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Bone Mineral Density In Systemic Lupus Erythematosis
Abstracts
457
Leweicki, MD, CCD, Albuquerque, New Mexico; S. Baim, MD, CCD, Denver, Colorado; N.C. Binkley, MD, CCD, Wisconsin Quality of DXA testing is related in part to machine performance, to operator, to interpreter competence. Operators are encouraged to scan phantoms daily, to plot the results graphically for visual assessment, then to apply statistical tests such as Cusum s and Shewhart s rules, mostly applied retrospectively. We studied 6 systems (3 GE and 3 Hologic) in the US, Canada, and Switzerland. We applied Med-Imaps software to phantom data obtained from 1996 to nowadays. The software analyzed phantom data and generated a report of all violations of statistical rules. We estimated the length of time patients might have been exposed to an unstable system using traditional QC. We assumed that the Med-Imaps QC, if used in an automatic daily fashion, would result in restoration of system stability after one day. We then compared the duration of system instability using traditional QC to the time of exposure likely from automated software. We found violations 1015 days over 217 months for 2 systems yet analyzed. There was a large variability in system stability for example with HOLOGIC1 having 0 unusable day and HOLOGIC2 having 3 majors periods of unstabilities detected (Shewhart s rules). In aggregate, this may expose patients to a system with suboptimal QC for 523 days; with semi-automated software this would result in (estimated) 140 days of suboptimal QC testing. We conclude that instrument QC using traditional methods is suboptimal. Live, daily, automated QC would provide an opportunity to reduce the exposure of patients to DXA systems generating unreliable test results.
Poster Number 144
Epidemiology
PSYCHOSOCIAL IMPACTS ON BONE TURNOVER IN ADULT MEN: PRELIMINARY FINDINGS FROM THE MIDUS STUDY Arun Karlamangla, UCLA, Division of Geriatrics Neil Binkley, MD, University of Wisconsin Institute on Aging; Gayle Love, University of Wisconsin Institute on Aging; Diane Krueger, University of Wisconsin Institute on Aging; Gail Greendale, Carolyn Crandall, Teresa Seeman and Carol Ryff Recent work demonstrates that bone remodeling is, at least in part, regulated centrally in the hypothalamus. As osteoporosis ultimately results from disordered bone remodeling, it is plausible that psychosocial factors, both negative (e.g., depression) but also positive (e.g., purpose in life), could impact skeletal health. This work investigates correlations between psychosocial variables and serum bone turnover markers in adult male participants in MIDUS (Midlife in the US), a nationally representative cohort study of aging. In this preliminary analysis, serum turnover markers (BSAP, P1NP and NTx) in 247 men were correlated with positive and negative psychosocial variables. Additionally, a bone balance index (BBI), developed by deriving turnover marker T-scores and defining bone balance as formation T-score minus resorption T-score, was used to investigate associations between bone balance and psychosocial variables. A negative BBI favors resorption. In men age e 66 years (n 5 75) measures of positive psychosocial status are negatively correlated with serum NTx while aspects of psychological ill-being are positively linked with NTx. In this group, the BBI is consistent, with negative psychological factors favoring resorption while positive variables favor formation. In contrast, among younger men (age 35e49, n 5 61) the relationship between psychosocial factors and BBI is opposite to that in older men in that positive psychosocial factors are associated with increased bone resorption and a negative BBI. In conclusion, psychosocial factors may play an important role in osteoporosis pathogenesis in men. Differential associations between bone turnover and psychosocial status may exist at various ages.
