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Published in: Osteoporosis International 6/2009

01-06-2009 | Original Article

DXA-based hip structural analysis of once-weekly bisphosphonate-treated postmenopausal women with low bone mass

Authors: S. L. Bonnick, T. J. Beck, F. Cosman, M. C. Hochberg, H. Wang, A. E. de Papp

Published in: Osteoporosis International | Issue 6/2009

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Abstract

Summary

DXA-based hip structural analysis from 947 individuals completing two large osteoporosis clinical trials was pooled and analyzed. Treatment with once-weekly (OW) ALN or OW RIS resulted in significant improvements from baseline in geometric parameters at all three HSA ROIs. Improvements were generally greater with OW ALN than OW RIS.

Introduction

BMD can be altered by changes in distribution and quantity of bone and changes in mineralization. These effects cannot be distinguished with conventional measurements of BMD. Currently, tissue composition is evaluated only by invasive means. Structural geometry of the proximal femur, however, can be measured in vivo by several methods, including dual energy X-ray absorptiometry (DXA) using specialized hip structure analysis (HSA) software.

Methods

DXA-based HSA was obtained and analyzed in a subset of 947 subjects participating in the Fosamax Actonel Comparison Trials. Data were pooled to evaluate treatment effects on the structural geometry of the proximal femur by once-weekly alendronate (ALN) 70 mg and risedronate (RIS) 35 mg in postmenopausal women with low bone mass.

Results

Both ALN and RIS treatment over 2 years resulted in improvements in HSA-derived geometry at all three HSA regions of interest (ROI). The largest treatment effects were seen at the intertrochanteric ROI. Consistently greater treatment effects were seen with ALN compared with RIS at all three HSA-ROIs.

