1
|
Samad N, Nguyen HH, Aleksova J, Pasco JA, Kotowicz MA, Ebeling PR, Vincent AJ, Zebaze R, Milat F. Femora of women with premature ovarian insufficiency exhibit reduced strength and misalignment with the transmitted vertical forces from the upper body. Eur J Endocrinol 2024; 190:182-191. [PMID: 38064575 DOI: 10.1093/ejendo/lvad158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND Women with premature ovarian insufficiency (POI) lack oestrogen, which is a key determinant of bone growth, epiphyseal closure, and bone tissue organisation. Although dual-energy X-ray absorptiometry (DXA)-derived areal bone mineral density (BMD) remains the gold standard for fracture risk evaluation, it does not fully characterise the skeletal abnormalities present in these women. Hence, we aimed to assess hip/femur anatomy, strength, and geometry and femoral alignment using advanced hip analysis (AHA). METHODS We conducted a cross-sectional, case-control study including 89 women with spontaneous normal karyotype POI (s-POI) or iatrogenic POI (i-POI), aged 20-50 years compared with 89 age- and body mass index (BMI)-matched population-based female controls. Hip anatomy, strength, geometrical parameters, and femur alignment were measured using hip DXA images and Lunar AHA software. Femoral orientation angle (FOA) was quantified as the overall orientation of the femur with respect to the axis of the forces transmitted from the upper body. RESULTS The median age of POI diagnosis was 35 (18-40) years; the mean POI duration at the time of DXA was 2.07 (range 0-13) years, and 84% of POI women received oestrogen therapy. Areal BMD at all sites was significantly lower in the POI group (all P < .05). Indices of compressive and bending strength were lower in women with POI compared with controls, specifically the cross-sectional area (CSA, mm2) and section modulus (SM, mm3) (139.30 ± 29.08 vs 157.29 ± 22.26, P < .001 and 665.21 ± 129.54 vs 575.53 ± 150.88, P < .001, respectively). The FOA was smaller (124.99 ± 3.18) in women with POI as compared with controls (128.04 ± 3.80; P < .001) at baseline and after adjusting for height and femoral neck BMD. CONCLUSION Alongside lower BMD at multiple sites, the femora of women with POI demonstrate reduced strength and a misalignment with forces transmitted from the upper body. Further research is needed to establish the role of these newly identified features and their role in fracture risk prediction in this population.
Collapse
Affiliation(s)
- Navira Samad
- Department of Endocrinology, Monash Health, Clayton, 3168 VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, 3168 VIC, Australia
| | - Hanh H Nguyen
- Department of Endocrinology, Monash Health, Clayton, 3168 VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, 3168 VIC, Australia
| | - Jasna Aleksova
- Department of Endocrinology, Monash Health, Clayton, 3168 VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, 3168 VIC, Australia
- Hudson Institute of Medical Research, Melbourne, 3168 VIC, Australia
| | - Julie A Pasco
- Deakin University, IMPACT-Institute for Physical and Mental Health and Clinical Translation, Geelong, 3220 VIC, Australia
- Department of Medicine, Western Health, The University of Melbourne, St Albans, 3021 VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, 3168 VIC, Australia
- Barwon Health, University Hospital Geelong, Geelong, 3220 VIC, Australia
| | - Mark A Kotowicz
- Deakin University, IMPACT-Institute for Physical and Mental Health and Clinical Translation, Geelong, 3220 VIC, Australia
- Department of Medicine, Western Health, The University of Melbourne, St Albans, 3021 VIC, Australia
- Department of Endocrinology & Diabetes, University Hospital Geelong, Barwon Health, Geelong, 3220 VIC, Australia
| | - Peter R Ebeling
- Department of Endocrinology, Monash Health, Clayton, 3168 VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, 3168 VIC, Australia
| | - Amanda J Vincent
- Department of Endocrinology, Monash Health, Clayton, 3168 VIC, Australia
- Monash Centre for Health Research and Implementation, Monash University, 3168 VIC, Australia
| | - Roger Zebaze
- Department of Endocrinology, Monash Health, Clayton, 3168 VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, 3168 VIC, Australia
| | - Frances Milat
- Department of Endocrinology, Monash Health, Clayton, 3168 VIC, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, 3168 VIC, Australia
- Hudson Institute of Medical Research, Melbourne, 3168 VIC, Australia
| |
Collapse
|
2
|
Gregg E, Beggs C, Bissas A, Nicholson G. A machine learning approach to identify important variables for distinguishing between fallers and non-fallers in older women. PLoS One 2023; 18:e0293729. [PMID: 37906588 PMCID: PMC10617741 DOI: 10.1371/journal.pone.0293729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023] Open
Abstract
Falls are a significant ongoing public health concern for older adults. At present, few studies have concurrently explored the influence of multiple measures when seeking to determine which variables are most predictive of fall risks. As such, this cross-sectional study aimed to identify those functional variables (i.e. balance, gait and clinical measures) and physical characteristics (i.e. strength and body composition) that could best distinguish between older female fallers and non-fallers, using a machine learning approach. Overall, 60 community-dwelling older women (≥65 years), retrospectively classified as fallers (n = 21) or non-fallers (n = 39), attended three data collection sessions. Data (281 variables) collected from tests in five separate domains (balance, gait, clinical measures, strength and body composition) were analysed using random forest (RF) and leave-one-variable-out partial least squares correlation analysis (LOVO PLSCA) to assess variable importance. The strongest discriminators from each domain were then aggregated into a multi-domain dataset, and RF, LOVO PLSCA, and logistic regression models were constructed to identify the important variables in distinguishing between fallers and non-fallers. These models were used to classify participants as either fallers or non-fallers, with their performance evaluated using receiver operating characteristic (ROC) analysis. The study found that it is possible to classify fallers and non-fallers with a high degree of accuracy (e.g. logistic regression: sensitivity = 90%; specificity = 87%; AUC = 0.92; leave-one-out cross-validation accuracy = 63%) using a combination of 18 variables from four domains, with the gait and strength domains being particularly informative for screening programmes aimed at assessing falls risk.
Collapse
Affiliation(s)
- Emily Gregg
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- York Health Economics Consortium, University of York, York, United Kingdom
| | - Clive Beggs
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
- Department of Medicine for the Elderly, Cambridge University Hospitals, Cambridge, United Kingdom
| | - Athanassios Bissas
- School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom
| | - Gareth Nicholson
- Carnegie School of Sport, Leeds Beckett University, Leeds, United Kingdom
| |
Collapse
|
3
|
Heck A, Godang K, Lekva T, Markussen KN, De Vincentis S, Ueland T, Bollerslev J. Endocortical Trabecularization in Acromegaly: The Cause for the Paradoxically Increased Vertebral Fracture Risk? JBMR Plus 2023; 7:e10787. [PMID: 37808394 PMCID: PMC10556260 DOI: 10.1002/jbm4.10787] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/26/2023] [Accepted: 06/02/2023] [Indexed: 10/10/2023] Open
Abstract
Growth hormone (GH) is nonphysiologically increased in acromegaly, stimulating target tissues directly and indirectly via insulin-like growth factor type 1 (IGF-1). Despite GH having anabolic effects on bone growth and renewal, the risk of vertebral fractures is paradoxically increased in acromegaly. We hypothesized that bone tissue compartments were differentially affected by hormonal alterations in active and controlled acromegaly. We aimed to study the effect of sex and gonadal status on long-term outcome of bone mass and structure to understand the biomechanical competence of bone. We followed 62 patients with newly diagnosed acromegaly longitudinally (median 4.8 years after pituitary surgery) to investigate changes assessed by dual X-ray absorptiometry (DXA), trabecular bone score (TBS), and hip structure analysis (HSA). At diagnosis, patients had increased bone mineral density (BMD) in most compartments compared with normative data (Z-scores). Conversely, TBS Z-score was decreased (Z = -0.64 (SD 1.73), p = 0.028). Following treatment of acromegaly, BMD increased further in compartments containing predominantly trabecular bone, such as the lumbar spine, in eugonadal and male subjects, while compartments with predominantly cortical bone, such as the hip and femoral neck, were unchanged. Total body measurements showed further increase in BMD independent of sex and gonadal status. TBS did not change. HSA revealed a significant decrease in cortical thickness in both sexes independent of gonadal status, whereas the overall size of bone (hip axis length and neck width) did not change over time. In conclusion, patients with acromegaly had increased bone mass and dimensions by DXA. Following normalization of disease activity, BMD increased mainly in compartments rich in trabecular bone, reflecting a closure of the remodeling space. However, HSA revealed a significant decrease in cortical thickness, implying endocortical trabecularization, potentially explaining the increased risk for incident vertebral fractures following treatment. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Ansgar Heck
- Section of Specialized Endocrinology, Medical ClinicOslo University HospitalOsloNorway
| | - Kristin Godang
- Section of Specialized Endocrinology, Medical ClinicOslo University HospitalOsloNorway
| | - Tove Lekva
- Research Institute of Internal MedicineOslo University HospitalOsloNorway
| | - Kjersti Norman Markussen
- Section of Specialized Endocrinology, Medical ClinicOslo University HospitalOsloNorway
- Faculty of MedicineUniversity of OsloOsloNorway
| | - Sara De Vincentis
- Section of Specialized Endocrinology, Medical ClinicOslo University HospitalOsloNorway
- Unit of Endocrinology, Department of Biomedical, Metabolic and Neural SciencesUniversity of Modena and Reggio EmiliaModenaItaly
| | - Thor Ueland
- Research Institute of Internal MedicineOslo University HospitalOsloNorway
- Faculty of MedicineUniversity of OsloOsloNorway
| | - Jens Bollerslev
- Section of Specialized Endocrinology, Medical ClinicOslo University HospitalOsloNorway
- Faculty of MedicineUniversity of OsloOsloNorway
| |
Collapse
|
4
|
Nordic walking with an integrated resistance shock absorber affects the femur strength and muscles torques in postmenopausal women. Sci Rep 2022; 12:20089. [PMID: 36418455 PMCID: PMC9684118 DOI: 10.1038/s41598-022-24131-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/10/2022] [Indexed: 11/24/2022] Open
Abstract
Deterioration of the structure and function of the musculoskeletal system represents a significant problem during aging and intervention with a suitable load of physical activity may improve the quality of life. Nordic walking (NW) has become a popular and easily accessible form of activity, especially for older adults people around the world. Thus, the purpose of the study was to evaluate the influence of an Nordic walking training program with classic poles (NW) and with integrated resistance shock absorber (RSA) on bone mineral density and the peak torques of upper limb muscles and to compare the effects of both intervention programs. 25 women were randomly assigned to two training groups: 10 subjects using RSA (68 ± 4.19 years) and 15 subjects using NW poles (65 ± 3.40 years), which completed 8 weeks of training program. The hip, spine and forearm areal bone mineral density, torques of the flexors and extensors at the elbow and shoulder joints were measured before starting the training programs and after their completion. The most significant effect was found in differences between the two groups of women with respect to the femur strength index (p = 0.047) and the ratio of the flexors to extensors in the elbow (p = 0.049) and shoulder (p = 0.001) joints and peak torque of flexors in the shoulder joint (p = 0.001) for the left arm. A significant difference was also found in the index of torque asymmetry of flexors in the shoulder joint (p = 0.002). The study shows that Nordic walking with RSA poles for postmenopausal women led to beneficial changes in the femur strength index. However, we found no significant influence on bone mineral density values measured on the whole body, the femoral neck, forearm or lumbar spine regions. The occurrence of asymmetry in biomechanical muscle parameters, which was observed using RSA poles, may suggest the necessity of systematic controlling the gait technique to avoid the adverse consequences of asymmetrical rotation of the lumbar spine.
Collapse
|
5
|
Yuan D, Wu Z, Yang L, Zou Q, Hua D, Zou Z, Ye C. Biomechanical analysis of the drilling parameters for early osteonecrosis of the femoral head. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 219:106737. [PMID: 35325669 DOI: 10.1016/j.cmpb.2022.106737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Core decompression is a surgical procedure commonly used to treat the early osteonecrosis of the femoral head. However, It is not known whether different drilling parameters affect postoperative biomechanical strength. This study aimed to analyze the mechanical stability of different drilling locations and diameters of core decompression using finite element analysis. METHODS Finite element models were established based on computed tomography images obtained from five healthy participants, including the different drilling locations (Lesser trochanter: Above, Parallel, and Below) and diameters. Biomechanical parameters including stiffness and stress were evaluated under slow running loads. RESULTS At the same drilling diameter, the femoral stiffness was highest (p < 0.05) in the Above group and lowest in the Below group, while the maximum equivalent stress of the entry area and the necrotic area was highest (p < 0.05) in the Below group and lowest in the Above group. With the increase of drilling diameters, the stiffness decreased and its decreased percentage comparing the preoperative: Above (1.06-8.82%), Parallel (2.51-13.61%), and Below (3.99-15.06%). The maximum equivalent stress of the entry area and necrotic area increased as the drilling diameter increased, and its increased percentage comparing the preoperative, for the entry area: Above (14.11-219.58%), Parallel (35.91-306.37%), and Below (46.12-240.98%); for the necrotic area: Above (13.64-114.69%), Parallel (29.37-187.76%), and Below (44.76-202.10%). The range of safety drilling parameters (SDP) was obtained (Below<9 mm, Parallel<11 mm, and Above<13 mm) by comparing the maximum equivalent stress of two areas and its yield strength. For patients of different sizes and normal bone mineral density (BMD), the maximum equivalent stress of the two areas did not exceed its yield strength using the range of SDP, except for the patients with abnormal BMD (Osteoporosis) or high body mass index (BMI≥28 kg/m2). CONCLUSIONS The biomechanical properties of early osteonecrosis of the femoral head deceased with increasing drilling diameters parameters, especially at the location below the lesser trochanter. The SDP (Below<9 mm, Parallel<11 mm, and Above<13 mm) is a suitable reference for most patients to perform slow running postoperatively, while it may be not suitable for patients with osteoporosis or obesity.