Poster Number 145
Epidemiology
THE DISTRIBUTION AND CORRELATES OF BONE MINERAL DENSITY IN JAMAICAN YOUNG ADULTS Sheerin Ansari Eyre, Senior Lecturer, University of the West Indies, Kingston, Jamaica Dr. Kenneth Vaughn, Dr. Micheal Boyne, Dr. Trevor Ferguson, Dr. Novie Younger, Dr. Marshall Tulloch Reid, Dr. Maria Jackson, Dr. Maureen Samms Vaughn, and Professor Rainford Wilks, Objective: To describe the distribution of bone mineral density (BMD) among Jamaican young adults and evaluate factors associated with low BMD. Methods: 902 participants from a sub sample of the 1986 Jamaica Perinatal Mortality Survey
Journal of Clinical Densitometry: Assessment of Skeletal Health
were studied. BMD was estimated by stiffness index (SI) using quantitative ultrasound (Lunar Achilles ExpressÒ) of the right calcaneus in 701 participants, age 18-20 years. Questionnaires were used to obtain data on tobacco, marijuana, alcohol use and history of bone fracture. Anthropometry by standardized techniques used to calculate body mass index (BMI). Data were analyzed using Stata 9.2; associations with risk factors for low BMD were assessed using chi-square test, ANOVA and linear regression. Low BMD was defined as z-score ! 1 in the absence of normative values. Results: The mean stiffness index (SI) was 113.8 22.4, significantly higher in males (116.5 24.1 vs. 111.4 20.6; p ! 0.01). There were no significant differences in mean SI across the narrow age-band. Low BMD was found in 15.6% of participants (males 14.9%, females 16.2%). In univariate analysis mean SI was positively associated with BMI (p ! 0.01), weight (p ! 0.01) and marijuana use (p ! 0.04). In multivariable models female sex (p ! 0.01) and BMI (p ! 0.01) remained statistically significant. There was no association between BMD and tobacco smoking, alcohol use or previous fracture. Conclusions: Almost 16% of Jamaican young adults have low BMD as defined. Female sex and low BMI are associated with low BMD.
Poster Number 146
Epidemiology
BONE MINERAL DENSITY IN SYSTEMIC LUPUS ERYTHEMATOSIS Mariam Khan, MD, Internal Medicine Resident, Section of Rheumatology, Rush University Medical Center, Chicago, IL Lisa Maskala Streff, BA, RT, CDT, Rush University Medical Center, Chicago IL; Meenakshi Jolly, MD, Section of Rheumatology, Rush University Medical Center, Chicago IL; Charlotte Harris, MD, Section of Rheumatology, Rush University Medical Center, Chicago IL; Joel Block, MD, Section of Rheumatology, Rush University Medical Center, Chicago IL We evaluated BMD, osteoporosis (OP) screening, and osteoporosis among an ethnically diverse group of patients with systemic lupus erythematosis (SLE). With IRB approval, records of 106 female SLE patients at Rush University were reviewed for a history of OP screening, presence of low BMD (T score of 5 1.0) or osteoporosis based on DXA. SLE features were recorded, and the data were stratified by demographics, disease features and OP risk factors. Chi square & Student s t test were performed. Subjects were 42.5 13.1years old (mean SD), had SLE 9.2 8.6 years, and were 54% African American, 27% Caucasian, 19% of other ethnicity. 71% had previously received prednisone 5 7.5 mg/day or equivalent for 5 3 months. 68% had been screened for OP. Screening for OP did not vary by ethnicity, disease features or risk factors for OP. Older age (p 5 0.001), post menopausal status (p 5 0.001), and greater disease duration (p 5 0.004) were associated with OP screening. Of those screened, 47.6% had low BMD which included 9.5% with OP. Patients with low BMD or OP did not differ from the others by ethnicity, disease features or OP risk factors. Higher serum creatinine (p 5 0.02) and low BMI (p 5 0.05) were associated with low BMD. We observed no racial disparities in OP screening. Low BMD was associated with age, later menarche, BMI, SLE disease duration, and decreased renal function, but not with ethnicity, disease activity or damage among patients with SLE. OP screening is important in SLE, especially in older patients with longer disease duration.
