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The Effects of Circuit Training on Bone Mineral Density, Physical Fitness, and Quality of Life in Postmenopausal Osteopenic Women
426 Conclusion: Early intervention with a bisphosphonate for 12 months in the menopausal transition may be effective in maintaining BMD and microarchitectural integrity. Disclosure of Interest: A. Khan Contract with: Amgen, Merck, NPS, S. Dubois: None Declared, Z. Rahman: None Declared, O. Khan: None Declared, C. Derzko: None Declared
P173 ASSESSMENT OF VITAMIN D STATUS: A CONTROVERSY A. Chausmer*; Endocrinology and Metabolism, Johns Hopkins Medical Institutions, Laurel, United States Aims: There is some controversy regarding the assessment of vitamin D status. The aim of this presentation is to provide literature based evidence suggesting this is an only marginally viable surrogate and that it is vastly overused to justify unnecessary treatment with pharmacologic doses of vitamin D. This is particularly important in the differentiation between osteoporosis and elements of osteomalacia for therapeutic purposes Methods: A literature search and analysis of the physiology of calcium and vitamin D metabolism are reviewed and discussed in the light of decision making regarding the need and advisability of therapeutic intervention and concurrent risk of potentially life threatening hypervitaminosis D. Results: There is no data in any animal species regarding the measurement of the total body vitamin D burden, either as cholecalciferol, 25-hydroxycholecalciferol or 1,25-dihydroxycholecalciferol and so there is no test which has been demonstrated to reflect total body stores of any element of the D pathway. The measurement of the inactive intermediary metabolite, 25-hydroxycholecalciferol, although commonly used for the diagnosis of vitamin D deficiency, has some statistical relationship, but no causal relationship, with any aspect calcium homeostasis, but no clear relationship with the active metabolite, 1,25-dihydroxy cholecalciferol. Multiple confounding factors are presented which make this a poor choice for the determination of clinical vitamin D sufficiency. Conclusion: While it is more costly than simply measuring 25-hydroxycholecalciferol, it is concluded that the actual evaluation of vitamin D status requires different testing. This includes element of its interaction with calcium metabolism as a whole, which cannot be assessed by the simplistic approach of a single test. Rather a true assessment of vitamin D status includes measurement of the 1,25-dihydroxycholecalciferol in concert with PTH, calcium, phosphorus and renal function testing. Simply measuring the 25-hydroxycalciferol should not be the basis for treatment with potentially toxic amounts of vitamin D. Disclosure of Interest: None Declared
P174 THE ‘‘OWN THE BONE’’ SITE AND SATISFACTION SURVEY B. J. Edwards1,*, K. J. Jeray2, A. D. Bunta3, W. B. Macaulay4, C. B. Jones5, L. L. Tosi6, D. L. Sietsema5, J. D. Kaufman7, S. A. Murphy8, J. A. Goulet9, S. S. Saraykar1, G. E. Friedlaender10, M. F. Swiontkowski11, D. R. Dirschl12; 1 General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, 2Greenville Health System University Medical Center, Greenville, 3 Orthopaedics, Northwestern University, Chicago, 4Orthopaedics, Columbia University, New York, 5Othropaedics Associates of Michigan, Grand Rapids, 6 Childrens National Medical Center, Washington DC, 7John Kaufman Orthopaedics, Valencia, 8The American Orthopaedic Association, Rosemont, 9 University of Michigan Health System, Ann Arbor, 10Yale School of Medicine, New Haven, 11University of Minnesota, Minneapolis, 12University of North Carolina, Chapel Hill, United States Aims: ‘‘Own the Bone’’, a quality improvement program focusing on secondary fracture prevention and osteoporosis treatment encompassing 136 institution across 44 states has demonstrated that collaboration between orthopaedic surgeons, medical specialists, and primary care physicians can overcome the welldocumented gap in osteoporosis and bone health care in patients who have sustained a fragility fracture. A survey was distributed to all sites to learn about OTB implementation, to gauge participants’ satisfaction. Methods: An electronic survey generated by Survey Monkey was sent to all the contacts from the enrolling sites. The Own the Bone Survey collected information on participating institutions, reasons to choose OTB, challenges in implementing OTB, and use and effectiveness of the educational activities offered by OTB. The survey was distributed to 386 Own the Bone contacts from enrolling/interested sites to learn about efforts to implement. The Own the Bone Site Satisfaction Survey gauged participant satisfaction with the program, perceived valuable aspects of