Collapse
Affiliation(s)
- DaiZhu Yuan
- Medical College, Soochow University, Suzhou 215006, China; Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China; Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang 550004, China
| | - ZhanYu Wu
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China; Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang 550004, China
| | - Long Yang
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China; Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang 550004, China
| | - Qiang Zou
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China; Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang 550004, China
| | - DaWei Hua
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - ZiHao Zou
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - Chuan Ye
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China; Center for Tissue Engineering and Stem Cells, Guizhou Medical University, Guiyang 550004, China.
| |
Collapse
|
6
|
Mazza E, Ferro Y, Pujia R, Maurotti S, Geirola N, Gazzaruso C, Romeo S, Pujia A, Montalcini T. Bending Resistance at Hip and Fractures Risk in Postmenopausal Women Independent of Bone Mineral Density. J Clin Densitom 2022; 25:198-207. [PMID: 34465538 DOI: 10.1016/j.jocd.2021.08.001] [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: 06/03/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022]
Abstract
Several studies suggest that aging loss of bone mass is not necessarily associated with reduced mechanical proprieties as bending resistance. Since postmenopausal women with fracture and without osteoporosis might have an impairment in the bending mechanisms at hip, our aim was to assess if women with and without fractures differ in the femoral parameters of resistance to bending, independent of the bone loss. In this cross-sectional study we enrolled 192 postmenopausal women who underwent X-ray absorptiometry scan to measure bone mineral density as well as cross-sectional geometry parameters at the hip (Hip structure analysis). Among women with osteoporosis, a higher odds ratio for fracture was found in the first tertile of NN-Dmax, a parameter linked to the resistance to bending forces in a cross-section (tertile I, OR = 6.7, p = 0.03; CI 1.19-38.01; reference tertile III). We also found a significantly higher risk for major fracture in the first tertile of NN-Dmax (tertile I, OR = 6.0, p = 0.02; CI 1.26-28.4; reference tertile III). Among women without osteoporosis, a significantly higher odds ratio for fracture was found in the first tertile of IT-CSA, a parameter of resistance to axial load (tertile I, OR = 7.2, p = 0.002; CI 2.04-25.9; reference tertile III). We also found a significantly higher risk for major fracture in the first tertile of IT-CSA (OR = 18.4, p = 0.001; CI 1.52-221.8; tertile III reference). We demonstrate that some hip structural parameters are independently associated to the fracture risk in postmenopausal women.
Collapse
Affiliation(s)
- Elisa Mazza
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro, Italy
| | - Yvelise Ferro
- Department of Health Science, University Magna Grecia, Catanzaro, Italy
| | - Roberta Pujia
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro, Italy
| | - Samantha Maurotti
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro, Italy
| | - Nadia Geirola
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro, Italy
| | - Carmine Gazzaruso
- Institute "Beato Matteo" (Hospital Group San Donato), Vigevano, Italy.; Department of Biomedical Science for Health, University of Milan, Milano, Italy
| | - Stefano Romeo
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro, Italy.; Department of Molecular and Clinical Medicine, Sahlgrenska Center for Cardiovascolar and Metabolic Research, University of Gothenburg, Göteborg, Sweden
| | - Arturo Pujia
- Department of Medical and Surgical Science, University Magna Grecia, Catanzaro, Italy.; Research Center for the Prevention and Treatment of Metabolic Diseases (CR METDIS), University Magna Grecia, Catanzaro, Italy
| | - Tiziana Montalcini
- Research Center for the Prevention and Treatment of Metabolic Diseases (CR METDIS), University Magna Grecia, Catanzaro, Italy.; Department of Clinical and Experimental Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy..
| |
Collapse
|
7
|
Cha YH, Yoo JI. Comparison of hip structure analysis and grip strength between femoral neck and basicervical fractures. BMC Musculoskelet Disord 2021; 22:461. [PMID: 34011356 PMCID: PMC8135173 DOI: 10.1186/s12891-021-04363-w] [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: 02/15/2021] [Accepted: 05/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to analyze differences in geometrical properties of the proximal femur and predict the occurrence of basicervical fractures through a comparative study of femoral neck and basicervical fractures in patients undergoing hip structural analysis (HSA). Methods All patients with hip fractures who were at least 65 years old and admitted to our hospital between March 2017 and December 2019 were eligible for this study. During the study period, 149 femur neck fractures (FNF) and basicervical fractures (intertrochanteric fractures of A31.2) were included in this study. Fifty-nine patients were included in the final analysis. Factors considered to be important confounders affecting the occurrence of basicervical hip fractures were chosen for propensity-score analysis. A logistic model with basicervical hip fracture as the outcome and age, sex, weight, spinal T-score, hip T-score, and vitamin D levels as confounders was used to estimate the propensity score. Results The cross-sectional moment of inertia (CSMI) of the intertrochanter was significantly lower in patients with basicervical hip fracture (HF) than in patients with FNF (p = 0.045). However, there was no significant differences in any other HSA variable between the two groups. Receiver operating characteristic (ROC) analysis showed that cutoff point for HSA was 100 for hip axis length (HAL) (AUC = 0.659, p < 0.001) and 5.712 for CSMI of the intertrochanter (AUC = 0.676, p < 0.001). ROC analysis showed that cutoff points of HAL, CSMI of intertrochanter, and handgrip strength were 104.8, 8.75, and 16.9, respectively (AUC = 0.726, p < 0.001). Conclusions Proximal femoral geometric analysis using HSA is a useful method for predicting the type of hip fracture. Additionally, a lower CSMI, a shorter HAL, and a lower grip strength are major predictors of basicervical fractures.
Collapse
Affiliation(s)
- Yong-Han Cha
- Department of Orthopaedic Surgery, Eulji University hospital, Daejeon, South Korea
| | - Jun-Il Yoo
- Department of Orthopaedic Surgery, Gyeongsang national university hospital, Jinju, Gyeongnamdo, South Korea.
| |
Collapse
|
8
|
Nguyen HH, Milat F, Vincent AJ. New insights into the diagnosis and management of bone health in premature ovarian insufficiency. Climacteric 2021; 24:481-490. [PMID: 33955314 DOI: 10.1080/13697137.2021.1917539] [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: 12/15/2022]
Abstract
Premature ovarian insufficiency (POI), defined as a loss of ovarian function before the age of 40 years, is a life-changing diagnosis that has numerous long-term consequences. Musculoskeletal complications, including osteoporosis and fractures, are a key concern for women with POI. The risk of bone loss is influenced by the underlying etiology of POI, and the degree and duration of estrogen deficiency. A decline in muscle mass as a result of estrogen and androgen deficiency may contribute to skeletal fragility, but has not been examined in women with POI. This article aims to review musculoskeletal health in POI; summarize the traditional and novel modalities available to screen for skeletal fragility and muscle dysfunction; and provide updated evidence for available management strategies.
Collapse
Affiliation(s)
- H H Nguyen
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia.,Department of Endocrinology, Monash Health, Clayton, VIC, Australia.,Department of Endocrinology and Diabetes, Western Health, St. Albans, VIC, Australia
| | - F Milat
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC, Australia.,Department of Endocrinology, Monash Health, Clayton, VIC, Australia.,Metabolic Bone Research Group, Hudson Institute of Medical Research, Clayton, VIC, Australia
| | - A J Vincent
- Department of Endocrinology, Monash Health, Clayton, VIC, Australia.,Monash Centre for Health Research and Implementation, Monash University, Clayton, VIC, Australia
| |
Collapse
|
9
|
Bonetto LM, Corso PFCDL, Kuchar GG, Gerber JT, Cunha LF, Elsalanty M, Zielak JC, Gonzaga CC, Scariot R. Effect of Age and Sodium Alendronate on Femoral Fracture Repair: Biochemical and Biomechanical Study in Rats. Front Cell Dev Biol 2021; 9:558285. [PMID: 34026748 PMCID: PMC8131822 DOI: 10.3389/fcell.2021.558285] [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] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Bisphosphonates are drugs widely used to reduce bone resorption, increase bone mineral density and control age-related bone loss. Although there are studies reporting differences in bone structure between young and old adults, it is still difficult to predict changes related to bone aging. The aim of this study was to evaluate the effect of age and sodium alendronate on bone repair of femoral fractures in rats. METHODS Wistar rats (n = 40) were allocated into groups: O (control old-rats), Y (control young-rats), OA (alendronate old-rats) and YA (alendronate young-rats). All animals underwent linear fracture surgery followed by fixation. Groups OA and YA received 1 mg/kg alendronate three times a week until euthanasia. Biochemical analysis of calcium and alkaline phosphatase was done. After euthanasia, femurs were evaluated in relation to cross-section and flexural strength, with three-point bending test. Data were submitted to statistical analysis with significance level of 0.05. RESULTS There was no difference in calcium and alkaline phosphatase levels (p > 0.05). Young animals presented lower cross-section than older animals (p < 0.05). Only fractured side, young animals presented major flexural strength than older animals (p < 0.05). There was no difference between the animals that used or not alendronate in relation to cross-section and flexural strength (p > 0.05). When compared fractured and non-fractured femurs, major cross-section on fractured side was observed (p < 0.05). Flexural strength presented higher values in femurs on non-fractured side (p < 0.05). There was correlation of weight and cross-section (R = +0.91) and weight with flexural strength of fractured and non-fractured side, respectively (R = -0.97 and -0.71). CONCLUSION In short, there was no difference of calcium and alkaline phosphatase during the bone repair process. Age has influence in cross-section and flexural strength. Alendronate showed no association with these factors.
Collapse
Affiliation(s)
| | | | | | | | | | - Mohammed Elsalanty
- Department of Medical Anatomical Science, Western University of Health Sciences, Pomona, CA, Unioted States
| | | | | | - Rafaela Scariot
- Department of Dentistry, Federal University of Parana, Curitiba, Brazil
| |
Collapse
|
10
|
Finianos B, Zunquin G, El Hage R. Composite Indices of Femoral Neck Strength in Middle-Aged Inactive Subjects Vs Former Football Players. J Clin Densitom 2021; 24:214-224. [PMID: 32631739 DOI: 10.1016/j.jocd.2020.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/08/2020] [Accepted: 06/08/2020] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to compare composite indices of femoral neck strength ((compression strength index [CSI], bending strength index [BSI], and impact strength index [ISI]) in inactive middle-aged men (n = 20) and middle-aged former football players (n = 15). 35 middle-aged men participated in this study. Body composition and bone variables were evaluated by dual-energy X-ray absorptiometry. Composite indices of femoral neck strength (CSI, BSI, and ISI) were calculated. Handgrip strength, vertical jump, maximum power of the lower limbs (watts), horizontal jump, maximal half-squat strength, maximal bench-press strength, sprint performance (10 meters), and maximum oxygen consumption (VO2 max, ml/min/kg) were evaluated using validated tests. CSI, BSI, and ISI were significantly higher in football players compared to inactive men. Vertical jump, horizontal jump, maximal half-squat strength, VO2 max and sprint performance were significantly different between the 2 groups. CSI, BSI, and ISI remained significantly higher in football players compared to inactive men after adjusting for physical activity level. The current study suggests that former football practice is associated with higher composite indices of femoral neck strength in middle-aged men.
Collapse
Affiliation(s)
- Boutros Finianos
- Department of Physical Education, Division of Education, Faculty of Arts and Sciences, University of Balamand, Kelhat El-Koura, Lebanon; EA 7369 - URePSSS - unité de recherche pluridisciplinaire sport santé société, Université Littoral Côte d'Opale, France
| | - Gautier Zunquin
- EA 7369 - URePSSS - unité de recherche pluridisciplinaire sport santé société, Université Littoral Côte d'Opale, France; Laboratoire Mouvement, Equilibre, Performance, Santé (MEPS, EA-4445), Université de Pau et des Pays de l'Adour, Tarbes, France
| | - Rawad El Hage
- Department of Physical Education, Division of Education, Faculty of Arts and Sciences, University of Balamand, Kelhat El-Koura, Lebanon.
| |
Collapse
|
11
|
Samad N, Nguyen HH, Ebeling PR, Milat F. Musculoskeletal Health in Premature Ovarian Insufficiency. Part Two: Bone. Semin Reprod Med 2021; 38:289-301. [PMID: 33784746 DOI: 10.1055/s-0041-1722849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Accelerated bone loss and muscle loss coexist in women with premature ovarian insufficiency (POI), but there are significant gaps in our understanding of musculoskeletal health in POI. This review describes estrogen signaling in bone and its role in skeletal health and disease. Possible mechanisms contributing to bone loss in different forms of POI and current evidence regarding the utility of available diagnostic tests and therapeutic options are also discussed. A literature review from January 2000 to March 2020 was conducted to identify relevant studies. Women with POI experience significant deterioration in musculoskeletal health due to the loss of protective effects of estrogen. In bone, loss of bone mineral density (BMD) and compromised bone quality result in increased fracture risk; however, tools to assess bone quality such as trabecular bone score (TBS) need to be validated in this population. Timely initiation of HRT is recommended to minimize the deleterious effects of estrogen deficiency on bone in the absence of contraindications; however, the ideal estrogen replacement regimen remains unknown. POI is associated with compromised bone health, regardless of the etiology. Ongoing research is warranted to refine our management strategies to preserve bone health in women with POI.
