Journal of Bone and Mineral Metabolism最新文献

Introduction: Surgery has increasingly been reported as an effective treatment for medication-related osteonecrosis of the jaw (MRONJ), but concrete intervention criteria are lacking. On computed tomography (CT) images, the boundary between the healthy site and necrotic lesion, which we defined as "MRONJ demarcation line", is sometimes visible. This study aimed to identify the factors associated with this boundary to improve surgical planning.

Materials and methods: 95 patients with MRONJ who underwent their first CT at our institution between May 2010 and June 2022 were included. The Mann-Whitney U test, Fisher's exact test, and multivariate logistic regression analysis were performed. The cumulative incidence rates were calculated using the Kaplan-Meier method. Statistical significance was set at p < 0.05.

Results: MRONJ demarcation line was observed in 63 patients and absent in 32. Significant associations were identified between MRONJ demarcation line formation and denosumab (p = 0.013), antiresorptive agent (ARA) discontinuation (p = 0.024), and periosteal reaction ( p = 0.034). The cumulative incidence rates of MRONJ demarcation line formation at 12, 24, and 36 months after discontinuation of high-dose ARA were 58.0%, 89.2%, and 96.4% for denosumab, and 29.9%, 68.8%, and 88.3% for bisphosphonates, respectively. In the low-dose group, the rates at 12, 24, and 36 months after discontinuation of denosumab were 41.7%, 51.4%, and 63.5%, respectively, while those for bisphosphonates were 22.2%, 35.8%, and 51.1%.

Conclusion: Denosumab administration, ARA discontinuation, and periosteal reaction are significantly associated with the MRONJ demarcation line, which may help in establishing criteria for surgical intervention.

Introduction: Glucocorticoid-induced osteoporosis (GIOP) is the most common form of secondary osteoporosis, and bisphosphonates (BPs) are widely used for treatment. Localized cortical thickening (LCT, "beaking" or "flaring") is a characteristic radiographic finding and a potential precursor of atypical femoral fracture, a known complication of long-term BP use. The incidence of LCT and its association with BP duration in GIOP remain unclear.

Materials and methods: In this cross-sectional study, 86 outpatients with GIOP (mean age, 60.6 years; 62.8% women) were included. Femoral radiographs were evaluated for LCT, cortical thickness index (CTI; diaphyseal/subtrochanteric), and lateral bowing angle (LBA). Patients were stratified by BP duration (≥2 or ≥4 years), and 1:1 propensity score matching was used to evaluate the association with LCT. Associations of BP duration with CTI and LBA were analyzed using linear mixed-effects models; correlations with bone turnover markers (BTMs) and bone mineral density (BMD) were also examined.

Results: LCT was observed in 11 (12.8%) patients, including 10 undergoing BP therapy. Patients with LCT had a significantly longer duration of BP use (median: 8.0 years vs. 1.2 years, p <0.01). After matching, BP use for ≥4 years was significantly associated with LCT (odds ratio=11.29, p=0.01), whereas that for ≥2 years was not. Diaphyseal CTI significantly increased with BP duration; no associations were found with subtrochanteric CTI, LBA, BTMs, or BMD.

Conclusion: In GIOP, prolonged BP use, especially for ≥4 years, was associated with LCT and greater diaphyseal cortical thickness. Radiographic assessment is essential in patients with GIOP and long-term BP use.

Introduction: Accurate prediction of fracture risk is important for treatment decisions, yet evaluations of commonly used thresholds are limited, and the added value of volumetric bone mineral density (vBMD) remains uncertain. We conducted the first head-to-head comparison of the SHAFRE and FRAX algorithms using identical predictor information.

Materials and methods: We included 3525 community-dwelling Swedish men and women (mean age 71.4 years) who underwent a health examination with femoral neck areal BMD (aBMD) and radial vBMD. Incident fractures were retrieved from the National Patient Register. Model performance was evaluated using threshold-specific sensitivity and specificity.

Results: Over a mean follow-up of 8.7 years, 559 participants sustained a fracture. SHAFRE predicted a mean 10-year fracture risk of 21.9% in those who fractured versus 15.6% in the remaining cohort (ROC-area: 68%, 95% CI: 66-71%). Corresponding FRAX values were 16.7% and 12.6% (ROC-area: 66%, 95% CI: 63-68%), and FRAX slightly underestimated fracture risk in this cohort. Adding radial vBMD on top of aBMD did not materially improve discrimination for SHAFRE (70%, 95% CI: 67-72%) or FRAX (68%, 95% CI: 65-70%). Threshold-specific analysis identified an optimal predicted risk threshold of 13-17%, consistently below the commonly recommended 20%.

Conclusions: Predictive ability for major fractures remained modest for both algorithms and was not improved by adding vBMD. The estimated optimal threshold for treatment initiation was lower than the commonly recommended 20%. These findings reinforce that discrimination is substantially stronger for hip fracture than for major osteoporotic fractures.

Introduction: To determine the incidence and risk factors of fragility fractures and atypical femoral fracture (AFF)-related events in patients with systemic lupus erythematosus (SLE) receiving long-term glucocorticoid (GC) therapy.

Materials and methods: A retrospective analysis was conducted of 170 SLE patients followed from 2016 to 2023. Data on GC use, bisphosphonate (BP) therapy, bone-related events, and clinical characteristics were collected. Risk factors for fragility fractures and AFF-related events, including localized periosteal thickening (LPT), were analyzed using multivariate logistic regression.

Results: Although the median daily dose of prednisolone decreased over time, 82.9% of patients still met the criteria for pharmacologic intervention for GC-induced osteoporosis in 2023, and most continued to receive > 5 mg/day of GC. The median duration of BP therapy was 10.4 years, with 69 patients maintaining BP treatment throughout the observation period (median, 12.5 years). Fragility fractures and AFF-related events occurred in 7.6% and 5.8% of patients, respectively. Fragility fractures were independently associated with SLE flares and infection-related hospitalizations, whereas AFF-related events were significantly associated with prolonged BP use.

Conclusion: Despite a gradual reduction in GC dosage, many patients with longstanding SLE remain at elevated risk for fractures. The comparable frequencies of fragility fractures and AFF-related events highlight the clinical relevance of both complications. The prevention of SLE flares and infections may contribute to lowering the risk of fragility fractures. In addition, careful monitoring for AFF/LPT is warranted in patients receiving long-term BP and GC therapy.