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Wu G, Lei C, Gong X. Development and Validation of a Nomogram Model for Individualizing the Risk of Osteopenia in Abdominal Obesity. J Clin Densitom 2024; 27:101469. [PMID: 38479134 DOI: 10.1016/j.jocd.2024.101469] [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: 10/25/2023] [Revised: 12/22/2023] [Accepted: 01/18/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVE This study was aimed to create and validate a risk prediction model for the incidence of osteopenia in individuals with abdominal obesity. METHODS Survey data from the National Health and Nutrition Examination Survey (NHANES) database for the years 2013-2014 and 2017-2018 was selected and included those with waist circumferences ≥102 m in men and ≥88 cm in women, which were defined as abdominal obesity. A multifactor logistic regression model was constructed using LASSO regression analysis to identify the best predictor variables, followed by the creation of a nomogram model. The model was then verified and evaluated using the consistency index (C-index), area under the receiver operating characteristic (ROC) curve (AUC), calibration curve, and decision curve analysis (DCA). Results Screening based on LASSO regression analysis revealed that sex, age, race, body mass index (BMI), alkaline phosphatase (ALP) and Triglycerides (TG) were significant predictors of osteopenia development in individuals with abdominal obesity (P < 0.05). These six variables were included in the nomogram. In the training and validation sets, the C indices were 0.714 (95 % CI: 0.689-0.738) and 0.701 (95 % CI: 0.662-0.739), respectively, with corresponding AUCs of 0.714 and 0.701. The nomogram model exhibited good consistency with actual observations, as demonstrated by the calibration curve. The DCA nomogram showed that early intervention for at-risk populations has a net positive impact. CONCLUSION Sex, age, race, BMI, ALP and TG are predictive factors for osteopenia in individuals with abdominal obesity. The constructed nomogram model can be utilized to predict the clinical risk of osteopenia in the population with abdominal obesity.
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Affiliation(s)
- Gangjie Wu
- General Practice, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, PR China
| | - Chun Lei
- General Practice, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, PR China
| | - Xiaobing Gong
- General Practice, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong 510630, PR China.
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Maldonado LY, Bosques L, Cromer SJ, Azar SS, Yu EW, Burnett-Bowie SAM. Racial and Ethnic Disparities in Metabolic Bone Disease. Endocrinol Metab Clin North Am 2023; 52:629-641. [PMID: 37865478 DOI: 10.1016/j.ecl.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Racial and ethnic disparities exist in the prevalence and management of osteoporosis, metastatic cancer, and sickle cell disease. Despite being the most common metabolic bone disease, osteoporosis remains underscreened and undertreated among Black women. Skeletal-related events in metastatic cancer include bone pain, pathologic fractures, and spinal cord compression. Disparities in screening for and treating skeletal-related events disproportionately affect Black patients. Metabolic bone disease contributes significantly to morbidity in sickle cell disease; however, clinical guidelines for screening and treatment do not currently exist. Clinical care recommendations are provided to raise awareness, close health care gaps, and guide future research efforts.
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Affiliation(s)
- Lauren Y Maldonado
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Bigelow 730, Boston, MA 02114, USA; Department of Pediatrics, MassGeneral Hospital for Children and Harvard Medical School, 175 Cambridge Street, Boston, MA 02114, USA
| | - Linette Bosques
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Bigelow 730, Boston, MA 02114, USA
| | - Sara J Cromer
- Department of Medicine, Endocrine Division, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Thier 1051, Boston, MA 02114, USA
| | - Sharl S Azar
- Hematology and Medical Oncology Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Yawkey 9-536, Boston, MA 02114, USA
| | - Elaine W Yu
- Department of Medicine, Endocrine Division, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Thier 1051, Boston, MA 02114, USA
| | - Sherri-Ann M Burnett-Bowie
- Department of Medicine, Endocrine Division, Massachusetts General Hospital and Harvard Medical School, 50 Blossom Street, Thier 1051, Boston, MA 02114, USA.
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Park KY, Jung JH, Hwang HS, Park HK, Han K, Nam GE. Bone Mineral Density and the Risk of Parkinson's Disease in Postmenopausal Women. Mov Disord 2023; 38:1606-1614. [PMID: 37602978 DOI: 10.1002/mds.29579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Whether bone mineral density (BMD) is related to the risk of Parkinson's disease (PD) is unclear. OBJECTIVES The objective of this study was to examine the association between BMD status and incident PD in postmenopausal women. METHODS We retrospectively examined a nationwide cohort of 272,604 women aged 66 years who participated in the 2009-2012 Korean national health screening for transitional ages. BMD was evaluated using dual-energy X-ray absorptiometry of the central bones. The use of antiosteoporosis medications (AOMs) was assessed. We performed multivariable Cox proportional hazards regression to evaluate the association between BMD and PD risk by calculating hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS During the median follow-up of 7.7 years, 2,884 (1.1%) incident PD cases developed. After adjusting for confounding factors, lower BMD was associated with an increased risk of PD (P for trend <0.001). Individuals with osteoporosis had a 1.40-fold higher HR (1.40, 95% CI: 1.25-1.56) than those with a normal BMD. Sensitivity analyses suggested the associations robust to longer lag periods and further adjustment. These associations were prominent in individuals without AOM use before or after enrollment (P for interaction = 0.031 and 0.014). Increased risks of PD in individuals with osteopenia and osteoporosis who did not use AOMs were attenuated by the medication use during the follow-up period, regardless of previous AOM use. CONCLUSIONS Lower postmenopausal BMD and osteoporosis were associated with an increased risk of PD. In addition, this association could be mitigated using AOMs. Proper management of BMD in postmenopausal women may help prevent PD. © 2023 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Kye-Yeung Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Jin-Hyung Jung
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Hwan-Sik Hwang
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Hoon-Ki Park
- Department of Family Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, South Korea
| | - Ga Eun Nam
- Department of Family Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
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4
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Lin J, Guo S, Zuo W, Wu H, Li Y, Yang X, Yang Y, Fei Q. Validation of Three Tools for Estimating the Risk of Primary Osteoporosis in an Elderly Male Population in Beijing. Clin Interv Aging 2023; 18:845-853. [PMID: 37256154 PMCID: PMC10225276 DOI: 10.2147/cia.s410239] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/10/2023] [Indexed: 06/01/2023] Open
Abstract
Purpose This cross-sectional study estimated three clinical tools including the Osteoporosis Self-Assessment Tool for Asians (OSTA), Body Mass Index (BMI), and Beijing Friendship Hospital Osteoporosis Self-assessment Tool for Elderly Male (BFH-OSTM) for identifying primary osteoporosis and found optimal cut-off values in an elderly Han Beijing male population. Materials and Methods We conducted a cross-sectional study, enrolling 400 community-dwelling elderly Han Beijing males aged ≥50 from 8 medical institutions. Osteoporosis was diagnosed as a T-score of -2.5 standard deviations or lower than that of the average young adult in different diagnostic criteria [lumbar spine (L1-L4), femoral neck, total hip, WHO]. BFH-OSTM, OSTA, and BMI were assessed for predicting OP by receiver operating characteristic (ROC) curves. Sensitivity, specificity, and areas under the ROC curves (AUC) were determined. Ideal thresholds for the omission of screening BMD were proposed. Results The prevalence of osteoporosis ranged from 9.25% to 19.0% according to different diagnostic criteria. The present study indicated the highest discriminating ability was BFH-OSTM in different criteria. The AUCs of OSTA and BMI were 0.748 and 0.770 in WHO criteria, which suggested limiting predictive value for identifying OP in elderly Beijing males. The AUC of BFH-OSTM to predict OP based on WHO criteria was 0.827, yielding a sensitivity of 65.8% and specificity of 82.7%, respectively. With a cost of missing 6.5% of osteoporosis patients, BFH-OSTM could reduce 73.5% of participants in screening BMD tests. Conclusion BFH-OSTM may be a simple and effective tool for identifying OP in the elderly male population in Beijing to omit BMD screening reasonably.
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Affiliation(s)
- Jisheng Lin
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Sijia Guo
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Weiyang Zuo
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Hao Wu
- Fangzhuang Community Health Service Center, Beijing, People’s Republic of China
| | - Yongjin Li
- Tuanjiehu Community Health Service Center, Beijing, People’s Republic of China
| | - Xiuquan Yang
- Wangzuo Community Health Service Center, Beijing, People’s Republic of China
| | - Yong Yang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Qi Fei
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China
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5
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van Abswoude DH, Pellikaan K, Rosenberg AGW, Davidse K, Coupaye M, Høybye C, Markovic TP, Grugni G, Crinò A, Caixàs A, Poitou C, Mosbah H, Weir T, van Vlimmeren LA, Rutges JPHJ, De Klerk LWL, Zillikens MC, van der Lely AJ, de Graaff LCG. Bone Health in Adults With Prader-Willi Syndrome: Clinical Recommendations Based on a Multicenter Cohort Study. J Clin Endocrinol Metab 2022; 108:59-84. [PMID: 36149817 PMCID: PMC9759176 DOI: 10.1210/clinem/dgac556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/13/2022] [Indexed: 02/03/2023]
Abstract
CONTEXT Prader-Willi syndrome (PWS) is a rare complex genetic syndrome, characterized by delayed psychomotor development, hypotonia, and hyperphagia. Hormone deficiencies such as hypogonadism, hypothyroidism, and growth hormone deficiency are common. The combination of hypotonia, low physical activity, and hypogonadism might lead to a decrease in bone mass and increase in fracture risk. Moreover, one would expect an increased risk of scoliosis due to hypotonia and low physical activity. OBJECTIVE To study the prevalence and risk factors for skeletal problems (reduced bone mineral density, fractures, and scoliosis) in adults with PWS. METHODS We retrospectively collected patient characteristics, medical history, medication, biochemical measurements, dual-energy X-ray absorptiometry scans, and spinal X-rays and reviewed the current literature. RESULTS We included 354 adults with PWS (median age 31 years; 43% males), of whom 51 (14%) had osteoporosis (T-score below -2.5) and 143 (54%) had osteopenia (T-score -1 to -2.5). The most prevalent modifiable risk factors for osteoporosis were hypogonadism, insufficient dairy intake, sedentary lifestyle, and corticosteroid use. Male sex was associated with osteoporosis (P = .005). Growth hormone treatment was not associated with osteoporosis. A history of vertebral fractures was present in 10 (3%) and nonvertebral fractures in 59 (17%). Scoliosis was present in 263 (80%), but no modifiable risk factors were identified. CONCLUSION Besides scoliosis, osteoporosis is common in adults with PWS. Based on the literature and the risk factors for osteoporosis found in our cohort, we provide practical clinical recommendations to avoid skeletal complications in these vulnerable patients.
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Affiliation(s)
| | | | - Anna G W Rosenberg
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical
Center, University Medical Center Rotterdam, 3015 GD
Rotterdam, The Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal
Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center
Rotterdam, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome,
3015 GD Rotterdam, The
Netherlands
- Academic Center for Growth Disorders, Erasmus Medical Center, University
Medical Center Rotterdam, 3015 GD Rotterdam,
The Netherlands
| | - Kirsten Davidse
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical
Center, University Medical Center Rotterdam, 3015 GD
Rotterdam, The Netherlands
- Center for Adults with Rare Genetic Syndromes, Department of Internal
Medicine, Division of Endocrinology, Erasmus Medical Center, University Medical Center
Rotterdam, 3015 GD Rotterdam, The Netherlands
- Dutch Center of Reference for Prader-Willi Syndrome,
3015 GD Rotterdam, The
Netherlands
- Academic Center for Growth Disorders, Erasmus Medical Center, University
Medical Center Rotterdam, 3015 GD Rotterdam,
The Netherlands
| | - Muriel Coupaye
- Assistance Publique-Hôpitaux de Paris, Rare Diseases Center of reference
‘Prader-Willi Syndrome and obesity with eating disorders’ (PRADORT), Nutrition
Department, Institute of Cardiometabolism and Nutrition, ICAN, Pitié-Salpêtrière
Hospital, Sorbonne Université, INSERM, Nutriomics, F75013
Paris, France
- International Network for Research, Management & Education on adults
with Prader-Willi Syndrome (INfoRMEd-PWS)
| | - Charlotte Høybye
- International Network for Research, Management & Education on adults
with Prader-Willi Syndrome (INfoRMEd-PWS)
- ENDO-ERN (European Reference Network)
- Department of Molecular Medicine and Surgery, Karolinska Institute and
Karolinska University Hospital, Stockholm,
Sweden
- Department of Endocrinology, Karolinska Institute and Karolinska University
Hospital, Stockholm, Sweden
| | - Tania P Markovic
- International Network for Research, Management & Education on adults
with Prader-Willi Syndrome (INfoRMEd-PWS)
- Metabolism & Obesity Services, Royal Prince Alfred
Hospital, Camperdown, Australia
- Boden Initiative, Charles Perkins Centre, University of
Sydney, SydneyAustralia
| | - Graziano Grugni
- International Network for Research, Management & Education on adults
with Prader-Willi Syndrome (INfoRMEd-PWS)
- ENDO-ERN (European Reference Network)
- Divison of Auxology, Istituto Auxologico Italiano, IRCCS,
Piancavallo (VB), Italy
| | - Antonino Crinò
- International Network for Research, Management & Education on adults
with Prader-Willi Syndrome (INfoRMEd-PWS)
- Reference Center for Prader-Willi syndrome, Bambino Gesù Hospital, Research
Institute, Palidoro (Rome), Italy
| | - Assumpta Caixàs
- International Network for Research, Management & Education on adults
with Prader-Willi Syndrome (INfoRMEd-PWS)
- Department of Endocrinology and Nutrition, Hospital Universitari Parc
Taulí, Institut d’Investigació i Innovació Parc Taulí (I3PT), Universitat Autònoma de
Barcelona, Sabadell, Spain
- Department of Medicine, Universitat Autònoma de Barcelona,
Sabadell, Spain
| | - Christine Poitou
- Assistance Publique-Hôpitaux de Paris, Rare Diseases Center of reference
‘Prader-Willi Syndrome and obesity with eating disorders’ (PRADORT), Nutrition
Department, Institute of Cardiometabolism and Nutrition, ICAN, Pitié-Salpêtrière
Hospital, Sorbonne Université, INSERM, Nutriomics, F75013
Paris, France
- International Network for Research, Management & Education on adults
with Prader-Willi Syndrome (INfoRMEd-PWS)
- ENDO-ERN (European Reference Network)
| | - Helena Mosbah
- Assistance Publique-Hôpitaux de Paris, Rare Diseases Center of reference
‘Prader-Willi Syndrome and obesity with eating disorders’ (PRADORT), Nutrition
Department, Institute of Cardiometabolism and Nutrition, ICAN, Pitié-Salpêtrière
Hospital, Sorbonne Université, INSERM, Nutriomics, F75013
Paris, France
| | - Tessa Weir
- Department of Endocrinology, Nepean-Blue Mountains Hospital,
Sydney, NSW, Australia
- Northern Clinical School, Faculty of Medicine and Health, University of
Sydney, Sydney, NSW, Australia
| | - Leo A van Vlimmeren
- Department of Rehabilitation and Pediatric Physical Therapy, Radboud
University Medical Centrum, 6525 GA Nijmegen,
The Netherlands
| | - Joost P H J Rutges
- Department of Orthopedic surgery, Erasmus Medical Center, University
Medical Center Rotterdam, 3015 GD Rotterdam,
The Netherlands
| | - Luuk W L De Klerk
- Department of Orthopedic surgery, Sint Maartensclinic,
6500 GM Nijmegen, The
Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical
Center, University Medical Center Rotterdam, 3015 GD
Rotterdam, The Netherlands
- ENDO-ERN (European Reference Network)
- Academic Center for Rare Bone Disorders, Erasmus Medical Center, University
Medical Center Rotterdam, 3015 GD Rotterdam,
The Netherlands
- European Reference Network for rare bone diseases (ERN BOND)
| | - Aart J van der Lely
- Department of Internal Medicine, Division of Endocrinology, Erasmus Medical
Center, University Medical Center Rotterdam, 3015 GD
Rotterdam, The Netherlands
| | - Laura C G de Graaff
- Correspondence: Laura de Graaff, MD, PhD, Dept. of Internal Medicine, Erasmus
MC, University Medical Center, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
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Camacho-Cardenosa A, Camacho-Cardenosa M, Martínez-Guardado I, Leal A, Andrada JMV, Timón R. Resistance circuit training combined with hypoxia stimulates bone system of older adults: A randomized trial. Exp Gerontol 2022; 169:111983. [PMID: 36243220 DOI: 10.1016/j.exger.2022.111983] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/15/2022] [Accepted: 10/10/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Aging leads to gradual irreversible decline in bone mass. As adherence to pharmacological treatment is poor, hypoxia combined with strength training has been suggested for therapeutic benefit for clinical populations. The present study investigated the effects of normobaric cyclic hypoxic exposure combined with resistance circuit training on bone of older adults. METHODS Healthy older adults (n = 50) were randomly assigned to a (1) control group (CON; n = 20), who were instructed to continue with their normal daily activities, (2) a group that performed resistance training in normoxia (RTN; n = 17) and (3) a group that performed resistance training in hypoxia (RTH; n = 13). During 24 weeks, RTH group performed resistance training with elastic bands under normobaric hypoxic conditions (16.1 % FiO2). A session of both exercise groups included nine exercises of several body areas with a structure of 3 sets × 12-15 repetitions per exercise, with a 1-minute rest between sets. Bone mineral density (g·cm-2) was measured using dual-energy X-ray absorptiometry. Bone turnover markers of formation (N-terminal propeptide of type I procollagen; PINP) and resorption (C-terminal telopeptide of type I collagen; bCTX) were analysed with enzyme-linked immunosorbent assay (ELISA) microplate reader. RESULTS Values of bCTX and bCTX/PINP significant decreased in RTN (bCTX: 47.79 %; p = 0.002; bCTX/PINP: 61.43 %; p = 0.007) and RTH (bCTX: 59.09 %; p = 0.001; bCTX/PINP: 62.61 %; p = 0.003) groups compared with CON group. Change in bone mineral density was not significantly different between groups. Based on clinically significant change, 23 % of the participants in the RTH group reached this value for femoral neck and trochanter bone mineral density (vs 0 % and 6 % of the RTN group, respectively). CONCLUSIONS 24-Weeks of normobaric cyclic hypoxic exposure combined with resistance circuit training has potential to generate positive effects on bone in older adults. TRIAL REGISTRATION NUMBER NCT04281264 (date of registration: February 24, 2020).
