Treatments of osteoporosis increase bone material strength index in patients with low bone mass

Schoeb, M.; Malgo, F.; Peeters, J. J. M.; Winter, E. M.; Papapoulos, S. E.; Appelman-Dijkstra, N. M.

Affiliations

¹Center for Bone Quality, Department of Medicine, Division Endocrinology, Leiden University Medical Center, Leiden, The Netherlands

Abstract and keywords

Summary: Effects on bone material properties of two-year antiosteoporotic treatment were assessed using in vivo impact microindentation (IMI) in patients with low bone mineral density (BMD) values. Antiresorptive treatment, in contrast to vitamin D ± calcium treatment alone, induced BMD-independent increases in bone material strength index, measured by IMI, the magnitude of which depended on pretreatment values.

Introduction: Bone material strength index (BMSi), measured by IMI in vivo, is reduced in patients with fragility fractures, but there is no information about changes in values during long-term therapy. In the present study, we assessed changes in BMSi in patients receiving antiosteoporotic treatments for periods longer than 12 months.

Methods: We included treatment-naive patients with low bone mass who had a BMSi measurement with OsteoProbe® at presentation and consented to a repeat measurement after treatment.

Results: We studied 54 patients (34 women), median age 58 years, of whom 30 were treated with bisphosphonates or denosumab (treatment group) and 24 with vitamin D ± calcium alone (control group). There were no differences in clinical characteristics between the two groups with the exception of a higher number of previous fragility fractures in the treatment group. Baseline hip BMD and BMSi values were lower in the treatment group. After 23.1 ± 6.6 months, BMSi increased significantly in the treatment group (82.4 ± 4.3 vs 79.3 ± 4.1; p < 0.001), but did not change in the control group (81.5 ± 5.2 vs 82.2 ± 4.1; p = 0.35). Changes in BMSi with antiresorptives were inversely related with baseline values (r = − 0.43; p = 0.02) but not with changes in BMD. Two patients in the control group with large decreases in BMSi values sustained incident fractures.

Conclusion: In patients at increased fracture risk, antiresorptive treatments induced BMD-independent increases in BMSi values, the magnitude of which depended on pretreatment values.

Keywords: Bisphosphonates; Bone material strength index (BMSi); Denosumab; Fragility fracture; Impact microindentation; Reference point indentation

Links

DOI: 10.1007/s00198-020-05375-3

PubMed: 32270252

WoS: 000556985600001

History

Received: 2019-12-09

Accepted: 2020-03-03

Online: 2020-04-08

Cited Works (10)

Year	Entry
2010	Donnelly E, Chen DX, Boskey AL, Baker SP, van der Meulen MCH. Contribution of mineral to bone structural behavior and tissue mechanical properties. Calcif Tiss Int. November 2010;87(5):450-460.
2009	Boskey AL, Spevak L, Weinstein RS. Spectroscopic markers of bone quality in alendronate-treated postmenopausal women. Osteoporos Int. May 2009;20(5):793-800.
2017	Paschalis EP, Gamsjaeger S, Klaushofer K. Vibrational spectroscopic techniques to assess bone quality. Osteoporos Int. August 2017;28(8):2275-2291.
2016	Diez-Perez A, Bouxsein M, Eriksen E, Khosla S, Nyman J, Papapoulos S, Tang S. Technical note: recommendations for a standard procedure to assess cortical bone at the tissue-level in vivo using impact microindentation. Bone Rep. December 2016;5:181-185.
2010	Gourion-Arsiquaud S, Allen MR, Burr DB, Vashishth D, Tang SY, Boskey AL. Bisphosphonate treatment modifies canine bone mineral and matrix properties and their heterogeneity. Bone. March 2010;46(3):666-672.
2020	Rokidi S, Bravenboer N, Gamsjaeger S, Misof B, Blouin S, Chavassieux P, Klaushofer K, Paschalis E, Papapoulos S, Appelman-Dijkstra N. Impact microindentation assesses subperiosteal bone material properties in humans. Bone. February 2020;131:115110.
2011	Gamsjaeger S, Buchinger B, Zwettler E, Recker R, Black D, Gasser JA, Eriksen EF, Klaushofer K, Paschalis EP. Bone material properties in actively bone-forming trabeculae in postmenopausal women with osteoporosis after three years of treatment with once-yearly zoledronic acid. J Bone Miner Res. January 2011;26(1):12-18.
2016	Furst JR, Bandeira LC, Fan W-W, Agarwal S, Nishiyama KK, McMahon DJ, Dworakowski E, Jiang H, Silverberg SJ, Rubin MR. Advanced glycation endproducts and bone material strength in type 2 diabetes. J Clin Endocrinol Metab. June 2016;101(6):2502-2510.
1993	Genant HK, Wu CY, van Kuijk C, Nevitt MC. Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res. September 1993;8(9):1137-1148.
2003	Paschalis EP, Boskey AL, Kassem M, Eriksen EF. Effect of hormone replacement therapy on bone quality in early postmenopausal women. J Bone Miner Res. June 2003;18(6):955-959.

Cited By (4)

Year	Entry
2020	Rokidi S, Bravenboer N, Gamsjaeger S, Chavassieux P, Zwerina J, Paschalis E, Papapoulos S, Appelman-Dijkstra N. Impact microindentation measurements correlate with cortical bone material properties measured by Fourier transform infrared imaging in humans. Bone. August 2020;137:115437.
2022	Holloway-Kew KL, Rufus-Membere P, Anderson KB, Tembo MC, Sui SX, Hyde NK, Diez-Perez A, Kotowicz MA, Pasco JA. Associations between parameters of peripheral quantitative computed tomography and bone material strength index. Bone. February 2022;155:116268.
2022	Hepp N, Folkestad L, Møllebæk S, Frederiksen AL, Duno M, Jørgensen NR, Hermann AP, Jensen J-EB. Bone-microarchitecture and bone-strength in a sample of adults with hypophosphatasia and a matched reference population assessed by HR-pQCT and impact microindentation. Bone. July 2022;160:116420.
2023	Jaiswal R, Zoulakis M, Axelsson KF, Darelid A, Rudäng R, Sundh D, Litsne H, Johansson L, Lorentzon M. Increased bone material strength index is positively associated with the risk of incident osteoporotic fractures in older Swedish women. J Bone Miner Res. June 2023;38(6):860-868.