Poster Number 147
Epidemiology
THE RELATIONSHIP BETWEEN FREE TESTOSTERONE AND LONGITUDINAL CHANGES IN BONE MINERAL DENSITY IN ELDERLY MEN Denise Angelica Teves, MD, Division of Endocrinology, Medical College of Wisconsin Edith Burns, MD, Geriatrics, Medical College of Wisconsin; Prakash Laud, PhD, Biostatistics, Medical College of Wisconsin; Joan Neuner, MD, Internal Medicine, Medical College of Wisconsin We analyzed the male cohort of an existing database collected between 1993 and 1999 in greater Milwaukee, to determine the relationship between Free Testosterone levels and Bone mineral density. Methods: A secondary data analysis of the male cohort of the prospective study: ‘‘Causes of Lean Body Mass Atrophy in Aging Men and Women’’ was performed. These were community-dwelling men age 60 and older. Bone mineral density, hormonal measurements, and dietary intake were measured at 6 month intervals. We studied simple correlations between free testosterone(FT) and bone mineral density(BMD) at different study points
Volume 11, 2008
457
Leweicki, MD, CCD, Albuquerque, New Mexico; S. Baim, MD, CCD, Denver, Colorado; N.C. Binkley, MD, CCD, Wisconsin Quality of DXA testing is related in part to machine performance, to operator, to interpreter competence. Operators are encouraged to scan phantoms daily, to plot the results graphically for visual assessment, then to apply statistical tests such as Cusum s and Shewhart s rules, mostly applied retrospectively. We studied 6 systems (3 GE and 3 Hologic) in the US, Canada, and Switzerland. We applied Med-Imaps software to phantom data obtained from 1996 to nowadays. The software analyzed phantom data and generated a report of all violations of statistical rules. We estimated the length of time patients might have been exposed to an unstable system using traditional QC. We assumed that the Med-Imaps QC, if used in an automatic daily fashion, would result in restoration of system stability after one day. We then compared the duration of system instability using traditional QC to the time of exposure likely from automated software. We found violations 1015 days over 217 months for 2 systems yet analyzed. There was a large variability in system stability for example with HOLOGIC1 having 0 unusable day and HOLOGIC2 having 3 majors periods of unstabilities detected (Shewhart s rules). In aggregate, this may expose patients to a system with suboptimal QC for 523 days; with semi-automated software this would result in (estimated) 140 days of suboptimal QC testing. We conclude that instrument QC using traditional methods is suboptimal. Live, daily, automated QC would provide an opportunity to reduce the exposure of patients to DXA systems generating unreliable test results.
Poster Number 144
Epidemiology
PSYCHOSOCIAL IMPACTS ON BONE TURNOVER IN ADULT MEN: PRELIMINARY FINDINGS FROM THE MIDUS STUDY Arun Karlamangla, UCLA, Division of Geriatrics Neil Binkley, MD, University of Wisconsin Institute on Aging; Gayle Love, University of Wisconsin Institute on Aging; Diane Krueger, University of Wisconsin Institute on Aging; Gail Greendale, Carolyn Crandall, Teresa Seeman and Carol Ryff Recent work demonstrates that bone remodeling is, at least in part, regulated centrally in the hypothalamus. As osteoporosis ultimately results from disordered bone remodeling, it is plausible that psychosocial factors, both negative (e.g., depression) but also positive (e.g., purpose in life), could impact skeletal health. This work investigates correlations between psychosocial variables and serum bone turnover markers in adult male participants in MIDUS (Midlife in the US), a nationally representative cohort study of aging. In this preliminary analysis, serum turnover markers (BSAP, P1NP and NTx) in 247 men were correlated with positive and negative psychosocial variables. Additionally, a bone balance index (BBI), developed by deriving turnover marker T-scores and defining bone balance as formation T-score minus resorption T-score, was used to investigate associations between bone balance and psychosocial variables. A negative BBI favors resorption. In men age e 66 years (n 5 75) measures of positive psychosocial status are negatively correlated with serum NTx while aspects of psychological ill-being are positively linked with NTx. In this group, the BBI is consistent, with negative psychological factors favoring resorption while positive variables favor formation. In contrast, among younger men (age 35e49, n 5 61) the relationship between psychosocial factors and BBI is opposite to that in older men in that positive psychosocial factors are associated with increased bone resorption and a negative BBI. In conclusion, psychosocial factors may play an important role in osteoporosis pathogenesis in men. Differential associations between bone turnover and psychosocial status may exist at various ages.