Collapse
Affiliation(s)
- Navira Samad
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria, Australia.,Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Hanh H Nguyen
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria, Australia.,Department of Endocrinology and Diabetes, Western Health, Victoria, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria, Australia
| | - Frances Milat
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria, Australia.,Department of Endocrinology and Diabetes, Western Health, Victoria, Australia
| |
Collapse
|
12
|
Dias TRDS, Batista BB, Chang RWML, Noriega JEA, Figueiredo GLPD. Evaluation of Nutritional Status and Correlation with Postoperative Complications in Elderly Patients Submitted to Surgical Treatment of Proximal Femoral Fractures. Rev Bras Ortop 2021; 56:104-108. [PMID: 33627908 PMCID: PMC7895625 DOI: 10.1055/s-0040-1721365] [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] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 09/16/2020] [Indexed: 11/15/2022] Open
Abstract
Objective
This study aims to evaluate and correlate the nutritional status with potential complications during the immediate postoperative period of elderly patients surgically treated for proximal femoral fractures.
Methods
A prospective, cross-sectional analytical study with a quantitative approach, targeting patients aged 60 years old or more who were admitted to a hospital in Amazonas, Brazil, for surgical treatment of proximal femoral fractures. Surgical complications during the immediate postoperative period and their relationship with the nutritional status of the patient were determined using the mini nutritional assessment (MNA); in addition, the lymphocyte numbers and serum albumin levels were determined and correlated with the length of hospital stay.
Results
The sample consisted of 19 elderly patients, of both genders, with a mean age of 70.8 years. Most of the subjects (68.4%) were female. Malnutrition was diagnosed in 15.8% of the subjects using the body mass index (BMI) as, an anthropometric variable, and the MNA identified 31.6% of the subjects with malnutrition. Regarding total lymphocyte count, 100% of the sample showed a positive association with malnutrition in varying degrees; using serum albumin level as a parameter, malnutrition was identified in 89.4% of the subjects. Malnourished patients had the highest average length of stay. Surgical complications as surgical site infections occurred in 10.5% of the patients at risk of malnutrition.
Conclusion
This study revealed a higher rate of postoperative complications in elderly patients diagnosed with malnutrition.
Collapse
Affiliation(s)
- Tiane Raquel da Silva Dias
- Serviço de Ortopedia e Traumatologia, Hospital Universitário Getúlio Vargas (HUGV), Universidade Federal do Amazonas (UFAM), Manaus, AM, Brasil
| | - Bruno Bellaguarda Batista
- Serviço de Ortopedia e Traumatologia, Hospital Universitário Getúlio Vargas (HUGV), Universidade Federal do Amazonas (UFAM), Manaus, AM, Brasil
| | - Rafael Wei Min Leal Chang
- Serviço de Ortopedia e Traumatologia, Hospital Universitário Getúlio Vargas (HUGV), Universidade Federal do Amazonas (UFAM), Manaus, AM, Brasil
| | - Jorge Enrique Acosta Noriega
- Serviço de Ortopedia e Traumatologia, Hospital Universitário Getúlio Vargas (HUGV), Universidade Federal do Amazonas (UFAM), Manaus, AM, Brasil
| | | |
Collapse
|
13
|
Watanabe D, Kimura T, Yamashita A, Minowa T, Miura K, Mizushima A. The influence of androgen deprivation therapy on hip geometric properties and bone mineral density in Japanese men with prostate cancer and its relationship with the visceral fat accumulation. Aging Male 2020; 23:1158-1164. [PMID: 31959023 DOI: 10.1080/13685538.2020.1713741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The influence of androgen deprivation therapy (ADT) for prostate cancer on the hip geometric properties evaluated by dual-energy X-ray absorptiometry (DXA) has not yet been demonstrated. This study aimed to investigate the changes in these properties after 1 year of ADT. A total of 65 Japanese men with prostate cancer who underwent ADT for the first time in our facility were included in the study. The hip geometric parameters and the bone mineral density (BMD) taken before and after 1 year of ADT were retrospectively examined. With ADT, we not only confirmed significant BMD annual changes in the lumbar spine, the femoral neck, and the total hip of -1.65%, -1.91%, and -2.20%, respectively, but we also confirmed significant annual changes in cross-sectional areas, cross-sectional moments of inertia, and section modulus in the narrow femoral neck of -2.55%, -3.50%, and -3.14%, respectively. The annual rate of decrease in the femoral neck BMD was significantly higher in patients with visceral fat obesity than in those without visceral obesity (-1.79% vs. -0.28%). One year of ADT for Japanese men with prostate cancer might decrease the strength of bending and the structural rigidity as well as BMD at the femoral neck.
Collapse
Affiliation(s)
- Daisuke Watanabe
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Urology, Koto Hospital, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | | | | | - Kunihisa Miura
- Department of Anesthesiology and Pain Medicine, Koto Hospital, Tokyo, Japan
| | - Akio Mizushima
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
14
|
Zakhem E, Sabbagh P, Ghanem-Zakhem A, El Khoury C, El Khoury G, Zunquin G, Baquet G, El Hage R. Influence of Physical Activity Level on Composite Indices of Femoral Neck Strength in a Group of Young Overweight Men. J Clin Densitom 2020; 23:596-603. [PMID: 32037206 DOI: 10.1016/j.jocd.2020.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/30/2019] [Accepted: 01/06/2020] [Indexed: 01/05/2023]
Abstract
The aim of the present study was to explore the influence of physical activity level on composite indices of femoral neck strength (compression strength index [CSI], bending strength index, and impact strength index) in a group of young overweight men. To do so, we compared composite indices of femoral neck strength in active overweight men and insufficiently active overweight men. They were divided into 2 groups based on their physical activity level: 70 active overweight men (engaging in more than 150 minutes of physical activity per week; 8.7 ± 4.8 h/wk) and 26 insufficiently active overweight men (engaging in less than 150 minutes of physical activity per week; 1.2 ± 0.7 h/wk). Height (m) and weight (kg) were measured, and body mass index (kg/m2) was calculated. Bone mineral density was measured by dual-energy X-ray absorptiometry at whole body, lumbar spine, total hip, and femoral neck. Body weight, lean mass, fat mass, and body mass index were not significantly different between the 2 groups. CSI, bending strength index, and impact strength index were significantly higher in active overweight men compared to insufficiently active overweight men. After adjustment for age, physical activity (h/wk) and lean mass, only CSI remained higher in active overweight men compared to insufficiently active overweight men. This study suggests that, in young overweight men, being active (engaging in more than 150 minutes of physical activity per week) is associated with greater composite indices of femoral neck strength. To our knowledge, this is the first study that finds a significant difference regarding composite indices of femoral neck strength between 2 groups of young overweight men with different levels of physical activity.
Collapse
Affiliation(s)
- Eddy Zakhem
- Department of Physical Education, Division of Education, Faculty of Arts and Sciences, University of Balamand, Kelhat El-Koura, Lebanon
| | - Patchina Sabbagh
- Department of Physical Education, Division of Education, Faculty of Arts and Sciences, University of Balamand, Kelhat El-Koura, Lebanon; University of Lille, EA 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Ronchin, France
| | - Aline Ghanem-Zakhem
- Department of Physical Education, Division of Education, Faculty of Arts and Sciences, University of Balamand, Kelhat El-Koura, Lebanon
| | - César El Khoury
- Department of Physical Education, Division of Education, Faculty of Arts and Sciences, University of Balamand, Kelhat El-Koura, Lebanon
| | - Georges El Khoury
- Department of Physical Education, Division of Education, Faculty of Arts and Sciences, University of Balamand, Kelhat El-Koura, Lebanon
| | - Gautier Zunquin
- Université Littoral Côte d'Opale, EA 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Dunkerque, France; Laboratoire Mouvement, Equilibre, Performance et Santé (UPRES EA 4445), Département STAPS, Université de Pau et des Pays de l'Adour, Tarbes, France
| | - Georges Baquet
- University of Lille, EA 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Ronchin, France
| | - Rawad El Hage
- Department of Physical Education, Division of Education, Faculty of Arts and Sciences, University of Balamand, Kelhat El-Koura, Lebanon.
| |
Collapse
|
15
|
Shin YH, Gong HS, Kim KM, Lee JH, Kwon O, Baek GH. Evaluation of Hip Geometry Parameters in Patients With a Distal Radius Fracture. J Clin Densitom 2020; 23:576-581. [PMID: 31253483 DOI: 10.1016/j.jocd.2019.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with a distal radius fracture (DRF) have an increased risk of subsequent fractures including hip fractures. The purpose of this study was to evaluate whether women with a DRF have certain hip geometry parameters known to indicate susceptibility to hip fractures. METHODS We compared bone mineral density (BMD) and hip geometry parameters (hip axis length, neck shaft angle, mean cortical thickness, femur neck width, cross-sectional area [CSA], cross-sectional moment of inertia, section modulus, and buckling ratio) in 181 women with a DRF (DRF group) and 362 propensity score-matched women without a fracture (control group). We evaluated the associations between DRF and hip geometry parameters using logistic regression analysis. RESULTS The DRF group had lower hip BMD; lower cortical thickness, CSA, and section modulus; and higher buckling ratio than the control group (all p < 0.05). The occurrence of a DRF was significantly associated with decreases in neck shaft angle (odds ratio [OR], 1.047; 95% confidence interval [CI], 1.008-1.088) and CSA (OR, 3.114; 95% CI, 1.820-5.326) after adjusting for age, BMI, and total hip BMD. CONCLUSIONS In this study, women with a DRF were more likely than women without a DRF to have hip geometry parameters known to indicate susceptibility to hip fractures. Our results suggest that not only low hip BMD but also a decreased CSA could account for the increased risk of subsequent hip fracture in patients with a DRF.
Collapse
Affiliation(s)
- Young Ho Shin
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyun Sik Gong
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seoungnam-si, Gyeonggi-do, South Korea.
| | - Kyoung Min Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seoungnam-si, Gyeonggi-do, South Korea
| | - Jeong Hyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seoungnam-si, Gyeonggi-do, South Korea
| | - Ohsang Kwon
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seoungnam-si, Gyeonggi-do, South Korea
| | - Goo Hyun Baek
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
16
|
Impact of sleeve gastrectomy on hip structural analysis in adolescents and young adults with obesity. Surg Obes Relat Dis 2020; 16:2022-2030. [PMID: 32861645 DOI: 10.1016/j.soard.2020.07.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/12/2020] [Accepted: 07/15/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sleeve gastrectomy (SG), the most commonly performed metabolic and bariatric surgery, is associated with reductions in areal bone mineral density at multiple sites, and changes in bone structure at the distal radius and tibia without reductions in strength estimates at these peripheral sites. Data are lacking regarding effects on hip strength estimates. OBJECTIVE To evaluate effects of SG on measures of hip structural analysis in adolescents and young adults over 12 months using dual-energy x-ray absorptiometry. SETTINGS Translational and Clinical Research Center. METHODS We enrolled 48 youth 14- to 22-years old with moderate-to-severe obesity; 24 underwent SG and 24 controls were followed without surgery (18 females, 6 males in each group). Hip structure was assessed using dual-energy x-ray absorptiometry at baseline and 12 months. Analyses are adjusted for age, sex, race, and the baseline bone measure. RESULTS The SG group lost 25.9% weight versus .3% in controls. Compared with controls, SG had reductions in narrow neck, intertrochanteric and femoral shaft bone mineral density Z-scores (P ≤ .012). Furthermore, SG had greater reductions in narrow neck and intertrochanteric region (but not femoral shaft) cross-sectional area, cortical thickness, cross-sectional moment of inertia and section modulus, and increases in buckling ratio (P ≤ .039). Differences were attenuated after adjusting for 12-month body mass index change. At 12 months, differences were minimal after adjusting for age, sex, race, and weight. CONCLUSIONS Over 12 months, SG had negative effects at the narrow neck and intertrochanteric regions of the hip, but not the femoral shaft. Reduced body mass index may compensate for these deleterious effects on bone.
Collapse
|
17
|
Loundagin LL, Haider IT, Cooper DM, Edwards WB. Association between intracortical microarchitecture and the compressive fatigue life of human bone: A pilot study. Bone Rep 2020; 12:100254. [PMID: 32258250 PMCID: PMC7110329 DOI: 10.1016/j.bonr.2020.100254] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 11/18/2022] Open
Abstract
Many mechanical properties of cortical bone are largely governed by the underlying microarchitecture; however, the influence of microarchitecture on the fatigue life of bone is poorly understood. Furthermore, imaging-based studies investigating intracortical microarchitecture may expose bone samples to large doses of radiation that may compromise fatigue resistance. The purpose of this pilot study was to 1) investigate the relationship between intracortical microarchitecture and the fatigue life of human bone in compression and 2) examine the effects of synchrotron irradiation on fatigue life measurements. Cortical samples were prepared from the femoral and tibial shafts of three cadaveric donors. A subset of samples was imaged using synchrotron X-ray microCT to quantify microarchitecture, including porosity, canal diameter, lacunar density, lacunar volume, and lacunar orientation. A second group of control samples was not imaged and used only for mechanical testing. Fatigue life was quantified by cyclically loading both groups in zero-compression until failure. Increased porosity and larger canal diameter were both logarithmically related to a shorter fatigue life, whereas lacunar density demonstrated a positive linear relationship with fatigue life (r2 = 45–73%, depending on measure). Irradiation from microCT scanning reduced fatigue life measurements by 91%, but relationships with microarchitecture measurements remained. Additional research is needed to support the findings of this pilot study and fully establish the relationship between intracortical microarchitecture and the compressive fatigue life of bone. Increased porosity and larger canal diameters were associated with a shorter compressive fatigue life. A higher lacunar density was related to a longer compressive fatigue life. Irradiation from synchrotron X-ray microCT scanning reduced fatigue life by 91%. The influence of microarchitecture on fatigue life exhibited similar trends for both irradiated and non-irradiated bone.
