Further reductions in nonvertebral fracture rate with long-term denosumab treatment in the FREEDOM open-label extension and influence of hip bone mineral density after 3 years

Limited data exist on the efficacy of long-term therapies for osteoporosis. In osteoporotic postmenopausal women receiving denosumab for 7 years, nonvertebral fracture rates significantly decreased in years 4-7 versus years 1-3. This is the first demonstration of a further benefit on fracture outcomes with long-term therapy for osteoporosis. INTRODUCTION This study aimed to evaluate whether denosumab treatment continued beyond 3 years is associated with a further reduction in nonvertebral fracture rates. METHODS Participants who completed the 3-year placebo-controlled Fracture REduction Evaluation of Denosumab in Osteoporosis every 6 Months (FREEDOM) study were invited to participate in an open-label extension. The present analysis includes 4,074 postmenopausal women with osteoporosis (n = 2,343 long-term; n = 1,731 cross-over) who enrolled in the extension, missed ≤1 dose during their first 3 years of denosumab treatment, and continued into the fourth year of treatment. Comparison of nonvertebral fracture rates during years 1-3 of denosumab with that of the fourth year and with the rate during years 4-7 was evaluated. RESULTS For the combined group, the nonvertebral fracture rate per 100 participant-years was 2.15 for the first 3 years of denosumab treatment (referent) and 1.36 in the fourth year (rate ratio [RR] = 0.64; 95 % confidence interval (CI) = 0.48 to 0.85, p = 0.003). Comparable findings were observed in the groups separately and when nonvertebral fracture rates during years 1-3 were compared to years 4-7 in the long-term group (RR = 0.79; 95 % CI = 0.62 to 1.00, p = 0.046). Fracture rate reductions in year 4 were most prominent in subjects with persisting low hip bone mineral density (BMD). CONCLUSIONS Denosumab treatment beyond 3 years was associated with a further reduction in nonvertebral fracture rate that persisted through 7 years of continuous denosumab administration. The degree to which denosumab further reduces nonvertebral fracture risk appears influenced by the hip bone density achieved with initial therapy.

A meta-analysis of trabecular bone score in fracture risk prediction and its relationship to FRAX

Trabecular bone score (TBS) is a grey-level textural index of bone microarchitecture derived from lumbar spine dual-energy X-ray absorptiometry (DXA) images. TBS is a BMD-independent predictor of fracture risk. The objective of this meta-analysis was to determine whether TBS predicted fracture risk independently of FRAX probability and to examine their combined performance by adjusting the FRAX probability for TBS. We utilized individual level data from 17,809 men and women in 14 prospective population-based cohorts. Baseline evaluation included TBS and the FRAX risk variables and outcomes during follow up (mean 6.7 years) comprised major osteoporotic fractures. The association between TBS, FRAX probabilities and the risk of fracture was examined using an extension of the Poisson regression model in each cohort and for each sex and expressed as the gradient of risk (GR; hazard ratio per 1SD change in risk variable in direction of increased risk). FRAX probabilities were adjusted for TBS using an adjustment factor derived from an independent cohort (the Manitoba Bone Density Cohort). Overall, the GR of TBS for major osteoporotic fracture was 1.44 (95% CI: 1.35-1.53) when adjusted for age and time since baseline and was similar in men and women (p > 0.10). When additionally adjusted for FRAX 10-year probability of major osteoporotic fracture, TBS remained a significant, independent predictor for fracture (GR 1.32, 95%CI: 1.24-1.41). The adjustment of FRAX probability for TBS resulted in a small increase in the GR (1.76, 95%CI: 1.65, 1.87 vs. 1.70, 95%CI: 1.60-1.81). A smaller change in GR for hip fracture was observed (FRAX hip fracture probability GR 2.25 vs. 2.22). TBS is a significant predictor of fracture risk independently of FRAX. The findings support the use of TBS as a potential adjustment for FRAX probability, though the impact of the adjustment remains to be determined in the context of clinical assessment guidelines. This article is protected by copyright. All rights reserved.

