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Zhang L, Zhang D, Wei L, Zhou Y, Li X, Chen R, Zhang X, Chen S, Bai F. H. pylori infection and osteoporosis: a large-scale observational and mendelian randomization study. BMC Infect Dis 2024; 24:305. [PMID: 38475712 DOI: 10.1186/s12879-024-09196-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/06/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE There is controversy concerning the relationship between Helicobacter pylori (H. pylori) infection and osteoporosis. This study is to examine the causal relationship between H. pylori infection and osteoporosis and to analyze the potential mechanism underlying the relationship. METHODS The clinical data of H. pylori infection and bone mineral density from patients or physical examiner with good general condition in our hospital between September 2019 and September 2020 were retrospectively collected. The relationship between H. pylori infection and osteoporosis was compared and analyzed, using logistic regression to examine the potential mechanism underlying the association. To investigate the causal effects of H. pylori infection and osteoporosis, we conducted a two-sample bidirectional Mendelian randomization (MR) analysis. RESULTS A total of 470 patients were positive for H. pylori, with a detection rate of 52.22%. It was found that age, SBP, FPG, DBP, ALB, LDL-C, hs-CRP, and OC were positively correlated with osteoporosis, while negative correlations were observed with BMI, LYM, ALB, TP, TG, HDL-C, SCr, UA, and VitD. After stratified analysis of sex and age, it was found that there was a significant correlation between H. pylori infection and osteoporosis. The levels of SBP, ALP, FPG, LDL-C, hs-CRP, and OC in both H. pylori-positive group and osteoporosis group were higher than those in the H. pylori-negative group while the levels of BMI, ALB, TP, HDL-C, SCr, UA, and VitD in the positive group were significantly lower than those in the negative group. Logistic regression analyses with gender and age showed that ALB, FPG, HDL-C, and VitD were common risk factors for osteoporosis and H. pylori infection. In the MR analysis, the IVW results found a positive effect of H. pylori infection on osteoporosis (OR = 1.0017, 95% CI: 1.0002-1.0033, P = 0.0217). Regarding the reverse direction analysis, there was insufficient evidence to prove the causal effects of osteoporosis on H. pylori infection. CONCLUSION Our study provides evidence for causal effects of H. pylori infection on osteoporosis. H. pylori may affect osteoporosis through serum albumin, high-density lipoprotein, fasting blood glucose and vitamin D.
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Affiliation(s)
- Ling Zhang
- Department of Hospital infection management, LinYi people's Hospital, LinYi, Shandong Province, China
| | - Daya Zhang
- Graduate School of Hainan Medical University, Haikou, China
| | - Ling Wei
- Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical University, Yehai Avenue, #368, Longhua District, Haikou, Hainan Province, China
- The Gastroenterology Clinical Medical Center of Hainan Province, Haikou, China
| | - Yan Zhou
- The Third School of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Ximei Li
- The Third School of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Runxiang Chen
- Graduate School of Hainan Medical University, Haikou, China
| | - Xiaodong Zhang
- Graduate School of Hainan Medical University, Haikou, China
| | - Shiju Chen
- Graduate School of Hainan Medical University, Haikou, China
| | - Feihu Bai
- Department of Gastroenterology, The Second Affiliated Hospital of Hainan Medical University, Yehai Avenue, #368, Longhua District, Haikou, Hainan Province, China.
- The Gastroenterology Clinical Medical Center of Hainan Province, Haikou, China.
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Kose C, Korpe B, Ibanoglu M, Sahin B, Engin Ustun Y. Controlling Nutritional Status score and postmenopausal osteoporosis. Menopause 2023; 30:539-544. [PMID: 36944147 DOI: 10.1097/gme.0000000000002175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE This study investigated the association between CONUT score and postmenopausal osteoporosis. METHODS Postmenopausal women who were seen at an outpatient clinic in a tertiary hospital for routine gynecologic examination between January 2017 and June 2022 were included in the study. Based on their T-scores, a total of 423 women were divided into two groups. Group 1 included 216 women with osteoporosis (T-score < -2.5 SD), and group 2 included 207 women with normal bone mineral density (T-score > -1 SD). The formula for the CONUT score corresponds to collection of scores from albumin, total cholesterol, and total lymphocyte count. Higher scores indicate poorer nutritional control. RESULTS Mean age and mean age at menopause were similar in both groups. The duration of menopause, however, was higher in the women with osteoporosis (11.55 ± 6.82 vs 9.202 ± 6.14 y, P < 0.001). The 25-hydroxy vitamin D level was low in both groups. Body mass index of women with normal bone mineral density was higher than that of women with osteoporosis (31.54 ± 4.19 vs 28.52 ± 4.43 kg/m 2 , P < 0.001). The CONUT scores of the two groups were calculated and found to be higher in women with osteoporosis (3.180 ± 1.804 vs 0.391 ± 0.687, P < 0.001). According to the receiver operating characteristic curve analysis of the CONUT score for predicting osteoporosis, the area under the curve was calculated as 0.932, with a sensitivity of 86.6% and a specificity of 91.1% ( P < 0.001). CONCLUSIONS Diet plays an important role in the development of osteoporosis. In this study, it was shown that there is a relationship between CONUT score and osteoporosis.
