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Ke Y, Hu H, Zhang J, Yuan L, Li T, Feng Y, Wu Y, Fu X, Wang M, Gao Y, Huo W, Chen Y, Zhang W, Wang L, Li X, Pang J, Zheng Z, Hu F, Zhang M, Sun L, Zhao Y, Lu J, Hu D. Alcohol Consumption and Risk of Fractures: A Systematic Review and Dose-Response Meta-Analysis of Prospective Cohort Studies. Adv Nutr 2023; 14:599-611. [PMID: 36966875 PMCID: PMC10334160 DOI: 10.1016/j.advnut.2023.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/27/2023] [Accepted: 03/21/2023] [Indexed: 04/11/2023] Open
Abstract
Alcohol consumption remains inconsistently correlated with fracture risk, and a dose-response meta-analysis for specific outcomes is lacking. The objective of this study was to quantitatively integrate the data on the relationship between alcohol consumption and fracture risk. Pertinent articles were identified in PubMed, Web of Science, and Embase databases up to 20 February 2022. Combined RRs and 95% CIs were estimated by random- or fixed-effects models. Restricted cubic splines were used to model linear or nonlinear relationships. Forty-four articles covering 6,069,770 participants and 205,284 cases of fracture were included. The combined RRs and 95% CIs for highest compared with lowest alcohol consumption were 1.26 (1.17-1.37), 1.24 (1.13-1.35), and 1.20 (1.03-1.40) for total, osteoporotic, and hip fractures, respectively. A linear positive relationship between alcohol consumption and total fracture risk was detected (Pnonlinearity = 0.057); the risk was correlated with a 6% increase (RR, 1.06; 95% CI: 1.02, 1.10) per 14 g/d increment of alcohol consumption. J-shaped relationships of alcohol consumption with risk of osteoporotic fractures (Pnonlinearity < 0.001) and hip fractures (Pnonlinearity < 0.001) were found. Alcohol consumption of 0 to 22 g/d was linked to a reduced risk of osteoporotic fractures and hip fractures. Our findings show that any level of alcohol consumption is a risk factor for total fractures. Moreover, this dose-response meta-analysis shows that an alcohol consumption level of 0 to 22 g/d is related to a reduction in the risk of osteoporotic and hip fractures. The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42022320623).
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Affiliation(s)
- Yamin Ke
- Department of General Practice, The Affiliated Luohu Hospital of Shenzhen University Medical School, Shenzhen, Guangdong, China, 47 Youyi Road, Luohu District, Shenzhen, Guangdong, 518001, People's Republic of China
| | - Huifang Hu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Jinli Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Lijun Yuan
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Tianze Li
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yifei Feng
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yuying Wu
- Department of General Practice, The Affiliated Luohu Hospital of Shenzhen University Medical School, Shenzhen, Guangdong, China, 47 Youyi Road, Luohu District, Shenzhen, Guangdong, 518001, People's Republic of China
| | - Xueru Fu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Mengmeng Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yajuan Gao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Weifeng Huo
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yaobing Chen
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Wenkai Zhang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Longkang Wang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Xi Li
- Department of General Practice, The Affiliated Luohu Hospital of Shenzhen University Medical School, Shenzhen, Guangdong, China, 47 Youyi Road, Luohu District, Shenzhen, Guangdong, 518001, People's Republic of China
| | - Jinyuan Pang
- Department of Preventive Medicine, School of Public Health, Shenzhen University Medical School, ShenZhen, Guangdong, People's Republic of China
| | - Zeqiang Zheng
- Department of Preventive Medicine, School of Public Health, Shenzhen University Medical School, ShenZhen, Guangdong, People's Republic of China
| | - Fulan Hu
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen, Guangdong, People's Republic of China
| | - Ming Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Medical School, Shenzhen, Guangdong, People's Republic of China
| | - Liang Sun
- Department of Social Medicine and Health Management, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Yang Zhao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Jie Lu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, Henan, People's Republic of China
| | - Dongsheng Hu
- Department of General Practice, The Affiliated Luohu Hospital of Shenzhen University Medical School, Shenzhen, Guangdong, China, 47 Youyi Road, Luohu District, Shenzhen, Guangdong, 518001, People's Republic of China.
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Ross J, Bowden MR, Yu C, Diaz-Thomas A. Transition of young adults with metabolic bone diseases to adult care. Front Endocrinol (Lausanne) 2023; 14:1137976. [PMID: 37008909 PMCID: PMC10064010 DOI: 10.3389/fendo.2023.1137976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/06/2023] [Indexed: 03/19/2023] Open
Abstract
As more accurate diagnostic tools and targeted therapies become increasingly available for pediatric metabolic bone diseases, affected children have a better prognosis and significantly longer lifespan. With this potential for fulfilling lives as adults comes the need for dedicated transition and intentional care of these patients as adults. Much work has gone into improving the transitions of medically fragile children into adulthood, encompassing endocrinologic conditions like type 1 diabetes mellitus and congenital adrenal hyperplasia. However, there are gaps in the literature regarding similar guidance concerning metabolic bone conditions. This article intends to provide a brief review of research and guidelines for transitions of care more generally, followed by a more detailed treatment of bone disorders specifically. Considerations for such transitions include final adult height, fertility, fetal risk, heritability, and access to appropriately identified specialists. A nutrient-dense diet, optimal mobility, and adequate vitamin D stores are protective factors for these conditions. Primary bone disorders include hypophosphatasia, X-linked hypophosphatemic rickets, and osteogenesis imperfecta. Metabolic bone disease can also develop secondarily as a sequela of such diverse exposures as hypogonadism, a history of eating disorder, and cancer treatment. This article synthesizes research by experts of these specific disorders to describe what is known in this field of transition medicine for metabolic bone diseases as well as unanswered questions. The long-term objective is to develop and implement strategies for successful transitions for all patients affected by these various conditions.
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Affiliation(s)
- Jordan Ross
- Division of Pediatric Endocrinology, University of Tennessee Health Science Center, Memphis, TN, United States
- *Correspondence: Jordan Ross,
| | - Michelle R. Bowden
- Division of General Pediatrics, University of Tennessee Health Science Center, Memphis, TN, United States
- Le Bonheur Children’s Hospital, Memphis, TN, United States
| | - Christine Yu
- Endocrinology Division, St. Jude Children’s Research Hospital, Memphis, TN, United States
| | - Alicia Diaz-Thomas
- Division of Pediatric Endocrinology, University of Tennessee Health Science Center, Memphis, TN, United States
- Le Bonheur Children’s Hospital, Memphis, TN, United States
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Beschloss AM, Taghlabi KM, Rodriguez DA, Lee N, Gupta S, Bondar K, Lombardi JM, Varthi A, Faraji A, Saifi C. Demographic and economic trends in vertebral fracture surgeries throughout the United States. NORTH AMERICAN SPINE SOCIETY JOURNAL 2022; 12:100175. [PMID: 36281323 PMCID: PMC9587355 DOI: 10.1016/j.xnsj.2022.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022]
Abstract
Background Vertebral fractures, frequently resulting from high-impact trauma to the spine, are an increasingly relevant public health concern. Little is known about the long-term economic and demographic trends affecting patients undergoing surgery for such fractures. This study examines national economic and demographic trends in vertebral fracture surgery in the United States to improve value-based care and health care utilization. Methods The National Inpatient Sample (NIS) was queried for patients who underwent surgical treatment of a vertebral fracture (ICD-9-CM-3.53) (excluding kyphoplasty and vertebroplasty) between 1993 and 2015. Demographic data included patient age, sex, income, insurance type, hospital size, and location. Economic data including aggregate charge, aggregate cost, hospital cost, and hospital charge were analyzed. Results The number of vertebral fracture surgeries, excluding kyphoplasty and vertebroplasty, increased 461% from 3,331 in 1993 to 18,675 in 2014, while inpatient mortality increased from 1.9% to 2.5%.The mean age of patients undergoing vertebral fracture surgeries increased from 42 in 1993 to 53 in 2015. The aggregate cost of surgery increased from $189,164,625 in 2001 to $1,060,866,580 in 2014, a 461% increase. Conclusions The significant increase in vertebral fracture surgeries between 1993 and 2014 may reflect an increased rate of fractures, more surgeons electing to treat fractures surgically, or a combination of both. The increasing rate of vertebral fracture surgery, coupled with increasing hospital costs and mortality, signifies that the treatment of vertebral fractures remains a challenging issue in healthcare. Further research is necessary to determine the underlying cause of both the increase in surgeries and the increasing mortality rate.
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Affiliation(s)
- Alexander M. Beschloss
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, The Spine Center at Pennsylvania Hospital, University of Pennsylvania Hospital System, 801 Spruce Street, Philadelphia, PA 19107, United States
| | - Khaled M. Taghlabi
- Department of Neurosurgery, Houston Methodist Hospital, 6670 Bertner Avenue, Houston, TX 77030, United States
| | - Daniel A. Rodriguez
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, The Spine Center at Pennsylvania Hospital, University of Pennsylvania Hospital System, 801 Spruce Street, Philadelphia, PA 19107, United States
| | - Nathan Lee
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY 10034, United States
| | - Sachin Gupta
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, The Spine Center at Pennsylvania Hospital, University of Pennsylvania Hospital System, 801 Spruce Street, Philadelphia, PA 19107, United States
| | - Kevin Bondar
- Department of Orthopedic Surgery and Sports Medicine, Houston Methodist Hospital, 6670 Bertner Avenue, Houston, TX 77030, United States
| | - Joseph M. Lombardi
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York-Presbyterian, 5141 Broadway, New York, NY 10034, United States
| | - Arya Varthi
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, 1 Long Wharf Dr 6th Floor, New Haven, CT 06511, United States
| | - Amir Faraji
- Department of Neurosurgery, Houston Methodist Hospital, 6670 Bertner Avenue, Houston, TX 77030, United States
| | - Comron Saifi
- Department of Orthopedic Surgery and Sports Medicine, Houston Methodist Hospital, 6670 Bertner Avenue, Houston, TX 77030, United States
- Corresponding author.
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Smoking and fracture risk in men: a meta-analysis of cohort studies, using both frequentist and Bayesian approaches. Sci Rep 2022; 12:9270. [PMID: 35661791 PMCID: PMC9166727 DOI: 10.1038/s41598-022-13356-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 05/16/2022] [Indexed: 11/15/2022] Open
Abstract
Past studies indicate that men are more likely to smoke and be at higher risk of smoking-related conditions than women. Our research aimed, through meta-analysis, to assess the association between smoking and fracture risk in men. The following databases were searched, including MEDLINE, EMBASE, Scopus, PsycINFO, ISI Web of Science, Google Scholar, WorldCat, and Open Grey, for identifying related studies. A random-effects model was used to pool the confounder-adjusted relative risk (R.R.). Frequentist and Bayesian hierarchical random-effects models were used for the analysis. The heterogeneity and publication bias were evaluated in this study. Twenty-seven studies met the inclusion criteria. Overall, smoking is associated with a significantly increased risk of fracture in both the frequentist approach (R.R., 1.37; 95% confidence interval: 1.22, 1.53) and the Bayesian approach (R.R., 1.36; 95% credible interval: 1.22, 1.54). Significant heterogeneity was observed in the meta-analysis (Higgin's I2 = 83%) and Cochran's Q statistic (p < 0.01). A significant association was also observed in multiple pre-specified sensitivity and subgroup analyses. Similar results were observed in the group containing a large sample size (≥ 10,000 participants), and the group has a small sample size (< 10,000 participants); the pooled R.R was 1.23 (95% confidence interval, 1.07–1.41) and 1.56 (95% confidence interval, 1.37–1.78), respectively. With the Bayesian method, the effect size was 1.23 (95% credible interval, 1.05, 1.45) for the large sample size group and 1.57 (95% credible interval, 1.35, 1.82) for the small sample size group. Smoking is associated with a significant increase in fracture risk for men. Thus, smoking cessation would also greatly reduce fracture risk in all smokers, particularly in men.
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Liu H, Wang W, Huang Y, Hu X, Li X, Yang H. Influence of Different Surgical Timing after Percutaneous Kyphoplasty for Osteoporotic Vertebral Compression Fractures: A Retrospective Study. Int J Clin Pract 2022; 2022:7500716. [PMID: 35832796 PMCID: PMC9251147 DOI: 10.1155/2022/7500716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/15/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A large number of people suffer from osteoporotic vertebral compression fractures (OVCFs) worldwide. Percutaneous kyphoplasty (PKP), considered a minimally invasive surgery, has been widely used to treat OVCFs and achieves satisfactory outcomes. However, the surgical timing of PKP is still under discussion. METHODS A total of 149 patients were enrolled in the study and were divided into 3 groups according to different surgical timing. Group A (n = 52) included patients who required emergency surgery. Group B (n = 50) included patients who required surgery around a week after injury. Group C (n = 47) included patients who required surgery a month or more after injury. Characteristics of patients and radiological images were recorded. The Visual Analog Scale (VAS) scores and the Oswestry Disability Index (ODI) scores were analyzed before, 1 day, 1 month, and 6 months after surgery. In addition, compression rates of anterior vertebral height (AVH) were calculated and the kyphosis Cobb angle was measured before and after surgery. RESULTS There was a significant difference in the VAS and ODI scores between the three groups at 1 day, 1 month, and 6 months after PKP. The VAS and ODI scores of Group C were higher than those of Groups A and B. The AVH compression rates of Group C were significantly higher than those of Groups A and B postoperatively 1 day, 1 month, and 6 months. The kyphosis Cobb angles in Group C was significantly larger than those in Groups A and B at 1 day and 1 month after PKP. CONCLUSIONS Emergency PKP showed more advantages in both clinical and radiological outcomes. We recommend early PKP for the treatment of OVCFs.
