Program Book and Abstracts - ISCD

Poster Number 005
Oral Session
Use of QUS Bone Evaluation in Clinical Practice in Romania
Carmen Barbu, Carol Davila University; Catalina Poiana, Carol Davila Univesrity;
Alina Roman, Elais Hospital; Simona Fica, Carol Davila University
Background: There are a significant number of bone QUS equipments in Romania.
The specific end points of our study were: QUS equipments distribution by region
and type of medical office, QUS problems in clinical practice, the QUS use for
diagnostic, therapy initiation and monitoring, fracture risk evaluation and the
implications of social security reimbursement of QUS in Romania. Methods: different
sources of information were used: public health network, questionnaire addressed to
clinicians attending QUS course (100 subjects), previous reports from screening
campaign (800women), medical records from 2200 patients refereed for
osteoporosis treatment trough a National Program in two endocrinology
department segregated in different study groups according to the first indication –
refereed for DXA, refereed for Treatment, refereed for screening). Results: Number
of the QUS equipments rose constantly with a report nowadays of 4/1 comparing to
DXA machines, used mostly by endocrinologists and rheumatologists (35 % each).
From 1500 patient refereed for QUS screening, 93.4% were women vs. 6.6 % men
with a mean age of 62 ± 9.8 yrs; 23% has no clinical risk factors. Clinicians tend to
use QUS results similar to DXA results (almost 42% are using WHO classification
based on QUS T score); in spite of this aspect which can be due to the social
reimbursement restriction of the treatment, a significant part of the clinicians (37%)
are using QUS parameters to evaluate fracture risk. 21% of the patients refereed to
DXA had QUS evaluation; from it, 7% had also treatment initiated after QUS and
significantly (min 6 months) before DXA. 50% of the patients refereed for medical
prescription were diagnosed based only on QUS evaluation. Social reimbursement
was a major determinant of the raise of QUS use in Romania but is depending by the
diagnostic of osteoporosis on the medical record. Consequently, there is a pressure
on the clinician to simplify the evaluation’s results leading to inadequate
interpretation. Conclusion: osteoporosis treatment in Romania is frequently based on
a QUS evaluation only; clinicians are using either an inadequate extrapolation of
WHO criteria for diagnosis or a modern concept of high fracture risk for initiating
therapy. This aspect suggests the need for clinical guidelines integrating both QUS
results and social reimbursement criteria in a context of a more adequate training
of the physicians in using fracture risk assessment.
Poster Number 010
Young Investigator Awardees
Clinical Impact of Revised Osteoporosis Treatment Guidelines
Laura Wilson, Bone & Mineral Unit, Oregon Health & Science University, Portland,
OR; Linda Norcutt, Bone & Mineral Unit, Oregon Health & Science University,
Portland, OR
Both bone mineral density (BMD)-dependent and independent factors contribute to
osteoporotic fracture risk. Thus, the US National Osteoporosis Foundation (NOF) has
recommended treatment guidelines combining BMD measures with additional risk
factors for the past decade. Recently, the US NOF incorporated absolute fracture risk
calculations derived from population-specific World Health Organization FRAX
algorithms. To determine the clinical impact of these revised guidelines on
osteoporosis treatment recommendations, we retrospectively applied FRAX w/o BMD,
FRAX w/ BMD, NOF 2005 and NOF 2008 treatment criteria to 600 women between
the ages of 40 and 90 who were evaluated in our bone densitometry unit between
January 2002 and December 2008. 41% of the study population was 65 or older
and 25% was younger than 50 years. No subjects had received hormone
replacement therapy or osteoporosis medication. FRAX w/o BMD, FRAX w/ BMD,
NOF 2005 and NOF 2008 criteria recommended treatment initiation in 37%, 32%,
23% and 38%, respectively. There were 71 women (12%) for whom FRAX w/o BMD
and FRAX w/ BMD yielded different treatment conclusions (p = 0.0006). Adding the
BMD information moved 29 patients (all 70 or older) out of the treatment category.
There were 130 women (22%) for whom NOF 2005 and NOF 2008 yielded
different treatment conclusions (p < 0.0001). NOF 2008 added 110 women (across
the age spectrum/without age specificity) to the treatment category. There were 72
women (12%) for whom FRAX w/ BMD and NOF 2008 yielded different treatment
conclusions (p < 0.0001). NOF 2008 added 55 patients (all younger than 70) to the
treatment category. Our results indicate that the particular criteria employed can
substantially alter drug treatment decisions for a specific woman. Given these
clinically relevant discrepancies, it is now, more than ever, crucial that drug treatment
decisions based on a given criterion are supported by prospective fracture trials.
Poster Number 011
Young Investigator Awardees
Association of Luteinizing Hormone Receptor Polymorphism with Bone
Mineral Density in Men – Results from Odense Androgen Study
Claus Brasen, MD, Clinical Biochemistry, Odense University Hospital, Denmark; T.L.
