Low bone mineral density is associated with metabolic syndrome in South Korean men but not in women: The 2008-2010 Korean National Health and Nutrition Examination Survey

Fracture Risk Assessment in Metabolic Syndrome in Terms of Secondary Osteoporosis Potential. A Narrative Review

Osteoporosis is a major global public health problem with the associated bone fractures contributing significantly to both morbidity and mortality. In many countries, osteoporotic fractures will affect one in three women and one in five men over the age of 50. Similarly, diabetes, obesity, and metabolic syndrome (MetS) are among the leading public health problems due to their worldwide prevalence and burden on health budgets. Although seemingly disparate, metabolic disorders are known to affect bone health, and the interaction between fat and bone tissue is increasingly well understood. For example, it is now well established that diabetes mellitus (both type 1 and 2) is associated with fracture risk. In this narrative review, we focus on the potential link between MetS and bone health as expressed by bone mineral density and fracture risk. This narrative review demonstrates the association of MetS and its components with increased fracture risk, and also highlights the need for fracture risk assessment in patients with obesity and MetS.

Waist circumference, among metabolic syndrome components, predicts degraded trabecular bone score: a retrospective study of a female population from the 2005-2008 NHANES cohorts

Background

Osteoporosis and metabolic syndrome (MetS) are conditions associated with ageing and chronic inflammation; among MetS' components, visceral obesity has been correlated to low bone mineral density in postmenopausal women. However, data on an increased fracture risk in MetS are still contrasting. The trabecular bone score (TBS) is an indicator of bone quality and a potential predictive factor for fractures. We aim to explore the relationship between MetS components and TBS.

Methods

we analyzed data from 3962 women in the 2005-2006 and 2007-2008 NHANES cohorts, for whom a valid TBS value was available. All analyses were adjusted for the principal risk factors of altered bone metabolism.

Results

An inverse significant association was observed between TBS and most of the MetS variables investigated, with the strongest correlation found with waist circumference (WC) (P <0.001). WC represented the major predictor of degraded TBS (P <0.001), in adjusted models considering age, 25(OH)Vitamin D, smoke and insulin resistance. Increased WC was significantly associated with the presence of bone fractures at the logistic regression analysis (P = 0.001) in all study participants and in the subgroup of women ≤50 years old after adjustment for potential confounders (P = 0.006).

Conclusion

This study, using a large sample of women, found a negative association of MetS on bone health, mainly driven by visceral obesity.

Linking metabolic syndrome with low bone mass through insights from BMI and health behaviors

The objective of this study is to investigate the relationship between metabolic syndrome (MetS), and bone density in a 30- to 50-year-old Taiwanese population, and to explore the combined effects of BMI and health behaviors on this association. A total of 52,912 individuals aged 30-50 years from the Taiwan Biobank were included in this cross-sectional study. Bone density status was assessed using quantitative ultrasound (QUS). The joint effect was assessed by including an interaction term in the multi-logistic regression models to test the association between MetS, BMI, and bone density while controlling for potential confounders. MetS was associated with reduced bone density, with the risk of severe low bone density (SLBD) higher among BMI < 24 kg/m2 individuals with MetS (adjusted odds ratio [aOR] 1.5, 95% confidence interval [CI] 1.09-2.16), while the risk was not significant among BMI ≥ 24 kg/m2 individuals with MetS. Smoking, alcohol consumption, and lack of regular exercise among individuals with a BMI < 24 kg/m2 and MetS were associated with higher risk of severe low bone density (SLBD), the aORs (95%CI) were 2.9 (1.59-5.20), 2.1 (1.06-4.22), and 1.8 (1.24-2.54) respectively. Our study suggests that metabolic syndrome could increase the risk of severe low bone density, but this risk can be minimized through higher BMI, non-smoking, no alcohol consumption, and regular exercise. Conversely, smoking, alcohol consumption or lack of regular exercise may exacerbate the risk of severe low bone density. These findings highlight the importance of a multifactorial approach in managing bone healthcare.