Conclusions

HSA offers insight into the potential mechanisms of fracture risk reduction from pharmacologic intervention. In the current study, treatment with once-weekly bisphosphonates resulted in significant improvements in hip geometric parameters.
Literature
1.
go back to reference Beck TJ (2007) Extending DXA beyond bone mineral density: understanding hip structure analysis. Curr Osteoporos Rep 5:49–55PubMedCrossRef Beck TJ (2007) Extending DXA beyond bone mineral density: understanding hip structure analysis. Curr Osteoporos Rep 5:49–55PubMedCrossRef
3.
go back to reference Beck TJ, Ruff CB, Warden KE et al (1990) Predicting femoral neck strength from bone mineral data. A structural approach. Invest Radiol 25:6–18 Beck TJ, Ruff CB, Warden KE et al (1990) Predicting femoral neck strength from bone mineral data. A structural approach. Invest Radiol 25:6–18
4.
go back to reference Beck T (2003) Measuring the structural strength of bones with dual-energy X-ray absorptiometry: principles, technical limitations, and future possibilities. Osteoporos Int 14:S81–S88PubMedCrossRef Beck T (2003) Measuring the structural strength of bones with dual-energy X-ray absorptiometry: principles, technical limitations, and future possibilities. Osteoporos Int 14:S81–S88PubMedCrossRef
5.
go back to reference Yoshikawa T, Turner CH, Peacock M et al (1994) Geometric structure of the femoral neck measured using dual-energy X-ray absorptiometry. J Bone Miner Res 9:1053–1064PubMedCrossRef Yoshikawa T, Turner CH, Peacock M et al (1994) Geometric structure of the femoral neck measured using dual-energy X-ray absorptiometry. J Bone Miner Res 9:1053–1064PubMedCrossRef
6.
go back to reference Rosen CJ, Hochberg MC, Bonnick SL et al (2005) Treatment with once-weekly alendronate 70 mg compared with once-weekly risedronate 35 mg in women with postmenopausal osteoporosis: a randomized double-blind study. J Bone Miner Res 20:141–151PubMedCrossRef Rosen CJ, Hochberg MC, Bonnick SL et al (2005) Treatment with once-weekly alendronate 70 mg compared with once-weekly risedronate 35 mg in women with postmenopausal osteoporosis: a randomized double-blind study. J Bone Miner Res 20:141–151PubMedCrossRef
7.
go back to reference Reid DM, Hosking D, Kendler D et al (2006) Alendronic acid produces greater effects than risedronic acid on bone density and turnover in postmenopausal women with osteoporosis : results of FACTS—international. Clin Drug Investig 26:63–74PubMedCrossRef Reid DM, Hosking D, Kendler D et al (2006) Alendronic acid produces greater effects than risedronic acid on bone density and turnover in postmenopausal women with osteoporosis : results of FACTS—international. Clin Drug Investig 26:63–74PubMedCrossRef
8.
go back to reference Bonnick S, Saag KG, Kiel DP et al (2006) Comparison of weekly treatment of postmenopausal osteoporosis with alendronate versus risedronate over two years. J Clin Endocrinol Metab 91:2631–2637PubMedCrossRef Bonnick S, Saag KG, Kiel DP et al (2006) Comparison of weekly treatment of postmenopausal osteoporosis with alendronate versus risedronate over two years. J Clin Endocrinol Metab 91:2631–2637PubMedCrossRef
9.
go back to reference Reid DM, Hosking D, Kendler D et al (2008) A comparison of the effect of alendronate and risedronate on bone mineral density in postmenopausal women with osteoporosis: 24-month results from FACTS—International. Int J Clin Pract 62:575–584PubMedCrossRef Reid DM, Hosking D, Kendler D et al (2008) A comparison of the effect of alendronate and risedronate on bone mineral density in postmenopausal women with osteoporosis: 24-month results from FACTS—International. Int J Clin Pract 62:575–584PubMedCrossRef
10.
go back to reference Martin RB, Burr DB (1984) Non-invasive measurement of long bone cross-sectional moment of inertia by photon absorptiometry. J Biomech 17:195–201PubMedCrossRef Martin RB, Burr DB (1984) Non-invasive measurement of long bone cross-sectional moment of inertia by photon absorptiometry. J Biomech 17:195–201PubMedCrossRef
11.
go back to reference Cummings SR, Karpf DB, Harris F et al (2002) Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs. Am J Med 112:281–289PubMedCrossRef Cummings SR, Karpf DB, Harris F et al (2002) Improvement in spine bone density and reduction in risk of vertebral fractures during treatment with antiresorptive drugs. Am J Med 112:281–289PubMedCrossRef
12.
go back to reference Wasnich RD, Miller PD (2000) Antifracture efficacy of antiresorptive agents are related to changes in bone density. J Clin Endocrinol Metab 85:231–236PubMedCrossRef Wasnich RD, Miller PD (2000) Antifracture efficacy of antiresorptive agents are related to changes in bone density. J Clin Endocrinol Metab 85:231–236PubMedCrossRef
13.