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Affiliation(s)
- Alba Camacho-Cardenosa
- PROFITH (PROmoting FITness and Health through Physical Activity) Research Group, Sport and Health University Research Institute (iMUDS), Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, 18007 Granada, Spain.
| | - Marta Camacho-Cardenosa
- Clinical Management Unit of Endocrinology and Nutrition - GC17. Maimónides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofía University Hospital, 14004, Córdoba, Spain.
| | | | - Alejo Leal
- Medical Center Alejo Leal, 10001 Cáceres, Spain.
| | | | - Rafael Timón
- Faculty of Sport Sciences, University of Extremadura, 10003 Cáceres, Spain.
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Mohseni M, Eisen S, Stum S, Civitelli R. The Association of Pelvic Bone Mineral Density and With Proximal Femoral and Spine Bone Mineral Density in Post-menopausal Women. J Clin Densitom 2022; 25:328-333. [PMID: 35177349 DOI: 10.1016/j.jocd.2022.01.003] [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: 09/25/2021] [Revised: 12/01/2021] [Accepted: 01/04/2022] [Indexed: 10/19/2022]
Abstract
Pelvic fragility fractures result in significant morbidity and their incidence has increased over the past 30 years. One of the main risk factors in skeletal fragility is bone mineral density (BMD). Most of the current literature has focused on understanding spine and hip BMD. We aimed to measure the BMD of pelvis in a cohort of post-menopausal women and compare it to BMD at other skeletal sites. A questionnaire regarding risk factors for osteoporosis was completed by each participant. DXA scan of the pelvis was performed using research software. Three areas of the pelvis corresponding to common fractures were defined on pelvic DXA: R1 = symphysis public, R2 = inferior public rami, R3 = superior public rami. Pelvic BMD was calculated as the average BMD of R1-3. BMD at each location was reported as mean and standard deviation (SD). ANOVA was used to compare BMD between R1-R3 and pelvis, femoral neck, total hip, and spine. Pearson correlation was used to correlate pelvic BMD to BMD of proximal femur and spine. BMD was compared in four participant groups: 1- osteoporosis in spine and hip, 2- osteoporosis in spine only, 3-osteoporosis in hip only, and 4- no osteoporosis in spine and hip. The effect of diabetes and obesity on BMD at various skeletal sites was analyzed. Among the one hundred postmenopausal women enrolled in the study, age was: 64 ± 8, 31% were obese (BMI ≥ 30), and 8% had a diagnosis of type 2 diabetes. Pelvic area R3 had significantly higher BMD than R1 or R2 (p < 0.001). Pelvic BMD (0.50 ± 0.16) was significantly lower than total hip (0.70 ± 0.20) and spine BMD (0.97 ± 0.19) (p < 0.001). Pelvic BMD correlated with BMD at other skeletal locations, with the highest correlation with total hip (total hip: R2: 0.70, femoral neck R2: 0.50, spine R2: 0.65). Pelvic BMD was significantly lower in patients with osteoporosis of both hip and spine compared to the group without osteoporosis at both locations (p = 0.02). Obesity and type 2 diabetes were both associated with significantly higher BMD at pelvis, spine, and total hip. Pelvic BMD is lower than at other skeletal sites and is highly correlated with total hip area bone density. Obesity and type 2 diabetes are associated with higher pelvic BMD. To establish guidelines for the treatment pelvic BMD, studies defining the association of pelvic BMD with pelvic fracture risk are needed.
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Affiliation(s)
- Mahshid Mohseni
- Division of Bone and Mineral Disease, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, USA.
| | - Seth Eisen
- Division of Rheumatology, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Shannon Stum
- Division of Bone and Mineral Disease, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Roberto Civitelli
- Division of Bone and Mineral Disease, Department of Internal Medicine, Washington University School of Medicine, Saint Louis, MO, USA
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Schmorl's nodes could be associated with intervertebral disc degeneration at upper lumbar levels and end-plate disease at lower lumbar level in patients with low back pain. J Clin Neurosci 2022; 100:66-74. [PMID: 35427987 DOI: 10.1016/j.jocn.2022.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/03/2022] [Accepted: 04/06/2022] [Indexed: 01/01/2023]
Abstract
Schmorl's nodes (SNs) have increasingly been recognized on vertebral end-plates using advanced imaging techniques. Even though vertebral end-plates are the closest structures to discs, their pathologies are underestimated in the etiology of low back pain (LBP). We aimed to detect the prevalence of SNs and other end-plate defects in subjects with/without LBP and to understand whether SNs were associated with LBP and spinal degeneration. Subjects were evaluated in terms of end-plate defects, intervertebral disc degeneration (IVDD), and vertebral end-plate changes (Modic changes) at all lumbar levels on lumbar spine magnetic resonance imagings (MRI). Control subjects were compared to patients with LBP. Higher Pfirrmann scores (OR: 2.696) and higher SN scores (OR: 8.076) were significantly associated with Modic changes at L4-L5 disc level. Patients with higher SN scores at L1-L2 or L2-L3 levels had approximately 7-fold increased risk of severe IVDD at the corresponding levels. The most significant factor associated with presence of SNs was body weight of the patients (OR: 1.417). The most significant factor associated with intensity of LBP was severe IVDD at L5-S1 level (OR: 3.670). Having higher total SN score had an OR of 1.230 (95% CI: 1.003-1.509; p = 0.047) for predicting LBP. Schmorl's nodes were seen in 33.1% of patients and 11.5% of asymptomatic subjects. Body weight was the most significant factor associated with SNs. The most significant factor associated with LBP was severe IVDD at L5-S1 level.
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9
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Vitamin D, skin filaggrin, allergic sensitization, and race. Ann Allergy Asthma Immunol 2022; 128:399-407.e3. [PMID: 35081436 PMCID: PMC9109635 DOI: 10.1016/j.anai.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND In addition to its involvement in both the innate and adaptive immune systems, vitamin D has been found to affect keratinocyte function and proliferation, suggesting a possible role for vitamin D in cutaneous allergic sensitization. OBJECTIVE To explore the role of circulating vitamin D levels in allergic sensitization. METHODS Serum 25-hydroxyvitamin D (25(OH)D) levels were measured in a subset of children (N = 323) enrolled in the Mechanisms of Progression of Atopic Dermatitis to Asthma in Children cohort, a prospective early life cohort of children with atopic dermatitis. Allergic sensitization was determined using skin prick testing, and FLG expression in the keratinocytes was measured by quantitative polymerase chain reaction. Multiple Poisson regression was used to evaluate interaction effects between serum 25(OH)D levels and FLG expression with sensitization load as the outcome. RESULTS Black participants had significantly lower mean levels of serum 25(OH)D compared with non-Black participants (29.3 vs 32.9 ng/mL; P < .001). FLG expression and sensitization load were negatively correlated in non-Black participants with 25(OH)D levels less than 27.2 ng/mL (Rho = -0.45; P = .02). No association between FLG expression and sensitization load was found in Black participants or participants with 25(OH)D levels greater than or equal to 27.2 ng/mL. Multiple Poisson regression models confirmed that 25(OH)D levels interact with FLG expression to affect sensitization load in non-Black participants. CONCLUSION Despite lower vitamin D levels in Black participants, sensitization load was associated with nonlesional skin FLG expression in non-Black, but not Black, children with low vitamin D levels. Thus, a complex interplay of factors determines the impact of vitamin D on allergic sensitization.
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10
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Shen X, Peng C, Zhao Y, Zhong L, Cai H, Kan B, Zhang Y, Xue S, Qiao W, Zhao Q, Guo D, Li B, Vuong AM, Yang S. Plasma Fluorescent Oxidation Products and Bone Mineral Density Among Male Veterans: A Cross-Sectional Study. J Clin Densitom 2022; 25:141-149. [PMID: 34716086 DOI: 10.1016/j.jocd.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 09/12/2021] [Accepted: 09/21/2021] [Indexed: 02/03/2023]
Abstract
In vitro and vivo studies indicate that oxidative stress contributes to bone loss. Fluorescent oxidation products (FlOPs) are novel biomarkers of oxidative stress; they reflect global oxidative damage of lipids, proteins, carbohydrates, and DNA. However, whether FlOPs are associated with bone mineral density (BMD) is still unclear. In the present study, we examined the association between FlOPs and BMD among male veterans. This cross-sectional study was conducted among participants recruited from the Department of Medical Examination, The Second Hospital of Jilin University in Jilin, China. We identified male veterans who were at least 50 y old between June and October of 2019. Plasma FlOPs were measured with a fluorescent microplate reader (excitation/emission wavelength: 320/420 nm). BMD were measured by dual-energy X-ray absorptiometry (DXA). The association between FlOPs and BMD was tested by multivariable linear regression models. A total of 164 male veterans were enrolled in the study, the average age was 56.6 y. After adjusting for covariates, veterans who had FlOP levels in the highest tertile had a statistically significant lower femoral neck (β = -0.044; p = 0.007) and total hip BMD (β = -0.045; p = 0.020) as compared to those with FlOP levels in the lowest tertile. Similar results were found when FlOPs were treated as a continuous variable (per 1-SD increase, β = -0.014 and p = 0.033 for femoral neck BMD; β = -0.016 and p = 0.047 for total hip BMD). Higher FlOP levels were associated with lower BMD among male veterans.
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Affiliation(s)
- Xue Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Chuangang Peng
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yan Zhao
- Department of Medical Examination, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Lili Zhong
- Department of Molecular and Chemical Genetic Laboratory, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Hanqing Cai
- Department of Endocrinology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Bo Kan
- Department of Laboratory Medicine, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yuzheng Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Shanshan Xue
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Wenjing Qiao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Qianqian Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Dingjie Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Binbin Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Ann M Vuong
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Shuman Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China.
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11
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Choi YS, Kim TW, Jeong JH, Han SB, Chang MJ, Chang CB, Kang SB. Comparative Analysis of T-score Discordance between a Registry-Based Korean Population and Atypical Femoral Fracture Patients of a Single Institution. Clin Orthop Surg 2022; 14:352-360. [PMID: 36061840 PMCID: PMC9393286 DOI: 10.4055/cios21258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 11/06/2022] Open
Abstract
Background The purpose of this study was to analyze the epidemiology of T-score discordance between the spine and femur in the South Korean population and compare the prevalence of T-score discordance between the Korean osteoporosis population and atypical femoral fracture (AFF) patients. Methods A total of 12,422 subjects from the Korea National Health and Nutrition Examination Survey were reviewed retrospectively. T-score discordance was defined as a difference of ≥ 1 standard deviation between the lumbar spine (LS) and femoral neck (FN) bone mineral density (BMD). The prevalence of T-score discordance (low LS [LS BMD < FN BMD], low FN [LS BMD > FN BMD], and total [low LS + low FN]) was investigated in the osteoporosis and non-osteoporosis groups and stratified by sex and age. T-score discordance of 63 patients with AFFs diagnosed at a single institution was compared with that of the Korean osteoporosis population using propensity score matching. Results T-score discordance was prevalent in the Korean osteoporosis population (44.8%), and low LS discordance (37.5%) was more frequently seen than low FN discordance (7.2%) (p < 0.001). The prevalence of total and low LS discordance was significantly higher in AFF patients than in the Korean osteoporosis population (total discordance: 69.8% and 42.5%, respectively; low LS discordance: 63.5% and 31.7%, respectively; p < 0.001). Conclusions T-score discordance was highly prevalent in the Korean osteoporosis population, and low LS discordance was more common than low FN discordance. Nevertheless, the prevalence of low LS discordance was significantly higher in AFF patients than in the Korean osteoporosis population.
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Affiliation(s)
- Yun Seong Choi
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Woo Kim
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Hwa Jeong
- Joint center, Cheil Orthopedic Hospital, Seoul, Korea
| | - Seung-Beom Han
- Department of Orthopaedic Surgery, Korea University Anam Hospital, Korea University School of Medicine, Seoul, Korea
| | - Moon Jong Chang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Chong Bum Chang
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Baik Kang
- Department of Orthopedic Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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12
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Chin EL, Van Loan M, Spearman SS, Bonnel EL, Laugero KD, Stephensen CB, Lemay DG. Machine Learning Identifies Stool pH as a Predictor of Bone Mineral Density in Healthy Multiethnic US Adults. J Nutr 2021; 151:3379-3390. [PMID: 34313764 DOI: 10.1093/jn/nxab266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/14/2021] [Accepted: 07/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A variety of modifiable and nonmodifiable factors such as ethnicity, age, and diet have been shown to influence bone health. Previous studies are usually limited to analyses focused on the association of a few a priori variables or on a specific subset of the population. OBJECTIVE Dietary, physiological, and lifestyle data were used to identify directly modifiable and nonmodifiable variables predictive of bone mineral content (BMC) and bone mineral density (BMD) in healthy US men and women using machine-learning models. METHODS Ridge, lasso, elastic net, and random forest models were used to predict whole-body, femoral neck, and spine BMC and BMD in healthy US men and women ages 18-66 y, with a BMI (kg/m2) of 18-44 (n = 313), using nonmodifiable anthropometric, physiological, and demographic variables; directly modifiable lifestyle (physical activity, tobacco use) and dietary (via FFQ) variables; and variables approximating directly modifiable behavior (circulating 25-hydroxycholecalciferol and stool pH). RESULTS Machine-learning models using nonmodifiable variables explained more variation in BMC and BMD (highest R2 = 0.75) compared with when using only directly modifiable variables (highest R2 = 0.11). Machine-learning models had better performance compared with multivariate linear regression, which had lower predictive value (highest R2 = 0.06) when using directly modifiable variables only. BMI, body fat percentage, height, and menstruation history were predictors of BMC and BMD. For directly modifiable features, betaine, cholesterol, hydroxyproline, menaquinone-4, dihydrophylloquinone, eggs, cheese, cured meat, refined grains, fruit juice, and alcohol consumption were predictors of BMC and BMD. Low stool pH, a proxy for fermentable fiber intake, was also predictive of higher BMC and BMD. CONCLUSIONS Modifiable factors, such as diet, explained less variation in the data compared with nonmodifiable factors, such as age, sex, and ethnicity, in healthy US men and women. Low stool pH predicted higher BMC and BMD. This trial was registered at www.clinicaltrials.gov as NCT02367287.
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Affiliation(s)
- Elizabeth L Chin
- USDA ARS Western Human Nutrition Research Center, Davis, CA, USA
| | | | - Sarah S Spearman
- USDA ARS Western Human Nutrition Research Center, Davis, CA, USA
| | - Ellen L Bonnel
- USDA ARS Western Human Nutrition Research Center, Davis, CA, USA.,University of California, Davis, Davis, CA, USA
| | - Kevin D Laugero
- USDA ARS Western Human Nutrition Research Center, Davis, CA, USA.,University of California, Davis, Davis, CA, USA
| | - Charles B Stephensen
- USDA ARS Western Human Nutrition Research Center, Davis, CA, USA.,University of California, Davis, Davis, CA, USA
| | - Danielle G Lemay
- USDA ARS Western Human Nutrition Research Center, Davis, CA, USA.,University of California, Davis, Davis, CA, USA
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13
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Shahrestani S, Chen XT, Ballatori AM, Ton A, Bakhsheshian J, Hah RJ, Wang JC, Buser Z. Complication Trends and Costs of Surgical Management in 11,086 Osteoporotic Patients Receiving Lumbar Fusion. Spine (Phila Pa 1976) 2021; 46:1478-1484. [PMID: 33813581 DOI: 10.1097/brs.0000000000004051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The aim of this study was to compare different aspects of fusion surgery in patients with osteoporosis with regard to graft subtype and surgical approach. SUMMARY OF BACKGROUND DATA Osteoporosis and chronic lower back pain are common in elderly populations and significantly increase the risk of compression fractures within the spine. METHODS Using the 2016-2017 National Readmission Database we identified 11,086 osteoporotic patients who received lumbar fusion using ICD-10 coding. Information regarding biologic graft type and surgical approach was collected. Patients were stratified by number of levels fused. Perioperative complications were collected at 30-, 90-, and 180-day follow-up intervals. Statistical analysis included univariate testing and multivariate regression modeling, controlling for patient demographics and comorbidities. RESULTS Patients receiving single-level fusion with autologous grafts had higher rates of hardware failure (P = 0.00014) at 30-day follow-up and 90-day follow-up (P < 0.0001) and higher rates of lumbar vertebral fractures at 90-day follow-up (P = 0.045) compared to those treated with nonautologous grafts. Patients receiving lumbar fusion with anterior and posterior approaches had no difference in readmission or infection rates, but the anterior approach was associated with a higher cost. CONCLUSION In this study, osteoporotic patients treated with autologous grafts had higher rates of complications compared to those treated with nonautologous grafts. Anterior and posterior approaches had similar complication rates; however, the anterior approach was associated with a higher total cost.Level of Evidence: 4.