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Affiliation(s)
- Caner Kose
- From the University of Health Sciences Etlik Zubeyde Hanım Women's Health Training and Research Hospital, Ankara, Turkey
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Assessment of Metabolic Markers and Osteoporosis in 250 Patients with Superior Semicircular Canal Dehiscence Treated With Middle Fossa Craniotomy. World Neurosurg 2022; 166:e52-e59. [PMID: 35760329 DOI: 10.1016/j.wneu.2022.06.090] [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: 05/15/2022] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Superior semicircular canal dehiscence (SSCD) is caused by bony defects in the osseous shell of the arcuate eminence separating the labyrinth and the intracranial space. This pathologic third window causes hydroacoustic transmission resulting in debilitating symptoms. We examine the pathophysiologic association between metabolic markers, previous medical history, and SSCD symptoms before and after middle fossa craniotomy (MFC) treatment. METHODS This study was conducted between March 2011 and September 2020 with patients with SSCD who underwent MFC. We used a Fisher test to compare variables, including bilateral SSCD, second surgery, ear anomaly, osteoporosis, arthritis, vitamin D, and preoperative/postoperative symptoms, and others. Point-biserial correlation analysis was performed to test correlations between continuous variables and categorical variables. RESULTS A total of 250 patients with SSCD underwent MFC repair. There was significant postoperative resolution in all symptoms (P < 0.0001). Laboratory 25-hydroxyvitamin D values correlated with preoperative aural fullness (rpb= 0.29; P = 0.03), and preoperative disequilibrium (rpb= -0.32; P = 0.02). Serum calcium values correlated with preoperative hearing loss (rpb= 0.16; P = 0.02). Osteoporosis history (n = 16; 6%) was more prevalent in female patients (P = 0.0001), associated with higher levels of preoperative hearing loss (odds ratio, 4.56; P = 0.02) and higher postoperative hearing loss resolution (odds ratio, 2.89; P = 0.0509). CONCLUSIONS Certain metabolic markers may predict SSCD presentation before and after surgery. Previous history of osteoporosis, autoimmune conditions, or arthritis may play a role in SSCD pathophysiology and can help predict clinical outcomes. Future evaluation should take metabolic laboratory values and acquire an exact medical history.
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Wang S, Tang W, Zhou J, You F, Lei F, Yang Y, Zha X, Zhou Y. Combination of QCT and blood biochemistry for evaluating the relationship between nutrition and bone mineral density in patients on maintenance hemodialysis. J Ren Nutr 2022; 32:744-750. [DOI: 10.1053/j.jrn.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 01/02/2022] [Accepted: 03/19/2022] [Indexed: 11/11/2022] Open
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Xiu S, Chhetri JK, Sun L, Mu Z, Wang L. Association of serum prealbumin with risk of osteoporosis in older adults with type 2 diabetes mellitus: a cross-sectional study. Ther Adv Chronic Dis 2019; 10:2040622319857361. [PMID: 31223465 PMCID: PMC6566483 DOI: 10.1177/2040622319857361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 05/24/2019] [Indexed: 01/08/2023] Open
Abstract
Background: Poor nutritional status is associated with osteoporosis. Prealbumin is a more sensitive marker than albumin to assess nutritional status. Therefore, the relationship between serum levels of prealbumin and osteoporosis in older adults with type 2 diabetes mellitus (T2DM) was investigated. Methods: A total of 370 older adults with T2DM were divided into two groups: older adults with osteoporosis (n = 249) and older adults without osteoporosis (n = 121). Bone mineral density (BMD) and appendicular skeletal muscle (ASM) were measured by dual-energy X-ray absorptiometry (DEXA). Serum levels of prealbumin, highly sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), 25-hydroxyvitamin D3 [25(OH) D3] were also tested. Logistic regression analysis was performed to assess the association between prealbumin and osteoporosis. Results: The adults with osteoporosis had lower prealbumin levels than those without osteoporosis (235.40 ± 60.66 versus 261.34 ± 55.28 mg/l, p < 0.001). The proportion of adults with prealbumin levels below the normal range was significantly higher in individuals with osteoporosis compared with those without osteoporosis (16.53% versus 4.42%, respectively). After adjusting for age, sex, body mass index (BMI), anemia, handgrip strength and skeletal muscle index (SMI), logistic regression showed that participants with lower levels of prealbumin had a higher risk of osteoporosis [odds ratio (OR): 3.85; 95% confidence interval (CI): 1.54–6.34; p = 0.004]. Conclusion: Our findings suggested that low levels of prealbumin were associated with an increased risk of osteoporosis in older adults with T2DM. Further longitudinal studies should be conducted to determine if there is a causative association between prealbumin and osteoporosis.