Evaluation of the Association between Amount and Type of Milk Consumption and Periodontitis: Data from the Korea National Health and Nutrition Examination Survey (2016-2018)

This study evaluated the association between the consumption of milk and having severe periodontitis. It is based on the information from the 2016-2018 Korea National Health and Nutrition Examination Survey. Severe periodontitis was characterized as a community periodontal index of code 4. A total of 18,034 individual respondents (7835 men and 10,199 women) without missing values were included in this study. Adjusted odds ratios and a 95% confidence interval of periodontitis in a multivariate logistic regression model for the amount of milk consumption were 0.774 [0.633-0.945] after the adjustment of confounding factors. This trend was maintained in a subgroup analysis of males with adjusted odds ratios, with a 95% confidence interval of 0.705 [0.538-0.924]. Overall, the findings showed a negative association between Korean adults' milk consumption and the prevalence of severe periodontitis. Men with higher milk consumption were more likely to have a lower prevalence of severe periodontitis regardless of age, body mass index, smoking or drinking habits, education, income, region, and physical exercise, diabetes mellitus, hypertension, metabolic syndrome, white blood cell count and toothbrushing frequency. By contrast, in women, the amount of milk consumption was not significantly associated with severe periodontitis. The amount of milk consumed was discovered to be a potential risk indicator for severe periodontitis in men in this study.

Association of Triglyceride-Glucose Index with Bone Mineral Density in Non-diabetic Koreans: KNHANES 2008-2011

The association of insulin resistance (IR), as indicated by the homeostasis model assessment of insulin resistance, with bone metabolism is yet to be clarified. We aimed to investigate the relationship of IR with bone mass by using the triglyceride-glucose (TyG) index as an alternative marker of IR. Data of 4810 non-diabetes individuals (2552 men aged ≥ 50 years and 2258 postmenopausal women) from the Korean National Health and Nutritional Examination Survey IV and V were analyzed. Bone mineral density (BMD) at the lumbar spine, femoral neck, total hip, and whole body were measured using dual-energy X-ray absorptiometry. After adjusting for confounding factors, there were inverse relationships of TyG index with femoral neck, total hip, and whole body BMD in men (β =  - 0.085, P < 0.001 at femoral neck; β =  - 0.046, P = 0.037 at total hip; β =  - 0.098, P < 0.001 at whole body). However, in women, femoral neck and whole body BMD were negatively associated with the TyG index (β =  - 0.071, P = 0.008 at femoral neck and β =  - 0.065, P = 0.005 at whole body). The highest TyG index tertile exhibited reduced femoral neck BMD in both sexes (P = 0.003 in men and P = 0.013 in women) and reduced whole body BMD in men (P < 0.001) after adjusting for confounders. When the study subjects were divided into BMI (body mass index) < 23 kg/m² and ≥ 23 kg/m² groups, the TyG index was significantly associated with femoral neck BMD only in the women with BMI < 23 kg/m² (P = 0.009). We observed a significant association between the highest TyG index tertile and low bone mass at the femoral neck in women with BMI < 23 kg/m² (P = 0.003) that was not observed in women with BMI ≥ 23 kg/m² and men. In conclusion, IR evaluated using the TyG index was inversely associated with femoral neck BMD in non-diabetic men aged ≥ 50 years and postmenopausal women. The negative influence of IR on femoral neck BMD was robust in the women with BMI < 23 kg/m². This indicates a differential effect of IR on BMD according to skeletal site, sex, and BMI.

Coexistence of metabolic syndrome and osteopenia associated with social inequalities and unhealthy lifestyle among postmenopausal women in South Korea: the 2008 to 2011 Korea National Health and Nutritional Examination Survey (KNHANES)

OBJECTIVE

The prevalence of metabolic syndrome (MetS) and osteoporosis (OP) among postmenopausal women has been rapidly increasing. We examined the associations between socioeconomic status-related factors, unhealthy lifestyle, and the coexistence of MetS and osteopenia or OP.

METHODS

One thousand nine hundred ninety-one postmenopausal women aged 45 to 65 years were used to select a representative sample of the civilian, noninstitutionalized South Korean population from the 2008 to 2011 Korea National Health and Nutrition Examination Survey data. Women were grouped as neither MetS nor OP (normal), MetS, OP, and both MetS and OP (MetS + OP). Socioeconomic status (education, household income, place of residence, employment status), health-related behaviors (physical activity, alcohol consumption, smoking), and diet-related factors (intake of nutrients and food groups, eating habits, food insecurity) were obtained. Logistic regression models were used to examine the odds ratio (OR) and 95% confidence interval (CI).

