Jorge Malouf-Sierra

Background: Bone fragility depends not only on bone mineral density (BMD), but also on bone microarchitecture. In adults, Trabecular Bone Score (TBS) is being used as an indirect marker of bone microarchitecture It is a software that applicated to the vertebral image obtained by conventional densitometry, informs about the thickness of the trabeculae, the trabecular connectivity and the space between them. A high score indicates a better bone microstructure. In adults, a TBS equal to or greater than 1,350 is considered to represent a normal microarchitecture Objectives: To evaluate the usefulness of TBS in pediatric population with risk factors for Low Bone Mass (LBM) Methods: TBS was assessed by analyzing vertebral densitometries performed on patients from 4 to 20 years of age, assessed in the pediatric rheumatology office of our hospital for presenting risk factors for LBM, consecutively from 2016 until 2018 Data were compared with normal pediatric population Results: Data from 83...

The current guidelines of the International Society for Clinical Densitometry (1) recommend that in children with linear growth or maturational delay, Z score results should be adjusted. Height for age Z score (HAZ) adjustment is valid and can be calculated using the formula the formula proposed by Zemmel et al(2).It is possible that pediatric populations without linear growth or maturational delay, also benefit from HAZ, to prevent bone size from influencing the final Z score.To evaluate Z score variability adjusted and without adjusting for height for age.We analysed data from densitometry performed on patients 2-20 years of age, from 2016 to 2018, assessed in the pediatric rheumatology office of our hospital for presenting risk factors for low bone mass/osteoporosis. The HAZ was calculated according to Zemel’s formula.Data from 103 patients are presented. Its characteristics are summarized in Table 1Table 1.Mean age9,8 yearsFemale52,4%Height Percentil ≤ 36,8%Height Percentil ≥ 97...

Background and aims: An association between cardiovascular disease and osteoporosis is described. A number of drugs often used by patients with coronary heart disease, such as thiazides, statins and beta-blockers, have shown controversial effects on bone. 1) To study the possible association between coronary heart disease (CHD) and bone mass density (BMD), quantitative ultrasound measurements (QUS) and the prevalence of fragility and vertebral fractures. 2) To study the possible influence of a number of drugs, statins, thiazides and beta-blockers, on BMD and fractures. Methods: Case-control study performed on 74 postmenopausal women who had recently suffered from CHD, and 111 age-matched controls. BMD was measured by Dual X-Ray Absorptiometry (DXA) at the lumbar spine and proximal femur. Quantitative Ultrasound (QUS) was also measured at the heel. Vertebral fractures were diagnosed by lateral, thoracic and lumbar X-rays. The occurrence of non-vertebral fractures was determined by examination of medical records. Results: Patients with CHD had higher values of BMI. They had a higher prevalence of arterial hypertension and hyperlipidemia, and consequently higher consumption of beta-blockers and statins, but not of thiazides, and had lower alcohol consumption. Patients with CHD had higher BMD values, measured by DXA at the proximal femur, than controls, but there were no differences in DXA values at the lumbar spine or QUS at the heel between the two groups. The prevalence of all fragility factures was slightly higher in patients with CHD, but not to a significant extent. The prevalence of vertebral fractures was similar in the two groups. In a logistic analysis to identify factors associated with all fractures, beta-blockers were positively associated with fragility fractures, and DXA at the femoral neck was inversely associated with fragility fractures. Conclusions: Postmenopausal women with CHD have higher values of BMD at the proximal femur but, despite this, show a slight but non-significant increase in the prevalence of fragility fractures. Beta-blockers are independently associated with fragility fractures, but thiazides and statins are not.

We present final results of a study comparing teriparatide 20 μg every day (QD) with risedronate 35 mg once per week (QW) started within 2 weeks after surgery for a pertrochanteric hip fracture. Patients with BMD T-score ≤ -2.0 and 25OHD ≥9.2 ng/mL were randomized to receive 26-week double-dummy treatment plus calcium and vitamin D, followed by 52-week open-label treatment with the same assigned active drug. Primary endpoint was change from baseline in lumbar spine (LS) BMD at 78 weeks. Secondary and exploratory endpoints were change in BMD at the proximal femur, function, hip pain (Charnley score and 100 mm Visual Analog Scale [VAS]), quality of life (Short Form-36), radiology outcomes, and safety. Data were analyzed with mixed models for repeated measures (MMRM) and logistic regression. Totally, 224 patients were randomized; 171 (teriparatide: 86) contributed to the efficacy analyses (mean ± SD age: 77 ± 7.7 years, 77% females). Mean baseline LS, femoral neck (FN), and total hip (...

