The Relationship Between Free Testosterone and Longitudinal Changes In Bone Mineral Density In Elderly Men

The Relationship Between Free Testosterone and Longitudinal Changes In Bone Mineral Density In Elderly Men

Abstracts 457 Leweicki, MD, CCD, Albuquerque, New Mexico; S. Baim, MD, CCD, Denver, Colorado; N.C. Binkley, MD, CCD, Wisconsin Quality of DXA testin...

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Abstracts

457

Leweicki, MD, CCD, Albuquerque, New Mexico; S. Baim, MD, CCD, Denver, Colorado; N.C. Binkley, MD, CCD, Wisconsin Quality of DXA testing is related in part to machine performance, to operator, to interpreter competence. Operators are encouraged to scan phantoms daily, to plot the results graphically for visual assessment, then to apply statistical tests such as Cusum s and Shewhart s rules, mostly applied retrospectively. We studied 6 systems (3 GE and 3 Hologic) in the US, Canada, and Switzerland. We applied Med-Imaps software to phantom data obtained from 1996 to nowadays. The software analyzed phantom data and generated a report of all violations of statistical rules. We estimated the length of time patients might have been exposed to an unstable system using traditional QC. We assumed that the Med-Imaps QC, if used in an automatic daily fashion, would result in restoration of system stability after one day. We then compared the duration of system instability using traditional QC to the time of exposure likely from automated software. We found violations 1015 days over 217 months for 2 systems yet analyzed. There was a large variability in system stability for example with HOLOGIC1 having 0 unusable day and HOLOGIC2 having 3 majors periods of unstabilities detected (Shewhart s rules). In aggregate, this may expose patients to a system with suboptimal QC for 523 days; with semi-automated software this would result in (estimated) 140 days of suboptimal QC testing. We conclude that instrument QC using traditional methods is suboptimal. Live, daily, automated QC would provide an opportunity to reduce the exposure of patients to DXA systems generating unreliable test results.

Poster Number 144

Epidemiology

PSYCHOSOCIAL IMPACTS ON BONE TURNOVER IN ADULT MEN: PRELIMINARY FINDINGS FROM THE MIDUS STUDY Arun Karlamangla, UCLA, Division of Geriatrics Neil Binkley, MD, University of Wisconsin Institute on Aging; Gayle Love, University of Wisconsin Institute on Aging; Diane Krueger, University of Wisconsin Institute on Aging; Gail Greendale, Carolyn Crandall, Teresa Seeman and Carol Ryff Recent work demonstrates that bone remodeling is, at least in part, regulated centrally in the hypothalamus. As osteoporosis ultimately results from disordered bone remodeling, it is plausible that psychosocial factors, both negative (e.g., depression) but also positive (e.g., purpose in life), could impact skeletal health. This work investigates correlations between psychosocial variables and serum bone turnover markers in adult male participants in MIDUS (Midlife in the US), a nationally representative cohort study of aging. In this preliminary analysis, serum turnover markers (BSAP, P1NP and NTx) in 247 men were correlated with positive and negative psychosocial variables. Additionally, a bone balance index (BBI), developed by deriving turnover marker T-scores and defining bone balance as formation T-score minus resorption T-score, was used to investigate associations between bone balance and psychosocial variables. A negative BBI favors resorption. In men age e 66 years (n 5 75) measures of positive psychosocial status are negatively correlated with serum NTx while aspects of psychological ill-being are positively linked with NTx. In this group, the BBI is consistent, with negative psychological factors favoring resorption while positive variables favor formation. In contrast, among younger men (age 35e49, n 5 61) the relationship between psychosocial factors and BBI is opposite to that in older men in that positive psychosocial factors are associated with increased bone resorption and a negative BBI. In conclusion, psychosocial factors may play an important role in osteoporosis pathogenesis in men. Differential associations between bone turnover and psychosocial status may exist at various ages.

