Clinical Edge Journal Scan

Key clinical point: The risk for moderate coronary artery calcification (CAC) is inversely and independently associated with bone mineral density (BMD) of the lumbar spine in adults with osteoporosis.

Major finding: After adjustments for significant factors of CAC, BMD of the lumbar spine was significantly and inversely associated with moderate CAC in patients with osteoporosis (odds ratio, 0.38; P = .035). However, no association between CAC and BMD was seen in patients with osteopenia.

Study details: The findings are based on a retrospective medical review study of 246 patients (osteoporosis group, n = 52; osteopenia group, n = 194).

Disclosures: The study was funded by Buddhist Tzu Chi Medical Foundation. The authors declared no conflicts of interest.

Citation: Chuang TL et al. Diagnostics (Basel). 2020 Sep 16. doi: 10.3390/diagnostics10090699.

Key clinical point: The risk for moderate coronary artery calcification (CAC) is inversely and independently associated with bone mineral density (BMD) of the lumbar spine in adults with osteoporosis.

Major finding: After adjustments for significant factors of CAC, BMD of the lumbar spine was significantly and inversely associated with moderate CAC in patients with osteoporosis (odds ratio, 0.38; P = .035). However, no association between CAC and BMD was seen in patients with osteopenia.

Study details: The findings are based on a retrospective medical review study of 246 patients (osteoporosis group, n = 52; osteopenia group, n = 194).

Disclosures: The study was funded by Buddhist Tzu Chi Medical Foundation. The authors declared no conflicts of interest.

Citation: Chuang TL et al. Diagnostics (Basel). 2020 Sep 16. doi: 10.3390/diagnostics10090699.

Key clinical point: The risk for moderate coronary artery calcification (CAC) is inversely and independently associated with bone mineral density (BMD) of the lumbar spine in adults with osteoporosis.

Major finding: After adjustments for significant factors of CAC, BMD of the lumbar spine was significantly and inversely associated with moderate CAC in patients with osteoporosis (odds ratio, 0.38; P = .035). However, no association between CAC and BMD was seen in patients with osteopenia.

Study details: The findings are based on a retrospective medical review study of 246 patients (osteoporosis group, n = 52; osteopenia group, n = 194).

Disclosures: The study was funded by Buddhist Tzu Chi Medical Foundation. The authors declared no conflicts of interest.

Citation: Chuang TL et al. Diagnostics (Basel). 2020 Sep 16. doi: 10.3390/diagnostics10090699.

Key clinical point: Metabolic syndrome (MetS) is associated with an increased risk for low bone mineral density (BMD) in women examined by dual-energy X-ray absorptiometry (DXA) for suspected osteoporosis.

Major finding: MetS was associated with an increased risk for low BMD (odds ratio [OR], 1.19; P = .001). Among MetS components, hypertension significantly correlated with an increased risk for low BMD (OR, 1.23; P = .002), whereas high fasting glucose level/diabetes correlated with a reduced occurrence of low BMD (OR, 0.84; P = .003).

Study details: The data come from a cross-sectional study of 13,182 free-living Caucasian women in Italy (mean age, 62.8 years) who underwent diagnostic assessment of BMD by DXA and of all MetS constitutive elements.

Disclosures: This study received no external funding. The authors declared no conflicts of interest.

Citation: Rendina D et al. J Endocrinol Invest. 2020 Sep 22. doi: 10.1007/s40618-020-01428-w.

Key clinical point: Metabolic syndrome (MetS) is associated with an increased risk for low bone mineral density (BMD) in women examined by dual-energy X-ray absorptiometry (DXA) for suspected osteoporosis.

Major finding: MetS was associated with an increased risk for low BMD (odds ratio [OR], 1.19; P = .001). Among MetS components, hypertension significantly correlated with an increased risk for low BMD (OR, 1.23; P = .002), whereas high fasting glucose level/diabetes correlated with a reduced occurrence of low BMD (OR, 0.84; P = .003).