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Affiliation(s)
- Shane Shahrestani
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Department of Medical Engineering, California Institute of Technology, Pasadena, CA
| | - Xiao T Chen
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Alexander M Ballatori
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Andy Ton
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Joshua Bakhsheshian
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Raymond J Hah
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jeffrey C Wang
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Zorica Buser
- Department of Orthopedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA
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14
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Frisoli A, Paes AT, Kimura AD, Azevedo E, Ambrosio V. Measuring forearm bone density instead of lumbar spine bone density improves the sensitivity of diagnosing osteoporosis in older adults with cardiovascular diseases: Data from SARCOS study. Bone Rep 2021; 15:101134. [PMID: 34660851 PMCID: PMC8502712 DOI: 10.1016/j.bonr.2021.101134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/24/2021] [Accepted: 09/26/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction In older individuals with cardiovascular diseases, it has been challenging to diagnose osteoporosis due to aortic calcification and degenerative processes in the spine of older adults, especially in very old adults. Aim To assess whether the distal forearm BMD with the proximal femur BMD has greater sensitivity for the diagnosis of osteoporosis than the lumbar spine BMD with the proximal femur BMD. Methods We evaluated 515 older adults with cardiovascular disease from the SARCOS study and stratified them into under and over 80-year-old age groups and according to gender. Two diagnostic criteria were used to assess osteoporosis, SPF (lumbar spine and proximal femur BMD) and DFF (distal forearm and proximal femur BMD), which were compared with the multiple bone sites (MS) criteria (lumbar spine, distal radius, femoral neck, and total femur BMD). Results 43.9% were aged ≥80 years. Osteoporosis by SPF was diagnosed in 34% (n = 175), by DFF in 42.2% (n = 216), and by MS in 46.8% (n = 241). The characteristics of the three groups were similar. For every 100 older individuals with osteoporosis based on MS, 27 were not diagnosed by the SPF, and nine were not diagnosed by DFF (p = 0.001). The SPF did not diagnose osteoporosis in 23/100 in older adults aged <80 years, while DFF did not diagnose 16/100 (p.ns). In adults aged ≥80 years, the SPF did not identify osteoporosis in 31/100 older adults, while the DFF failed to identify it in only 5/100 (p < 0.001). In men and women aged ≥80 years, DFF showed higher sensitivity for the diagnosis of osteoporosis compared to the SPF criterion. Conclusion In the elderly population with cardiovascular disease evaluated in our study, the use of distal forearm BMD instead of lumbar spine BMD, associated with proximal femur BMD, showed higher sensitivity for the diagnosis of osteoporosis, regardless of gender, and especially among the very older adults. Diagnosis of osteoporosis (OP) in the elderly with cardiovascular disease is challenging. We evaluated the sensitivity of distal forearm (DF) BMD vs. lumbar spine (LS) BMD. LS BMD did not diagnose OP in 27/100, and DF BMD in 9/100 (p = 0.001). LS BMD did not identify OP in 31/100, and DF BMD in 5/100 (p < 0.001) aged ≥80 years. DF BMD showed higher sensitivity for diagnosing osteoporosis, regardless of gender.
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Affiliation(s)
- Alberto Frisoli
- Geriatric Cardiology Clinic, Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.,Elderly Vulnerability Disease Research Group - Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Angela T Paes
- Statistics Department, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Amanda Diniz Kimura
- Geriatric Cardiology Clinic, Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.,Elderly Vulnerability Disease Research Group - Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Elaine Azevedo
- Geriatric Cardiology Clinic, Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil.,Elderly Vulnerability Disease Research Group - Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
| | - Valdir Ambrosio
- Geriatric Cardiology Clinic, Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brazil
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15
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Noel SE, Santos MP, Wright NC. Racial and Ethnic Disparities in Bone Health and Outcomes in the United States. J Bone Miner Res 2021; 36:1881-1905. [PMID: 34338355 PMCID: PMC8607440 DOI: 10.1002/jbmr.4417] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 11/10/2022]
Abstract
Osteoporosis is a bone disease classified by deterioration of bone microarchitecture and decreased bone strength, thereby increasing subsequent risk of fracture. In the United States, approximately 54 million adults aged 50 years and older have osteoporosis or are at risk due to low bone mass. Osteoporosis has long been viewed as a chronic health condition affecting primarily non-Hispanic white (NHW) women; however, emerging evidence indicates racial and ethnic disparities in bone outcomes and osteoporosis management. The primary objective of this review is to describe disparities in bone mineral density (BMD), prevalence of osteoporosis and fracture, as well as in screening and treatment of osteoporosis among non-Hispanic black (NHB), Hispanic, and Asian adults compared with NHW adults living on the US mainland. The following areas were reviewed: BMD, osteoporosis prevalence, fracture prevalence and incidence, postfracture outcomes, DXA screening, and osteoporosis treatments. Although there are limited studies on bone and fracture outcomes within Asian and Hispanic populations, findings suggest that there are differences in bone outcomes across NHW, NHB, Asian, and Hispanic populations. Further, NHB, Asian, and Hispanic populations may experience suboptimal osteoporosis management and postfracture care, although additional population-based studies are needed. There is also evidence that variation in BMD and osteoporosis exists within major racial and ethnic groups, highlighting the need for research in individual groups by origin or background. Although there is a clear need to prioritize future quantitative and qualitative research in these populations, initial strategies for addressing bone health disparities are discussed. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Sabrina E Noel
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA.,Center for Population Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Michelly P Santos
- Department of Biomedical and Nutritional Sciences, University of Massachusetts Lowell, Lowell, MA, USA.,Center for Population Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Nicole C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
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16
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Ling CW, Miao Z, Xiao ML, Zhou H, Jiang Z, Fu Y, Xiong F, Zuo LSY, Liu YP, Wu YY, Jing LP, Dong HL, Chen GD, Ding D, Wang C, Zeng FF, Zhu HL, He Y, Zheng JS, Chen YM. The Association of Gut Microbiota With Osteoporosis Is Mediated by Amino Acid Metabolism: Multiomics in a Large Cohort. J Clin Endocrinol Metab 2021; 106:e3852-e3864. [PMID: 34214160 DOI: 10.1210/clinem/dgab492] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Indexed: 01/15/2023]
Abstract
CONTEXT Several small studies have suggested that the gut microbiome might influence osteoporosis, but there is little evidence from human metabolomics studies to explain this association. OBJECTIVE This study examined the association of gut microbiome dysbiosis with osteoporosis and explored the potential pathways through which this association occurs using fecal and serum metabolomics. METHODS We analyzed the composition of the gut microbiota by 16S rRNA profiling and bone mineral density using dual-energy X-ray absorptiometry in 1776 community-based adults. Targeted metabolomics in feces (15 categories) and serum (12 categories) were further analyzed in 971 participants using ultra-high-performance liquid chromatography coupled to tandem mass spectrometry. RESULTS This study showed that osteoporosis was related to the beta diversity, taxonomy, and functional composition of the gut microbiota. The relative abundance of Actinobacillus, Blautia, Oscillospira, Bacteroides, and Phascolarctobacterium was positively associated with osteoporosis. However, Veillonellaceae other, Collinsella, and Ruminococcaceae other were inversely associated with the presence of osteoporosis. The association between microbiota biomarkers and osteoporosis was related to levels of peptidases and transcription machinery in microbial function. Fecal and serum metabolomics analyses suggested that tyrosine and tryptophan metabolism and valine, leucine, and isoleucine degradation were significantly linked to the identified microbiota biomarkers and to osteoporosis, respectively. CONCLUSION This large population-based study provided robust evidence connecting gut dysbiosis, fecal metabolomics, and serum metabolomics with osteoporosis. Our results suggest that gut dysbiosis and amino acid metabolism could be targets for intervention in osteoporosis.
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Affiliation(s)
- Chu-Wen Ling
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zelei Miao
- Zhejiang Provincial Laboratory of Life Sciences and Biomedicine, Key Laboratory of Growth Regulation and Translational Research of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
| | - Mian-Li Xiao
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hongwei Zhou
- Microbiome Medicine Center, Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Southern Medical University, Guangzhou, China
| | - Zengliang Jiang
- Zhejiang Provincial Laboratory of Life Sciences and Biomedicine, Key Laboratory of Growth Regulation and Translational Research of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Yuanqing Fu
- Zhejiang Provincial Laboratory of Life Sciences and Biomedicine, Key Laboratory of Growth Regulation and Translational Research of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
| | - Feng Xiong
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Luo-Shi-Yuan Zuo
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yu-Ping Liu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan-Yan Wu
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li-Peng Jing
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hong-Li Dong
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Geng-Dong Chen
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ding Ding
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Cheng Wang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Fang-Fang Zeng
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Hui-Lian Zhu
- Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yan He
- Microbiome Medicine Center, Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ju-Sheng Zheng
- Zhejiang Provincial Laboratory of Life Sciences and Biomedicine, Key Laboratory of Growth Regulation and Translational Research of Zhejiang Province, School of Life Sciences, Westlake University, Hangzhou, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Hangzhou, China
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Yu-Ming Chen
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health; Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
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17
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The relationship between transforming growth factor β superfamily members (GDF11 and BMP4) and lumbar spine bone mineral density in postmenopausal Chinese women. Arch Gynecol Obstet 2021; 305:737-747. [PMID: 34417839 DOI: 10.1007/s00404-021-06183-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The relationship between transforming growth factor β superfamily members (GDF11 and BMP4) and bone metabolism remains controversial. The aim of this study was to investigate the association between serum GDF11 and BMP4 levels and lumbar spine bone mineral density (LBMD) in a cohort of postmenopausal Chinese women. METHODS This was a non-prospective cross-sectional study of 350 postmenopausal women with a mean age of 63.13 ± 8.66 years who came from Shenyang, China. LBMD was measured using dual-energy X-ray absorptiometry. Serum GDF11 and BMP4 concentrations were detected using a sandwich enzyme immunoassay kit. Pearson's correlation analysis and regression analyses were carried out to investigate the relationships between LBMD and serum GDF11 and BMP4 levels. RESULTS A linear association between LBMD and serum LgGDF11 concentration was observed after adjusting for numerous confounders (P = 0.018). In addition, the osteoporosis (OP) was inversely related to LgGDF11 and the odds ratios for postmenopausal women with lumbar OP in LgGDF11 quartile group 2, group 3, and group 4 were 0.46 (95% CI 0.23-0.90, P < 0.05), 0.41 (95% CI 0.20-0.84, P < 0.05), and 0.30 (95% CI 0.14-0.63, P < 0.01), respectively (P = 0.001 for the trend), when compared to the highest quartile of LgGDF11 after adjustments for many confounding variables in this study. CONCLUSIONS This study showed that serum GDF11 levels were linearly related to LBMD, and it was also revealed that serum GDF11 levels were significantly associated with lumbar OP in postmenopausal women. However, serum BMP4 levels were not associated with LBMD and lumbar OP.
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18
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Palmer ND, Lu L, Register TC, Lenchik L, Carr JJ, Hicks PJ, Smith SC, Xu J, Dimitrov L, Keaton J, Guan M, Ng MCY, Chen YDI, Hanley AJ, Engelman CD, Norris JM, Langefeld CD, Wagenknecht LE, Bowden DW, Freedman BI, Divers J. Genome-wide association study of vitamin D concentrations and bone mineral density in the African American-Diabetes Heart Study. PLoS One 2021; 16:e0251423. [PMID: 34014961 PMCID: PMC8136717 DOI: 10.1371/journal.pone.0251423] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/26/2021] [Indexed: 12/29/2022] Open
Abstract
Relative to European Americans, African Americans have lower 25-hydroxyvitamin D (25OHD) and vitamin D binding protein (VDBP) concentrations, higher 1,25-dihydroxyvitamin D (1,25(OH)2D3) concentrations and bone mineral density (BMD), and paradoxically reduced burdens of calcified atherosclerotic plaque (subclinical atherosclerosis). To identify genetic factors contributing to vitamin D and BMD measures, association analysis of >14M variants was conducted in a maximum of 697 African American-Diabetes Heart Study participants with type 2 diabetes (T2D). The most significant association signals were detected for VDBP on chromosome 4; variants rs7041 (β = 0.44, SE = 0.019, P = 9.4x10-86) and rs4588 (β = 0.17, SE = 0.021, P = 3.5x10-08) in the group-specific component (vitamin D binding protein) gene (GC). These variants were found to be independently associated. In addition, rs7041 was also associated with bioavailable vitamin D (BAVD; β = 0.16, SE = 0.02, P = 3.3x10-19). Six rare variants were significantly associated with 25OHD, including a non-synonymous variant in HSPG2 (rs116788687; β = -1.07, SE = 0.17, P = 2.2x10-10) and an intronic variant in TNIK (rs143555701; β = -1.01, SE = 0.18, P = 9.0x10-10), both biologically related to bone development. Variants associated with 25OHD failed to replicate in African Americans from the Insulin Resistance Atherosclerosis Family Study (IRASFS). Evaluation of vitamin D metabolism and bone mineral density phenotypes in an African American population enriched for T2D could provide insight into ethnic specific differences in vitamin D metabolism and bone mineral density.
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Affiliation(s)
- Nicholette D. Palmer
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
- Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
- * E-mail: (NDP); (BIF)
| | - Lingyi Lu
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Thomas C. Register
- Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Leon Lenchik
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - J. Jeffrey Carr
- Department of Radiology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Pamela J. Hicks
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - S. Carrie Smith
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Jianzhao Xu
- Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Latchezar Dimitrov
- Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Jacob Keaton
- Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
- Molecular Genetics and Genomics Program, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Meijian Guan
- Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Maggie C. Y. Ng
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Yii-der I. Chen
- Department of Pediatrics, The Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, United States of America
| | - Anthony J. Hanley
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Corinne D. Engelman
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States of America
| | - Jill M. Norris
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States of America
| | - Carl D. Langefeld
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Lynne E. Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Donald W. Bowden
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
- Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Barry I. Freedman
- Center for Precision Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
- Department of Internal Medicine-Section on Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
- * E-mail: (NDP); (BIF)
| | - Jasmin Divers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
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Ma Q, Hou X, Cheng X, You Y, Yang Z, Ma D, Wang Z. Risk of vertebral fractures: evaluation on vertebral trabecular attenuation value and hydroxyapatite concentration in patients by chest spectral CT. Br J Radiol 2021; 94:20200234. [PMID: 33417486 DOI: 10.1259/bjr.20200234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To analyze vertebral fractures risk in patients with chest scans by evaluating vertebral hydroxyapatite concentration measured on spectral CT compared to trabecular attenuation value measured on conventional CT. METHODS Our retrospective study reviewed CT of 216 patients. Analysis of vertebral (T11 - L1) hydroxyapatite concentration by spectral imaging and trabecular attenuation value by conventional CT imaging were performed in patients with chest CT examinations. Specificity, sensitivity, negative predictive value (NPV), and positive predictive value (PPV) were performed by using receiver operating characteristic (ROC) curves in patients with and without vertebral fractures. RESULTS In male patients, vertebral hydroxyapatite concentration had high area under the ROC curve (0.916), by using the optimal threshold of 72.27 mg/cm3, specificity, sensitivity, NPV, and PPV were 91.7, 80.2, 36.7, and 98.7%, respectively. In female patients, vertebral hydroxyapatite concentration also had high area under the ROC curve (0.870), by using the optimal threshold of 74.79 mg/cm3, specificity, sensitivity, NPV, and PPV were 100.0, 77.8, 47.4, and 100.0%, respectively. Area under the ROC curve was significantly different between spectral CT-measured bone hydroxyapatite concentration and conventional CT-measured attenuation value in distinguishing vertebral fractures (p = 0.007 for males; p = 0.005 for females). CONCLUSIONS Quantitative assessment with spectral CT may appear as higher accuracy than that of conventional CT imaging to analyze risk of vertebral fractures. Hydroxyapatite concentration measured with chest spectral CT may be used to evaluate risk of bone fractures. ADVANCES IN KNOWLEDGE Hydroxyapatite concentration measured with chest spectral CT may be used to evaluate risk of bone fractures.