RESULTS

The prevalence of MetS + OP was 32.5%. The average number of MetS risk factors in MetS + OP was 3.5, higher than that of normal and OP groups (P < 0.001). Bone mineral density at all sites was significantly lower in MetS + OP than normal and MetS groups (P < 0.001). Also, calcium, phosphorus, vitamin A, riboflavin, and niacin levels were lowest in the MetS + OP group compared with the three other groups (P < 0.05). After controlling for covariates, low-income and low-education women were more likely to have MetS + OP (OR 1.97, 95% CI 1.04-3.72); high-income and high-education group was 70% less likely to have MetS + OP (OR 0.30, 95% CI 0.10-0.86) compared with the middle-income and middle-education group.

CONCLUSIONS

Social inequalities might be powerful contributors in Korean postmenopausal women with coexistence of MetS and OP. Therefore, social and political perspective approaches are required in this population for prevention and treatment of MetS and OP. Future studies should explore to find controllable factors and thereby improve health status in postmenopausal women.

The analysis of risk for peptic ulcer disease using Korean national health and nutrition examination survey: a cross-sectional analysis of a national survey sample

Background

To evaluate the risk factors associated with the incidence of peptic ulcer disease (PUD), study was conducted to assess the relationship between socioeconomic and environmental factors and PUD in a large scales data of the Korean population using the Korea National Health and Nutrition Examination Survey (KNHANES).

Methods

We conducted a cross sectional study of 12,095 enrollment in the Health Professionals Follow-Up Study. The data was collected from KNHANES between 2008 and 2009 by the Division of Chronic Disease Surveillance under the Korea Centers for Disease Control and Prevention and the Korean Ministry of Health and Welfare. Multiple logistic regression analyses were used to assess the associations of PUD with the multiple variables.

Results

An association between old age, mental and psychosocial factor and PUD could be seen in both genders under multivariate analysis. Additionally, PUD in male associated with lower BMI and lesser exercise in life.

Conclusions

These findings suggest that, in Korean, mental health is associated with increased prevalence of PUD.

Positive association between metabolic syndrome and bone mineral density among Malaysians

Objectives: Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that elevates the individual risk of cardiovascular diseases. These abnormalities are also known to alter bone remodelling. Therefore, MetS may be associated with osteoporosis. This study aims to determine the association between MetS and its components and bone mineral density (BMD) assessed by dual-energy X-ray absorptiometry (DXA) among Malaysians. Methods: 400 Malaysians aged ≥ 40 years (52.5% women) residing in Klang Valley, Malaysia, were recruited. Subjects' demographic and lifestyle details were collected using a questionnaire, and blood pressure and body anthropometry were measured. Subjects' lumbar spine and total hip BMD were measured by DXA. Their fasting blood was collected for blood glucose level and lipid profile analysis. Regression analysis was used to analyze the relationship between MetS or its components and BMD. Results: Subjects with MetS had higher BMD compared to subjects without MetS in models unadjusted for BMI (spine p=0.008; hip p<0.001). This difference was attenuated with BMI adjustment (spine p=0.625; hip p=0.478). Waist circumference was associated positively with BMD in models unadjusted for BMI (spine p=0.012; hip p<0.001), but the association became negative with BMI adjustment (spine p=0.044; hip p=0.021). Systolic blood pressure was associated positively with total hip BMD (p=0.019) but BMI adjustment attenuated the relationship (p=0.080). Triglyceride level was associated with osteoporosis in a fully adjusted model (p=0.001). Overall, MetS was associated with osteoporosis (p=0.019) but lifestyle (p=0.188) and BMI adjustment attenuated the relationship (p=0.904). Conclusion: MetS is positively associated with BMD, and this relationship is predominantly mediated by BMI. Although MetS is not a significant risk factor for osteoporosis, the inverse relationship between waist circumference, a marker of central obesity, and BMD highlights the need to prevent adiposity to improve metabolic and skeletal health.

