Tuesday, October 8, 2013

ASBMR Annual Meeting

I just returned from the Annual Meeting of the American Society for Bone and Mineral Research (ASBMR) held in Baltimore, MD. While there, I had the opportunity to meet lots of great researchers and doctors who specialize in osteoporosis plus sit in on lectures--all of which were absolutely packed with the latest discoveries in osteoporosis research and therapy.

On my first day in Baltimore I attended a course on densitometry and the diagnosis and management of osteoporosis that was sponsored by the International Society for Clinical Densitometry. I had attended one of their courses about 10 years ago but decided to take it again as a refresher. Although helpful, it also sadly reminded me that bone density testing is not as accurate as one might think.

The next day was all about the interconnectedness of muscle and bone. The ASBMR sponsored a full day symposium entitled Cutting Edge Discoveries in Muscle Biology, Disease and Therapeutics. I was absolutely riveted by some of the lectures. We saw video footage of muscle stem cells (called satellite cells), heard about new discoveries in mitochondrial bioenergetics and why this is so important to bone health, learned about myokines (muscle signaling molecules) that "talk" to bone, and honed in on the connection between sarcopenia (muscle wasting) and bone loss.

The next three days were spent at the ASBMR Annual Meeting proper. Not only did I get to listen, 8 to 5, to fascinating lectures but also viewed hundreds of posters and spoke with many of the lead researchers in these projects. I was absolutely blown away to hear things like:

- Vitamin D is not only important for ensuring gut absorption of calcium, enhancing immunological function, and promoting muscle strength through its direct action on bone--but vitamin D also improves neuromusclular function through its effects on the brain's central nervous system.

- There is a huge problem in our current ability to assess patient's vitamin D levels. Not only are assays commonly off by 15 to 20% (or more), but there is no industry standardization in the assessment or reporting of vitamin D levels. Also, for anyone taking vitamin D2, there is a huge variability of ingested vitamin D2 recovery. This means that any immunoassay testing (rather than HPLC/Tandem MS testing) of these patient's vitamin D levels will yield totally innacurate, and therefore useless, results.

- Bone mineral density examinations (DXAs) are absolutely fraught with potential errors not only by the technician performing the scan but also by the radiologist doing the reading and evaluation. It can be very helpful to know a scanning facility's "precision error" and also the date that it was last measured. The only way to determine "least significant change" (LSC) (the amount of change in bone density that is necessary to know that the change in density from one scan to the next is real) is by knowing a facility's precision error assessment. The bottom line is that you can't take DXA T scores at face value. You need to have the report evaluated by someone familiar with all the possible pitfalls in bone density measuring and reporting.

It was a very fruitful five days!
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