The 2011 European Congress on Osteoporosis and Osteoarthritis/International Osteoporosis Foundation

Papers from the 2011 European Congress on Osteoporosis and Osteoarthritis/International Osteoporosis Foundation

Five-year results of denosumab trial
Denosumab significantly improves bone mineral density (BMD), according to the results of the open-label extension of the FREEDOM trial, representing up to five years of denosumab treatment. The study included 4,550 postmenopausal women, 2,207 of whom were treated with denosumab for two years and formed the control group. The remainder, who formed the long-term group, were treated with 60mg denosumab every six months for five years.

During the fourth and fifth years of treatment, the long-term group had 1.9 per cent and 1.7 per cent increases in lumbar spine BMD and 0.7 per cent and 0.6 per cent increases in total hip BMD. Five years of treatment with denosumab resulted in a 13.7 per cent total increase in BMD.

In the control group, two years of denosumab treatment resulted in a 7.9 per cent increase in BMD. Adverse events were similar in both groups; 83.4 per cent of patients in the long-term group reported adverse events compared with 82.8 per cent of patients in the control group.
Papapoulos S, Man Z, Mellstrom D et al. Osteopor Int 2011; 22(Supp 1): abstract OC25

FRAX for management of osteoporosis
Researchers have compared the effectiveness of the Royal College of Physicians' (RCP) case-finding strategy and the updated guideline from the National Osteoporosis Guideline Group (NOGG), which incorporates the FRAX tool.

The researchers simulated a sample of 1,000 women aged 50-85 years and compared the number identified as high risk, incidence of hip fracture and femoral neck BMD, number of BMD tests needed to identify a prospective hip fracture, and cost. They found that the NOGG strategy identified slightly fewer women at high risk than the RCP strategy, with fewer scans needed; this also meant that costs were lower.

The authors concluded that the FRAX-based NOGG guideline makes more efficient use of resources than the RCP strategy.
McCloskey E, Johansson H, Compston J et al. Osteopor Int 2011; 22(Supp 1): abstract P404

Radiographic diagnosis of hip osteoarthritis
This study investigated whether self- or clinician-reported osteoarthritis is a better predictor of physical function than radiographic diagnosis. Using data on 8,601 subjects from the European project on osteoarthritis, the investigators measured self-reported osteoarthritis, clinical judgment and radiography. Physical function was also measured.

The researchers found that self-reported or clinically diagnosed osteoarthritis was associated with impaired physical performance (p <0.01), while radiographically diagnosed hip osteoarthritis was associated with better physical performance. Self-report or clinical diagnosis of osteoarthritis was a better predictor of physical performance than radiographic diagnosis of hip osteoarthritis.
Dennison E, Jameson K, Edwards M et al. Osteopor Int 2011; 22(Supp 1): abstract P451

Glucocorticoids and bone formation
Commonly used to treat chronic inflammatory diseases, glucocorticoids are associated with side-effects including induction of osteoporosis.

Researchers aimed to identify the molecular mechanisms involved in glucocorticoid-induced osteoporosis. Using mouse models of glucocorticoid-induced osteoporosis, they identified the type of gene regulation by the glucocorticoid receptor. They also identified the molecular actions of the glucocorticoid receptor that result in the inhibition of bone formation. In mice lacking the glucocorticoid receptor, glucocorticoids were unable to inhibit bone formation and failed to induce bone loss. In mice possessing the glucocorticoid receptor that was unable to activate target genes, glucocorticoid treatment still resulted in reduced bone formation.

This finding paves the way for further research into selective glucocorticoid-receptor modulators that could maintain anti-inflammatory activity while sparing the adverse effects to bone.
Rauch A, Baschant U, Rauner M et al. Osteopor Int 2011; 22(Supp 1): abstract PC-OC10

Metabolic syndrome and osteoarthritis
Metabolic syndrome is more common in patients with severe osteoarthritis, according to researchers. This study included 323 patients with osteoarthritis, whose waist circumference, BP, blood sugar level, HDL and triglyceride levels were obtained.

The patients were mostly female (93.2 per cent) and the most frequent site of osteoarthritis was the knee; 46.1 per cent of the patients had metabolic syndrome. Central obesity was the most common component of metabolic syndrome (53.3 per cent), followed by high triglyceride level (51.4 per cent) and hyperglycemia (33.4 per cent).
Tehrani M, Kalhor L, Marjaneh K et al. Osteopor Int 2011; 22(Supp 1): abstract P125

Birthweight and adult bone mass
A meta-analysis has shown that high birthweight is associated with greater bone mineral content (BMC) in the spine and hip during adulthood. The authors included 14 studies that investigated the association between birthweight or weight at one year of age and BMC in adulthood.

They found that a 1kg increase in birthweight was associated with a 1.49g increase in lumbar spine BMC and a 1kg increase in birthweight was associated with a 1.41g increase in hip BMC. Higher weight at age one year was associated with higher BMC of the lumbar spine and hip in adulthood. These results suggest skeletal development is programmed in the uterus.
Baird J, Kurshid MA, Kim M et al. Osteopor Int 2011; 22(Supp 1): abstract P159

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