Study details: The data come from a cross-sectional study of 13,182 free-living Caucasian women in Italy (mean age, 62.8 years) who underwent diagnostic assessment of BMD by DXA and of all MetS constitutive elements.

Disclosures: This study received no external funding. The authors declared no conflicts of interest.

Citation: Rendina D et al. J Endocrinol Invest. 2020 Sep 22. doi: 10.1007/s40618-020-01428-w.

Key clinical point: Metabolic syndrome (MetS) is associated with an increased risk for low bone mineral density (BMD) in women examined by dual-energy X-ray absorptiometry (DXA) for suspected osteoporosis.

Major finding: MetS was associated with an increased risk for low BMD (odds ratio [OR], 1.19; P = .001). Among MetS components, hypertension significantly correlated with an increased risk for low BMD (OR, 1.23; P = .002), whereas high fasting glucose level/diabetes correlated with a reduced occurrence of low BMD (OR, 0.84; P = .003).

Study details: The data come from a cross-sectional study of 13,182 free-living Caucasian women in Italy (mean age, 62.8 years) who underwent diagnostic assessment of BMD by DXA and of all MetS constitutive elements.

Disclosures: This study received no external funding. The authors declared no conflicts of interest.

Citation: Rendina D et al. J Endocrinol Invest. 2020 Sep 22. doi: 10.1007/s40618-020-01428-w.

Key clinical point: Higher serum vitamin K1 (phylloquinone) concentration is associated with a reduced risk for fracture in women with postmenopausal osteoporosis (PMO).

Major finding: Serum vitamin K1 was significantly lower in women with prevalent fractures vs. those without (0.53 μg/L vs. 0.65 μg/L; P = .04). Vitamin K1 inversely correlated with fracture risk (adjusted odds ratio per μg/L increase in serum vitamin K1, 0.550; P = .042). Hip geometry and mechanical strength parameters including cross-sectional area, cross-sectional moment of inertia, and section modulus ‘Z’ at the narrow neck of femur were positively associated with vitamin K1.

Study details: The data come from a cross-sectional study of 374 women with PMO (mean age, 68.7 years).

Disclosures: The study was funded, in part, by the Royal Osteoporosis Society, U.K. The authors declared no conflicts of interest.

Citation: Moore AE et al. Bone. 2020 Sep 10. doi: 10.1016/j.bone.2020.115630.

Key clinical point: Higher serum vitamin K1 (phylloquinone) concentration is associated with a reduced risk for fracture in women with postmenopausal osteoporosis (PMO).

Major finding: Serum vitamin K1 was significantly lower in women with prevalent fractures vs. those without (0.53 μg/L vs. 0.65 μg/L; P = .04). Vitamin K1 inversely correlated with fracture risk (adjusted odds ratio per μg/L increase in serum vitamin K1, 0.550; P = .042). Hip geometry and mechanical strength parameters including cross-sectional area, cross-sectional moment of inertia, and section modulus ‘Z’ at the narrow neck of femur were positively associated with vitamin K1.

Study details: The data come from a cross-sectional study of 374 women with PMO (mean age, 68.7 years).

Disclosures: The study was funded, in part, by the Royal Osteoporosis Society, U.K. The authors declared no conflicts of interest.

Citation: Moore AE et al. Bone. 2020 Sep 10. doi: 10.1016/j.bone.2020.115630.

Key clinical point: Higher serum vitamin K1 (phylloquinone) concentration is associated with a reduced risk for fracture in women with postmenopausal osteoporosis (PMO).

Major finding: Serum vitamin K1 was significantly lower in women with prevalent fractures vs. those without (0.53 μg/L vs. 0.65 μg/L; P = .04). Vitamin K1 inversely correlated with fracture risk (adjusted odds ratio per μg/L increase in serum vitamin K1, 0.550; P = .042). Hip geometry and mechanical strength parameters including cross-sectional area, cross-sectional moment of inertia, and section modulus ‘Z’ at the narrow neck of femur were positively associated with vitamin K1.

