Interim report and recommendations of the World Health Organization Task-Force for Osteoporosis

Associations of individual and mixtures of organophosphate pesticides with the risk of osteoporosis in adult population

The impact of organophosphate pesticide (OPP) exposure on osteoporosis in adult population remains unclear. Thus, it is necessary to explore the association between the exposure to a mixture of OPPs and the prevalence of osteoporosis as well as to identify the major contributor of OPPs in this association. Participants were selected from the 2005-2008 cycle of the NHANES cross-sectional study. OPP exposure was estimated using six different metabolites found in urine. Dual-energy X-ray absorptiometry (DXA) was used to measure bone mineral density (BMD). Survey-weighted generalized linear regression models (SWGLMs) were used to estimate the association between individual OPP exposure and osteoporosis/BMD. Weighted quantile sum (WQS) regression and quantile g-computation (Qgcomp) models were used to assess the mixture of OPPs and identify the key pollutants. SWGLMs indicated that higher concentrations of dimethyl dithiophosphate (DMDTP) and diethyl dithiophosphate (DEDTP) were associated with increased osteoporosis risk in the upper quartiles. WQS models revealed a significant combined effect of six OPP metabolites on osteoporosis (OR = 1.35, 95% CI: 1.06-1.73, P = 0.015), femoral neck BMD (β = -0.012, 95% CI: -0.020, -0.004, P = 0.003) and lumbar spine BMD (β = -0.015, 95% CI: -0.025, -0.006, P = 0.001), with DMDTP and DEDTP identified as key pollutants. Results from the Qgcomp models showed no substantial changes. This study indicated that exposure to both individual OPPs and their mixtures were associated with decreased BMD and increased osteoporosis risk, with DMDTP and DEDTP identified as major contributors to these associations. This underscores the need to prioritize control of these two pollutants to limit their exposure for osteoporosis prevention.

Relationship between albumin and osteoporosis in patients with type 2 diabetes mellitus

Purpose

This study aimed to investigate whether low albumin levels are a risk factor for osteoporosis (OP) in patients with type 2 diabetes mellitus (T2DM).

Patients and methods

This study included adult patients with T2DM hospitalized at the Hebei General Hospital in China between 2019 and 2020. Patients were divided into groups based on OP to explore the differences between the two groups and stratified by sex. Confounding factors were screened based on the statistical results and clinical practice, and regression analysis was used to explore the relationship between albumin levels and OP.

Results

In total, 125 patients (68 men and 57 women) with T2DM were included in this study. Triglyceride and high-density lipoprotein cholesterol levels significantly differed between groups. In the low-albumin group, after adjusting for all confounding factors, the P value was 0.041 and the odds ratio (OR) was 4.608 [95% confidence interval (CI): 1.063, 19.063] compared with that in the normal-albumin group. Among male patients, considering all confounding factors, the OR was 12.936 (95% CI: 1.130, 148.125) and P = 0.040 in the low-albumin group compared with that for the normal-albumin group. No such relationship was found in female patients.

Conclusion

A low albumin level is a risk factor for OP in the total population and in male patients but not in female patients. Therefore, albumin levels should be considered when controlling glucose levels in patients with T2DM.

Research hotspots and frontier analysis on Mendelian randomization in osteoporosis-related fields: A review based on bibliometric and visual analysis

This research seeks to thoroughly examine the present state and research hotspots in Mendelian randomization (MR) in osteoporosis (OP)-related fields, providing a reference for future research directions in this area. Following an exhaustive search of the Web of Science Core Collection database, our analysis utilized citation statistics for osteoporosis studies conducted from January 1, 2007, through March 15, 2024. Bibliometric and visual analyses were conducted using two online analysis systems, CiteSpace and VOSviewer. The analysis included a variety of dimensions, including the distribution of citations, authorship, published journals, year of publication, countries, co-occurrence keywords and keyword clustering. From 2007 to 2024, the number of publications in MR in OP-related fields showed an overall increased. High-impact publications and leading contributors were primarily from China, followed by the USA and England. The journal with the largest number of publications in MR in OP-related fields is the Journal of Bone and Mineral Research. Risk factor research, genome-wide associations, meta-analysis, fractures, and gene loci were the main research hotspots. Interdisciplinary integration, MR research combined with data from clinical trials and observational studies, represents the future development trend. Research on MR in OP-related fields has mainly been conducted in China, the USA, and England. The research hotspots were aimed at exploring the causative between risk factors and OP. Future studies are likely to center on multidisciplinary integration.

Relationship between insulin resistance surrogates and bone mineral density in postmenopausal women

OBJECTIVE

This study aimed to investigate the association between four insulin resistance (IR) surrogates and bone mineral density (BMD) and whether IR surrogates could be risk factors for osteoporosis (OP) in Chinese non-diabetic postmenopausal individuals.

METHODS

Four non-insulin-based surrogates including triglyceride glucose (TyG), triglyceride glucose with body mass index (TyG-BMI), triglycerides (TG)/high-density lipoprotein cholesterol (HDL-C) and the metabolic score for insulin resistance (METS-IR) index were calculated. All individuals underwent dual-energy X-ray absorptiometry for measurement of BMD. Pearson correlation analysis was employed to evaluate the correlations between IR indices and BMD. Subsequently, logistic regression analysis was performed to investigate the relationship between these indices and OP while the receiver-operating characteristic curve was used to assess the predictive values for OP.

RESULTS

Both TyG-BMI and the METS-IR index were significantly positively associated with BMD. As TyG-BMI and the METS-IR index increased, the prevalence of OP decreased. After adjusting confounding factors, the fourth quartile of TyG-BMI and the METS-IR index showed significantly decreased odds ratio of 0.304 and 0.352, respectively, for OP with respect to its first quartile value. The area under the curve of TyG-BMI and the METS-IR index was 0.616 and 0.605, respectively.

CONCLUSIONS

IR surrogates TyG-BMI and the METS-IR index were positively associated with BMD and may be protective factors for OP in Chinese non-diabetic postmenopausal women.

Risk Factors Influencing Medication-Related Osteonecrosis of the Jaws (MRONJ) Following Dental Extraction Among Osteoporotic Patients in Taiwan

AIM

Antiresorptive therapy (ART) is commonly used in osteoporotic patients to prevent bone loss. This retrospective cohort study aimed to identify the risk factors associated with medication-related osteonecrosis of the jaw (MRONJ) in osteoporotic patients receiving dental extraction during ART.

MATERIALS AND METHODS

Data were collected from 937 patients with 1067 dental extractions conducted between January 2003 and May 2022, including 519 patients on oral alendronate, 276 on denosumab, and 172 on zoledronate. Multivariate logistic regression analysis was employed to assess potential risk factors.

RESULTS

Regression model analysis revealed older age (AOR 1.09 per year; 95% CI, 1.06-1.12) and drug treatment exceeding 24 months (AOR 2.07; 95% CI, 1.29-3.30) as significant risk factors. A drug interruption of 3 or more months prior to tooth extraction lowered MRONJ risk (AOR 0.11; 95% CI, 0.07-0.17). Stratified by drug type, denosumab users had significantly lower risk of MRONJ after extraction (AOR 0.14; 95% CI, 0.07-0.27) compared to those on other medications. Factors of drug duration ≥ 24 months, < 3 months of interruption, and posterior mandibular tooth extraction posed the highest synergistic MRONJ risk (AOR 80.29; 95% CI, 33.05-195.09).

CONCLUSION

Our results suggest an association between a three-month ART interruption prior to tooth extraction and reduced MRONJ risk, especially in long-term ART patients undergoing posterior mandibular extractions. However, these findings require validation through prospective randomized controlled trials.

CLINICAL RELEVANCE

Scientific Rationale for Study: The study fills crucial knowledge gaps regarding MRONJ risks in osteoporotic patients undergoing dental extraction during antiresorptive therapy (ART), providing a foundation for informed clinical decisions.

PRINCIPAL FINDINGS

Noteworthy findings include elevated MRONJ risk with older age and prolonged ART, the protective effect of a 3-month ART interruption, and denosumab users showing significantly reduced postextraction MRONJ risk.

PRACTICAL IMPLICATIONS

Implementing a 3-month ART interruption before dental extraction is recommended to reduce MRONJ occurrences.

A causal association between osteoporosis and postural instability: a Mendelian randomization study

Many observational studies have found an association between osteoporosis and postural instability. However, it is unclear whether there is a genetic causal relationship between osteoporosis and postural instability. In this study, we conducted a two-sample Mendelian randomization (MR) analysis to investigate the causal relationship between osteoporosis and postural instability, with osteoporosis represented by bone mineral density (BMD). We used random effects Inverse Variance Weighted (IVW), weighted median, and MR-Egger methods after Steiger filtering, followed by FDR correction, to assess the causal relationship. We also used the Cochran Q statistic and MR-PRESSO to detect and exclude heterogeneity, the MR-Egger intercept to detect horizontal pleiotropy, and the leave-one-out method for sensitivity analyses. After excluding the heterogeneity in causal estimates across different SNPs and after Steiger filtering, the inverse variance weighted analysis showed a significant negative correlation between femoral neck BMD (FN-BMD) and the occurrence of postural instability, with an OR of 0.9171 (95% CI: 0.8745-0.9617; FDR P.value = 0.0009). Similar results were obtained in the weighted median analysis, with an OR of 0.923 (95% CI: 0.8717-0.9733; FDR P = 0.0180), and in the analysis of lumbar spine BMD (LS-BMD) in IVW, with an OR of 0.9491 (95% CI: 0.9156-0.9838; FDR P.value = 0.0129). However, there was no significant correlation between forearm BMD (FA-BMD) and postural instability. Further analysis showed no horizontal pleiotropy or heterogeneity in FN-BMD and LS-BMD after excluding heterogeneous SNPs. This study demonstrates a causal association between BMD and postural instability, suggesting that individuals with osteoporosis may be at higher risk of experiencing postural instability.

