- Email: [email protected]
Effect of tumor necrosis factor-alpha inhibition on bone turnover in psoriatic arthritis
Abstracts
215
In an effort to understand how the physiological pattern of bone turnover marker levels vary throughout the menstrual cycle, this study measured serum C-terminal telopeptide of type 1 collagen (sCTX) levels in healthy women of childbearing age. Blood samples were drawn during one menstrual cycle from female volunteers (ages 18e35) for measurement of sCTX levels. No study drug was administered. Each menstrual cycle was divided into 2 phases relative to the serum luteinizing hormone (LH) peak (day 0) and normalized to 29 days. The range of variation of sCTX in relation to the menstrual cycle and the percent change from sCTX levels during the serum LH peak were determined. Of the 62 subjects who enrolled, 58 (93.5%) completed the study. Median values of sCTX levels were 0.463 ng/mL during the follicular phase (FP, Days 14 to 1), 0.452 ng/mL at serum LH peak (Day 0), and 0.42 2 ng/mL during the luteal phase (LP, Days 1e14). Expressed as percent change from the sCTX level at LH peak, mean levels varied from +4.35% during the FP to 5.11% during the LP and median levels varied from approximately +6% during the FP to 18% during the LP (Figure). The tendency for median percent changes in sCTX levels to be lower during the LP versus FP was statistically significant (p 5 0.0014). In healthy pre-menopausal women, sCTX levels vary throughout the menstrual cycle, with percent change from levels at LH peak significantly higher during the earlier part of the menstrual cycle than during the later phase.
BC risk factors. The EvistaÒ/Alendronate Comparison trial enrolled postmenopausal women without a preexisting vertebral fracture with low BMD or osteoporosis. Spine radiographs were taken to identify preexisting vertebral fractures, and 1420 women completed the Gail questionnaire. Relationships between baseline BMD, preexisting fractures, and known osteoporosis risk factors confirm previously established results. Women with osteoporosis at the femoral neck actually had statistically significantly higher BC risk than women with low bone mass at this site (Table). There was no significant relationship between lumbar spine or total hip BMD and BC risk. The proportions of women at high BC risk (e1.67%) ranged from 42% to 46%, irrespective of baseline BMD T-score and measurement site. BC risks in women with a history of previous nonvertebral fractures (1.87%1.00) were similar to those in women with no previous fractures (1.83%0.95), as were proportions of women at high risk for BC (43% and 45%, respectively; P 5 0.45 for both comparisons). Therefore, postmenopausal women in this cohort have an elevated BC risk, which is similar, irrespective of lumbar spine or total hip BMD T-score. Relationships between Bone Mineral Density and Breast Cancer Risk (by Gail Model) in Postmenopausal Women with Low Bone Mass or Osteoporosis
Poster Number 158
Other
EFFECT OF TUMOR NECROSIS FACTOR-ALPHA INHIBITION ON BONE TURNOVER IN PSORIATIC ARTHRITIS DH Dalal, MD, Rheumatology, George Washington University Medical H Wildman, George Washington University Medical Center, Washington DC; RV Curiel, Rheumatology, George Washington University Medical Center, Washington DC
Poster Number 157
Other
RELATIONSHIPS BETWEEN BONE MINERAL DENSITY AND BREAST CANCER RISK (BY GAIL MODEL) IN POSTMENOPAUSAL WOMEN WITH LOW BONE MASS OR OSTEOPOROSIS John L Stock, MD, Eli Lilly and Company, Indianapolis, IN David L Kendler, Osteoporosis Research Ctr, Vancouver, BC, Canada; Robert Recker, Creighton University Osteoporosis Research Ctr, Omaha, NE; E Michael Lewiecki, New Mexico Clin Res & Osteoporosis Ctr, Albuquerque, NM; Jane Cauley, University of Pittsburgh, Pittsburgh, PA; Neil Binkley, University of Wisconsin, Madison, WI; Wojciech Olszynski, University of Saskatchewan, Saskatoon, SK, Canada; Joanne Lorraine, Eli Lilly and Company; Yongming Qu, Eli Lilly and Company; Mayme Wong, Eli Lilly and Company; Leo Plouffe, Eli Lilly and Company Postmenopausal women are at higher risk for osteoporosis and breast cancer (BC) with increasing age. Studies have found women with higher bone mineral density (BMD) have increased risk of BC, compared to women with low BMD. This analysis examines relationships between BMD and BC risk, assessed using the Gail model which estimates 5-yr predicted invasive BC risk based upon recognized