Relationship Between Metabolic Syndrome and Bone Health - An Evaluation of Epidemiological Studies and Mechanisms Involved

Metabolic syndrome (MetS) and osteoporosis are two medical problems plaguing the ageing populations worldwide. Though seemingly distinctive to each other, metabolic derangements are shown to influence bone health. This review summarises the relationship between MetS and bone health derived from epidemiological studies and explains the mechanistic basis of this relationship. The discourse focuses on the link between MetS and bone mineral density, quantitative sonometric indices, geometry and fracture risk in humans. The interesting sex-specific trend in the relationship, probably due to factors related to body composition and hormonal status, is discussed. Mechanistically, each component of MetS affects the bone distinctly, forming a complex interacting network influencing the skeleton. Lastly, the effects of MetS management, such as pharmacotherapies, exercise and bariatric surgery, on bone, are presented. This review aims to highlight the significant relationship between MetS and bone, and proper management of MetS with the skeletal system in mind could prevent cardiovascular and bone complications.

Identification of hypertriglyceridemia based on bone density, body fat mass, and anthropometry in a Korean population

BACKGROUND

Hypertriglyceridemia is strongly associated with the risks of cardiovascular disease, coronary heart disease, and metabolic syndrome. The relationship between hypertriglyceridemia or high triglyceride levels and bone mineral density remains controversial. Furthermore, to date, no study has simultaneously examined the association among hypertriglyceridemia, bone area, bone mineral content, bone mineral density, body fat mass, and anthropometrics. The present study aimed to evaluate the association among hypertriglyceridemia, anthropometrics and various bone density and body fat composition variables to identify the best indicator of hypertriglyceridemia in a Korean population.

METHODS

The data were obtained from the fifth Korea National Health and Nutrition Examination Survey. In total, 3918 subjects aged 20-80 years participated in this study. In the variable analysis of the waist circumference (WC), trunk fat mass (Trk-Ft), body mass index, etc., a binary logistic regression analysis was performed to examine the significance of the differences between the normal group and hypertriglyceridemia groups.

RESULTS

In both men and women, the WC showed the strongest association with hypertriglyceridemia in the crude analysis (odds ratio (OR) = 1.738 [confidence interval = 1.529-1.976] and OR = 2.075 [1.797-2.397]), but the Trk-Ft was the most strongly associated with the disease after adjusting for age and body mass index (adjusted OR = 1.565 [1.262-1.941] and adjusted OR = 1.730 [1.291-2.319]). In particular, the Pelvis area (Plv-A) was the most significant among the bone variables in women (adjusted OR = 0.641 [0.515-0.796]). In the predictive power analysis, the best indicator of hypertriglyceridemia was WC in women (the area under the receiver operating characteristic curve (AUC) = 0.718 [0.685-0.751]) and Trk-Ft in men (AUC = 0.672 [0.643-0.702]). The WC was also the most predictive among the anthropometric variables in men (AUC = 0.670 [0.641-0.700]). The strength of the association and predictive power was stronger in women than in men.

CONCLUSIONS

The WC in women and Trk-Ft in men exhibited the best predictive power for hypertriglyceridemia. Our findings support the use of basic information for the identification of hypertriglyceridemia or high triglyceride levels in initial health screening efforts.

Height Loss Was Associated With Osteoporosis in Korean Elderly Men, Not in Women: The Korea National Health and Nutrition Examination Survey 2008-2010

The degree of height loss varies among individuals, and excessive height loss can be a vertebral fracture or bone loss manifestation. The objective of this study was to examine the relationships between height loss and bone mineral density (BMD) and to assess the prevalence of osteoporosis according to the height loss quartiles. Data from the Korea National Health and Nutrition Examination Survey were analyzed. A total of 2799 participants more than 60 years old were included and subdivided into quartiles according to height loss (Q1-Q4). Height loss was calculated with the difference between the self-reported maximum adult height and the actual measured height. BMD was measured by dual-energy X-ray absorptiometry at the total femur (TF), femoral neck, and lumbar spine. Multivariable linear and logistic regression analyses were conducted to study the height loss-BMD and the height loss-osteoporosis prevalence relationships, respectively. After adjustments for all covariates, height loss was negatively associated with BMD at all the 3 sites (TF and lumbar spine, p < 0.001; femoral neck, p = 0.002) in men, but only at TF (p = 0.008) in women. Men with Q4 height loss had an increased prevalence of osteoporosis compared with those with Q1 (odds ratio = 2.092 and 95% confidence interval = 1.076-4.068). In women, the prevalence of osteoporosis was not associated with height loss. In conclusion, Q4 height loss in elderly men was associated with the increased prevalence of osteoporosis in Korea.