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Affiliation(s)
- Qiang Ma
- Radiology Department, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Xinmeng Hou
- Radiology Department, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Xiaoyue Cheng
- Radiology Department, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Yuangang You
- Beijing Tropical Medicine Research Institute, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Zhenghan Yang
- Radiology Department, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Daqing Ma
- Radiology Department, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
| | - Zhenchang Wang
- Radiology Department, Capital Medical University Affiliated Beijing Friendship Hospital, Beijing, China
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20
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Bon J, Nouraie SM, Smith KJ, Dransfield MT, McDonald ML, Hoffman EA, Newell JD, Comellas AP, Saha PK, Bowler RP, Regan EA. Lung-Specific Risk Factors Associated With Incident Hip Fracture in Current and Former Smokers. J Bone Miner Res 2020; 35:1952-1961. [PMID: 32754944 PMCID: PMC8773459 DOI: 10.1002/jbmr.4103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 05/14/2020] [Accepted: 06/01/2020] [Indexed: 11/06/2022]
Abstract
Hip fractures are associated with significant morbidity and mortality in smokers with lung disease, but whether lung-specific factors are associated with fracture risk is unknown. Our goal was to determine whether lung-specific factors associate with incident hip fracture and improve risk discrimination of traditional fracture risk models in smokers. The analysis consisted of a convenience sample of 9187 current and former smokers (58,477 participant follow-up years) participating in the Genetic Epidemiology of chronic obstructive pulmonary disease (COPD) longitudinal observational cohort study. Participants were enrolled between 2008 and 2011 with follow-up data collection through July 2018. Traditional risk factors associated with incident hip fracture (n = 361) included age, female sex, osteoporosis, prevalent spine and hip fracture, rheumatoid arthritis, and diabetes. Lung-specific risk factors included post-bronchodilator percent forced expiratory volume in 1 s (FEV1 %) predicted (OR, 0.95; 95% CI, 0.92-0.99 for each 10% increase), Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification (OR, 1.09; 95% CI, 1.002-1.19 for each higher stage), presence of CT-determined emphysema (OR, 1.34; 95% CI, 1.06-1.69), symptom scores (OR, 1.10; 95% CI, 1.03-1.19 for each higher unit score), 6-min walk distance (OR, 0.92; 95% CI, 0.90-0.95 for each 30-m increase), body mass index, airflow obstruction, dyspnea, and exercise (BODE) index (OR, 1.07; 95% CI, 1.01-1.13 for each higher unit score), total exacerbations (OR, 1.13; 95% CI, 1.10-1.16 per exacerbation), and annual exacerbations (OR, 1.37; 95% CI, 1.21-1.55 per exacerbation). In multivariable modeling, age, black race, osteoporosis, prevalent hip and spine fracture, rheumatoid arthritis, and diabetes were associated with incident hip fracture. The presence of emphysema, 6-min walk distance, and total number of exacerbations added to traditional models improved risk discrimination (integrated discrimination improvement [IDI] values 0.001 [95% CI, 0.0003-0.002], 0.001 [95% CI, 0.0001-0.002], and 0.008 [95% CI, 0.003-0.013], corresponding to relative IDIs of 12.8%, 6.3%, and 34.6%, respectively). These findings suggest that the incorporation of lung-specific risk factors into fracture risk assessment tools may more accurately predict fracture risk in smokers. © 2020 American Society for Bone and Mineral Research.
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Affiliation(s)
- Jessica Bon
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine and VA Pittsburgh Healthcare System, University of Pittsburgh, Pittsburgh, PA, USA
| | - Seyed Mehdi Nouraie
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kenneth J Smith
- Department of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mark T Dransfield
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Lung Health Center, Birmingham, AL, USA
| | - Merry-Lynn McDonald
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Lung Health Center, Birmingham, AL, USA
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - John D Newell
- Department of Radiology, University of Iowa, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Alejandro P Comellas
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, IA, USA
| | - Punam K Saha
- Department of Radiology, University of Iowa, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Department of Biomedical Engineering, University of Iowa, Iowa City, IA, USA
| | - Russell P Bowler
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO, USA
| | - Elizabeth A Regan
- Department of Medicine, Division of Rheumatology, National Jewish Health, Denver, CO, USA
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21
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Chen KK, Wee SL, Pang BWJ, Lau LK, Jabbar KA, Seah WT, Srinivasan S, Jagadish MU, Ng TP. Bone mineral density reference values in Singaporean adults and comparisons for osteoporosis establishment - The Yishun Study. BMC Musculoskelet Disord 2020; 21:633. [PMID: 32977780 PMCID: PMC7519574 DOI: 10.1186/s12891-020-03646-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/14/2020] [Indexed: 01/22/2023] Open
Abstract
Background While there have been studies in Singapore on the prevalence and economic burden of osteoporotic hip fracture, there is a severe lack of reference data on bone mineral density and prevalence of osteoporosis. The purpose of this study is to establish the reference values for BMD and compare prevalence of osteoporotic conditions using other available reference values so as to better understand the status of bone health in Singaporean adults. Methods We carried out a population-based cross-sectional study using dual-energy x-ray absorptiometry (Hologic Discovery Wi) to measure the bone mineral density of Singaporean adults aged ≥21 years. A total of 542 participants were recruited from the large north-eastern residential town of Yishun. We computed T- scores (denoted by TSG) for each individual in the study. Similar diagnoses were also done based on T-scores provided by the densitometer (TDXA), NHANES database (TNHANES), and China (TCHN), and the differences in prevalence compared. We then compared the concordance between TSG and TDXA in the classification of osteoporosis. Osteoporosis was defined according to criteria by the World Health Organization (WHO). Results Peak lumbar spine BMD was 1.093 ± 0.168 g/cm2 in women, and 1.041 ± 0.098 g/cm2 for men. Peak whole-body BMD was 1.193 ± 0.93 g/cm2 in women at, and 1.224 ± 0.112 g/cm2 for men. Prevalence of osteoporosis based on lumbar spine was 9.3% in postmenopausal women, and 0.7% in men after 50 years of age. The percentage difference in prevalence range from 60.5–163.6%, when using reference values from TDXA, TNHANES, and TCHN. Comparing diagnosis using TDXA and TSG cut-off values, 28 versus 15 women were diagnosed as osteoporotic respectively. The kappa statistics was 0.81 for women and 0.85 for men. Conclusion: Our study shows that T-scores provided by DXA manufacturer over-diagnosed osteoporosis in Singaporeans, and the prevalence of osteoporotic conditions is not accurately represented. This over-diagnosis may result in unnecessary treatment in some individuals.
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Affiliation(s)
- Kexun Kenneth Chen
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Tower E Level 4 GERI Admin, Singapore, 768024, Singapore.
| | - Shiou-Liang Wee
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Tower E Level 4 GERI Admin, Singapore, 768024, Singapore. .,Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore. .,Programme of Health Services and System Research, Duke-National University of Singapore Graduate Medical School, Singapore, Singapore.
| | - Benedict Wei Jun Pang
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Tower E Level 4 GERI Admin, Singapore, 768024, Singapore
| | - Lay Khoon Lau
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Tower E Level 4 GERI Admin, Singapore, 768024, Singapore
| | - Khalid Abdul Jabbar
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Tower E Level 4 GERI Admin, Singapore, 768024, Singapore
| | - Wei Ting Seah
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Tower E Level 4 GERI Admin, Singapore, 768024, Singapore
| | | | - Mallya Ullal Jagadish
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Tower E Level 4 GERI Admin, Singapore, 768024, Singapore.,Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Tze Pin Ng
- Geriatric Education and Research Institute (GERI), 2 Yishun Central 2, Tower E Level 4 GERI Admin, Singapore, 768024, Singapore.,Department of Psychological Medicine, National University of Singapore, Singapore, Singapore
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22
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Chan CY, Subramaniam S, Mohamed N, Ima-Nirwana S, Muhammad N, Fairus A, Ng PY, Jamil NA, Aziz NA, Chin KY. Prevalence and factors of T-score discordance between hip and spine among middle-aged and elderly Malaysians. Arch Osteoporos 2020; 15:142. [PMID: 32918631 DOI: 10.1007/s11657-020-00821-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 09/08/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED T-score discordance between hip and spine is a common problem in the diagnosis of osteoporosis based on dual-energy X-ray absorptiometry. Not much information on the prevalence and risk factors of this problem is available in Malaysia. Our study found that factors like age, height, physical activity and menopausal status should be taken into account in the diagnosis of osteoporosis. INTRODUCTION AND OBJECTIVE T-score discordance between hip and spine is a common problem in bone mineral density assessment. A difference ≥ 1 standard deviation (SD) (regardless of diagnostic class) is considered minor, and a difference more than one diagnostic class is considered major discordance. This study aimed to determine the prevalence and factors of hip and spine T-score discordance in a population aged ≥ 40 years in Klang Valley, Malaysia. SUBJECTS AND METHODS In this cross-sectional study, subjects answered a demographic questionnaire and underwent body composition and bone health assessment using dual-energy X-ray absorptiometry. Chi-square and binary logistic regression analysis were used to assess the prevalence of T-score discordance among the subjects. RESULTS A total of 786 Malaysians (382 men, 404 women) subjects were recruited. The prevalence of minor and major discordance was 30.3% and 2.3%, respectively. Overall, factors related to T-score discordance were advanced age, decreased height, and being physically active. Sub-analysis showed that decreased height and being physically active predicted T-score discordance in men, being menopausal and Indian (vs Chinese) were predictors in women. CONCLUSIONS T-score discordance between hip and spine is common among Malaysian middle-aged and elderly population. Diagnosis of osteopenia/osteoporosis should be based on the T-score of more than one skeletal site as per the current recommendations.
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Affiliation(s)
- Chin Yi Chan
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, 56000, Cheras, Malaysia
| | - Shaanthana Subramaniam
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, 56000, Cheras, Malaysia
| | - Norazlina Mohamed
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, 56000, Cheras, Malaysia
| | - Soelaiman Ima-Nirwana
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, 56000, Cheras, Malaysia
| | - Norliza Muhammad
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, 56000, Cheras, Malaysia
| | - Ahmad Fairus
- Department of Anatomy, Universiti Kebangsaan Malaysia Medical Centre, 56000, Cheras, Malaysia
| | - Pei Yuen Ng
- Drug and Herbal Research Centre, Faculty of Pharmacy, Universiti Kebangsaan Malaysia Kuala Lumpur Campus, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Nor Aini Jamil
- Centre for Community Health Studies, Faculty of Health Science, Universiti Kebangsaan Malaysia Kuala Lumpur Campus, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Noorazah Abd Aziz
- Department of Family Medicine, Universiti Kebangsaan Malaysia Medical Centre, 56000, Cheras, Malaysia
| | - Kok-Yong Chin
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, 56000, Cheras, Malaysia. .,State Key Laboratory of Oncogenes and Related Genes, Renji-Med X Clinical Stem Cell Research Center, Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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23
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Wang Y, Wang H, Chen P. Higher Fibroblast Growth Factor 23 Levels Are Causally Associated With Lower Bone Mineral Density of Heel and Femoral Neck: Evidence From Two-Sample Mendelian Randomization Analysis. Front Public Health 2020; 8:467. [PMID: 32984251 PMCID: PMC7492544 DOI: 10.3389/fpubh.2020.00467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/24/2020] [Indexed: 01/18/2023] Open
Abstract
Background: Previous observational studies have indicated that high levels of fibroblast growth factor 23 (FGF23), a phosphoric hormone that inhibits calcitriol synthesis, in the blood is associated with the reduced bone mineral density (BMD); however, whether this association is causal remains unclear. In this study, we conducted a Mendelian Random (MR) study to investigate whether the genetic predisposition of higher FGF23 levels was causally associated with lower BMD in adults. Methods: A two-sample MR was performed with five single nucleotide polymorphisms significantly associated with FGF23, selected as instrumental variables. Two-sample MR estimates were derived from summary-level data of large-sample genome-wide association studies for BMD and the levels of bone metabolism characteristics. Results: The two-sample MR analysis showed that for every 1-unit increase in the log-transformed blood FGF23 level (pg/mL), the decreased levels of adult heel BMD (β = −0.201, se = 0.084, P = 0.016) and femoral neck BMD (β = −0.286, se = 0.126, P = 0.022) were noted, indicative of a causal relationship based on the inverse variance weighting method. However, FGF23 levels were not correlated with adult lumbar spine BMD (β = −0.166, se = 0.193, P = 0.389), and forearm BMD (β = −0.186, se = 0.366, P = 0.610). Moreover, the two-sample MR analysis suggested that there was no evidence for associations between FGF23 and adult calcium, phosphorus, 25(OH)D, creatinine, and magnesium levels. Conclusions: This study suggests that there may be a causal relationship between blood FGF23 levels and BMD of the heel and femoral neck in adults; however, more investigations are necessary to determine whether FGF23 may be a potential biomarker and/or therapeutic target for diseases that affect bone mineralization.
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Affiliation(s)
- Yue Wang
- Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Wang
- Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peizhan Chen
- Clinical Research Center, Ruijin Hospital North, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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24
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Fan Z, Li X, Zhang X, Yang Y, Fei Q, Guo A. Comparison of OSTA, FRAX and BMI for Predicting Postmenopausal Osteoporosis in a Han Population in Beijing: A Cross Sectional Study. Clin Interv Aging 2020; 15:1171-1180. [PMID: 32764904 PMCID: PMC7381824 DOI: 10.2147/cia.s257166] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/30/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To validate the efficacies of three screening tools including the Osteoporosis Self-Assessment Tool for Asians (OSTA), Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD), and body mass index (BMI) for predicting postmenopausal osteoporosis (OP) and to define the ideal thresholds for avoidance of dual-energy X-ray absorptiometry (DXA) scanning in a Han Chinese population in Beijing. Patients and Methods A total of 2055 community-dwelling Han Beijing postmenopausal females aged ≥45 years were enrolled in this study. All participants completed a questionnaire, and BMD was measured by DXA. OP was defined by a T-score at least -2.5 SD less than that of average young adults in different diagnostic criteria [lumbar spine, femoral neck, total hip, worst hip, WHO]. The abilities of the OSTA, FRAX, and BMI to predict OP were analyzed by receiver operating characteristic (ROC) curves. Sensitivity, specificity, and area under the ROC curves (AUC) were calculated. Ideal thresholds for identifying OP were proposed. Results The prevalence of OP ranged from 8.1% to 28.4% according to different diagnostic criteria. The AUC range for the OSTA (0.758-0.849) was similar to the FRAX (0.728-0.855), which revealed that both tools predicted OP reliably. The AUC range for BMI was 0.643-0.682, suggesting limited predictive value. According to WHO criteria, the AUC values for the FRAX for hip fracture risk (FRAX-HF) and for the OSTA were 0.796 and 0.798, with corresponding sensitivities of 74.79% and 69.64% and specificities of 70.45% and 75.07%, respectively. At defined thresholds, the FRAX-HF and OSTA allowed avoidance of DXA in 42.4-37.6% of participants, at a cost of missing only 7.2-8.6% of individuals with OP. Conclusion The OSTA and FRAX-HF may be reliable and effective tools for identifying postmenopausal OP in the Han Beijing population without BMD.
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Affiliation(s)
- Zihan Fan
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaoyu Li
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Xiaodong Zhang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yong Yang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Qi Fei
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Ai Guo
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China
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25
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Crandall CJ, Larson J, Cauley JA, Schousboe JT, LaCroix AZ, Robbins JA, Watts NB, Ensrud KE. Do Additional Clinical Risk Factors Improve the Performance of Fracture Risk Assessment Tool (FRAX) Among Postmenopausal Women? Findings From the Women's Health Initiative Observational Study and Clinical Trials. JBMR Plus 2019; 3:e10239. [PMID: 31844827 PMCID: PMC6894725 DOI: 10.1002/jbm4.10239] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 09/11/2019] [Accepted: 09/18/2019] [Indexed: 01/03/2023] Open
Abstract
The ability of the fracture risk assessment tool (FRAX) to discriminate between women who do and do not experience major osteoporotic fractures (MOFs) is suboptimal. Adding common clinical risk factors may improve discrimination. We used data from the Women's Health Initiative, a prospective study of women aged 50 to 79 years at baseline (n = 99,413; n = 5722 in BMD subset) enrolled at 40 US clinical centers. The primary outcome was incident MOFs assessed annually during 10 years' follow‐up. For prediction of incident MOF, we examined the area under the receiver operatic characteristic curve (AUC) and net reclassification index (NRI) of the FRAX model alone and FRAX plus additional risk factors (singly or together: type 2 diabetes mellitus, frequent falls [≥2 falls in the past year], vasomotor symptoms, self‐reported physical function score [RAND 36‐item Health Survey subscale), and lumbar spine BMD). For NRI calculations, high risk was defined as predicted MOF risk ≥20%. We also assessed calibration as observed MOF events/expected MOF events. The AUC value for FRAX without BMD information was 0.65 (95% CI, 0.65 to 0.66). Compared with the FRAX model (without BMD), the AUC value was not improved by the addition of vasomotor symptoms, diabetes, or frequent falls, but was minimally increased by adding physical function score (AUC 0.66, 95% CI, 0.66 to 0.67). FRAX was well‐calibrated for MOF prediction. The NRI of FRAX + additional variables versus FRAX alone was 5.7% (p < 0.001) among MOF cases and −1.7% among noncases (p > 0.99). Additional variables (diabetes, frequent falls, vasomotor symptoms, physical function score, or lumbar spine BMD) did not yield meaningful improvements in NRI or discrimination of FRAX for MOFs. Future studies should assess whether tools other than FRAX provide superior discrimination for prediction of MOFs. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Carolyn J Crandall
- Division of General Internal Medicine and Health Services Research David Geffen School of Medicine at University of California Los Angeles CA USA
| | - Joseph Larson
- Fred Hutchinson Cancer Research Center Seattle WA USA
| | - Jane A Cauley
- Department of Epidemiology, Department of Epidemiology Graduate School of Public Health, University of Pittsburgh Pittsburgh PA USA
| | - John T Schousboe
- HealthPartners Institute, Park Nicollet Clinic, and University of Minnesota Minneapolis MN USA
| | - Andrea Z LaCroix
- Department of Family and Public Health University of California, San Diego La Jolla CA USA
| | - John A Robbins
- Department of Medicine UC Davis Medical Center Sacramento CA USA
| | - Nelson B Watts
- Mercy Health Osteoporosis and Bone Health Services Cincinnati OH USA
| | - Kristine E Ensrud
- Division of Epidemiology & Community Health University of Minnesota Medical School Minneapolis MN USA
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26
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Yueniwati Y, Rosa. The Significant Correlation Between the Density of the Cochlea Otic Capsule and Spine in Hearing Loss Patients. Indian J Otolaryngol Head Neck Surg 2019; 71:1163-1168. [PMID: 31750143 PMCID: PMC6841858 DOI: 10.1007/s12070-018-01580-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/27/2018] [Indexed: 11/26/2022] Open
Abstract
Osteoporosis and osteopenia are systemic disorders that affect all bones. Osteoporosis in the ear bone and cochlea otic capsule contribute to the occurrence of conduction and sensorineural deaf. The osteoporosis prevalence in RSSA is 38%; meanwhile hearing interference in osteoporosis patients is 66.67%. The femur and spine DXA are the golden standard to calculate the bone mineral density. The temporal bone density can be measured with CT scan using the Hounsfield Unit units. There is a hypothesis that the femur bone mass density can illustrate the temporal bone density. This study aimed to analyzes the correlation between the density of the cochlea otic capsule and the ear bone towards the femur and spine density in patients with reduction in bone density. This was a cross-sectional observational type analytic retrospective study analyzing 30 samples of patients with a reduction in bone density that have HRCT Mastoid examination results during 2017 at RSSA Malang's osteoporosis polyclinic. From 30 samples, most were female with an age range of 51-60 years old. The average femur, spine, ear bone and cochlea otic capsule of the osteoporosis group was lower than the osteopenia group. The spine density was significantly correlated with the otic capsule density. There was a positive significant correlation between the spine density towards the otic capsule density. The lower the spine density, the lower the otic capsule became.