Study details: The data come from a cross-sectional study of 374 women with PMO (mean age, 68.7 years).

Disclosures: The study was funded, in part, by the Royal Osteoporosis Society, U.K. The authors declared no conflicts of interest.

Citation: Moore AE et al. Bone. 2020 Sep 10. doi: 10.1016/j.bone.2020.115630.

Key clinical point: Patients with osteoporosis with age-related macular degeneration (AMD) are at a significantly higher risk of developing spine and hip fractures.

Major finding: The AMD vs. non-AMD group had a significantly higher risk for spine and hip fractures (hazard ratio [HR], 1.09; P less than .001 and HR, 1.18; P = .001; respectively). The risk for mortality was significantly higher in patients with osteoporosis with older age, male sex, and all types of comorbidities (P less than .05), except for hyperthyroidism (P = .200).

Study details: This Taiwanese nationwide study included 1,206,247 patients with osteoporosis using insurance claims data. After propensity score matching, 13,548 and 54,336 patients were analyzed in the AMD and non-AMD groups, respectively.

Disclosures: The study was supported by Chang Gung Medical Research Foundation. The authors declared no conflicts of interest.

Citation: Sun CC et al. BMJ Open. 2020 Sep 17. doi: 10.1136/bmjopen-2020-037028.

Key clinical point: Patients with osteoporosis with age-related macular degeneration (AMD) are at a significantly higher risk of developing spine and hip fractures.

Major finding: The AMD vs. non-AMD group had a significantly higher risk for spine and hip fractures (hazard ratio [HR], 1.09; P less than .001 and HR, 1.18; P = .001; respectively). The risk for mortality was significantly higher in patients with osteoporosis with older age, male sex, and all types of comorbidities (P less than .05), except for hyperthyroidism (P = .200).

Study details: This Taiwanese nationwide study included 1,206,247 patients with osteoporosis using insurance claims data. After propensity score matching, 13,548 and 54,336 patients were analyzed in the AMD and non-AMD groups, respectively.

Disclosures: The study was supported by Chang Gung Medical Research Foundation. The authors declared no conflicts of interest.

Citation: Sun CC et al. BMJ Open. 2020 Sep 17. doi: 10.1136/bmjopen-2020-037028.

Key clinical point: Patients with osteoporosis with age-related macular degeneration (AMD) are at a significantly higher risk of developing spine and hip fractures.

Major finding: The AMD vs. non-AMD group had a significantly higher risk for spine and hip fractures (hazard ratio [HR], 1.09; P less than .001 and HR, 1.18; P = .001; respectively). The risk for mortality was significantly higher in patients with osteoporosis with older age, male sex, and all types of comorbidities (P less than .05), except for hyperthyroidism (P = .200).

Study details: This Taiwanese nationwide study included 1,206,247 patients with osteoporosis using insurance claims data. After propensity score matching, 13,548 and 54,336 patients were analyzed in the AMD and non-AMD groups, respectively.

Disclosures: The study was supported by Chang Gung Medical Research Foundation. The authors declared no conflicts of interest.

Citation: Sun CC et al. BMJ Open. 2020 Sep 17. doi: 10.1136/bmjopen-2020-037028.

Some young women can present with very low bone density and multiple fragility fractures. While multiple FDA-approved therapies exist for post-menopausal osteoporosis, pre-menopausal osteoporosis remains an “orphan disease.” Previous evidence suggests that bone anabolic agents such as teriparatide may be useful for women with idiopathic pre-menopausal osteoporosis (IOP). In a phase 2 randomized clinical trial from New York and Nebraska, 41 women with IOP and multiple fractures were randomized to receive placebo or teriparatide in a cross-over study design. The primary endpoint was bone density in the spine and hip after 6 months of treatment, which was significantly increased by teriparatide versus placebo. In addition, bone biopsies were obtained for measurement of bone formation rate using quadruple labeling with tetracycline and demeclocycline three months into treatment. As expected, biopsies showed that teriparatide treatment increased bone formation rates using this ‘gold standard’ method. This prospective randomized study adds to a growing body of evidence that teriparatide may be a safe method to boost bone density in women with IOP. Future studies are needed to assess the impact of this therapy on fracture risk in this specific patient population.

