Socioeconomic status and risk of osteoporotic fractures and the use of DXA scans: data from the Danish population-based ROSE study.

There is a need of studies exploring the link between socioeconomic status and DXA scans and osteoporotic fracture, which was the aim of the present study. No differences in socioeconomic status and risk of osteoporotic fractures were found. However, women with further/higher education and higher income are more often DXA-scanned. INTRODUCTION: Lower socioeconomic status is known to be associated with a range of chronic conditions and with access to health care services. The link between socioeconomic status and the use of DXA scans and osteoporotic fracture, however, needs to be explored more closely. Therefore, the aim of this study was to examine the relationship between socioeconomic status and both DXA scan utilization and major osteoporotic fractures (MOF) using a population-based cohort of Danish women and national registers. METHODS: The study included 17,155 women (65-81 years) sampled from the Risk-stratified Osteoporosis Strategy Evaluation study (ROSE). Information on socioeconomic background, DXA scans, and MOFs was retrieved from national registers. Competing-risk regression analyses were performed. Mean follow-up was 4.8 years. RESULTS: A total of 4245 women had a DXA scan (24.7%) and 1719 (10.0%) had an incident MOF during follow-up. Analyses showed that women with basic education had a lower probability of undergoing DXA scans than women with further or higher education (greater than upper secondary education and vocational training education) (subhazard ratio (SHR) = 0.82; 95% CI 0.75-0.89, adjusted for age and comorbidity). Moreover, women with disposable income in the low and medium tertiles had a lower probability of undergoing DXA scans than women in the high-income tertile (SHR = 0.90; 95% CI 0.84-0.97 and SHR = 0.88, 95% CI 0.82-0.95, respectively, adjusted for age and comorbidity). No association between socioeconomic background and probability of DXA was found in adjusted analyses. CONCLUSION: The study found no differences in risk of osteoporotic fractures depending on socioeconomic status. However, women with further or higher education as well as higher income are more often DXA-scanned.

Does growth hormone therapy in adult patients with growth hormone deficiency protect against bone loss?

Fracture incidence is increased in growth hormone deficiency (GHD). However, the efficacy of growth hormone (GH) in the prevention of fractures in GHD is not documented. GH is important to attain normal peak bone mass; it increases bone mass in children and adolescents, but is less important with increasing age and is insignificant above the age of 55-60 years old. Placebo-controlled trials of 12 months' duration have failed to improve bone mass density, while uncontrolled studies have suggested that GH treatment for 2-4 years may increase bone mass by 0.5 of a standard deviation in adults. Given the current high price of GH treatment, however, routine substitution with the intention to decrease fracture incidence in adult GHD patients is not likely to be cost effective. GH substitution should probably be extended until peak bone mass has been achieved, and repeated dual energy X-ray scan measurements with intervals of 1-2 years could be helpful in deciding when to stop treatment.

Assessment of bone involvement in patients with multiple myeloma using bone densitometry.

To evaluate the use of dual energy X-ray absorptiometry (DXA) in multiple myeloma (MM) we performed a prospective study of 34 patients with newly diagnosed MM. Most patients had advanced disease and all but two patients had osteolytic bone destructions and/or pathological fractures. Bone mineral content (BMC) and bone mineral density (BMD) of the lumbar spine (L1-L4) and hip were measured using a Hologic QDR-1000 scanner. Collapsed vertebrae were not excluded from analysis. Data from 289 healthy Danish volunteers aged 21-79 yr were used for calculation of Z-scores. Lumbar spine BMC (Z-score -0.46 +/- 0.23, p = 0.05) and lumbar spine BMD (Z-score -0.56 +/- 0.23, p = 0.02) were significantly reduced in MM patients, whereas no reduction was seen in hip BMC or BMD. Collapsed vertebrae had marked reduced BMD (Z-score -1.34 +/- 0.22, p < 0.001), as had non-fractured vertebrae in the same individuals (Z-score -1.42 +/- 0.25, p < 0.001). Lumbar spine BMD correlated with radiologically assessed bone morbidity (r -0.37, p = 0.03) and stronger with the incidence of vertebral fractures (r -0.64, p < 0.001). Thus, osteopenia of the back is common in multiple myeloma and correlates with an increased incidence of fractures. DXA may identify subjects with increased risk of vertebral fractures for more intensive chemotherapeutic or anti-resorptive treatment.

Spect bone scintigraphy in assessment of cranial Paget's disease.

Single photon emission computed tomography (SPECT) bone scintigraphy was used in the assessment of Paget's disease in 3 patients with skull involvement. In comparison with conventional scintigraphy, SPECT improved the three-dimensional perception and made precise outlining of involved bones possible. The radionuclide uptake in lesions expressed as counts per pixel was 1.5 to 10 times that of normal bones. Routine use of SPECT in cranial Paget's disease for staging and monitoring the effect of treatment is proposed.