Poster Number 145
Epidemiology
THE DISTRIBUTION AND CORRELATES OF BONE MINERAL DENSITY IN JAMAICAN YOUNG ADULTS Sheerin Ansari Eyre, Senior Lecturer, University of the West Indies, Kingston, Jamaica Dr. Kenneth Vaughn, Dr. Micheal Boyne, Dr. Trevor Ferguson, Dr. Novie Younger, Dr. Marshall Tulloch Reid, Dr. Maria Jackson, Dr. Maureen Samms Vaughn, and Professor Rainford Wilks, Objective: To describe the distribution of bone mineral density (BMD) among Jamaican young adults and evaluate factors associated with low BMD. Methods: 902 participants from a sub sample of the 1986 Jamaica Perinatal Mortality Survey
Journal of Clinical Densitometry: Assessment of Skeletal Health
were studied. BMD was estimated by stiffness index (SI) using quantitative ultrasound (Lunar Achilles ExpressÒ) of the right calcaneus in 701 participants, age 18-20 years. Questionnaires were used to obtain data on tobacco, marijuana, alcohol use and history of bone fracture. Anthropometry by standardized techniques used to calculate body mass index (BMI). Data were analyzed using Stata 9.2; associations with risk factors for low BMD were assessed using chi-square test, ANOVA and linear regression. Low BMD was defined as z-score ! 1 in the absence of normative values. Results: The mean stiffness index (SI) was 113.8 22.4, significantly higher in males (116.5 24.1 vs. 111.4 20.6; p ! 0.01). There were no significant differences in mean SI across the narrow age-band. Low BMD was found in 15.6% of participants (males 14.9%, females 16.2%). In univariate analysis mean SI was positively associated with BMI (p ! 0.01), weight (p ! 0.01) and marijuana use (p ! 0.04). In multivariable models female sex (p ! 0.01) and BMI (p ! 0.01) remained statistically significant. There was no association between BMD and tobacco smoking, alcohol use or previous fracture. Conclusions: Almost 16% of Jamaican young adults have low BMD as defined. Female sex and low BMI are associated with low BMD.
Poster Number 146
Epidemiology
BONE MINERAL DENSITY IN SYSTEMIC LUPUS ERYTHEMATOSIS Mariam Khan, MD, Internal Medicine Resident, Section of Rheumatology, Rush University Medical Center, Chicago, IL Lisa Maskala Streff, BA, RT, CDT, Rush University Medical Center, Chicago IL; Meenakshi Jolly, MD, Section of Rheumatology, Rush University Medical Center, Chicago IL; Charlotte Harris, MD, Section of Rheumatology, Rush University Medical Center, Chicago IL; Joel Block, MD, Section of Rheumatology, Rush University Medical Center, Chicago IL We evaluated BMD, osteoporosis (OP) screening, and osteoporosis among an ethnically diverse group of patients with systemic lupus erythematosis (SLE). With IRB approval, records of 106 female SLE patients at Rush University were reviewed for a history of OP screening, presence of low BMD (T score of 5 1.0) or osteoporosis based on DXA. SLE features were recorded, and the data were stratified by demographics, disease features and OP risk factors. Chi square & Student s t test were performed. Subjects were 42.5 13.1years old (mean SD), had SLE 9.2 8.6 years, and were 54% African American, 27% Caucasian, 19% of other ethnicity. 71% had previously received prednisone 5 7.5 mg/day or equivalent for 5 3 months. 68% had been screened for OP. Screening for OP did not vary by ethnicity, disease features or risk factors for OP. Older age (p 5 0.001), post menopausal status (p 5 0.001), and greater disease duration (p 5 0.004) were associated with OP screening. Of those screened, 47.6% had low BMD which included 9.5% with OP. Patients with low BMD or OP did not differ from the others by ethnicity, disease features or OP risk factors. Higher serum creatinine (p 5 0.02) and low BMI (p 5 0.05) were associated with low BMD. We observed no racial disparities in OP screening. Low BMD was associated with age, later menarche, BMI, SLE disease duration, and decreased renal function, but not with ethnicity, disease activity or damage among patients with SLE. OP screening is important in SLE, especially in older patients with longer disease duration.
Poster Number 147
Epidemiology
THE RELATIONSHIP BETWEEN FREE TESTOSTERONE AND LONGITUDINAL CHANGES IN BONE MINERAL DENSITY IN ELDERLY MEN Denise Angelica Teves, MD, Division of Endocrinology, Medical College of Wisconsin Edith Burns, MD, Geriatrics, Medical College of Wisconsin; Prakash Laud, PhD, Biostatistics, Medical College of Wisconsin; Joan Neuner, MD, Internal Medicine, Medical College of Wisconsin We analyzed the male cohort of an existing database collected between 1993 and 1999 in greater Milwaukee, to determine the relationship between Free Testosterone levels and Bone mineral density. Methods: A secondary data analysis of the male cohort of the prospective study: ‘‘Causes of Lean Body Mass Atrophy in Aging Men and Women’’ was performed. These were community-dwelling men age 60 and older. Bone mineral density, hormonal measurements, and dietary intake were measured at 6 month intervals. We studied simple correlations between free testosterone(FT) and bone mineral density(BMD) at different study points
Volume 11, 2008