Abdominal aortic calcification and risk of fracture among older women - The SOF study

Data concerning the link between severity of abdominal aortic calcification (AAC) and fracture risk in postmenopausal women are discordant. This association may vary by skeletal site and duration of follow-up. Our aim was to assess the association between the AAC severity and fracture risk in older women over the short- and long term. This is a case-cohort study nested in a large multicenter prospective cohort study. The association between AAC and fracture was assessed using Odds Ratios (OR) and 95% confidence intervals (95%CI) for vertebral fractures and using Hazard Risks (HR) and 95%CI for non-vertebral and hip fractures. AAC severity was evaluated from lateral spine radiographs using Kauppila's semiquantitative score. Severe AAC (AAC score 5+) was associated with higher risk of vertebral fracture during 4 years of follow-up, after adjustment for confounders (age, BMI, walking, smoking, hip bone mineral density, prevalent vertebral fracture, systolic blood pressure, hormone replacement therapy) (OR=2.31, 95%CI: 1.24-4.30, p<0.01). In a similar model, severe AAC was associated with an increase in the hip fracture risk (HR=2.88, 95%CI: 1.00-8.36, p=0.05). AAC was not associated with the risk of any non-vertebral fracture. AAC was not associated with the fracture risk after 15 years of follow-up. In elderly women, severe AAC is associated with higher short-term risk of vertebral and hip fractures, but not with the long-term risk of these fractures. There is no association between AAC and risk of non-vertebral-non-hip fracture in older women. Our findings lend further support to the hypothesis that AAC and skeletal fragility are related.

(Table 1) K-Ar age of alkaline igneous rocks from the Jan Mayen fracture zone

Bottom morphology of the Jan Mayen transform fracture zone and rock chemistry data show that petrological and chemical specific features of igneous rocks can result from higher permeability of the transform fracture zone and deeper penetration of ocean water into the lithosphere in comparison with rift zones of the Kolbeinsey and Mohn's mid-ocean ridges. Age of alkaline magmatism of the Jan Mayen fracture zone is similar to that of rift zones due to palingenesis of metamorphosed and hydrated mantle and crustal rocks.

Composition of sulfides from the Sierra Leone Fracture Zone (Central Atlantic Ocean)

An analysis of data on the location of hydrothermal fields, seismicity, and satellite altimetry evidences that in mid-ocean ridges with low spreading rate hydrothermal fields tend to be grouped in areas with generally low seismic activity and at intersections of discontinuities and rift zones. Based on this assumption, the Sierra Leone Fracture Zone was studied in 2000 during Cruise 22 of R/V Akademik Nikolaj Strakhov. A study of gabbrodolerite and dolerite showed that sulfide ore minerals in them were formed both by hydrothermal and magmatic processes. An analysis of melt inclusions demonstrated that magmatic complexes formed from a high-temperature (1210-1255°C) low-potassium melt of the N-MORB type. Investigations of fluid inclusions revealed that gabbro and dolerite formed under influence of an active hydrothermal system at temperature 205-226°C. Thus, the Sierra Leone Fracture Zone is considered to be perspective for a discovery of a new hydrothermal field.

Geochemistry of basalts near the Tamayo Fracture Zone

Recent investigations of the southern Gulf of California (22°N) on Leg 65 of the Deep Sea Drilling Project (DSDP) allow important comparisons with drilled sections of ocean crust formed at different spreading rates. During Leg 65 the Glomar Challenger drilled seven basement holes at sites forming a transect across the ridge axis near the Tamayo Fracture Zone. An additional site was drilled on the fracture zone itself, where a small magnetic "diapir" was located. Together with the material from Site 474 (drilled during Leg 64) the cores recovered at these sites are representative of the upper basaltic and sedimentary crust formed since the initial opening of the Gulf. The pattern of magmatic accretion at the ridge axis is conditioned by the moderate to high rate of spreading (~6 cm/y.) and comparatively high sedimentation rates that now characterize the Gulf of California. In terms of spreading rate, this region is intermediate between the "superfast" East Pacific Rise axis to the south (up to 17 cm/y.) and the slow-spreading Mid-Atlantic Ridge (2-4 cm/y.) both of which have been extensively studied by dredging and drilling.

Rocks and minerals from the Strakhov Fracture Zone, 4°N Mid-Atlantic Ridge

Geological-geophysical data obtained during Cruises 7, 11, and 12 of R/V Akademic Nikolay Strakhov (1989-1991) within the international project EQUARIDGE in the Strakhov Fracture Zone region (4°N) are presented. The trough of the fracture is interpreted as an open extension joint, a graben produced by stretching along the axis of the Mid-Atlantic Ridge. Bedrock studies showed that typical mid-ocean tholeiitic basalts occur within the narrow (60 nm wide) axial rift zone, whereas igneous rocks not typical for the ocean were found on the eastern and western flank plateaus. This allows to suppose that a reworked relict continental-type basement of pre-Upper Jurassic age possibly exists beneath the flank plateaus, within the segment under discussion. The above data correspond to the hypothesis of E. Bonatti about nonspreading nature of the basement of Mid-Atlantic Ridge within the equatorial segment and the Strakhov Fracture Zone.