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Affiliation(s)
- Yuyun Yueniwati
- Radiology Department, Faculty of Medicine, Universitas Brawijaya, Jl Veteran, Malang, 65145 Indonesia
| | - Rosa
- Radiology Department, Faculty of Medicine, Universitas Brawijaya, Jl Veteran, Malang, 65145 Indonesia
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Camacho-Cardenosa M, Camacho-Cardenosa A, Burtscher M, Brazo-Sayavera J, Tomas-Carus P, Olcina G, Timón R. Effects of Whole-Body Vibration Training Combined With Cyclic Hypoxia on Bone Mineral Density in Elderly People. Front Physiol 2019; 10:1122. [PMID: 31543827 PMCID: PMC6728928 DOI: 10.3389/fphys.2019.01122] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/13/2019] [Indexed: 12/13/2022] Open
Abstract
Prevention and treatment of osteoporosis are an issue of great concern in public health so that the increase/maintenance of whole-body bone mineral density (BMD) is clinically relevant and could reduce the financial burden. Whole-body vibration (WBV) has been recently proposed as a potential alternative to bone stimulation, which combined with therapies, could provide a new treatment for osteoporosis prevention. In this sense, moderate cyclic hypoxia protocols may help to restrain osteoclastic activity and/or stimulate osteoblastic activity, enhance the effects of whole-body vibration alone. So, the present study investigated the effects of cyclic hypoxic exposure combined with WBV training on BMD of the elderly. Healthy elderly persons (n = 30) were randomly assigned to a (1) Hypoxia-Whole Body Vibration group (HWBV; n = 10), (2) Normoxic-Whole Body Vibration group (NWBV; n = 10) or (3) Control group (CON; n = 10). During 18 weeks, HWBV performed WBV treatment under normobaric hypoxic conditions (16.1% FiO2). A vibration session included 4 bouts of 30 s (12.6 Hz–4 mm) with 1 min rest between bouts. NWBV performed the same vibration treatment as HWBV but under normoxic conditions. Whole-body and proximal femur BMD (g⋅cm−2) were measured using dual-energy X-ray absorptiometry. Two-way ANOVA indicated a borderline significant (p = 0.07) time x group interaction for total BMD; post hoc analysis revealed a slight but significant (p = 0.021) increase of BMD after treatment in the HWBV group. In conclusion, 18-week WBV training with hypoxic stimuli has shown positive effects for the participants of the current study. As changes did not differ significantly between groups, future large-scale studies will be necessary to confirm these findings.
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Affiliation(s)
| | | | - Martin Burtscher
- Department of Sport Science, Medical Section, University of Innsbruck, Innsbruck, Austria
| | - Javier Brazo-Sayavera
- Instituto Superior de Educación Física, Universidad de la República, Rivera, Uruguay.,Polo de Desarrollo Universitario EFISAL, Universidad de la República, Rivera, Uruguay
| | - Pablo Tomas-Carus
- Departamento de Desporto e Saúde, Escola de Ciências e Tecnologia, Universidade de Évora, Évora, Portugal.,Comprehensive Health Research Centre (CHRC), Universidade de Évora, Évora, Portugal
| | - Guillermo Olcina
- Faculty of Sport Sciences, University of Extremadura, Cáceres, Spain
| | - Rafael Timón
- Faculty of Sport Sciences, University of Extremadura, Cáceres, Spain
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28
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Scott D, Seibel MJ, Cumming R, Naganathan V, Blyth F, Le Couteur DG, Handelsman DJ, Hsu B, Waite LM, Hirani V. Associations of Body Composition Trajectories with Bone Mineral Density, Muscle Function, Falls, and Fractures in Older Men: The Concord Health and Ageing in Men Project. J Gerontol A Biol Sci Med Sci 2019; 75:939-945. [DOI: 10.1093/gerona/glz184] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Indexed: 12/17/2022] Open
Abstract
Abstract
Background
Weight loss increases fracture risk in older adults. We aimed to determine associations of 2-year body composition trajectories with subsequent falls and fractures in older men.
Methods
We measured appendicular lean mass (ALM) and total fat mass (FM) by dual-energy X-ray absorptiometry at baseline and Year 2 in 1,326 community-dwelling men aged ≥70 and older. Body composition trajectories were determined from residuals of a linear regression of change in ALM on change in FM (higher values indicate maintenance of ALM over FM), and a categorical variable for change in ALM and FM (did not lose [≥−5% change] versus lost [<−5% change]). Bone mineral density (BMD), hand grip strength, and gait speed were assessed at Years 2 and 5. After Year 2, incident fractures (confirmed by radiographical reports) and falls were recorded for 6.8 years.
Results
Compared with men who did not lose ALM or FM, men who did not lose ALM but lost FM, and men who lost both ALM and FM, had reduced falls (−24% and −34%, respectively; both p < .05). Men who lost ALM but did not lose FM had increased falls (incidence rate ratio = 1.73; 95% CI 1.37–2.18). ALM/FM change residuals were associated with improved lumbar spine BMD (B = 0.007; 95% CI 0.002–0.012 g/cm2 per SD increase) and gait speed (0.015; 0.001–0.029 m/s), and reduced hip fractures (hazard ratio = 0.68; 95% CI 0.47–0.99).
Conclusions
Fracture risk may be increased in older men who lose higher ALM relative to FM. Weight loss interventions for obese older men should target maintenance of lean mass.
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Affiliation(s)
- David Scott
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Department of Medicine and Australian Institute of Musculoskeletal Science, Melbourne Medical School – Western Campus, The University of Melbourne, St Albans, Victoria, Australia
| | - Markus J Seibel
- Bone Research Program, ANZAC Research Institute, and Department of Endocrinology & Metabolism, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Robert Cumming
- School of Public Health, University of Sydney, New South Wales, Australia
- Centre for Education and Research on Ageing and Alzheimer’s Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, New South Wales, Australia
- The ARC Centre of Excellence in Population Ageing Research, University of Sydney, New South Wales, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing and Alzheimer’s Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Fiona Blyth
- Centre for Education and Research on Ageing and Alzheimer’s Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, New South Wales, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing and Alzheimer’s Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, New South Wales, Australia
- ANZAC Research Institute & Charles Perkins Centre, University of Sydney, New South Wales, Australia
| | - David J Handelsman
- Department of Andrology, Concord Hospital & ANZAC Research Institute, University of Sydney, New South Wales, Australia
| | - Benjumin Hsu
- Department of Andrology, Concord Hospital & ANZAC Research Institute, University of Sydney, New South Wales, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing and Alzheimer’s Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, New South Wales, Australia
| | - Vasant Hirani
- Centre for Education and Research on Ageing and Alzheimer’s Institute, Concord Hospital, Concord Clinical School, Faculty of Medicine and Health, Concord Hospital, University of Sydney, New South Wales, Australia
- School of Life and Environmental Sciences, Charles Perkins Centre, University of Sydney, New South Wales, Australia
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29
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Binkley HM, Rudd LE. Head-Out Aquatic Exercise for Generally Healthy Postmenopausal Women: A Systematic Review. J Phys Act Health 2018; 16:1-22. [PMID: 30501546 DOI: 10.1123/jpah.2017-0598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Aquatic exercise (AE) is a method for exercise and rehabilitation to enhance function for various clients. OBJECTIVES Investigate the effects of head-out AE interventions on the physiological and psychological outcomes of healthy postmenopausal women of age 50-70 years. SEARCH STRATEGIES Databases searched included Scopus, ScienceDirect, ResearchGate, PubMed/MEDLINE, PEDro, CINAHL, The Cochrane Library, Nursing & Allied Health Collection: Comprehensive, JSTOR, and OTSeeker.com, through January 2015. Search Criteria: Randomized controlled trial and quasi-randomized controlled trial studies. DATA COLLECTION AND ANALYSIS Two researchers scanned studies based on inclusion and exclusion criteria. Studies included were critically appraised using the Physiotherapy Evidence Database scale (PEDro scale). RESULTS A total of 15 studies including postmenopausal women and head-out AE intervention were reviewed. Considerable variation existed in the interventions and assessments. Outcome measures showed anthropometric measures (body mass index, circumference, skinfolds, and body fat) were inconclusive; upper and lower body strength improved; flexibility improved; all functional movements (short-distance walk, long-distance walk/run, power, agility, balance and falls) improved; bone density improved; biochemical and hormonal variables were inconclusive; and quality of life outcomes improved. CONCLUSIONS Head-out AE appears to be an effective training and conditioning method for postmenopausal women to improve strength, flexibility, functional movements, bone density, and quality of life.
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30
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Ko CH, Yu SF, Su FM, Chen JF, Chen YC, Su YJ, Lai HM, Chiu WC, Hsu CY, Cheng TT, Chang SJ. High prevalence and correlates of osteoporosis in men aged 50 years and over: A nationwide osteoporosis survey in Taiwan. Int J Rheum Dis 2018; 21:2112-2118. [DOI: 10.1111/1756-185x.13409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 08/23/2018] [Accepted: 09/15/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Chi-Hua Ko
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Shan-Fu Yu
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
- Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Fu-Mei Su
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Jia-Feng Chen
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Ying-Chou Chen
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
- Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Yu-Jih Su
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
- Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Han-Ming Lai
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Wen-Chan Chiu
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Chung-Yuan Hsu
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine; Kaohsiung Chang Gung Memorial Hospital; Kaohsiung Taiwan
- Chang Gung University College of Medicine; Kaohsiung Taiwan
| | - Shun-Jen Chang
- Department of Kinesiology, Health and Leisure Studies; University of Kaohsiung; Kaohsiung Taiwan
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31
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Secular trends in incidence of osteoporosis in Taiwan: A nationwide population-based study. Biomed J 2018; 41:314-320. [PMID: 30580795 PMCID: PMC6306299 DOI: 10.1016/j.bj.2018.08.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 11/03/2017] [Accepted: 08/01/2018] [Indexed: 11/23/2022] Open
Abstract
Background The present study aimed to assess the changes in trend of osteoporosis among the Taiwanese population from 2001 to 2011. Methods The National Health Insurance Research Database (NHIRD) of Taiwan, containing records from approximately 23 million insures from 2001 to 2011, was analyzed. Insurees aged≧50 years with osteoporosis were identified either from previously documented osteoporotic diagnosis or osteoporosis-related fractures according to Clinical Modification (ICD-9-CM) diagnostic code. Results The prevalence of osteoporosis increased from 17.4% in 2001 to 25.0% in 2011. The prevalence trend increased from 2001 to 2005 and plateaued thereafter. During 2001–2005, the incidence rate of hip fracture held steady from 277 to 281 per 100,000 person-years, and decreased thereafter from 262 to 247 per 100,000 person-years. The overall incidence of osteoporosis declined among patients younger than 84 years from 2001 to 2011, especially after 2005. As compared with 2005 and before, the incidence rate of osteoporosis was significantly decreased since 2006. Conclusions The secular changes of osteoporosis in Taiwan are quite similar to the trend in western countries. It reveals how osteoporosis awareness and policy interventions can affect the prevalence trend of osteoporosis.
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32
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Kindilien S, Goldberg EM, Roberts MH, Gonzales-Pacheco D. Nutrition status, bone mass density, and selective serotonin reuptake inhibitors. Prev Med 2018; 113:62-67. [PMID: 29746975 DOI: 10.1016/j.ypmed.2018.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 04/25/2018] [Accepted: 05/06/2018] [Indexed: 02/06/2023]
Abstract
The association between selective serotonin reuptake inhibitor (SSRI) use and bone mass density (BMD) has been debated. Inadequate diet, which may occur in depressed individuals prescribed SSRIs is also associated with decreased BMD. This study seeks to determine if SSRI use in adults is associated with lower than average BMD while controlling for nutrition related variables. Further, it investigates whether there are potential interactions between micronutrients and SSRI use on BMD. Adults, 655 with an SSRI prescription ≥180 days and 12,372 non-users, were identified in the 2005-2014 National Health and Nutrition Examination Survey (NHANES) data. Survey respondents were propensity score matched on propensity to have an SSRI prescription and compared on femoral neck BMD t-scores. A sub-analysis within SSRI users was conducted to calculate the odds ratio (OR) of having a low (osteopenia or osteoporosis) BMD t-score given SSRI exposure and inadequate daily micronutrient intake. Inadequate daily micronutrient intake was common; over half of SSRI users and non-users had inadequate calcium, vitamin D, and potassium. SSRI use was associated with an absolute reduction of 0.11 in BMD t-score. Inadequate daily vitamin D intake was associated with lower BMD t-scores in both SSRI users and non-users. The interaction of SSRI use and inadequate daily intake of zinc was also associated with low BMD (OR: 1.11, 95% CI: 1.01-1.23). Patient health may be improved by nutritional education, referral to a dietitian, or by micronutrient monitoring by the prescribing physician.
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Affiliation(s)
- Shannon Kindilien
- MSC09 5360 College of Pharmacy, University of New Mexico, Albuquerque, NM 87131, United States.
| | - Elle M Goldberg
- Data System Analytics and Decision Support Team, UNMH Quality Outcomes Department, room 3112 HOPE Building/933 Bradbury Dr. SE, Albuquerque, NM 87106, United States.
| | - Melissa H Roberts
- MSC09 5360 College of Pharmacy, University of New Mexico, Albuquerque, NM 87131, United States.
| | - Diana Gonzales-Pacheco
- Simpson Hall MSC05 3040, University of New Mexico, Albuquerque, NM 87131-0001, United States.
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Schmidt T, Ebert K, Rolvien T, Oehler N, Lohmann J, Papavero L, Kothe R, Amling M, Barvencik F, Mussawy H. A retrospective analysis of bone mineral status in patients requiring spinal surgery. BMC Musculoskelet Disord 2018; 19:53. [PMID: 29439698 PMCID: PMC5811985 DOI: 10.1186/s12891-018-1970-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/08/2018] [Indexed: 11/30/2022] Open
Abstract
Background Impaired bone quality is associated with poor outcome of spinal surgery. The aim of the study was to assess the bone mineral status of patients scheduled to undergo spinal surgery and to report frequencies of bone mineral disorders. Methods We retrospectively analyzed the bone mineral status of 144 patients requiring spinal surgery including bone mineral density by dual-energy X-ray absorptiometry (DXA) as well as laboratory data with serum levels of 25-hydroxyvitamin D (25-OH-D), parathyroid hormone, calcium, bone specific alkaline phosphate, osteocalcin, and gastrin. High-resolution peripheral quantitative computed tomography (HR-pQCT) was additionally performed in a subgroup of 67 patients with T-Score below − 1.5 or history of vertebral fracture. Results Among 144 patients, 126 patients (87.5%) were older than 60 years. Mean age was 70.1 years. 42 patients (29.1%) had suffered from a vertebral compression fracture. 12 previously undiagnosed vertebral deformities were detected in 12 patients by vertebral fracture assessment (VFA). Osteoporosis was present in 39 patients (27.1%) and osteopenia in 63 patients (43.8%). Only 16 patients (11.1%) had received anti-osteoporotic therapy, while 54 patients (37.5%) had an indication for specific anti-osteoporotic therapy but had not received it yet. The majority of patients had inadequate vitamin D status (73.6%) and 34.7% of patients showed secondary hyperparathyroidism as a sign for a significant disturbed calcium homeostasis. In a subgroup of 67 patients, severe vertebral deformities were associated with stronger deficits in bone microarchitecture at the distal radius compared to the distal tibia. Conclusions This study shows that bone metabolism disorders are highly prevalent in elderly patients scheduled for spinal surgery. Vertebral deformities are associated with a predominant deterioration of bone microstructure at the distal radius. As impaired bone quality can compromise surgical outcome, we strongly recommend an evaluation of bone mineral status prior to operation and anti-osteoporotic therapy if necessary.