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Affiliation(s)
- Hao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Wenhao Wang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Yixue Huang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Xiayu Hu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
- Orthopaedic Institute, Medical College, Soochow University, Suzhou 215000, China
| | - Xuefeng Li
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Huilin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
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Ambrosio MR, Aliberti L, Gagliardi I, Franceschetti P, Zatelli MC. Bone health in adolescence. Minerva Obstet Gynecol 2021; 73:662-677. [PMID: 34905874 DOI: 10.23736/s2724-606x.20.04713-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adolescence is a fundamental period for the formation of the skeleton, because is the stage in which bones grow more in both size and strength, laying a solid foundation for the future health of the skeleton. Any condition interfering with optimal peak bone mass accrual can increase fracture risk later in life. Up to 80% of peak bone mass is genetically determined while the remaining 20% is modulated by environmental factors that, if deleterious, may result in low bone mineral density (BMD) and an increased risk of fracture. The preferred test to assess bone health is dual-energy x-ray absorptiometry (spine or total body less head) using Z scores instead of T scores, even though in short stature or growth delay, should be used the height Z-score. The correction of risk factors is the first treatment for low BMD in children and adolescents. It's necessary having a correct lifestyle for preserving bone health: a proper nutrition, an adequate physical weight-bearing activity and avoidance of alcohol intake and tobacco smoke. Bisphosphonates could be used in children who sustained osteoporotic fractures, impairing quality of life, when spontaneous recovery is low for the persistence of osteoporosis risk factors. This clinical review discusses factors affecting bone health during childhood and adolescence and deals with diagnosis and treatment of low bone mass or osteoporosis in this age group.
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Affiliation(s)
- Maria R Ambrosio
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy -
| | - Ludovica Aliberti
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Irene Gagliardi
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Paola Franceschetti
- Operative Unit of Endocrinology and Metabolic Diseases, Department of Oncology and Specialty Medicine, Ferrara University Hospital, Ferrara, Italy
| | - Maria C Zatelli
- Section of Endocrinology and Internal Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
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Sun PD, Zhang XX, Zhang YW, Wang Z, Wu XY, Wu YC, Yu XL, Gan HR, Liu XD, Ai ZZ, He JY, Dong XP. Stress analysis of the thoracolumbar junction in the process of backward fall: An experimental study and finite element analysis. Exp Ther Med 2021; 22:1117. [PMID: 34504571 PMCID: PMC8383768 DOI: 10.3892/etm.2021.10551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/21/2020] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to evaluate the biomechanical mechanism of injuries of the thoracolumbar junction by the methods of a backward fall simulation experiment and finite element (FE) analysis (FEA). In the backward fall simulation experiment, one volunteer was selected to obtain the contact force data of the sacrococcygeal region during a fall. Utilizing the fall data, the FEA simulation of the backward fall process was given to the trunk FE model to obtain the stress status of local bone structures of the thoracolumbar junction during the fall process. In the fall simulation test, the sacrococcygeal region of the volunteer landed first; the total impact time was 1.14±0.58 sec, and the impact force was up to 4,056±263 N. The stress of thoracic (T)11 was as high as 42 MPa, that of the posterior margin and the junction of T11 was as high as 70.67 MPa, and that of the inferior articular process and the superior articular process was as high as 128 MPa. The average stress of T12 and the anterior margin of lumbar 1 was 25 MPa, and that of the endplate was as high as 21.7 MPa, which was mostly distributed in the back of the endplate and the surrounding cortex. According to the data obtained from the fall experiment as the loading condition of the FE model, the backward fall process can be simulated to improve the accuracy of FEA results. In the process of backward fall, the front edge of the vertebral body and the root of vertebral arch in the thoracolumbar junction are stress concentration areas, which have a greater risk of injury.
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Affiliation(s)
- Pei-Dong Sun
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi 330006, P.R. China.,Department of Human Anatomy, Southern Medical University, Guangdong Key Laboratory of Medical Biomechanics, Guangzhou, Guangdong 510515, P.R. China
| | - Xiao-Xiang Zhang
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Yuan-Wei Zhang
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Zhe Wang
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Xiao-Yu Wu
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Yan-Chao Wu
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Xing-Liang Yu
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Hao-Ran Gan
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Xiang-Dong Liu
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Zi-Zheng Ai
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Jian-Ying He
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Xie-Ping Dong
- Department of Orthopedics, Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, Jiangxi 330006, P.R. China
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Making Sense of the Highly Variable Effects of Alcohol on Bone. Clin Rev Bone Miner Metab 2021. [DOI: 10.1007/s12018-021-09277-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Butscheidt S, Tsourdi E, Rolvien T, Delsmann A, Stürznickel J, Barvencik F, Jakob F, Hofbauer LC, Mundlos S, Kornak U, Seefried L, Oheim R. Relevant genetic variants are common in women with pregnancy and lactation-associated osteoporosis (PLO) and predispose to more severe clinical manifestations. Bone 2021; 147:115911. [PMID: 33716164 DOI: 10.1016/j.bone.2021.115911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/19/2021] [Accepted: 03/08/2021] [Indexed: 12/17/2022]
Abstract
Pregnancy and lactation-associated osteoporosis (PLO) is a rare skeletal disorder characterized by early-onset osteoporosis typically manifestating with vertebral compression fractures or transient osteoporosis of the hip. We hypothesized that genetic variants may play a role in the development of PLO. This study aimed to analyze the presence of genetic variants and a potential association with the clinical presentation in PLO. 42 women with PLO were included from 2013 to 2019 in a multicenter study in Germany. All cases underwent comprehensive genetic analysis based on a custom-designed gene panel including genes relevant for skeletal disorders. The skeletal status was assessed using dual-energy X-ray absorptiometry (DXA). Subgroups were further analyzed by serum bone turnover markers (n = 31) and high-resolution peripheral computed tomography (HR-pQCT; n = 23). We detected relevant genetic variants in 21 women (50%), with LRP5, WNT1 and COL1A1/A2 being the most commonly involved genes. The mean number of vertebral compression fractures was 3.3 ± 3.4 per case with a significantly higher occurrence in the subgroup with genetic variants (4.8 ± 3.7 vs. 1.8 ± 2.3, p = 0.02). Among the total cohort, DXA Z-scores were significantly lower at the lumbar spine compared to the femoral neck (p = 0.002). HR-pQCT revealed a pronounced reduction of trabecular and cortical thickness, while trabecular number was within the reference range. Eighteen women (43%) received a bone-specific therapy (primarily teriparatide). Overall, a steep increase in bone mass (+37.7%) was observed after 3 years. In conclusion, pregnancy and lactation represent skeletal risk factors, which may unmask hereditary bone disorders leading to PLO. These cases were affected more severely. Nevertheless, a timely diagnosis and adequate treatment can ensure a substantial recovery potential even without specific therapy. Patients with genetically induced low bone turnover (e.g.; LRP5, WNT1) may especially benefit from osteo-anabolic medication.
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Affiliation(s)
- Sebastian Butscheidt
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elena Tsourdi
- Department of Medicine III, Technische Universität Dresden Medical Center, Dresden, Germany; Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Tim Rolvien
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Division of Orthopaedics, Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alena Delsmann
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Stürznickel
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florian Barvencik
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franz Jakob
- Orthopedic Center for Musculoskeletal Research, Orthopedic Department, University of Würzburg, Germany
| | - Lorenz C Hofbauer
- Department of Medicine III, Technische Universität Dresden Medical Center, Dresden, Germany; Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Stefan Mundlos
- Institute of Medical Genetics and Human Genetics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Uwe Kornak
- Institute of Medical Genetics and Human Genetics, Charité Universitätsmedizin Berlin, Berlin, Germany; Institute of Human Genetics, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Lothar Seefried
- Orthopedic Center for Musculoskeletal Research, Orthopedic Department, University of Würzburg, Germany
| | - Ralf Oheim
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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AlHajri L, Ayoub A, Ahmed H, AlMulla M. Effect of Vitamin K2 Alone or in Combination on Various Bone Turnover Markers Amongst Postmenopausal Females. J Bone Metab 2021; 28:11-26. [PMID: 33730780 PMCID: PMC7973400 DOI: 10.11005/jbm.2021.28.1.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 01/28/2021] [Indexed: 11/27/2022] Open
Abstract
Background Osteoporosis is common in postmenopausal women. Some studies have demonstrated the usefulness of vitamin K through the action of bone-specific proteins and osteoblast and osteoclast activities. However, no systematic review had explored this aspect in postmenopausal women. Hence, this systematic review aimed to explore the effect of vitamin K2 alone or in combination with other agents (vitamin D3 or calcium) on various bone turnover markers (BTMs) and bone mineral density (BMD) in postmenopausal women. Methods MEDLINE, ScienceDirect, PubMed, and Google Scholar were searched to identify relevant studies using specific inclusion criteria. Data extraction and quality assessment were carried out using standardized tests, and the results were narratively synthesized and presented in the form of tables. Results Vitamin K2 was beneficial in inducing an improvement or preventing deterioration, as evidenced by the BMD and osteocalcin (OC), undercarboxylated OC (ucOC), carboxylated OC (cOC), and γ-carboxylated OC levels. However, its effect was not conclusive when procollagen type 1 N-terminal propeptide, carboxyterminal propeptide of type I procollagen, C-terminal telopeptide of type I collagen, bone alkaline phosphatase, deoxypyridinoline, and N-terminal telopeptide levels (NTX) and ucOC:cOC or cOC:ucOC, and NTX:creatinine ratios were examined. Conclusions Vitamin K2 supplementation combined with vitamin D and calcium was found to be advantageous. However, vitamin K2 supplementation cannot replace the existing treatment options. In addition, vitamin K2 should be used with caution, considering its interactions with food and other drugs.
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Affiliation(s)
- Lamia AlHajri
- Department of Health Sciences and Pharmacy, Higher Colleges of Technology, Dubai, United Arab Emirates.,Department of Health Research, Lancaster University, Lancaster, UK
| | - Amna Ayoub
- United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hessa Ahmed
- Department of Health Sciences and Pharmacy, Higher Colleges of Technology, Dubai, United Arab Emirates
| | - Marwa AlMulla
- Department of Health Sciences and Pharmacy, Higher Colleges of Technology, Dubai, United Arab Emirates
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11
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Asoudeh F, Salari-Moghaddam A, Larijani B, Esmaillzadeh A. A systematic review and meta-analysis of prospective cohort studies on the association between alcohol intake and risk of fracture. Crit Rev Food Sci Nutr 2021; 62:5623-5637. [PMID: 33596741 DOI: 10.1080/10408398.2021.1888691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Previous studies on the association between alcohol intake and risk of fracture have reached conflicting findings. The aim of this systematic review and meta-analysis of prospective cohort studies was to summarize earlier studies on the association of alcohol intake with risk of fracture. A systematic search of PubMed, Scopus, and ISI Web of Science was conducted up to November 2020. Prospective cohort studies that had considered alcohol consumption as the exposure variable and fracture as the main outcome or as one of the outcome variables were included in this systematic review. Publications in which odds ratios (ORs), rate or risk ratios (RRs), or hazard ratios (HRs) and 95% confidence intervals (CIs) were reported, were included in the meta-analysis. In total, 40 prospective cohort studies including 5,084,303 participants and 170,916 subjects with fracture were included in this systematic review; of them 38 studies with a total sample size of 5,053,117 participants and 169,560 cases of fracture were included in the meta-analysis. Using a random-effects meta-analysis, we found a significant positive association between alcohol consumption and risk of total fractures (RR: 1.35; 95% CI: 1.01, 1.81) and any fractures (RR: 1.24; 95% CI: 1.11, 1.38). However, no significant association was observed between alcohol intake and risk of hip fractures (RR: 1.19; 95% CI: 0.96, 1.48), osteoporotic fractures (RR: 2.01; 95% CI: 0.76, 5.34), vertebral fractures (RR: 0.98; 95% CI: 0.68, 1.40), and wrist fractures (RR: 0.99; 95% CI: 0.85, 1.16). In conclusion, we found that alcohol consumption was positively associated with risk of total fractures and any fractures. However, we did not observe any significant association between alcohol consumption and risk of hip, osteoporotic, vertebral, and wrist fractures.