Cement-Augmented Pedicle Screw Fixation in Patients with Osteoporosis : Safety, Efficacy and Complications

Cement-augmented pedicle screw instrumentation is a widely accepted method for managing osteoporotic fractures, but it carries inherent risks, particularly related to cement leakage and embolism. This study aimed to analyze a clinical case of complications following cement fixation and provide a detailed review of relevant literature. A 70-year-old patient underwent transpedicular screw instrumentation from L2-L4 with polymethyl methacrylate augmentation, which resulted in cement leakage into the spinal canal and subsequent pulmonary embolism. After revision surgery and conservative treatment for the embolism, the patient's condition stabilized, demonstrating that conservative measures can be effective in managing cement embolism. To complement this case, a comprehensive literature review was conducted to explore the causes, prevention, and treatment of complications related to cement augmentation. The findings support that while cement-augmented pedicle screw instrumentation remains a leading technique for osteoporotic fractures, the associated risks are manageable with proper treatment protocols. This study holds practical significance for healthcare professionals by highlighting both the risks and solutions associated with cement fixation, thus contributing to improved patient outcomes and the development of standardized treatment guidelines.

Association between air pollution and osteoporosis: A Mendelian randomization study

Osteoporosis (OP) is a significant disease in the aging society, which poses a threat to the physical well-being of older adults. Some studies suggest that air pollution may contribute to an increased incidence of OP; however, this causal relationship has not been firmly established. To address this gap, we conducted Mendelian randomization (MR) analysis to assess the potential causal association between air pollution (including nitrogen dioxide [N = 456,380], nitrogen oxides [N = 456,380], particulate matter [PM]2.5 [N = 423,796], and PM10 [N = 455,314]) and total-body bone mineral density (BMD) (N = 56,284). We utilized summary data from IEU Open GWAS on the database of genome-wide association studies (GWAS) and employed inverse variance weighting (IVW) as our primary analytical approach. The findings from our MR study in the European population using the IVW method indicated a potential causal link between nitrogen oxides: β = -0.59, confidence interval (CI) = (-1.03 to -0.16), P = 0.008; PM2.5: β = -0.60, CI = (-1.12 to -0.08), P = .025. These results suggest that there might be a causative relationship between nitrogen oxides, PM2.5, and BMD with regards to OP development among individuals exposed to air pollution. Importantly, the observed associations passed all statistical tests without any evidence of heterogeneity or pleiotropy. Furthermore, the presence of air pollution was found to be associated with an elevated risk of developing OP. This study provides compelling evidence for a causal connection between nitrogen oxides, PM2.5, and OP, suggesting that reducing air pollution could play a crucial role in preventing OP development.

UTE MRI technical developments and applications in osteoporosis: a review

Osteoporosis (OP) is a metabolic bone disease that affects more than 10 million people in the USA and leads to over two million fractures every year. The disease results in serious long-term disability and death in a large number of patients. Bone mineral density (BMD) measurement is the current standard in assessing fracture risk; however, the majority of fractures cannot be explained by BMD alone. Bone is a composite material of mineral, organic matrix, and water. While bone mineral provides stiffness and strength, collagen provides ductility and the ability to absorb energy before fracturing, and water provides viscoelasticity and poroelasticity. These bone components are arranged in a complex hierarchical structure. Both material composition and physical structure contribute to the unique strength of bone. The contribution of mineral to bone's mechanical properties has dominated scientific thinking for decades, partly because collagen and water are inaccessible using X-ray based techniques. Accurate evaluation of bone requires information about its components (mineral, collagen, water) and structure (cortical porosity, trabecular microstructure), which are all important in maintaining the mechanical integrity of bone. Magnetic resonance imaging (MRI) is routinely used to diagnose soft tissue diseases, but bone is "invisible" with clinical MRI due to its short transverse relaxation time. This review article discusses using ultrashort echo time (UTE) sequences to evaluate bone composition and structure. Both morphological and quantitative UTE MRI techniques are introduced. Their applications in osteoporosis are also briefly discussed. These UTE-MRI advancements hold great potential for improving the diagnosis and management of osteoporosis and other metabolic bone diseases by providing a more comprehensive assessment of bone quantity and quality.

Circular RNAs in the management of human osteoporosis

BACKGROUND

Osteoporosis (OP) is a metabolic bone disease producing reduction in bone mass with consequent bone fragility. Circular ribonucleic acid (CircRNA) is a form of RNA that forms a loop structure rather than a linear one. CircRNA can be used for therapeutic purposes, including molecular targets or to test new therapies.

SOURCES OF DATA

A systematic search of different databases to July 2024 was performed to define the role of circRNA in OP therapy. Seventeen suitable studies were identified.

AREAS OF AGREEMENT

CircRNAs may be useful in studying metabolic processes in OP and identify possible therapeutic targets and new drug therapies.

AREAS OF CONTROVERSY

The metabolic processes involved in OP are regulated by many genes and cytokines that can be targeted by CircRNAs. However, it is not easy to predict whether the in vitro responses of the studied CircRNAs and their interaction with drugs are also applicable in vivo.

GROWING POINTS

Metabolic processes can be affected by gene dysregulation of CircRNAs on various growth factors. Areas timely for developing research: Despite the predictability of CircRNA pharmacological response in vitro, such pharmacological response cannot be expected to be replicated in vivo.

DATA AVAILABILITY

The data that support the findings of this study are available from the corresponding author.

Review: Application of Protein-Based Raw Materials in Health Foods in China

Raw protein materials are beneficial for human health, so they are being increasingly used in health foods. In recent years, there has been more and more research on and applications of raw protein materials, but few teams have conducted a detailed review of the application status of raw protein materials in China's health foods, the basis for their compliance and use, and the research on their health care functions. Therefore, this review evaluates the application of animal and plant proteins in China's health foods, the impact of animal and plant proteins on human health, and future research recommendations for animal and plant proteins. This review analyzes and discusses the data on approved health foods that have been verified to contain raw protein materials (mainly including the number of protein health foods approved over the years, the classification of raw protein materials and types of relevant regulations, the analysis of the frequency of use of raw protein materials, and the functions of approved health foods). Through this process, the application of raw protein materials in health foods in China is systematically reviewed. In short, through data analysis, this study found that in 1996~2024, a total of 1142 health foods containing raw protein materials were approved in China, which are mainly divided into animal proteins, vegetable proteins, microbial proteins, and peptide raw materials, and peptide raw materials comprise the majority. The compliance applications of these ingredients are mainly related to China's five categories of food regulations. The results show the following for health foods containing raw protein materials: in terms of the dosage form, they are mainly solid preparations; according to their functional claims, they mainly help to enhance immunity, help improve bone density, help improve skin moisture, and relieve physical fatigue; and in the application of raw materials, it is found that the use of raw materials such as casein phosphopeptide, soybean protein isolate, whey protein, collagen, spirulina, and other raw materials in products is relatively high. Finally, based on these studies, this paper discusses suggestions for raw protein materials in the future development of health food in China and also discusses the limitations of the current research in this review.

Adipose Mesenchymal Stem Cell-Derived Exosomes as Nanocarriers for Treating Musculoskeletal Disorders

Musculoskeletal disorders are a series of diseases involving bone, muscle, cartilage, and tendon, mainly caused by chronic strain, degenerative changes, and structural damage due to trauma. The disorders limit the function of patients due to pain and significantly reduce their quality of life. In recent years, adipose-derived mesenchymal stem cells have been extensively applied in regeneration medicine research due to their particular abilities of self-renewal, differentiation, and targeted homing and are more easily accessed compared with other sources. The paracrine effect of ADSCs plays a crucial role in intercellular communication by releasing mass mediators, including cytokines and growth factors, particularly the exosomes they secrete. Not only do these exosomes possess low immunogenicity, low toxicity, and an enhanced ability to penetrate a bio-barrier, but they also inherit their parent cells' characteristics and carry various bioactive molecules to release to targeted cells, modulating their biological process. Meanwhile, these characteristics also make exosomes a natural nanocarrier capable of targeted drug delivery to specific sites, enhancing the bioavailability of drugs within the body and achieving precision therapy with fewer toxic side effects. Furthermore, the integration of exosomes with tissue engineering and chemical modification strategies can also significantly enhance their efficacy in facilitating tissue repair. However, the current research on ADSC-Exos for improving MSDs remains at an early stage and needs further exploration. Therefore, this review summarized the ADSC-Exo as a nanodrug carrier characteristics and mechanism in the treatment of fracture, osteoporosis, osteoarthritis, intervertebral disc degeneration, and tendon injury, which push forward the research progress of ADSC-Exo therapy for MSDs.

Opportunistic Screening for Osteoporosis by CT as Compared with DXA

BACKGROUND

Osteoporosis is commonly evaluated using dual-energy X-ray absorptiometry (DXA) for bone mineral density (BMD). Non-contrast computed tomography (CT) scans provide an alternative for opportunistic osteoporosis assessment. This study aimed to evaluate screening thresholds for osteoporosis based on CT attenuation values in Hounsfield units (HU) of L1-L4 vertebrae from CT scans of the abdominal region, compared to DXA assessments of the lumbar spine and hips.

METHODS

Conducted retrospectively over approximately two years, the analysis included 109 patients who had both CT and DXA scans within 12 months, excluding those with metal artifacts affecting the vertebrae. CT attenuation values in the trabecular region of the vertebrae were measured and compared among three groups based on the lowest T-score from DXA.