Type 2 diabetes and osteoporosis are both major problems in our aging population. While some diabetes medications such as thiazolidinediones clearly increase fracture risk, the effects of newer diabetes medications on bone biology and fracture risk remain incompletely understood. In addition to beneficial effects on glycemic control, SGLT2 inhibitors show promise with improving cardiovascular and renal outcomes, even in patients without diabetes. Some studies have suggested adverse effects of SGLT2 inhibitor monotherapy on bone density and fracture risk. However, the impact of combined therapy with SGLT2 inhibitors and metformin on fracture risk remains to be established. In this meta-analysis of 25 randomized controlled trials involving 19,500 patients, fracture risk was assessed, based on available information, for individuals who received metformin monotherapy or metformin plus SGLT2 inhibitor treatment. In general, combination therapy did not increase fracture risk compared to metformin alone. Only 6 of the 25 RCTs included in the meta-analysis investigated bone density or bone turnover markers. In these 6 studies, no obvious changes in skeletal outcomes were noted when comparing metformin alone versus metformin plus SGLT2 inhibitor therapy. Although these data are somewhat reassuring for the skeletal safety of combination metformin/SGLT2 inhibitor therapy, confidence is limited by relatively short follow-up time and lack of detailed information about fractures in these studies which focused primarily on diabetes-related outcomes. Future prospective studies are needed to specifically address the skeletal impact of this commonly-used combination of diabetes medications.

Marc Wein, M.D., Ph.D
Assistant Professor of Medicine
Massachusetts General Hospital Endocrine Unit, Harvard Medical School

Some young women can present with very low bone density and multiple fragility fractures. While multiple FDA-approved therapies exist for post-menopausal osteoporosis, pre-menopausal osteoporosis remains an “orphan disease.” Previous evidence suggests that bone anabolic agents such as teriparatide may be useful for women with idiopathic pre-menopausal osteoporosis (IOP). In a phase 2 randomized clinical trial from New York and Nebraska, 41 women with IOP and multiple fractures were randomized to receive placebo or teriparatide in a cross-over study design. The primary endpoint was bone density in the spine and hip after 6 months of treatment, which was significantly increased by teriparatide versus placebo. In addition, bone biopsies were obtained for measurement of bone formation rate using quadruple labeling with tetracycline and demeclocycline three months into treatment. As expected, biopsies showed that teriparatide treatment increased bone formation rates using this ‘gold standard’ method. This prospective randomized study adds to a growing body of evidence that teriparatide may be a safe method to boost bone density in women with IOP. Future studies are needed to assess the impact of this therapy on fracture risk in this specific patient population.

Type 2 diabetes and osteoporosis are both major problems in our aging population. While some diabetes medications such as thiazolidinediones clearly increase fracture risk, the effects of newer diabetes medications on bone biology and fracture risk remain incompletely understood. In addition to beneficial effects on glycemic control, SGLT2 inhibitors show promise with improving cardiovascular and renal outcomes, even in patients without diabetes. Some studies have suggested adverse effects of SGLT2 inhibitor monotherapy on bone density and fracture risk. However, the impact of combined therapy with SGLT2 inhibitors and metformin on fracture risk remains to be established. In this meta-analysis of 25 randomized controlled trials involving 19,500 patients, fracture risk was assessed, based on available information, for individuals who received metformin monotherapy or metformin plus SGLT2 inhibitor treatment. In general, combination therapy did not increase fracture risk compared to metformin alone. Only 6 of the 25 RCTs included in the meta-analysis investigated bone density or bone turnover markers. In these 6 studies, no obvious changes in skeletal outcomes were noted when comparing metformin alone versus metformin plus SGLT2 inhibitor therapy. Although these data are somewhat reassuring for the skeletal safety of combination metformin/SGLT2 inhibitor therapy, confidence is limited by relatively short follow-up time and lack of detailed information about fractures in these studies which focused primarily on diabetes-related outcomes. Future prospective studies are needed to specifically address the skeletal impact of this commonly-used combination of diabetes medications.