Journal of Clinical Densitometry
Psoriatic Arthritis, an inflammatory arthritis associated with psoriasis, is characterized by increased levels of tumor necrosis factor-alpha (TNF) in synovium and lesional skin. TNF has also been shown to increase osteoclast activation. Inhibitors of TNF are used to treat joint and skin inflammation in psoriatic arthritis. We examine whether TNF inhibition affects bone turnover in psoriatic patients and if this correlates with changes in inflammatory markers. Patients with active psoriatic arthritis meeting criteria for TNF inhibitor treatment were enrolled. Spot urinary concentrations of type I collagen cross-linked N-telopeptide (NTX) were measured at baseline and after 12 weeks of treatment. Serum C-reactive protein (CRP) was also measured at these times. The percent change in NTX and CRP was determined and correlation was compared. After 12 weeks of TNF inhibitor treatment, NTX decreased 34.6% (pd0.014). Serum CRP levels decreased 57.75% (pd0.023) from baseline. A positive correlation between change in CRP and NTX was seen using Pearson Correlation (R 5 0.69). In active psoriatic arthritis patients, we see a trend towards decrease of bone resorption marker NTX after 3 months of TNF inhibition. This correlates with a decrease in CRP levels. This suggests that TNF inhibition can reduce bone turnover in psoriatic arthritis.
Poster Number 159
Other
INTER-TECHNOLOGIST COMPARISON OF PATIENT HEIGHT MEASUREMENT IN A CLINICAL BONE DENSITY LABORATORY Terry DeFrancisco, CDT, Oregon Osteoporosis Center, Portland, OR Sharon Neis, Oregon Osteoporosis Center, Portland, OR; Lorna Cole, Oregon Osteoporosis Center, Portland, OR; Edward Mossman, Oregon Osteoporosis Center, Portland, OR; Michael McClung, MD Height measurement is an important part of the clinical bone mineral density (BMD) assessment procedure and contributes to factors that can be used with BMD measurement to estimate a patient s risk of fracture such as BMI and height loss. When measuring patient height, there can be differences in results measured by the same technologist, as well as in those measured by different technologists. The extent of such differences and their implications for assessment of patient
Volume 10, 2007
215
In an effort to understand how the physiological pattern of bone turnover marker levels vary throughout the menstrual cycle, this study measured serum C-terminal telopeptide of type 1 collagen (sCTX) levels in healthy women of childbearing age. Blood samples were drawn during one menstrual cycle from female volunteers (ages 18e35) for measurement of sCTX levels. No study drug was administered. Each menstrual cycle was divided into 2 phases relative to the serum luteinizing hormone (LH) peak (day 0) and normalized to 29 days. The range of variation of sCTX in relation to the menstrual cycle and the percent change from sCTX levels during the serum LH peak were determined. Of the 62 subjects who enrolled, 58 (93.5%) completed the study. Median values of sCTX levels were 0.463 ng/mL during the follicular phase (FP, Days 14 to 1), 0.452 ng/mL at serum LH peak (Day 0), and 0.42 2 ng/mL during the luteal phase (LP, Days 1e14). Expressed as percent change from the sCTX level at LH peak, mean levels varied from +4.35% during the FP to 5.11% during the LP and median levels varied from approximately +6% during the FP to 18% during the LP (Figure). The tendency for median percent changes in sCTX levels to be lower during the LP versus FP was statistically significant (p 5 0.0014). In healthy pre-menopausal women, sCTX levels vary throughout the menstrual cycle, with percent change from levels at LH peak significantly higher during the earlier part of the menstrual cycle than during the later phase.