Abstracts the program, effectiveness of educational activities and resources, comments on improving OTB, and recommendations for overcoming implementation barriers. Results: Seventy-seven institutional representatives responded (22%). Orthopaedic surgeons were more commonly represented (70%), medical specialists included endocrinology (6.8%), geriatric medicine (6.5%), family medicine (6%), obstetrics and gynecology (4.5%), and rheumatology (2%), among others. Academic hospitals were most commonly involved (44%), followed by community hospitals (33%) and group practices (28%). The most common reasons for participation involved improving the care of patients with osteoporosis (73%), ability to document, track and benchmark data (64%), and availability of resources and tools to start a fracture liaison service (49%). The most helpful educational activities comprised educational material on the website (48%), presentations at meetings, webinars (28%), informational packets and the bone health bulletin. Patients were seen at follow up visits (49%) or contacted by phone (46%). Institutional barriers cited were unwillingness of hospital administration to pay for nursing staff (45%), uninterested clinicians (40%), and low priority of addressing osteoporosis in the institution. Conclusion: The ‘‘Own the Bone’’ intervention has succeeded in improving the behaviors of participating orthopaedic surgeons, primary care physicians, and medical specialists in the areas of osteoporosis counselling, BMD testing, initiation of pharmacotherapy, and coordination of care for patients who have experienced a fragility fracture. Reducing barriers to the establishment of fracture liaison services will require incentives for institutional administration to finance the nurse liaison’s position. Insurance support as seen in ‘‘Get with the Guidelines’’ could provide necessary support. Disclosure of Interest: None Declared
P175 THE EFFECTS OF CIRCUIT TRAINING ON BONE MINERAL DENSITY, PHYSICAL FITNESS, AND QUALITY OF LIFE IN POSTMENOPAUSAL OSTEOPENIC WOMEN L. T. Kuo1, R. W.-W. Hsu1,2, W.-H. Hsu1,2, Z.-R. Lin3, F.-Y. Ju4,*; 1Orthopaedics, Chang Gang Memorial Hospital at Chiayi, Chiayi, 2College of Medicine, Chang Gang University, Taoyuan, 3Graduate Institute of Sport and Leisure Education, National Chung Cheng University, 4Nursing Care, Chang Gang Memorial Hospital at Chiayi, Chiayi, Taiwan, Province of China Aims: This study aimed to validate the efficacy of circuit exercise training on BMD, and physical fitness parameters including fall-preventive balance in postmenopausal women with osteopenia (T-score!-1.0). Methods: Fifty postmenopausal women 50 years of age were enrolled in this study and randomized to either the circuit exercise (CE) or control group. The BMD, physical fitness, and QOL were measured at baseline and 12 weeks. Patients at each groups received calcium and vitamin D supplementation during treatment period. Participants in the exercise group were asked to attend three 1-h sessions of a circuit training program consisting of aerobic training, resistance training, and stretching each week for consecutive 12 weeks. Results: A total of 22 participants in the exercise group and 18 participants in the control group completed the study. The BMD at the anteroposterior lumbar spine significantly increased from 0.7050.085 g/cm2 to 0.7230.096 g/cm2 in the exercise group in the end of 12-week of exercise training (p!0.05). In addition, the results of physical fitness including reaction time, balance and flexibility and quality of life (QOL) measured by SF-36 were also significantly improved in the exercise group. No significant changes were found in any aspect of measurement in the control group. Conclusion: Circuit training can significantly improve BMD, physical fitness, and QOL in postmenopausal women with osteopenia. These findings suggest exercise should be incorporated into the medical management of patients with low BMD. Disclosure of Interest: None Declared
P176 EFFECT OF PRIOR HIP FRACTURE STATUS IN PATIENTS WITH OSTEOPOROSIS RECEIVING TERIPARATIDE K. Krohn1, G. Valenzuela2,*, J. M. Lane3, B. Gruber4, J. Alam1, A. Y. Chiang1, J. H. Krege1; 1Lilly USA, LLC, Indianapolis, 2Integral Rheumatology Specialists, Plantation, 3Hospital for Special Surgery, 4Long Island Regional Arthritis & Osteoporosis Care, New York, United States Aims: In the Direct Assessment of Nonvertebral fractures in Community Experience (DANCE) study, the incidence of new non-vertebral fragility fractures decreased in patients receiving teriparatide (TPTD) for longer than 6 months