Marc Wein, M.D., Ph.D
Assistant Professor of Medicine
Massachusetts General Hospital Endocrine Unit, Harvard Medical School

Some young women can present with very low bone density and multiple fragility fractures. While multiple FDA-approved therapies exist for post-menopausal osteoporosis, pre-menopausal osteoporosis remains an “orphan disease.” Previous evidence suggests that bone anabolic agents such as teriparatide may be useful for women with idiopathic pre-menopausal osteoporosis (IOP). In a phase 2 randomized clinical trial from New York and Nebraska, 41 women with IOP and multiple fractures were randomized to receive placebo or teriparatide in a cross-over study design. The primary endpoint was bone density in the spine and hip after 6 months of treatment, which was significantly increased by teriparatide versus placebo. In addition, bone biopsies were obtained for measurement of bone formation rate using quadruple labeling with tetracycline and demeclocycline three months into treatment. As expected, biopsies showed that teriparatide treatment increased bone formation rates using this ‘gold standard’ method. This prospective randomized study adds to a growing body of evidence that teriparatide may be a safe method to boost bone density in women with IOP. Future studies are needed to assess the impact of this therapy on fracture risk in this specific patient population.

Type 2 diabetes and osteoporosis are both major problems in our aging population. While some diabetes medications such as thiazolidinediones clearly increase fracture risk, the effects of newer diabetes medications on bone biology and fracture risk remain incompletely understood. In addition to beneficial effects on glycemic control, SGLT2 inhibitors show promise with improving cardiovascular and renal outcomes, even in patients without diabetes. Some studies have suggested adverse effects of SGLT2 inhibitor monotherapy on bone density and fracture risk. However, the impact of combined therapy with SGLT2 inhibitors and metformin on fracture risk remains to be established. In this meta-analysis of 25 randomized controlled trials involving 19,500 patients, fracture risk was assessed, based on available information, for individuals who received metformin monotherapy or metformin plus SGLT2 inhibitor treatment. In general, combination therapy did not increase fracture risk compared to metformin alone. Only 6 of the 25 RCTs included in the meta-analysis investigated bone density or bone turnover markers. In these 6 studies, no obvious changes in skeletal outcomes were noted when comparing metformin alone versus metformin plus SGLT2 inhibitor therapy. Although these data are somewhat reassuring for the skeletal safety of combination metformin/SGLT2 inhibitor therapy, confidence is limited by relatively short follow-up time and lack of detailed information about fractures in these studies which focused primarily on diabetes-related outcomes. Future prospective studies are needed to specifically address the skeletal impact of this commonly-used combination of diabetes medications.

Marc Wein, M.D., Ph.D
Assistant Professor of Medicine
Massachusetts General Hospital Endocrine Unit, Harvard Medical School

Key clinical point: Sodium-glucose transporter-2 inhibitors (SGLT2is) combined with metformin therapy did not influence fracture risk in patients with type 2 diabetes mellitus (T2DM).

Major finding: SGLT2is and metformin combination therapy did not increase the risk of fracture vs. metformin monotherapy or other comparators in patients with T2DM (odds ratio, 0.97; 95% confidence interval, 0.71-1.32).

Study details: A meta-analysis of 25 randomized controlled trials including 19,500 participants with T2DM.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Source: Qian BB et al. Osteoporos Int. 2020 Aug 11. doi: 10.1007/s00198-020-05590-y.

Key clinical point: Sodium-glucose transporter-2 inhibitors (SGLT2is) combined with metformin therapy did not influence fracture risk in patients with type 2 diabetes mellitus (T2DM).