Nielsen, Odense University Hospital; K. Wraae, Odense University Hospital; B.
Abrahamsen, Odense University Hospital; L. Christiansen, Odense University
Hospital; C. Hagen, Odense University Hospital; M. Andersen, Odense University
Hospital; K. Brixen, Odense University Hospital; L. Bathum, Odense University
Hospital
We have previously shown, that the N312S polymorphism in the luteinizing
hormone receptor (LHR) is associated with bone mineral density (BMD) in young
men. Through in vitro studies, we found, that N312S and N291S influences the
activation of the receptor. We therefore tested the influence of both SNP’s on
BMD.We genotyped 783 healthy men aged 20-29 years and 600 men aged 60-76
from the population-based Odense Androgen Study for both SNP’s and investigated
association with BMD in the spine and hip. 406 of the young and 282 of the
elderly participants underwent MRI scans to determine visceral and subcutaneous
adipose tissue(VAT and SAT) and muscle tissue. We furthermore tested for
association with testicular volume, height, lean body mass, testosterone, oestrogen,
dihydrotestosterone and androstenedione. We also tested for association with BMD
in truncus, whole body BMD, LH and carboxy-terminal telopeptide of type I
collagen(ICTP) in the young population. All genotype distributions were consistent
with the Hardy-Weinberg equilibrium. Using the young study group, we found
significant association between N312S alleles and testicular-volume (p=0.03) as well
as with BMD in spine (p=0.04) and trend association between LHR alleles and BMD
in truncus and whole body BMD. Stratifying the young participants into “sedentary”
and “non-sedentary”, we found that in the non-sedentary participants (n=615),
LHR N312S was significantly associated with testicular volume, BMD in spine,
truncus, and whole body. The results also indicated a trend association with BMD in
hip and extremities, as well as the level of ICTP. N291S indicated a trend with
whole body BMD(p=0.075). Using the elderly population, we found significant
association between N312S and BMD of the hip (p=0.05). We also found trend
association between N291S and BMD in the spine and the hip, the CC-genotype
showing respectively a 15.6% and 8.6% drop in BMD compared to wildtype.These
findings strengthen the hypothesis that the LHR N312S polymorphism is associated
to genital undermasculinization and hereby low BMD. More studies are needed to
verify these results. More participants are needed to estimate the true significance
of N291S. In vitro and fracture data studies will be discussed.The contents of this
abstract has been submitted and accepted for WCO for oral presentation id OC7,
Osteoporosis Int (2008) 19 (Suppl. 2).
Poster Number 012
Young Investigator Awardees
Genistein Aglycone for the Management of Secondary Osteoporosis: An
Experimental Study
Alessandra Bitto, University of Messina; Bruce Burnett, Primus Pharmaceuticals;
Antonio Bonaiuto, University of Messina; Domenica Altavilla, University of Messina;
Francesco Squadrito, University of Messina
Background: Glucocorticoid-induced osteoporosis (GIO) is the most important
secondary cause of osteoporosis.Methods: In a first set of animals (n= 21) of animals
we tested if genistein aglycone (5 mg/kg/sc) may prevent methylprednisolone-induced
osteoporosis. In a following experiment (28 rats) we tested if genistein aglycone at
the same dose could represent an efficacious treatment for GIO compared to
alendronate. Female Sprague-Dawley rats were used. GIO was induced by daily
injections of methylprednisolone (MP; 30mg/kg/sc) for 60 days in both experimental
procedures. Sham GIO animals (n=14) were daily injected with the
methylprednisolone vehicle. In the first experiment a group of animals (n=7)
received only MP and the other group received also genistein (n=7) for 60 days. In
the second experiment all animals (n=21) received MP for 60 days to develop
osteoporosis, subsequently MP rats were randomized to receive: vehicle (n=7),
genistein aglycone (5 mg/kg/sc; n=7) or alendronate (0.03 mg/kg/sc; n=7).
Thetreatment lasted for additional 60 days. Sham GIO animals were treated with
vehicle for an additional 60 days. At thebeginning and at the end of the treatment
period all animals were examined for bone mineral density (BMD) and bone mineral
content (BMC). At the time of sacrifice, bone-alkaline phosphatase (b-ALP) and
carboxy-terminalcollagen crosslinks (CTX) were determined in serum. Femurs were
removed and tested for breaking strength or histology.Results: In the first experiment
genistein aglycone was able to preserve bone mineral content, bone morphology and
mechanical properties compared to vehicle. In the second experiment genistein
aglycone showed a greater increase in both BMD and BMC than alendronate,
significantly increased b-alp (bone formation marker), reduced CTX (bone
resorption marker), and caused a greater increase in breaking strength than
alendronate. Finally, a more beneficial effect of genistein aglycone on bone histology
and mechanical properties has been observed.Conclusion: The results suggest that
genistein in its aglycone form might be useful for the management of GIO.
— 2009 Annual Meeting 19