Journal of Clinical Densitometry: Assessment & Management of Musculoskeletal Health
Volume 17, 2014
P173 ASSESSMENT OF VITAMIN D STATUS: A CONTROVERSY A. Chausmer*; Endocrinology and Metabolism, Johns Hopkins Medical Institutions, Laurel, United States Aims: There is some controversy regarding the assessment of vitamin D status. The aim of this presentation is to provide literature based evidence suggesting this is an only marginally viable surrogate and that it is vastly overused to justify unnecessary treatment with pharmacologic doses of vitamin D. This is particularly important in the differentiation between osteoporosis and elements of osteomalacia for therapeutic purposes Methods: A literature search and analysis of the physiology of calcium and vitamin D metabolism are reviewed and discussed in the light of decision making regarding the need and advisability of therapeutic intervention and concurrent risk of potentially life threatening hypervitaminosis D. Results: There is no data in any animal species regarding the measurement of the total body vitamin D burden, either as cholecalciferol, 25-hydroxycholecalciferol or 1,25-dihydroxycholecalciferol and so there is no test which has been demonstrated to reflect total body stores of any element of the D pathway. The measurement of the inactive intermediary metabolite, 25-hydroxycholecalciferol, although commonly used for the diagnosis of vitamin D deficiency, has some statistical relationship, but no causal relationship, with any aspect calcium homeostasis, but no clear relationship with the active metabolite, 1,25-dihydroxy cholecalciferol. Multiple confounding factors are presented which make this a poor choice for the determination of clinical vitamin D sufficiency. Conclusion: While it is more costly than simply measuring 25-hydroxycholecalciferol, it is concluded that the actual evaluation of vitamin D status requires different testing. This includes element of its interaction with calcium metabolism as a whole, which cannot be assessed by the simplistic approach of a single test. Rather a true assessment of vitamin D status includes measurement of the 1,25-dihydroxycholecalciferol in concert with PTH, calcium, phosphorus and renal function testing. Simply measuring the 25-hydroxycalciferol should not be the basis for treatment with potentially toxic amounts of vitamin D. Disclosure of Interest: None Declared
P174 THE ‘‘OWN THE BONE’’ SITE AND SATISFACTION SURVEY B. J. Edwards1,*, K. J. Jeray2, A. D. Bunta3, W. B. Macaulay4, C. B. Jones5, L. L. Tosi6, D. L. Sietsema5, J. D. Kaufman7, S. A. Murphy8, J. A. Goulet9, S. S. Saraykar1, G. E. Friedlaender10, M. F. Swiontkowski11, D. R. Dirschl12; 1 General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, 2Greenville Health System University Medical Center, Greenville, 3 Orthopaedics, Northwestern University, Chicago, 4Orthopaedics, Columbia University, New York, 5Othropaedics Associates of Michigan, Grand Rapids, 6 Childrens National Medical Center, Washington DC, 7John Kaufman Orthopaedics, Valencia, 8The American Orthopaedic Association, Rosemont, 9 University of Michigan Health System, Ann Arbor, 10Yale School of Medicine, New Haven, 11University of Minnesota, Minneapolis, 12University of North Carolina, Chapel Hill, United States Aims: ‘‘Own the Bone’’, a quality improvement program focusing on secondary fracture prevention and osteoporosis treatment encompassing 136 institution across 44 states has demonstrated that collaboration between orthopaedic surgeons, medical specialists, and primary care physicians can overcome the welldocumented gap in osteoporosis and bone health care in patients who have sustained a fragility fracture. A survey was distributed to all sites to learn about OTB implementation, to gauge participants’ satisfaction. Methods: An electronic survey generated by Survey Monkey was sent to all the contacts from the enrolling sites. The Own the Bone Survey collected information on participating institutions, reasons to choose OTB, challenges in implementing OTB, and use and effectiveness of the educational activities offered by OTB. The survey was distributed to 386 Own the Bone contacts from enrolling/interested sites to learn about efforts to implement. The Own the Bone Site Satisfaction Survey gauged participant satisfaction with the program, perceived valuable aspects of