Purpose: To describe clinical and biological characteristics of pediatric patients with at least one risk factor (RF) for low bone mass for chronological age (LBMca)/childhood osteoporosis (cOP) and to assess its influence on bone mineral density (BMD).Methods: Patients between 2 and 20 years of age with at least 1 RF were recruited. Daily calcium intake, number of previous fractures and other RFs and their distribution among different groups were assessed. Spine and whole body DXA and vertebral morphometry were performed.Results: 103 patients were included. Mean age was 9.8 years old. 52.4% were female. Of the RFs, 84.5% presented insufficient calcium intake, 38.8% were receiving or had received corticosteroids, 31.1% were receiving other treatments with osteotoxic potential, 13.6% led a sedentary lifestyle, 12.6% presented history of fractures, and up to 8.1% had hypovitaminosis D. 38% of the cohort had 2 RFs, 31% had 3 RFs, 15% had 4 RFs, and 12% associated 5 or more RFs. 10.5% m...

Patients with cirrhosis often have functional limitations, decreased muscle mass, and a high risk of falls. These variables could improve with exercise. The aim was to study the effects of moderate exercise on functional capacity, body composition and risk of falls in patients with cirrhosis. Twenty-three cirrhotic patients were randomized to an exercise programme (n = 14) or to a relaxation programme (n = 9). Both programmes consisted of a one-hour session 3 days a week for 12 weeks. At the beginning and end of the study, we measured functional capacity using the cardiopulmonary exercise test, evaluated body composition using anthropometry and dual energy X-ray absorptiometry, and estimated risk of falls using the Timed Up&Go test. In the exercise group, cardiopulmonary exercise test showed an increase in total effort time (p<0.001) and ventilatory anaerobic threshold time (p = 0.009). Upper thigh circumference increased and mid-arm and mid-thigh skinfold thickness decreased. Du...

Abbreviations ACRO Acromegaly aBMD Areal bone mineral density CTx C-terminal telopeptide of type 1 collagen aBMD Areal bone mineral density DKK1 Dickkopf-related protein 1 DXA Dual-energy X-ray absorptiometry EAT Epicardial adipose tissue FFA Free fatty acids GH Growth hormone GHD Growth hormone deficiency IGF-I Insulin-like growth factor-I LS vBMD Lumbar spine volumetric bone mineral density MDCT Multidetector computed tomography rGH Recombinant growth hormone QCT Quantitative computed tomography SAT Subcutaneous adipose tissue TBS Trabecular bone score P1NP Total procollagen type 1 amino-terminal propeptide VAT Visceral adipose tissue Wnt Wingless-type

Objective: To study the effects of a moderate exercise programme on body composition and effort capacity evaluated by means of densitometry and ergospirometry, respectively, in overweight patients with cirrhosis. Patients and methods: Fourteen compensated overweight patients with cirrhosis underwent a moderate exercise programme during 3 months one hour 3 days/week. We analyzed the changes in anthropometric measures, body composition by densitometry, effort capacity by ergospirometry and quality of life by SF-36 questionnaire. Results: At the end of the study there were not differences in body mass index with respect to basal values, but we observed an increase in total body muscle mass evaluated by densitometry and a decrease in total fat body mass. Ergospirometry showed an increase in effort time and in aerobic effort time. Mean arterial pressure and serum creatinine decreased at the end of the study. With respect to quality of life, there was an improvement in all SF-36 domains t...