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Affiliation(s)
- Farzaneh Asoudeh
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Asma Salari-Moghaddam
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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12
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Abstract
Bone mass is a key determinant of osteoporosis and fragility fractures. Epidemiologic studies have shown that a 10% increase in peak bone mass (PBM) at the population level reduces the risk of fracture later in life by 50%. Low PBM is possibly due to the bone loss caused by various conditions or processes that occur during adolescence and young adulthood. Race, gender, and family history (genetics) are responsible for the majority of PBM, but other factors, such as physical activity, calcium and vitamin D intake, weight, smoking and alcohol consumption, socioeconomic status, age at menarche, and other secondary causes (diseases and medications), play important roles in PBM gain during childhood and adolescence. Hence, the optimization of lifestyle factors that affect PBM and bone strength is an important strategy to maximize PBM among adolescents and young people, and thus to reduce the low bone mass or osteoporosis risk in later life. This review aims to summarize the available evidence for the common but important factors that influence bone mass gain during growth and development and discuss the advances of developing high PBM.
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Affiliation(s)
- Xiaowei Zhu
- Disease & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, Hangzhou, 310024, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Westlake University, Hangzhou, 310024, China
- School of Life Sciences, Fudan University, Shanghai, 200433, China
| | - Houfeng Zheng
- Disease & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, Hangzhou, 310024, China.
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Westlake University, Hangzhou, 310024, China.
- School of Life Sciences, Fudan University, Shanghai, 200433, China.
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13
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Adolescent Sport Participation and Age at Menarche in Relation to Midlife Body Composition, Bone Mineral Density, Fitness, and Physical Activity. J Clin Med 2020; 9:jcm9123797. [PMID: 33255351 PMCID: PMC7760316 DOI: 10.3390/jcm9123797] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 12/23/2022] Open
Abstract
This study aimed to investigate the associations of competitive sport participation in adolescence and age at menarche (AAM) with body composition, femoral neck bone mineral density (BMD), physical performance, and physical activity (PA) in middle-aged women. 1098 women aged 47–55 years formed the sample of this retrospective study. Participants self-reported their PA level at age 13–16 years and AAM. The protocol also included dual-energy X-ray absorptiometry, physical performance tests, and accelerometer-measured PA. Participants were divided into three groups according to their PA level at the age of 13–16 (no exercise, regular PA, and competitive sport) and according to their AAM (≤12, 13, and ≥14 years). After adjusting for potential confounding factors, participation in competitive sport at age 13–16 was associated with higher midlife lean mass and BMD, and better physical performance compared to groups with no exercise or regular PA. Individuals with AAM ≥ 14 years had lower midlife BMI and fat mass than participants in the other AAM groups and pre- and perimenopausal women with AAM ≥ 14 years had lower BMD than those with AAM ≤ 12. The findings indicate that participation in competitive sport in adolescence is associated with healthier body composition, higher BMD, and better physical performance in midlife, but BMD might be impaired if menarche occurs late.
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14
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Song J, Zhang R, Lv L, Liang J, Wang W, Liu R, Dang X. The Relationship Between Body Mass Index and Bone Mineral Density: A Mendelian Randomization Study. Calcif Tissue Int 2020; 107:440-445. [PMID: 32989491 DOI: 10.1007/s00223-020-00736-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/21/2020] [Indexed: 01/28/2023]
Abstract
Body mass index (BMI) is closely associated with bone mineral density (BMD) in both men and women. However, the relationship between BMI and BMD varies according to different studies. Using SNPs strongly associated with BMI in 336,107 individuals, we conducted a two-sample Mendelian randomization study to identify whether and to what extent BMD at different skeletal sites was affected by BMI. A power calculation was also performed. We found that BMI may causally increase lumbar BMD (β 0.087; 95% CI 0.025 to 0.149; P = 0.006) and heel calcaneus BMD (β 0.120; 95% CI 0.082 to 0.157; P = 1 × 10-7). The associations of BMI with forearm and femoral neck BMD were not statistically significant. Our study suggested that higher BMI plays a causal role in increasing BMD and the effects are similar across the skeleton. BMI was causally and positively associated with lumbar and heel calcaneus BMD. However, no statistically significant effects were observed for BMI on femoral neck or forearm BMD.
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Affiliation(s)
- Jidong Song
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Rupeng Zhang
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Leifeng Lv
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Jialin Liang
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Wei Wang
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Ruiyu Liu
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, 710004, Shaanxi, China
| | - Xiaoqian Dang
- Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, No.157, Xiwu Road, Xi'an, 710004, Shaanxi, China.
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15
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Wallace TC, Bailey RL, Lappe J, O’Brien KO, Wang DD, Sahni S, Weaver CM. Dairy intake and bone health across the lifespan: a systematic review and expert narrative. Crit Rev Food Sci Nutr 2020; 61:3661-3707. [DOI: 10.1080/10408398.2020.1810624] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Taylor C. Wallace
- Department of Nutrition and Food Studies, George Mason University, Fairfax, Virginia, USA
- Think Healthy Group, Inc, Washington, DC, USA
| | - Regan L. Bailey
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
| | - Joan Lappe
- College of Nursing, Creighton University, Omaha, Nebraska, USA
| | - Kimberly O. O’Brien
- Division of Nutritional Sciences, College of Human Ecology, Cornell University, Ithaca, New York, USA
| | | | - Shivani Sahni
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife and Harvard Medical School, Boston, Massachusetts, USA
| | - Connie M. Weaver
- Department of Nutrition Science, Purdue University, West Lafayette, Indiana, USA
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16
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Hidayat K, Du X, Shi BM, Qin LQ. Systematic review and meta-analysis of the association between dairy consumption and the risk of hip fracture: critical interpretation of the currently available evidence. Osteoporos Int 2020; 31:1411-1425. [PMID: 32383066 DOI: 10.1007/s00198-020-05383-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/06/2020] [Indexed: 12/14/2022]
Abstract
UNLABELLED In the present meta-analysis, reductions in the risk of hip fracture with milk consumption were only observed among American adults, but not among Scandinavian adults, possibly because milk products are more commonly fortified with vitamin D in the former population than in Scandinavian countries. The reduction in the risk of hip fracture was also observed with yogurt consumption, which is often associated with healthy lifestyles and dietary patterns that contribute to improved bone health. INTRODUCTION Although dairy products contain bone-beneficial nutrients, the association between dairy consumption and the risk of hip fracture remains equivocal. Fueling this uncertainty, the elevated risk of hip fracture in association with milk consumption was observed in a cohort of Swedish women. A systematic review and meta-analysis of prospective cohort studies was performed to critically evaluate the association, or lack thereof, between dairy consumption (milk, yogurt, and cheese) and the risk of hip fracture. METHODS A random effects model was used to generate the summary relative risks (RRs) with their 95% confidence intervals (CIs) for the associations of interest. RESULTS In the meta-analysis of the highest versus lowest category of consumption, higher consumption of yogurt (RR 0.78, 95% CI 0.68, 0.90), but not milk (RR 0.86, 95% CI 0.73, 1.02) or cheese (RR 0.85, 95% CI 0.66, 1.08), was associated with a lower risk of hip fracture. For milk, the reduced risk of fracture with higher milk consumption was observed in the USA (RR 0.75, 95% CI 0.65, 0.87), but not in Scandinavian countries (RR 1.00, 95% CI 0.85, 1.17). These findings were further supported by the fact that American studies (RR 0.93, 95% CI 0.88, 0.98; per 1 glass/day), but not Scandinavian studies (RR 1.01, 95% CI 0.95, 1.07; per 1 glass/day), demonstrated a linear association between milk consumption and the risk of hip fracture. CONCLUSIONS The cumulative evidence from prospective cohort studies reassuringly suggests that the risk of hip fracture may not be elevated among people who consume milk, yogurt, and cheese, and that a greater consumption of milk or yogurt may even be associated with a lower risk of hip fracture depending on the factors that may differ across the population of interest.
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Affiliation(s)
- K Hidayat
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, China.
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, No. 199 Ren'ai Road, Suzhou, 215123, China.
| | - X Du
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, China
| | - B-M Shi
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, China.
| | - L-Q Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, No. 199 Ren'ai Road, Suzhou, 215123, China.
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17
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Abstract
The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) led the development of a framework to help clinicians assess and manage people who may have serious spinal pathology. While rare, serious spinal pathology can have devastating and life-changing or life-limiting consequences, and must be identified early and managed appropriately. Red flags (signs and symptoms that might raise suspicion of serious spinal pathology) have historically been used by clinicians to identify serious spinal pathology. Currently, there is an absence of high-quality evidence for the diagnostic accuracy of most red flags. This framework is intended to provide a clinical-reasoning pathway to clarify the role of red flags. J Orthop Sports Phys Ther 2020;50(7):350-372. Epub 21 May 2020. doi:10.2519/jospt.2020.9971.
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18
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Is Bone Nonunion, Vertebral Deformity, or Spinopelvic Malalignment the Best Therapeutic Target for Amelioration of Low Back Pain After Osteoporotic Vertebral Fracture? Spine (Phila Pa 1976) 2020; 45:E760-E767. [PMID: 32049935 DOI: 10.1097/brs.0000000000003422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cohort study (level 3). OBJECTIVE The aim of this study was to identify independent risk factors for residual low back pain (LBP) following osteoporotic vertebral fracture (OVF). SUMMARY OF BACKGROUND DATA Nonunion has been proposed as the primary cause of residual LBP following OVF. However, LBP can occur even when union is maintained. Other reported causes of LBP after OVF include vertebral deformities and spinopelvic malalignment. METHODS Sixty-seven patients with single-level thoracolumbar OVF who had not received previous osteoporotic treatment were enrolled. Conservative treatment was conducted using a soft lumbosacral orthosis plus osteoporosis drugs, either weekly alendronate (bisphosphonate) or daily teriparatide. Pain scores, kyphosis angle of fractured vertebra (VKA), and spinopelvic alignment, including pelvic incidence minus lumbar lordosis (PI-LL), were assessed periodically during treatment. Radiographic union was evaluated independently by three specialists at 24 weeks post-admission. Patients were divided by pain scores >40% at 24 weeks into the LBP (n = 36) and non-LBP (n = 31) groups. Temporal changes and statistical associations were examined to identify risk factors for LBP at 24 weeks. RESULTS At 24 weeks, 25% of OVFs failed to achieve union. The LBP group consisted of 71% of nonunion and 48% of union cases. Stepwise multinomial regression analysis showed VKA at 24 weeks >25° was significant risk factor for the LBP group (odds ratio: 6.24, 95% confidence interval: 1.77-22.02, P = 0.004). Significant differences in VKA emerged during treatment in the LBP group, but PI-LL showed the tendency not to change throughout the treatment period. Non-union was correlated with VKA (area under the curve: 0.864). CONCLUSION Although spinopelvic malalignment is considered as a preexisting factor for LBP, VKA exacerbated by nonunion predominantly led to LBP after a new OVF. Each incidence of OVF should be treated to limit further morphological changes to the fractured vertebra. LEVEL OF EVIDENCE 3.
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19
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Borgen TT, Bjørnerem Å, Solberg LB, Andreasen C, Brunborg C, Stenbro MB, Hübschle LM, Figved W, Apalset EM, Gjertsen JE, Basso T, Lund I, Hansen AK, Stutzer JM, Dahl C, Nordsletten L, Frihagen F, Eriksen EF. Determinants of trabecular bone score and prevalent vertebral fractures in women with fragility fractures: a cross-sectional sub-study of NoFRACT. Osteoporos Int 2020; 31:505-514. [PMID: 31754755 PMCID: PMC7075860 DOI: 10.1007/s00198-019-05215-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 10/28/2019] [Indexed: 12/15/2022]
Abstract
UNLABELLED Determinants of trabecular bone score (TBS) and vertebral fractures assessed semiquantitatively (SQ1-SQ3) were studied in 496 women with fragility fractures. TBS was associated with age, parental hip fracture, alcohol intake and BMD, not SQ1-SQ3 fractures. SQ1-SQ3 fractures were associated with age, prior fractures, and lumbar spine BMD, but not TBS. INTRODUCTION Trabecular bone score (TBS) and vertebral fractures assessed by semiquantitative method (SQ1-SQ3) seem to reflect different aspects of bone strength. We therefore sought to explore the determinants of and the associations between TBS and SQ1-SQ3 fractures. METHODS This cross-sectional sub-study of the Norwegian Capture the Fracture Initiative included 496 women aged ≥ 50 years with fragility fractures. All responded to a questionnaire about risk factors for fracture, had bone mineral density (BMD) of femoral neck and/or lumbar spine assessed, TBS calculated, and 423 had SQ1-SQ3 fracture assessed. RESULTS Mean (SD) age was 65.6 years (8.6), mean TBS 1.27 (0.10), and 33.3% exhibited SQ1-SQ3 fractures. In multiple variable analysis, higher age (βper SD = - 0.26, 95% CI: - 0.36,- 0.15), parental hip fracture (β = - 0.29, 95% CI: - 0.54,- 0.05), and daily alcohol intake (β = - 0.43, 95% CI - 0.79, - 0.08) were associated with lower TBS. Higher BMD of femoral neck (βper SD = 0.34, 95% CI 0.25-0.43) and lumbar spine (βper SD = 0.40, 95% CI 0.31-0.48) were associated with higher TBS. In multivariable logistic regression analyses, age (ORper SD = 1.94, 95% CI 1.51-2.46) and prior fragility fractures (OR = 1.71, 95% CI 1.09-2.71) were positively associated with SQ1-SQ3 fractures, while lumbar spine BMD (ORper SD = 0.75 95% CI 0.60-0.95) was negatively associated with SQ1-SQ3 fractures. No association between TBS and SQ1-SQ3 fractures was found. CONCLUSION Since TBS and SQ1-SQ3 fractures were not associated, they may act as independent risk factors, justifying the use of both in post-fracture risk assessment.
