- Email: [email protected]
Intra and intervariability of bone microarchitecture in women iliac crest
S370
Abstracts / Bone 44 (2009) S339–S450
Results are given in Table 1, with values well below 1% for trabecular variables and in the order of 1% for cortical variables. To conclude, we developed a fast and precise method for the semiautomatic segmentation of complete human vertebrae that allows assessing several aspects of bone microstructure besides volumetric BMD. Table 1
Trab. BV/TV Trab. Tb.Sp [mm] Trab. BMD [mg/cm3] Cort. BMD [mg/cm3] Cort. thickness [mm] Tot. volume [mm3]
Mean
PE
PE in %
0.232 1.38 100.7 285.7 0.49 29 078.1
0.001 0.007 0.70 3.26 0.005 222.3
0.60 0.54 0.69 1.14 1.00 0.76
Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.220
P309 Limits in accuracy of DXA measurement associated to software upgrade C. Perron*, P. Grazina, O. Perron, D.O. Slosman Institute of Nuclear Medicine, Clinic Generale-Beaulieu, Geneva, Switzerland Aims: Limits in accuracy of bone mineral density (BMD) measurements by Dual-energy X-ray Absorptiometry (DXA) are known to exist inter-manufacturer as well as inter-apparatus. Nevertheless, careful daily quality control enables to minimize intra-apparatus variability. Recently, Hologic Inc (Waltham, MA, USA) released a software called APEX 2 aiming to improve precision by means of a new analysis algorithm. In the following months, version 2.2 and later on, version 2.3 were released to adjust for differences of measurements between this “new algorithm” and the standard “12.6 algorithm”. Methods: Because of the possible impact in multi-centric longitudinal clinical trial, we evaluated the possible impact of software migration to APEX on BMD lumbar spine (L1–L4), femoral neck and total hip measurements. In addition we further evaluated the effect on BMD lumbar spine in presence of individual vertebrae exclusion from analysis. Thirty women (mean age 68 yrs) were investigated at our institute following standard manufacturer's instructions using a Hologic discovery W with software 12.6. Scans were reanalyzed using APEX 2.2, and APEX 2.3 as well as with a dedicated option (b. “based analysis”) developed for the APEX to minimize the differences from the standard 12.6 version. Same global ROI and automatic bone recognition on hip and spine were applied. Same technician analyzed all scans. Results: Summary of results of the “based analysis” are given in Table 1 and are in %. Conclusion: These results demonstrate that BMD measurement could be affected by migration to APEX software particularly at the level of the femoral neck. In addition, version 2.3 of APEX or option “based analysis” brought little benefits. Migration in APEX software may induce additional alteration of accuracy in multi-centric longitudinal clinical trial. Table 1 12.6 versus
Mean
Min
Max
SD
L1–L4 APEX 2.2b L1–L4 APEX 2.3b Total hip APEX 2.2b Total hip APEX 2.3b Fem neck APEX 2.2b Fem neck APEX 2.3b
0.2 0.2 0.2 0.01 0.03 −0.11
−3.1 −3.2 −0.82 −1.23 −3.95 −3.95
+2.5 +2.9 +1.96 +1.22 +4.43 +2.55
+ 0.9 + 1.0 + 0.63 + 0.63 + 1.72 + 1.21
Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.221