go back to reference Hochberg MC, Greenspan S, Wasnich RD et al (2002) Changes in bone density and turnover explain the reductions in incidence of nonvertebral fractures that occur during treatment with antiresorptive agents. J Clin Endocrinol Metab 87:1586–1592PubMedCrossRef Hochberg MC, Greenspan S, Wasnich RD et al (2002) Changes in bone density and turnover explain the reductions in incidence of nonvertebral fractures that occur during treatment with antiresorptive agents. J Clin Endocrinol Metab 87:1586–1592PubMedCrossRef
14.
go back to reference Sarkar S, Mitlak BH, Wong M et al (2002) Relationships between bone mineral density and incident vertebral fracture risk with raloxifene therapy. J Bone Miner. Res 17:1–10PubMedCrossRef Sarkar S, Mitlak BH, Wong M et al (2002) Relationships between bone mineral density and incident vertebral fracture risk with raloxifene therapy. J Bone Miner. Res 17:1–10PubMedCrossRef
15.
go back to reference Shih J, Bauer DC, Orloff J et al (2007) Proportion of fracture risk reduction explained by BMD changes using Freedman analysis depends on choice of predictors. Osteoporos Int 13:S38–S39 Shih J, Bauer DC, Orloff J et al (2007) Proportion of fracture risk reduction explained by BMD changes using Freedman analysis depends on choice of predictors. Osteoporos Int 13:S38–S39
16.
go back to reference Watts NB, Cooper C, Lindsay R et al (2004) Relationship between changes in bone mineral density and vertebral fracture risk associated with risedronate: greater increases in bone mineral density do not relate to greater decreases in fracture risk. J Clin Densitom 7:255–261PubMedCrossRef Watts NB, Cooper C, Lindsay R et al (2004) Relationship between changes in bone mineral density and vertebral fracture risk associated with risedronate: greater increases in bone mineral density do not relate to greater decreases in fracture risk. J Clin Densitom 7:255–261PubMedCrossRef
17.
go back to reference Li Z, Meredith MP, Hoseyni MS (2001) A method to assess the proportion of treatment effect explained by a surrogate endpoint. Stat Med 20:3175–3188PubMedCrossRef Li Z, Meredith MP, Hoseyni MS (2001) A method to assess the proportion of treatment effect explained by a surrogate endpoint. Stat Med 20:3175–3188PubMedCrossRef
18.
go back to reference Chen P, Miller PD, Delmas PD et al (2006) Change in lumbar spine BMD and vertebral fracture risk reduction in teriparatide-treated postmenopausal women with osteoporosis. J Bone Miner Res 21:1785–1790PubMedCrossRef Chen P, Miller PD, Delmas PD et al (2006) Change in lumbar spine BMD and vertebral fracture risk reduction in teriparatide-treated postmenopausal women with osteoporosis. J Bone Miner Res 21:1785–1790PubMedCrossRef
19.
go back to reference Buckley JM, Loo K, Motherway J (2007) Comparison of quantitative tomography-based measures in predicting vertebral compressive strength. Bone 40:767–774PubMedCrossRef Buckley JM, Loo K, Motherway J (2007) Comparison of quantitative tomography-based measures in predicting vertebral compressive strength. Bone 40:767–774PubMedCrossRef
20.
go back to reference Crawford RP, Cann CE, Keaveny TM (2003) Finite elements models predict in vitro vertebral body compressive strength better than quantitative computed tomography. Bone 33:744–750PubMedCrossRef Crawford RP, Cann CE, Keaveny TM (2003) Finite elements models predict in vitro vertebral body compressive strength better than quantitative computed tomography. Bone 33:744–750PubMedCrossRef
21.
go back to reference Keyak JH, Rossi SA, Jones KA et al (1998) Prediction of femoral fracture load using automated finite element modeling. J Biomech 31:125–133PubMedCrossRef Keyak JH, Rossi SA, Jones KA et al (1998) Prediction of femoral fracture load using automated finite element modeling. J Biomech 31:125–133PubMedCrossRef
22.
go back to reference Pistoia W, Van Rietbergen BV, Lochmüller E-M et al (2002) Estimation of distal radius failure load with micro-finite element analysis models based on three-dimensional peripheral quantitative computed tomography images. Bone 30:842–848PubMedCrossRef Pistoia W, Van Rietbergen BV, Lochmüller E-M et al (2002) Estimation of distal radius failure load with micro-finite element analysis models based on three-dimensional peripheral quantitative computed tomography images. Bone 30:842–848PubMedCrossRef
23.
go back to reference Kopperdahl DL, Morgan EF, Keaveny TM (2002) Quantitative computed tomography estimates of the mechanical properties of human vertebral trabecular bone. J Orthop Res 20:801–805PubMedCrossRef Kopperdahl DL, Morgan EF, Keaveny TM (2002) Quantitative computed tomography estimates of the mechanical properties of human vertebral trabecular bone. J Orthop Res 20:801–805PubMedCrossRef
24.
go back to reference Kaptoge S, Beck TJ, Reeve J, et al (2008) Prediction of incident hip fracture risk by femur geometry variables measured by hip structural analysis in the Study of Osteoporotic Fractures. J Bone Miner Res doi:10.1359/jbmr.080802 Kaptoge S, Beck TJ, Reeve J, et al (2008) Prediction of incident hip fracture risk by femur geometry variables measured by hip structural analysis in the Study of Osteoporotic Fractures. J Bone Miner Res doi:10.​1359/​jbmr.​080802