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Affiliation(s)
- T T Borgen
- Department of Rheumatology, Vestre Viken Hospital Trust, Drammen Hospital, Box 800, 3004, Drammen, Norway.
- Department of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Å Bjørnerem
- Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway
| | - L B Solberg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - C Andreasen
- Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway
| | - C Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - M-B Stenbro
- Department of Rheumatology, Vestre Viken Hospital Trust, Drammen Hospital, Box 800, 3004, Drammen, Norway
| | - L M Hübschle
- Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Drammen Hospital, Drammen, Norway
| | - W Figved
- Department of Orthopedic Surgery, Vestre Viken Hospital Trust, Bærum Hospital, Bærum, Norway
| | - E M Apalset
- Bergen group of Epidemiology and Biomarkers in Rheumatic Disease, Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - J-E Gjertsen
- Department of Orthopedic Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - T Basso
- Department of Orthopedic Surgery, St. Olavs University Hospital, Trondheim, Norway
| | - I Lund
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - A K Hansen
- Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Orthopedic Surgery, University Hospital of North Norway, Tromsø, Norway
| | - J-M Stutzer
- Department of Orthopedic Surgery, Møre and Romsdal Hospital Trust, Molde Hospital, Molde, Norway
| | - C Dahl
- Department of Community Medicine and Global health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - L Nordsletten
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - F Frihagen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - E F Eriksen
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
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20
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McKay M, Jackman TM, Hussein AI, Guermazi A, Liu J, Morgan EF. Association of vertebral endplate microstructure with bone strength in men and women. Bone 2020; 131:115147. [PMID: 31706053 PMCID: PMC6930346 DOI: 10.1016/j.bone.2019.115147] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/23/2019] [Accepted: 11/05/2019] [Indexed: 11/26/2022]
Abstract
Epidemiological and biomechanical evidence indicates that the risk of vertebral fracture differs between men and women, and that vertebral fracture frequently involves failure of the endplate region. The goal of this study was to compare the bone microstructure of the endplate region-defined as the (bony) vertebral endplate and underlying subchondral trabecular bone-between sexes and to determine whether any such sex differences are associated with vertebral strength. The bone density (volume fraction, apparent density and tissue mineral density) of the superior-most 2 mm of the vertebra, and the bone density and trabecular architecture of the next 5 mm were quantified using micro-computed tomography in human T8 (12 female, 16 male) and L1 (13 female, 12 male) vertebrae. Average density of the vertebra (integral bone mineral density (BMD)) was determined by quantitative computed tomography and compressive strength by mechanical testing. Few differences were found between male and female vertebrae in the density of the endplate region; none were found in trabecular architecture. However, whereas endplate volume fraction was positively correlated with integral BMD in male vertebrae (r = 0.654, p < .001), no correlation was found in the female vertebrae (r = 0.157, p = .455). Accounting for the density of the endplate region improved predictions of vertebral strength (p < .034) and eliminated sex-specificity in the strength prediction that was based on integral BMD alone. These results suggest that the density of the endplate region influences vertebral fracture and that non-invasive assessment of this region's density can contribute to predictions of vertebral strength in men and women.
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Affiliation(s)
- MeiLissa McKay
- Department of Mechanical Engineering, 110 Cummington Mall, Boston University, Boston, MA 02215, USA
| | - Timothy M Jackman
- Department of Mechanical Engineering, 110 Cummington Mall, Boston University, Boston, MA 02215, USA
| | - Amira I Hussein
- Department of Mechanical Engineering, 110 Cummington Mall, Boston University, Boston, MA 02215, USA
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118, USA
| | - Jingjiang Liu
- Department of Mechanical Engineering, 110 Cummington Mall, Boston University, Boston, MA 02215, USA
| | - Elise F Morgan
- Department of Mechanical Engineering, 110 Cummington Mall, Boston University, Boston, MA 02215, USA.
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21
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Tanaka H, Tarumi T, Rittweger J. Aging and Physiological Lessons from Master Athletes. Compr Physiol 2019; 10:261-296. [PMID: 31853968 DOI: 10.1002/cphy.c180041] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Sedentary aging is often characterized by physical dysfunction and chronic degenerative diseases. In contrast, masters athletes demonstrate markedly greater physiological function and more favorable levels of risk factors for cardiovascular disease, osteoporosis, frailty, and cognitive dysfunction than their sedentary counterparts. In many cases, age-related deteriorations of physiological functions as well as elevations in risk factors that are typically observed in sedentary adults are substantially attenuated or even absent in masters athletes. Older masters athletes possess greater functional capacity at any given age than their sedentary peers. Impressive profiles of older athletes provide insight into what is possible in human aging and place aging back into the domain of "physiology" rather than under the jurisdiction of "clinical medicine." In addition, these exceptional aging athletes can serve as a role model for the promotion of physical activity at all ages. The study of masters athletes has provided useful insight into the positive example of successful aging. To further establish and propagate masters athletics as a role model for our aging society, future research and action are needed. © 2020 American Physiological Society. Compr Physiol 10:261-296, 2020.
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Affiliation(s)
- Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA
| | - Takashi Tarumi
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan.,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
| | - Jörn Rittweger
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany.,Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
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22
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Wáng YXJ, Che-Nordin N, Deng M, Griffith JF, Leung JCS, Kwok AWL, Leung PC, Kwok TCY. Elderly males with or without existing osteoporotic vertebral fracture have much lower future vertebral fracture risk than elderly females: the MrOS (Hong Kong) year-4 follow-up spine radiograph study. Osteoporos Int 2019; 30:2505-2514. [PMID: 31478068 DOI: 10.1007/s00198-019-05136-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022]
Abstract
UNLABELLED MrOS (Hong Kong)'s year-4 follow-up shows, for subjects at baseline without vertebral deformity (VD) and endplate or/and cortex fracture (ECF), the VD progression/new VD rate during follow-up in males was half of our paired MsOS (Hong Kong) study's results. For those with VD or ECF, the VD progression/new VD was less than one sixth of females' rate. INTRODUCTION This study documents MrOS (Hong Kong)'s year-4 follow-up, and the results are compared with the MsOS (Hong Kong) study. Of elderly females with Genant's grade-0, -1, -2, and -3 VD, at year-4 follow-up, 4.6%, 8%, 10.6%, and 28.9% had at least one VD progression or incident VD, respectively. METHODS Spine radiographs of 1500 Chinese males with baseline (mean age 71.7 years, range 65-91 years) and year-4 follow-up were evaluated according to Genant's VD criteria and ECF (non-existent, ECF0; or existent, ECF1). Grade-2 VDs were divided into mild (VD2m, 25-34% height loss) and severe (VD2s, 34-40% height loss) subgroups. Study subjects were graded into eight categories: VD0/ECF0, VD1/ECF0, VD2m/ECF0, VD0/ECF1, VD1/ECF1, VD2m/ECF1, VD2s/ECF1, and VD3/ECF1. With an existing VD, a further height loss of ≥ 15% was a VD progression. A new VD incident was a change from grade-0 to grade-2/3, or to grade-1 with ≥ 10% height loss. RESULTS Of subjects with Genant's grade-0, 2.05% (25/1219) developed at least one VD progression or/and new VD, while of subjects with Genant's grade-1, -2, and -3 VD, only 2% (3/149), 3.1% (3/96), and 2.8% (1/36) developed at least one VD progression/new VD, respectively. Among the three ECF0 groups, there was a significant difference in new ECF incidence, with VD0/ECF0 being the lowest and VD2m/ECF0 being the highest. CONCLUSION VD progression/new VD is much less common in elderly men than in elderly women. Vertebrae with VD had a higher risk of developing ECF.
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Affiliation(s)
- Y X J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China.
| | - N Che-Nordin
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - M Deng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - J F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - J C S Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - A W L Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - P C Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - T C Y Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
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23
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Pubertal timing and adult fracture risk in men: A population-based cohort study. PLoS Med 2019; 16:e1002986. [PMID: 31790400 PMCID: PMC6886748 DOI: 10.1371/journal.pmed.1002986] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/04/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Puberty is a critical period for bone mass accrual, and late puberty in boys is associated with reduced bone mass in adult men. The role of variations in pubertal timing within the normal range for adult fracture risk in men is, however, unknown. We, therefore, assessed the association between age at peak height velocity (PHV), an objective measure of pubertal timing, and fracture risk in adult men. METHODS AND FINDINGS In the BMI Epidemiology Study Gothenburg, 31,971 Swedish men born between January 1, 1945, and December 31, 1961, with detailed growth data (height and weight) available from centrally archived school healthcare records and the conscription register were followed until December 31, 2016. Age at PHV was calculated according to a modified infancy-childhood-puberty model, and fracture information was retrieved from the Swedish National Patient Register. The mean ± SD age at PHV was 14.1 ± 1.1 years. In total, 5,872 men (18.4%) sustained at least 1 fracture after 20 years of age and 5,731 men (17.9%) sustained a non-vertebral fracture after 20 years of age during a mean ± SD follow-up of 37.3 ± 11.7 years. Cox proportional hazards models adjusted for birth year and country of origin revealed that age at PHV was associated with the risk of any fracture and non-vertebral fracture. Participants with age at PHV in the highest tertile (after 14.5 years of age) were at greater risk of any fracture (hazard ratio [HR] 1.15, 95% confidence interval [CI] 1.08-1.22, P < 0.001) and non-vertebral fracture (HR 1.16, 95% CI 1.09-1.24, P < 0.001) compared with those with age at PHV in the lowest tertile (at 13.6 years of age or younger). Additional adjustments for birthweight, childhood BMI, adult educational level, and young adult height did not attenuate the associations between age at PHV and adult fracture risk. Limitations of this study include the inability to adjust for important risk factors for fracture, inadequate power to assess the relation between pubertal timing and specific fracture types, and the limited generalizability to other populations. CONCLUSIONS In this study, we observed that late pubertal timing was associated with increased adult fracture risk in men. These findings suggest that information on pubertal timing might aid in the identification of those men at greatest risk of fracture.
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24
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LaMonte MJ, Wactawski-Wende J, Larson JC, Mai X, Robbins JA, LeBoff MS, Chen Z, Jackson RD, LaCroix AZ, Ockene JK, Hovey KM, Cauley JA. Association of Physical Activity and Fracture Risk Among Postmenopausal Women. JAMA Netw Open 2019; 2:e1914084. [PMID: 31651972 PMCID: PMC6822158 DOI: 10.1001/jamanetworkopen.2019.14084] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/04/2019] [Indexed: 01/11/2023] Open
Abstract
Importance Physical activity is inversely associated with hip fracture risk in older women. However, the association of physical activity with fracture at other sites and the role of sedentary behavior remain unclear. Objective To assess the associations of physical activity and sedentary behavior with fracture incidence among postmenopausal women. Design, Setting, and Participants The Women's Health Initiative prospective cohort study enrolled 77 206 postmenopausal women aged 50 to 79 years between October 1993 and December 1998 at 40 US clinical centers. Participants were observed for outcomes through September 2015, with data analysis conducted from June 2017 to August 2019. Exposures Self-reported physical activity and sedentary time. Main Outcomes and Measures Hazard ratios (HRs) and 95% CIs for total and site-specific fracture incidence. Results During a mean (SD) follow-up period of 14.0 (5.2) years among 77 206 women (mean [SD] age, 63.4 [7.3] years; 66 072 [85.6%] white), 25 516 (33.1%) reported a first incident fracture. Total physical activity was inversely associated with the multivariable-adjusted risk of hip fracture (>17.7 metabolic equivalent [MET] h/wk vs none: HR, 0.82; 95% CI, 0.72-0.95; P for trend < .001). Inverse associations with hip fracture were also observed for walking (>7.5 MET h/wk vs none: HR, 0.88; 95% CI, 0.78-0.98; P for trend = .01), mild activity (HR, 0.82; 95% CI, 0.73-0.93; P for trend = .003), moderate to vigorous activity (HR, 0.88; 95% CI, 0.81-0.96; P for trend = .002), and yard work (HR, 0.90; 95% CI, 0.82-0.99; P for trend = .04). Total activity was positively associated with knee fracture (>17.7 MET h/wk vs none: HR, 1.26; 95% CI, 1.05-1.50; P for trend = .08). Mild activity was associated with lower risks of clinical vertebral fracture (HR, 0.87; 95% CI, 0.78-0.96; P for trend = .006) and total fractures (HR, 0.91; 95% CI, 0.87-0.94; P for trend < .001). Moderate to vigorous activity was positively associated with wrist or forearm fracture (HR, 1.09; 95% CI, 1.03-1.15; P for trend = .004). After controlling for covariates and total physical activity, sedentary time was positively associated with total fracture risk (>9.5 h/d vs <6.5 h/d: HR, 1.04; 95% CI, 1.01-1.07; P for trend = .01). When analyzed jointly, higher total activity mitigated some of the total fracture risk associated with sedentary behavior. Analysis of time-varying exposures resulted in somewhat stronger associations for total physical activity, whereas those for sedentary time were materially unchanged. Conclusions and Relevance In older ambulatory women, higher total physical activity was associated with lower total and hip fracture risk but higher knee fracture risk. Mild activity and walking were associated with lower hip fracture risk, a finding with important public health implications because these activities are common in older adults. The positive association between sedentary time and total fracture risk requires further investigation.