P310 Cross-calibration of two types of DXA hologic instruments with two different software (12.6 and APEX 2.3) C. Perrona,*, O. Perrona, S. Zawadynskib, P. Grazinaa, D.O. Slosmana, R. Rizzolic a Institute of Nuclear Medicine, Clinic Generale-Beaulieu, Switzerland b Nuclear Medicine Service, University Hospital, Geneva, Switzerland c Bone Disease Service, University Hospital, Geneva, Switzerland DXA quality assessment is of utmost importance in multicenter clinical trials when measuring bone mineral density (BMD). It includes appropriate daily quality control and cross-calibration of DXA equipment. Hologic Inc. (Waltham, MA, USA) has introduced a new software called APEX 2.3 with a new analysis algorithm aimed to improve precision as compared to previous versions. Following the release of this software, an option called “based 12.6” has been introduced in order to improve accuracy for follow-up examination. In the present study we compared BMD measurements of local spine phantom (LSP) and European Spine Phantom (ESP) with acquisitions performed with both the Hologic version 12.6 and the APEX 2.3 softwares. Before and immediately after software changes (12.6 to APEX 2.3), DXA measurements were performed on 12 Hologic DXA scanners. Measurements consisted on 20 ESP repeated scans and 10 LSP repeated scans. Precision is expressed as coefficient of variation (CV%). Accuracy was evaluated using the formula: DXAdiff = [(meanBMD DXA1 − meanBMD DXA2) / meanBMD DXA1] ⁎ 100. Results are expressed in mean +/− SD, and the range: min–max. With LSP, mean DXA precision was 0.3 and 0.3% for 12.6 and APEX software, respectively. With ESP, mean DXA precision was 0.45 and 0.5 for 12.6 and APEX software, respectively. When DXA results were pooled, the mean differences between software for each phantom were 0.03 +/− 1.45% for ESP and 0.4 +/− 0.6 for LSP. Nevertheless, on a single DXA apparatus basis, these mean differences ranged from −3.5 to +2.6% for ESP, and from −0.9 to +2.9 for LSP. These results demonstrate that in case of changes of software, a cross-calibration procedure is mandatory to avoid inaccurate evaluation of longitudinal data. Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.222
P311 Intra and intervariability of bone microarchitecture in women iliac crest I. Arnault, C.C.C. Chappard⁎, C.C.L.B. Benhamou INSERM, U658, Orleans, France Aim: In pharmacological bone studies, bone microarchitecture is characterized on iliac crest biopsies by histomorphometry and microcomputed tomography 3D (/μ-CT) before treatment at one side and after at the opposite side. The inter and intrabiopsy variability have not been yet quantified precisely. Materials and methods: We sampled right (R) and left (L) iliac crest biopsies on 26 anatomical cadaveric subjects (post-menopausal women 74 ± 10.4 years old). We obtained 3D images of defatted samples with /μ-CT (Skyscan 1072®) at 80 kV, 100/μA, 415 projections, and voxel size: 10.77/μm. Volumes of interest (VOI) were defined as 25% of total volume. We analysed the 25% central trabecular area (central) and the 25% trabecular tissue close to cortical (periph). The trabecular bone parameters were: % bone volume (BV/TV, %), bone surface/bone volume (BS/BV 1/mm), trabecular thickness and spacing (Tb.Th⁎, Tb.Sp⁎/μm), trabecular number (Tb.N 1/mm) trabecular pattern factor (Tb.Pf) and degree of anisotropy (DA).