Abstracts the program, effectiveness of educational activities and resources, comments on improving OTB, and recommendations for overcoming implementation barriers. Results: Seventy-seven institutional representatives responded (22%). Orthopaedic surgeons were more commonly represented (70%), medical specialists included endocrinology (6.8%), geriatric medicine (6.5%), family medicine (6%), obstetrics and gynecology (4.5%), and rheumatology (2%), among others. Academic hospitals were most commonly involved (44%), followed by community hospitals (33%) and group practices (28%). The most common reasons for participation involved improving the care of patients with osteoporosis (73%), ability to document, track and benchmark data (64%), and availability of resources and tools to start a fracture liaison service (49%). The most helpful educational activities comprised educational material on the website (48%), presentations at meetings, webinars (28%), informational packets and the bone health bulletin. Patients were seen at follow up visits (49%) or contacted by phone (46%). Institutional barriers cited were unwillingness of hospital administration to pay for nursing staff (45%), uninterested clinicians (40%), and low priority of addressing osteoporosis in the institution. Conclusion: The ‘‘Own the Bone’’ intervention has succeeded in improving the behaviors of participating orthopaedic surgeons, primary care physicians, and medical specialists in the areas of osteoporosis counselling, BMD testing, initiation of pharmacotherapy, and coordination of care for patients who have experienced a fragility fracture. Reducing barriers to the establishment of fracture liaison services will require incentives for institutional administration to finance the nurse liaison’s position. Insurance support as seen in ‘‘Get with the Guidelines’’ could provide necessary support. Disclosure of Interest: None Declared
P175 THE EFFECTS OF CIRCUIT TRAINING ON BONE MINERAL DENSITY, PHYSICAL FITNESS, AND QUALITY OF LIFE IN POSTMENOPAUSAL OSTEOPENIC WOMEN L. T. Kuo1, R. W.-W. Hsu1,2, W.-H. Hsu1,2, Z.-R. Lin3, F.-Y. Ju4,*; 1Orthopaedics, Chang Gang Memorial Hospital at Chiayi, Chiayi, 2College of Medicine, Chang Gang University, Taoyuan, 3Graduate Institute of Sport and Leisure Education, National Chung Cheng University, 4Nursing Care, Chang Gang Memorial Hospital at Chiayi, Chiayi, Taiwan, Province of China Aims: This study aimed to validate the efficacy of circuit exercise training on BMD, and physical fitness parameters including fall-preventive balance in postmenopausal women with osteopenia (T-score!-1.0). Methods: Fifty postmenopausal women 50 years of age were enrolled in this study and randomized to either the circuit exercise (CE) or control group. The BMD, physical fitness, and QOL were measured at baseline and 12 weeks. Patients at each groups received calcium and vitamin D supplementation during treatment period. Participants in the exercise group were asked to attend three 1-h sessions of a circuit training program consisting of aerobic training, resistance training, and stretching each week for consecutive 12 weeks. Results: A total of 22 participants in the exercise group and 18 participants in the control group completed the study. The BMD at the anteroposterior lumbar spine significantly increased from 0.7050.085 g/cm2 to 0.7230.096 g/cm2 in the exercise group in the end of 12-week of exercise training (p!0.05). In addition, the results of physical fitness including reaction time, balance and flexibility and quality of life (QOL) measured by SF-36 were also significantly improved in the exercise group. No significant changes were found in any aspect of measurement in the control group. Conclusion: Circuit training can significantly improve BMD, physical fitness, and QOL in postmenopausal women with osteopenia. These findings suggest exercise should be incorporated into the medical management of patients with low BMD. Disclosure of Interest: None Declared
P176 EFFECT OF PRIOR HIP FRACTURE STATUS IN PATIENTS WITH OSTEOPOROSIS RECEIVING TERIPARATIDE K. Krohn1, G. Valenzuela2,*, J. M. Lane3, B. Gruber4, J. Alam1, A. Y. Chiang1, J. H. Krege1; 1Lilly USA, LLC, Indianapolis, 2Integral Rheumatology Specialists, Plantation, 3Hospital for Special Surgery, 4Long Island Regional Arthritis & Osteoporosis Care, New York, United States Aims: In the Direct Assessment of Nonvertebral fractures in Community Experience (DANCE) study, the incidence of new non-vertebral fragility fractures decreased in patients receiving teriparatide (TPTD) for longer than 6 months
Journal of Clinical Densitometry: Assessment & Management of Musculoskeletal Health
Volume 17, 2014