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Affiliation(s)
- Michael J. LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo
| | - Joseph C. Larson
- Data Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Xiaodan Mai
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo
| | - John A. Robbins
- Department of Medicine, University of California, Davis, Sacramento
| | - Meryl S. LeBoff
- Division of Endocrine, Diabetes, and Hypertension, Brigham and Woman’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Zhao Chen
- Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson
| | - Rebecca D. Jackson
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, The Ohio State University, Columbus
| | - Andrea Z. LaCroix
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego
| | - Judith K. Ockene
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester
| | - Kathleen M. Hovey
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo
| | - Jane A. Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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25
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Lespessailles E, Paccou J, Javier RM, Thomas T, Cortet B. Obesity, Bariatric Surgery, and Fractures. J Clin Endocrinol Metab 2019; 104:4756-4768. [PMID: 30901056 DOI: 10.1210/jc.2018-02084] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 03/13/2019] [Indexed: 12/14/2022]
Abstract
CONTEXT Obesity and its associated comorbidities are a recognized and growing public health problem. For a long time, obesity-associated effects on bone were considered to strengthen the bone, mainly because of the known relationship between body weight and bone mass and the long-term weight-bearing load effect on bone. However, recent epidemiologic studies have shown that obesity may not have a fully protective effect on the occurrence of fragility fractures. The goal of this article is to review updated information on the link between obesity, bariatric surgery, and fractures. METHODS The primary source literature for this review was acquired by searching a published database for reviews and articles up to January 2018. Additional references were selected through the in-depth analysis of the relevant studies. RESULTS We present data showing that overweight and obesity are often encountered in fracture cases. We also analyzed possible reasons and risk factors for fractures associated with overweight and patients with obesity. In addition, this review focuses on the complex effects of dramatic changes in body composition when interpreting dual-energy X-ray absorptiometry readings and findings. Finally, we review the data on the effects and consequences of bariatric surgery on bone metabolism and the risk of fractures in patients undergoing these procedures. CONCLUSION Because of various adiposity-induced effects, patients with obesity are at risk for fracture in certain sites. Bariatric surgery increases the risk of fractures in patients undergoing malabsorptive procedures.
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Affiliation(s)
- Eric Lespessailles
- Department of Rheumatology, Regional Hospital of Orleans, University of Orleans, Orleans, France
| | - Julien Paccou
- Department of Rheumatology, University Hospital of Lille, University of Lille, Lille, France
| | - Rose-Marie Javier
- Department of Rheumatology, Strasbourg University Hospital, Strasbourg, France
| | - Thierry Thomas
- Department of Rheumatology, Nord Hospital, University Hospital of St-Etienne, University of Lyon, Saint-Etienne, France
| | - Bernard Cortet
- Department of Rheumatology, University Hospital of Lille, University of Lille, Lille, France
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26
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Mikkilä S, Calogiuri G, Emaus N, Morseth B. A cross-sectional and 6-year follow-up study of associations between leisure time physical activity and vertebral fracture in adults. BMC Musculoskelet Disord 2019; 20:435. [PMID: 31526375 PMCID: PMC6747745 DOI: 10.1186/s12891-019-2821-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 09/10/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction Vertebral fractures are common osteoporotic fractures, affecting 2–46% of the population, causing morbidity and increased risk of mortality. Physical activity has beneficial effects for bone health, including increased bone mineral density and reduced hip fractures. However, evidence concerning prevention of vertebral fractures is scarce. Therefore, the aim of this study was to investigate the association between leisure time physical activity and vertebral fracture risk. Methods The data were retrieved from the 2001 and 2007–2008 surveys of the Tromsø Study, a longitudinal population study in Norway. A total of 1904 participants (1030 women and 874 men, age 38–87 yr and 40–87 yr respectively) were included in the cross-sectional analysis (2007–2008). Prospective follow-up data (2001 to 2007) on physical activity were available for 1131 participants (636 women and 495 men, age 32–69 yr and 33–69 yr respectively). Physical activity was assessed by a questionnaire and vertebral fracture by lateral vertebral fracture assessment from dual-energy x-ray absorptiometry scans. Logistic regression was used to examine associations between physical activity and vertebral fracture. Results After controlling for confounders (age, height, weight, smoking, osteoporosis, osteoporosis medication, left hip total bone mineral density, and use of hormones in women only), no cross-sectional associations between physical activity levels and vertebral fracture were observed, OR 1.13 (95% CI: 0.59–2.13), for moderately active women and 1.44 (0.61–3.42) for highly active women, compared with sedentary women. In men, the respective ORs were 1.74 (95% CI: 0.91–3.35) and 1.64 (0.78–3.41). In the prospective analyses, OR for vertebral fracture in women with reduced physical activity was 0.81 (95% CI: 0.18–3.62), 1.24 (95% CI: 0.29–5.26) for increased physical activity and 1.54 (95% CI: 0.43–5.50) for active unchanged physical activity pattern, compared with sedentary unchanged physical activity. In men, the respective ORs were 2.05 (95% CI: 0.57–7.42), 2.23 (95% CI: 0.63–7.87), and 1.81 (95% CI: 0.54–6.02). Subanalyses of women and men ≥50 yr showed similar results. Conclusions Our findings suggest that physical activity does not play a major role in preventing vertebral fractures in Norwegian adults. Future studies may benefit from data on incident vertebral fracture, and objectively measured physical activity.
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Affiliation(s)
- Saija Mikkilä
- School of sport sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway. .,Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Giovanna Calogiuri
- Department of Dental Care and Public Health, Inland Norway University of Applied Sciences (INN), Elverum, Norway
| | - Nina Emaus
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bente Morseth
- School of sport sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Paik JM, Rosen HN, Katz JN, Rosner BA, Rimm EB, Gordon CM, Curhan GC. BMI, Waist Circumference, and Risk of Incident Vertebral Fracture in Women. Obesity (Silver Spring) 2019; 27:1513-1519. [PMID: 31318497 PMCID: PMC6707901 DOI: 10.1002/oby.22555] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/10/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The study aimed to investigate the association between BMI, waist circumference, and vertebral fracture (VF) risk in women. METHODS This prospective study was conducted in 54,934 Nurses' Health Study participants. BMI was assessed biennially, and waist circumference was assessed in the year 2000. Self-reports of VF were confirmed by record review. BMI reflects lean body mass, and waist circumference reflects abdominal adiposity when included in the same regression model. RESULTS This study included 536 VF cases (2002 to 2014). Compared with women with BMI of 21.0 to 24.9 kg/m2 , the multivariable-adjusted relative risk (RR) of VF for women with BMI ≥ 32.0 was 0.84 (95% CI: 0.61-1.14; Ptrend = 0.08). After further adjustment for waist circumference, the multivariable-adjusted RR of VF for women with BMI ≥ 32.0 was 0.70 (95% CI: 0.49-0.98; Ptrend = 0.003). Compared with women with waist circumference < 71.0 cm, the multivariable-adjusted RR of VF for women with waist circumference ≥ 108.0 cm was 1.76 (95% CI: 1.06-2.92; Ptrend = 0.01), and after further adjustment for BMI, the multivariable-adjusted RR of VF was 2.49 (95% CI: 1.44-4.33; Ptrend < 0.001). CONCLUSIONS Greater lean body mass was independently associated with lower VF risk. Larger waist circumference was independently associated with higher VF risk. These findings suggest that fat distribution is an important predictor of VF and that avoiding central adiposity, as well as maintaining muscle mass, may potentially confer reduced risk of VF in older women.
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Affiliation(s)
- Julie M Paik
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Harold N Rosen
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Endocrinology Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jeffrey N Katz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Rheumatology Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bernard A Rosner
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Eric B Rimm
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Catherine M Gordon
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Gary C Curhan
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
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Kanazawa I, Notsu M, Takeno A, Tanaka KI, Sugimoto T. Overweight and underweight are risk factors for vertebral fractures in patients with type 2 diabetes mellitus. J Bone Miner Metab 2019; 37:703-710. [PMID: 30238431 DOI: 10.1007/s00774-018-0960-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 09/09/2018] [Indexed: 12/20/2022]
Abstract
The aim of this cross-sectional study was to examine the association between body mass index (BMI) and the prevalence of vertebral fracture (VF) in Japanese patients with type 2 diabetes (T2DM). A total of 798 patients with T2DM were enrolled. VF was determined semi-quantitatively using lateral X-ray films. The association between BMI quartiles (Q1: ≤ 21.2 kg/m2, Q2: 21.3-23.4 kg/m2, Q3: 23.5-25.8 kg/m2, Q4: 25.9≤ kg/m2) and the presence of VF was examined. Multiple logistic regression analyses adjusted for age, sex, diabetes duration, hemoglobin A1c (HbA1c), estimated glomerular filtration rate, and albumin showed that Q1, Q3, and Q4 were significantly associated with an increased VF risk compared to Q2, which served as a reference [Q1; odds ratio (OR) = 1.91, 95% confidence interval (CI) 1.24-2.95, p = 0.004, Q3; OR = 1.65, 95% CI 1.07-2.55, p = 0.023, and Q4; OR = 2.18, 95% CI 1.39-3.41, p < 0.001]. Moreover, these associations remained significant after additional adjustment for femoral neck T-score, a bone resorption marker, urinary N-terminal cross-linked telopeptide of type-I collagen, and use of insulin and thiazolidinedione. Our study shows for the first time that both overweight and underweight were associated with the bone mineral density (BMD)-independent risk of VF in patients with T2DM. Therefore, body weight control should be considered as a protective measure against diabetes-related bone fragility.
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Affiliation(s)
- Ippei Kanazawa
- Department of Internal Medicine 1, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
| | - Masakazu Notsu
- Department of Internal Medicine 1, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Ayumu Takeno
- Department of Internal Medicine 1, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Ken-Ichiro Tanaka
- Department of Internal Medicine 1, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
| | - Toshitsugu Sugimoto
- Department of Internal Medicine 1, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan
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Matía-Martín P, Torrego-Ellacuría M, Larrad-Sainz A, Fernández-Pérez C, Cuesta-Triana F, Rubio-Herrera MÁ. Effects of Milk and Dairy Products on the Prevention of Osteoporosis and Osteoporotic Fractures in Europeans and Non-Hispanic Whites from North America: A Systematic Review and Updated Meta-Analysis. Adv Nutr 2019; 10:S120-S143. [PMID: 31089740 PMCID: PMC6518141 DOI: 10.1093/advances/nmy097] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 09/19/2018] [Accepted: 10/24/2018] [Indexed: 12/20/2022] Open
Abstract
Nutrition plays an important role in bone health. The aim of our study was to update the evidence regarding dairy intake, osteoporotic fracture (OF) risk, and prospective bone mass density (BMD) evolution assessed by dual-energy X-ray absorptiometry in Europeans and non-Hispanic whites from North America. A systematic search was conducted in MEDLINE, EMBASE, and Scopus for papers published from 1 January, 2000 to 30 April, 2018. The eligibility criteria were as follows: healthy adults; measurable dairy exposure; hip, vertebral, wrist or OF as outcomes; and cohort or case-control studies. Two independent investigators conducted the search and the data extraction. A pooled analysis was conducted with random-effects models. Publication bias and meta-regression were considered. Ten cohort studies relating to OF risk were selected for meta-analysis. Three papers reporting BMD changes associated with dairy intake could not be aggregated in the meta-analysis. The pooled HRs of the highest compared with the lowest levels of dairy intake were 0.95 (95% CI: 0.87, 1.03; I2 = 82.9%; P-heterogeneity < 0.001) for OF at any site; 0.87 (95% CI: 0.75, 1.01; I2 = 86.7%; P-heterogeneity < 0.001) for hip fractures; and 0.82 (95% CI: 0.68, 0.99; I2 = 0.0%; P-heterogeneity = 0.512) for vertebral fractures. Concerning BMD, the selected studies described a 1.7-3% lower hip BMD in young and postmenopausal women with poor intake of milk in their youth, a positive relationship between baseline milk ingestion and the percentage of trochanter BMD change in elderly people, and a positive correlation between milk consumption and BMD change at the radius in women aged >65 y. In conclusion, in the studied population, the highest consumption of dairy products did not show a clear association with the total OF or hip fracture risks; however, a diminished risk of vertebral fracture could be described. The results regarding BMD change were heterogeneous and did not allow for a definitive conclusion.