Abstracts / Bone 44 (2009) S339–S450
Results: +p < 0.05, ++p < 0.01, and +++p < 0.0001. Central-R vs periph-R: +++(BV/TV, BS/BV, Tb.Th⁎,Tb.Pf) ++DA, Central-L vs periph-L: +BV/TV, +++(BS/BV,Tb.Th⁎,Tb.Pf) ++DA, Central-R vs periph-L: +++(BV/TV,BS/BV,Tb.Th⁎,Tb.Pf) ++DA, and Central-L vs periph-R: +BS/BV, ++(Tb.Pf, DA). Values for Tb.Sp and Tb.N did not significantly differ, whatever comparing data. Withinside variability: the differences between central and peripheric data were significant for BV/TV, BS/BV, Tb.Th⁎, Tb.Pf and DA for both sides. Side to side variability: when comparing right to left iliac crests, there was no statistical difference between right and left data when VOI were identically located in each biopsy, except for Tb.Th (p < 0.05). It was possible to find differences if comparison was made between central area at one side and peripheric area at the other side. Conclusion: Considering the lack of significant difference between right and left when taken at the same location, localization of VOI must be cautiously standardized. Table 1 Param, mean ± SD
Central-R
Periph-R
Central-L
Periph-L
BV/TV BS/BV DA Tb.Th⁎ Tb.Pf Tb.N Tb.Sp⁎
16.0 ± 8.2 25.2 ± 6.0 1.7 ± 0.5 0.16 ± 0.04 2.8 ± 2.9 0.97 ± 0.26 0.64 ± 0.12
18.7 ± 7.8 22.2 ± 4.9 1.8 ± 0.2 0.18 ± 0.04 1.6 ± 2.8 1.03 ± 0.22 0.65 ± 0.09
17.3 ± 7.5 23.8 ± 5.7 1.7 ± 0.3 0.17 ± 0.04 2.9 ± 2.5 1.0 ± 0.25 0.64 ± 0.09
20.4 ± 8.9 21.1 ± 5.5 1.8 ± 0.3 0.19 ± 0.04 1.6 ± 2.9 1.03 ± 0.25 0.65 ± 0.10
Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.223
P312 Which DXA sites to choose for prospective fracture risk assessment? Comparison of different guidelines based on data from the opus study C.C. Glüera,*, R. Barkmanna, C. Rouxb, D.M. Reidc, D. Felsenbergd, R. Eastelle a Medical Physics, Diagnostic Radiology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany b Department de Rheumatologie, René Descartes University, Paris, France c Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, UK d Diagnostic Radiology, Charité Universitätsmedizin, Berlin, Germany e Clinical Sciences Centre, University of Sheffield, Sheffield, UK There is lack of consensus among guidelines which Dual X-ray Absorptiometry (DXA) measurement(s) should be used for estimation of fracture risk. Some recommend a DXA measurement at a single site, others recommend the minimum T-score of various sites. A single site is easier to communicate but may be inappropriate in patients with site-specific bone loss. Few studies have assessed gradients of risk for combination criteria. We compared approaches, some recommended by international guidelines, with regard to their power to predict osteoporotic fractures at different sites. The OPUS study is a population-based prospective study carried out at five centres in Europe. We compared predictive power of various approaches in a subset of 1545 women age 55–80 over 6.1 years of follow-up. Vertebral fracture incidence was assessed radiographically at one centre, all other fractures were self-reported. DXA was obtained on Hologic (3 sites) and GE-Lunar (2 sites) devices, cross-calibrated, and expressed in T-scores. Predictive power as compared by Receiver Operating Characteristic (ROC) analysis based on Area Under the Curve (AUC) is depicted in Table 1.
S371
In a population based sample the gradients of risk at different sites and those of combination models are of similar magnitude. Combinations based on average T-scores rather than minimum T-scores may have advantages. Appropriate combination models combine high predictive power with ability to identify patients with low bone mineral density at specific sites and thus offer a more flexible assessment of osteoporosis in the management of individual patients. Table 1 AUCs of models for predicting fracture incidence. Age adjusted models Spine Total hip Femoral neck Min of spine and total hip Min spi, necktroch, tothip Ave of spine and total hip Ave spi, necktroch, tothip
Guidance document
All fractures n = 268
Vertebral fx n = 64
Non-vert fx n = 216
WHO/FRAX Fra, Ger, UK ISCD
.618 .629 .622 .625 .629 .627 .631
.680 .679 .685 .677 .690 .684 .692
.596 .615 .602 .606 .609 .608 .612
Min = minimum, Ave = average T-score of sites listed.
Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.224
P313 Increased serum PTH levels in postmenopausal women with osteoporosis. Prevalence and clinical characteristics D. Cerdàa,*, P. Perisb, A. Monegalb, C. Albaladejoc, M. Martínezb, Á. Muxíd, M.Martínez de Osabae, X. Surísa, N. Guañabensb a Rheumatology, Hospital General de Granollers, Granollers, Barcelona, Spain b Rheumatology, Hospital Clínic, Barcelona, Spain c Rheumatology, CAP Manso, Barcelona, Spain d Nuclear Medicine, Barcelona, Spain e Hormonal Laboratory, Hospital Clínic, Barcelona, Spain In postmenopausal women with osteoporosis (OP) there are many coexisting medical conditions that contribute to bone loss and can remain hidden unless additional diagnostic testing is performed. Increased serum PTH levels are not uncommon in postmenopausal women with osteoporosis. Aims: To analyse the prevalence of increased serum PTH levels in postmenopausal women with osteoporosis, as well as the clinical characteristics of these patients. Methods: 204 postmenopausal women with OP with a mean age 64.9 ± 10 years who were referred to an outpatient Rheumatology department to evaluate treatment of OP. None had an evident secondary cause of OP. Bone mass assessment (BMD), spine X-ray, laboratory testing including complete blood count, chemistry profile, PTH, 25(OH) vitamin D (25OHD), thyroid hormones, urinary NTX, 24h urinary calcium and glomerular filtration rate (GFR) were performed in all patients before treatment. Results: 35% had increased PTH levels (> 65 pg/ml), 5 of them had a primary hyperparathyroidism. Comparing women with and without increased serum PTH levels, patients with increased serum PTH levels were older (67 ± 9 vs 63 ± 11 years, p = 0.03) and had higher BMI (26.1 ± 4 vs 24.8 ± 4 kg/m2, p = 0.03). There were no significant differences between groups in the other analysed variables (25-OHD, NTx and GFR). Nevertheless, patients with increased PTH serum levels showed significantly lower urinary calcium excretion (153.6 ± 99 vs 192.5 ± 130, p = 0.03). Although, lumbar and femoral BMD were similar in both groups of patients, those with lower femoral Z-scores, less that − 2, showed significantly higher PTH values (80.3 ± 32 vs 57.5 ± 22, p = 0.01). There were no significant differences in skeletal fractures between patients with or without increased serum PTH levels. Serum PTH
Abstracts / Bone 44 (2009) S339–S450
Results are given in Table 1, with values well below 1% for trabecular variables and in the order of 1% for cortical variables. To conclude, we developed a fast and precise method for the semiautomatic segmentation of complete human vertebrae that allows assessing several aspects of bone microstructure besides volumetric BMD. Table 1
Trab. BV/TV Trab. Tb.Sp [mm] Trab. BMD [mg/cm3] Cort. BMD [mg/cm3] Cort. thickness [mm] Tot. volume [mm3]
Mean
PE
PE in %
0.232 1.38 100.7 285.7 0.49 29 078.1
0.001 0.007 0.70 3.26 0.005 222.3
0.60 0.54 0.69 1.14 1.00 0.76
Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.220
P309 Limits in accuracy of DXA measurement associated to software upgrade C. Perron*, P. Grazina, O. Perron, D.O. Slosman Institute of Nuclear Medicine, Clinic Generale-Beaulieu, Geneva, Switzerland Aims: Limits in accuracy of bone mineral density (BMD) measurements by Dual-energy X-ray Absorptiometry (DXA) are known to exist inter-manufacturer as well as inter-apparatus. Nevertheless, careful daily quality control enables to minimize intra-apparatus variability. Recently, Hologic Inc (Waltham, MA, USA) released a software called APEX 2 aiming to improve precision by means of a new analysis algorithm. In the following months, version 2.2 and later on, version 2.3 were released to adjust for differences of measurements between this “new algorithm” and the standard “12.6 algorithm”. Methods: Because of the possible impact in multi-centric longitudinal clinical trial, we evaluated the possible impact of software migration to APEX on BMD lumbar spine (L1–L4), femoral neck and total hip measurements. In addition we further evaluated the effect on BMD lumbar spine in presence of individual vertebrae exclusion from analysis. Thirty women (mean age 68 yrs) were investigated at our institute following standard manufacturer's instructions using a Hologic discovery W with software 12.6. Scans were reanalyzed using APEX 2.2, and APEX 2.3 as well as with a