Reduction in normalized bone elasticity following long-term bisphosphonate treatment as measured by ultrasound critical angle reflectometry

• Published in: Osteoporosis international Vol. 16; no. 11; pp. 1384 - 1392
• Main Authors: RICHER, Edmond, LEWIS, Matthew A, ODVINA, Clarita V, VAZQUEZ, Miguel A, SMITH, Billy J, PETERSON, Roy D, POINDEXTER, John R, ANTICH, Peter P, PAK, Charles Y. C
• Format: Journal Article
• Language: English
• Published: London Springer 01.11.2005; Springer Nature B.V
• Subjects: Adult; Aged; Biological and medical sciences; Bisphosphonates; Bone Density; Bone Density Conservation Agents - adverse effects; Bone Diseases, Metabolic - diagnostic imaging; Bone Diseases, Metabolic - physiopathology; Bones, joints and connective tissue. Antiinflammatory agents; Calcaneus - diagnostic imaging; Calcaneus - physiopathology; Diphosphonates - adverse effects; Diseases of the osteoarticular system; Elasticity; Elasticity of demand; Estrogens; Female; Fractures; Humans; Kidney Transplantation - physiology; Kidney transplants; Male; Medical sciences; Middle Aged; Osteoporosis; Osteoporosis - diagnostic imaging; Osteoporosis - drug therapy; Osteoporosis - physiopathology; Osteoporosis. Osteomalacia. Paget disease; Pharmacology. Drug treatments; Steroids; Steroids - therapeutic use; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Trabecular Meshwork - diagnostic imaging; Trabecular Meshwork - physiopathology; Ultrasonic imaging; Ultrasonography - methods; Osteoporosis; Bone elasticity; Bisphosphonate; Treatment; Diseases of the osteoarticular system; Rheumatology; Elasticity; Renal transplantation; Bisphosphonates; Long bone; Ultrasound; Kidney transplantation
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-005-1848-x

Using an improved version of ultrasound critical angle reflectometry, the bone quality of cortical and trabecular bone was assessed in vivo by measuring elastic moduli (normalized for bone density) at both principal axes, referred to as the minimum and maximum normalized elasticities. The measurements were made in 30 normal premenopausal women, 30 normal postmenopausal women, 22 untreated postmenopausal women with osteoporosis, 74 postmenopausal women with osteoporosis or osteopenia on bisphosphonate treatment, and 32 patients with renal transplantation (16 women and 16 men) taking steroids. Cortical elasticity was higher than trabecular elasticity; both declined slightly and non-significantly with age in normal women. Among untreated postmenopausal women with osteoporosis, cortical maximum normalized elasticity (E(cmax)) remained within 95% prediction intervals of normal women. Among patients on bisphosphonate, E(cmax) was low in the majority of patients. E(cmax) was significantly more depressed among those taking the drug > or =3 years than <3 years (22.1% below normal premenopausal women versus 17.2%, P =0.001), and among those with incident non-spinal fractures than without (75.9 vs. 81.5%, P =0.008). E(cmax) was independent of bone mineral density at the calcaneus. Most patients with renal transplantation had low E(cmax), with a mean 20.8% below the normal premenopausal mean. Qualitatively similar findings were found with cortical minimum elasticity and with trabecular minimum and maximum elasticities. Thus, the material bone quality of cortical and trabecular bone may be impaired following bisphosphonate treatment, as in renal transplantation on steroids.