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Affiliation(s)
- Pilar Matía-Martín
- Faculty of Medicine, Department of Medicine
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
- Instituto de Investigación Sanitaria San Carlos
| | - Macarena Torrego-Ellacuría
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
- Instituto de Investigación Sanitaria San Carlos
| | - Angélica Larrad-Sainz
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
- Instituto de Investigación Sanitaria San Carlos
| | - Cristina Fernández-Pérez
- Faculty of Nursing, Department of Health Sciences, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Sanitaria San Carlos
- Departments of Preventive Medicine
| | - Federico Cuesta-Triana
- Faculty of Medicine, Department of Medicine
- Instituto de Investigación Sanitaria San Carlos
- Geriatrics, Hospital Clínico San Carlos, Madrid, Spain
| | - Miguel Ángel Rubio-Herrera
- Faculty of Medicine, Department of Medicine
- Endocrinology and Nutrition Department, Hospital Clínico San Carlos, Madrid, Spain
- Instituto de Investigación Sanitaria San Carlos
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Malmir H, Larijani B, Esmaillzadeh A. Consumption of milk and dairy products and risk of osteoporosis and hip fracture: a systematic review and Meta-analysis. Crit Rev Food Sci Nutr 2019; 60:1722-1737. [DOI: 10.1080/10408398.2019.1590800] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Hanieh Malmir
- Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- Obesity and Eating Habits Research Center Endocrinology and Metabolism Molecular Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Food Security Research Center, Department of Community Nutrition, Isfahan University of Medical Sciences, Isfahan, Iran
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Hariri AF, Almatrafi MN, Zamka AB, Babaker AS, Fallatah TM, Althouwaibi OH, Hamdi AS. Relationship between Body Mass Index and T-Scores of Bone Mineral Density in the Hip and Spine Regions among Older Adults with Diabetes: A Retrospective Review. J Obes 2019; 2019:9827403. [PMID: 31179127 PMCID: PMC6501245 DOI: 10.1155/2019/9827403] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 04/03/2019] [Indexed: 01/03/2023] Open
Abstract
Diabetes mellitus (DM) cases are increasing worldwide, especially in Saudi Arabia. Previous studies suggested a positive relationship between body mass index (BMI) and bone mineral density (BMD) levels. Generally, patients with low BMI (<18.5 kg/m2) have reduced BMD levels and, thus, low T-scores; hence, they are categorized as osteopenic or osteoporotic. In this study, we aimed to determine whether a relationship between BMI and BMD T-scores in the hip and spine regions of patients with diabetes exists. This retrospective record review investigated older adult patients with diabetes in King Abdulaziz University Hospital (n=198; age 50-90 years) who underwent BMD scan between January 1, 2016, and June 25, 2018, regardless of their sex but limited to type 2 DM. The height and weight of all subjects were recorded, and BMI was calculated and categorized. We used SPSS version 21 for data analysis; measures of central tendencies, Pearson's correlations, chi-square tests, and independent t-tests were employed. We found positive relationships between BMI and BMD T-scores in the hip and spine regions (right femoral neck: R=+0.214, P ≤ 0.002; total right hip: R=+0.912, P ≤ 0.001; left femoral neck: R=+0.939, P ≤ 0.001; total left hip: R=+0.885, P ≤ 0.001; and total lumbar region: R=+0.607, P ≤ 0.001). Low BMI (<18.5 kg/m2) could be a risk factor for osteoporosis, whereas normal/high BMI could be protective against osteoporosis among adults with diabetes.
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Affiliation(s)
| | | | - Aws B. Zamka
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Tariq M. Fallatah
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Amre S. Hamdi
- Consultant and Assistant Professor of Orthopedic Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Kim D, Yang PS, Kim TH, Uhm JS, Park J, Pak HN, Lee MH, Joung B. Effect of Atrial Fibrillation on the Incidence and Outcome of Osteoporotic Fracture - A Nationwide Population-Based Study. Circ J 2018; 82:1999-2006. [PMID: 29794400 DOI: 10.1253/circj.cj-17-1179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Both atrial fibrillation (AF) and osteoporosis are common in older adults. The purpose of this study was to investigate whether comorbid AF in patients with osteoporosis is associated with fracture incidence, or death after fracture.Methods and Results:From the National Health Insurance Service database of Korea, we selected 31,778 patients with osteoporosis. During a median follow-up of 48 months, the incidence of bone fractures was higher in AF patients than in non-AF patients (3.20 vs. 2.18 per 100 person-years), respectively. In the multivariate Cox regression analysis, AF was associated with fracture independently of other risk factors with an adjusted hazard ratio (HR) of 1.21 (95% confidence interval [CI], 1.02-1.41; P=0.031). The mortality rate after fracture was significantly higher in AF patients than it was in non-AF patients (adjusted HR, 1.92; 95% CI, 1.35-3.27; P=0.016). After propensity score-matching, AF was consistently associated with a higher risk of osteoporotic fracture and subsequent death after fracture. In AF patients, older age, female sex, being underweight (body mass index <18.5 kg/m2), decreased physical activity (exercise <3 times/week), history of stroke or transient ischemic attack, thiazide use, sedative use, and higher CHADS2(≥2 points) or CHA2DS2-VASc (≥2 points) scores were associated with the incidence of fractures. CONCLUSIONS Comorbid AF in patients with osteoporosis was associated with an increased risk of bone fracture and death after fracture.
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Affiliation(s)
- Daehoon Kim
- Division of Cardiology, Yonsei University College of Medicine
| | - Pil-Sung Yang
- Division of Cardiology, Yonsei University College of Medicine.,Department of Cardiology, CHA Bundang Medical Center, CHA University
| | - Tae-Hoon Kim
- Division of Cardiology, Yonsei University College of Medicine
| | - Jae-Sun Uhm
- Division of Cardiology, Yonsei University College of Medicine
| | - Junbeom Park
- Department of Cardiology, School of Medicine, Ewha Womans University
| | - Hui-Nam Pak
- Division of Cardiology, Yonsei University College of Medicine
| | - Moon-Hyoung Lee
- Division of Cardiology, Yonsei University College of Medicine
| | - Boyoung Joung
- Division of Cardiology, Yonsei University College of Medicine
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Lee JH, Hong AR, Kim JH, Kim KM, Koo BK, Shin CS, Kim SW. Amount of smoking, pulmonary function, and bone mineral density in middle-aged Korean men: KNHANES 2008-2011. J Bone Miner Metab 2018; 36:95-102. [PMID: 28144749 DOI: 10.1007/s00774-017-0811-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 12/15/2016] [Indexed: 01/21/2023]
Abstract
Smoking induces bone loss; however, data on the relationship between smoking history and bone mineral density (BMD) are lacking. Age and pulmonary function can affect BMD. We investigated the relationships among pack-years (PYs) of smoking, pulmonary function, and BMD in middle-aged Korean men (50-64 years old). This cross-sectional study used data from the Korean National Health and Nutrition Examination Survey, 2008-2011. All participants underwent BMD measurements using dual energy X-ray absorptiometry and pulmonary function tests using standardized spirometry. In total, 388 never-smokers and 1088 ever-smokers were analyzed. The number of PYs of smoking was negatively correlated with total hip BMD (r = -0.088; P = 0.004) after adjusting for age, height, and weight. Ever-smokers were classified into 3 groups according to PYs of smoking. The highest tertile (n = 482) exhibited significantly lower total hip bone mass than the lowest tertile (n = 214) after adjusting for confounding factors (age, height, weight, forced expiratory volume in 1 s (FEV1), alcohol consumption, physical activity, and vitamin D levels) that could affect bone metabolism (P = 0.003). In conclusion, smoking for >30 PYs was significantly associated with low hip BMD after adjusting for pulmonary function in middle-aged Korean men. Long-term smoking may be a risk factor for bone loss in middle-aged men independent of age, height, weight, and pulmonary function.
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Affiliation(s)
- Ji Hyun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - A Ram Hong
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Kyoung Min Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, South Korea
| | - Bo Kyung Koo
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
- Department of Internal Medicine, Boramae Medical Center, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 156-707, South Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
- Department of Internal Medicine, Boramae Medical Center, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 156-707, South Korea.
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Park KY, Hwang HS, Park HK. Modifiable lifestyle factors associated with osteoporosis in Korean men: a case-control study. Arch Osteoporos 2017; 12:56. [PMID: 28578545 DOI: 10.1007/s11657-017-0349-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 05/15/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED The prevention, education, and treatment of osteoporosis are all recognized as important components in men as well as women. This study revealed that the lifestyle factors associated with male osteoporosis included being underweight and being a current smoker. Being overweight or obese and having a regular exercise habit were negatively associated with male osteoporosis. PURPOSE Osteoporosis is a significant health problem in Korea and worldwide. Although osteoporosis is less prevalent in males than in females, the fracture-related mortality rate is higher in males than in females. The aim of this study was to investigate the relationship of modifiable lifestyle factors in males with osteoporosis. METHODS A case-control study was performed in men who visited a single university hospital for a medical check-up between August 2003 and July 2016. Patients were classified in the case group according to the World Health Organization (WHO) Osteoporosis Criteria. The control group was created by matching patients according to age and check-up date. Lifestyle factors were evaluated by a self-assessment questionnaire. Multivariate conditional logistic regression was used to examine the association between lifestyle factors and male osteoporosis with age stratification at 50 years. RESULTS A total of 1304 subjects were included in this analysis, 326 of whom were in the case group and 978 of whom were in the control group. Within their age group, subjects with osteoporosis were more often underweight (odds ratio [OR] = 2.35, 95% confidence interval [CI], 1.11-4.98) or more often current smokers (2.22, 1.50-3.28) than control subjects. The subjects who were overweight (0.45, 0.32-0.64), obese (0.19, 0.13-0.27), had an irregular exercise habit (0.64, 0.43-0.94), or had a regular exercise habit (0.40, 0.28-0.57) were more likely to have normal bone status. Alcohol drinking habit had no significant association with male osteoporosis. CONCLUSIONS Several modifiable lifestyle factors were associated with male osteoporosis. Current smokers at any age and underweight men below age 50 were more likely to have osteoporosis, whereas men who were overweight, obese, or had a regular exercise habit were more likely to have normal bone status, regardless of age.
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Affiliation(s)
- Kye-Yeung Park
- Department of Family Medicine, Hanyang University Medical Center, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea
| | - Hwan-Sik Hwang
- Department of Family Medicine, Hanyang University Medical Center, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea
| | - Hoon-Ki Park
- Department of Family Medicine, Hanyang University Medical Center, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea.
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Clark EM, Cummings SR, Schousboe JT. Spinal radiographs in those with back pain-when are they appropriate to diagnose vertebral fractures? Osteoporos Int 2017; 28:2293-2297. [PMID: 28444431 DOI: 10.1007/s00198-017-4052-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 04/10/2017] [Indexed: 12/19/2022]
Abstract
The presence of an osteoporotic vertebral fracture improves fracture risk assessment and may change management, so it is vital for healthcare professionals to assess patients for the presence or absence of these fractures. This may be particularly important in the presence of back pain. However, the correlation between low back symptoms and spinal imaging results is poor and the pathophysiology of most low back pain is not known, leading to a common conclusion that spinal radiographs are not appropriate for the assessment of back pain. For individual patients with back pain, spinal radiographs should be considered if they have certain features in the history and examination. As well as the traditional risk factors for osteoporosis, self-reported descriptives of back pain and novel physical examination findings have been shown to make the presence of vertebral fractures more likely. Systematic approaches have the potential to improve bone health across the population but need to be targeted to be cost-effective. Spinal radiographs should be considered for individual older patients with back pain if they have certain additional features in the history and examination.
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Affiliation(s)
- E M Clark
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Learning & Research Building, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - S R Cummings
- California Pacific Medical Centre Research Institute, San Francisco, USA
| | - J T Schousboe
- Park Nicollet Osteoporosis Center and HealthPartners Institute, Minneapolis, MN, USA
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Abstract
Delayed puberty is a common condition defined as the lack of sexual maturation by an age ≥2 SD above the population mean. In the absence of an identified underlying cause, the condition is usually self-limited. Although self-limited delayed puberty is largely believed to be a benign developmental variant with no long-term consequences, several studies have suggested that delayed puberty may in fact have both harmful and protective effects on various adult health outcomes. In particular, height and bone mineral density have been shown to be compromised in some studies of adults with a history of delayed puberty. Delayed puberty may also negatively affect adult psychosocial functioning and educational achievement, and individuals with a history of delayed puberty carry a higher risk for metabolic and cardiovascular disorders. In contrast, a history of delayed puberty appears to be protective for breast and endometrial cancer in women and for testicular cancer in men. Most studies on adult outcomes of self-limited delayed puberty have been in small series with significant variability in outcome measures and study criteria. In this article, we review potential medical and psychosocial issues for adults with a history of self-limited delayed puberty, discuss potential mechanisms underlying these issues, and identify gaps in knowledge and directions for future research.