25.
go back to reference Rivadeneira F, Zillikens MC, De Laet CE et al (2007) Femoral neck BMD is a strong predictor of hip fracture susceptibility in elderly men and women because it detects cortical bone instability: the Rotterdam Study. J Bone Miner Res 22:1781–1790PubMedCrossRef Rivadeneira F, Zillikens MC, De Laet CE et al (2007) Femoral neck BMD is a strong predictor of hip fracture susceptibility in elderly men and women because it detects cortical bone instability: the Rotterdam Study. J Bone Miner Res 22:1781–1790PubMedCrossRef
26.
go back to reference Duan Y, Beck TJ, Wang XF et al (2003) Structural and biomechanical basis of sexual dimorphism in femoral neck fragility has its origins in growth and aging. J Bone Miner Res 18:1766–1774PubMedCrossRef Duan Y, Beck TJ, Wang XF et al (2003) Structural and biomechanical basis of sexual dimorphism in femoral neck fragility has its origins in growth and aging. J Bone Miner Res 18:1766–1774PubMedCrossRef
27.
go back to reference Glüer CC, Cummings SR, Pressman A et al (1994) Prediction of hip fractures from pelvic radiographs: the Study of Osteoporotic Fractures. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 9:671–677PubMed Glüer CC, Cummings SR, Pressman A et al (1994) Prediction of hip fractures from pelvic radiographs: the Study of Osteoporotic Fractures. The Study of Osteoporotic Fractures Research Group. J Bone Miner Res 9:671–677PubMed
28.
go back to reference Bell KL, Loveridge N, Power J et al (1999) Structure of the femoral neck in hip fracture: cortical bone loss in the inferoanterior to superoposterior axis. J Bone Miner Res 14:111–119PubMedCrossRef Bell KL, Loveridge N, Power J et al (1999) Structure of the femoral neck in hip fracture: cortical bone loss in the inferoanterior to superoposterior axis. J Bone Miner Res 14:111–119PubMedCrossRef
29.
go back to reference Mayhew P, Kaptoge S, Loveridge N et al (2004) Discrimination between cases of hip fracture and controls is improved by hip structural analysis compared to areal bone mineral density. An ex vivo study of the femoral neck. Bone 34:352–361PubMedCrossRef Mayhew P, Kaptoge S, Loveridge N et al (2004) Discrimination between cases of hip fracture and controls is improved by hip structural analysis compared to areal bone mineral density. An ex vivo study of the femoral neck. Bone 34:352–361PubMedCrossRef
30.
go back to reference Uusi-Rasi K, Beck TJ, Semanick LM et al (2006) Structural effects of raloxifene on the proximal femur: results from the Multiple Outcomes of Raloxifene Evaluation trial. Osteoporos Int 17:575–586PubMedCrossRef Uusi-Rasi K, Beck TJ, Semanick LM et al (2006) Structural effects of raloxifene on the proximal femur: results from the Multiple Outcomes of Raloxifene Evaluation trial. Osteoporos Int 17:575–586PubMedCrossRef
31.
go back to reference Uusi-Rasi K, Semanick LM, Zanchetta JR et al (2005) Effects of teriparatide [rhPTH (1–34)] treatment on structural geometry of the proximal femur in elderly osteoporotic women. Bone 36:948–958PubMedCrossRef Uusi-Rasi K, Semanick LM, Zanchetta JR et al (2005) Effects of teriparatide [rhPTH (1–34)] treatment on structural geometry of the proximal femur in elderly osteoporotic women. Bone 36:948–958PubMedCrossRef
32.
go back to reference Greenspan SL, Beck TJ, Resnick NM et al (2005) Effect of hormone replacement, alendronate, or combination therapy on hip structural geometry: a 3-year, double-blind, placebo-controlled clinical trial. J Bone Miner Res 20:1525–1532PubMedCrossRef Greenspan SL, Beck TJ, Resnick NM et al (2005) Effect of hormone replacement, alendronate, or combination therapy on hip structural geometry: a 3-year, double-blind, placebo-controlled clinical trial. J Bone Miner Res 20:1525–1532PubMedCrossRef
33.
go back to reference van Londen GJ, Perera S, Vujevich KT, et al (2008) Effect of risedronate on hip structural geometry: a 1-year, double-blind trial in chemotherapy-induced postmenopausal women. Bone doi:10.1016/j.bone.2008.03.027 van Londen GJ, Perera S, Vujevich KT, et al (2008) Effect of risedronate on hip structural geometry: a 1-year, double-blind trial in chemotherapy-induced postmenopausal women. Bone doi:10.​1016/​j.​bone.​2008.​03.​027
34.
go back to reference Bone HG, Bolognese MA, Yuen CK, et al (2008) Effects of denosumab on bone mineral density and bone turnover in postmenopausal women. J Clin Endocrinol Metab doi:10.1210/jc.2007-2814 Bone HG, Bolognese MA, Yuen CK, et al (2008) Effects of denosumab on bone mineral density and bone turnover in postmenopausal women. J Clin Endocrinol Metab doi:10.​1210/​jc.​2007-2814
35.
go back to reference Beck TJ, Lewiecki EM, Miller PD, et al (2008) Effects of denosumab on the geometry of the proximal femur in postmenopausal women in comparison with alendronate. J Clin Densitom 11:351–359 Beck TJ, Lewiecki EM, Miller PD, et al (2008) Effects of denosumab on the geometry of the proximal femur in postmenopausal women in comparison with alendronate. J Clin Densitom 11:351–359