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Affiliation(s)
- Shuangling Xiu
- Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, No.45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Jagadish K Chhetri
- Department of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lina Sun
- Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhijing Mu
- Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li Wang
- Department of Endocrinology, Beijing Institute of Geriatrics, Xuanwu Hospital, Capital Medical University, Beijing, China
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Afshinnia F, Pennathur S. Association of Hypoalbuminemia With Osteoporosis: Analysis of the National Health and Nutrition Examination Survey. J Clin Endocrinol Metab 2016; 101:2468-74. [PMID: 27144935 PMCID: PMC4891797 DOI: 10.1210/jc.2016-1099] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
CONTEXT The association of hypoalbuminemia with osteoporosis in human studies is controversial. OBJECTIVE We tested the independent association between hypoalbuminemia and osteoporosis in a national dataset. DESIGN This is a cross-sectional observation. SETTING AND PARTICIPANTS Participants are individuals selected from the National Health and Nutrition Examination Survey (NHANES) with available clinical, laboratory, and densitometry data from the 2005-2010 and 2013-2014 cycles. EXPOSURE Exposure is hypoalbuminemia defined as serum albumin <3.5 g/dL. MAIN OUTCOME MEASURE Osteoporosis is defined as bone mineral density of ≤2.5 SD below the mean peak bone mass of young, healthy adults. Analysis took into account the hidden variance and the weighting methodology pertinent to analysis of NHANES. RESULTS Overall, 15 539 individuals were included. The mean age was 48.6 years (SE = 0.27). Fifty percent of the individuals were male, and 10.2% were of the black race. There was a graded decrease in the rate of osteoporosis from 15.2% at albumin <3.5 g/dL to 2.6% at albumin >4 g/dL (P = .007) at the femoral neck and from 11.0 to 1.4% at total femur (P = .009). In a fully adjusted model, the odds of osteoporosis with hypoalbuminemia were 5.37-fold (95% confidence interval [CI], 1.43 to 20.20; P = .014) at the femoral neck, 12.46-fold (95% CI, 3.24 to 48.01; P < .001) at total femur, and 4.59-fold (95% CI, 1.49 to 14.16; P = .025) at the lumbar spine higher as compared to albumin >4 mg/dL. CONCLUSION In the NHANES dataset, we report an independent association of osteoporosis with hypoalbuminemia at different anatomical sites.
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Affiliation(s)
- Farsad Afshinnia
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109
| | - Subramaniam Pennathur
- Division of Nephrology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109
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Formosa MM, Xuereb-Anastasi A. Biochemical Predictors of Low Bone Mineral Density and Fracture Susceptibility in Maltese Postmenopausal Women. Calcif Tissue Int 2016; 98:28-41. [PMID: 26400554 DOI: 10.1007/s00223-015-0060-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 09/09/2015] [Indexed: 01/11/2023]
Abstract
Osteoporosis and fractures are complex conditions influenced by an interplay of genetic and environmental factors. The aim of the study was to investigate three biochemical parameters including total serum calcium, total serum alkaline phosphatase (sALP) and albumin in relation to bone mineral density (BMD) at the lumbar spine and femoral neck (FN), and with all-type of low-trauma fractures in Maltese postmenopausal women. Levels were also correlated with age and physical activity. A case-control study of 1045 women was performed. Women who suffered a fracture were classified as cases whereas women without a fracture history were included as controls subdivided into normal, osteopenic, or osteoporotic according to their BMD measurements. Blood specimens were collected following good standard practice and testing was performed by spectrophotometry. Calcium and sALP levels were weakly correlated with FN BMD levels (calcium: r = -0.111, p = 0.002; sALP: r = 0.089, p = 0.013). Fracture cases had the lowest serum levels of calcium, sALP and albumin relative to all other control groups, which decreased with increasing age, possibly increasing fracture risk. Biochemical levels were lowest in women who sustained a hip fracture and more than one fracture. Biochemical parameters decreased with reduced physical activity; however, this was most evident for fracture cases. Reduced physical activity was associated with lower BMD levels at the hip, and to a lower extent at the spine. In conclusion, results suggest that levels of serum calcium and albumin could be indicative of fracture risk, whereas calcium levels and to lower extent sALP levels could be indicators of hip BMD.