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Affiliation(s)
- Jia Zhu
- Division of Endocrinology, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Yee-Ming Chan
- Division of Endocrinology, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
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Xiang BY, Huang W, Zhou GQ, Hu N, Chen H, Chen C. Body mass index and the risk of low bone mass-related fractures in women compared with men: A PRISMA-compliant meta-analysis of prospective cohort studies. Medicine (Baltimore) 2017; 96:e5290. [PMID: 28328798 PMCID: PMC5371435 DOI: 10.1097/md.0000000000005290] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Body mass index (BMI) is inconsistently associated with the progression of low bone mass-related fractures. We conducted a systematic review and meta-analysis to summarize the evidence regarding the relationship between BMI and the risk of fracture in men and women separately. Furthermore, we analyzed the association between BMI and fracture risk in women compared with men. METHODS PubMed, EmBase, and the Cochrane Library were searched up to November 2015 to identify prospective cohort studies of low bone mass-related fractures. Prospective cohort studies that reported effect estimates of fracture risk for different BMI categories compared to normal weight were included. Relative risk (RR) and the ratio of relative risk (RRR) were calculated using a random-effect model to measure the relationship between BMI and fracture risk. RESULTS We analyzed 37 cohorts (32 articles), which included a total of 506,004 women and 118,372 men; overall, 38,200 incident cases were reported. Overall, a lower BMI was not associated with fracture risk in men (RR: 1.50, 95% confidence interval [CI]: 1.00-2.26; P = 0.051) or women (RR: 1.25, 95% CI: 0.97-1.62; P = 0.083). Although a higher BMI might play a beneficial impact in men (RR: 0.80, 95% CI: 0.69-0.93; P = 0.003), it has little effect in women (RR: 0.91, 95% CI: 0.74-1.11; P = 0.343). In addition, an increase in BMI by 5 kg/m decreased the risk of fractures in men (RR: 0.90, 95% CI: 0.83-0.98; P = 0.017) and women (RR: 0.85, 95% CI: 0.81-0.89; P < 0.001). Finally, there was no evidence of a sex difference in the RR for fractures between participants with different BMI categories compared with those with normal BMI. Finally, gender did not affect the risk of fracture for any category of BMI values. CONCLUSION Higher BMI may affect the risk of fractures regardless of the sex. This association may be due to the interaction between the participants' BMI and their bone mass density.
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Affiliation(s)
- Bing-Yan Xiang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Wei Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Guo-Qi Zhou
- Department of Respiratory Medicine, Three Affiliated Hospital of Zunyi Medical College, Guizhou, China
| | - Ning Hu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Hong Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Cheng Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing
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Looker AC, Sarafrazi Isfahani N, Fan B, Shepherd JA. Trabecular bone scores and lumbar spine bone mineral density of US adults: comparison of relationships with demographic and body size variables. Osteoporos Int 2016; 27:2467-75. [PMID: 26952009 PMCID: PMC7593898 DOI: 10.1007/s00198-016-3550-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/22/2016] [Indexed: 12/12/2022]
Abstract
UNLABELLED This study examines demographic patterns and body size relationships in trabecular bone score and lumbar spine BMD of US adults from NHANES 2005-2008. INTRODUCTION Limited data exist on demographic and body size relationships for trabecular bone score (TBS), a new variable derived from bone texture analysis of lumbar spine dual-energy X-ray absorptiometry (DXA) scans. This study compares demographic patterns and correlations with body size (body mass index (BMI), weight, waist circumference, total body fat, trunk fat, trunk lean) between TBS and lumbar spine bone mineral density (LSBMD) for adults age ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 2005-2008 with BMI in the optimal range for TBS (15-37 kg/m(2)). METHODS LSBMD, TBS, body fat, and lean were obtained by DXA. Weight, height, and waist circumference were measured. BMI was calculated from height and weight. RESULTS Sex differences in TBS varied by age and race/ethnicity (p sex X age interaction and p sex X race/ethnicity interaction < 0.001). In most of the nine demographic subgroups examined, TBS did not differ by sex (four subgroups) or was significantly higher in women (three subgroups). TBS differences by race/ethnicity were inconsistent in men; in women, non-Hispanic whites (NHWs) had higher TBS than non-Hispanic blacks (NHBs) or Mexican Americans (MAs) in all age groups. In contrast, LSBMD was either significantly higher in men (five subgroups) or did not differ by sex (four subgroups). Race/ethnic differences in LSBMD were consistent across age and sex (NHB > NHW > MA). All body size variables were negatively related to TBS but positively related to LSBMD. CONCLUSIONS Demographic patterns and body size relationships differed between TBS and LSBMD.
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Affiliation(s)
- A C Looker
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Hyattsville, MD, 20782, USA.
| | - N Sarafrazi Isfahani
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Hyattsville, MD, 20782, USA
| | - B Fan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - J A Shepherd
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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Rozenberg S, Body JJ, Bruyère O, Bergmann P, Brandi ML, Cooper C, Devogelaer JP, Gielen E, Goemaere S, Kaufman JM, Rizzoli R, Reginster JY. Effects of Dairy Products Consumption on Health: Benefits and Beliefs--A Commentary from the Belgian Bone Club and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases. Calcif Tissue Int 2016; 98:1-17. [PMID: 26445771 PMCID: PMC4703621 DOI: 10.1007/s00223-015-0062-x] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/21/2015] [Indexed: 02/07/2023]
Abstract
Dairy products provide a package of essential nutrients that is difficult to obtain in low-dairy or dairy-free diets, and for many people it is not possible to achieve recommended daily calcium intakes with a dairy-free diet. Despite the established benefits for bone health, some people avoid dairy in their diet due to beliefs that dairy may be detrimental to health, especially in those with weight management issues, lactose intolerance, osteoarthritis, rheumatoid arthritis, or trying to avoid cardiovascular disease. This review provides information for health professionals to enable them to help their patients make informed decisions about consuming dairy products as part of a balanced diet. There may be a weak association between dairy consumption and a possible small weight reduction, with decreases in fat mass and waist circumference and increases in lean body mass. Lactose intolerant individuals may not need to completely eliminate dairy products from their diet, as both yogurt and hard cheese are well tolerated. Among people with arthritis, there is no evidence for a benefit to avoid dairy consumption. Dairy products do not increase the risk of cardiovascular disease, particularly if low fat. Intake of up to three servings of dairy products per day appears to be safe and may confer a favourable benefit with regard to bone health.
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Affiliation(s)
- Serge Rozenberg
- Department of Gynaecology-Obstetrics, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Jacques Body
- Department of Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Pierre Bergmann
- Department of Radioisotopes, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Luisa Brandi
- Metabolic Bone Unit, Department of Internal Medicine, University of Florence, Florence, Italy
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- University of Oxford, Oxford, UK
| | - Jean-Pierre Devogelaer
- Department of Rheumatology, Saint Luc University Hospital, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Evelien Gielen
- Gerontology and Geriatrics Section, Department of Experimental Medicine, Katholiek Universiteit Leuven, Leuven, Belgium
| | - Stefan Goemaere
- Department of Rheumatology and Endocrinology, State University of Ghent, Ghent, Belgium
| | - Jean-Marc Kaufman
- Department of Endocrinology, State University of Ghent, Ghent, Belgium
| | - René Rizzoli
- Division of Bones Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jean-Yves Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
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Zhu J, Chan YM. Fertility Issues for Patients with Hypogonadotropic Causes of Delayed Puberty. Endocrinol Metab Clin North Am 2015; 44:821-34. [PMID: 26568495 DOI: 10.1016/j.ecl.2015.07.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Delayed puberty presenting with low gonadotropins has multiple causes. Self-limited delay (constitutional delay) is generally considered benign, but adult height and bone mineral density may be compromised, and fertility has not been studied. Functional hypogonadotropic hypogonadism due to a stressor is thought to resolve with removal of the stressor, but reproductive endocrine dysfunction can sometimes persist. Most but not all patients with idiopathic hypogonadotropic hypogonadism, a typically long-lasting condition, can achieve fertility with exogenous hormone therapy. Future studies are needed to determine fertility outcomes in self-limited delayed puberty and to more clearly define prognostic factors for fertility in functional and idiopathic hypogonadotropic hypogonadism.
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Affiliation(s)
- Jia Zhu
- Division of Endocrinology, Department of Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Yee-Ming Chan
- Division of Endocrinology, Department of Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
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Bolland MJ, Leung W, Tai V, Bastin S, Gamble GD, Grey A, Reid IR. Calcium intake and risk of fracture: systematic review. BMJ 2015; 351:h4580. [PMID: 26420387 PMCID: PMC4784799 DOI: 10.1136/bmj.h4580] [Citation(s) in RCA: 171] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the evidence underpinning recommendations to increase calcium intake through dietary sources or calcium supplements to prevent fractures. DESIGN Systematic review of randomised controlled trials and observational studies of calcium intake with fracture as an endpoint. Results from trials were pooled with random effects meta-analyses. DATA SOURCES Ovid Medline, Embase, PubMed, and references from relevant systematic reviews. Initial searches undertaken in July 2013 and updated in September 2014. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Randomised controlled trials or cohort studies of dietary calcium, milk or dairy intake, or calcium supplements (with or without vitamin D) with fracture as an outcome and participants aged >50. RESULTS There were only two eligible randomised controlled trials of dietary sources of calcium (n=262), but 50 reports from 44 cohort studies of relations between dietary calcium (n=37), milk (n=14), or dairy intake (n=8) and fracture outcomes. For dietary calcium, most studies reported no association between calcium intake and fracture (14/22 for total, 17/21 for hip, 7/8 for vertebral, and 5/7 for forearm fracture). For milk (25/28) and dairy intake (11/13), most studies also reported no associations. In 26 randomised controlled trials, calcium supplements reduced the risk of total fracture (20 studies, n=58,573; relative risk 0.89, 95% confidence interval 0.81 to 0.96) and vertebral fracture (12 studies, n=48,967. 0.86, 0.74 to 1.00) but not hip (13 studies, n=56,648; 0.95, 0.76 to 1.18) or forearm fracture (eight studies, n=51,775; 0.96, 0.85 to 1.09). Funnel plot inspection and Egger's regression suggested bias toward calcium supplements in the published data. In randomised controlled trials at lowest risk of bias (four studies, n=44,505), there was no effect on risk of fracture at any site. Results were similar for trials of calcium monotherapy and co-administered calcium and vitamin D. Only one trial in frail elderly women in residential care with low dietary calcium intake and vitamin D concentrations showed significant reductions in risk of fracture. CONCLUSIONS Dietary calcium intake is not associated with risk of fracture, and there is no clinical trial evidence that increasing calcium intake from dietary sources prevents fractures. Evidence that calcium supplements prevent fractures is weak and inconsistent.
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Affiliation(s)
- Mark J Bolland
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - William Leung
- Department of Public Health, University of Otago, PO Box 7343, Wellington 6242, New Zealand
| | - Vicky Tai
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Sonja Bastin
- Department of Radiology, Starship Hospital, Private Bag 92024, Auckland 1142, New Zealand
| | - Greg D Gamble
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Andrew Grey
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Ian R Reid
- Department of Medicine, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
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Hu S, Li J, Liu L, Dai R, Sheng Z, Wu X, Feng X, Yao X, Liao E, Keller E, Jiang Y. Micro/Nanostructures and Mechanical Properties of Trabecular Bone in Ovariectomized Rats. Int J Endocrinol 2015; 2015:252503. [PMID: 26273294 PMCID: PMC4530249 DOI: 10.1155/2015/252503] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/29/2015] [Accepted: 02/01/2015] [Indexed: 01/08/2023] Open
Abstract
Bone mechanical properties encompass both geometric and material factors, while the effects of estrogen deficiency on the material and structural characteristics of bone at micro- to nanoscales are still obscure. We performed a series of combined methodological experiments, including nanoindentation assessment of intrinsic material properties, atomic force microscopy (AFM) characterization of trabecular (Tb) nanostructure, and Tb microarchitecture and 2D BMD. At 15 weeks after surgery, we found significantly less Tb bone mineral density (BMD) at organ (-27%) and at tissue level (-12%), Tb bone volume fraction (-29%), Tb thickness (-14%), and Tb number (-17%) in ovariectomy (OVX) rats than in sham operated (SHAM) rats, while the structure model index (+91%) and Tb separation (+19%) became significantly greater. AFM images showed lower roughness Tb surfaces with loosely packed large nodular structures and less compacted interfibrillar space in OVX than in SHAM. However, no statistically significant changes were in the Tb intrinsic material properties-nanoindentation hardness, elastic modulus, and plastic deformation-nanoindentation depths, and residual areas. Therefore, estrogen deprivation results in a dramatic deterioration in Tb micro/nanoarchitectures, 3D volumetric BMD at both organ and tissue levels, and 2D BMD, but not in the nanomechanical properties of the trabeculae per se.