Evaluation of the associations between immunoglobulin E levels and the number of natural teeth

BACKGROUND/PURPOSE

The purpose of the study was to evaluate the association between the number of natural teeth and the total serum immunoglobulin E (IgE), allergen-specific IgE against Dermatophagoides farina, allergen-specific IgE against cockroaches, or allergen-specific IgE against dogs with nationally representative data using the Korean National Health and Nutrition Examination Survey (KNHANES).

METHODS

This study involved a cross-sectional analysis using KNHANES data from 2010. A total of 1916 participants were eligible for this study. Multiple regression analyses were used to evaluate the risk of tooth loss in relation to IgE levels. The model was adjusted for age, sex, body mass index, smoking habits, drinking habits, exercise habits, vitamin D levels, metabolic syndrome, allergic rhinitis, asthma, atopic dermatitis, and tooth-brushing frequency.

RESULTS

The number of natural teeth of the first quartile to the fourth quartile of total serum IgE were 25.9 ± 0.2, 25.9 ± 0.2, 25.1 ± 0.2, and 25.4 ± 0.2, respectively, showing an inverse association (P < 0.05). The number of natural teeth of the first quartile to the fourth quartile of allergen-specific IgE against Dermatophagoides farina and allergen-specific IgE against dogs farina both showed an inverse association with statistical significance (P < 0.05).

CONCLUSION

This study clearly showed the inverse association between total serum IgE and number of natural teeth after adjustments, especially regarding participants without systemic diseases, including diabetes mellitus, hypertension, metabolic diseases, and obesity.

Fusion Techniques Are Related to a Lower Risk of Reoperation in Lumbar Disc Herniation: A 5-Year Observation Study of a Nationwide Cohort in Taiwan

OBJECTIVE

Lumbar disc herniation (LDH) is a common spinal problem, with reoperation rates of 6%-24%. Although different surgical techniques are used for treatment, there is still debate regarding whether fusion techniques can reduce the reoperation rate in patients with LDH.

METHODS

This retrospective study used a 5-year nationwide database to analyze reoperation rates in Taiwan. Patient age groups (≥20 and <90 years) treated by index surgery and reoperation for LDH were identified. Four surgical procedures were included in the analysis: discectomy (DC), anterior lumbar fusion with DC (FA + DC), posterior lumbar fusion (FP), and posterior lumbar fusion with DC (FP + DC).

RESULTS

There were 1743 index surgeries between 2008 and 2012, with 184 (10.56%) reoperations. Index surgery DC had the highest reoperation rate (n = 121, 20%). The reoperation risk was significantly lower for patients undergoing fusion procedures (FA + DC vs. DC [hazard ratio (HR), 0.24; 95% confidence interval (CI), 0.12-0.47; P < 0.01], FP versus DC [HR, 0.17; 95% C, 0.09-0.33; P <0.01], FP + DC versus DC [HR, 0.31; 95% CI, 0.22-0.44; P < 0.01]). Fusion procedures had significantly higher treatment costs compared with DC (FA + DC vs. FP vs. FP + DC vs. DC: 5851.74 ± 4808.94 vs. 5116.88 ± 3428.97 vs. 4782.16 ± 2902.19 vs. 3846.79 ± 3584.45 U.S. dollars/patient, respectively; P < 0.0001).

CONCLUSIONS

Among surgical procedures for LDH, fusion techniques are related to lower reoperation rates compared with discectomy, but at the expense of higher medical costs.

Periodontitis is associated with diabetic retinopathy in non-obese adults

PURPOSE

Patients with diabetes retinopathy appear to show increased susceptibility to periodontal disease. This study was performed to assess the relationship between periodontitis and the prevalence of diabetic retinopathy in a large probability sample of the Korean population. A subgroup analysis was performed using body mass index <25 kg/m2 as the criterion to evaluate the effect of obesity on this relationship.

METHODS

This study is based on data from the Korean National Health and Nutrition Examination Survey of the Korean population, conducted between 2008 and 2010. The presence of diabetic retinopathy in relation to demographic variables and anthropometric characteristics of the participants is presented as means with their standard errors. The presence of periodontitis and presence of retinopathy categorized by body mass index (<25 and ≥25 kg/m2) were evaluated. Multiple logistic regression analyses were used to assess the associations between periodontitis and diabetic retinopathy after adjustment with variables, including age, sex, smoking, drinking, exercise, hypertension, metabolic syndrome, HbA1c, and duration of diabetes mellitus.