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Affiliation(s)
- Melissa M Formosa
- Department of Applied Biomedical Science, Faculty of Health Sciences, Block A, Level 1, Mater Dei Hospital, University of Malta, Msida, MSD 2080, Malta.
| | - Angela Xuereb-Anastasi
- Department of Applied Biomedical Science, Faculty of Health Sciences, Block A, Level 1, Mater Dei Hospital, University of Malta, Msida, MSD 2080, Malta
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Afshinnia F, Wong KK, Sundaram B, Ackermann RJ, Pennathur S. Hypoalbuminemia and Osteoporosis: Reappraisal of a Controversy. J Clin Endocrinol Metab 2016; 101:167-75. [PMID: 26600169 PMCID: PMC4701840 DOI: 10.1210/jc.2015-3212] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
CONTEXT Human studies have reported conflicting results on the association of hypoalbuminemia with osteoporosis. OBJECTIVE The aim of the study is to test the independent association between hypoalbuminemia and osteoporosis. DESIGN This is a cross-sectional observation. SETTING AND PARTICIPANTS Patients are the outpatient consecutive individuals with available clinical, laboratory, and densitometry data from 2001 to 2013 in our tertiary care academic medical center. EXPOSURE Exposure is hypoalbuminemia defined as serum albumin less than 3.5 g/dL. MAIN OUTCOME MEASURE Osteoporosis is defined as bone mineral density of 2.5 SD or less below the mean peak bone mass of young, healthy adults. RESULTS Overall, 21 121 patients were included. Mean of age was 61 years (SD 14). There were 4244 males (20.1%) and 1614 patients of African-American ethnicity (7.6%). There was a graded decrease in rate of osteoporosis from 28.0% (n = 33) at albumin of 3 g/dL or less to 9.3% (n = 1548) at albumin greater than 4 g/dL (P < .001) at the femoral neck and from 20.3% (n = 24) to 6.1% (n = 1011) at the total hip (P < .001). In a fully adjusted model, the odds of osteoporosis at albumin of 3 g/dL or less was 3.31-fold (95% confidence interval [CI] 2.08-5.28, P < .001) at the femoral neck, 2.98-fold (95% CI 1.76-5.01, P < .001) at the total hip, and 2.18-fold (95% CI 1.43-3.31, P < .001) at the lumbar spine as compared with albumin greater than 4 mg/dL. A similar independent association was identified with a longer-observed duration of hypoalbuminemia. CONCLUSION In a large population, we report an independent association of osteoporosis with lower levels of serum albumin and a longer-observed duration of hypoalbuminemia.
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Affiliation(s)
- Farsad Afshinnia
- Division of Nephrology (F.A., S.P.), Department of Internal Medicine, Department of Nuclear Medicine/Radiology (K.K.W., R.J.A.), University of Michigan, Ann Arbor, Michigan 48109; Veterans Affairs Ann Arbor Healthcare System (K.K.W.), Ann Arbor, Michigan 48105; and Division of Radiology (B.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107
| | - Ka Kit Wong
- Division of Nephrology (F.A., S.P.), Department of Internal Medicine, Department of Nuclear Medicine/Radiology (K.K.W., R.J.A.), University of Michigan, Ann Arbor, Michigan 48109; Veterans Affairs Ann Arbor Healthcare System (K.K.W.), Ann Arbor, Michigan 48105; and Division of Radiology (B.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107
| | - Baskaran Sundaram
- Division of Nephrology (F.A., S.P.), Department of Internal Medicine, Department of Nuclear Medicine/Radiology (K.K.W., R.J.A.), University of Michigan, Ann Arbor, Michigan 48109; Veterans Affairs Ann Arbor Healthcare System (K.K.W.), Ann Arbor, Michigan 48105; and Division of Radiology (B.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107
| | - Robert J Ackermann
- Division of Nephrology (F.A., S.P.), Department of Internal Medicine, Department of Nuclear Medicine/Radiology (K.K.W., R.J.A.), University of Michigan, Ann Arbor, Michigan 48109; Veterans Affairs Ann Arbor Healthcare System (K.K.W.), Ann Arbor, Michigan 48105; and Division of Radiology (B.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107
| | - Subramaniam Pennathur
- Division of Nephrology (F.A., S.P.), Department of Internal Medicine, Department of Nuclear Medicine/Radiology (K.K.W., R.J.A.), University of Michigan, Ann Arbor, Michigan 48109; Veterans Affairs Ann Arbor Healthcare System (K.K.W.), Ann Arbor, Michigan 48105; and Division of Radiology (B.S.), Thomas Jefferson University, Philadelphia, Pennsylvania 19107