Collapse
Affiliation(s)
- Lindsay L. Loundagin
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada
- Corresponding author at: Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
| | - Ifaz T. Haider
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada
| | - David M.L. Cooper
- Department of Anatomy, Physiology and Pharmacology, University of Saskatchewan, 105 Administration Place, Saskatoon, SK S7N 5A2, Canada
| | - W. Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada
| |
Collapse
|
18
|
Godang K, Lekva T, Normann KR, Olarescu NC, Øystese KAB, Kolnes A, Ueland T, Bollerslev J, Heck A. Hip Structure Analyses in Acromegaly: Decrease of Cortical Bone Thickness After Treatment: A Longitudinal Cohort Study. JBMR Plus 2019; 3:e10240. [PMID: 31844828 PMCID: PMC6894724 DOI: 10.1002/jbm4.10240] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 08/23/2019] [Accepted: 09/03/2019] [Indexed: 02/03/2023] Open
Abstract
Long‐standing growth hormone (GH) excess causes the skeletal clinical signs of acromegaly with typical changes in bone geometry, including increased cortical bone thickness (CBT). However, a high prevalence and incidence of vertebral fractures has been reported. The aim of this study was to assess the course of cortical bone dimensions in the hip by comparing patients with acromegaly and clinically nonfunctioning pituitary adenomas (NFPAs) at baseline and 1 year after pituitary surgery (1‐year PO) in a longitudinal cohort study. DXA was performed in patients with acromegaly (n = 56) and NFPA (n = 47). CBT in the femoral neck (CBTneck), calcar (CBTcalcar), and shaft (CBTshaft) were determined by hip structural analysis (HSA). CBT at baseline and the change to 1‐year PO were compared. Test results were adjusted for differences in gender distribution, age, and gonadal status. Cortical thickness analyses showed higher values [mm] at baseline in patients with acromegaly compared with NFPA: CBTneck median [25th; 75th] 6.2 [4.7; 8.0] versus 5.1 [4.1; 6.4] (p = 0.006), CBTcalcar 4.8 [4.2, 5.7] versus 4.0 [3.2, 4.5] (p < 0.001), CBTshaft 6.2 [5.1, 7.2] versus 5.2 [4.6, 6.0], (p = 0.003). In acromegaly, GH was correlated with CBTneck (r = 0.31, p = 0.020), whereas IGF‐1 was correlated with CBTcalcar (r = 0.39, p = 0.003) at baseline. In acromegaly, CBTneck decreased by 11.2%, p = 0.002 during follow‐up. Finally, the decrease in CBTneck and CBTcalcar in acromegaly was significant compared with NFPA (p = 0.023 and p = 0.017, respectively). Previous observations of increased CBT in acromegaly were confirmed with DXA‐derived HSA in a large, well‐defined cohort. The decline in CBT in acromegaly could contribute to the increased fracture risk in acromegaly despite increased bone dimensions and disease control. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
Collapse
Affiliation(s)
- Kristin Godang
- Section of Specialized Endocrinology Oslo University Hospital Oslo Norway
| | - Tove Lekva
- Research Institute of Internal Medicine Oslo University Hospital Oslo Norway
| | - Kjersti Ringvoll Normann
- Section of Specialized Endocrinology Oslo University Hospital Oslo Norway.,Faculty of Medicine University of Oslo Oslo Norway
| | | | | | - Anders Kolnes
- Section of Specialized Endocrinology Oslo University Hospital Oslo Norway
| | - Thor Ueland
- Research Institute of Internal Medicine Oslo University Hospital Oslo Norway.,Faculty of Medicine University of Oslo Oslo Norway.,KG Jebsen TREC University of Tromsø Tromsø Norway
| | - Jens Bollerslev
- Section of Specialized Endocrinology Oslo University Hospital Oslo Norway.,Faculty of Medicine University of Oslo Oslo Norway
| | - Ansgar Heck
- Section of Specialized Endocrinology Oslo University Hospital Oslo Norway.,Faculty of Medicine University of Oslo Oslo Norway
| |
Collapse
|
19
|
Bone Mineral Density and Bone Turnover Markers in Postmenopausal Women Subjected to an Aqua Fitness Training Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142505. [PMID: 31337049 PMCID: PMC6678096 DOI: 10.3390/ijerph16142505] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/09/2019] [Accepted: 07/12/2019] [Indexed: 01/30/2023]
Abstract
The purpose of this study was to analyze the influence of aqua fitness training in deep water on bone tissue. The study was performed with 18 postmenopausal women separated into two groups: training and control groups. Before and after the training program, the hip and spine areal bone mineral density were measured along with the biochemical parameters of serum concentration of osteocalcin (OC) and C-terminal telopeptide of type I collagen (CTX). The most significant effect was found in differences between the two groups of women in terms of femur strength index (p < 0.05) during the period of the training program. The study demonstrated that an aqua fitness training program caused favorable changes in femur strength index in postmenopausal women, and this kind of exercise could be a useful form of physical activity for postmenopausal women.
Collapse
|
20
|
Shi X, Deng Y, Kang H, Liu M, Chen YM, Xiao SM. Association of body composition with predicted hip bone strength among Chinese postmenopausal women: a longitudinal study. Sci Rep 2019; 9:5507. [PMID: 30940851 PMCID: PMC6445069 DOI: 10.1038/s41598-019-42031-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 03/21/2019] [Indexed: 02/08/2023] Open
Abstract
Body composition and bone strength are closely associated. How lean mass (LM) and fat mass (FM) contribute to bone strength remains ambiguous. We investigated the associations of total body LM and FM with changes in predicted hip bone strength over a period of 3 years in 1,743 postmenopausal Chinese women from the communities of Guangzhou, China. The body compositions of the women were obtained with dual-energy X-ray absorptiometry. We used the hip structure analysis program to obtain the bone parameters at the femoral neck region, including the bone mineral density (BMD), cross-sectional area (CSA), cortical thickness (CT), section modulus (SM) and buckling ratio (BR). We found the FM and LM were positive predictors for hip bone strength (β > 0, P < 0.05). The LM had a larger contribution to the BMD, CSA, CT, SM and/or their annual percent changes (βLM > βFM), while the contribution of FM to the BR and its annual percent change was higher than LM (|βFM| > |βLM|). Further analysis found that the associations of FM and LM with bone parameters were stronger in the underweight and normal weight participants (|βBMI1| > |βBMI2|). Overall, FM and LM had positive but differential effects on predicted hip bone strength, with a higher impact in the thinner participants.
Collapse
Affiliation(s)
- Xin Shi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yunyang Deng
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Huili Kang
- Haizhu District Center for Disease Control and Prevention, Guangzhou, 510310, China
| | - Meng Liu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yu-Ming Chen
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Su-Mei Xiao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
| |
Collapse
|
21
|
Hong AR, Kim SW. Effects of Resistance Exercise on Bone Health. Endocrinol Metab (Seoul) 2018; 33:435-444. [PMID: 30513557 PMCID: PMC6279907 DOI: 10.3803/enm.2018.33.4.435] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 10/30/2018] [Accepted: 11/02/2018] [Indexed: 12/31/2022] Open
Abstract
The prevalence of chronic diseases including osteoporosis and sarcopenia increases as the population ages. Osteoporosis and sarcopenia are commonly associated with genetics, mechanical factors, and hormonal factors and primarily associated with aging. Many older populations, particularly those with frailty, are likely to have concurrent osteoporosis and sarcopenia, further increasing their risk of disease-related complications. Because bones and muscles are closely interconnected by anatomy, metabolic profile, and chemical components, a diagnosis should be considered for both sarcopenia and osteoporosis, which may be treated with optimal therapeutic interventions eliciting pleiotropic effects on both bones and muscles. Exercise training has been recommended as a promising therapeutic strategy to encounter the loss of bone and muscle mass due to osteosarcopenia. To stimulate the osteogenic effects for bone mass accretion, bone tissues must be exposed to mechanical load exceeding those experienced during daily living activities. Of the several exercise training programs, resistance exercise (RE) is known to be highly beneficial for the preservation of bone and muscle mass. This review summarizes the mechanisms of RE for the preservation of bone and muscle mass and supports the clinical evidences for the use of RE as a therapeutic option in osteosarcopenia.
Collapse
Affiliation(s)
- A Ram Hong
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.
| |
Collapse
|
22
|
Yang XJ, Sang HX, Bai B, Ma XY, Xu C, Lei W, Zhang Y. Ex Vivo Evaluation of Hip Fracture Risk by Proximal Femur Geometry and Bone Mineral Density in Elderly Chinese Women. Med Sci Monit 2018; 24:7438-7443. [PMID: 30334549 PMCID: PMC6392087 DOI: 10.12659/msm.910876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background The incidence of hip fracture is steadily increasing. We aimed to establish a creative approach to precisely estimate the risk of hip fracture by exploring the relationship between hip fracture and bone mineral density (BMD)/femur geometry. Material/Methods Sixteen samples of cadaveric female proximal femora were randomly selected. Experiments were performed experimental measurement of the femoral neck BMD and geometric parameters (including neck length, neck diameter, head diameter, and neck-shaft angle). In addition, the experimental measurements contain the failure load, which represents the mechanical strength of the femoral neck, and we calculated the correlation coefficient among BMD, geometric parameters, and failure load. Results Significant correlations were discovered between femoral mechanical properties and femoral neck BMD (r=0.792, r2=0.628, P<0.001), trochanteric BMD (r=0.749, r2=0.560, P=0.001), and head diameter (r=0.706, r2=0.499, P=0.002). Multiple linear regression analyses indicated that the best predictor of hip fracture was the combination of femoral neck BMD, head diameter, and neck diameter (r2=0.844, P<0.001). Conclusions The results confirmed that, compared with BMD alone, the combination of BMD and geometric parameters of proximal femur is a better estimation of hip fracture. The geometry of the proximal femur played an important role in assessing the biomechanical strength of femur. This method greatly assists in predicting the risk of hip fracture in clinical trials and will assist studies on why the incidence of hip fracture varies among races.
Collapse
Affiliation(s)
- Xiao-Jiang Yang
- Department of Orthopedic Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, Shaanxi, China (mainland)
| | - Hong-Xun Sang
- Department of Orthopedics, Shenzhen Hospital, Southern Medical University, Shenzhen, Guangdong, China (mainland)
| | - Bo Bai
- Department of Orthopedic Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, Shaanxi, China (mainland)
| | - Xiang-Yu Ma
- Department of Orthopedic Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, Shaanxi, China (mainland)
| | - Chao Xu
- Department of Orthopedic Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, Shaanxi, China (mainland)
| | - Wei Lei
- Department of Orthopedic Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, Shaanxi, China (mainland).,Department of Orthopaedics, Xijing Hospital, Air Force Medical University, Xi'an, China (mainland)
| | - Yang Zhang
- Department of Orthopedic Surgery, Xijing Hospital, The Air Force Medical University, Xi'an, Shaanxi, China (mainland)
| |
Collapse
|
23
|
Leslie WD, Lix LM, Majumdar SR, Morin SN, Johansson H, Odén A, McCloskey EV, Kanis JA. Total Hip Bone Area Affects Fracture Prediction With FRAX® in Canadian White Women. J Clin Endocrinol Metab 2017; 102:4242-4249. [PMID: 29092086 DOI: 10.1210/jc.2017-01327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 09/11/2017] [Indexed: 01/17/2023]
Abstract
CONTEXT Areal bone mineral density (BMD) measurements are confounded by skeletal size. Hip BMD is an input to the FRAX® tool (Centre for Metabolic Bone Diseases, University of Sheffield, United Kingdom), but it is unknown whether performance is affected by hip area. OBJECTIVE To examine whether fracture prediction by FRAX® is affected by hip area. DESIGN AND SETTING Cohort study using a population-based BMD registry. PATIENTS A total of 58,108 white women aged ≥40 years. MAIN OUTCOME MEASURES Incident major osteoporotic fracture (MOF; n = 4913) and hip fracture (n = 1369), stratified by total hip area quintile, before and after adjustment for hip axis length (HAL). RESULTS Smaller hip area was associated with younger age and lower FRAX® scores, whereas incident fractures were greater in those with larger hip area (P for trend < 0.001). Larger hip area quintile increased risk for MOF and hip fracture when adjusted for FRAX® score with BMD (P for trend < 0.001). Each standard deviation increase in hip area was associated with greater risk for incident MOF [adjusted hazard ratio (HR), 1.08; 95% confidence interval (CI), 1.05 to 1.11] and hip fracture (HR, 1.16; 95% CI, 1.11 to 1.21), but not after adjustment for HAL. FRAX® with BMD underestimated MOF risk in the largest hip area quintile and underestimated hip fracture risk in the three largest hip area quintiles. CONCLUSIONS In Canadian white women, skeletal size based on hip area affects fracture risk assessment based on FRAX® score with BMD, with risk underestimated in those with larger hip areas. Including HAL in the risk assessment compensates for this confounding by skeletal size and provides for more accurate assessment of fracture risk.