RESULTS

In a predominantly female cohort (mean age 66.3 years), the lowest CT attenuation values for L1-L4 vertebrae showed a moderate correlation with the lowest T-score, with a Pearson correlation coefficient of 0.542 (95% CI: 0.388, 0.667). A HU threshold of ≤142 at the L1 vertebra showed 91.9% sensitivity and 48.4% specificity, while a threshold of ≤160 HU showed 97.3% sensitivity and 31.3% specificity for screening osteoporosis.

CONCLUSIONS

This study supports the use of non-contrast CT with these HU thresholds as an opportunistic tool for osteoporosis assessment.

Dairy and Exercise for Bone Health: Evidence from Randomized Controlled Trials and Recommendations for Future Research

PURPOSE OF REVIEW

To examine evidence from randomized controlled trials (RCTs) on how modifiable factors such as exercise and nutrition, with a focus on dairy products, play a role in improving bone health across the lifespan.

RECENT FINDINGS

Meta-analyses of RCTs demonstrate the advantages of consuming dairy products to improve bone mineral density/content (BMD/BMC) and markers of bone metabolism and turnover (BTMs). Eighteen RCTs were conducted investigating the combined effects of dairy and exercise, with most indicating a benefit in youth and adult populations. Results were less conclusive in older adults, perhaps due to altered requirements for dairy/nutrients and exercise with increased age.   RCTs demonstrate that dairy product consumption alone benefits bone health and can enhance the effects of exercise on bone. This may help improve skeletal growth and development in adolescence and prevent osteoporosis with increased age. Future RCTs should account for habitual nutrient intakes, and dairy dosage, timing, and matrix effects.

Plasma proteins, circulating metabolites mediate causal inference studies on the effect of gut bacteria on the risk of osteoporosis development

BACKGROUND

The role of gut bacteria in preventing and delaying osteoporosis has been studied. However, the causal relationship between gut bacteria, plasma proteins, circulating metabolites and osteoporosis (OP) risk has not been fully revealed.

MATERIALS AND METHODS

In this study, a two-sample Mendelian randomization study (MR) approach was used to assess the causal associations between gut bacteria, plasma proteins and circulating metabolites, and osteoporosis risk using Genome Wide Association Study (GWAS) data from gut bacteria(n=8208), plasma proteins(n=2263), circulating metabolites (n=123), and osteoporosis (3203 cases and 16380452 controls). Inverse-variance weighted (IVW) was used as the main analytical method to estimate the MR causal effect and to perform directional sensitivity analysis of causality. Finally, the mediating effect values for the influence of gut flora on OP pathogenesis through circulating metabolites were calculated by univariate MR analysis, and multivariate MR analysis. Next, we evaluated the effect of Phosphatidylcholine on the osteogenic function of bone marrow mesenchymal stem cells (BMSCs) through relevant experiments, including Edu detection of cell proliferation, alkaline phosphatase (ALP) staining, Alizarin red staining to evaluate osteogenic function, qPCR and WB detection of osteogenic differentiation related gene expression.

RESULTS

A total of 9 gut microbial taxa, 15 plasma proteins and eight circulating metabolites were analysed for significant causal associations with the development of OP. Significant causal effects of 7 on gut bacteria, plasma proteins and circulating metabolites were analysed by univariate MR analysis and these results were used as exposure factors for subsequent multivariate MR. Multivariate MR analyses yielded a significant effect of circulating metabolites Phosphatidylcholine and other cholines on OP (P<0.05). Further mediation effect analysis showed that the mediation effect of Bifidobacteriaceae affecting OP through the circulating metabolite Phosphatidylcholine and other cholines was -0.0224, with a 95 % confidence interval for the mediation effect that did not include 0, and the complete mediation effect was significant. Phosphatidylcholine can promote BMSCs proliferation and osteogenesis.

CONCLUSION

Our study demonstrated significant causal associations of gut bacteria, plasma proteins and circulating metabolites on OP, and that Bifidobacteriaceae affect OP through the circulating metabolites Phosphatidylcholine and other cholines. Phosphatidylcholine affects the osteogenic ability of BMSCs. Further exploration of potential microbiota-associated mechanisms of bone metabolism may offer new avenues for osteoporosis prevention and treatment of osteoporosis.

Saturation Effect of Lipid Accumulation Product (LAP) Index on Spinal Bone Mineral Density: A Population-Based Study

Lipid accumulation product (LAP) has a positive effect on spinal bone mineral density (BMD). However, once LAP levels exceed 27.26, the rate of spinal BMD increase slow down or even decline. This indicates a biphasic relationship between lipid metabolism and BMD, suggesting potential benefits within a certain range and possible adverse effects beyond that range. This study aimed to investigate the potential association between LAP index and BMD in US adults, as well as to explore the presence of a potential saturation effect in this relationship. This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2018. A multiple stepwise regression model was employed to examine the association between LAP index and total spinal BMD. Additionally, a generalized additive model and a smooth curve fitting algorithm were utilized to examine the relationship, and saturation effect study was conducted to determine the saturation level. The calculation formula of LAP used in the study was: (LAP = (waist circumstances (WC) (cm) - 58) × triglyceride (TG) (mmol/L)) for women, and (LAP = (WC (cm) - 65) × TG (mmol/L)) for men. The study involved a total of 7913 participants aged 20 years or older. Through multiple stepwise regression analysis, it was found that individuals with higher LAP scores exhibited higher total spinal BMD. In both the crude and partially adjusted models, total spinal BMD was significantly higher in the highest LAP quartile (Q4) compared to the lowest LAP quartile (Q1) (P < 0.05). Utilizing a generalized additive model and smooth curve, a nonlinear relationship between LAP and total spinal BMD was observed. Furthermore, the study identified the saturation value of LAP to be 27.26, indicating a saturation effect. This research highlights a nonlinear relationship between LAP and total spinal BMD, along with the presence of a saturation effect.

Water Extract of Pulsatilla koreana Nakai Inhibits Osteoclast Differentiation and Alleviates Ovariectomy-Induced Bone Loss

Pulsatilla koreana Nakai (P. koreana) is a perennial herb traditionally used to treat malaria and fever. Although the pharmacological properties of P. koreana have been explored in various contexts, its effects on bone diseases, such as osteoporosis, remain poorly studied. In this study, we investigated the effects of water extracts of P. koreana (WEPK) on osteoclasts, which play a crucial role in bone remodeling, and an ovariectomized (OVX) mouse model, which mimics osteoporosis. Phytochemical profiling of WEPK revealed several compounds that regulate bone or fat metabolism. WEPK suppressed osteoclast differentiation by downregulating the expression of receptor activator of nuclear factor-κB ligand (RANKL), a cytokine that induces osteoclastogenesis. Additionally, WEPK directly inhibited RANKL-induced differentiation of osteoclast precursors by downregulating nuclear factor of activated T cells 1 (NFATc1), the master transcription factor for osteoclastogenesis, by modulating its upstream regulators. In vivo, oral administration of WEPK suppressed bone loss, reduced weight gain, and mitigated fat accumulation in the liver and gonadal tissues of OVX mice. Given its positive impact on bone and fat accumulation under estrogen deficiency, WEPK may serve as a promising alternative therapy for postmenopausal osteoporosis, especially when accompanied by other metabolic disorders, such as obesity and fatty liver.

Evaluation of the information quality related to osteoporosis on TikTok

BACKGROUND

Osteoporosis is currently considered the most common bone disease in the world and is characterized by low bone mass, deterioration of the bone tissue microstructure, and decreased bone strength. With the increasing popularity of smartphones and short videos, many patients search for various types of health information through social media, such as short videos. As one of China's short video giants, TikTok has played a significant role in spreading health information. We found that there are many videos about osteoporosis on TikTok; however, the quality of these short videos has not yet been evaluated.

OBJECTIVE

The purpose of this study was to evaluate the information quality of osteoporosis videos on the domestic TikTok platform.

METHODS

We retrieved and screened 100 videos about osteoporosis from TikTok, extracted the basic information, encoded the video content, and recorded the source of each video. Two independent raters evaluated the information quality of each video via the DISCERN rating scale.

RESULT

The videos were divided into three groups according to their source: medical personnel, science communicators, and news media, with medical personnel posting the most videos. The content of the video is divided into 7 groups, namely, disease prevention, disease diagnosis, disease symptoms, disease overview, life-style, drug knowledge, and drug treatment, with the most videos related to disease overview. The average DISCERN score of the videos is 37.69 (SD = 6.78), mainly within the 'poor' (54/100, 54%) and 'appropriate' (43/100, 43%) rating ranges, with overall quality being low. Further analysis revealed a positive correlation between the number of shares, comments, likes, and favorites, and a positive correlation between the DISCERN score and the number of shares and favorites.

CONCLUSION

The overall quality of videos concerning osteoporosis on TikTok is lower, but the quality of videos varies significantly across different sources. We should be selective and cautious when watching videos about osteoporosis on TikTok.

Bone Loss and Fractures in Post-Menopausal Women Living with HIV: A Narrative Review

INTRODUCTION

Post-menopausal women living with Human Immunodeficiency Virus (WLHIV) face an increased risk of bone fractures due to the relationship between HIV-related factors and menopause. This narrative review aims to summarise the current knowledge about fracture risk among post-menopausal WLHIV in particular looking at hormonal changes, combined antiretroviral therapy (cART), lifestyle factors, and psychosocial implications. We also profiled a summary of the significant, recent studies of post-menopausal WLHIV residing in low-income countries (LIC).

METHODS

A thorough search of the literature was performed across PubMed, Medline, Scopus, and Google Scholar, focussing on studies published between 2000 and 2024. Inclusion criteria entailed original research, reviews, and meta-analyses addressing bone mineral density (BMD), fracture incidence, and related risk factors in post-menopausal WLHIV.