dedicated option (b. “based analysis”) developed for the APEX to minimize the differences from the standard 12.6 version. Same global ROI and automatic bone recognition on hip and spine were applied. Same technician analyzed all scans. Results: Summary of results of the “based analysis” are given in Table 1 and are in %. Conclusion: These results demonstrate that BMD measurement could be affected by migration to APEX software particularly at the level of the femoral neck. In addition, version 2.3 of APEX or option “based analysis” brought little benefits. Migration in APEX software may induce additional alteration of accuracy in multi-centric longitudinal clinical trial. Table 1 12.6 versus
Mean
Min
Max
SD
L1–L4 APEX 2.2b L1–L4 APEX 2.3b Total hip APEX 2.2b Total hip APEX 2.3b Fem neck APEX 2.2b Fem neck APEX 2.3b
0.2 0.2 0.2 0.01 0.03 −0.11
−3.1 −3.2 −0.82 −1.23 −3.95 −3.95
+2.5 +2.9 +1.96 +1.22 +4.43 +2.55
+ 0.9 + 1.0 + 0.63 + 0.63 + 1.72 + 1.21
Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.221
P310 Cross-calibration of two types of DXA hologic instruments with two different software (12.6 and APEX 2.3) C. Perrona,*, O. Perrona, S. Zawadynskib, P. Grazinaa, D.O. Slosmana, R. Rizzolic a Institute of Nuclear Medicine, Clinic Generale-Beaulieu, Switzerland b Nuclear Medicine Service, University Hospital, Geneva, Switzerland c Bone Disease Service, University Hospital, Geneva, Switzerland DXA quality assessment is of utmost importance in multicenter clinical trials when measuring bone mineral density (BMD). It includes appropriate daily quality control and cross-calibration of DXA equipment. Hologic Inc. (Waltham, MA, USA) has introduced a new software called APEX 2.3 with a new analysis algorithm aimed to improve precision as compared to previous versions. Following the release of this software, an option called “based 12.6” has been introduced in order to improve accuracy for follow-up examination. In the present study we compared BMD measurements of local spine phantom (LSP) and European Spine Phantom (ESP) with acquisitions performed with both the Hologic version 12.6 and the APEX 2.3 softwares. Before and immediately after software changes (12.6 to APEX 2.3), DXA measurements were performed on 12 Hologic DXA scanners. Measurements consisted on 20 ESP repeated scans and 10 LSP repeated scans. Precision is expressed as coefficient of variation (CV%). Accuracy was evaluated using the formula: DXAdiff = [(meanBMD DXA1 − meanBMD DXA2) / meanBMD DXA1] ⁎ 100. Results are expressed in mean +/− SD, and the range: min–max. With LSP, mean DXA precision was 0.3 and 0.3% for 12.6 and APEX software, respectively. With ESP, mean DXA precision was 0.45 and 0.5 for 12.6 and APEX software, respectively. When DXA results were pooled, the mean differences between software for each phantom were 0.03 +/− 1.45% for ESP and 0.4 +/− 0.6 for LSP. Nevertheless, on a single DXA apparatus basis, these mean differences ranged from −3.5 to +2.6% for ESP, and from −0.9 to +2.9 for LSP. These results demonstrate that in case of changes of software, a cross-calibration procedure is mandatory to avoid inaccurate evaluation of longitudinal data. Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.222
P311 Intra and intervariability of bone microarchitecture in women iliac crest I. Arnault, C.C.C. Chappard⁎, C.C.L.B. Benhamou INSERM, U658, Orleans, France Aim: In pharmacological bone studies, bone microarchitecture is characterized on iliac crest biopsies by histomorphometry and microcomputed tomography 3D (/μ-CT) before treatment at one side and after at the opposite side. The inter and intrabiopsy variability have not been yet quantified precisely. Materials and methods: We sampled right (R) and left (L) iliac crest biopsies on 26 anatomical cadaveric subjects (post-menopausal women 74 ± 10.4 years old). We obtained 3D images of defatted samples with /μ-CT (Skyscan 1072®) at 80 kV, 100/μA, 415 projections, and voxel size: 10.77/μm. Volumes of interest (VOI) were defined as 25% of total volume. We analysed the 25% central trabecular area (central) and the 25% trabecular tissue close to cortical (periph). The trabecular bone parameters were: % bone volume (BV/TV, %), bone surface/bone volume (BS/BV 1/mm), trabecular thickness and spacing (Tb.Th⁎, Tb.Sp⁎/μm), trabecular number (Tb.N 1/mm) trabecular pattern factor (Tb.Pf) and degree of anisotropy (DA).