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Affiliation(s)
- Tobias Schmidt
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany. .,Department of Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Katharina Ebert
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany
| | - Tim Rolvien
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany.,Department of Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Nicola Oehler
- Department of Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jens Lohmann
- Clinic for Spinal Surgery, Schoen Klinik Eilbek, Denhaide 120, 22081, Hamburg, Germany
| | - Luca Papavero
- Clinic for Spinal Surgery, Schoen Klinik Eilbek, Denhaide 120, 22081, Hamburg, Germany
| | - Ralph Kothe
- Clinic for Spinal Surgery, Schoen Klinik Eilbek, Denhaide 120, 22081, Hamburg, Germany
| | - Michael Amling
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany
| | - Florian Barvencik
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany
| | - Haider Mussawy
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Lottestraße 59, 22529, Hamburg, Germany.,Department of Orthopedic Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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34
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Zhang X, Lin J, Yang Y, Wu H, Li Y, Yang X, Fei Q. Comparison of three tools for predicting primary osteoporosis in an elderly male population in Beijing: a cross-sectional study. Clin Interv Aging 2018; 13:201-209. [PMID: 29440880 PMCID: PMC5798543 DOI: 10.2147/cia.s145741] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose In this cross-sectional study, three clinical tools, the Osteoporosis Self-Assessment Tool for Asians (OSTA), Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD), and body mass index (BMI), for predicting primary osteoporosis (OP) were compared and ideal thresholds for omission of screening BMD were proposed in a community-dwelling elderly Han Beijing male population. Patients and methods A total of 1,349 community-dwelling elderly Han Beijing males aged ≥50 years were enrolled in this study. All subjects completed a questionnaire and measured BMD by dual-energy X-ray absorptiometry (DXA). Osteoporosis was defined as a T-score of -2.5 SD or lower than that of the average young adult in different diagnostic criteria (lumbar spine [L1-L4], femoral neck, total hip, worst hip, and World Health Organization [WHO]). FRAX without BMD, OSTA, and BMI were assessed for predicting OP by receiver operating characteristic (ROC) curves. Sensitivity, specificity, and areas under the ROC curves (AUCs) were determined. Ideal thresholds for omission of screening BMD were proposed. Results The prevalence of OP ranged from 1.8% to 12.8% according to different diagnostic criteria. This study showed that the BMI has highest discriminating ability. The AUC of FRAX without BMD ranged from 0.536 to 0.630, which suggested limiting predictive value for identifying OP in elderly Beijing male. The AUCs of BMI (0.801-0.880) were slightly better than OSTA (0.722-0.874) in predicting OP at all sites. The AUC of BMI to identify OP in worst hip was 0.824, yielding a sensitivity of 84.8% and a specificity of 64.4%. 40% of participants on BMD measurements saved only 0.1%-2.7% missed OP. Compared to OSTA and FRAX without BMD, the BMI got the best predictive value for OP. Conclusion BMI may be a simple and effective tool for identifying OP in the elderly male population in Beijing to omit BMD screening reasonably.
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Affiliation(s)
- XiaoDong Zhang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University
| | - JiSheng Lin
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University
| | - Yong Yang
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University
| | - Hao Wu
- Fangzhuang Community Health Service Center
| | - Yongjin Li
- Tuanjiehu Community Health Service Center
| | - Xiuquan Yang
- Wangzuo Community Health Service Center, Beijing, People's Republic of China
| | - Qi Fei
- Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University
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35
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Chan GMF, Riandini T, Ng SHX, Goh SY, Tan CS, Tai ES, Duque G, Ng ACM, Venkataraman K. Role of Fat and Bone Biomarkers in the Relationship Between Ethnicity and Bone Mineral Density in Older Men. Calcif Tissue Int 2018; 102:64-72. [PMID: 29052745 PMCID: PMC5760609 DOI: 10.1007/s00223-017-0342-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/05/2017] [Indexed: 12/21/2022]
Abstract
Osteoporosis is an important health issue for older adults, and has been relatively understudied in older men. This study aimed to examine ethnic differences in bone mineral density (BMD), and elucidate the role of bone turnover markers (BTMs), fat and fat biomarkers on these ethnic differences. BMD at the lumbar spine and femoral neck, marrow fat at femoral neck, visceral adipose tissue (VAT) and subcutaneous adipose tissue, bone and fat biomarkers were evaluated in 120 healthy men aged ≥ 60 years. Indians had higher BMD values compared to Chinese at the lumbar spine (β = 20.336, SE = 4.749, p < 0.001) and the femoral neck (e β = 1.105, SE = 0.032, p < 0.001), after adjusting for BTMs, fat composition and lifestyle choices. Marrow fat, VAT and adiponectin were independent predictors of BMD. However, these factors did not explain the lower BMD observed in older Chinese men. Our findings suggest that older Chinese men are at significant risk of osteoporotic fractures due to lower BMD. Fat appears to be a key factor associated with lower BMD, and warrants further longitudinal studies to elucidate the complex interactions between adipose tissue and bone strength.
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Affiliation(s)
- Grace M F Chan
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 11, NUHS Tower Block, Singapore, 119228, Singapore
| | - Tessa Riandini
- Saw Swee Hock School of Public Health, National University of Singapore, #10-03 J, Level 10, Tahir Foundation Building (MD1), 12 Science Drive 2, Singapore, 117549, Singapore
| | - Sheryl Hui Xian Ng
- Saw Swee Hock School of Public Health, National University of Singapore, #10-03 J, Level 10, Tahir Foundation Building (MD1), 12 Science Drive 2, Singapore, 117549, Singapore
| | - Su Yen Goh
- Department of Endocrinology, Singapore General Hospital, Academia, Level 3, Outram Road, Singapore, 169608, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, #10-03 J, Level 10, Tahir Foundation Building (MD1), 12 Science Drive 2, Singapore, 117549, Singapore
| | - E Shyong Tai
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 11, NUHS Tower Block, Singapore, 119228, Singapore
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St. Albans, VIC, Australia
| | - Alvin Choon-Meng Ng
- The Endocrine Clinic, Mount Elizabeth Medical Centre, 3 Mount Elizabeth, #15-04, Singapore, 228510, Singapore
- Singapore General Hospital, Singapore, Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, #10-03 J, Level 10, Tahir Foundation Building (MD1), 12 Science Drive 2, Singapore, 117549, Singapore.
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Diem SJ, Peters KW, Gourlay ML, Schousboe JT, Taylor BC, Orwoll ES, Cauley JA, Langsetmo L, Crandall CJ, Ensrud KE. Screening for Osteoporosis in Older Men: Operating Characteristics of Proposed Strategies for Selecting Men for BMD Testing. J Gen Intern Med 2017; 32:1235-1241. [PMID: 28815485 PMCID: PMC5653561 DOI: 10.1007/s11606-017-4153-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 02/27/2017] [Accepted: 07/27/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND The optimal approach for selecting men for bone mineral density (BMD) testing to screen for osteoporosis is uncertain. OBJECTIVE To compare strategies for selecting older men for screening BMD testing. DESIGN Prospective cohort study. PARTICIPANTS A total of 4043 community-dwelling men aged ≥70 years at four US sites. MAIN MEASURES BMD at the total hip, femoral neck, and lumbar spine using dual-energy x-ray absorptiometry (DXA). Sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and area under the receiver operating curve (AUC) of the Osteoporosis Self-Assessment Tool (OST) and Fracture Risk Assessment Tool (FRAX) without BMD to discriminate between those with and without osteoporosis as defined by World Health Organization (WHO) diagnostic criteria, and between those recommended and not recommended for pharmacologic therapy based on the National Osteoporosis Foundation (NOF) guidelines. KEY RESULTS Among the cohort, 216 (5.3%) had a BMD T-score ≤ -2.5 at the femoral neck, total hip, or lumbar spine, and 1184 (29.2%) met criteria for consideration of pharmacologic therapy according to NOF guidelines. The OST had better discrimination (AUC 0.68) than the FRAX (AUC 0.62; p = 0.004) for identifying T-score-defined osteoporosis. Use of an OST threshold of <2 resulted in sensitivity of 0.83 and specificity of 0.36 for the identification of osteoporosis, compared to sensitivity of 0.59 and specificity of 0.59 for the use of FRAX with a cutoff of 9.3% 10-year risk of major osteoporotic fracture. CONCLUSIONS The OST performs modestly better than the more complex FRAX in selecting older men for BMD testing to screen for osteoporosis; the use of either tool substantially reduces the proportion of men referred for BMD testing compared to universal screening. Of 1000 men aged 70 and older in this community-based cohort, the use of an OST cutoff of <2 to select men for BMD testing would result in 654 men referred for BMD testing, of whom 44 would be identified as having osteoporosis, and nine with osteoporosis would be missed.
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Affiliation(s)
- Susan J Diem
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA.
| | - Katherine W Peters
- California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - Margaret L Gourlay
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - John T Schousboe
- Park Nicollet Clinic & HealthPartners Institute, Minneapolis, MN, USA
- Division of Health Policy & Management, University of Minnesota, Minneapolis, MN, USA
| | - Brent C Taylor
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, USA
| | - Eric S Orwoll
- Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa Langsetmo
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
| | | | - Kristine E Ensrud
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, USA
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Gourlay ML, Ritter VS, Fine JP, Overman RA, Schousboe JT, Cawthon PM, Orwoll ES, Nguyen TV, Lane NE, Cummings SR, Kado DM, Lapidus JA, Diem SJ, Ensrud KE. Comparison of fracture risk assessment tools in older men without prior hip or spine fracture: the MrOS study. Arch Osteoporos 2017; 12:91. [PMID: 29052793 PMCID: PMC5695884 DOI: 10.1007/s11657-017-0389-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/10/2017] [Indexed: 02/03/2023]
Abstract
Femoral neck bone mineral density (BMD), age plus femoral neck BMD T score, and three externally generated fracture risk tools had similar accuracy to identify older men who developed osteoporotic fractures. Risk tools with femoral neck BMD performed better than those without BMD. The externally developed risk tools were poorly calibrated. INTRODUCTION We compared the performance of fracture risk assessment tools in older men, accounting for competing risks including mortality. METHODS A comparative ROC curve analysis assessed the ability of the QFracture, FRAX® and Garvan fracture risk tools, and femoral neck bone mineral density (BMD) T score with or without age to identify incident fracture in community-dwelling men aged 65 years or older (N = 4994) without hip or clinical vertebral fracture or antifracture treatment at baseline. RESULTS Among risk tools calculated with BMD, the discriminative ability to identify men with incident hip fracture was similar for FRAX (AUC 0.77, 95% CI 0.73, 0.81), the Garvan tool (AUC 0.78, 95% CI 0.74, 0.82), age plus femoral neck BMD T score (AUC 0.79, 95% CI 0.75, 0.83), and femoral neck BMD T score alone (AUC 0.76, 95% CI 0.72, 0.81). Among risk tools calculated without BMD, the discriminative ability to identify hip fracture was similar for QFracture (AUC 0.69, 95% CI 0.66, 0.73), FRAX (AUC 0.70, 95% CI 0.66, 0.73), and the Garvan tool (AUC 0.71, 95% CI 0.67, 0.74). Correlated ROC curve analyses revealed better diagnostic accuracy for risk scores calculated with BMD compared with QFracture (P < 0.0001). Calibration was good for the internally generated BMD T score predictor with or without age and poor for the externally developed risk tools. CONCLUSION In untreated older men without fragility fractures at baseline, an age plus femoral neck BMD T score classifier identified men with incident hip fracture as accurately as more complicated fracture risk scores.
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Affiliation(s)
- Margaret L Gourlay
- Department of Family Medicine, University of North Carolina, Aycock Building, Manning Drive, CB #7595, UNC-Chapel Hill, Chapel Hill, NC, 27599-7595, USA.
| | - Victor S Ritter
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Jason P Fine
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | | | - John T Schousboe
- Department of Rheumatology, Park Nicollet Health Services, Minneapolis, MN, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Eric S Orwoll
- Bone and Mineral Unit, Oregon Health and Science University, Portland, OR, USA
| | - Tuan V Nguyen
- Garvan Institute of Medical Research, UNSW School of Public Health and Community Medicine, Kensington, NSW, Australia
- Centre for Health Technologies, University of Technology, Sydney, Australia
| | - Nancy E Lane
- Division of Rheumatology, Department of Medicine, Center for Musculoskeletal Health, UC Davis Health System, Sacramento, CA, USA
| | - Steven R Cummings
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Deborah M Kado
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Jodi A Lapidus
- School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | - Susan J Diem
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kristine E Ensrud
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
- Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, MN, USA
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Carfì A, Liperoti R, Fusco D, Giovannini S, Brandi V, Vetrano DL, Meloni E, Mascia D, Villani ER, Manes Gravina E, Bernabei R, Onder G. Bone mineral density in adults with Down syndrome. Osteoporos Int 2017; 28:2929-2934. [PMID: 28685282 DOI: 10.1007/s00198-017-4133-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 06/19/2017] [Indexed: 11/25/2022]
Abstract
UNLABELLED This study analyzed data of bone mineral density (BMD) from a large cohort of adults with Down syndrome (DS). BMD was found to decrease with age more rapidly in these subjects than in the general population, exposing adults with DS to an increased risk of osteoporosis and bone fracture. INTRODUCTION Down syndrome (DS) in adulthood presents with a high prevalence of osteoporosis. However, in DS, bone mineral density (BMD) can be underestimated due to short stature. Furthermore, the rate of age-related decline in BMD and its association with gender in DS has been rarely evaluated or compared with the general population. The present study is aimed at assessing the variation of BMD with age and gender in a sample of adults with DS and to compare these data with those of the general population, after adjusting for anthropometric differences. METHODS Adults with DS, aged 18 or older, were assessed dual-energy-X-ray-absorptiometry (DXA) at the femoral neck and at the lumbar spine. They were compared with the general population enrolled in the National Health and Nutrition Examination Survey (NHANES) 2009-2010 dataset. Bone mineral apparent density (BMAD) was calculated for each individual. RESULTS DXA was evaluated in 234 subjects with DS (mean age 36.93 ± 11.83 years, ranging from 20 to 69 years; 50.4% females). In the lumbar spine both mean BMD (DS 0.880 ± 0.141 vs. NHANES 1.062 ± 0.167, p < 0.001) and BMAD (DS 0.138 ± 0.020 vs. NHANES 0.152 ± 0.020, p < 0.001) were significantly lower in the DS sample than in the NAHNES cohort. The same trend was observed at the femoral neck in both BMD (DS 0.658 ± 0.128 vs. NHANES 0.835 ± 0.137, p < 0.001) and BMAD (DS 0.151 ± 0.030 vs. NHANES 0.159 ± 0.028, p<0.001). Age was associated with lower femoral neck BMAD in both samples; importantly, this association was significantly stronger in the DS sample. In the lumbar spine region, no significant association between BMAD and age could be observed in both samples. CONCLUSIONS Adults with DS have lower bone mineral density compared to the general population and they experience a steeper decline with age. Early screening programs are needed in DS population.
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Affiliation(s)
- A Carfì
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy.
| | - R Liperoti
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - D Fusco
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - S Giovannini
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - V Brandi
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - D L Vetrano
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - E Meloni
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - D Mascia
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - E R Villani
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - E Manes Gravina
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - R Bernabei
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
| | - G Onder
- Department of Gerontology, Neurosciences, Head and Neck and Orthopedics, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168, Rome, Italy
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Chin KY, Low NY, Dewiputri WI, Ima-Nirwanaa S. Factors Associated with Bone Health in Malaysian Middle-Aged and Elderly Women Assessed via Quantitative Ultrasound. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14070736. [PMID: 28684685 PMCID: PMC5551174 DOI: 10.3390/ijerph14070736] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 12/21/2022]
Abstract
Risk factors for osteoporosis may vary according to different populations. We aimed to investigate the relationship between risk factors of osteoporosis and bone health indices determined via calcaneal quantitative ultrasound (QUS) in a group of Malaysian women aged 50 years or above. A cross-sectional study was performed on 344 Malaysian women recruited from a tertiary medical centre in Kuala Lumpur, Malaysia. They answered a self-administered questionnaire on their social-demographic details, medical history, lifestyle, and physical activity status. Their height was measured using a stadiometer, and their body composition estimated using a bioelectrical impedance device. Their bone health status was determined using a water-based calcaneal QUS device that generated three indices, namely speed of sound (SOS), broadband ultrasound attenuation (BUA), and stiffness index (SI). A T-score was computed from SI values using a reference database from a mainland Chinese population. Women with three or more lifetime pregnancies, who were underweight and not drinking coffee had a significantly lower BUA. Stepwise multiple linear regression showed that SOS was predicted by age alone, BUA and SI by years since menopause, body mass index (BMI), and number of lifetime pregnancies, and T-score by years since menopause and percentage of body fat. As a conclusion, suboptimal bone health in middle-aged and elderly Malaysian women as indicated by QUS is associated with old age, being underweight, having a high body fat percentage, and a high number of lifetime pregnancies. Women having several risk factors should be monitored more closely to protect their bones against accelerated bone loss.
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Affiliation(s)
- Kok-Yong Chin
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Malaysia.
| | - Nie Yen Low
- ASASIpintar, PERMATApintar National Gifted Centre, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia.
| | - Wan Ilma Dewiputri
- ASASIpintar, PERMATApintar National Gifted Centre, Universiti Kebangsaan Malaysia, Bangi 43600, Malaysia.
| | - Soelaiman Ima-Nirwanaa
- Department of Pharmacology, Universiti Kebangsaan Malaysia Medical Centre, Cheras 56000, Malaysia.
