Il Trabecular Bone Score (TBS): un indice delle alterazioni della microarchitettura ossea predittivo per il rischio di frattura nel paziente HIV positivo.

Slides:



Advertisements
Similar presentations
How Should We Monitor, Prevent, and Treat Osteoporosis in IBD? All of Our IBD Patients are at Risk and Therefore all Should Begin Treatment at Diagnosis.
Advertisements

A progressive bone disease characterized by decrease bone mass decreased bone density increased fracture risk Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS.
Update on Osteoporosis Dr Terence O’Neill Consultant Rheumatologist.
N ORTHWEST A IDS E DUCATION AND T RAINING C ENTER Osteoporosis Screening in HIV Robert D. Harrington, M.D.
Chapter 66 Chapter 66 Clinical Use of Bone Densitometry Copyright © 2013 Elsevier Inc. All rights reserved.
WHO Osteoporosis Definition (1996)
Kuala Lumpur, Malaysia, 30 June - 3 July 2013 Abstract: WEABO205. HIV infection was associated with an increased risk of hip fracture,
Downloaded from 1 Alendronate vs. Risedronate Comparison Trial.
HIV Disease in Older Patients Donna M. Gallagher, ANP The International AIDS Society–USA DM Gallagher, ANP. Presented at IAS–USA/RWCA Clinical Conference,
Protective HLA Class I alleles are associated with reduced immune activation in Primary HIV infection Elizabeth Hamlyn 1, Stephen Hickling 2, Abdel Babiker.
Osteoporosis in Adults with Cerebral Palsy
Effects of HIV/HCV coinfection on Bone Mineral Density and Structure Amber Wheeler, MD WIHS Scientific Meeting June 30, 2014.
OSC Recommendations for Bone Mineral Density Reporting Slides prepared by Kerry Siminoski, MD, FRCPC William Leslie, M.Sc., MD,
Bone Mineral Density Testing March 29, Introduction Osteoporosis is a systemic skeletal disorder characterized by decreased bone mass and deterioration.
OSTEOPOROSIS Prof. Dr. Ülkü Akarırmak. Metabolic Bone Diseases Osteosclerosis Osteolysis Osteoporosis is the most common metabolic bone disease.
IS THE RATE OF PREECLAMPSIA AFFECTED BY HIV/AIDS?: A RETROSPECTIVE CASE-CONTROL STUDY. Dr. Vital Kalumba.
Results Premature Ovarian Deficiency in HIV-infected women Marialuisa PARTISANI 1,2, Jeanine OHL 2, Christine DEMANGEAT 3, Florence BINDER-FOUCARD 4, Israël.
1 Ipriflavone in the Treatment of Postmenopausal Osteoporosis Randomized placebo-controlled, 4-year study conducted Europe 475 postmenopausal white women,
HIV and HCV Independently Lower BMD through Different Mechanisms N Maalouf, MD; S Zhang, PhD; H Drechsler, MD; J Cutrell, MD, I Farukhi, MD; R Castanon,
“Known knowns, known unknowns, unknown unknowns….. Ronald Dumsfeld Senior Lecturer in Metabolic Bone Diseases.
Copyright © 2013 Elsevier Inc. All rights reserved.
Vietnam Osteoporosis Workshop, HCM Cty 2006 OSTEOPOROSIS IN MEN Tuan Van Nguyen and Nguyen Dinh Nguyen Garvan Institute of Medical Research Sydney, Australia.
Fracture risk assessment
Internal Medicine Weekly Conference 1392 Internal Medicine Weekly Conference 1392 Alimohammad Fatemi Assistant Professor of Rheumatology Alimohammad Fatemi.
A Phase II, Randomized, Placebo-Controlled Study of Once-Weekly Alendronate in HIV- Infected Subjects with Decreased Bone Mineral Density Receiving Calcium.
Exercise and the Elderly. Physiological Changes With Aging Aging or decrease in activity? Quality years.
Extended Treatment Effects with Zoledronic Acid Based on Poster 1070 “The Effect of 3 Versus 6 Years of Zoledronic Acid Treatment in Osteoporosis: a Randomized.
Estrogen plus Progestin, BMD and Fractures: Women’s Health Initiative Jane A. Cauley University of Pittsburgh JAMA 2003; 290 (13) :
Background ●Osteoporosis is characterized by low bone mass leading to increased bone fragility and increase in fracture risk, particularly the vertebrae,
Comparison of NRTI combinations  ZDV/3TC vs TDF + FTC –Study 934  ABC/3TC vs TDF/FTC –HEAT Study –ACTG A5202 Study –ASSERT Study  FTC/TDF vs FTC/TAF.
AFF: Bone Density and Structure with BP Use Based on Poster FR0030 “Bone Density and Structure of Patients on Bisphosphonates with Atypical Femur Fractures”
Lipoatrophy and lipohypertrophy are independently associated with hypertension: the effect of lipoatrophy but not lipohypertrophy on hypertension is independent.