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Affiliation(s)
- Shidi Hu
- Institute of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Jin Li
- Institute of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Lu Liu
- Institute of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Ruchun Dai
- Institute of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
- *Ruchun Dai:
| | - Zhifeng Sheng
- Institute of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Xianping Wu
- Institute of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Xiqiao Feng
- AML, Department of Engineering Mechanics, Tsinghua University, Beijing 100084, China
| | - Xuefeng Yao
- AML, Department of Engineering Mechanics, Tsinghua University, Beijing 100084, China
| | - Eryuan Liao
- Institute of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Evan Keller
- Comprehensive Cancer Center and Urology, University of Michigan, E Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Yebin Jiang
- Comprehensive Cancer Center and Urology, University of Michigan, E Medical Center Drive, Ann Arbor, MI 48109, USA
- Research & Development and Radiology, VA Southern Nevada Healthcare System, 6900 N. Pecos Road, North Las Vegas, NV 89086, USA
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Oldroyd A, Dubey S. The association between bone mineral density and higher body mass index in men. Int J Clin Pract 2015; 69:145-7. [PMID: 25496013 DOI: 10.1111/ijcp.12523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 07/14/2014] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND A number of studies have identified that higher body mass index is associated with higher bone mineral density. However, a small number of previous studies have indicated an association between higher body mass index (> 35 kg/m(2)) and lower bone mineral density. No previous study has investigated the association between higher body mass index and bone mineral density in a large male population. METHODS Data of men aged over 50 years of age who attended for a dual energy X-ray absorptiometry scan at a UK teaching hospital were collated. The population was divided according to body mass index increments of 5 kg/m(2). The mean bone mineral density of both the lumbar spine and femoral neck was ascertained for each body mass index category. Multiple linear regression analysis, adjusted for age, was used to investigate for an association between body mass index and bone mineral density. RESULTS Data of 1263 men were collated. Increasing body mass index was associated with increasing bone mineral density of both the lumbar spine and femoral neck up to 35 kg/m(2); further increase in body mass index was not associated with an increasing bone mineral density. CONCLUSIONS The beneficial effect upon bone mineral density of increasing body mass index exists up to 35 kg/m(2); a body mass index higher than 35 kg/m(2) is not associated with further increase in bone mineral density.
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Affiliation(s)
- A Oldroyd
- University Hospitals Coventry and Warwickshire, Coventry, UK
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Lambrinoudaki I, Flokatoula M, Armeni E, Pliatsika P, Augoulea A, Antoniou A, Alexandrou A, Creatsa M, Panoulis C, Dendrinos S, Papacharalambous X. Vertebral fracture prevalence among Greek healthy middle-aged postmenopausal women: association with demographics, anthropometric parameters, and bone mineral density. Spine J 2015; 15:86-94. [PMID: 25106754 DOI: 10.1016/j.spinee.2014.07.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 07/29/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The prevalence of skeletal fractures shows a marked geographic variability; however, data regarding the Greek population remain limited. PURPOSE To evaluate the frequency of asymptomatic vertebral fractures (VFs), and potential risk factors, in a large sample of Greek postmenopausal women. STUDY DESIGN A cross-sectional study at the University Menopause Clinic. PATIENT SAMPLE Four hundred fifty-four postmenopausal women aged 35 to 80 years, with an average menopausal age of 9.2±7.1 years. OUTCOME MEASURES They included medical history, anthropometric and biochemical parameters, bone mineral density (BMD) at lumbar spine (LS) and femoral neck (FN), and LS lateral radiographs. METHODS Lumbar spine lateral radiographs were evaluated according to quantitative procedures, aiming to identify VFs. Anthropometric and biochemical parameters and values of BMD were compared according to the presence of VFs. RESULTS A total of 37 (8.15%) women had at least one VF. Lumbar spine and FN-osteoporosis was identified in up to 23.1% and 40.9% subjects with prevalent VFs, respectively. The prevalence of VFs was largely associated with age, with women aged 60 years or more presenting an up to fourfold risk compared with younger women. Moreover, the presence of VFs was associated with higher menopausal age, advanced age at menarche, a history of early menopause, and prolonged lactation. Lower LS-BMD and, especially, FN-BMD were negatively associated with VF prevalence (prevalent VF vs. no VF: LS-BMD, 0.89±0.16 g/cm(2) vs. 0.98±0.16 g/cm(2), p=.010; FN-BMD, 0.72±0.10 g/cm(2) vs. 0.81±0.12 g/cm(2), p=.008). CONCLUSIONS Asymptomatic VFs are common among Greek healthy middle-aged postmenopausal women. More than 50% subjects with prevalent VFs present with normal BMD or osteopenia. Age and bone density classification at the FN presented the strongest association with the prevalence of VFs.
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Affiliation(s)
- Irene Lambrinoudaki
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece.
| | - Maria Flokatoula
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece
| | - Eleni Armeni
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece
| | - Paraskevi Pliatsika
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece
| | - Areti Augoulea
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece
| | - Aris Antoniou
- 1st Department of Radiology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece
| | - Andreas Alexandrou
- 1st Department of Surgery, University of Athens, Laiko Athens General Hospital, 17 Agiou Thoma St, GR-11527 Athens, Greece
| | - Maria Creatsa
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece
| | - Constantinos Panoulis
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece
| | - Spyridon Dendrinos
- 2nd Department of Obstetrics and Gynecology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece
| | - Xenofon Papacharalambous
- 1st Department of Radiology, University of Athens, Aretaieio Hospital, 76 Vas. Sofias Ave., GR-11528, Athens, Greece
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46
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Relationship between sagittal spinal alignment and the incidence of vertebral fracture in menopausal women with osteoporosis: a multicenter longitudinal follow-up study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:737-43. [DOI: 10.1007/s00586-014-3637-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 10/20/2014] [Accepted: 10/22/2014] [Indexed: 10/24/2022]
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Nakamura K, Kitamura K, Inoue M, Sawada N, Tsugane S. Physical activity and 10-year incidence of self-reported vertebral fractures in Japanese women: the Japan Public Health Center-based Prospective Study. Osteoporos Int 2014; 25:2565-71. [PMID: 24964892 DOI: 10.1007/s00198-014-2770-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 06/06/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED This study assessed the effects of physical activity on a 10-year incidence of self-reported vertebral fractures in adult women of a large Japanese cohort. Medium levels of strenuous activity and long-duration sedentary activity were associated with a lower incidence of vertebral fractures; association patterns appear to be different from hip fractures. INTRODUCTION Physical activity helps prevent hip fracture, but little is known about the longitudinal association between physical activity and vertebral fractures. The purpose of this study was to evaluate the effects of physical activity on the 10-year incidence of symptomatic vertebral fractures using data from the Japan Public Health Center-based Prospective Study. METHODS Baseline studies were conducted in 1993-1994, and the follow-up study was conducted 10 years later. We analyzed 23,757 women aged 40-69 years. At baseline, physical activity was assessed as a predictor by using a questionnaire. Subjects were asked to report vertebral fractures that occurred during the 10-year follow-up period. Relative risks (RRs) adjusted for confounders were estimated by multiple logistic regression analysis. RESULTS The 10-year cumulative incidence of vertebral fractures was 0.67%. Those who engaged in strenuous physical activity of <1 h/day had a significantly lower incidence of vertebral fractures than those who did not engage in such activity (RR = 0.52, 95% CI 0.28-0.97), while those engaged in such activity ≥1 h/day did not (RR = 0.82, 95% CI 0.58-1.14). Long-duration sedentary activity was associated with a low incidence of vertebral fractures (P for trend = 0.0002), but the frequencies of sports activities and metabolic equivalents were not (P for trend = 0.0729 and 0.4341, respectively). CONCLUSIONS Strenuous activity and sedentary activity are associated with the incidence of vertebral fractures, although the association may not be linear. The pattern of association between physical activity and vertebral fractures appears to be different from that of hip fractures.
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Affiliation(s)
- K Nakamura
- Department of Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan,
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Abstract
Pubertal maturation plays a fundamental role in bone acquisition. In retrospective epidemiological surveys in pre- and postmenopausal women, relatively later menarcheal age was associated with low bone mineral mass and increased risk of osteoporotic fracture. This association was usually ascribed to shorter time exposure to estrogen from the onset of pubertal maturation to peak bone mass attainment. Recent prospective studies in healthy children and adolescents do not corroborate the limited estrogen exposure hypothesis. In prepubertal girls who will experience later menarche, a reduced bone mineral density was observed before the onset of pubertal maturation, with no further accumulated deficit until peak bone mass attainment. In young adulthood, later menarche is associated with impaired microstructural bone components and reduced mechanical resistance. This intrinsic bone deficit can explain the fact that later menarche increases fracture risk during childhood and adolescence. In healthy individuals, both pubertal timing and bone development share several similar characteristics including wide physiological variability and strong effect of heritable factors but moderate influence of environmental determinants such as nutrition and physical activity. Several conditions modify pubertal timing and bone acquisition, a certain number of them acting in concert on both traits. Taken together, these facts should prompt the search for common genetic regulators of pubertal timing and bone acquisition. It should also open epigenetic investigation avenues to pinpoint which environmental exposure in fetal and infancy life, such as vitamin D, calcium, and/or protein supplies, influences both pubertal timing and bone acquisition.
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Affiliation(s)
- Jean-Philippe Bonjour
- Division of Bone Diseases, University Hospitals and Faculty of Medicine, CH-1211 Geneva, Switzerland
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High-dose diosgenin reduces bone loss in ovariectomized rats via attenuation of the RANKL/OPG ratio. Int J Mol Sci 2014; 15:17130-47. [PMID: 25257532 PMCID: PMC4200779 DOI: 10.3390/ijms150917130] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/11/2014] [Accepted: 09/16/2014] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to evaluate effect of diosgenin (DG) on rats that had osteoporosis-like features induced by ovariectomy (OVX). Seventy-two six-month-old female Wistar rats were subjected to either ovariectomy (n = 60) or Sham operation (SHAM group, n = 12). Beginning at one week post-ovariectomy, the OVX rats were treated with vehicle (OVX group, n = 12), estradiol valerate (EV group, n = 12), or DG at three doses (DG-L, -M, -H group, n = 12, respectively). After a 12-week treatment, administration of EV or DG-H inhibited OVX-induced weight gain, and administration of EV or DG-H or DG-M had a significantly uterotrophic effect. Bone mineral density (BMD) and indices of bone histomorphometry of tibia were measured. Levels of protein and mRNA expression of osteoprotegerin (OPG) and receptor activator of nuclear factor kappa-B ligand (RANKL) in tibia were evaluated by immunohistochemistry and in situ hybridization. Our results show that DG at a high dose (DG-H) had a significant anti-osteoporotic effect compared to OVX control. DG-H treatment down-regulated expression of RANKL and up-regulated expression of OPG significantly in tibia from OVX rats compared to control, and thus lowered the RANKL/OPG ratio. This suggests that the anti-osteoporotic effect of DG might be associated with modulating the RANKL/OPG ratio and DG had potential to be developed as alternative therapeutic agents of osteoporosis induced by postmenopause.
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Lee DR, Lee J, Rota M, Lee J, Ahn HS, Park SM, Shin D. Coffee consumption and risk of fractures: a systematic review and dose-response meta-analysis. Bone 2014; 63:20-8. [PMID: 24576685 DOI: 10.1016/j.bone.2014.02.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 01/28/2014] [Accepted: 02/15/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The data on the association between coffee consumption and the risk of fractures are inconclusive. We performed a comprehensive literature review and meta-analysis to better quantify this association. METHODS We identified all potentially relevant articles by searching MEDLINE, EMBASE, Cochrane Library, Web of Science, SCOPUS, and CINAHL (until February 2013). The keywords "coffee," "caffeine," "drink," and "beverage" were used as the exposure factors, and the keyword "fracture" was used as the outcome factor. We determined the overall relative risk (RR) and confidence interval (CI) for the highest and lowest levels of coffee consumption. A dose-response analysis was performed to assess the risk of fractures based on the level of coffee consumption. RESULTS We included 253,514 participants with 12,939 fracture cases from 9 cohort and 6 case-control studies. The estimated RR of fractures at the highest level of coffee consumption was 1.14 (95% CI: 1.05-1.24; I(2)=0.0%) in women and 0.76 (95% CI: 0.62-0.94; I(2)=7.3%) in men. In the dose-response analysis, the pooled RRs of fractures in women who consumed 2 and 8 cups of coffee per day were 1.02 (95% CI: 1.01-1.04) and 1.54 (95% CI: 1.19-1.99), respectively. CONCLUSIONS Our meta-analysis suggests that daily consumption of coffee is associated with an increased risk of fractures in women and a contrasting decreased risk in men. However, future well-designed studies should be performed to confirm these findings.
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Affiliation(s)
- Dong Ryul Lee
- Department of Family Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Republic of Korea.
| | - Jungun Lee
- Department of Family Medicine, Wonkwang University Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Republic of Korea.
| | - Matteo Rota
- Department of Health Sciences, Centre of Biostatistics for Clinical Epidemiology, University of Milan-Bicocca, Monza, Italy; Dipartimento di Epidemiologia, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri", Milano, Italy.
| | - Juneyoung Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea.
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea; Department of Biomedical Sciences, Seoul National University College of Medicine, 101 Daehangno, Jongno-gu, Seoul 110-744, Republic of Korea.
| | - Doosup Shin
- Jangseong Public Health Center, Jangseong, Republic of Korea.
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