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Gourlay ML, Overman RA, Fine JP, Crandall CJ, Robbins J, Schousboe JT, Ensrud KE, LeBlanc ES, Gass ML, Johnson KC, Womack CR, LaCroix AZ. Time to Clinically Relevant Fracture Risk Scores in Postmenopausal Women. Am J Med 2017; 130:862.e15-862.e23. [PMID: 28285070 PMCID: PMC5474146 DOI: 10.1016/j.amjmed.2017.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/07/2017] [Accepted: 02/18/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Clinical practice guidelines recommend use of fracture risk scores for screening and pharmacologic treatment decisions. The timing of occurrence of treatment-level (according to 2014 National Osteoporosis Foundation guidelines) or screening-level (according to 2011 US Preventive Services Task Force guidelines) fracture risk scores has not been estimated in postmenopausal women. METHODS We conducted a retrospective competing risk analysis of new occurrence of treatment-level and screening-level fracture risk scores in postmenopausal women aged 50 years and older, prior to receipt of pharmacologic treatment and prior to first hip or clinical vertebral fracture. RESULTS In 54,280 postmenopausal women aged 50 to 64 years without a bone mineral density test, the time for 10% to develop a treatment-level FRAX score could not be estimated accurately because of rare incidence of treatment-level scores. In 6096 women who had FRAX scores calculated with bone mineral density, the estimated unadjusted time to treatment-level FRAX ranged from 7.6 years (95% confidence interval [CI], 6.6-8.7) for those aged 65 to 69, to 5.1 years (95% CI, 3.5-7.5) for those aged 75 to 79 at baseline. Of 17,967 women aged 50 to 64 with a screening-level FRAX at baseline, 100 (0.6%) experienced a hip or clinical vertebral fracture by age 65 years. CONCLUSIONS Postmenopausal women with sub-threshold fracture risk scores at baseline were unlikely to develop a treatment-level FRAX score between ages 50 and 64 years. After age 65, the increased incidence of treatment-level fracture risk scores, osteoporosis, and major osteoporotic fracture supports more frequent consideration of FRAX and bone mineral density testing.
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Affiliation(s)
- Margaret L Gourlay
- Department of Family Medicine, University of North Carolina, Chapel Hill.
| | - Robert A Overman
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Jason P Fine
- Department of Biostatistics, University of North Carolina, Chapel Hill
| | | | - John Robbins
- Department of Internal Medicine, University of California at Davis, Sacramento
| | - John T Schousboe
- Division of Health Policy and Management, University of Minnesota, Minneapolis
| | - Kristine E Ensrud
- Department of Medicine, Division of Epidemiology, University of Minnesota, Minneapolis; Department of Medicine, Minneapolis VA Health Care System, Minn
| | - Erin S LeBlanc
- Center for Health Research, Kaiser Permanente Northwest, Portland, Ore
| | | | - Karen C Johnson
- Department of Preventive Medicine and Medicine, University of Tennessee Health Science Center, Memphis
| | - Catherine R Womack
- Department of Preventive Medicine and Medicine, University of Tennessee Health Science Center, Memphis
| | - Andrea Z LaCroix
- Division of Epidemiology, School of Medicine, University of California at San Diego
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Looker AC, Sarafrazi Isfahani N, Fan B, Shepherd JA. Trends in osteoporosis and low bone mass in older US adults, 2005-2006 through 2013-2014. Osteoporos Int 2017; 28:1979-1988. [PMID: 28315954 PMCID: PMC7891684 DOI: 10.1007/s00198-017-3996-1] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/28/2017] [Indexed: 11/25/2022]
Abstract
This study examined trends in osteoporosis and low bone mass in older US adults between 2005 and 2014 using bone mineral density (BMD) data from the National Health and Nutrition Examination Survey (NHANES). Osteoporosis and low bone mass appear to have increased at the femur neck but not at the lumbar spine during this period. INTRODUCTION Recent preliminary data from Medicare suggest that the decline in hip fracture incidence among older US adults may have plateaued in 2013-2014, but comparable data on BMD trends for this time period are currently lacking. This study examined trends in the prevalence of osteoporosis and low bone mass since 2005 using BMD data from NHANES. The present study also updated prevalence estimates to 2013-2014 and included estimates for non-Hispanic Asians. METHODS Femur neck and lumbar spine BMD by DXA were available for 7954 adults aged 50 years and older from four NHANES survey cycles between 2005-2006 and 2013-2014. RESULTS Significant trends (quadratic or linear) were observed for the femur neck (mean T-score and osteoporosis in both sexes; low bone mass in women) but not for the lumbar spine. The trend in femur neck status was somewhat U-shaped, with prevalences being most consistently significantly higher (by 1.1-6.6 percentage points) in 2013-2014 than 2007-2008. Adjusting for changes in body mass index, smoking, milk intake, and physician's diagnosis of osteoporosis between surveys did not change femur neck trends. In 2013-2014, the percent of older adults with osteoporosis was 6% at the femur neck, 8% at the lumbar spine, and 11% at either site. CONCLUSIONS There was some evidence of a decline in femur neck BMD between 2005-2006 and 2013-2014, but not in lumbar spine BMD. Changes in the risk factors that could be examined did not explain the femur neck BMD trends.
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Affiliation(s)
- A C Looker
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Room 3416, Hyattsville, MD, 20782, USA.
| | - N Sarafrazi Isfahani
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, 3311 Toledo Road, Room 3416, Hyattsville, MD, 20782, USA
| | - B Fan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - J A Shepherd
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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Qiu R, Cao WT, Tian HY, He J, Chen GD, Chen YM. Greater Intake of Fruit and Vegetables Is Associated with Greater Bone Mineral Density and Lower Osteoporosis Risk in Middle-Aged and Elderly Adults. PLoS One 2017; 12:e0168906. [PMID: 28045945 PMCID: PMC5207626 DOI: 10.1371/journal.pone.0168906] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 12/08/2016] [Indexed: 11/25/2022] Open
Abstract
Objective A few studies have suggested that the consumption of fruit and vegetables (FV) may benefit bone health, but limited data are available in Asian subjects. We examined the association between FV intake and bone mineral density (BMD) and osteoporosis in Chinese adults. Methods This population-based cross-sectional study involved 2083 women and 1006 men aged 40–75 years in Guangzhou, China. Habitual dietary data was collected from a 79-item food frequency questionnaire by face-to-face interviews. The BMD was measured for the whole body (WB), lumbar spine (LS), total hip (TH) and femur neck (FN) with dual-energy X-ray absorptiometry. Results After adjustment for potential covariates, we observed dose-dependent associations between total FV intake and BMD and osteoporosis risk. The mean BMD was higher in tertile 3 vs. tertile 1 by 1.33% (TH) and 1.31% (FN) for FV, and 1.10% (WB), 1.57% (TH), and 2.05% (FN) for fruit (all P-trends < 0.05). Significant beneficial associations with BMD at some sites were also found in most fruit categories but not in total vegetables or their subgroups. The odds ratios (95% confidence interval) of osteoporosis (T-score ≤ −2.5) in tertile 3 (vs. 1) were 0.73 (0.58–0.92), 0.37 (0.22–0.60), and 0.71 (0.52–0.97) for FV; 0.82 (0.66–1.03), 0.48 (0.30–0.77) and 0.89 (0.61–1.12) for fruit; and 0.80 (0.64–1.01), 0.57 (0.35–0.92) and 0.76 (0.55–1.05) for vegetables at the LS, TH, and FN, respectively. The favorable association between FV intake and the occurrence of osteoporosis was evident only in subjects with lower BMI (<24.0 kg/m2, P-trends < 0.05). Conclusions Greater intake of FV was independently associated with a higher BMD and a lower presence of osteoporosis in middle-aged and elderly Chinese subjects with lower BMI. Fruit tended to have more contribution to the favorable association than vegetables.
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Affiliation(s)
- Rui Qiu
- Department of Medical Statistics and Epidemiology, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Wen-ting Cao
- Department of Medical Statistics and Epidemiology, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Hui-yuan Tian
- Department of Medical Statistics and Epidemiology, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Juan He
- Department of Medical Statistics and Epidemiology, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Geng-dong Chen
- Department of Medical Statistics and Epidemiology, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yu-ming Chen
- Department of Medical Statistics and Epidemiology, Guangdong Provincial Key Laboratory of Food, Nutrition and Health, School of Public Health, Sun Yat-sen University, Guangzhou, People's Republic of China
- * E-mail:
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Kim YW, Kim JH, Yoon SH, Lee JH, Lee CH, Shin CS, Park YS. Vertebral bone attenuation on low-dose chest CT: quantitative volumetric analysis for bone fragility assessment. Osteoporos Int 2017; 28:329-338. [PMID: 27480628 DOI: 10.1007/s00198-016-3724-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 07/26/2016] [Indexed: 01/09/2023]
Abstract
UNLABELLED This study evaluated the use of low-dose chest computed tomography (LDCT) for detecting bone fragility. LDCT-measured vertebral bone attenuation by volumetric methods showed good correlation with bone mineral density (BMD) measured by dual-energy x-ray absorptiometry (DXA, and good diagnostic performance for identifying osteoporosis and compression fractures. The results of this study suggest the feasibility of obtaining comprehensive information on bone health in subjects undergoing LDCT. INTRODUCTION Osteoporosis is a prevalent but underdiagnosed disease that increases fracture risk. This study evaluated the utility of vertebral attenuation derived from low-dose chest computed tomography (LDCT) compared to dual-energy x-ray absorptiometry (DXA) for detecting bone fragility. METHODS A total of 232 subjects (78 men and 154 women) aged above 50 years who underwent both LDCT and DXA within 30 days were evaluated. LDCT-measured bone attenuation in Hounsfield units (HU) of four vertebrae (T4, T7, T10, and L1) was evaluated using volumetric methods for correlation with DXA-measured bone mineral density (BMD) and for the diagnosis of compression fractures, osteoporosis, and low BMD (osteoporosis or osteopenia) in men and women, with DXA measurements as the reference standard. RESULTS The average attenuation of the four vertebrae showed strong correlation with DXA-measured BMD of the lumbar spine (r = 0.726, p < 0.05). In receiver-operating characteristic (ROC) analyses, the area under the curve (AUC) across LDCT-measured thresholds of the average attenuation to distinguish compression fractures was 0.827, and a threshold of 129.5 HU yielded 90.9 % sensitivity and 64.4 % specificity. Similarly, average attenuation showed high AUCs and good diagnostic performance for detecting osteoporosis and low BMD in both men and women. Among 44 subjects with compression fractures, the average bone attenuation showed strong negative correlation with both the worst fracture grade (r = -0.525, p < 0.05) and cumulative fracture grade score (r = -0.633, p < 0.05). CONCLUSION LDCT-measured bone attenuation by volumetric methods showed good correlation with BMD measured by DXA and good diagnostic performance for identifying bone fragility.
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Affiliation(s)
- Y W Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea
| | - J H Kim
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - S H Yoon
- Department of Radiology, Institute of Radiation Medicine, Seoul National University Medical Research Center, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - J H Lee
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - C-H Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea
| | - C S Shin
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Y S Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Medicine, Seoul National University, 101 Daehak-Ro, Jongno-Gu, Seoul, 110-744, Republic of Korea.
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Lu JL, Molnar MZ, Ma JZ, George LK, Sumida K, Kalantar-Zadeh K, Kovesdy CP. Racial Differences in Association of Serum Calcium with Mortality and Incident Cardio- and Cerebrovascular Events. J Clin Endocrinol Metab 2016; 101:4851-4859. [PMID: 27631543 PMCID: PMC5155693 DOI: 10.1210/jc.2016-1802] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Abnormalities in calcium metabolism may potentially contribute to the development of vascular disease. Calcium metabolism may be different in African American (AA) vs white individuals, but the effect of race on the association of serum calcium with clinical outcomes remains unclear. OBJECTIVE This study sought to examine race-specific associations of serum calcium levels with mortality and with major incident cardiovascular events. DESIGN AND SETTING This was a historical cohort study in the U.S. Department of Veterans Affairs health care facilities. PARTICIPANTS Participants included veterans (n = 1 967 622) with estimated glomerular filtration rate ≥ 60 mL/min/1.73 m2. MAIN OUTCOME MEASURES The association between serum calcium levels with all-cause mortality, incident coronary heart disease (CHD), and ischemic stroke incidence was examined in multivariable adjusted Cox proportional hazards models, including an interaction term for calcium and race. RESULTS The association of calcium with all-cause mortality was U-shaped in both AA and white patients, but race modified the association of calcium with all-cause mortality. Compared with white patients, AA patients experienced lower risk of mortality when calcium was ≥ 8.8 mg/dL, with a statistically significant interaction (P < .001). Conversely, AA vs white race was associated with higher mortality when calcium was < 8.8 mg/dL. Calcium showed no significant association with ischemic stroke or CHD in both races; and race did not modify these associations (P = .37 and 0.11, respectively for interaction term). CONCLUSIONS Race modified the U-shaped association between calcium and all-cause mortality. Serum calcium is not associated with incident stroke or CHD in either AA or white patients. The race-specific difference in the association of calcium levels with mortality warrants further examination.
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Affiliation(s)
- Jun Ling Lu
- Division of Nephrology (J.L.L., M.Z.M., L.K.G., K.S., C.P.K.), University of Tennessee Health Science Center, Memphis Tennessee 38163; Department of Public Health Sciences and Division of Nephrology, Department of Medicine (J.Z.M.), University of Virginia, Charlottesville, Virginia 22908; Nephrology Center (K.S.), Toranomon Hospital Kajigaya, Kanagawa 213-8587, Japan; Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension (K.K.-Z.), University of California-Irvine Medical Center, Orange, California 92868; and Nephrology Section (C.P.K.), Memphis VA Medical Center, Memphis, Tennessee 38104
| | - Miklos Z Molnar
- Division of Nephrology (J.L.L., M.Z.M., L.K.G., K.S., C.P.K.), University of Tennessee Health Science Center, Memphis Tennessee 38163; Department of Public Health Sciences and Division of Nephrology, Department of Medicine (J.Z.M.), University of Virginia, Charlottesville, Virginia 22908; Nephrology Center (K.S.), Toranomon Hospital Kajigaya, Kanagawa 213-8587, Japan; Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension (K.K.-Z.), University of California-Irvine Medical Center, Orange, California 92868; and Nephrology Section (C.P.K.), Memphis VA Medical Center, Memphis, Tennessee 38104
| | - Jennie Z Ma
- Division of Nephrology (J.L.L., M.Z.M., L.K.G., K.S., C.P.K.), University of Tennessee Health Science Center, Memphis Tennessee 38163; Department of Public Health Sciences and Division of Nephrology, Department of Medicine (J.Z.M.), University of Virginia, Charlottesville, Virginia 22908; Nephrology Center (K.S.), Toranomon Hospital Kajigaya, Kanagawa 213-8587, Japan; Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension (K.K.-Z.), University of California-Irvine Medical Center, Orange, California 92868; and Nephrology Section (C.P.K.), Memphis VA Medical Center, Memphis, Tennessee 38104
| | - Lekha K George
- Division of Nephrology (J.L.L., M.Z.M., L.K.G., K.S., C.P.K.), University of Tennessee Health Science Center, Memphis Tennessee 38163; Department of Public Health Sciences and Division of Nephrology, Department of Medicine (J.Z.M.), University of Virginia, Charlottesville, Virginia 22908; Nephrology Center (K.S.), Toranomon Hospital Kajigaya, Kanagawa 213-8587, Japan; Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension (K.K.-Z.), University of California-Irvine Medical Center, Orange, California 92868; and Nephrology Section (C.P.K.), Memphis VA Medical Center, Memphis, Tennessee 38104
| | - Keiichi Sumida
- Division of Nephrology (J.L.L., M.Z.M., L.K.G., K.S., C.P.K.), University of Tennessee Health Science Center, Memphis Tennessee 38163; Department of Public Health Sciences and Division of Nephrology, Department of Medicine (J.Z.M.), University of Virginia, Charlottesville, Virginia 22908; Nephrology Center (K.S.), Toranomon Hospital Kajigaya, Kanagawa 213-8587, Japan; Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension (K.K.-Z.), University of California-Irvine Medical Center, Orange, California 92868; and Nephrology Section (C.P.K.), Memphis VA Medical Center, Memphis, Tennessee 38104
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology (J.L.L., M.Z.M., L.K.G., K.S., C.P.K.), University of Tennessee Health Science Center, Memphis Tennessee 38163; Department of Public Health Sciences and Division of Nephrology, Department of Medicine (J.Z.M.), University of Virginia, Charlottesville, Virginia 22908; Nephrology Center (K.S.), Toranomon Hospital Kajigaya, Kanagawa 213-8587, Japan; Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension (K.K.-Z.), University of California-Irvine Medical Center, Orange, California 92868; and Nephrology Section (C.P.K.), Memphis VA Medical Center, Memphis, Tennessee 38104
| | - Csaba P Kovesdy
- Division of Nephrology (J.L.L., M.Z.M., L.K.G., K.S., C.P.K.), University of Tennessee Health Science Center, Memphis Tennessee 38163; Department of Public Health Sciences and Division of Nephrology, Department of Medicine (J.Z.M.), University of Virginia, Charlottesville, Virginia 22908; Nephrology Center (K.S.), Toranomon Hospital Kajigaya, Kanagawa 213-8587, Japan; Harold Simmons Center for Chronic Disease Research and Epidemiology, Division of Nephrology and Hypertension (K.K.-Z.), University of California-Irvine Medical Center, Orange, California 92868; and Nephrology Section (C.P.K.), Memphis VA Medical Center, Memphis, Tennessee 38104
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Chalhoub D, Orwoll ES, Cawthon PM, Ensrud KE, Boudreau R, Greenspan S, Newman AB, Zmuda J, Bauer D, Cummings S, Cauley JA. Areal and volumetric bone mineral density and risk of multiple types of fracture in older men. Bone 2016; 92:100-106. [PMID: 27554426 PMCID: PMC5056840 DOI: 10.1016/j.bone.2016.08.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 08/01/2016] [Accepted: 08/18/2016] [Indexed: 10/21/2022]
Abstract
Although many studies have examined the association between low bone mineral density (BMD) and fracture risk in older men, none have simultaneously studied the relationship between multiple BMD sites and risk of different types of fractures. Using data from the Osteoporotic Fractures in Men study, we evaluated the association between areal BMD (aBMD) by dual-energy X-ray absorptiometry (DXA) and volumetric BMD (vBMD) by quantitative computed tomography (QCT) measurements, and different types of fractures during an average of 9.7years of follow-up. Men answered questionnaires about fractures every 4months (>97% completions). Fractures were confirmed by centralized review of radiographic reports; pathological fractures were excluded. Risk of fractures was assessed at the hip, spine, wrist, shoulder, rib/chest/sternum, ankle/foot/toe, arm, hand/finger, leg, pelvis/coccyx, skull/face and any non-spine fracture. Age and race adjusted Cox proportional-hazards modeling was used to assess the risk of fracture in 3301 older men with both aBMD (at the femoral neck (FN) and lumbar spine) and vBMD (at the trabecular spine and FN, and cortical FN) measurements, with hazard ratios (HRs) expressed per standard deviation (SD) decrease. Lower FN and spine aBMD were associated with an increased risk of fracture at the hip, spine, wrist, shoulder, rib/chest/sternum, arm, and any non-spine fracture (statistically significant HRs per SD decrease ranged from 1.24-3.57). Lower trabecular spine and FN vBMD were associated with increased risk of most fractures with statistically significant HRs ranging between 1.27 and 3.69. There was a statistically significant association between FN cortical vBMD and fracture risk at the hip (HR=1.55) and spine sites (HR=1.26), but no association at other fracture sites. In summary, both lower aBMD and vBMD were associated with increased fracture risk. The stronger associations observed for trabecular vBMD than cortical vBMD may reflect the greater metabolic activity of the trabecular compartment.