Collapse
Affiliation(s)
- William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba R3E 3P5, Canada
| | - Lisa M Lix
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba R3E 3P5, Canada
| | - Sumit R Majumdar
- Department of Medicine, University of Alberta, Edmonton, Alberta T6G 2G3, Canada
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montreal, Quebec H4A 3J1, Canada
| | - Helena Johansson
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield S10 2RX, United Kingdom
- Institute for Health and Aging, Catholic University of Australia, Melbourne, Victoria 3000, Australia
| | - Anders Odén
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield S10 2RX, United Kingdom
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield S10 2RX, United Kingdom
| | - John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield S10 2RX, United Kingdom
- Institute for Health and Aging, Catholic University of Australia, Melbourne, Victoria 3000, Australia
| |
Collapse
|
24
|
Edmondson CP, Schwartz EN. Non-BMD DXA measurements of the hip. Bone 2017; 104:73-83. [PMID: 28476576 DOI: 10.1016/j.bone.2017.03.050] [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: 01/16/2017] [Revised: 03/19/2017] [Accepted: 03/19/2017] [Indexed: 12/31/2022]
Abstract
Hip fracture is one of the most serious complications of osteoporosis. More than 50% of hip and other fractures occur in patients without densitometric osteoporosis. Therefore, areal bone mineral density (aBMD) may not be the best way to assess fracture risk. In order to improve assessment of fracture risk, many other approaches have been taken. At the present time, the Fracture Risk Algorithm (FRAX©) is one of the most notable ways to improve assessment of fracture risk. However, since early in the initiation of the dual energy x-ray absorptiometry (DXA) era, several non-BMD DXA approaches to the assessment of hip fracture risk have been proposed. This review will cover some of those methodologies, including hip-axis length (HAL), hip-structural analysis (HSA), finite element analysis (FEA) by DXA, and body composition of the thigh by DXA (BCT). These methods have been utilized in models of hip fracture occurrence and in pharmacological clinical trials. How they should be used in clinical practice or if they should be used in clinical practice is more of an issue. In addition, we will discuss the recent proposal of the use of Long Femur Scan Field in the effort to diagnose atypical femoral fractures.
Collapse
Affiliation(s)
- Clinten P Edmondson
- The Northern California Institute for Bone Health, Inc., Orinda, CA 94563, United States.
| | - Elliott N Schwartz
- The Northern California Institute for Bone Health, Inc., Orinda, CA 94563, United States.
| |
Collapse
|
25
|
Bonaccorsi G, Fila E, Messina C, Maietti E, Ulivieri FM, Caudarella R, Greco P, Guglielmi G. Comparison of trabecular bone score and hip structural analysis with FRAX ® in postmenopausal women with type 2 diabetes mellitus. Aging Clin Exp Res 2017; 29:951-957. [PMID: 27722900 DOI: 10.1007/s40520-016-0634-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate (a) the performance in predicting the presence of bone fractures of trabecular bone score (TBS) and hip structural analysis (HSA) in type 2 diabetic postmenopausal women compared to a control group and (b) the fracture prediction ability of TBS versus Fracture Risk Calculator (FRAX®) as well as whether TBS can improve the fracture prediction ability of FRAX® in diabetic women. METHODS Eighty diabetic postmenopausal women were matched with 88 controls without major diseases for age and body mass index. The individual 10-year fracture risk was assessed by FRAX® tool for Europe-Italy; bone mineral density (BMD) at lumbar spine, femoral neck and total hip was evaluated through dual-energy X-ray absorptiometry; TBS measurements were taken using the same region of interest as the BMD measurements; HSA was performed at proximal femur with the HSA software. RESULTS Regarding variables of interest, the only significant difference between diabetic and control groups was observed for the value of TBS (median value: 1.215; IQR 1.138-1.285 in controls vs. 1.173; IQR 1.082-1.217 in diabetic; p = 0.002). The prevalence of fractures in diabetic women was almost tripled than in controls (13.8 vs. 3.4 %; p = 0.02). The receiver operator characteristic curve analysis showed that TBS alone (AUC = 0.71) had no significantly lower discriminative power for fracture prediction in diabetic women than FRAX major adjusted for TBS (AUC = 0.74; p = 0.65). CONCLUSION In diabetic postmenopausal women TBS is an excellent tool in identifying fragility fractures.
Collapse
|
26
|
Abstract
Bone mineral density (BMD) measurement by dual-energy X-ray absorptiometry (DXA) is the most commonly used method to assess fracture risk. DXA utilizes two different energy X-rays to calculate BMD and, by comparison to a young normative database, the T-score. In 1994, the World Health Organization defined osteoporosis based on T-score, changing the paradigm of the field and forever placing DXA measurements in the center of osteoporosis diagnosis. Since then, many large studies have demonstrated the predictive value of BMD by DXA-for every standard deviation decline in BMD, there is a relative risk of 1.5-2.5 for fracture. This predictive ability is similar to how blood pressure can predict myocardial infarction. Limitations of DXA are also important to consider. While BMD by DXA can identify those at risk, there is a significant overlap in the BMD of patients who will and will not fracture. Special considerations are also needed in men and ethnic minority groups. These groups may have different bone size, thus affecting the normative range of BMD, and/or distinct bone structure that affect the association between BMD and fractures. Finally, BMD can be affected by positioning errors or artifacts, including osteoarthritis, fracture, and jewelry. Of course, DXA has tremendous strengths as well-namely its wide availability, its low radiation exposure, and a large body of evidence that relate DXA measurements to fracture risk. For these reasons, DXA remains the cornerstone of fracture assessment now and for the foreseeable future.
Collapse
Affiliation(s)
- Rajesh K Jain
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637; Department of Medicine, Section of Diabetes, Metabolism, and Endocrinology, Temple University Hospital, 3401 N Broad St, Philadelphia, PA 19140.
| | - Tamara Vokes
- Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637
| |
Collapse
|
27
|
Jung KY, Hong AR, Lee DH, Kim JH, Kim KM, Shin CS, Kim SY, Kim SW. The natural history and hip geometric changes of primary hyperparathyroidism without parathyroid surgery. J Bone Miner Metab 2017; 35:278-288. [PMID: 27038988 DOI: 10.1007/s00774-016-0751-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 02/22/2016] [Indexed: 10/22/2022]
Abstract
There have been few reports on changes in bone geometry in asymptomatic patients with primary hyperparathyroidism (PHPT) not treated surgically. We reviewed the records concerning biochemical parameters, bone mineral density (BMD), and hip geometry in 119 PHPT patients who did not undergo parathyroidectomy, followed up at one of three hospitals affiliated to Seoul National University from 1997 to 2013. We examined biochemical parameters over 7 years and BMD and hip geometry over 5 years of follow-up. We further compared hip geometry and BMD derived from dual-energy X-ray absorptiometry (DXA) between patients and age- and sex-matched controls. The median follow-up duration of 56 patients for whom surgery was not indicated was 33.9 months (range 11.2-131.2 months), and 19.6 % of these patients had disease progression during follow-up. Serum calcium levels remained stable for 7 years in all 119 patients. From a comparison of the PHPT patients for whom surgery was not indicated with controls, both male and postmenopausal female patients had significantly lower hip axis length (P < 0.001), cross-sectional moment of inertia (P < 0.001), cross-sectional area (P < 0.001), and section modulus (P < 0.001). In addition, cortical thickness was significantly decreased at 5 years compared with individual baseline values (P = 0.003). However, there was no significant change in BMD for the duration of the 5-year follow-up. DXA-derived geometry can detect skeletal change in asymptomatic PHPT patients for whom surgery is not indicated, supporting the concept that even mild PHPT can eventually compromise the cortical bones. Hip geometry is a potential tool for monitoring skeletal complication in asymptomatic PHPT patients.
Collapse
Affiliation(s)
- Kyong Yeun Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam City, Gyeonggi-do, Republic of Korea
| | - A Ram Hong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Hwa Lee
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam City, Gyeonggi-do, Republic of Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung Min Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam City, Gyeonggi-do, Republic of Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong Yeon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 156-707, Republic of Korea.
| |
Collapse
|
28
|
Zymbal V, Janz KF, Baptista F. Sexual dimorphism in bone–muscle relationship in young adults. J Sports Sci 2016; 35:2433-2438. [DOI: 10.1080/02640414.2016.1273535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Vera Zymbal
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| | - Kathleen F. Janz
- Department of Health and Human Physiology and Department of Epidemiology, University of Iowa, Iowa City, IA, USA
| | - Fátima Baptista
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisbon, Portugal
| |
Collapse
|
29
|
Han J, Hahn MH. Proximal Femoral Geometry as Fracture Risk Factor in Female Patients with Osteoporotic Hip Fracture. J Bone Metab 2016; 23:175-82. [PMID: 27622182 PMCID: PMC5018611 DOI: 10.11005/jbm.2016.23.3.175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/03/2016] [Accepted: 08/03/2016] [Indexed: 11/18/2022] Open
Abstract
Background Proximal femoral geometry may be a risk factor of osteoporotic hip fractures. However, there existed great differences among studies depending on race, sex and age of subjects. The purpose of the present study is to analyze proximal femoral geometry and bone mineral density (BMD) in the osteoporotic hip fracture patients. Furthermore, we investigated proximal femoral geometric parameters affecting fractures, and whether the geometric parameters could be an independent risk factor of fractures regardless of BMD. Methods This study was conducted on 197 women aged 65 years or more who were hospitalized with osteoporotic hip fracture (femur neck fractures ; 84, intertrochanteric fractures; 113). Control group included 551 women who visited to check osteoporosis. Femur BMD and proximal femoral geometry for all subjects were measured using dual energy X-ray absorptiometry (DXA), and compared between the control and fracture groups. Besides, proximal femoral geometric parameters associated with fractures were statistically analyzed. Results There were statistically significant differences in the age and weight, cross-sectional area (CSA)/length/width of the femoral neck and BMD of the proximal femur between fracture group and control group. BMD of the proximal femur in the control group was higher than in the fracture group. For the femoral neck fractures group, the odds ratio (OR) for fractures decrease in the CSA and neck length (NL) of the femur increased by 1.97 times and 1.73 times respectively, regardless of BMD. The OR for fractures increase in the femoral neck width increased by 1.53 times. In the intertrochanteric fracture group, the OR for fractures increase in the femoral neck width increased by 1.45 times regardless of BMD. Conclusions We found that an increase of the femoral neck width could be a proximal femoral geometric parameter which plays important roles as a risk factor for fracture independently of BMD.
Collapse
Affiliation(s)
- Jun Han
- Department of Orthopeadics, Ajou University School of Medicine, Suwon, Korea
| | - Myung Hoon Hahn
- Department of Orthopaedics, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Cheonan, Korea
| |
Collapse
|
30
|
Leslie WD, Lix LM, Morin SN, Johansson H, Odén A, McCloskey EV, Kanis JA. Adjusting Hip Fracture Probability in Men and Women Using Hip Axis Length: the Manitoba Bone Density Database. J Clin Densitom 2016; 19:326-31. [PMID: 26257267 DOI: 10.1016/j.jocd.2015.07.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 10/23/2022]
Abstract
Most studies report that longer hip axis length (HAL) is associated with increased hip fracture risk in women, but comparable data in men are sparse. Using a registry of all dual-energy X-ray absorptiometry (DXA) results for Manitoba, Canada, we identified 4738 men and 50,420 women aged 40 yr and older with baseline hip DXA results, HAL measurements, and Fracture Risk Assessment Tool (FRAX) hip fracture probability computed with femoral neck bone mineral density (BMD). Population-based health service records were assessed for a subsequent hospitalization with a primary diagnosis of hip fracture. During mean 6.2 yr of follow-up, 70 men and 1020 women developed incident hip fractures. Mean HAL was significantly greater in those with vs without incident hip fractures (men 123.0 ± 7.6 vs 121.3 ± 7.4 mm, p = 0.050; women 106.9 ± 6.2 vs 104.6 ± 6.2 mm, p < 0.001). When adjusted for age and femoral neck BMD, each millimeter increase in HAL increased hip fracture risk by 3.6% in men (p = 0.022) and 4.6% in women (p < 0.001); this association was unaffected by sex (p value for interaction = 0.477). When adjusted for log-transformed FRAX hip fracture probability, each millimeter increase in HAL increased hip fracture risk by 3.4% in men (p = 0.031) and 4.8% in women (p < 0.001); this association was again unaffected by sex (p interaction = 0.409). A bilinear adjustment applicable to both men and women was developed: relative increase in hip fracture probability 4.7% for every millimeter that HAL is above the sex-specific average, relative decrease in hip fracture probability 3.8% for every millimeter that HAL is below the sex-specific average. We concluded that greater DXA-derived HAL is associated with increased incident hip fracture risk in both men and women, and this risk is independent of BMD and FRAX probability.
Collapse
Affiliation(s)
- William D Leslie
- College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - Lisa M Lix
- College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montréal, Québec, Canada
| | - Helena Johansson
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, University of Sheffield, Sheffield, UK
| | - Anders Odén
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, University of Sheffield, Sheffield, UK
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, University of Sheffield, Sheffield, UK
| | - John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, University of Sheffield, Sheffield, UK
| |
Collapse
|
31
|
Hernandez-de Sosa N, Athanasiadis G, Malouf J, Laiz A, Marin A, Herrera S, Farrerons J, Soria JM, Casademont J. Genetic Contribution of Femoral Neck Bone Geometry to the Risk of Developing Osteoporosis: A Family-Based Study. PLoS One 2016; 11:e0154833. [PMID: 27163365 PMCID: PMC4862643 DOI: 10.1371/journal.pone.0154833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/20/2016] [Indexed: 11/19/2022] Open
Abstract
Femoral neck geometry parameters are believed to be as good as bone mineral density as independent factors in predicting hip fracture risk. This study was conducted to analyze the roles of genetic and environmental factors in femoral properties measured in a sample of Spanish families with osteoporotic fractures and extended genealogy. The "Genetic Analysis of Osteoporosis (GAO) Project" involved 11 extended families with a total number of 376 individuals. We studied three categorical phenotypes of particular clinical interest and we used a Hip structural analysis based on DXA to analyze 17 strength and geometrical phenotypes of the hip. All the femoral properties had highly significant heritability, ranging from 0.252 to 0.586. The most significant correlations were observed at the genetic level (ρG). Osteoporotic fracture status (Affected 2) and, particularly, low bone mass and osteoporotic condition (Affected 3) had the highest number of significant genetic correlations with diverse femoral properties. In conclusion, our findings suggest that a relatively simple and easy to use method based on DXA studies can provide useful data on properties of the Hip in clinical practice. Furthermore, our results provide a strong motivation for further studies in order to improve the understanding of the pathophysiological mechanism underlying bone architecture and the genetics of osteoporosis.