Major finding: SGLT2is and metformin combination therapy did not increase the risk of fracture vs. metformin monotherapy or other comparators in patients with T2DM (odds ratio, 0.97; 95% confidence interval, 0.71-1.32).

Study details: A meta-analysis of 25 randomized controlled trials including 19,500 participants with T2DM.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Source: Qian BB et al. Osteoporos Int. 2020 Aug 11. doi: 10.1007/s00198-020-05590-y.

Key clinical point: Sodium-glucose transporter-2 inhibitors (SGLT2is) combined with metformin therapy did not influence fracture risk in patients with type 2 diabetes mellitus (T2DM).

Major finding: SGLT2is and metformin combination therapy did not increase the risk of fracture vs. metformin monotherapy or other comparators in patients with T2DM (odds ratio, 0.97; 95% confidence interval, 0.71-1.32).

Study details: A meta-analysis of 25 randomized controlled trials including 19,500 participants with T2DM.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Source: Qian BB et al. Osteoporos Int. 2020 Aug 11. doi: 10.1007/s00198-020-05590-y.

Key clinical point: Adults younger than 65 years with sepsis are at an increased risk of developing osteoporosis.

Major finding: The risk for osteoporosis was significantly higher in the sepsis vs. nonsepsis group (adjusted hazard ratio [aHR], 1.17; 95% confidence interval [CI], 1.04-1.31). The risk for osteoporosis in the sepsis vs. nonsepsis group was significantly higher for young patients aged 20-49 years (aHR, 1.93; 95% CI, 1.08-3.44) and patients aged 50-64 years (aHR, 2.01; 95% CI, 1.52-2.65).

Study details: This Taiwanese population-based study included 13,178 patients diagnosed with sepsis and 13,178 propensity-score matched individuals without sepsis using data from the insurance claims database.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Source: Lee YF et al. Osteoporos Int. 2020 Aug 22. doi: 10.1007/s00198-020-05599-3.

Key clinical point: Adults younger than 65 years with sepsis are at an increased risk of developing osteoporosis.

Major finding: The risk for osteoporosis was significantly higher in the sepsis vs. nonsepsis group (adjusted hazard ratio [aHR], 1.17; 95% confidence interval [CI], 1.04-1.31). The risk for osteoporosis in the sepsis vs. nonsepsis group was significantly higher for young patients aged 20-49 years (aHR, 1.93; 95% CI, 1.08-3.44) and patients aged 50-64 years (aHR, 2.01; 95% CI, 1.52-2.65).

Study details: This Taiwanese population-based study included 13,178 patients diagnosed with sepsis and 13,178 propensity-score matched individuals without sepsis using data from the insurance claims database.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Source: Lee YF et al. Osteoporos Int. 2020 Aug 22. doi: 10.1007/s00198-020-05599-3.

Key clinical point: Adults younger than 65 years with sepsis are at an increased risk of developing osteoporosis.

Major finding: The risk for osteoporosis was significantly higher in the sepsis vs. nonsepsis group (adjusted hazard ratio [aHR], 1.17; 95% confidence interval [CI], 1.04-1.31). The risk for osteoporosis in the sepsis vs. nonsepsis group was significantly higher for young patients aged 20-49 years (aHR, 1.93; 95% CI, 1.08-3.44) and patients aged 50-64 years (aHR, 2.01; 95% CI, 1.52-2.65).

Study details: This Taiwanese population-based study included 13,178 patients diagnosed with sepsis and 13,178 propensity-score matched individuals without sepsis using data from the insurance claims database.

Disclosures: No study sponsor was identified. The authors declared no conflicts of interest.

Source: Lee YF et al. Osteoporos Int. 2020 Aug 22. doi: 10.1007/s00198-020-05599-3.

Key clinical point: The presence of osteoporosis correlates with a higher likelihood for revision surgery within 2 years following a long spinal fusion for adult spinal deformity (ASD).