Background In a phase 2 study, treatment with romosozumab significantly increased bone mass in women with low bone mineral density (BMD). Objectives To report the results of STRUCTURE, a phase 3 study evaluating the effect of romosozumab or teriparatide (TPTD) in women with postmenopausal osteoporosis (PMO) transitioning from bisphosphonate (BP) therapy (NCT01796301). Methods This open-label study enrolled women with PMO who had taken an oral BP for ≥3 years prior to screening and alendronate (70 mg QW or equivalent) in the year prior to screening; had a BMD T-score ≤−2.5 at the total hip (TH), lumbar spine (LS), or femoral neck (FN); and had a history of nonvertebral fracture after age 50 or vertebral fracture. Women were randomized to receive SC romosozumab 210 mg QM or TPTD 20 μg QD for 12 months. The primary endpoint was percent change from baseline in BMD by DXA at the TH through month 12. Secondary endpoints included percent change from baseline at months 6 and 12 in BMD by DXA at the TH, LS, and FN; hip integral and cortical BMD by quantitative computed tomography (QCT); and estimated hip strength by finite element analysis. Results The 436 women enrolled in the study had a mean age of 72 years and mean TH, LS, and FN T-scores of −2.2, −2.9, and −2.5, respectively. Through 12 months, the mean (95% CI) percent change from baseline in TH BMD by DXA was 2.6% (2.2, 3.0) with romosozumab and −0.6% (−1.0, −0.2) with TPTD (p<0.0001 between groups). TH BMD changes at months 6 and 12 were significantly larger with romosozumab than with TPTD (p<0.0001): month 6, 2.3% (1.9, 2.7) vs −0.8% (−1.2, −0.4); month 12, 2.9% (2.5, 3.4) vs −0.5% (−0.9, 0), respectively. Romosozumab also resulted in significantly larger BMD gains at the LS at months 6 and 12 vs TPTD (p<0.0001): month 6, 7.2% (6.6, 7.8) vs 3.5% (2.9, 4.0); month 12, 9.8% (9.0, 10.5) vs 5.4% (4.7, 6.1), respectively. QCT assessments of the hip demonstrated significantly greater gains in integral and cortical BMD with romosozumab vs TPTD at months 6 and 12 (p<0.0001). Estimated hip strength gains were also significantly larger with romosozumab at both time points (p<0.0001) and declined from baseline in TPTD-treated subjects at month 6. The subject incidences of adverse events were generally balanced between treatment groups. Conclusions In subjects transitioning from BP therapy, romosozumab was well-tolerated and associated with greater BMD gains and improved estimated hip strength compared with TPTD. Acknowledgement Amgen Inc./UCB Pharma funded Disclosure of Interest B. Langdahl Grant/research support from: Eli Lilly, Orkla, Consultant for: Amgen Inc., Eli Lilly, Merck, UCB Pharma, C. Libanati Shareholder of: UCB Pharma, Employee of: UCB Pharma, D. Crittenden Shareholder of: Amgen Inc., Employee of: Amgen Inc., M. Bolognese Grant/research support from: Amgen Inc., Lilly, Pfizer, Sanofi, Consultant for: Amgen Inc., J. Brown Grant/research support from: Amgen Inc., Eli Lilly, Consultant for: Amgen Inc., Eli Lilly, Merck, N. Daizadeh Shareholder of: Amgen Inc., Employee of: Amgen Inc., E. Dokoupilova Consultant for: Amgen Inc., K. Engelke Employee of: BioClinica, J. Finkelstein: None declared, H. Genant Consultant for: Amgen Inc., Janssen, Lilly, Merck, Roche, Synarc, S. Goemaere Consultant for: Amgen Inc., MSD, Novartis, L. Hyldstrup Consultant for: Amgen, Denmark; Eli-Lilly, Denmark, E. Jodar-Gimeno Consultant for: Amgen Inc., MSD, T. Keaveny Shareholder of: O.N. Diagnostics, Consultant for: Agnovos, Amgen Inc., O.N. Diagnostics, D. Kendler Grant/research support from: Amgen Inc., Astalis, Astra Zeneca, Eli Lilly, Consultant for: Amgen Inc., Eli Lilly, Merck, Pfizer, P. Lakatos: None declared, J. Maddox Shareholder of: Amgen Inc., Employee of: Amgen Inc., J. Malouf Grant/research support from: Amgen Inc., Lilly España, F. Massari: None declared, J. Molina Grant/research support from: Amgen Inc., M. Ulla: None declared, A. Grauer Shareholder of: Amgen Inc., Employee of: Amgen Inc.