RESULTS

The review identified 223 relevant studies. Post-menopausal WLHIV exhibit significantly lower BMD and higher fracture rates compared to both HIV-negative post-menopausal women and pre-menopausal WLHIV. cART, particularly tenofovir disoproxil fumarate (TDF), contributes to reduced BMD. Menopausal status exacerbates this risk through decreased oestrogen levels, leading to increased bone resorption. Moreover, lifestyle choices such as smoking, alcohol consumption, and low physical activity are more prevalent in PWHIV, which further elevates fracture risk. Different psychosocial factors may make WLWHIV more vulnerable at this stage of their life, such as depression, isolation, stigma, and housing and nutritional issues. Women living in LICs face a variety of challenges in accessing HIV care. There are gaps in research related to the prevalence of osteoporosis and bone loss in post-menopausal WLHIV in LICs.

CONCLUSION

Post-menopausal women living with HIV face a significantly higher risk of bone loss and fractures due to the combined effects of HIV and menopause. Antiretroviral therapy (particularly TDF), lifestyle factors, and psychosocial challenges exacerbate this risk. There is a need for careful selection of cART, hormone replacement therapy (HRT), and emerging treatments such as Abaloparatide. A holistic approach including lifestyle changes and psychosocial support is crucial to reduce fracture risk in WLHIV, especially in low-income countries.

Insight of Chinese Herbal Medicine in Treating Osteoporosis: Achievements from 2013 to 2023

Osteoporosis is the most common bone metabolic disease, and it is becoming increasingly common as the global population ages. Osteoporosis and its complications, such as fractures and pain, negatively affect patient quality of life and easily lead to disability, placing enormous burdens on society. Although several anti-osteoporosis drugs are currently available, many adverse reactions have been observed during the long-term application of these drugs. Therefore, safer and more useful medications are urgently needed to replace those currently available. Chinese herbal medicine has been extensively used to treat osteoporosis, and the current literature confirms that such medicines have anti-osteoporosis effects, are safe, and have minimal side effects. Thus, Chinese herbal medicines are natural alternatives to pharmaceutical approaches to treating osteoporosis, and these medicines must be further developed and utilized. In this article, we review the mechanisms underlying the anti-osteoporosis effects of single herbal extracts and traditional Chinese medicine (TCM) formulas that have been elucidated since 2013, providing key evidence and support for future research on the anti-osteoporosis effects of Chinese herbal medicines. In addition, due to the complexity of the ingredients in Chinese herbal medicine, more thorough investigations are needed to determine the specific ingredients that are effective in osteoporosis treatment. Therefore, identifying the effective ingredients of Chinese herbal medicines will be a necessary focus in laboratory research and clinical application.

Pro-Osteogenic Effect of the Nutraceutical BlastiMin Complex® in Women with Osteoporosis or Osteopenia: An Open Intervention Clinical Trial

Osteoporosis is a chronic disease that affects millions of patients worldwide and is characterized by low bone mineral density (BMD) and increased risk of fractures. Notably, natural molecules can increase BMD and exert pro-osteogenic effects. Noteworthily, the nutraceutical BlastiMin Complex® (Mivell, Italy, European Patent Application EP4205733A1) can induce differentiation of human bone marrow mesenchymal stem cells (BM-MSCs) in osteoblasts and can exert in vitro pro-osteogenic and anti-inflammatory effects. Thus, the purpose of this study was to verify the effects of BlastiMin Complex® on bone turnover markers (BTMs) and BMD in patients with senile and postmenopausal osteopenia or osteoporosis. The efficacy of BlastiMin Complex® on BTMs in serum was evaluated through biochemical assays. BMD values were analyzed by dual-energy X-ray absorptiometry (DXA) and Radiofrequency Echographic Multi Spectrometry (R.E.M.S.) techniques, and the SNPs with a role in osteoporosis development were evaluated by PCR. Clinical data obtained after 12 months of treatment showed an increase in bone turnover index, a decrease in C-reactive protein levels, and a remarkable increase in P1NP levels, indicating the induction of osteoblast proliferation and activity in the cohort of 100% female patients recruited for the study. These findings show that the nutraceutical BlastiMin Complex® could be used as an adjuvant in combination with synthetic drugs for the treatment of osteoporosis pathology.

Predicting osteoporosis from kidney-ureter-bladder radiographs utilizing deep convolutional neural networks

Osteoporosis is a common condition that can lead to fractures, mobility issues, and death. Although dual-energy X-ray absorptiometry (DXA) is the gold standard for osteoporosis, it is expensive and not widely available. In contrast, kidney-ureter-bladder (KUB) radiographs are inexpensive and frequently ordered in clinical practice. Thus, it is a potential screening tool for osteoporosis. In this study, we explored the possibility of predicting the bone mineral density (BMD) and classifying high-risk patient groups using KUB radiographs. We proposed DeepDXA-KUB, a deep learning model that predicts the BMD values of the left hip and lumbar vertebrae from an input KUB image. The datasets were obtained from Taiwanese medical centers between 2006 and 2019, using 8913 pairs of KUB radiographs and DXA examinations performed within 6 months. The images were randomly divided into training and validation sets in a 4:1 ratio. To evaluate the model's performance, we computed a confusion matrix and evaluated the sensitivity, specificity, accuracy, precision, positive predictive value, negative predictive value, F1 score, and area under the receiver operating curve (AUROC). Moderate correlations were observed between the predicted and DXA-measured BMD values, with a correlation coefficient of 0.858 for the lumbar vertebrae and 0.87 for the left hip. The model demonstrated an osteoporosis detection accuracy, sensitivity, and specificity of 84.7 %, 81.6 %, and 86.6 % for the lumbar vertebrae and 84.2 %, 91.2 %, and 81 % for the left hip, respectively. The AUROC was 0.939 for the lumbar vertebrae and 0.947 for the left hip, indicating a satisfactory performance in osteoporosis screening. The present study is the first to develop a deep learning model based on KUB radiographs to predict lumbar spine and femoral BMD. Our model demonstrated a promising correlation between the predicted and DXA-measured BMD in both the lumbar vertebrae and hip, showing great potential for the opportunistic screening of osteoporosis.

Prevalence of Osteosarcopenia and Frailty in Patients with Chronic Liver Disease

Introduction

Chronic liver disease (CLD) can have a significant impact on the nutritional status of patients. Malnutrition is an under-recognized condition in patients with cirrhosis. Malnutrition increases the incidence and severity of decompensation, increases the risk of infections, and increases mortality. The present study aimed to assess osteosarcopenia and frailty in patients with CLD.

Materials and methods

This prospective cross-sectional study included 151 cases of CLD, aged between 18 and 85 years. Anthropometric measurements were performed. Sarcopenia was assessed by handgrip strength using a hand-held dynamometer. Bone mineral density was measured with the help of an office-based DEXA scan (Osteosys). Liver frailty was assessed through performance-based tests.

Results

Out of 151 patients, 98 were male (69.5%); mean age was 51.8 ± 13.2. The presarcopenia was seen in 91 (60%) patients, and sarcopenia in 45(30%). Osteopenia was present in 75 (50%) and osteoporosis in 24 (16%). The patients with osteopenia and osteoporosis had a high liver frailty index (LFI) (p-value < 0.001). A significant correlation between body mass index, waist circumference, LFI, calcium level, bilirubin and Child Pugh scores was seen with T and Z scores. Factors associated with low bone mineral density included increasing age and LFI, low calcium and higher PTH.

Conclusion

There is a high prevalence of pre-sarcopenia, sarcopenia, osteopenia, osteoporosis and high frailty in our patients with CLD. Early detection and timely intervention in these conditions are important to reduce the associated consequences. All patients with CLD should be assessed for osteosarcopenia and frailty, both at baseline and longitudinally.

How to cite this article

Nazir S, Abbas Z, Amjad S, et al. Prevalence of Osteosarcopenia and Frailty in Patients with Chronic Liver Disease. Euroasian J Hepato-Gastroenterol 2024;14(2):156-159.

Fracture Risk Among Stroke Survivors According to Poststroke Disability Status and Stroke Type

BACKGROUND

Stroke survivors face physical and cognitive challenges, leading to an increased dependency and a higher fall risk. We aimed to investigate the impact of poststroke disability and stroke type on fracture risk at various sites compared with matched controls.

METHODS

This retrospective cohort study used data from the Korean National Health Insurance System database (2010-2018), including patients with stroke and 1:1 matched controls. Stroke survivors were grouped based on the presence and severity of their poststroke disability and stroke type. The primary outcome was a newly diagnosed fracture, analyzed by Cox proportional hazard regression analyses adjusting for potential confounders.

RESULTS

Among 223 358 stroke survivors (mean age, 64.8±10.9 years; 61.2% men), 16 344 fractures occurred during a mean follow-up of 3.7±2.5 years. In matched controls (n=322 161; mean age, 65.4±11.2 years; 61.3% men), 20 398 fractures were identified. Stroke survivors had increased overall fracture risk compared with matched controls (adjusted hazard ratio [aHR], 1.40 [95% CI, 1.37-1.43]). Specifically, hip fracture risk was even greater in stroke survivors (incidence rate per 1000 person-years, 4.7 [95% CI, 4.5-4.8]; aHR, 2.42 [95% CI, 2.30-2.55]) than controls (incidence rate, 2.2 [95% CI, 2.1-2.3]). The risk of vertebral fractures (aHR, 1.29 [95% CI, 1.25-1.34]) and other fractures (aHR, 1.19 [95% CI, 1.15-1.23]) was also higher than that of the control group. Hip fracture risk was the highest among stroke survivors with severe poststroke disability (aHR, 4.82 [95% CI, 4.28-5.42]), although vertebral or other fracture risk was the highest among those with mild poststroke disability. No significant difference in fracture risk was found between hemorrhagic and ischemic stroke survivors when stratified by disability status.