Collapse
Affiliation(s)
- Nerea Hernandez-de Sosa
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- * E-mail:
| | - Georgios Athanasiadis
- Department of Genomics of Complex Diseases, Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Bioinformatics Research Centre, Aarhus University, Aarhus, Denmark
| | - Jorge Malouf
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Laiz
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Marin
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Silvia Herrera
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Farrerons
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose Manuel Soria
- Department of Genomics of Complex Diseases, Research Institute, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Jordi Casademont
- Department of Internal Medicine, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| |
Collapse
|
32
|
Choi YJ. Dual-Energy X-Ray Absorptiometry: Beyond Bone Mineral Density Determination. Endocrinol Metab (Seoul) 2016; 31:25-30. [PMID: 26996419 PMCID: PMC4803557 DOI: 10.3803/enm.2016.31.1.25] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 01/15/2016] [Accepted: 01/21/2016] [Indexed: 01/06/2023] Open
Abstract
Significant improvements in dual-energy X-ray absorptiometry (DXA) concerning quality, image resolution and image acquisition time have allowed the development of various functions. DXA can evaluate bone quality by indirect analysis of micro- and macro-architecture of the bone, which and improve the prediction of fracture risk. DXA can also detect existing fractures, such as vertebral fractures or atypical femur fractures, without additional radiologic imaging and radiation exposure. Moreover, it can assess the metabolic status by the measurement of body composition parameters like muscle mass and visceral fat. Although more studies are required to validate and clinically use these parameters, it is clear that DXA is not just for bone mineral densitometry.
Collapse
Affiliation(s)
- Yong Jun Choi
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea.
| |
Collapse
|
33
|
Moon JH, Jung KY, Kim KM, Choi SH, Lim S, Park YJ, Park DJ, Jang HC. The effect of thyroid stimulating hormone suppressive therapy on bone geometry in the hip area of patients with differentiated thyroid carcinoma. Bone 2016; 83:104-110. [PMID: 26518742 DOI: 10.1016/j.bone.2015.10.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 09/24/2015] [Accepted: 10/25/2015] [Indexed: 11/22/2022]
Abstract
Subclinical hyperthyroidism has been reported to increase the fracture risk. However, the effect of thyroid stimulating hormone (TSH) suppressive therapy on bone geometry in the hip area of patients with differentiated thyroid carcinoma (DTC) is still unclear. The aim of this study was to investigate the effect of TSH suppression on bone geometry in the hip area of pre- and postmenopausal women with DTC. We conducted a retrospective cohort study including 99 women with DTC (25 pre- and 74 postmenopausal) who had received TSH suppressive therapy for at least 3years and 297 control subjects (75 and 222, respectively) matched for sex and age. Bone mineral density (BMD) in the spine and hip area and bone geometry at the femoral neck measured by dual energy X-ray absorptiometry (DXA) were compared between patients and controls. The association between thyroid hormone and bone parameters was investigated. All analyses of bone parameters were adjusted for age, body mass index, and serum calcium levels. In premenopausal subjects, TSH suppressive therapy was not associated with poor bone parameters. In postmenopausal subjects, patients with DTC undergoing TSH suppression showed lower cross-sectional moment of inertia (CSMI), cross-sectional area, and section modulus and thinner cortical thickness at the femoral neck than those of control subjects, whereas their femoral neck BMD was comparable with controls. Total hip BMD was lower in postmenopausal patients than in controls. CSMI and section modulus at the femoral neck were independently associated with serum free T4 levels in postmenopausal patients. The difference in femoral neck bone geometry between patients and controls was only apparent in postmenopausal DTC patients with free T4 >1.79ng/dL (23.04pmol/l), and not in those with free T4 levels ≤1.79ng/dL (23.04pmol/l). TSH suppression in postmenopausal DTC patients was associated with decreased bone strength by altering bone geometry rather than BMD in the hip area, especially the femoral neck. This alteration in bone quality was observed only in patients with free T4 levels above the upper normal limit.
Collapse
Affiliation(s)
- Jae Hoon Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Kyong Yeun Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Kyoung Min Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Sung Hee Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Young Joo Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Do Joon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Republic of Korea
| | - Hak Chul Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Republic of Korea.
| |
Collapse
|
34
|
Luo Y. A biomechanical sorting of clinical risk factors affecting osteoporotic hip fracture. Osteoporos Int 2016; 27:423-39. [PMID: 26361947 DOI: 10.1007/s00198-015-3316-6] [Citation(s) in RCA: 13] [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: 08/01/2015] [Accepted: 09/03/2015] [Indexed: 02/07/2023]
Abstract
Osteoporotic fracture has been found associated with many clinical risk factors, and the associations have been explored dominantly by evidence-based and case-control approaches. The major challenges emerging from the studies are the large number of the risk factors, the difficulty in quantification, the incomplete list, and the interdependence of the risk factors. A biomechanical sorting of the risk factors may shed lights on resolving the above issues. Based on the definition of load-strength ratio (LSR), we first identified the four biomechanical variables determining fracture risk, i.e., the risk of fall, impact force, bone quality, and bone geometry. Then, we explored the links between the FRAX clinical risk factors and the biomechanical variables by looking for evidences in the literature. To accurately assess fracture risk, none of the four biomechanical variables can be ignored and their values must be subject-specific. A clinical risk factor contributes to osteoporotic fracture by affecting one or more of the biomechanical variables. A biomechanical variable represents the integral effect from all the clinical risk factors linked to the variable. The clinical risk factors in FRAX mostly stand for bone quality. The other three biomechanical variables are not adequately represented by the clinical risk factors. From the biomechanical viewpoint, most clinical risk factors are interdependent to each other as they affect the same biomechanical variable(s). As biomechanical variables must be expressed in numbers before their use in calculating LSR, the numerical value of a biomechanical variable can be used as a gauge of the linked clinical risk factors to measure their integral effect on fracture risk, which may be more efficient than to study each individual risk factor.
Collapse
Affiliation(s)
- Y Luo
- Department of Mechanical Engineering, University of Manitoba, Winnipeg, MB, Canada.
- Department of Biomedical Engineering, University of Manitoba, Winnipeg, MB, Canada.
- Department of Anatomy, South Medical University, Guangzhou, China.
| |
Collapse
|
35
|
Lee DH, Jung KY, Hong AR, Kim JH, Kim KM, Shin CS, Kim SY, Kim SW. Femoral geometry, bone mineral density, and the risk of hip fracture in premenopausal women: a case control study. BMC Musculoskelet Disord 2016; 17:42. [PMID: 26809738 PMCID: PMC4727305 DOI: 10.1186/s12891-016-0893-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 01/15/2016] [Indexed: 01/06/2023] Open
Abstract
Background The purpose of this study was to determine the relationships among hip geometry, bone mineral density, and the risk of hip fracture in premenopausal women. Methods The participants in this case–control study were 16 premenopausal women with minimal-trauma hip fractures (fracture group) and 80 age-and BMI-adjusted controls. Subjects underwent dual-energy X-ray absorptiometry (DXA) to assess BMD at the proximal femur and to obtain DXA-derived hip geometry measurements. Results The fracture group had a lower mean femoral neck and total hip BMD than the control group (0.721 ± 0.123 vs. 0.899 ± 0.115, p <0.001 for the femoral neck BMD and 0.724 ± 0.120 vs. 0.923 ± 0.116, p <0.001 for the total hip BMD). In addition, participants in the fracture group had a longer hip axis length (HAL; p = 0.007), narrower neck shaft angle (NSA; p = 0.008), smaller cross sectional area (CSA; p < 0.001) and higher cross sectional moment of inertia (CSMI; p = 0.004) than those in control group. After adjusting for BMD, the fracture group still had a significantly longer mean HAL (p = 0.020) and narrower NSA (p = 0.006) than the control group. Conclusions BMD is an important predictor of hip fracture in premenopausal women. Furthermore, HAL and NSA are BMD-independent predictors of hip fracture in premenopausal women. Hip geometry may be clinically useful for identification of premenopausal women for whom active fracture prevention should be considered.
Collapse
Affiliation(s)
- Dong-Hwa Lee
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
| | - Kyong Yeun Jung
- Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Kyunggi-do, 463-707, Korea.
| | - A Ram Hong
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
| | - Kyoung Min Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Kyunggi-do, 463-707, Korea.
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
| | - Seong Yeon Kim
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Korea.
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 156-707, Korea.
| |
Collapse
|
36
|
Kang H, Chen YM, Han G, Huang H, Chen WQ, Wang X, Zhu YY, Xiao SM. Associations of Age, BMI, and Years of Menstruation with Proximal Femur Strength in Chinese Postmenopausal Women: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:157. [PMID: 26805871 PMCID: PMC4772177 DOI: 10.3390/ijerph13020157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/17/2016] [Accepted: 01/19/2016] [Indexed: 12/19/2022]
Abstract
This study aimed to elucidate the associations of age, BMI, and years of menstruation with proximal femur strength in Chinese postmenopausal women, which may improve the prediction of hip fracture risk. A cross-sectional study was conducted in 1322 Chinese postmenopausal women recruited from communities. DXA images were used to generate bone mineral density (BMD) and geometric parameters, including cross-sectional area (CSA), outer diameter (OD), cortical thickness (CT), section modulus (SM), buckling ratio (BR) at the narrow neck (NN), intertrochanter (IT), and femoral shaft (FS). Relationships of age, BMI, and years of menstruation with bone phenotypes were analyzed with the adjustment of height, age at menarche, total daily physical activity, education, smoking status, calcium tablet intake, etc. Age was associated with lower BMD, CSA, CT, SM, and higher BR (p < 0.05), which indicated a weaker bone strength at the proximal femur. BMI and years of menstruation had the positive relationships with proximal femur strength (p < 0.05). Further analyses showed that the ranges of absolute value of change slope per year, per BMI or per year of menstruation were 0.14%-1.34%, 0.20%-2.70%, and 0.16%-0.98%, respectively. These results supported that bone strength deteriorated with aging and enhanced with higher BMI and longer time of years of menstruation in Chinese postmenopausal women.
Collapse
Affiliation(s)
- Huili Kang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Yu-Ming Chen
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Guiyuan Han
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Hua Huang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Wei-Qing Chen
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Xidan Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Ying-Ying Zhu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
| | - Su-Mei Xiao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-Sen University, Guangzhou 510080, China.
| |
Collapse
|
37
|
Iolascon G, Moretti A, Cannaviello G, Resmini G, Gimigliano F. Proximal femur geometry assessed by hip structural analysis in hip fracture in women. Aging Clin Exp Res 2015; 27 Suppl 1:S17-21. [PMID: 26178633 DOI: 10.1007/s40520-015-0406-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 07/01/2015] [Indexed: 02/08/2023]
Abstract
INTRODUCTION In the pathogenesis of hip fracture, proximal femur geometry plays a key role as well as decreased bone density. The hip structural analysis (HSA) processes dual energy X-ray absorptiometry (DXA) images containing information on the geometry closely related to the strength of the proximal femur. The objective of this study was to investigate bone mineral density (BMD) and mechanical properties of the proximal femur in a group of women with a previous contralateral hip fragility fracture compared to women without history of hip fracture. MATERIALS AND METHODS In a population of postmenopausal women, we evaluated bone density by DXA and bone geometry using the HSA parameters (femoral strength index, cross-sectional moment of inertia, cross-sectional area, section modulus, and buckling ratio) including hip axis length (HAL) and neck shaft angle. RESULTS Of a total of 62 postmenopausal women, twenty-six with a history of hip fracture had a mean femoral neck BMD significantly lower in comparison with 36 women in the control group (0.703 versus 0.768 g/cm(2), p = 0.0347). There was a statistically significant difference between groups also for HAL (106.75 mm in fracture group versus 100.93 mm in control group, p = 0.0015). DISCUSSION AND CONCLUSIONS Our results demonstrated that all the geometrical parameters resulted worst into the group of patients with history of hip fracture, even though only the HAL was significantly lower in control subjects. In our opinion HSA is useful to characterize the risk of hip fracture in postmenopausal women, providing additional data on the spatial distribution of bone mass strongly related to bone strength.
Collapse
Affiliation(s)
- Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy.