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Huo YR, Suriyaarachchi P, Gomez F, Curcio CL, Boersma D, Gunawardene P, Demontiero O, Duque G. Comprehensive nutritional status in sarco-osteoporotic older fallers. J Nutr Health Aging 2015; 19:474-80. [PMID: 25809813 DOI: 10.1007/s12603-014-0543-z] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES In older persons, the combination of osteoporosis and sarcopenia has been proposed as a subset of frailer individuals at higher risk of falls and fractures. However, the particular nutritional status of the sarco-osteoporotic (SOP) patients remains unknown. The goal of this study was to obtain a comprehensive picture of nutritional status in SOP patients. DESIGN Cross-sectional study. SETTING Falls and Fractures Clinic, Nepean Hospital (Penrith, Australia). PARTICIPANTS 680 subjects (mean age=79, 65% female) assessed between 2008-2013. MEASUREMENTS Assessment included medical history, mini-nutritional assessment, physical examination, bone densitometry and body composition by DXA, and blood tests for nutritional status (albumin, creatinine, hemoglobin, vitamin D, vitamin B-12, calcium, phosphate and folate). Patients were divided in 4 groups: 1) osteopenia/osteoporosis (BMD<-1.0 SD); 2) sarcopenia; 3) SOP; and 4) normal (no sarcopenia/no osteoporosis). Difference between groups was assessed with one-way ANOVA and chi square analysis. Multivariable linear regression evaluated the association between the groups and measures of nutritional parameters. RESULTS Sarcopenia was present in 47.4% of those with osteopenia (167/352) and 62.7% in those with osteoporosis (91/145). Mean age of the SOP was 80.4±7 years. SOP patients showed significantly higher prevalence of falls and fractures. Univariate analyses showed that SOP were more likely than normal to have a BMI< 25 (OR 2.42 95%CI 1.45-4.041, p<0.001), a MNA score <12 (OR 2.0, 95%CI 1.15-3.49, p<0.05), serum folate <20 nmol/L (OR 4.0 95%CI 1.35-11.87, p<0.01) and hemoglobin <120g/L (OR 2.0 95%CI 1.28-3.30, p<0.01). Multivariate analysis showed that a MNA score <12 was independently associated with SOP compared to normal when adjusted for age and gender. Hemoglobin <120g/L, BMI <25, and GDS >6 remained independently associated with SOP after adjustment for all variables including inflammatory conditions. Hypoalbuminemia (<35 g/L) was associated with just osteopenia/osteoporosis (OR: 2.03, 95%CI 1.08-3.81, p<0.01) and just sarcopenia (OR: 1.77, 95%CI 1.0-3.0, p<0.01) compared to normal. No differences in vitamin D, glomerular filtration rate, albumin, corrected calcium, phosphate, red blood cells folate or vitamin B12 levels were found between the subgroups. CONCLUSIONS In approaching SOP patients, early prevention protocols directed to optimize their nutritional status would be a key strategy to prevent poor outcomes such as falls and fractures in this high risk population. Therefore, nutritional assessment and early nutritional supplementation should be essential domains in this strategy.
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Affiliation(s)
- Y R Huo
- Gustavo Duque, MD, PhD, FRACP, Ageing Bone Research Program, Sydney Medical School Nepean, The University of Sydney, PO Box 63 Penrith NSW 2751, Australia, Tel: +61 2 4734 4278; Facsimile: +61 2 4734 2614,
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Nakamura K, Oyama M, Saito T, Oshiki R, Kobayashi R, Nishiwaki T, Nashimoto M, Tsuchiya Y. Nutritional and biochemical parameters associated with 6-year change in bone mineral density in community-dwelling Japanese women aged 69 years and older: The Muramatsu Study. Nutrition 2011; 28:357-61. [PMID: 21917422 DOI: 10.1016/j.nut.2011.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Revised: 05/12/2011] [Accepted: 05/12/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Predictors of bone loss in elderly Asian women have been unclear. This cohort study aimed to assess lifestyle, nutritional, and biochemical predictors of bone loss in elderly Japanese women. METHODS Subjects included 389 community-dwelling women aged 69 y and older from the Muramatsu cohort initiated in 2003; follow-up ended in 2009. We obtained data on physical characteristics, osteoporosis treatment (with bisphosphonates or selective estrogen receptor modulators), physical activity, calcium intake, serum 25-hydroxyvitamin D, undercarboxylated osteocalcin, serum albumin, and bone turnover markers as predictors. The outcome was a 6-y change in forearm BMD (ΔBMD). Osteoporosis treatment was coded as 0 for none, 1 for sometimes, and 2 for always during the follow-up period. Stepwise multiple linear regression analysis was used to identify independent predictors of ΔBMD. RESULTS Mean age of the subjects was 73.3 y. Mean values of ΔBMD and Δweight were -0.019 g/cm(2) (-5.8%) and -2.2 kg, respectively. Stepwise multiple linear regression analysis revealed baseline BMD (β = -0.137, P < 0.0001), osteoporosis treatment (β = 0.0068, P = 0.0105), serum albumin levels (β = 0.0122, P = 0.0319), and Δweight (β = 0.0015, P = 0.0009) as significant independent predictors of ΔBMD. However, none of the other nutritional or biochemical indices were found to be significant predictors of ΔBMD. CONCLUSIONS Our findings indicate that adequate general nutrition and appropriate osteoporosis medication, rather than specific nutritional regimens, may be effective in preventing bone loss in elderly women.
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Affiliation(s)
- Kazutoshi Nakamura
- Department of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8510, Japan.