CONCLUSIONS

Our findings showed increased subsequent fracture risk among stroke survivors, particularly those with poststroke disability and for hip fracture. Bone health assessment and treatment should be emphasized as an essential part of stroke management.

Exogenous and endogenous antioxidants in osteoporosis risk: causal associations unveiled by Mendelian Randomization analysis

Background

Recent epidemiological studies and animal experiments have highlighted the significant role of oxidative stress in the development of osteoporosis (OP). The provision of antioxidants is widely considered a fundamental strategy to combat free radical-induced stress, inhibit oxidative damage, and potentially reverse the adverse effects of oxidative stress on bone health. However, there is no consensus in the scientific literature regarding the practical effectiveness of antioxidants in OP prevention and treatment. Some studies have not shown a clear connection between antioxidant supplementation and decreased OP risk. Therefore, it is essential to clarify the potential causal relationship between antioxidants and the development of OP.

Methods

The study utilized the inverse variance weighted (IVW) approach as the primary analytical method in the Mendelian Randomization (MR) framework to investigate the causal effects of five exogenous and six endogenous antioxidants on the risk of OP. To thoroughly assess potential pleiotropic effects and heterogeneity among the data analyzed, the MR-Egger intercept test was employed, and Cochran's Q statistic was calculated.

Results

In the evaluation of exogenous antioxidants, single-directional two-sample MR analyses did not reveal any statistically significant relationship between these agents and the risk of OP. Regarding endogenous antioxidants, bidirectional two-sample MR analyses were conducted, which generally indicated that most genetically regulated endogenous antioxidants had no significant association with the onset risk of OP. A significant causal relationship was found between OP and serum albumin levels (β: -0.0552, 95%CI: -0.0879 to -0.0225, p < 0.0011 after Bonferroni adjustment, power = 100%).

Conclusion

The research uncovers OP as a possible determinant contributing to a decrement in serum albumin levels, and further suggests a potentially intimate relationship between the downward trajectory of serum albumin concentrations and the advancement of the OP disease process.

Association between the atherogenic index of plasma and bone mineral density among adult women: NHANES (2011-2018)

Background

Studies on the relationship between the atherogenic index of plasma (AIP) and bone mineral density (BMD) among adult women in the United States are limited. The purpose of this study was to explore this association using a sizable, nationally representative sample.

Methods

Data from the 2011 to 2018 National Health and Nutrition Examination Survey (NHANES) were used in this observational study. The AIP was computed as log10 (triglycerides/high-density lipoprotein cholesterol). Total BMD was measured via dual-energy X-ray densitometry. We constructed multiple linear regression models to evaluate the correlation between the AIP and BMD. The non-linear relationship was characterized by smooth curve fitting and generalized additive models. We also conducted subgroup and interaction analyses.

Results

In this study, we included 2,362 adult women with a mean age of 38.13 ± 12.42 years. The results of multiple linear regression analysis, the AIP and total BMD showed a negative association (β = -0.021, 95%CI: -0.037, -0.006). The curve fitting analysis and threshold effect analysis showed a non-linear relationship between the two variables, and the inflection point of the AIP was found to be -0.61. The total BMD decreased significantly when the AIP reached this value (β = -0.03, 95%CI: -0.04, -0.01). The results of the subgroup analysis showed that AIP and total BMD had a strong negative relationship in participants who were below 45 years old (β = -0.023; 95% CI: -0.041, -0.004), overweight (BMI ≥ 25 kg/m2) (β = -0.022; 95% CI: -0.041, -0.002), had a higher education level (β = -0.025; 95% CI: -0.044, -0.006), and had no partners (β = -0.014; 95% CI: -0.06, -0.009).

Conclusions

We found a negative correlation between the AIP and total BMD. Clinicians should pay attention to patients with high AIP, which might indicate a low BMD and has reference significance in preventing osteoporosis.

Advances in exosome modulation of ferroptosis for the treatment of orthopedic diseases

Current treatments for orthopaedic illnesses frequently result in poor prognosis, treatment failure, numerous relapses, and other unpleasant outcomes that have a significant impact on patients' quality of life. Cell-free therapy has emerged as one of the most promising options in recent decades for improving the status quo. As a result, using exosomes produced from various cells to modulate ferroptosis has been proposed as a therapeutic method for the condition. Exosomes are extracellular vesicles that secrete various bioactive chemicals that influence disease treatment and play a role in the genesis and progression of orthopaedic illnesses. Ferroptosis is a recently defined kind of controlled cell death typified by large iron ion buildup and lipid peroxidation. An increasing number of studies indicate that ferroptosis plays a significant role in orthopaedic illnesses. Exosomes, as intercellular information transfer channels, have been found to play a significant role in the regulation of ferroptosis processes. Furthermore, accumulating research suggests that exosomes can influence the course of many diseases by regulating ferroptosis in injured cells. In order to better understand the processes by which exosomes govern ferroptosis in the therapy of orthopaedic illnesses. This review discusses the biogenesis, secretion, and uptake of exosomes, as well as the mechanisms of ferroptosis and exosomes in the therapy of orthopaedic illnesses. It focuses on recent research advances and exosome mechanisms in regulating iron death for the therapy of orthopaedic illnesses. The present state of review conducted both domestically and internationally is elucidated and anticipated as a viable avenue for future therapy in the field of orthopaedics.

High-sensitivity immunoassay on interdigitated electrode to detect osteoporosis biological marker

Osteoporosis is with porous bones, which refers to a decrease in the bone mineral density and weakens the bones to become brittle. Osteoporosis often progresses without any pain or symptoms until the bone fractures. Monitoring the condition of bone regularly helps to identify the bone that weakens at its earlier stages. In general, radiological techniques have been used to measure bone mineral density, are expensive, and the procedures are complicated. Therefore, researchers are focusing on the alternative method of biomarker quantification to identify bone mineral density. This research work was focused on quantifying the osteoporosis biomarker of C-terminal telopeptide of type I collagen (CTX-I) on an interdigitated electrode (IDE) sensor. Gold nanomaterial-modified anti-CTX-I antibody was attached to silica nanomaterial-decorated IDE and then identified by CTX-I interaction. Higher immobilization of antibodies was recorded on diamond-modified IDE through gold nanoparticles, and detected CTX-I as low as 0.5 pg/mL [y = 1.5507x - 0.9043 R2 = 0.9715], determined on a linear curve at the range 0.5-3.5 ng/mL. Further, specific identification of CTX-I was confirmed by control performances with osteopontin, IL-6, and anti-IgG antibody.

Identification of potential cell death-related biomarkers for diagnosis and treatment of osteoporosis

BACKGROUND

This study aimed to identify potential biomarkers for the diagnosis and treatment of osteoporosis (OP).

METHODS

Data sets were downloaded from the Gene Expression Omnibus database, and differentially programmed cell death-related genes were screened. Functional analyses were performed to predict the biological processes associated with these genes. Least absolute shrinkage and selection operator (LASSO), support vector machine (SVM), and random forest (RF) machine learning algorithms were used to screen for characteristic genes, and receiver operating characteristics were used to evaluate the diagnosis of disease characteristic gene values. Gene set enrichment analysis (GSEA) and single-sample GSEA were conducted to analyze the correlation between characteristic genes and immune infiltrates. Cytoscape and the Drug Gene Interaction Database (DGIdb) were used to construct the mitochondrial RNA-mRNA-transcription factor network and explore small-molecule drugs. Reverse transcription real-time quantitative PCR (RT-qPCR) analysis was performed to evaluate the expression of biomarker genes in clinical samples.

RESULTS

In total, 25 differential cell death genes were identified. Among these, two genes were screened using the LASSO, SVM, and RF algorithms as characteristic genes, including BRSK2 and VPS35. In GSE56815, the area under the receiver operating characteristic curve of BRSK2 was 0.761 and that of VPS35 was 0.789. In addition, immune cell infiltration analysis showed that BRSK2 positively correlated with CD56dim natural killer cells and negatively correlated with central memory CD4 + T cells. Based on the data from DGIdb, hesperadin was associated with BRSK2, and melagatran was associated with VPS35. BRSK2 and VPS35 were expectably upregulated in OP group compared with controls (all p < 0.05).

CONCLUSIONS

BRSK2 and VPS35 may be important diagnostic biomarkers of OP.

Artificial intelligence insights into osteoporosis: assessing ChatGPT's information quality and readability

Accessible, accurate information, and readability play crucial role in empowering individuals managing osteoporosis. This study showed that the responses generated by ChatGPT regarding osteoporosis had serious problems with quality and were at a level of complexity that that necessitates an educational background of approximately 17 years.

PURPOSE

The use of artificial intelligence (AI) applications as a source of information in the field of health is increasing. Readable and accurate information plays a critical role in empowering patients to make decisions about their disease. The aim was to examine the quality and readability of responses provided by ChatGPT, an AI chatbot, to commonly asked questions regarding osteoporosis, representing a major public health problem.

METHODS

"Osteoporosis," "female osteoporosis," and "male osteoporosis" were identified by using Google trends for the 25 most frequently searched keywords on Google. A selected set of 38 keywords was sequentially inputted into the chat interface of the ChatGPT. The responses were evaluated with tools of the Ensuring Quality Information for Patients (EQIP), the Flesch-Kincaid Grade Level (FKGL), and the Flesch-Kincaid Reading Ease (FKRE).

