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| |  ECO-DG DISPATCH: New Diagnostic Techniques May Aid In Osteoporosis Management By Andreas Hey, M.D.
Special to DG NewsBERLIN, GERMANY -- Sept. 15, 1998 -- The measurement of bone mineral density (BMD) by dual x-ray absorptiometry (DXA) has been acknowledged as the gold standard for the diagnosis, treatment evaluation, and prognosis of osteoporosis. Nevertheless, physicians are unable to assess the risk of bone loss in the individual patient. Presentations yesterday at the European Congress on Osteoporosis (ECO) suggest that new diagnostic techniques may soon be available as adjuncts in osteoporosis management.
Quantitative Ultrasound Quantitative ultrasound (QUS) has a number of intrinsic advantages over established DXA methods, namely low cost, lack of ionising radiation exposure, minimal regulatory requirements and portability. Some independent prospective studies have recently confirmed the ability of QUS -- mostly measured at the heel -- to assess the fracture risk in osteoporosis patients. This has also led to the United States Food and Drug Administration’s approval of the first QUS device this year. Dr. David deTakats, from the World Health Organization (WHO) collaborating Centre for Metabolic Bone Diseases, in Sheffield, UK, presented evidence at the ECO that broadband ultrasound attenuation (BUA), one of the parameters measured by most of the QUS devices, is sensitive to bone changes induced by anti-resorptive therapy. A total of 273 women aged 75 years or more completed a one-year course of treatment with either clodronate (800 mg once daily) or placebo in a randomised, double-blind, controlled study. At the end of treatment, changes from baseline were significantly different between clodronate and placebo both for BMD measured at the total hip and heel BUA. Dr. de Takats said that QUS and, in particular, heel BUA may be used as an outcome variable in clinical trials. Biochemical Bone Markers Yesterday in Berlin, Dr. Ravn, from Ballerup, Denmark, presented data showing that several biochemical markers of bone metabolism can be used as fast and valid indicators of the response to osteoporosis treatment. Dr. Ravn’s presentation was based on the EPIC (Early Postmenopausal Intervention Cohort) study, an on-going, randomised, double-blind, placebo-controlled, four-centre trial of daily alendronate treatment for the prevention of postmenopausal osteoporosis. A subgroup of 1,202 of the 1,609 women enrolled in this study were followed over a two-year period on a six-monthly basis for BMD and a number of other bone markers. Bone marker levels reached the pre-menopausal range within six months of treatment. "In the vast majority of patients there was a significant association between the six-months response in all bone markers and two-year response in spinal BMD," Ravn said. In his lecture on appropriate use of bone markers, professor Lindsay of the Helen Hayes Hospital, in West Haverstraw, N.Y., explained that markers are on the brink of being established clinically as tools for following-up osteoporosis patients and probably also in predicting the response to treatment. It remains unclear, however, whether they will be able to assist in predicting fracture, he said.
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