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Coin A, Sergi G, Marin S, Vianello A, Perissinotto E, Sarti S, Rinaldi G, Mosele M, Inelmen EM, Enzi G, Manzato E. Predictors of low bone mineral density in elderly males with chronic obstructive pulmonary disease: the role of body mass index. Aging Male 2010; 13:142-7. [PMID: 20429721 DOI: 10.3109/13685531003657784] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the relationships between nutritional indices (Body mass index (BMI), serum albumin), sarcopenia, bone mineral density (BMD) and the severity of their pulmonary obstruction in elderly patients with chronic obstructive pulmonary disease (COPD). METHODS The method involved was a prospective transversal study; 82 males >65 years old, 41 stable patients with COPD and 41 healthy elderly individuals (controls). All subjects underwent spirometry, biochemical analyses and dual energy X-ray absorptiometry. The significance of the differences between mean values and prevalence rates was tested. The relationships between BMD and independent predictors were analysed by multiple linear regressions. Logistic regression models were applied on dichotomised variables. RESULTS In patients with COPD, the prevalence of osteoporosis was higher in subjects with sarcopenia (46% vs. 0%; p < 0.05) and with BMI < 25.1 kg/m(2) (58% vs. 15%; p < 0.02). Multiple regression analysis indicated that BMI, appendicular skeletal muscle mass (ASMM), albumin, and forced expiration volume after 1 s (FEV1) explained the 70% of BMD variability at the hip and 56% at the spine. Logistic regression showed that a BMI < 25.1 kg/m(2) was independently associated with osteoporosis risk (OR = 10.0; 95%CI 1.3-76); no independent effect emerged for FEV1% (<and 50%). CONCLUSION In elderly males with COPD, the BMI values < or =25 kg/m(2) are more strongly related to low BMD levels than albumin values. Among those patients, BMI values within the normal range for younger adults might point out a higher risk of osteoporosis.
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Finigan J, Greenfield DM, Blumsohn A, Hannon RA, Peel NF, Jiang G, Eastell R. Risk factors for vertebral and nonvertebral fracture over 10 years: a population-based study in women. J Bone Miner Res 2008; 23:75-85. [PMID: 17784843 DOI: 10.1359/jbmr.070814] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
UNLABELLED Risk factors may vary for different types of fracture, in particular for vertebral fractures. We followed 367 women >50 yr of age from a population-based cohort for up to 10 yr. Factors that predicted vertebral rather than nonvertebral fractures related to physical weakness, poor health, and weight loss. Similar factors were also associated with greater bone loss at the hip. INTRODUCTION Many risk factors predict fractures overall, but it is less clear whether certain factors relate to vertebral fractures in particular. The aim of this study was to compare the risk factors for vertebral and nonvertebral fractures. MATERIALS AND METHODS We carried out a 10-yr prospective population-based study of 375 women who were 50-85 yr of age initially. At baseline, we measured BMD, blood and urine biochemistry, and anthropometric measurements. Medical and lifestyle data were obtained by questionnaire. Incident vertebral fractures were determined for 311 subjects from spinal radiographs at 0, 2, 5, 7, and 10 yr using an algorithm-based qualitative method, and nonvertebral fractures were confirmed radiographically. Relative risks were calculated by Cox regression analysis. RESULTS During follow-up, 70 subjects sustained one or more nonvertebral fractures and 29 sustained one or more vertebral fractures. Risk factors that predicted both types of fracture included increasing age, decreasing BMD at all sites, prevalent vertebral fracture, and shorter estrogen exposure. For nonvertebral fractures only, the risk factors included low urinary creatinine and less frequent use of stairs. The factors for vertebral fractures included lighter weight, reduced body fat, heavy smoking, lower serum calcium, albumin, and thyroid T(3), weak grip strength, and poor physical capability. In a multivariate model, weight, fat mass, serum calcium and T(3), prevalent vertebral fracture, and physical capability remained significant. Furthermore, grip strength, serum albumin, weight loss, and physical capability were associated with rate of bone loss at the femoral neck, and a fast rate of bone loss was also associated with vertebral fractures. CONCLUSIONS We conclude that overall frailty, which may consist of general poor health, small or thin body size, and lack of strength and physical capability, predicts vertebral fractures but is not a significant predictor of nonvertebral fractures. Bone loss rates are associated with similar risk factors and also with the incidence of vertebral fractures.
