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Earlier assessment of fragility, fracture risk possible by gauging bone strength
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Changes in bone strength may provide an earlier indication of treatment effects of glucocorticoid and anti-osteoporosis therapies compared with bone mineral density changes, according to research published in the Journal of Bone and Mineral Research.
Investigators compared the reference point indentation (RPI) technique as a measure of bone strength at the tissue level with DXA for measuring BMD.
“[RPI] can measure very early changes in [bone material strength index] in patients initiating glucocorticoid treatment as well as the differential effects of various pharmacologic therapies,” the researchers wrote.
In the proof-of-concept study, Leonardo Mellibovsky, MD, of the Universitat Autònoma de Barcelona in Spain, and colleagues enrolled 52 consecutive patients within 4 weeks of beginning glucocorticoid treatment (≥ 5 mg/day prednisone or equivalent); participants had not previously used radiation or drugs known to affect bone. All patients received calcium 1,000 mg/day and vitamin D 800 IU/day. Those younger than 65 years with T-scores greater than –1.5 (n = 19) were assigned only calcium and vitamin D supplementation (calcium+D group). Those with T-score –3.5 or lower, with or without previous fractures (n = 14), also were assigned risedronate. Of the remaining participants, 14 were assigned Prolia (denosumab, Amgen) and five Forteo (teriparatide, Lilly) at approved doses.
For all participants, BMD was measured at the lumbar spine and hip at baseline, week 7 and week 20. RPI was performed with the hand-held OsteoProbe device at baseline, 7 weeks and 20 weeks, with results expressed as bone material strength index (BSMi) units.
At week 20, no association was found between initial glucocorticoid dose and change in BMSi. BMSi increased by 16 units in the combined active treatment groups compared with the calcium+D group (P < .001). In the individual groups, compared with baseline, BMSi decreased by 11.4% in the calcium+D group (P = .002) and increased by 9.4% (P = .001) in the denosumab group and 16.8% (P = .043) in the teriparatide group. No significant change was observed in the risedronate group. No changes in BMD were evident between baseline and weeks 7 or 20.
“This new paper is a real breakthrough because it’s the first time it’s been possible to do a longitudinal study of bone material properties in patients,” Paul Hansma, PhD, of the University of California at Santa Barbara, said in a press release. “Up until now, medical professionals have been limited to doing [BMD] studies, which can take a year or more to show bone changes.”
Hansma’s research group developed the device — OsteoProbe (Active Life Scientific) — used to perform RPI in the trial. The device is not FDA approved but is being used for commercial research applications.
“These results open new possibilities to explore the effects of various interventions on bone mechanical properties at the tissue level in the clinic, either for diagnosis and monitoring or developing new therapies,” the researchers wrote. – by Jill Rollet
Disclosure: Mellibovsky reports no relevant financial disclosures. Hansma reports being a member of Active Life Scientific. One other researcher reports being an external adviser for and owning stock in Active Life Scientific.
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