Metabolic Syndrome in HIV- Infected Patients from MTCT-Plus, Thai Outpatient Population J. JANTARAPAKDE1,2,*, C. CHATURAWIT1,2, S. PENGNONYANG1,2, W. PIMA1,
Osteoporosis. Background ► The problem  Osteoporosis is common  Over 50% of women and 30-45% of men over age 50 have osteopenia/osteoporosis  White.
The role of IL-17A in postmenopausal inflammatory events, such as in osteoporosis 1 Ildikó Molnár, MD, CSc, 2 Ilona Bohaty, MD, 1 Éva Somogyiné-Vári 1.
Osteoporosis Dr Ramin Rafiei Alzahra Hospital Rheumatology Department.
Osteoporosis By Dr. Khattab Omar Prof. & Head of Obstetrics and Gynaecology Department Faculty of Medicine, Al-Azhar University, Damietta.
Five-year incident fracture risk assessed by quantitative multisite ultrasound: the Canadian Multicentre Osteoporosis Study. W. P. Olszynski 1, J. P. Brown.
Prediction of Hip Fracture in Elderly Men and Women by Fall-related Factors ND Nguyen, C Pongchaiyakul, JR Center, JA Eisman, TV Nguyen Bone and Mineral.
TAMARA VOKES 1, DISHA KUMAR 1, MAUREEN COSTELLO 1 AND DIDIER HANS 2 UNIVERSITY OF CHICAGO MEDICINE, CHICAGO, ILLINOIS, USA 1 CENTER OF BONE DISEASES, LAUSANNE.
Marwan Ahmed Dr George Muntingh Prof Paul Rheeder
HCV Co-infection is Associated with a High Risk of Osteoporotic Fractures Among HIV Patients Roger Bedimo, MD; Henning Drechsler, MD; Song Zhang, PhD;
MUSCULOSKELETAL BLOCK PATHOLOGY LECTURE 2: MUSCULOSKELETAL BLOCK PATHOLOGY LECTURE 2: CONGENITAL AND DEVELOPMENTAL BONE DISEASES Dr. Maha Arafah Dr. Abdulmalik.
Weekly Alendronate Safe and Effective at Increasing Bone Mineral Density in HIV-Infected Persons on Antiretroviral Therapy Slideset on: McComsey GA, Kendall.
Effect of ART on malaria parasitaemia and clinical episodes in adults in rural Uganda: A population-based cohort study Billy N. Mayanja 1, Kathy Baisley.
Chapter 47 Assessing Fracture Risk: Who Should Be Screened? © American Society for Bone and Mineral Research Contributed by John Schousboe, Brent Taylor,
Count Age (y) Height (cm) Weight (kg) BMI (kg/m 2 ) (DOI) (mo) Tetra/Para Male/Female N=15 35±15 174± ± ±5.4 54±71 9 / 6 12 / 3 Range 20 –
Date of download: 6/21/2016 From: Opportunistic Screening for Osteoporosis Using Abdominal Computed Tomography Scans Obtained for Other Indications Ann.
R1 김형오 / Prof. 김덕윤 1.  Osteoporosis  Asian region is considered to be on the verge of an emerging osteoporosis epidemic  50% of the world’s osteoporotic.
J Clin Endocrinol Metab, Sep 2006, 91(9):
Date of download: 7/6/2016 From: Vitamin D and Calcium Attenuate Bone Loss With Antiretroviral Therapy Initiation: A Randomized Trial Ann Intern Med. 2015;162(12):
Vitamin D Inadequacy is Highly Prevalent Among North American Women Treated for Osteoporosis MF Holick1, ES Siris2, N Binkley3, MK Beard4, AA Khan5, JT.
- Higher SBP visit-to-visit variability (SBV) has been associated
Management of Osteoporosis
Intensive Lifestyle Intervention in Older Adults with Diabetes Improves Glycemic Control, Body Composition, Physical Function, and Bone Quality Alessandra.
Copyright © 2011 American Medical Association. All rights reserved.
Patient 65 years old retired teacher with severe back pain
FRAX & ITS ASSOCIATIONS IN RHEUMATOID ARTHRITIS
Carcinoid tumors and DXA assessment –
Post Menopausal Osteoporosis
Fig. 1. Trial profile. From: Randomized Teriparatide [Human Parathyroid Hormone (PTH) 1–34] Once-Weekly Efficacy Research (TOWER) Trial for Examining the.
Factors Associated with Low Bone Mineral Density (BMD) in a Large Cohort of HIV-Infected U.S. Adults – Baseline Results from the SUN Study # 836 ET Overton1,
Osteoporosis Diagnosis 9/21/2018 OSTEOPOROSIS.
Deciding on Pharmacological Treatment Post Fracture
Deciding on Pharmacological Treatment Post Fracture
Reduced bone mineral density in adults treated with high-dose corticosteroids for childhood nephrotic syndrome  Janet Hegarty, M. Zulf Mughal, Judith.
Interpretation The World Health Organization (WHO) Osteoporosis Guidelines (T Score vs Z score) A Z-score less than –2 indicates the diagnosis is below.
Volume 119, Issue 5, Pages (November 2000)
Comparison of NRTI combinations
Enrollment and Outcomes
Presentation transcript:

Il Trabecular Bone Score (TBS): un indice delle alterazioni della microarchitettura ossea predittivo per il rischio di frattura nel paziente HIV positivo Dr. Lorenzo Ciullini Sapienza Università di Roma Azienda Ospedaliera Sant’Andrea - Malattie Infettive – C.R. AIDS e MST Roma – Italia *The presenting author has no conflict of interest to report #297 – Infezioni da HIV

Background chronic infection decreased mortality  ageing HIV associated bone metabolism disorders (virus + immune activation + HAART) HIV infection in HAART era Aim of the study Prevalence of vertebral fractures Bone mineral density (BMD) alterations Bone microarchitecture evaluation Study of risk factors associated to vertebral fractures

Population Demographic characteristics Men [n/total (%)]131/149(87,9%) Women [n/total (%)]18/149(12,1%) menopausal status [n/total women (%)]2/1811% Age (years) [median (IQR)]44(37-52) Men (years) [median (IQR)]44(38-53) Women (years) [median (IQR)]40,5(36-44) HIV infection’s characteristics Duration of HIV infection (years) [median (IQR)]7(5-8) CD4 cells count (cell/μL)[median (IQR)]501( ) HAART-experienced patients [n/total (%)]140/14994% Duration of HAART (years) [median (IQR)]6(4-8)

Methods (1) Clinical interview, viro-immunological HIV markers, bone biochemical markers 10-year fracture probability with FRAX® algorythm Lateral thoracic and lumbar spine X-ray (vertebral fracture: height ratio reduction ≥ 20%) BMD measurement (DXA) at femoral neck, total hip and lumbar spine Lumbar Trabecular Bone Score (TBS) to evaluate bone microarchitecture

What’s TBS ? Methods (2) TBS is computed from texture of spine DXA examination file by a software (TBS iNsight ™ ) Trabecular Bone Score (TBS) is a parameter of bone quality related to bone microarchitecture and fracture risk (1) (2) TBS value is direct related to number of bone trabeculae and their connectivity; otherwise is inverse related to inter- trabecular distances TBS (1. Silva BC, 2014) (2. Boutroy S, 2013) TBS

Results (1) Characteristics of vertebral fractures No vertebral deformity [n (%)] 122(86,5%) Vertebral fracture [n (%)] 19(13,5%) Vertebral fractures prevalence stratified by TBS quartiles (1st-2nd vs 3rd-4th) No statistically signficant differences (p=0,510) p=0,025 osteoporosisosteopenianormal BMD and by BMD status

Results (2) Analysis of risk factors associated with vertebral fractures among HIV+ patients *Mann-Whitney test**multivariate logistic regression OR (p-value ** ) 1,025 (0,343) 1,128 (0,058) 0,004 (0,034) 141 patients Group F (with vertebral fractures) (n=19) median (IQR) Group NF (no vertebral fractures) (n=122) median (IQR) P-value* Age (years)48 (40-57)43 (37-51)0,043 BMI (kg/m²)27,9 (24-30)24,5 (22-26)0,012 Duration HIV infection (years)8 (5-10)6 (4-9)0,219 Duration HAART exposure (years)4 (2-8)5 (3-8)0,993 CD4 cells count (cell/μL)657 ( )575 ( )0,315 Vitamin D serum levels (ng/ml)15 (10-24)18 (13-24)0,329 BMD lumbar spine (g/cm²)0,998 (0,901-1,048)0,994 (0,903-1,085)0,673 BMD femoral neck (g/cm²)0,779 (0,704-0,866)0,765 (0,679-0,839)0,422 BMD total hip (g/cm²)0,962 (0,872-1,043)0,909 (0,833-0,995)0,283 TBS lumbar1,226 (1,172-1,333)1,337 (1,270-1,405)%0,001 FRAX® (%)4,3 (3-6)4,3 (2-6)77

High prevalence of vertebral fractures among HIV positive patients BMD is no associated to vertebral fractures independent association between TBS and vertebral fractures Further studies: higher HIV+ sample size and HIV- control group Conclusions bone microarchitecture deterioration: one of the major causes of vertebral fractures low BMD explains only partially bone fragility

Aknowledgments U.O.C. Malattie Infettive - C.R. AIDS e MST Prof. A. Pennica Dott.ssa D. Novarini Dott.ssa L. Gianserra Dott.ssa E. Teti U.O.C Medicina Interna 2 Prof. F. Conti U.O.C. Radiologia Prof. G. Argento Dott.ssa L. De Biasio