36.
go back to reference Ettinger B, Black DM, Mitlak BH et al (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. JAMA 282:637–645PubMedCrossRef Ettinger B, Black DM, Mitlak BH et al (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. JAMA 282:637–645PubMedCrossRef
37.
go back to reference Goh JCH, Low SL, Bose K (1995) Effect of femoral rotation on bone mineral density measurements with dual energy X-ray absorptiometry. Calcif Tissue Int 57:340–343PubMedCrossRef Goh JCH, Low SL, Bose K (1995) Effect of femoral rotation on bone mineral density measurements with dual energy X-ray absorptiometry. Calcif Tissue Int 57:340–343PubMedCrossRef
38.
go back to reference Khoo BCC, Beck TJ, Qiao QH et al (2005) In vivo short-term precision of hip structure analysis variables in comparison with bone mineral density using paired dual-energy X-ray absorptiometry scans from multi-center clinical trials. Bone 37:112–121PubMedCrossRef Khoo BCC, Beck TJ, Qiao QH et al (2005) In vivo short-term precision of hip structure analysis variables in comparison with bone mineral density using paired dual-energy X-ray absorptiometry scans from multi-center clinical trials. Bone 37:112–121PubMedCrossRef
39.
go back to reference Roschger P, Rinnerthaler S, Yates J et al (2001) Alendronate increases degree and uniformity of mineralization in cancellous bone and decreases the porosity in cortical bone of osteoporotic women. Bone 29:185–191PubMedCrossRef Roschger P, Rinnerthaler S, Yates J et al (2001) Alendronate increases degree and uniformity of mineralization in cancellous bone and decreases the porosity in cortical bone of osteoporotic women. Bone 29:185–191PubMedCrossRef
40.
go back to reference Ste-Marie L-G, Sod E, Johnson T et al (2004) Five years of treatment with risedronate and its effects on bone safety in women with postmenopausal osteoporosis. Calcif Tissue Int 75:469–476PubMedCrossRef Ste-Marie L-G, Sod E, Johnson T et al (2004) Five years of treatment with risedronate and its effects on bone safety in women with postmenopausal osteoporosis. Calcif Tissue Int 75:469–476PubMedCrossRef
41.
go back to reference Boivin G, Lips P, Ott SM et al (2003) Contribution of raloxifene and calcium and vitamin D3 supplementation to the increase of the degree of mineralization of bone in postmenopausal women. J Clin Endocrinol Metab 88:4199–4205PubMedCrossRef Boivin G, Lips P, Ott SM et al (2003) Contribution of raloxifene and calcium and vitamin D3 supplementation to the increase of the degree of mineralization of bone in postmenopausal women. J Clin Endocrinol Metab 88:4199–4205PubMedCrossRef
42.
go back to reference Boivin G, Vedi S, Purdie DW et al (2005) Influence of estrogen therapy at conventional and high doses on the degree of mineralization of iliac bone tissue: a quantitative microradiographic analysis in postmenopausal women. Bone 36:562–567PubMedCrossRef Boivin G, Vedi S, Purdie DW et al (2005) Influence of estrogen therapy at conventional and high doses on the degree of mineralization of iliac bone tissue: a quantitative microradiographic analysis in postmenopausal women. Bone 36:562–567PubMedCrossRef
43.
go back to reference Misof BM, Roschger P, Cosman F et al (2003) Effects of intermittent parathyroid hormone administration on bone mineralization density in iliac crest biopsies from patients with osteoporosis: a paired study before and after treatment. J Clin Endocrinol Metab 88:1150–1156PubMedCrossRef Misof BM, Roschger P, Cosman F et al (2003) Effects of intermittent parathyroid hormone administration on bone mineralization density in iliac crest biopsies from patients with osteoporosis: a paired study before and after treatment. J Clin Endocrinol Metab 88:1150–1156PubMedCrossRef
44.
go back to reference Ahlborg HG, Nguyen ND, Nguyen TV et al (2005) Contribution of hip strength indices to hip fracture risk in elderly men and women. J Bone Miner Res 20:1820–1827PubMedCrossRef Ahlborg HG, Nguyen ND, Nguyen TV et al (2005) Contribution of hip strength indices to hip fracture risk in elderly men and women. J Bone Miner Res 20:1820–1827PubMedCrossRef
45.
go back to reference Melton LJ, Beck TJ, Amin S et al (2005) Contributions of bone density and structure to fracture risk assessment in men and women. Osteoporos Int 16:460–467PubMedCrossRef Melton LJ, Beck TJ, Amin S et al (2005) Contributions of bone density and structure to fracture risk assessment in men and women. Osteoporos Int 16:460–467PubMedCrossRef
Metadata
Title
DXA-based hip structural analysis of once-weekly bisphosphonate-treated postmenopausal women with low bone mass
Authors
S. L. Bonnick
T. J. Beck
F. Cosman
M. C. Hochberg
H. Wang
A. E. de Papp
Publication date
01-06-2009
Publisher
Springer-Verlag
Published in
Osteoporosis International / Issue 6/2009
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-008-0762-4

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