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Affiliation(s)
- Didier Chalhoub
- Intramural Research Program, Laboratory of Epidemiology, and Population Sciences, National Institute on Aging, National Institutes of Health, United States.
| | - Eric S Orwoll
- Oregon Health and Sciences University, Portland, OR, United States.
| | - Peggy M Cawthon
- California Pacific Medical Center, San Francisco, CA, United States.
| | | | - Robert Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Susan Greenspan
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Joseph Zmuda
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Douglas Bauer
- University of California Medical Center, San Francisco, CA, United States.
| | - Steven Cummings
- University of California Medical Center, San Francisco, CA, United States.
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.
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Saffarzadeh M, Hightower RC, Talton JW, Miller AN, Stitzel JD, Weaver AA. Multicenter analysis of CIREN occupant lumbar bone mineral density and correlation with age and fracture incidence. TRAFFIC INJURY PREVENTION 2016; 17 Suppl 1:34-41. [PMID: 27586100 DOI: 10.1080/15389588.2016.1203429] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/15/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE This study aimed to quantify lumbar volumetric bone mineral density (vBMD) for 873 seriously injured Crash Injury Research and Engineering Network (CIREN) motor vehicle crash occupants (372 male, 501 female) from 8 centers using phantomless computed tomography scans and to associate vBMD with age, fracture incidence, and osteopenia/osteoporosis diagnoses. The novelty of this work is that it associates vBMD with region of injury by applying an established method for vBMD measurement using phantomless computed tomography (CT). METHODS A validated phantomless CT calibration method that uses patient-specific fat and muscle measurements to calibrate vBMD measured from the L1-L5 trabeculae was applied on 873 occupants from various CIREN centers. CT-measured lumbar vBMD < 145 mg/cc is indicative of osteopenia using a published threshold. CIREN occupant lumbar vBMD in milligrams per cubic centimeter was regressed against age, osteopenia/osteoporosis comorbidities, height, weight, body mass index (BMI), and the incidence of fracture in vertebral (cervical, thoracic, lumbar) and rib/sternum regions. RESULTS Among the 873 occupants analyzed, 11% (92 occupants) were diagnosed as osteopenic in CIREN. Of these 92 occupants, 42% (39 occupants) had normal vBMD measures (≥145 mg/cc), suggesting possible misclassification in CIREN. Of the 134 occupants classified as osteopenic in vBMD analysis, 60% were not classified as osteopenic in CIREN, suggesting undiagnosed osteopenia, and 40% were correctly classified in CIREN. Age was negatively correlated with vBMD (P <.0001) and occupants with <145 mg/cc vBMD sustained a median number of 2 rib/sternum fractures compared to a median value of 0 rib/sternum fractures for the ≥145 mg/cc vBMD group (P <.0001). Vertebral fracture analysis revealed that the thoracolumbar region was the most common region of injury in the spine. Though the incidence of fracture was not significantly different in the thoracic (10% versus 6%, P =.122) and lumbar (16% versus 13%, P =.227) regions between the 2 bone quality groups, the proportion of thoracolumbar fractures was significantly higher in occupants with <145 mg/cc vBMD versus occupants with ≥145 mg/cc vBMD (24% versus 17%, P =.043). CONCLUSIONS Low lumbar vertebral bone quality is associated with an increased number of rib/sternum fractures and a greater incidence of thoracolumbar vertebral body fractures within the CIREN population analyzed.
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Affiliation(s)
- Mona Saffarzadeh
- a Virginia Tech-Wake Forest University Center for Injury Biomechanics , Winston-Salem , North Carolina
- b Wake Forest School of Medicine , Winston-Salem , North Carolina
| | - R Caresse Hightower
- a Virginia Tech-Wake Forest University Center for Injury Biomechanics , Winston-Salem , North Carolina
- b Wake Forest School of Medicine , Winston-Salem , North Carolina
| | - Jennifer W Talton
- c Wake Forest School of Medicine, Public Health Sciences , Winston-Salem , North Carolina
| | - Anna N Miller
- d Wake Forest School of Medicine, Orthopaedic Surgery , Winston-Salem , North Carolina
| | - Joel D Stitzel
- a Virginia Tech-Wake Forest University Center for Injury Biomechanics , Winston-Salem , North Carolina
- b Wake Forest School of Medicine , Winston-Salem , North Carolina
| | - Ashley A Weaver
- a Virginia Tech-Wake Forest University Center for Injury Biomechanics , Winston-Salem , North Carolina
- b Wake Forest School of Medicine , Winston-Salem , North Carolina
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Chin KY, Kamaruddin AAA, Low NY, Ima-Nirwana S. Effects of age, sex, and ethnicity on bone health status of the elderly in Kuala Lumpur, Malaysia. Clin Interv Aging 2016; 11:767-73. [PMID: 27358558 PMCID: PMC4912315 DOI: 10.2147/cia.s108772] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Osteoporosis is a significant health problem in the developing countries and its prevalence data are important for the estimation of health care burden and policy making. This study aimed to determine the age-related changes in bone health and the prevalence of osteoporosis in males and females aged 50 years or above living in Kuala Lumpur, Malaysia. Methods A cross-sectional study was conducted between December 2014 and December 2015. Subjects answered a demographic questionnaire and underwent body anthropometric and bone health measurement. Assessment of bone health was performed using a quantitative ultrasound device that generated speed of sound, broadband ultrasound attenuation, stiffness index, and T-score based on stiffness index value as bone health indices. Results The prevalence of osteoporosis was 10.6% in males and 8.0% in females. Significant age-related decline of bone health indices (speed of sound, broadband ultrasound attenuation, stiffness index, and T-score) and a concurrent increase in the prevalence of osteoporosis and osteopenia were observed in females (P<0.05) but not in males (P>0.05). Ethnic differences in bone health indices and prevalence of osteoporosis/osteopenia were not observed (P>0.05). Conclusion A significant proportion of males and females age 50 years or above have suboptimal bone health. Preventive measures such as early screening should be implemented to retard the progression of osteoporosis.
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Affiliation(s)
- Kok-Yong Chin
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
| | - Alia Annessa Ain Kamaruddin
- ASASIpintar, PERMATApintar National Gifted Centre, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Nie Yen Low
- ASASIpintar, PERMATApintar National Gifted Centre, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Soelaiman Ima-Nirwana
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Cheras, Kuala Lumpur, Malaysia
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Gourlay ML, Overman RA, Fine JP, Filteau G, Cawthon PM, Schousboe JT, Orwoll ES, Wilt TJ, Nguyen TV, Lane NE, Szulc P, Taylor BC, Dam TT, Nielson CM, Cauley JA, Barrett-Connor E, Fink HA, Lapidus JA, Kado DM, Diem SJ, Ensrud KE. Time to Osteoporosis and Major Fracture in Older Men: The MrOS Study. Am J Prev Med 2016; 50:727-736. [PMID: 26821835 PMCID: PMC4875888 DOI: 10.1016/j.amepre.2015.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 10/26/2015] [Accepted: 11/10/2015] [Indexed: 01/13/2023]
Abstract
INTRODUCTION For older men who undergo bone mineral density (BMD) testing, the optimal osteoporosis screening schedule is unknown. Time-to-disease estimates are necessary to inform screening intervals. METHODS A prospective cohort study of 5,415 community-dwelling men aged ≥65 years without hip or clinical vertebral fracture or antifracture treatment at baseline was conducted. Participants had concurrent BMD and fracture follow-up between 2000 and 2009, and additional fracture follow-up through 2014. Data were analyzed in 2015. Time to incident osteoporosis (lowest T-score ≤ -2.50) for men without baseline osteoporosis, and time to hip or clinical vertebral fracture or major osteoporotic fracture for men without or with baseline osteoporosis, were estimated. RESULTS Nine men (0.2%) with BMD T-scores >-1.50 at baseline developed osteoporosis during follow-up. The adjusted estimated time for 10% to develop osteoporosis was 8.5 (95% CI=6.7, 10.9) years for those with moderate osteopenia (lowest T-score, -1.50 to -1.99) and 2.7 (95% CI=2.1, 3.4) years for those with advanced osteopenia (lowest T-score, -2.00 to -2.49) at baseline. The adjusted times for 3% to develop a first hip or clinical vertebral fracture ranged from 7.1 (95% CI=6.0, 8.3) years in men with baseline T-scores > -1.50 to 1.7 (95% CI=1.0, 3.1) years in men with baseline osteoporosis. CONCLUSIONS Men aged 65 years and older with femoral neck, total hip, and lumbar spine BMD T-scores >-1.50 on a first BMD test were very unlikely to develop osteoporosis during follow-up. Additional BMD testing may be most informative in older men with T-scores ≤-1.50.
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Affiliation(s)
- Margaret L Gourlay
- Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina.
| | - Robert A Overman
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
| | - Jason P Fine
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Guillaume Filteau
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, California
| | - John T Schousboe
- Department of Rheumatology, Park Nicollet Health Services, Minneapolis, Minnesota; Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota
| | - Eric S Orwoll
- Bone and Mineral Unit, Oregon Health and Science University, Portland, Oregon
| | - Timothy J Wilt
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, Minnesota
| | - Tuan V Nguyen
- Garvan Institute of Medical Research, UNSW School of Public Health and Community Medicine, New South Wales, Australia; Centre for Health Technologies, University of Technology, Sydney, Australia
| | - Nancy E Lane
- Departments of Medicine and Division of Rheumatology, Center for Musculoskeletal Health, UC Davis Health System, Sacramento, California
| | - Pawel Szulc
- INSERM UMR 1033, University of Lyon, Lyon, France
| | - Brent C Taylor
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, Minnesota; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Thuy-Tien Dam
- Department of Medicine, Columbia University, New York, New York
| | - Carrie M Nielson
- Bone and Mineral Unit, Oregon Health and Science University, Portland, Oregon; School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth Barrett-Connor
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Howard A Fink
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, Minnesota; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota; Geriatric Research Education and Clinical Center, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - Jodi A Lapidus
- School of Public Health, Oregon Health and Science University, Portland, Oregon
| | - Deborah M Kado
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California; Department of Medicine, University of California, San Diego, La Jolla, California
| | - Susan J Diem
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Kristine E Ensrud
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Center for Chronic Disease Outcomes Research, VA Health Care System, Minneapolis, Minnesota; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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Palmer ND, Divers J, Lu L, Register TC, Carr JJ, Hicks PJ, Smith SC, Xu J, Judd SE, Irvin MR, Gutierrez OM, Bowden DW, Wagenknecht LE, Langefeld CD, Freedman BI. Admixture mapping of serum vitamin D and parathyroid hormone concentrations in the African American-Diabetes Heart Study. Bone 2016; 87:71-7. [PMID: 27032714 PMCID: PMC4862915 DOI: 10.1016/j.bone.2016.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/17/2015] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
Vitamin D and intact parathyroid hormone (iPTH) concentrations differ between individuals of African and European descent and may play a role in observed racial differences in bone mineral density (BMD). These findings suggest that mapping by admixture linkage disequilibrium (MALD) may be informative for identifying genetic variants contributing to these ethnic disparities. Admixture mapping was performed for serum 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, vitamin D-binding protein (VDBP), bioavailable vitamin D, and iPTH concentrations and computed tomography measured thoracic and lumbar vertebral volumetric BMD in 552 unrelated African Americans with type 2 diabetes from the African American-Diabetes Heart Study. Genotyping was performed using a custom Illumina ancestry informative marker (AIM) panel. For each AIM, the probability of inheriting 0, 1, or 2 copies of a European-derived allele was determined. Non-parametric linkage analysis was performed by testing for association between each AIM using these probabilities among phenotypes, accounting for global ancestry, age, and gender. Fine-mapping of MALD peaks was facilitated by genome-wide association study (GWAS) data. VDBP levels were significantly linked in proximity to the protein coding locus (rs7689609, LOD=11.05). Two loci exhibited significant linkage signals for 1,25-dihydroxyvitamin D on 13q21.2 (rs1622710, LOD=3.20) and 12q13.2 (rs11171526, LOD=3.10). iPTH was significantly linked on 9q31.3 (rs7854368, LOD=3.14). Fine-mapping with GWAS data revealed significant known (rs7041 with VDBP, P=1.38×10(-82)) and novel (rs12741813 and rs10863774 with VDBP, P<6.43×10(-5)) loci with plausible biological roles. Admixture mapping in combination with fine-mapping has focused efforts to identify loci contributing to ethnic differences in vitamin D-related traits.
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Affiliation(s)
- Nicholette D Palmer
- Department of Biochemistry, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA; Center for Diabetes Research, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA; Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA; Center for Public Health Genomics, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Jasmin Divers
- Center for Public Health Genomics, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA; Department of Biostatistical Sciences, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Lingyi Lu
- Center for Public Health Genomics, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA; Department of Biostatistical Sciences, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Thomas C Register
- Department of Pathology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - J Jeffrey Carr
- Department of Radiology, Vanderbilt University School of Medicine, 2525 West End Ave, Suite 300-B, Nashville, TN 37203, USA.
| | - Pamela J Hicks
- Department of Biochemistry, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - S Carrie Smith
- Department of Biochemistry, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Jianzhao Xu
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Suzanne E Judd
- Department of Biostatistics, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294, USA.
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294, USA.
| | - Orlando M Gutierrez
- Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294, USA; Department of Medicine, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35294, USA.
| | - Donald W Bowden
- Department of Biochemistry, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA; Center for Diabetes Research, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA; Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Lynne E Wagenknecht
- Division of Public Health Sciences, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Carl D Langefeld
- Center for Public Health Genomics, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA; Department of Biostatistical Sciences, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA.
| | - Barry I Freedman
- Center for Diabetes Research, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA; Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA; Center for Public Health Genomics, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA; Department of Internal Medicine-Section on Nephrology, Wake Forest School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157, USA.
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Tønnesen R, Schwarz P, Hovind PH, Jensen LT. Physical exercise associated with improved BMD independently of sex and vitamin D levels in young adults. Eur J Appl Physiol 2016; 116:1297-304. [PMID: 27146169 PMCID: PMC4911375 DOI: 10.1007/s00421-016-3383-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 04/28/2016] [Indexed: 02/02/2023]
Abstract
Purpose Young men and women accrue the majority of their bone mass in their teens and twenties, where their bone mass peaks (PBM), yet little is known about the roles of physical exercise, vitamin D levels and bone mineral density (BMD) near PBM. Methods To comparatively examine the effect of physical exercise and two vitamin D levels (insufficient s-25[OH]D <50 nmol/L and sufficient s-25[OH]D >80 nmol/L) on the BMD measured at the femoral neck, total hip (bilaterally) and the lumbar spine (L2–L4) in male and female participants approaching PBM. Results The insufficient s-25[OH]D group, median age 21.6 (19.8–22.8) years, and BMI 24.2 ± 5.0 kg/m2 had BMD 0.10 (0.03, 0.17) g/cm2 (p = 0.008) lower at all DXA-scan sites compared to the sufficient s-25[OH]D group, median age 19.5 (19.0–22.3) years, and BMI of 22.6 ± 1.8 kg/m2. Exercise was positively associated with the BMD at all DXA-scan sites (ptrend = 0.0001) and with equal benefit; there was no interaction between exercise and the DXA-scan site (p = 0.09). The male participants did not have a systematically higher BMD than the female participants for all scan sites; only for hips total and femoral neck bilaterally, while it was equal at the lumbar spine. Conclusion The BMD in young healthy adults is associated with physical exercise, independent of sex and s-25[OH]D status. A sufficient s-25[OH]D status was systematically associated with a higher BMD for all levels of exercise. For both sexes and vitamin D levels exercise was equally positively associated with BMD.
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Affiliation(s)
- Rune Tønnesen
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Nordre Ringvej 57, Glostrup, 2600, Copenhagen, Denmark.
| | - Peter Schwarz
- Department of Endocrinology PE and Research Centre of Ageing and Osteoporosis, Rigshospitalet, Copenhagen, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Hambak Hovind
- Department of Clinical Physiology and Nuclear Medicine, Rigshospitalet, Nordre Ringvej 57, Glostrup, 2600, Copenhagen, Denmark
| | - Lars Thorbjørn Jensen
- Department of Clinical Physiology and Nuclear Medicine, University Hospital of Herlev, Copenhagen, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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