Poster Number 145

Epidemiology

THE DISTRIBUTION AND CORRELATES OF BONE MINERAL DENSITY IN JAMAICAN YOUNG ADULTS Sheerin Ansari Eyre, Senior Lecturer, University of the West Indies, Kingston, Jamaica Dr. Kenneth Vaughn, Dr. Micheal Boyne, Dr. Trevor Ferguson, Dr. Novie Younger, Dr. Marshall Tulloch Reid, Dr. Maria Jackson, Dr. Maureen Samms Vaughn, and Professor Rainford Wilks, Objective: To describe the distribution of bone mineral density (BMD) among Jamaican young adults and evaluate factors associated with low BMD. Methods: 902 participants from a sub sample of the 1986 Jamaica Perinatal Mortality Survey

Journal of Clinical Densitometry: Assessment of Skeletal Health

were studied. BMD was estimated by stiffness index (SI) using quantitative ultrasound (Lunar Achilles ExpressÒ) of the right calcaneus in 701 participants, age 18-20 years. Questionnaires were used to obtain data on tobacco, marijuana, alcohol use and history of bone fracture. Anthropometry by standardized techniques used to calculate body mass index (BMI). Data were analyzed using Stata 9.2; associations with risk factors for low BMD were assessed using chi-square test, ANOVA and linear regression. Low BMD was defined as z-score ! 1 in the absence of normative values. Results: The mean stiffness index (SI) was 113.8  22.4, significantly higher in males (116.5  24.1 vs. 111.4  20.6; p ! 0.01). There were no significant differences in mean SI across the narrow age-band. Low BMD was found in 15.6% of participants (males 14.9%, females 16.2%). In univariate analysis mean SI was positively associated with BMI (p ! 0.01), weight (p ! 0.01) and marijuana use (p ! 0.04). In multivariable models female sex (p ! 0.01) and BMI (p ! 0.01) remained statistically significant. There was no association between BMD and tobacco smoking, alcohol use or previous fracture. Conclusions: Almost 16% of Jamaican young adults have low BMD as defined. Female sex and low BMI are associated with low BMD.

Poster Number 146

Epidemiology

BONE MINERAL DENSITY IN SYSTEMIC LUPUS ERYTHEMATOSIS Mariam Khan, MD, Internal Medicine Resident, Section of Rheumatology, Rush University Medical Center, Chicago, IL Lisa Maskala Streff, BA, RT, CDT, Rush University Medical Center, Chicago IL; Meenakshi Jolly, MD, Section of Rheumatology, Rush University Medical Center, Chicago IL; Charlotte Harris, MD, Section of Rheumatology, Rush University Medical Center, Chicago IL; Joel Block, MD, Section of Rheumatology, Rush University Medical Center, Chicago IL We evaluated BMD, osteoporosis (OP) screening, and osteoporosis among an ethnically diverse group of patients with systemic lupus erythematosis (SLE). With IRB approval, records of 106 female SLE patients at Rush University were reviewed for a history of OP screening, presence of low BMD (T score of 5 1.0) or osteoporosis based on DXA. SLE features were recorded, and the data were stratified by demographics, disease features and OP risk factors. Chi square & Student s t test were performed. Subjects were 42.5  13.1years old (mean  SD), had SLE 9.2  8.6 years, and were 54% African American, 27% Caucasian, 19% of other ethnicity. 71% had previously received prednisone 5 7.5 mg/day or equivalent for 5 3 months. 68% had been screened for OP. Screening for OP did not vary by ethnicity, disease features or risk factors for OP. Older age (p 5 0.001), post menopausal status (p 5 0.001), and greater disease duration (p 5 0.004) were associated with OP screening. Of those screened, 47.6% had low BMD which included 9.5% with OP. Patients with low BMD or OP did not differ from the others by ethnicity, disease features or OP risk factors. Higher serum creatinine (p 5 0.02) and low BMI (p 5 0.05) were associated with low BMD. We observed no racial disparities in OP screening. Low BMD was associated with age, later menarche, BMI, SLE disease duration, and decreased renal function, but not with ethnicity, disease activity or damage among patients with SLE. OP screening is important in SLE, especially in older patients with longer disease duration.

Poster Number 147

Epidemiology

THE RELATIONSHIP BETWEEN FREE TESTOSTERONE AND LONGITUDINAL CHANGES IN BONE MINERAL DENSITY IN ELDERLY MEN Denise Angelica Teves, MD, Division of Endocrinology, Medical College of Wisconsin Edith Burns, MD, Geriatrics, Medical College of Wisconsin; Prakash Laud, PhD, Biostatistics, Medical College of Wisconsin; Joan Neuner, MD, Internal Medicine, Medical College of Wisconsin We analyzed the male cohort of an existing database collected between 1993 and 1999 in greater Milwaukee, to determine the relationship between Free Testosterone levels and Bone mineral density. Methods: A secondary data analysis of the male cohort of the prospective study: ‘‘Causes of Lean Body Mass Atrophy in Aging Men and Women’’ was performed. These were community-dwelling men age 60 and older. Bone mineral density, hormonal measurements, and dietary intake were measured at 6 month intervals. We studied simple correlations between free testosterone(FT) and bone mineral density(BMD) at different study points