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Coin A, Perissinotto E, Enzi G, Zamboni M, Inelmen EM, Frigo AC, Manzato E, Busetto L, Buja A, Sergi G. Predictors of low bone mineral density in the elderly: the role of dietary intake, nutritional status and sarcopenia. Eur J Clin Nutr 2007; 62:802-9. [PMID: 17637603 DOI: 10.1038/sj.ejcn.1602779] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The aims of this study were to investigate the relationship between sarcopenia, dietary intake, nutritional indices and hip bone mineral density (BMD) in the elderly, and to estimate the risk of low BMD due to specific independent predictor thresholds. SUBJECTS AND METHODS Body mass index (BMI), serum albumin, energy and protein intake were studied in 352 elderly outpatients (216 women aged 73.5+/-5.3 years and 136 men aged 73.9+/-5.6 years). BMD at different hip sites and appendicular skeletal muscle mass (ASMM) were assessed by dual-energy X-ray absorptiometry. RESULTS The prevalence of osteoporosis was 13% in men and 45% in women, while the prevalence of sarcopenia (50%) and hypoalbuminemia (5%) were similar in both genders. BMI, albumin and ASMM were significantly associated with BMD in both genders: so was protein intake, but only in men. By multiple regression analysis, the variables that retained their independent explanatory role on total hip BMD, were BMI and protein intake in men, and BMI and albumin in women. By logistic regression analysis, men risked having a low BMD with a BMI <22 (OR=12) and a protein intake <65.7 g/day (OR=3.7). Women carried some risk already in the BMI 25-30 class (OR=5), and a much greater risk in the BMI <22 class (OR=26). Albumin <40 g/l also emerged as an independent risk factor (OR=2.6). CONCLUSIONS BMI in both genders, albumin in women and protein intake in men have an independent effect on BMD. BMI values <22 are normal for younger adults but carry a higher risk of osteoporosis in the elderly, particularly in women. Age-related sarcopenia does not seem to be involved in bone mass loss.
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Affiliation(s)
- A Coin
- Department of Medical and Surgical Sciences, Geriatrics Unit, University of Padova, Italy
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Nakamura K, Nishiwaki T, Ueno K, Yamamoto M. Age-related decrease in serum 25-hydroxyvitamin D concentrations in the frail elderly: a longitudinal study. J Bone Miner Metab 2007; 25:232-6. [PMID: 17593493 DOI: 10.1007/s00774-007-0755-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Accepted: 02/20/2007] [Indexed: 11/27/2022]
Abstract
Several cross-sectional studies have demonstrated an age-related decrease in serum 25-hydroxyvitamin D [25(OH)D] concentrations. No prospective studies, however, have been conducted to examine this correlation to date. The objectives of this study were to measure age-related changes in serum 25(OH)D concentrations and to identify predictors of change in serum 25(OH)D concentrations in the frail elderly during a 2-year follow-up period. Eighty elderly subjects (48 women and 32 men) were selected from people utilizing the long-term care insurance system in a community in Japan. All subjects participated in both the baseline and follow-up (2 years later) medical examinations. Baseline measurements included age, height, body mass index, and weight. Additionally, levels of activities of daily living (Barthel index), grip strength, lifestyle, serum 25(OH)D, intact parathyroid hormone (PTH), albumin, total protein, and creatinine concentrations were also determined at baseline. The average age of the subjects was 82.1 years (SD, 8.8). The 2-year decrease in serum 25(OH)D concentrations was calculated to be 6 nmol/l. Multiple linear regression analyses found that the 2-year change (Delta) in the log-transformed 25(OH)D was associated with Deltaalbumin (beta = 0.503, R (2) = 0.288, P < 0.0001), and Deltalog-transformed intact PTH was associated with baseline creatinine (beta = 0.453, R (2) = 0.142, P = 0.0006) and Deltalog-transformed 25(OH)D (beta = -0.512, R (2) = 0.103, P = 0.0037). In conclusion, serum 25(OH)D concentrations decreased in the 2-year follow-up. This information is useful for the maintenance of vitamin D status and prevention of vitamin D insufficiency in the frail elderly.
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Affiliation(s)
- Kazutoshi Nakamura
- Department of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata, 951-8510, Japan.
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Kaysen GA, Müller HG, Young BS, Leng X, Chertow GM. The influence of patient- and facility-specific factors on nutritional status and survival in hemodialysis. J Ren Nutr 2004; 14:72-81. [PMID: 15060871 DOI: 10.1053/j.jrn.2004.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Parameters of nutritional status, including serum albumin, serum creatinine, and body mass index (BMI), are powerful predictors of mortality and hospitalization in patients with end stage renal disease (ESRD). Patient-specific characteristics and facility-related practice patterns modify certain parameters of nutritional status. We aimed to determine whether patient and facility characteristics modify the risk profiles associated with malnutrition in hemodialysis patients. METHODS We analyzed data on 5,234 prevalent hemodialysis patients from the Dialysis Morbidity and Mortality Study (DMMS) Wave 1 for whom information on demographic, clinical, nutritional, and facility-related characteristics were available. We evaluated the associations among facility characteristics and serum albumin, serum creatinine, and BMI, adjusting for the effects of age, sex, race/ethnicity, diabetes, and dialysis vintage. We determined correlates of mortality and hospitalization, focusing on nutritional parameters, facility effects, and the interactions among patient-specific and facility-specific characteristics, albumin, creatinine, and BMI. RESULTS Serum albumin was lower with older age, diabetes, nonblack race, and hemodialysis using a catheter. Serum albumin was higher with annual vascular access surveillance, higher BMI among women, higher urea reduction ratio, among patients in whom dialyzers were reprocessed (particularly with bleach), among dialysis units in which water purification was used, and when vascular access blood flow rates were > or =350 mL/min. Overall survival was decreased with lower albumin, creatinine, and BMI. There were interactions among albumin, age, and vintage. Whereas lower serum albumin concentrations consistently were associated with an increased risk of death, the differences were attenuated among older patients and accentuated among patients of longer vintage. CONCLUSION Some facility-specific factors are associated with nutritional parameters including serum albumin, serum creatinine, and BMI. The associations of nutritional parameters with mortality and hospitalization vary by age, sex, and vintage but not by facility-specific factors, including those associated with the nutritional parameters themselves.