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Giovanni Cannaviello
- Department of Medical and Surgical Specialties and Dentistry, Second University of Naples, Naples, Italy
| | - Giuseppina Resmini
- Centre for the Study of Osteoporosis and Metabolic Bone Disease, Section of Orthopaedic and Traumatology, Treviglio-Caravaggio Hospital, Bergamo, Italy
| | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, Second University of Naples, Naples, Italy
| |
Collapse
|
38
|
Shao HD, Li GW, Liu Y, Qiu YY, Yao JH, Tang GY. Contributions of fat mass and fat distribution to hip bone strength in healthy postmenopausal Chinese women. J Bone Miner Metab 2015; 33:507-15. [PMID: 25269857 DOI: 10.1007/s00774-014-0613-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 06/15/2014] [Indexed: 11/27/2022]
Abstract
The fat and bone connection is complicated, and the effect of adipose tissue on hip bone strength remains unclear. The aim of this study was to clarify the relative contribution of body fat accumulation and fat distribution to the determination of proximal femur strength in healthy postmenopausal Chinese women. This cross-sectional study enrolled 528 healthy postmenopausal women without medication history or known diseases. Total lean mass (LM), appendicular LM (ALM), percentage of lean mass (PLM), total fat mass (FM), appendicular FM (AFM), percentage of body fat (PBF), android and gynoid fat amount, android-to-gynoid fat ratio (AOI), bone mineral density (BMD), and proximal femur geometry were measured by dual energy X-ray absorptiometry. Hip structure analysis was used to compute some variables as geometric strength-related parameters by analyzing the images of the hip generated from DXA scans. Correlation analyses among anthropometrics, variables of body composition and bone mass, and geometric indices of hip bone strength were performed with stepwise linear regression analyses as well as Pearson's correlation analysis. In univariate analysis, there were significantly inverse correlations between age, years since menopause (YSM), hip BMD, and hip geometric parameters. Bone data were positively related to height, body weight, LM, ALM, FM, AFM, and PBF but negatively related to AOI and amount of android fat (all P < 0.05). AFM and AOI were significantly related to most anthropometric parameters. AFM was positively associated with height, body weight, and BMI. AFM was negatively associated with age and YSM. AOI was negatively associated with height, body weight, and BMI. AOI positively associated with age and YSM. LM, ALM, and FM had a positive relationship with anthropometric parameters (P < 0.05 for all). PLM had a negative relationship with those parameters. The correlation between LM, ALM, FM, PLM, ALM, age, and YSM was not significant. In multivariate linear regression analysis, the hip bone strength was observed to have a consistent and unchanged positive association with AFM and a negative association with AOI, whereas its association with other variables of body composition was not significant after adjusting for age, years since menopause, height, body weight, and BMI. AFM may be a positively protective effect for hip bone strength while AOI, rather than android fat, shows a strong negative association with hip bone strength after making an adjustment for confounders (age, YSM, height, body weight, and BMI) in healthy postmenopausal Chinese women. Rational weight control and AOI reduction during menopause may have vital clinical significance in decreasing postmenopausal osteoporosis.
Collapse
Affiliation(s)
- Hong Da Shao
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | | | | | | | | | | |
Collapse
|
39
|
Śliwicka E, Nowak A, Zep W, Leszczyński P, Pilaczyńska-Szcześniak Ł. Bone mass and bone metabolic indices in male master rowers. J Bone Miner Metab 2015; 33:540-6. [PMID: 25224128 DOI: 10.1007/s00774-014-0619-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 07/07/2014] [Indexed: 12/25/2022]
Abstract
The purpose of this study was to assess bone mass and bone metabolic indices in master athletes who regularly perform rowing exercises. The study was performed in 29 men: 14 master rowers and 15 non-athletic, body mass index-matched controls. Dual-energy X-ray absorptiometry measurements of the areal bone mineral density (aBMD) were performed for the total body, regional areas (arms, total forearms, trunk, thoracic spine, pelvis, and legs), lumbar spine (L1-L4), left hip (total hip and femoral neck), and forearm (33 % radius of the dominant and nondominant forearm). Serum concentrations of osteocalcin, collagen type I cross-linked C-telopeptide, visfatin, resistin, insulin, and glucose were determined. Comparative analyses showed significantly lower levels of body fat and higher lean body mass values in the rowers compared to the control group. The rowers also had significantly higher values of total and regional (left arm, trunk, thoracic spine, pelvis, and leg) BMD, as well as higher BMD values for the lumbar spine and the left hip. There were significant differences between the groups with respect to insulin, glucose, and the index of homeostasis model assessment insulin resistance. In conclusion, the systematic training of master rowers has beneficial effects on total and regional BMD and may be recommended for preventing osteoporosis.
Collapse
Affiliation(s)
- Ewa Śliwicka
- Department of Hygiene, University School of Physical Education in Poznań, Królowej Jadwigi 27/39, 61-871, Poznań, Poland,
| | | | | | | | | |
Collapse
|
40
|
Broy SB, Cauley JA, Lewiecki ME, Schousboe JT, Shepherd JA, Leslie WD. Fracture Risk Prediction by Non-BMD DXA Measures: the 2015 ISCD Official Positions Part 1: Hip Geometry. J Clin Densitom 2015; 18:287-308. [PMID: 26277848 DOI: 10.1016/j.jocd.2015.06.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 06/22/2015] [Indexed: 01/19/2023]
Abstract
Bone mineral density (BMD) measured by dual-energy X-ray absorptiometry is the current imaging procedure of choice to assess fracture risk. However, BMD is only one of the factors that explain bone strength or resistance to fracture. Other factors include bone microarchitecture and macroarchitecture. We now have the ability to assess some of these non-BMD parameters from a dual-energy X-ray absorptiometry image. Available measurements include various measurements of hip geometry including hip structural analysis, hip axis length, and neck-shaft angle. At the 2015 Position Development Conference, the International Society of Clinical Densitometry established official positions for the clinical utility of measurements of hip geometry. We present the official positions approved by an expert panel after careful review of the recommendations and evidence prepared by an independent task force. Each question addressed by the task force is presented followed by the official position with the associated medical evidence and rationale.
Collapse
Affiliation(s)
- Susan B Broy
- Department of Medicine, Rosalind Franklin School of Medicine, Chicago Medical School, North Chicago, IL, USA.
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael E Lewiecki
- New Mexico Clinical Research & Osteoporosis Center, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - John T Schousboe
- Park Nicollet Clinic, HealthPartners, Division of Health Policy and Management, University of Minnesota, USA
| | - John A Shepherd
- Department of Radiology and Biomedical Imaging, UCSF School of Medicine, San Francisco, CA, USA
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada; Department of Radiology, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
41
|
Duckham RL, Masud T, Taylor R, Kendrick D, Carpenter H, Iliffe S, Morris R, Gage H, Skelton DA, Dinan-Young S, Brooke-Wavell K. Randomised controlled trial of the effectiveness of community group and home-based falls prevention exercise programmes on bone health in older people: the ProAct65+ bone study. Age Ageing 2015; 44:573-9. [PMID: 25906791 DOI: 10.1093/ageing/afv055] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/16/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND exercise can reduce osteoporotic fracture risk by strengthening bone or reducing fall risk. Falls prevention exercise programmes can reduce fall incidence, and also include strengthening exercises suggested to load bone, but there is little information as to whether these programmes influence bone mineral density (BMD) and strength. OBJECTIVE to evaluate the skeletal effects of home (Otago Exercise Programme, OEP) and group (Falls Exercise Management, FaME) falls prevention exercise programmes relative to usual care in older people. METHODS men and women aged over 65 years were recruited through primary care. They were randomised by practice to OEP, FaME or usual care. BMD, bone mineral content (BMC) and structural properties were measured in Nottingham site participants before and after the 24-week intervention. RESULTS participants were 319 men and women, aged mean(SD) 72(5) years. Ninety-two percentage of participants completed the trial. The OEP group completed 58(43) min/week of home exercise, while the FaME group completed 39(16) and 30(24) min/week of group and home exercise, respectively. Femoral neck BMD changes did not differ between treatment arms: mean (95% CI) effect sizes in OEP and FaME relative to usual care arm were -0.003(-0.011,0.005) and -0.002(-0.010,0.005) g cm(-2), respectively; P = 0.44 and 0.53. There were no significant changes in BMD or BMC at other skeletal sites, or in structural parameters. CONCLUSIONS falls prevention exercise programmes did not influence BMD in older people. To increase bone strength, programmes may require exercise that exerts higher strains on bone or longer duration.
Collapse
Affiliation(s)
- Rachel L Duckham
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK Present Address: Centre for Physical Activity and Nutrition Research, Deakin University, Australia
| | - Tahir Masud
- Healthcare for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rachael Taylor
- Healthcare for Older People, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Denise Kendrick
- Department of Medicine, University of Nottingham, Nottingham, UK
| | - Hannah Carpenter
- Department of Medicine, University of Nottingham, Nottingham, UK
| | - Steve Iliffe
- Department of Primary Care & Population Health, University College London, London, UK
| | - Richard Morris
- Department of Primary Care & Population Health, University College London, London, UK
| | - Heather Gage
- School of Economics, University of Surrey, Guilford, UK
| | - Dawn A Skelton
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Susie Dinan-Young
- Department of Primary Care & Population Health, University College London, London, UK
| | | |
Collapse
|
42
|
VAN DEN MUNCKHOF SVEN, NIKOOYAN ALIASADI, ZADPOOR AMIRABBAS. ASSESSMENT OF OSTEOPOROTIC FEMORAL FRACTURE RISK: FINITE ELEMENT METHOD AS A POTENTIAL REPLACEMENT FOR CURRENT CLINICAL TECHNIQUES. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415300033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Femoral fracture risk prediction is a necessary step preceding effective pharmacological intervention or pre-operative planning. Current clinical methods for fracture risk prediction rely on 2D imaging methods and have limited predictive value. Researchers are therefore trying to find improved methods for fracture prediction. During last few decades, many studies have focused on integration of 3D imaging techniques and the finite element (FE) method to improve the accuracy of fracture assessment techniques. In this paper, we review the recent advances in FE and other techniques for predicting the risk of femoral fractures. Based on a number of selected studies, the different steps that are involved in generation of patient-specific FE models are reviewed with particular emphasis on the fracture criteria. The inaccuracies that might arise due to the imperfections of the involved steps are also discussed. It is concluded that compared to image- and geometry-based techniques, FE is a more promising approach for prediction of fracture loads. However, certain technological advancements in FE modeling protocols are required before FE modeling can be recruited in clinical settings.
Collapse
Affiliation(s)
- SVEN VAN DEN MUNCKHOF
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, Delft 2628 CD, The Netherlands
| | - ALI ASADI NIKOOYAN
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, Delft 2628 CD, The Netherlands
- Department of Integrative Physiology, University of Colorado, Boulder, CO 80309, USA
| | - AMIR ABBAS ZADPOOR
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering, Delft University of Technology (TU Delft), Mekelweg 2, Delft 2628 CD, The Netherlands
| |
Collapse
|
43
|
Mori T, Ishii S, Greendale GA, Cauley JA, Ruppert K, Crandall CJ, Karlamangla AS. Parity, lactation, bone strength, and 16-year fracture risk in adult women: findings from the Study of Women's Health Across the Nation (SWAN). Bone 2015; 73:160-6. [PMID: 25528102 PMCID: PMC4364696 DOI: 10.1016/j.bone.2014.12.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 11/18/2014] [Accepted: 12/08/2014] [Indexed: 11/15/2022]
Abstract
Our objective was to examine the associations of lifetime parity and accumulated length of lactation with bone strength in women prior to the menopause transition and fracture risk during and after the transition. Participants were 2239 pre- or early peri-menopausal women from the Study of Women's Health Across the Nation (SWAN), ages 42-53 years at baseline, who had no childbirths after age 42. Bone mineral density (BMD) was measured in the femoral neck and the lumbar spine at the baseline SWAN visit using dual-energy x-ray absorptiometry, and the composite indices of femoral neck strength relative to load (in three failure modes: compression, bending, and impact) were calculated from femoral neck BMD, femoral neck size, and body size. Data on fractures after age 42 were collected for a median follow-up of 15.7 years (interquartile range, 11.4-18.5 years). In multiple linear regressions adjusted for covariates, lifetime parity was associated positively with femoral neck strength relative to load (0.024 standard deviation (SD) increment in impact strength index per childbirth, p=0.049), but accumulated length of lactation was associated negatively with lumbar spine BMD (0.018 SD decrement per every additional 6 months of lactation, p=0.040). In Cox proportional hazards regressions adjusted for covariates, neither parity nor lactation was associated with fracture hazard after age 42. In conclusion, parity and lactation have little impact on peak bone strength prior to menopause, and do not affect fracture risk after age 42 over 16-year follow-up.
Collapse
Affiliation(s)
- Takahiro Mori
- Department of Medicine/Division of General Internal Medicine, Kameda Medical Center, 929 Higashi-cho, Kamogawa, Chiba 296-8602, Japan.
| | - Shinya Ishii
- Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Gail A Greendale
- Department of Medicine/Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, Ste. 2339, Los Angeles CA 90095, USA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, A510 Crabtree Hall, Pittsburgh, PA 15260, USA
| | - Kristine Ruppert
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, A510 Crabtree Hall, Pittsburgh, PA 15260, USA
| | - Carolyn J Crandall
- Department of Medicine/Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 911 Broxton Ave, 1st floor, Los Angeles, CA 90024, USA
| | - Arun S Karlamangla
- Department of Medicine/Division of Geriatrics, David Geffen School of Medicine at UCLA, 10945 Le Conte Ave, Ste. 2339, Los Angeles CA 90095, USA
| |
Collapse
|
44
|
Wang Q, Chen D, Cheng SM, Nicholson P, Alen M, Cheng S. Growth and aging of proximal femoral bone: a study with women spanning three generations. J Bone Miner Res 2015; 30:528-34. [PMID: 25195663 DOI: 10.1002/jbmr.2353] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 08/30/2014] [Accepted: 09/03/2014] [Indexed: 02/05/2023]
Abstract
Osteoporotic hip fracture is a serious clinical event associated with high morbidity and mortality. Understanding femoral growth patterns is important for promoting bone health in the young and preventing fractures in later life. In this study, growth patterns of areal bone mineral density (aBMD) and geometric properties of the proximal femur were measured by dual-energy X-ray absorptiometry. They were studied in 251 girls from premenarche (11.2 ± 0.7 years) to late adolescence (18.3 ± 1.1 years) and compared with their premenopausal mothers (n = 128, aged 44.9 ± 4.1 years) and postmenopausal grandmothers (n = 128, aged 70.0 ± 6.3 years). Hip axis length (HAL) was the first to reach peak growth velocity (-10.5 months before menarche), followed by neck diameter (ND) and neck cross-sectional area (CSA), (-7.1 and -4.1 months before menarche, respectively). Both neck-shaft angle (NSA) and aBMD of neck and total hip peaked at menarche. At 18 years (7-year follow-up), girls already had higher femoral neck aBMD but similar HAL and NSA compared with their mothers. Grandmothers had the longest HAL, narrowest NSA, widest ND but lowest aBMD and CSA. Hip strength index (HSI), an index of femoral neck strength during a fall, dropped rapidly after menarche in girls but thereafter remained relatively constant. Grandmothers had lower HSI than either mothers or girls. In conclusion, differences in proximal femoral bone mass and structure in adulthood are largely established before menarche, indicating that heritable factors are responsible for most of the individual variance. The development of geometric properties precedes aBMD in puberty, resulting in relatively constant hip strength after menarche. This asynchronous growth leads to adaptation of bone strength to the imposed loads, avoiding fractures in a biologically efficient manner. Both deterioration of aBMD and inadequate compensatory change in bone geometry after menopause contribute to the increased fracture risk later in life.