Major finding: The rate of revision surgery was significantly higher in ASD patients with osteoporosis vs. those without osteoporosis (40.5% vs. 28.0%; P = .01). The incidence of multiple revision surgeries was similar in both groups (8.4% vs. 8.6%; P = .95). Age and sex were not statistically correlated with the incidence of revision surgery.

Study details: A retrospective comparative study of 399 patients with ASD (40 years or older) who underwent long spinal fusion surgery (osteoporotic group, n=131; nonosteoporotic group, n=268).

Disclosures: The study did not receive any funding.

Source: Gupta A et al. Spine J. 2020 Aug 10. doi: 10.1016/j.spinee.2020.08.002.

Key clinical point: The presence of osteoporosis correlates with a higher likelihood for revision surgery within 2 years following a long spinal fusion for adult spinal deformity (ASD).

Major finding: The rate of revision surgery was significantly higher in ASD patients with osteoporosis vs. those without osteoporosis (40.5% vs. 28.0%; P = .01). The incidence of multiple revision surgeries was similar in both groups (8.4% vs. 8.6%; P = .95). Age and sex were not statistically correlated with the incidence of revision surgery.

Study details: A retrospective comparative study of 399 patients with ASD (40 years or older) who underwent long spinal fusion surgery (osteoporotic group, n=131; nonosteoporotic group, n=268).

Disclosures: The study did not receive any funding.

Source: Gupta A et al. Spine J. 2020 Aug 10. doi: 10.1016/j.spinee.2020.08.002.

Key clinical point: The presence of osteoporosis correlates with a higher likelihood for revision surgery within 2 years following a long spinal fusion for adult spinal deformity (ASD).

Major finding: The rate of revision surgery was significantly higher in ASD patients with osteoporosis vs. those without osteoporosis (40.5% vs. 28.0%; P = .01). The incidence of multiple revision surgeries was similar in both groups (8.4% vs. 8.6%; P = .95). Age and sex were not statistically correlated with the incidence of revision surgery.

Study details: A retrospective comparative study of 399 patients with ASD (40 years or older) who underwent long spinal fusion surgery (osteoporotic group, n=131; nonosteoporotic group, n=268).

Disclosures: The study did not receive any funding.

Source: Gupta A et al. Spine J. 2020 Aug 10. doi: 10.1016/j.spinee.2020.08.002.

Key clinical point: Both total hip bone mineral density (BMD) change and T-score can serve as surrogates for predicting vertebral fracture risk in patients with osteoporosis receiving denosumab treatment.

Major finding: Total hip BMD change and T-score were strong predictors of subsequent vertebral fracture risk, with total hip BMD change accounting for 73% and T-score accounting for 23% of the treatment effect.

Study details: Post hoc analysis of the DIRECT trial involving 1,011 Japanese postmenopausal women and men who were randomly assigned (2:2:1) to receive denosumab, placebo, or alendronate.

Disclosures: The study was funded by Daiichi Sankyo Co., Ltd., Tokyo, Japan. N Okubo, T Osakabe, K Watanabe, and H Takami were Daiichi Sankyo employees. Other authors reported relationships with various pharmaceutical companies, including Daiichi Sankyo.

Source: Okubo N et al. Calcif Tissue Int. 2020 Aug 25. doi: 10.1007/s00223-020-00750-y.

Key clinical point: Both total hip bone mineral density (BMD) change and T-score can serve as surrogates for predicting vertebral fracture risk in patients with osteoporosis receiving denosumab treatment.

Major finding: Total hip BMD change and T-score were strong predictors of subsequent vertebral fracture risk, with total hip BMD change accounting for 73% and T-score accounting for 23% of the treatment effect.

Study details: Post hoc analysis of the DIRECT trial involving 1,011 Japanese postmenopausal women and men who were randomly assigned (2:2:1) to receive denosumab, placebo, or alendronate.

