatment, among other clinical variables. At baseline, the mean BMD in JSLE patients was 0.978 g/cm2 and in controls 1.038 g/cm2 (P = 0.31). At 1 year (time 2), this value became 0.947 g/cm2 in JSLE children; the mean individual difference was 0.28 g/cm2 (3.4%). Only in those patients aged 19-25 years BMD was significantly lower than in controls, both at baseline and at time 2. Considering the steroid treatment, no significant difference between the two groups was found either at baseline or at time 2; however, the mean yearly BMD loss in the steroid patients was 0.031 g/cm2 (3.5%) vs. 0.005 g/cm2 (0.5%) in those who had not taken steroids. A significantly inverse correlation between BMD and the cumulative dosage of corticosteroids has been detected. BMD produced a significantly inverse correlation to the cumulative dosage of corticosteroids; no significant correlation has been found between BMD and disease activity or duration.

show abstract

“…Several techniques are available to estimate bone mineral density (BMD), which accounts for about 70% of bone strength [1]. Bone fragility depends on bone density and also on bone microarchitecture [2], which is not assessed by conventional bone measurements with dual-energy X-ray absorptiometry (DXA).…”

Section: Introductionmentioning

confidence: 99%

Efficiency of Quantitative Ultrasound Measurements as Compared with Dual-Energy X-ray Absorptiometry in the Assessment of Corticosteroid-Induced Bone Impairment

Daens

Peretz

Maertelaer³

et al. 1999

Osteoporosis International

View full text Add to dashboard Cite

Bone loss due to corticosteroid treatment differs from that of postmenopausal osteoporosis with regard to bone structure. Corticosteroids affect both horizontal and vertical trabeculae while horizontal trabeculae are damaged in postmenopausal osteoporosis. Dual-energy X-ray absorptiometry (DXA) is the gold standard to evaluate bone loss. The place of quantitative ultrasound (QUS), a technique that could theoretically provide information on bone structure, is not well established in corticosteroid-induced bone impairment. The aim of the study was to determine the usefulness of QUS in the assessment of corticosteroid-induced bone impairment. We hypothesized that the relationship between QUS and DXA could be influenced by changes in bone structure and thus differ with regard to corticosteroid treatment. Seventy-seven women with inflammatory diseases chronically treated with corticosteroids (dose: 7.5-15 mg/day), 29 without corticosteroids and 100 controls were investigated. Bone mineral density at the lumbar spine (BMDL) was measured by DXA and QUS parameters were measured at the calcaneus. Both the QUS parameters (SOS, BUA, Stiffness) and BMDL were significantly lower (by 1.3% for SOS, 5.8% for BUA, 12.7% for Stiffness and 11% for BMDL) in patients treated with corticosteroids compared with patients not taking corticosteroids and with controls (p < 0.001, ANCOVA, with age and height as covariates). Multiple linear regressions of Stiffness, SOS and BUA as dependent variables on age, BMDL, corticosteroid treatment and a computed new variable designed to test the interaction between BMDL and the treatment group showed that Stiffness, SOS and BUA were dependent on age and BMDL (p < 0.001); BUA and Stiffness were dependent on treatment group. Taking into account the age of the patients, a significant difference was observed in the relation between BUA and BMDL according to treatment with corticosteroids. A similar difference was found in the subgroup of patients without fractures. SOS and BUA were strongly correlated but their relation did not differ according to treatment. Thus, QUS is useful in the assessment of corticosteroid-associated bone loss. Furthermore, the observation of a significant difference in the relationship between BUA and BMDL with regard to corticosteroid treatment might support the hypothesis that QUS, especially BUA, could give additional information about bone structure.

show abstract

Current methods and recent advances in the diagnosis of osteoporosis

Cited by 72 publications

References 117 publications

Changes in bone mineral density in patients with Paget's disease treated with risedronate

Changes in bone mineral density in patients with Paget's disease treated with risedronate

Osteoporosis in juvenile systemic lupus erythematosus: a longitudinal study on the effect of steroids on bone mineral density

Efficiency of Quantitative Ultrasound Measurements as Compared with Dual-Energy X-ray Absorptiometry in the Assessment of Corticosteroid-Induced Bone Impairment

Contact Info

Product

Resources

About