RESULTS

There was a statistically significant increase in the prevalence of periodontitis in individuals who had proliferative diabetic retinopathy. The odds ratios [95% confidence intervals] of prevalence of diabetic retinopathy were 1.193 [0.757-1.881] for the whole population after adjustments with confounding factors. Subgroup analysis after adjustments with confounding factors showed that the odds ratios [95% confidence intervals] of prevalence were 2.206 [1.114-4.366] and 0.588 [0.326-1.061] among participants with body mass index <25 kg/m2 and body mass index 37 ≥25 kg/m2, respectively.

CONCLUSIONS

The diabetic retinopathy was positively associated with the presence of periodontitis in non-obese diabetic Korean adults after adjustment with confounding variables. Our findings suggest that when a periodontist finds the presence of periodontitis in non-obese diabetic patients, timely evaluation of the patient's ophthalmic evaluation should be 44 recommended.

Associations between the number of natural teeth in postmenopausal women and hormone replacement therapy

OBJECTIVES

Increasing research suggests that periodontal status is associated with hormone replacement therapy in postmenopausal women. This study was performed to assess the relationship between the number of natural teeth and ever use of hormone replacement therapy in postmenopausal women using nationally representative Korean data.

METHODS

Data from the Korea National Health and Nutrition Examination Survey between 2010 and 2012 were used, and the analysis in this study was confined to a total of 4869 respondents over 19 years old who had gone through menopause and who had no missing data for the reproductive factors and outcome variables in that study. The total number of natural teeth was then calculated after excluding third molars. The time of day when tooth brushing was done was recorded as representative oral health behavior. Multiple logistic regression analyses were used to assess association between the number of natural teeth and the use of hormone replacement therapy.

RESULTS

Among participants who had ever used hormone replacement therapy, the proportions (percentage and standard error) with no teeth, 1-9 teeth, 10-19 teeth, 20-27 teeth, and 28 teeth were 5.0±2.4%, 6.7±1.4%, 12.5±1.7%, 18.9±1.0%, and 20.7±1.6%, respectively (P<0.05). The adjusted odds ratio and 95% confidence interval for having fewer than 20 teeth <20 was 0.624 [0.464-0.840] for the individuals using hormone replacement therapy, after adjustments.

CONCLUSIONS

The analysis revealed that the use of hormone replacement therapy by postmenopausal women showed positive effects for retention of natural teeth. Lack of hormone replacement therapy may be considered to be an independent risk indicator for tooth loss in Korean postmenopausal women.

Assessment of trabecular bone score (TBS) in overweight/obese men: effect of metabolic and anthropometric factors

The "trabecular bone score" (TBS) indirectly explores bone quality, independently of bone mineral density (BMD). We investigated the effects of anthropometric and metabolic parameters on TBS in 87 overweight/obese men. We assessed BMD and TBS by DXA, and some parameters of glucose metabolism, sex-and calciotropic hormone levels. Regression models were adjusted for either age and BMI, or age and waist circumference, or age and waist/hip ratio, also considering BMI >35 (y/n) and metabolic syndrome (MS) (y/n). Correlations between TBS and parameters studied were higher when correcting for waist circumference, although not significant in subjects with BMI >35. The analysis of covariance showed that the same model always had a higher adjusted r-square index. BMD at lumbar spine and total hip, fasting glucose, bioavailable testosterone, and sex hormone-binding globulin are the only covariates having a significant effect (p < 0.05) on the variations of TBS. The presence of MS negatively affected only the association between TBS and BMD at total hip. We did not find any significant effect of BMI >35 on TBS values or significant interaction terms between each covariate and either BMI >35 or the presence of MS. Obesity negatively affected TBS, despite unchanged BMD. Alterations of glucose homeostasis and sex hormone levels seem to influence this relationship, while calciotropic hormones have no role. The effect of waist circumference on TBS is more pronounced than that of BMI.

Sex differences in the association between stroke and bone mineral density in elderly Koreans: The Korean National Health and Nutrition Examination Survey, 2008-2010

OBJECTIVES

The aim of this study was to investigate whether osteoporosis is more prevalent in elderly Korean people who have had a stroke and whether the association differs by sex.