Collapse
Affiliation(s)
- Qin Wang
- Department of Endocrinology, West China Hospital of Sichuan University, Sichuan, China; Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | | | | | | | | | | |
Collapse
|
45
|
Esenyel M, Ozen A, Esenyel CZ, Rezvani A, Sariyildiz MA, Ergin O. Hip structural changes and fracture risk in osteopenia and osteoporosis. Eurasian J Med 2015; 43:73-8. [PMID: 25610167 DOI: 10.5152/eajm.2011.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 07/08/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Although bone mineral density (BMD) is an important predictor of hip fracture, there is a large overlap of BMD values between those who fracture their hips and those who do not. The aim of this study was to evaluate differences in the structural parameters of the hip in patients with osteopenia and osteoporosis in the hip region and to assess their relationship with osteoporotic fracture risk, age and gender. MATERIALS AND METHODS In this observational retrospective study, 150 patients with osteopenia (100 postmenopausal women and 50 men ≥50 years of age) and 125 patients with osteoporosis in the hip (100 postmenopaussal women and 25 men ≥50 years of age) were included. In addition to densitometry measurements by DEXA (Dual Energy X-ray Absorbimetry), structural variables were determined using the Hip Strength Analysis program (HSA). RESULTS In logistic regression analyses, the femoral neck BMD (odds ratio (OR), 2.6; 95% Confidence Interval (CI) 1.8-3.8), age (OR per 10 years 1.4; 95% CI, 1.1-1.9), femoral neck shaft angle (NSA) (OR 1.5; 95% CI, 1.2-2.1), Femur Strength Index (FSI) (OR 1.6; 95% CI 1.3-2.2), and Cross sectional area (CSA) (OR 1.6; 95% CI 1.2-2.1) were all associated with osteoporotic fractures in women and men. Osteopenic patients had smaller femoral neck-shaft angles (NSA) compared to osteoporotic patients (p<0.05). This angle was larger in women (p<0.05); and women had decreased (FSI) (p<0.001) and CSA (p<0.05), which cause increased fracture risk. CONCLUSION Spatial distribution of bone tissue is a useful determinant of fracture risk.
Collapse
Affiliation(s)
- Meltem Esenyel
- Department of Physical Medicine and Rehabilitation, Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Aynur Ozen
- Department of Nuclear Medicine, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - Cem Zeki Esenyel
- Department of Orthopedy and Tarumatology, Okmeydanı Education and Research Hospital, Istanbul, Turkey
| | - Aylin Rezvani
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - Mustafa Akif Sariyildiz
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| | - Onder Ergin
- Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Bezmialem Vakıf University, Istanbul, Turkey
| |
Collapse
|
46
|
Takakuwa M, Iwamoto J. Five-Year Experience with Risedronate Therapy for Patients with Increased Fracture Risk: A Practice-Based Observational Study. Biol Pharm Bull 2015; 38:88-95. [DOI: 10.1248/bpb.b14-00592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
| | - Jun Iwamoto
- Institute for Integrated Sports Medicine, Keio University School of Medicine
| |
Collapse
|
47
|
Yang L, Palermo L, Black DM, Eastell R. Prediction of incident hip fracture with the estimated femoral strength by finite element analysis of DXA Scans in the study of osteoporotic fractures. J Bone Miner Res 2014; 29:2594-600. [PMID: 24898426 PMCID: PMC4388249 DOI: 10.1002/jbmr.2291] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 05/15/2014] [Accepted: 05/26/2014] [Indexed: 11/08/2022]
Abstract
A bone fractures only when loaded beyond its strength. The purpose of this study was to determine the association of femoral strength, as estimated by finite element (FE) analysis of dual-energy X-ray absorptiometry (DXA) scans, with incident hip fracture in comparison to hip bone mineral density (BMD), Fracture Risk Assessment Tool (FRAX), and hip structure analysis (HSA) variables. This prospective case-cohort study included a random sample of 1941 women and 668 incident hip fracture cases (295 in the random sample) during a mean ± SD follow-up of 12.8 ± 5.7 years from the Study of Osteoporotic Fractures (n = 7860 community-dwelling women ≥67 years of age). We analyzed the baseline DXA scans (Hologic 1000) of the hip using a validated plane-stress, linear-elastic finite element (FE) model of the proximal femur and estimated the femoral strength during a simulated sideways fall. Cox regression accounting for the case-cohort design assessed the association of estimated femoral strength with hip fracture. The age-body mass index (BMI)-adjusted hazard ratio (HR) per SD decrease for estimated strength (2.21; 95% CI, 1.95-2.50) was greater than that for total hip (TH) BMD (1.86; 95% CI, 1.67-2.08; p < 0.05), FN BMD (2.04; 95% CI, 1.79-2.32; p > 0.05), FRAX scores (range, 1.32-1.68; p < 0.0005), and many HSA variables (range, 1.13-2.43; p < 0.005), and the association was still significant (p < 0.05) after further adjustment for hip BMD or FRAX scores. The association of estimated strength with incident hip fracture was strong (Harrell's C index 0.770), significantly better than TH BMD (0.759; p < 0.05) and FRAX scores (0.711-0.743; p < 0.0001), but not FN BMD (0.762; p > 0.05). Similar findings were obtained for intracapsular and extracapsular fractures. In conclusion, the estimated femoral strength from FE analysis of DXA scans is an independent predictor and performs at least as well as FN BMD in predicting incident hip fracture in postmenopausal women.
Collapse
Affiliation(s)
- Lang Yang
- Academic Unit of Bone Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
- INSIGNEO Institute for in silico Medicine, University of Sheffield
| | - Lisa Palermo
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Dennis M Black
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Richard Eastell
- Academic Unit of Bone Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
- INSIGNEO Institute for in silico Medicine, University of Sheffield
| |
Collapse
|
48
|
Ayoub ML, Maalouf G, Bachour F, Barakat A, Cortet B, Legroux-Gérot I, Zunquin G, Theunynck D, Nehme A, El Hage R. DXA-based variables and osteoporotic fractures in Lebanese postmenopausal women. Orthop Traumatol Surg Res 2014; 100:855-8. [PMID: 25459457 DOI: 10.1016/j.otsr.2014.06.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 06/12/2014] [Accepted: 06/23/2014] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The aim of this study was to assess DXA-based variables (bone mineral density, bone mineral apparent density, compressive strength index of the femoral neck and trabecular bone score) in Lebanese postmenopausal women having presented a previous fracture. MATERIALS AND METHODS One thousand Lebanese postmenopausal women between 45 and 89 years participated in this study. The women were recruited by advertisements offering bone mineral density measurements at a reduced cost. Subjects with previous history of radiotherapy or chemotherapy were excluded. Informed written consent was obtained from all the participants. RESULTS Femoral neck compressive strength index (FN CSI) was significantly (P<0.001) associated with the presence of fracture using a simple logistic regression (odds ratio=0.51 [0.385-0.653]). When a multivariate logistic regression analysis was performed with the presence of fracture as a dependent variable and each of age, FN BMD and FN CSI as independent variables, only FN BMD (P=0.005) and FN CSI (P=0.004) were found to be associated with the presence of fracture. CONCLUSION This study suggests that FN CSI is associated with history of osteoporotic fractures in postmenopausal women. The use of FN CSI in clinical practice may help to identify patients with high risk of fracture. LEVEL OF EVIDENCE Epidemiological study, level IV.
Collapse
Affiliation(s)
- M-L Ayoub
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon
| | - G Maalouf
- Musculoskeletal Department, Bellevue Medical Center, Faculty of Medicine of Saint-Joseph University, Mansourieh, Lebanon
| | - F Bachour
- Musculoskeletal Department, Bellevue Medical Center, Faculty of Medicine of Saint-Joseph University, Mansourieh, Lebanon
| | - A Barakat
- Musculoskeletal Department, Bellevue Medical Center, Faculty of Medicine of Saint-Joseph University, Mansourieh, Lebanon
| | - B Cortet
- Department of Rheumatology, Roger Salengro Hospital, CHU de Lille, 59037 Lille cedex, France; EA4490, 62327 Boulogne-sur-Mer cedex, France
| | - I Legroux-Gérot
- Department of Rheumatology, Roger Salengro Hospital, CHU de Lille, 59037 Lille cedex, France; EA4490, 62327 Boulogne-sur-Mer cedex, France
| | - G Zunquin
- Départment of STAPS, URePSSS-EA 4110/EA448, ULCO, 59383 Dunkerque cedex 01, France
| | - D Theunynck
- Départment of STAPS, URePSSS-EA 4110/EA448, ULCO, 59383 Dunkerque cedex 01, France
| | - A Nehme
- Department of Orthopedic Surgery and Traumatology, Saint-Georges University Medical Center, University of Balamand, P.O. Box 166378, Achrafieh, 1100 2807 Beirut, Lebanon
| | - R El Hage
- Department of Physical Education, Faculty of Arts and Social Sciences, University of Balamand, El-Koura, Lebanon.
| |
Collapse
|
49
|
Leslie WD, Orwoll ES, Nielson CM, Morin SN, Majumdar SR, Johansson H, Odén A, McCloskey EV, Kanis JA. Estimated lean mass and fat mass differentially affect femoral bone density and strength index but are not FRAX independent risk factors for fracture. J Bone Miner Res 2014; 29:2511-9. [PMID: 24825359 DOI: 10.1002/jbmr.2280] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 04/26/2014] [Accepted: 05/04/2014] [Indexed: 11/07/2022]
Abstract
Although increasing body weight has been regarded as protective against osteoporosis and fractures, there is accumulating evidence that fat mass adversely affects skeletal health compared with lean mass. We examined skeletal health as a function of estimated total body lean and fat mass in 40,050 women and 3600 men age ≥50 years at the time of baseline dual-energy X-ray absorptiometry (DXA) testing from a clinical registry from Manitoba, Canada. Femoral neck bone mineral density (BMD), strength index (SI), cross-sectional area (CSA), and cross-sectional moment of inertia (CSMI) were derived from DXA. Multivariable models showed that increasing lean mass was associated with near-linear increases in femoral BMD, CSA, and CSMI in both women and men, whereas increasing fat mass showed a small initial increase in these measurements followed by a plateau. In contrast, femoral SI was relatively unaffected by increasing lean mass but was associated with a continuous linear decline with increasing fat mass, which should predict higher fracture risk. During mean 5-year follow-up, incident major osteoporosis fractures and hip fractures were observed in 2505 women and 180 men (626 and 45 hip fractures, respectively). After adjustment for fracture risk assessment tool (FRAX) scores (with or without BMD), we found no evidence that lean mass, fat mass, or femoral SI affected prediction of major osteoporosis fractures or hip fractures. Findings were similar in men and women, without significant interactions with sex or obesity. In conclusion, skeletal adaptation to increasing lean mass was positively associated with BMD but had no effect on femoral SI, whereas increasing fat mass had no effect on BMD but adversely affected femoral SI. Greater fat mass was not independently associated with a greater risk of fractures over 5-year follow-up. FRAX robustly predicts fractures and was not affected by variations in body composition.
Collapse
|
50
|
Abstract
Bone fragility is a major health concern, as the increased risk of bone fractures has devastating outcomes in terms of mortality, decreased autonomy, and healthcare costs. Efforts made to address this problem have considerably increased our knowledge about the mechanisms that regulate bone formation and resorption. In particular, we now have a much better understanding of the cellular events that are triggered when bones are mechanically stimulated and how these events can lead to improvements in bone mass. Despite these findings at the molecular level, most exercise intervention studies reveal either no effects or only minor benefits of exercise programs in improving bone mineral density (BMD) in osteoporotic patients. Nevertheless, and despite that BMD is the gold standard for diagnosing osteoporosis, this measure is only able to provide insights regarding the quantity of bone tissue. In this article, we review the complex structure of bone tissue and highlight the concept that its mechanical strength stems from the interaction of several different features. We revisited the available data showing that bone mineralization degree, hydroxyapatite crystal size and heterogeneity, collagen properties, osteocyte density, trabecular and cortical microarchitecture, as well as whole bone geometry, are determinants of bone strength and that each one of these properties may independently contribute to the increased or decreased risk of fracture, even without meaningful changes in aBMD. Based on these findings, we emphasize that while osteoporosis (almost) always causes bone fragility, bone fragility is not always caused just by osteoporosis, as other important variables also play a major role in this etiology. Furthermore, the results of several studies showing compelling data that physical exercise has the potential to improve bone quality and to decrease fracture risk by influencing each one of these determinants are also reviewed. These findings have meaningful clinical repercussions as they emphasize the fact that, even without leading to improvements in BMD, exercise interventions in patients with osteoporosis may be beneficial by improving other determinants of bone strength.
Collapse
|