Abstracts / Bone 44 (2009) S339–S450
Results: +p < 0.05, ++p < 0.01, and +++p < 0.0001. Central-R vs periph-R: +++(BV/TV, BS/BV, Tb.Th⁎,Tb.Pf) ++DA, Central-L vs periph-L: +BV/TV, +++(BS/BV,Tb.Th⁎,Tb.Pf) ++DA, Central-R vs periph-L: +++(BV/TV,BS/BV,Tb.Th⁎,Tb.Pf) ++DA, and Central-L vs periph-R: +BS/BV, ++(Tb.Pf, DA). Values for Tb.Sp and Tb.N did not significantly differ, whatever comparing data. Withinside variability: the differences between central and peripheric data were significant for BV/TV, BS/BV, Tb.Th⁎, Tb.Pf and DA for both sides. Side to side variability: when comparing right to left iliac crests, there was no statistical difference between right and left data when VOI were identically located in each biopsy, except for Tb.Th (p < 0.05). It was possible to find differences if comparison was made between central area at one side and peripheric area at the other side. Conclusion: Considering the lack of significant difference between right and left when taken at the same location, localization of VOI must be cautiously standardized. Table 1 Param, mean ± SD
Central-R
Periph-R
Central-L
Periph-L
BV/TV BS/BV DA Tb.Th⁎ Tb.Pf Tb.N Tb.Sp⁎
16.0 ± 8.2 25.2 ± 6.0 1.7 ± 0.5 0.16 ± 0.04 2.8 ± 2.9 0.97 ± 0.26 0.64 ± 0.12
18.7 ± 7.8 22.2 ± 4.9 1.8 ± 0.2 0.18 ± 0.04 1.6 ± 2.8 1.03 ± 0.22 0.65 ± 0.09
17.3 ± 7.5 23.8 ± 5.7 1.7 ± 0.3 0.17 ± 0.04 2.9 ± 2.5 1.0 ± 0.25 0.64 ± 0.09
20.4 ± 8.9 21.1 ± 5.5 1.8 ± 0.3 0.19 ± 0.04 1.6 ± 2.9 1.03 ± 0.25 0.65 ± 0.10
Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.223
P312 Which DXA sites to choose for prospective fracture risk assessment? Comparison of different guidelines based on data from the opus study C.C. Glüera,*, R. Barkmanna, C. Rouxb, D.M. Reidc, D. Felsenbergd, R. Eastelle a Medical Physics, Diagnostic Radiology, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany b Department de Rheumatologie, René Descartes University, Paris, France c Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, UK d Diagnostic Radiology, Charité Universitätsmedizin, Berlin, Germany e Clinical Sciences Centre, University of Sheffield, Sheffield, UK There is lack of consensus among guidelines which Dual X-ray Absorptiometry (DXA) measurement(s) should be used for estimation of fracture risk. Some recommend a DXA measurement at a single site, others recommend the minimum T-score of various sites. A single site is easier to communicate but may be inappropriate in patients with site-specific bone loss. Few studies have assessed gradients of risk for combination criteria. We compared approaches, some recommended by international guidelines, with regard to their power to predict osteoporotic fractures at different sites. The OPUS study is a population-based prospective study carried out at five centres in Europe. We compared predictive power of various approaches in a subset of 1545 women age 55–80 over 6.1 years of follow-up. Vertebral fracture incidence was assessed radiographically at one centre, all other fractures were self-reported. DXA was obtained on Hologic (3 sites) and GE-Lunar (2 sites) devices, cross-calibrated, and expressed in T-scores. Predictive power as compared by Receiver Operating Characteristic (ROC) analysis based on Area Under the Curve (AUC) is depicted in Table 1.