RESULTS

The EQIP score of the texts ranged from a minimum of 36.36 to a maximum of 61.76 with a mean value of 48.71 as having "serious problems with quality." The FKRE scores spanned from 13.71 to 56.06 with a mean value of 28.71 and the FKGL varied between 8.48 and 17.63, with a mean value of 13.25. There were no statistically significant correlations between the EQIP score and the FKGL or FKRE scores.

CONCLUSIONS

Although ChatGPT is easily accessible for patients to obtain information about osteoporosis, its current quality and readability fall short of meeting comprehensive healthcare standards.

The role of adipokines in osteoporosis management: a mini review

The prevalence of osteoporosis has been on the rise globally. With ageing populations, research has sought therapeutic solutions in novel areas. One such area is that of the adipokines. Current literature points to an important role for these chemical mediators in relation to bone metabolism. Well-established adipokines have been broadly reported upon. These include adiponectin and leptin. However, other novel adipokines such as visfatin, nesfatin-1, meteorin-like protein (Metrnl), apelin and lipocalin-2 are starting to be addressed pre-clinically and clinically. Adipokines hold pro-inflammatory and anti-inflammatory properties that influence the pathophysiology of various bone diseases. Omentin-1 and vaspin, two novel adipokines, share cardioprotective effects and play essential roles in bone metabolism. Studies have reported bone-protective effects of omentin-1, whilst others report negative associations between omentin-1 and bone mineral density. Lipocalin-2 is linked to poor bone microarchitecture in mice and is even suggested to mediate osteoporosis development from prolonged disuse. Nesfatin-1, an anorexigenic adipokine, has been known to preserve bone density. Animal studies have demonstrated that nesfatin-1 treatment limits bone loss and increases bone strength, suggesting exogenous use as a potential treatment for osteopenic disorders. Pre-clinical studies have shown adipokine apelin to have a role in bone metabolism, mediated by the enhancement of osteoblast genesis and the inhibition of programmed cell death. Although many investigations have reported conflicting findings, sufficient literature supports the notion that adipokines have a significant influence on the metabolism of bone. This review aims at highlighting the role of novel adipokines in osteoporosis while also discussing their potential for treating osteoporosis.

Novel Biomarkers of Bone Metabolism

Bone represents a metabolically active tissue subject to continuous remodeling orchestrated by the dynamic interplay between osteoblasts and osteoclasts. These cellular processes are modulated by a complex interplay of biochemical and mechanical factors, which are instrumental in assessing bone remodeling. This comprehensive evaluation aids in detecting disorders arising from imbalances between bone formation and reabsorption. Osteoporosis, characterized by a reduction in bone mass and strength leading to heightened bone fragility and susceptibility to fractures, is one of the more prevalent chronic diseases. Some epidemiological studies, especially in patients with chronic kidney disease (CKD), have identified an association between osteoporosis and vascular calcification. Notably, low bone mineral density has been linked to an increased incidence of aortic calcification, with shared molecules, mechanisms, and pathways between the two processes. Certain molecules emerging from these shared pathways can serve as biomarkers for bone and mineral metabolism. Detecting and evaluating these alterations early is crucial, requiring the identification of biomarkers that are reliable for early intervention. While traditional biomarkers for bone remodeling and vascular calcification exist, they suffer from limitations such as low specificity, low sensitivity, and conflicting results across studies. In response, efforts are underway to explore new, more specific biomarkers that can detect alterations at earlier stages. The aim of this review is to comprehensively examine some of the emerging biomarkers in mineral metabolism and their correlation with bone mineral density, fracture risk, and vascular calcification as well as their potential use in clinical practice.

PMAIP1, a novel diagnostic and potential therapeutic biomarker in osteoporosis

BACKGROUND

Osteoporosis is a common endocrine metabolic bone disease, which may lead to severe consequences. However, the unknown molecular mechanism of osteoporosis, the observable side effects of present treatments and the inability to fundamentally improve bone metabolism seriously restrict the impact of prevention and treatment. The study aims to identify potential biomarkers from osteoclast progenitors, specifically peripheral blood monocytes on predicting the osteoporotic phenotype.

METHODS

Datasets were obtained from Gene Expression Omnibus (GEO). Based on the differentially expressed genes (DEGs) and GSEA results, GO and KEGG analyses were performed using the DAVID database and Metascape database. PPI network, TF network, drug-gene interaction network, and ceRNA network were established to determine the hub genes. Its osteogenesis, migration, and proliferation abilities in bone marrow mesenchymal stem cells (BMSCs) were validated through RT-qPCR, WB, ALP staining, VK staining, wound healing assay, transwell assay, and CCK-8 assay.

RESULTS

A total of 63 significant DEGs were screened. Functional and pathway enrichment analysis discovered that the functions of the significant DEGs (SDEGs) are mainly related to immunity and metal ions. A comprehensive evaluation of all the network analyses, PMAIP1 was defined as osteoporosis's core gene. This conclusion was further confirmed in clinical cohort data. A series of experiments demonstrated that the PMAIP1 gene can promote the osteogenesis, migration and proliferation of BMSC cells.

CONCLUSIONS

All of these outcomes showed a new theoretical basis for further research in the treatment of osteoporosis, and PMAIP1 was identified as a potential biomarker for osteoporosis diagnosis and treatment.

The entrancing role of dietary polyphenols against the most frequent aging-associated diseases

Aging, a fundamental physiological process influenced by innumerable biological and genetic pathways, is an important driving factor for several aging-associated disorders like diabetes mellitus, osteoporosis, cancer, and neurodegenerative diseases including Alzheimer's and Parkinson's diseases. In the modern era, the several mechanisms associated with aging have been deeply studied. Treatment and therapeutics for age-related diseases have also made considerable advances; however, for the effective and long-lasting treatment, nutritional therapy particularly including dietary polyphenols from the natural origin are endorsed. These dietary polyphenols (e.g., apigenin, baicalin, curcumin, epigallocatechin gallate, kaempferol, quercetin, resveratrol, and theaflavin), and many other phytochemicals target certain molecular, genetic mechanisms. The most common pathways of age-associated diseases are mitogen-activated protein kinase, reactive oxygen species production, nuclear factor kappa light chain enhancer of activated B cells signaling pathways, metal chelation, c-Jun N-terminal kinase, and inflammation. Polyphenols slow down the course of aging and help in combatting age-linked disorders. This exemplified in the form of clinical trials on specific dietary polyphenols in various aging-associated diseases. With this context in mind, this review reveals the new insights to slow down the aging process, and consequently reduce some classic diseases associated with age such as aforementioned, and targeting age-associated diseases by the activities of dietary polyphenols of natural origin.

New Emerging Aspect of Herbal Extracts for the Treatment of Osteoporosis: Overview

As the global population ages, osteoporosis is becoming a more common silent disease. Osteoporosis is characterized by decreased bone quality and strength, which increases the risk of fragility fractures in the elderly. According to estimates, 50% of women eventually suffer from an osteoporotic fracture. Due to increasing disability, more frequent hospital hospitalizations, and most critically, fragility fractures have been linked to a reduced quality of life. Osteoporotic fractures have been linked to an increased mortality risk; and must be considered in awareness as a serious health concern. There are anti-osteoporotic medications available that improve bone quality. Considering the availability of various treatment options, still there are a lot of underserved needs in the treatment of fractures and osteoporosis. For example, the application of natural products and herbal resources for fracture healing, because of the androgen-like and antioxidant characteristics of the plants, they can play a crucial for accelerating the repair of bone fractures. In this article, we'll discuss the herbal remedies that are essential for treating osteoporosis (bone disease).

Amyotrophic lateral sclerosis and osteoporosis: a two-sample Mendelian randomization study

Background

A few observational studies revealed that amyotrophic lateral sclerosis (ALS) was tightly connected with osteoporosis. However, the results of previous studies were inconsistent, and the causal effect of ALS on osteoporosis has not been investigated. To do so, the two-sample Mendelian randomization (MR) method was employed to estimate the causality.

Methods

The instrumental variables (IVs) for ALS were selected from one GWAS summary dataset (27,205 ALS cases and 110,881 controls), and bone mineral density (BMD) in the femoral neck (FN), lumbar spine (LS), and forearm, extracted from another large-scale GWAS summary database (53,236 cases), were used as phenotypes for osteoporosis. Random-effects inverse variance weighted (IVW), MR Egger, weighted median, simple mode, and weighted mode were conducted to evaluate the causality. Sensitivity analyses were further performed to explore heterogeneity and pleiotropy.

Results

A total of 10 qualified SNPs were finally selected as proxies for ALS. The results of random effects from IVW revealed that ALS has no causal effect on FN-BMD (beta: -0.038, 95% CI: -0.090 to 0.015, SE: 0.027, p = 0.158), LS-BMD (beta: -0.015, 95% CI: -0.076 to 0.046, SE: 0.031, p = 0.629), and forearm BMD (beta: 0.044, 95% CI: -0.063 to 0.152, SE: 0.055, p = 0.418). These results were confirmed using the MR-Egger, weighted median, simple model, and weighted model. No heterogeneity or pleiotropy was detected (p > 0.05 for all).

Conclusion

Contrary to previous observational studies, our study figured out that no causal effect existed between ALS and osteoporosis. The disparity in results is probably attributed to secondary effects such as physical inactivity and muscle atrophy caused by ALS.

Role of lifestyle factors in mediating the effect of educational attainment on bone mineral density: a Mendelian randomization study

We performed two-step multivariable Mendelian randomization analysis to explore the mediating role of lifestyle factors in educational attainment (EA) and bone mineral density (BMD). Summary statistics from genome-wide association studies of European lineages were used. Coffee intake and processed-meat intake mediated the association between EA and BMD.