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458

Abstracts

and we built a mixed model to assess the rate of change of FT and BMD and determine if there was a relationship between them. Results: We found a decline in femoral neck BMD, at a rate of 0.0037 grams/cm2/year. The true relationship between femoral neck BMD and age fits a slightly quadratic model up to age 75. Free testosterone levels remained stable over 54 months of study. Simple correlations did not find any significance between FT and BMD at baseline or study end-point or between the change in FT and change in BMD over the entire 54 months. FT at baseline did not predict the decline in BMD at the femoral neck. The lag correlations did not reveal any significance between any of the variable pairs that were studied. Conclusions: Elderly men have a decline in femoral neck BMD over 54 months of 0.0037 gr/cm2/year (95 % confidence intervals: 0.0046, 0.0029). Free testosterone does not decrease over time. Free testosterone is not correlated with femoral neck BMD at baseline or at the study end-point.

inclusion. Their mean age was 70  9 years; 90% were Caucasian. Any decline in lumbar spine, hip or 33% radius BMD occurred in 41%, 20% and 42% of men respectively. Using precision errors, significant declines in BMD occurred in 1%, 9% and 8% of men at the lumbar spine, hip and 33% radius, respectively. Patient age associated inversely with difference in BMD (D-BMD), with hip D-BMD (r 5 0.22, p 5 0.008). Similarly, body weight associated inversely with spine DBMD (r 5 0.17, p 5 0.04). Adherence, defined as the medication possession ratio, correlated positively with spine and hip D-BMD (r 5 0.22, p 5 0.01 and r 5 0.18, p 5 0.03 respectively). We conclude that certain patient characteristics associate with BMD declines despite alendronate therapy. In this small study, BMD response showed a positive association with medication adherence and negative associations with age and body weight. Larger studies are needed to confirm and extend these findings.

Poster Number 148

Poster Number 151

Epidemiology

PREVALENCE OF OSTEOPOROSIS IN AN OHIO MENNONITE COMMUNITY Norman D.E. Raymond, D.O., Physician, Doctors Hospital/OhioHealth, Columbus Shalin E. Arnett, D.O., Resident, Doctors Hospital/OhioHealth, Columbus, OH; Linda Biddle, R.T., R., M., CDT, Radiology Technician, CDT, Osteoporosis Diagnostics & Treatment Center, Marysville, OH; Frank R. Raymond, D.O., Physician, Marysville OB/Gyn, Inc., Marysville, OH; James J. Perez, D.O. The purpose of this study was to evaluate the prevalence of osteoporosis/osteopenia in postmenopausal Mennonite women. Volunteers within a Mennonite community in Northwest Ohio were enrolled in this prospective descriptive pilot study. Approximately, 170 participants were weighed and completed a short survey. The survey included medical and family history, calcium intake, and weight recorded as over or under 127 pounds, as well as other risk factors. Heel scans were performed on the 170 participants using a Sahara ultrasound unit. Participants with a T-score of 1.0 SD or less with no risk factors and participants with two risk factors regardless of their T-scores were offered a Central DXA on a Hologic Discovery unit. One hundred and seventy women were evaluated, of which 73 failed the heel screen and 21 demonstrated at least two risk factors. Ninety-four patients went on to complete the Central DXA evaluation. Sixty-six percent (62 of the 94) were diagnosed with osteopenia or osteoporosis. Of these, (51 of the 62) had a positive family history (82%). Of the original 170 women studied, 36% (61) illustrated low bone mineral density (osteopenia or osteoporosis). Although multiple etiologic factors were included in this study, the distinctives of a late nineteenth century lifestyle combined with significant family history were most prevalent. Further evaluation of this otherwise understudied subgroup of the American population would be warranted in light of their extraordinary healthy way of life.