Disclosures: The study was funded by Daiichi Sankyo Co., Ltd., Tokyo, Japan. N Okubo, T Osakabe, K Watanabe, and H Takami were Daiichi Sankyo employees. Other authors reported relationships with various pharmaceutical companies, including Daiichi Sankyo.

Source: Okubo N et al. Calcif Tissue Int. 2020 Aug 25. doi: 10.1007/s00223-020-00750-y.

Key clinical point: Both total hip bone mineral density (BMD) change and T-score can serve as surrogates for predicting vertebral fracture risk in patients with osteoporosis receiving denosumab treatment.

Major finding: Total hip BMD change and T-score were strong predictors of subsequent vertebral fracture risk, with total hip BMD change accounting for 73% and T-score accounting for 23% of the treatment effect.

Study details: Post hoc analysis of the DIRECT trial involving 1,011 Japanese postmenopausal women and men who were randomly assigned (2:2:1) to receive denosumab, placebo, or alendronate.

Disclosures: The study was funded by Daiichi Sankyo Co., Ltd., Tokyo, Japan. N Okubo, T Osakabe, K Watanabe, and H Takami were Daiichi Sankyo employees. Other authors reported relationships with various pharmaceutical companies, including Daiichi Sankyo.

Source: Okubo N et al. Calcif Tissue Int. 2020 Aug 25. doi: 10.1007/s00223-020-00750-y.

Key clinical point: Diabetic patients with carcinoma in situ (CIS) under metformin therapy presented a lower osteoporosis rate vs. those who were not receiving metformin.

Major finding: The risk of osteoporosis was lower in diabetic patients with CIS who were receiving metformin therapy vs. those who were not receiving metformin (adjusted hazard ratio, 0.82; P = .022).

Study details: This retrospective matched-cohort study included 7,827 diabetic patients with CIS treated with metformin and 23,481 matched controls with no metformin therapy.

Disclosures: The study was funded by the Tri-Service General Hospital Research Foundation, the National Defense Medical Center, Ministry of National Defense-Medical Affairs Bureau, and the Teh-Tzer Study Group for Human Medical Research Foundation. The authors declared no conflicts of interest.

Source: Lu CH et al. J Clin Med. 2020 Sep 2. doi: 10.3390/jcm9092839.

Key clinical point: Diabetic patients with carcinoma in situ (CIS) under metformin therapy presented a lower osteoporosis rate vs. those who were not receiving metformin.

Major finding: The risk of osteoporosis was lower in diabetic patients with CIS who were receiving metformin therapy vs. those who were not receiving metformin (adjusted hazard ratio, 0.82; P = .022).

Study details: This retrospective matched-cohort study included 7,827 diabetic patients with CIS treated with metformin and 23,481 matched controls with no metformin therapy.

Disclosures: The study was funded by the Tri-Service General Hospital Research Foundation, the National Defense Medical Center, Ministry of National Defense-Medical Affairs Bureau, and the Teh-Tzer Study Group for Human Medical Research Foundation. The authors declared no conflicts of interest.

Source: Lu CH et al. J Clin Med. 2020 Sep 2. doi: 10.3390/jcm9092839.

Key clinical point: Diabetic patients with carcinoma in situ (CIS) under metformin therapy presented a lower osteoporosis rate vs. those who were not receiving metformin.

Major finding: The risk of osteoporosis was lower in diabetic patients with CIS who were receiving metformin therapy vs. those who were not receiving metformin (adjusted hazard ratio, 0.82; P = .022).

Study details: This retrospective matched-cohort study included 7,827 diabetic patients with CIS treated with metformin and 23,481 matched controls with no metformin therapy.

Disclosures: The study was funded by the Tri-Service General Hospital Research Foundation, the National Defense Medical Center, Ministry of National Defense-Medical Affairs Bureau, and the Teh-Tzer Study Group for Human Medical Research Foundation. The authors declared no conflicts of interest.

Source: Lu CH et al. J Clin Med. 2020 Sep 2. doi: 10.3390/jcm9092839.