PURPOSE

This study aimed to explore the causal relationship between educational attainment (EA) and bone mineral density (BMD), as well as the potential mediating roles of lifestyle factors in the expected EA-BMD relationship. By identifying modifiable lifestyle factors, we hope to provide relevant information to prevent osteoporosis or low BMD in the less educated population.

METHODS

Using summary statistics from genome-wide association studies (GWAS) of major European lineages, one- and two-sample Mendelian randomization (MR) analyses were performed to estimate the association between EA (in the social sciences genetic association consortium (SSGAC) involving 766,345 individuals and in the UK Biobank (UKB) involving 293,723 individuals) and BMD (in the Genetic Factors for Osteoporosis Consortium involving 426,824 individuals selected from the UKB). The EA variable in both consortia were expressed by years of schooling completed. Two-step multivariable MR was used to assess the mediating roles of eight lifestyle-related factors (moderate-to-vigorous physical activity, watching television, computer using, smoking initiation, coffee intake, alcohol intake frequency, tea intake, and processed-meat intake) in the EA and BMD association, and the corresponding mediating proportion was calculated. Meta-analysis was used to present a pooled estimate.

RESULTS

A total of 317 and 73 independent single-nucleotide polymorphisms (SNPs) of GWAS significance (P < 5.0 × 10-8) were selected as instrumental variables (IVs) for EA in the SSGAC and UKB, respectively. A total of 513 SNPs were selected as IVs for the BMD. The results of one- and two-sample MR revealed that the genetically predicted BMD increased by 0.094 and 0.047 g/cm2, respectively, in response to each SD increment of genetically predicted schooling years. Among the eight candidate mediators, coffee intake and processed-meat intake were potential mediators revealed by the two-step multivariable MR analysis, mediating 26.87% and 23.92% of EA's effect on BMD, respectively. Meta-analysis showed consistent findings. Results of sensitivity analysis indicated the robustness of our findings.

CONCLUSION

We elucidated the causal protective effect of EA on BMD and the mediating roles of coffee intake and processed-meat intake. Intervening with these factors can potentially reduce the burden of bone density loss or osteoporotic fractures among the less educated population.

Bone Mineral Density Evaluation Among Type 2 Diabetic Patients in Rural Haryana, India: An Analytical Cross-Sectional Study

Background and objective Diabetes is one of the most prevalent diseases globally, affecting almost all organ systems. The relationship between type 2 diabetes mellitus (T2DM) and bone mineral density (BMD) has been a matter of controversy, and data from developing countries in this regard is highly scarce. Early detection of low BMD in diabetic patients will help prevent further bone loss and risk of fragility fracture. In this study, we aimed to assess the effect of T2DM on BMD among the rural population of Haryana, India. Materials and methods This was a cross-sectional study involving 850 patients between 25 and 60 years of age, including 425 diabetic and 425 non-diabetic subjects (as controls). Calcaneus BMD was measured by using quantitative ultrasound (QUS), and the data were compared against matched parameters in both groups. Results The mean age of diabetics was 42.21 ± 10.5 years and that of non-diabetics was 42.18 ± 10.4 years. The mean BMI was 27.8 ± 4.17 kg/m2 in diabetics and 21.6 ± 3.32 kg/m2 in the non-diabetic control group. BMD values significantly differed between the groups: -4.3 ± 1.23 vs. -2.6 ± 0.34 in diabetics and non-diabetics, respectively (p=0.002). Conclusion A significant difference in BMD was observed between the diabetic and non-diabetic groups. Based on our findings, We recommend that all type 2 diabetics be screened for osteoporosis so that this silent bone loss can be detected in the early phase itself and appropriate preventive measures can be promptly initiated.

Mir-142-5p inhibits the osteogenic differentiation of bone marrow mesenchymal stem cells by targeting Lhx8

Osteoporosis (OP), a common systemic bone metabolism disease with a high incidence rate, is a serious health risk factor. Osteogenic differentiation balance is regulated by bone marrow mesenchymal stem cells (BMSCs) and plays a key role in OP occurrence and progression. Although, LIM homeobox 8 (Lhx8) has been identified to affect BMSCs osteogenic differentiation, its roles in OP and the associated mechanism remains unclear. Here, we aimed to elucidate the role and mechanism of Lhx8 in the osteogenic differentiation of BMSCs. BMSCs isolated from wild type and OP Sprague-Dawley rats were cultured and confirmed via flow cytometry and microscopy. Based on dual-luciferase reporter assay, BMSCs were transfected with miR-142-5p mimics and miR-NC (negative control). Real-time quantitative reverse transcription polymerase chain reaction and Western blot analyses were performed to determine the role of Lhx8 in BMSCs osteogenic differentiation. Lhx8 expression was significantly reduced in OP, whereas that of miR-142-5p, a possible Lhx8 regulator, was significantly upregulated. Dual-luciferase reporter assay demonstrated that miR-142-5p exerted a direct targeted regulatory effect on Lhx8. Moreover, miR-142-5p mimics significantly inhibited BMSCs osteogenic differentiation as well as Lhx8 expression in vitro, indicating that miR-142-5p may be involved in BMSCs osteogenic differentiation via Lhx8 expression regulation and may serve as a potential diagnostic target for OP. Overall, these findings indicated that miR-142-5p inhibits BMSCs osteogenic differentiation by suppressing Lhx8. These may serve as a foundation for further studies on OP treatment based on miR-142-5p targeting.

Impact of Osteoporosis Pharmacotherapy on Functional Outcomes after Ischemic Stroke

This study evaluated whether osteoporosis pharmacotherapy (OPT) affected functional outcomes in acute ischemic stroke patients with osteoporosis. Using a single-center registry database, we consecutively registered acute ischemic stroke patients between May 2016 and December 2020. All patients older than 55 years underwent routine bone densitometry within 7 days of stroke onset. OPT prescription was confirmed by reviewing medical records. We classified the patients into OPT and no OPT groups. We performed propensity score matching (PSM) to overcome the imbalance in multiple covariates between the two groups. We investigated whether OPT affected 1-year functional outcomes by multivariate analysis using a PSM cohort. Among 1307 consecutively registered acute ischemic stroke patients, 381 patients were enrolled in this study, of whom 134 (35.2%) were prescribed OPT at discharge, which was maintained for 1 year. In a multivariate analysis using a PSM cohort, the OPT group had a lower risk of dependency (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.27-0.996) and poor functional outcome at 1 year (OR, 0.24; 95% CI, 0.10-0.57). The OPT group also had increased chance of late functional improvement (OR, 6.16; 95% CI, 1.12-33.79). This study showed that OPT could reduce dependency and poor functional outcomes and increase the chance of improving functional outcomes at 3 months and 1 year after ischemic stroke onset, and these findings could be helpful for improving functional outcomes and bone health after ischemic stroke.

Osteoporosis: Review of Etiology, Mechanisms, and Approach to Management in the Aging Population

Osteoporosis is the most common metabolic bone disease. With special respect to the aging population, it is very common, not only due to changes in lifestyle and diet but as a result of the aging process there is low-grade inflammation and immune system activation that directly affects bone strength and quality. This article provides a review of the incidence, etiology, and approach to screening and management of osteoporosis in the aging population. A thorough screening of lifestyle, environmental, and clinical conditions will be reviewed which identifies appropriate candidates for screening and treatment.

Mechanistic advances in osteoporosis and anti-osteoporosis therapies

Osteoporosis is a type of bone loss disease characterized by a reduction in bone mass and microarchitectural deterioration of bone tissue. With the intensification of global aging, this disease is now regarded as one of the major public health problems that often leads to unbearable pain, risk of bone fractures, and even death, causing an enormous burden at both the human and socioeconomic layers. Classic anti-osteoporosis pharmacological options include anti-resorptive and anabolic agents, whose ability to improve bone mineral density and resist bone fracture is being gradually confirmed. However, long-term or high-frequency use of these drugs may bring some side effects and adverse reactions. Therefore, an increasing number of studies are devoted to finding new pathogenesis or potential therapeutic targets of osteoporosis, and it is of great importance to comprehensively recognize osteoporosis and develop viable and efficient therapeutic approaches. In this study, we systematically reviewed literatures and clinical evidences to both mechanistically and clinically demonstrate the state-of-art advances in osteoporosis. This work will endow readers with the mechanistical advances and clinical knowledge of osteoporosis and furthermore present the most updated anti-osteoporosis therapies.

Association of insulin resistance with bone mineral density in a nationwide health check-up population in China

INTRODUCTION

Insulin resistance (IR) is closely associated with cardio-metabolic diseases. However, the impact of IR on bone mass remains obscure. The present study is to evaluate the association between the triglyceride-glucose (TyG) indicated IR and bone mass in a nationwide health check-up population in China.

METHODS

We conducted a retrospective cross-sectional study including 788,247 participants and a longitudinal cohort study in 8770 participants who had repeated measurements of TyG index and bone mass in at least a 2-year follow-up period. The restricted cubic splines and logistic models were used to analyze the association between IR and bone mass in the cross-sectional study. The Cox model was applied to evaluate the relationship between baseline IR and the subsequent incidence of low bone mass and osteoporosis in the longitudinal study.

RESULTS

In the cross-sectional study, the TyG index had positive correlations with low bone mass, osteoporosis, or both after adjusting for confounding factors (all P < 0.001). In the longitudinal cohort study, the baseline TyG index was significantly associated with the incidence of low bone mass, osteoporosis, or both during the follow-up period, with hazard ratios (HRs) of 1.56 (95 % confidence interval [CI]: 1.25, 1.93, P < 0.05), 1.66 (95%CI: 1.06, 2.59, P < 0.05), and 1.55 (95%CI: 1.27, 1.88, P < 0.05) after adjusting for confounding factors, respectively.