Poster Number 150

Monitoring Therapy

PATIENT CHARACTERISTICS ASSOCIATED WITH BONE MINERAL DENSITY (BMD) RESPONSES TO ALENDRONATE Erik Dean Swenson, M.D., Rheumatology Fellow, University of Wisconsin, Madison, WI Mary E. Elliott, PharmD, PhD, RPh, Assistant Professor of Pharmacy, The University of Wisconsin, Madison, WI; Brooke L. Baltz, PharmD, Pharmacy Student, Univeristy of Wisconsin, Madison, WI; Arthur A. Schuna, M.S., F.A.S.H.P., R.Ph., Clinical Professor of Pharmacy, University of Wisconsin & William H Middleton VA Hospital, Madison, WI; Karen Elizabeth Hansen, M.D., CCD, Assistant Professor of Medicine, University of Wisconsin School of Medicine & Public Health, Madison, WI Some patients experience a decline in BMD despite bisphosphonate therapy. We performed a study to detect factors associated with decreased BMD despite alendronate therapy. In a retrospective chart review study, we identified men receiving primary care through one Veterans Affairs Medical Center who began alendronate between July 2000 and May 2004 for low bone mass. We excluded men receiving primary care elsewhere or taking alendronate for other indications. Two researchers reviewed each chart and recorded data using a standardized form. We analyzed data using Pearson s correlation coefficient, chi-square or Fisher exact test, and t-tests or Wilcoxon tests as appropriate. We identified 140 men for study

Journal of Clinical Densitometry: Assessment of Skeletal Health

Monitoring Therapy

IN VIVO LONGITUDINAL NON-INVASIVE MEASUREMENT OF CROSS-SECTIONAL BENDING STIFFNESS d A PILOT STUDY OF TERIPARATIDE THERAPY Angela M. Cheung, MD, PhD, FRCP(C), CCD, Associate Professor, University Health Network, University of Toronto Lianne Tile, University Health Network, University of Toronto; Heather McDonald-Blumer, Mount Sinai Hospital, University of Toronto; Moira Kapral, University Health Network, University of Toronto; Claudia Chan, Farrah Ahmed Hanxian Hu, Yuna Lee, Anna Sawka, and Rowena Ridout Mechanical Response Tissue Analyzer (MRTA) is a novel and emerging tool that measures cross-sectional bending stiffness (EI) non-invasively in vivo. In animal studies, cross-sectional bending stiffness is a strong indicator of whole bone strength. We conducted a pilot study to prospectively evaluate the changes in EI of the non-dominant ulna before and after teriparatide treatment. These subjects also had routine BMD measurements by DXA at the spine, hip and forearm on the non-dominant side. All subjects signed informed consent and the study was approved by the institutional research ethics board. Sixteen subjects (13 women and 3 men) participated in the study. Mean age was 62.5 years (range: 43.7 to 83.5). Baseline BMD for lumbar spine, total hip and 1/3 radius were 0.692 g/cm2 (Tscore: 2.2), 0.622 g/cm2 (T-score: 2.5), 0.588 g/cm2 (T-score: 2.2), respectively. On average, these subjects have previously taken one or more osteoporosis therapies (mostly bisphosphonates) for a mean of 4.4 years prior to starting teriparatide therapy. Mean duration of teriparatide therapy was 10.5 months (range: 5.7 to 18.8 months). Mean percent changes in BMD were 6.3% at the lumbar spine (p 5 0.009), -0.6% at the total hip (p 5 0.65), and 3.5% at the 1/3 radius (p 5 0.08). Mean EI of the ulna was 16.1 N/mm (range: 2.5 to 30.7) at baseline and 17.5 N/mm (range: 10.1 to 29.7) at the end of the study, with a mean increase of 45.7% (p 5 0.26). The intra-operator coefficient of variation for EI was 1.9%. Our study showed that measuring cross-sectional bending stiffness non-invasively in the clinical setting is potentially valuable in the assessment of the effect of drug therapy on bone strength. Future studies that include a larger sample of patients are needed to explore the clinical utility of this type of measurement.

Poster Number 152

Monitoring Therapy

QUANTIFICATION AND DESCRIPTION OF GASTROINTESTINAL ADVERSE EVENTS (GI AES) IN PATIENTS SWITCHED FROM BRANDED FOSAMAXÒ TO GENERIC ALENDRONATE Papaioannou Alexandra, Professor of Medicine, McMaster University, Ontario, Canada George Ioannidis, Scientist, McMaster University, Ontario, Canada; Daniel Grima, Scientist, McMaster University, Ontario, Canada; Jonathan D. Adachi, Professor of Medicine, McMaster University, Ontario, Canada Generic alendronate has recently been introduced into Canada with increased GI AEs noted. These occurred in those previously tolerant to branded alendronate (Fosamax). Thus, this study examined the GI AE profile of patients who were switched from Fosamax to generic alendronate. All postmenopausal women 50 years of age and older who were on Fosamax prior to July 2005 and who were subsequently switched to generic alendronate were included in the study. Patients on

Volume 11, 2008