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Affiliation(s)
- George A Kaysen
- Division of Nephrology, Department of Medicine, University of California Davis, Davis, CA 94118-1211, USA
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Morton DJ, Barrett-Connor E, Kritz-Silverstein D, Wingard DL, Schneider DL. Bone mineral density in postmenopausal Caucasian, Filipina, and Hispanic women. Int J Epidemiol 2003; 32:150-6. [PMID: 12690028 DOI: 10.1093/ije/dyg024] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous bone mineral density (BMD) studies have suggested Asian women have lower BMD and Hispanic women have similar or higher BMD compared with Caucasian women, partially explained by ethnic differences in body size. This study compared the effect of different variables representing body size on BMD in postmenopausal women aged 50-69 years from three ethnic groups in San Diego County, CA: 354 Caucasians, 285 Filipinas, and 164 Hispanics. METHODS In all three groups, BMD was measured by DXA (Hologic 2000) at the hip, lumbar spine, and total body. Lifestyle variables and anthropometric measures were assessed by standard methodology; medication and supplement use were validated by a nurse. RESULTS Regardless of the variables used to represent body size in the regression modelling, either body mass index or lean and fat tissue mass, ethnic differences were minimal across the three groups. The only significant differences observed using the two fully adjusted models (age, height, body mass index or lean and fat tissue mass, smoking, alcohol, exercise, current oestrogen and calcium supplement use, and osteoarthritis) were at the total body BMD site where Filipinas had significantly higher BMD than the Caucasians or Hispanics, whose total body BMD was similar to one another. The independent variables in the fully adjusted models explained approximately 20-40% of the variation in BMD at each of the four sites. Income or occupation did not help explain BMD differences, but a pattern of increased BMD among those with some college education in all three groups was observed. CONCLUSIONS Accounting for body size using either body mass index or fat and lean tissue mass along with height and other lifestyle variables minimizes ethnic differences and explains a considerable amount of variation in mean BMD among older ethnic minority and Caucasian women.
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Nakamura K, Nashimoto M, Matsuyama S, Hatakeyama M, Yamamoto M. Correlates of bone mineral density in elderly women living in nursing homes for the disabled in Japan. Aging Clin Exp Res 2002; 14:485-90. [PMID: 12674489 DOI: 10.1007/bf03327349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Characteristics of bone aging in the institutionalized elderly are not well known. The aim of this study was to determine the factors correlated with the forearm bone mineral density (BMD) in elderly women with disability. METHODS Of 175 female residents living in nursing homes for the disabled in Niigata, Japan, 119 agreed to participate and underwent medical examinations in 1999; 107 (age range, 66-100) met our inclusion criteria. We measured forearm BMD by dual-energy X-ray absorptiometry (DXA), and the serum concentrations of 25-hydroxyvitamin D3, 1,25-dihydroxyvitamin D3, intact parathyroid hormone, albumin, total protein, and creatinine. Body weight, score of activities of daily living, and history of femoral neck fractures were also recorded. RESULTS Forearm BMD decreased with age, and the regression equation was BMD=0.9035exp (-0.0179Age) (R2=0.170, p<0.0001). Multiple linear regression analysis revealed that only age (R2=0.178, p<0.0001), and serum creatinine (R2=0.153, p<0.0001) and albumin (R2=0.051, p=0.005) concentrations were independently associated with log-BMD. Twenty-five of the 107 subjects had a history of femoral neck fracture, and only serum albumin concentration (p=0.031) was shown to be associated with fracture history. CONCLUSIONS Forearm BMD was associated with age, serum creatinine and albumin, which may be useful parameters for assessing the bone health of elderly women with disability.
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Affiliation(s)
- Kazutoshi Nakamura
- Department of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
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Influence des apports en oligoéléments, protéines, lipides, glucides et vitamines sur le métabolisme osseux. ACTA ACUST UNITED AC 2000. [DOI: 10.1016/s1169-8330(00)00006-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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