CONCLUSIONS

These results suggest that IR indicated by TyG is significantly associated with an increased risk of low bone mass and osteoporosis. Therefore, bone mass monitoring and early prevention strategies may be needed in individuals with IR to prevent the occurrence of low bone mass and osteoporosis.

Twelve Loci Associated With Bone Density in Middle-aged and Elderly Chinese: The Shanghai Changfeng Study

CONTEXT

Previous genome-wide association studies (GWASs) of bone mineral density (BMD) were mainly conducted in Europeans.

OBJECTIVE

To explore genetic variants that affect BMD and sex differences in a Chinese population.

METHODS

A total of 5428 middle-aged and elderly Chinese were included. Dual-energy X-ray absorptiometry was used to measure BMD at the lumbar spine, and total and specific sites of the hip. A mixed linear model was used to analyze the associations between BMD and autosomal genetic variants, adjusting for age, age squared, sex, and menopausal women (model 1); model 2 was further adjusted for height and weight. A GWAS of osteoporosis in the Biobank Japan (BBJ) project was used for replication. GWAMA software was used to detect the statistical significance of sex differences of estimated effects. Gene annotation and pathway enrichment analysis were performed.

RESULTS

Women lost BMD at earlier ages and faster than men. The 2 models identified a total of 12 loci that were associated with BMD at any site. Single nucleotide polymorphisms rs72354346, rs2024219, rs1463093, rs10037512, and rs5880932 were successfully replicated in the BBJ. Variations of rs79262027 G>A (VKORC1L1) and rs4795209 A>G (DDX52) were associated with BMD only in men, and rs1239055408 G>GA (KCNJ2) was associated with BMD only in women. Gene enrichment analysis showed that BMD in a Chinese elderly population was mainly related to ossification, bone resorption, sex hormones, and kidney physiology.

CONCLUSION

The present GWAS identified 12 loci that were significantly associated with BMD at any site in a Chinese population, and 3 of them showed sex differences in their effects.

Fracture Risk in Pediatric Patients With MEN2B

CONTEXT

The skeletal phenotype of patients with MEN2B has been described but fracture risk in these patients has not yet been evaluated.

OBJECTIVE

This work aims to better delineate fracture risk in patients with multiple endocrine neoplasia type 2B (MEN2B).

METHODS

This case series with chart review was conducted at the National Institutes of Health, Pediatric Oncology Branch. A total of 48 patients with MEN2B were identified, with an age range of 5 to 36 years, median of 19; 24 of 48 (50%) patients were female. Medical records, demographic information, available imaging, and laboratory results were reviewed. History up to age 19 was included in the statistical analyses.

RESULTS

Of the 48 patients with MEN2B, 20 patients experienced at least one fracture. The majority (n = 18) experienced their first fracture at or before age 19. The observed frequency of fracture occurrence throughout childhood (0-19 years) was 38%, with very little difference between males and females. This frequency is higher than the 9.47 to 36.1 fractures per 1000 persons per year that has been reported in healthy pediatric cohorts in the United States. Less common sites of fracture including vertebral compression fracture and pelvic fractures were observed in patients with MEN2B.

CONCLUSION

In this group of patients with MEN2B, there was an increased overall risk of fracture compared to general pediatric cohorts in the United States. Less common sites of fracture were also observed. This suggests a possible effect of an activating RET mutation on bone physiology and warrants further investigation.

Comparing the effectiveness of type of the traditional Chinese exercises, frequency, intensity, time in osteoporosis: a protocol for systematic evaluation and network meta-analysis of randomised controlled trials

INTRODUCTION

As populations age, osteoporosis has become a hot topic of global public concern. The beneficial effects of traditional Chinese exercises on the musculoskeletal system have been demonstrated. However, previous research findings on osteoporosis are inconsistent, and it is unclear which type of exercise and its frequency and duration have the best effect on osteoporosis. This study aims to investigate the most appropriate exercise modality for people with osteoporosis through systematic evaluation and network meta-analysis to guide clinical practice.

METHODS AND ANALYSIS

The Cochrane Library, Web of Science, MEDLINE, Embase, China Biomedical Literature, China Knowledge Network, China Science and Technology Journal and Wanfang databases will be searched until January 2022. The language of the articles should be English or Chinese. All clinical randomised controlled trials on the effect of traditional Chinese exercises on osteoporosis will be included. We will use RevMan, Stata and GeMTC software to complete our network meta-analysis. We will perform risk of bias assessment, subgroup analysis and sensitivity analysis to correct the results. Finally, we will use the Grading of Recommendations Assessment, Development and Evaluation guideline development tool and Confidence in Network Meta-Analysis (CINeMA, a new method for assessing CINeMA results) approach to evaluate the reliability of our final results.

ETHICS AND DISSEMINATION

All data for this study will be obtained from published studies, so no ethical review will be needed. We will publish the results of the study in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42022323622.

Association between OPG polymorphisms and osteoporosis risk: An updated meta-analysis

Background: Numerous studies have demonstrated an association between osteoprotegerin (OPG) polymorphisms (A163G (rs3102735), T245G (rs3134069), T950C (rs2073617), G1181C (rs2073618)) and osteoporosis risk. However, their conclusions are inconsistent. In addition, some new studies have been updated, and more importantly, previous meta-analyses have not tested for false-positive results. In order to further explore these associations, we recently conducted a meta-analysis. Objectives: To study the relationship between OPG polymorphisms A163G, T245G, T950C, G1181C and the risk of osteoporosis. Methods: PubMed, Medline, International Statistical Institute (ISI), China National Knowledge Infrastructure (CNKI) and China Wanfang Database were used for research searches. Associations were assessed with five genetic models using odds ratios (ORs) with 95% confidence intervals (CIs). In addition, confidence in statistically significant associations was assessed using false-positive report probability (FPRP), Bayesian probability of False discovery (BFDP), and Venice criteria. Results: On the whole, the OPG A163G polymorphism was not significantly associated with risk of osteoporosis. However, in a subgroup analysis, we found that the OPG A163G polymorphism increased the risk of osteoporosis in Caucasians (AG + GG vs AA: OR = 1.35, 95% CI = 1.06-1.73; AA + GG vs AG: OR = 0.64, 95% CI = 0.49-0.82) and the female (G vs A: OR = 1.30, 95% CI = 1.03-1.64; AG + GG vs AA: OR = 1.42, 95% CI = 1.18-1.71). At the same time, the OPG G1181C polymorphism reduces the risk of osteoporosis (C vs G: OR = 0.84, 95% CI = 0.74-0.95; CC vs GG: OR = 0.75, 95% CI = 0.60-0.93; GC + CC vs GG: OR = 0.80, 95% CI = 0.67-0.95; CC vs GG + GC: OR = 0.84, 95% CI = 0.70-1.00). Moreover, a significantly decreased risk of osteoporosis was also discovered in Asian (C vs G: OR = 0.80, 95% CI = 0.66-0.98; CC vs GG: OR = 0.67, 95% CI = 0.47-0.95; GC + CC vs GG: OR = 0.74, 95% CI = 0.58-0.95) and the female (C vs G: OR = 0.85, 95% CI = 0.75-0.97; CC vs GG: OR = 0.77, 95% CI = 0.61-0.96; GC + CC vs GG: OR = 0.79, 95% CI = 0.66-0.95). Finally, we did not find a close association between OPG T245G and T950C polymorphisms and osteoporosis risk. However, when we retained only studies in the control group that was consistent with Hardy-Weinberg equilibrium (HWE) and high-quality scores, we observed that the OPG A163G polymorphism increased the risk of osteoporosis in the overall analysis (G vs A: OR = 1.40, 95% CI = 1.16-1.68; GG vs AA: OR = 1.96, 95% CI = 1.20-3.21; AG + GG vs AA: OR = 1.45, 95% CI = 1.22-1.72). Finally, after the credibility assessment, we concluded that all statistically significant association results in the meta-analysis in this study and those in the previous study were 'positive results with low confidence'. Conclusion: In conclusion, our study concluded that all meaningful results between OPG A163G and G1181C polymorphisms and osteoporosis risk were false-positive results rather than true associations.

Living alone decreased calcaneus ultrasound T-score in a large Taiwanese population follow-up study

Background

Osteoporosis is associated with many serious health conditions that have a severely negative impact on quality of life, as well as higher rates of morbidity and mortality. Due to the aging society and low birth rate in Taiwan, an increasing number of people are living alone. This longitudinal study was aimed to assess the relationship between living alone and calcaneus ultrasound T-score in a large cohort in Taiwan.

Methods

A total of 118,853 participants enrolled in the Taiwan Biobank since 2008 to 2016, who had complete calcaneus ultrasound examinations were collected in the baseline study. Of these participants, 26,850 received complete follow-up measurements after a median of 4 years. The T-score (g/cm²) of the calcaneus in the non-dominant foot was measured using ultrasound. Changes in the calcaneus ultrasound T-score (ΔT-score) were calculated as follow-up T-score minus baseline T-score. We analyzed these data in 2022. We used multivariable linear regression analysis to investigate correlation between living alone with baseline T-score and ΔT-score. We also carried out separate analyses for men and women.

Results

The mean age of the participants was 49.89 ± 10.95 years, and multivariable analysis showed that living alone was significantly correlated to low baseline T-score in whole cohort (β = -0.040; p = 0.012) and women (β = -0.055; p = 0.023). Furthermore, living alone (coefficient β = -0.049; p = 0.048) was significantly correlated to a low ΔT-score after 4 years of follow-up.

Conclusion

In this large population-based longitudinal study, living alone may be related to low baseline calcaneus ultrasound T-score and ΔT-score. Adopting long-term community-based care policies to increase the activity of people living alone may help to prevent osteoporosis and decrease the risk of fractures in Taiwan.