S371
In a population based sample the gradients of risk at different sites and those of combination models are of similar magnitude. Combinations based on average T-scores rather than minimum T-scores may have advantages. Appropriate combination models combine high predictive power with ability to identify patients with low bone mineral density at specific sites and thus offer a more flexible assessment of osteoporosis in the management of individual patients. Table 1 AUCs of models for predicting fracture incidence. Age adjusted models Spine Total hip Femoral neck Min of spine and total hip Min spi, necktroch, tothip Ave of spine and total hip Ave spi, necktroch, tothip
Guidance document
All fractures n = 268
Vertebral fx n = 64
Non-vert fx n = 216
WHO/FRAX Fra, Ger, UK ISCD
.618 .629 .622 .625 .629 .627 .631
.680 .679 .685 .677 .690 .684 .692
.596 .615 .602 .606 .609 .608 .612
Min = minimum, Ave = average T-score of sites listed.
Conflict of interest: None declared. doi:10.1016/j.bone.2009.03.224
P313 Increased serum PTH levels in postmenopausal women with osteoporosis. Prevalence and clinical characteristics D. Cerdàa,*, P. Perisb, A. Monegalb, C. Albaladejoc, M. Martínezb, Á. Muxíd, M.Martínez de Osabae, X. Surísa, N. Guañabensb a Rheumatology, Hospital General de Granollers, Granollers, Barcelona, Spain b Rheumatology, Hospital Clínic, Barcelona, Spain c Rheumatology, CAP Manso, Barcelona, Spain d Nuclear Medicine, Barcelona, Spain e Hormonal Laboratory, Hospital Clínic, Barcelona, Spain In postmenopausal women with osteoporosis (OP) there are many coexisting medical conditions that contribute to bone loss and can remain hidden unless additional diagnostic testing is performed. Increased serum PTH levels are not uncommon in postmenopausal women with osteoporosis. Aims: To analyse the prevalence of increased serum PTH levels in postmenopausal women with osteoporosis, as well as the clinical characteristics of these patients. Methods: 204 postmenopausal women with OP with a mean age 64.9 ± 10 years who were referred to an outpatient Rheumatology department to evaluate treatment of OP. None had an evident secondary cause of OP. Bone mass assessment (BMD), spine X-ray, laboratory testing including complete blood count, chemistry profile, PTH, 25(OH) vitamin D (25OHD), thyroid hormones, urinary NTX, 24h urinary calcium and glomerular filtration rate (GFR) were performed in all patients before treatment. Results: 35% had increased PTH levels (> 65 pg/ml), 5 of them had a primary hyperparathyroidism. Comparing women with and without increased serum PTH levels, patients with increased serum PTH levels were older (67 ± 9 vs 63 ± 11 years, p = 0.03) and had higher BMI (26.1 ± 4 vs 24.8 ± 4 kg/m2, p = 0.03). There were no significant differences between groups in the other analysed variables (25-OHD, NTx and GFR). Nevertheless, patients with increased PTH serum levels showed significantly lower urinary calcium excretion (153.6 ± 99 vs 192.5 ± 130, p = 0.03). Although, lumbar and femoral BMD were similar in both groups of patients, those with lower femoral Z-scores, less that − 2, showed significantly higher PTH values (80.3 ± 32 vs 57.5 ± 22, p = 0.01). There were no significant differences in skeletal fractures between patients with or without increased serum PTH levels. Serum PTH