BC risk factors. The EvistaÒ/Alendronate Comparison trial enrolled postmenopausal women without a preexisting vertebral fracture with low BMD or osteoporosis. Spine radiographs were taken to identify preexisting vertebral fractures, and 1420 women completed the Gail questionnaire. Relationships between baseline BMD, preexisting fractures, and known osteoporosis risk factors confirm previously established results. Women with osteoporosis at the femoral neck actually had statistically significantly higher BC risk than women with low bone mass at this site (Table). There was no significant relationship between lumbar spine or total hip BMD and BC risk. The proportions of women at high BC risk (e1.67%) ranged from 42% to 46%, irrespective of baseline BMD T-score and measurement site. BC risks in women with a history of previous nonvertebral fractures (1.87%1.00) were similar to those in women with no previous fractures (1.83%0.95), as were proportions of women at high risk for BC (43% and 45%, respectively; P 5 0.45 for both comparisons). Therefore, postmenopausal women in this cohort have an elevated BC risk, which is similar, irrespective of lumbar spine or total hip BMD T-score. Relationships between Bone Mineral Density and Breast Cancer Risk (by Gail Model) in Postmenopausal Women with Low Bone Mass or Osteoporosis
Poster Number 158
Other
EFFECT OF TUMOR NECROSIS FACTOR-ALPHA INHIBITION ON BONE TURNOVER IN PSORIATIC ARTHRITIS DH Dalal, MD, Rheumatology, George Washington University Medical H Wildman, George Washington University Medical Center, Washington DC; RV Curiel, Rheumatology, George Washington University Medical Center, Washington DC
Poster Number 157
Other
RELATIONSHIPS BETWEEN BONE MINERAL DENSITY AND BREAST CANCER RISK (BY GAIL MODEL) IN POSTMENOPAUSAL WOMEN WITH LOW BONE MASS OR OSTEOPOROSIS John L Stock, MD, Eli Lilly and Company, Indianapolis, IN David L Kendler, Osteoporosis Research Ctr, Vancouver, BC, Canada; Robert Recker, Creighton University Osteoporosis Research Ctr, Omaha, NE; E Michael Lewiecki, New Mexico Clin Res & Osteoporosis Ctr, Albuquerque, NM; Jane Cauley, University of Pittsburgh, Pittsburgh, PA; Neil Binkley, University of Wisconsin, Madison, WI; Wojciech Olszynski, University of Saskatchewan, Saskatoon, SK, Canada; Joanne Lorraine, Eli Lilly and Company; Yongming Qu, Eli Lilly and Company; Mayme Wong, Eli Lilly and Company; Leo Plouffe, Eli Lilly and Company Postmenopausal women are at higher risk for osteoporosis and breast cancer (BC) with increasing age. Studies have found women with higher bone mineral density (BMD) have increased risk of BC, compared to women with low BMD. This analysis examines relationships between BMD and BC risk, assessed using the Gail model which estimates 5-yr predicted invasive BC risk based upon recognized
Journal of Clinical Densitometry
Psoriatic Arthritis, an inflammatory arthritis associated with psoriasis, is characterized by increased levels of tumor necrosis factor-alpha (TNF) in synovium and lesional skin. TNF has also been shown to increase osteoclast activation. Inhibitors of TNF are used to treat joint and skin inflammation in psoriatic arthritis. We examine whether TNF inhibition affects bone turnover in psoriatic patients and if this correlates with changes in inflammatory markers. Patients with active psoriatic arthritis meeting criteria for TNF inhibitor treatment were enrolled. Spot urinary concentrations of type I collagen cross-linked N-telopeptide (NTX) were measured at baseline and after 12 weeks of treatment. Serum C-reactive protein (CRP) was also measured at these times. The percent change in NTX and CRP was determined and correlation was compared. After 12 weeks of TNF inhibitor treatment, NTX decreased 34.6% (pd0.014). Serum CRP levels decreased 57.75% (pd0.023) from baseline. A positive correlation between change in CRP and NTX was seen using Pearson Correlation (R 5 0.69). In active psoriatic arthritis patients, we see a trend towards decrease of bone resorption marker NTX after 3 months of TNF inhibition. This correlates with a decrease in CRP levels. This suggests that TNF inhibition can reduce bone turnover in psoriatic arthritis.
Poster Number 159
Other
INTER-TECHNOLOGIST COMPARISON OF PATIENT HEIGHT MEASUREMENT IN A CLINICAL BONE DENSITY LABORATORY Terry DeFrancisco, CDT, Oregon Osteoporosis Center, Portland, OR Sharon Neis, Oregon Osteoporosis Center, Portland, OR; Lorna Cole, Oregon Osteoporosis Center, Portland, OR; Edward Mossman, Oregon Osteoporosis Center, Portland, OR; Michael McClung, MD Height measurement is an important part of the clinical bone mineral density (BMD) assessment procedure and contributes to factors that can be used with BMD measurement to estimate a patient s risk of fracture such as BMI and height loss. When measuring patient height, there can be differences in results measured by the same technologist, as well as in those measured by different technologists. The extent of such differences and their implications for assessment of patient
Volume 10, 2007