STUDY DESIGN

A total of 3806 elderly subjects (1951 men and 1855 women) from the Korea National Health and Nutrition Examination Survey were included in this study. Stroke history was determined by self-administered questionnaire. Bone mineral density (BMD) was measured at the lumbar spine, total hip, and neck of the femur using dual-energy X-ray absorptiometry. It was categorized as normal, osteopenia, or osteoporosis.

RESULTS

In men who had had a stroke, the prevalence of osteoporosis was greater than that of both osteopenia and normal BMD, and the prevalence of osteopenia was greater than that of normal BMD (p<0.001). However, there were no significant differences in BMD level among women who had had a stroke. Men who had had a stroke undertook less vigorous exercise and moderate-or-vigorous exercise than did men who had not had a stroke (p=0.002 and 0.030, respectively). After adjusting for all covariates, the mean BMD at the lumbar spine, total hip and neck of the femur was lower in men who had had a stroke than in men who had not (p=0.034, 0.002, and 0.005, respectively). There were no significant differences in mean BMD at any of the three sites between women who had and women who had not had a stroke.

CONCLUSION

Men who have had a stroke have a higher prevalence of osteopenia and osteoporosis, and have lower BMD at the total hip and femur neck than men who have not had a stroke.

Association between socioeconomic status and oral health behaviors: The 2008-2010 Korea national health and nutrition examination survey

Socioeconomic status (SES) has been reported to be associated with oral health behavior. Therefore, the present study was conducted to assess the relationship between SES and oral health behaviors in a large sample of the Korean population. Data from the Korea National Health and Nutrition Examination Survey, which was conducted between 2008 and 2010 by the Division of Chronic Disease Surveillance under the Korea Centers for Disease Control and Prevention and the Korean Ministry of Health and Welfare, were used in the present study. Daily tooth brushing frequency and the use of secondary oral products according to demographic variables and anthropometric characteristics of the participants were assessed. Multivariate logistic regression analyses were used to analyze the associations between daily tooth brushing frequency and the use of secondary oral products, and SES, urban/rural residence, body mass index (BMI), alcohol intake and smoking. An association between SES and tooth brushing frequency and the use of secondary oral products was detected after adjustment. Following adjustment for age, gender, BMI, smoking, drinking, exercise, energy intake, fat intake, periodontal treatment needs and education or income, the adjusted odds ratios and 95% confidence intervals (CI) of tooth brushing ≥3 per day in the highest income group were 1.264 (95% CI, 1.094-1.460) and 2.686 (95% CI, 2.286-3.155) for highest education level group. The adjusted odds ratios for the use of secondary oral products in the highest income and highest education groups were 1.835 (95% CI, 1.559-2.161) and 5.736 (95% CI, 4.734-6.951), respectively, after adjustment for age, gender, smoking, BMI, exercise, calorie intake, periodontal treatment requirements or income. The present study demonstrated an association between SES and oral health behaviors in a large sample of the Korean population. Within the limits of the present study, income and education were suggested as potential risk indicators for oral health behaviors; therefore, patients with a low SES should be investigated further, in relation to oral health.

Association between Consumption of Coffee and the Prevalence of Periodontitis: The 2008-2010 Korea National Health and Nutrition Examination Survey

BACKGROUND

This study was performed to assess the relationship between the consumption of coffee and periodontitis using nationally representative data.

METHODS

The data from the Korea National Health and Nutrition Examination Survey were used; the analysis in this study was confined to a total of 16,730 respondents over 19 years old who had no missing values for the consumption of coffee or outcome variables. A community periodontal index greater than or equal to code 3 was defined as periodontal disease.

RESULTS

Consumption of coffee was significantly higher in the individuals with periodontitis in males. The odds ratios of the percentage of individuals with periodontitis tended to increase with the consumption of coffee. Adjusted odds ratios and their 95% confidence intervals of the male participants were 1, 1.131(0.792-1.617), 1.161(0.857-1.573), 1.053(0.805-1.379), 1.299(1.007-1.676), and 1.458(1.141-1.862) for once per month or less, once per month

CONCLUSIONS

Consumption of coffee may be considered an independent risk indicator of periodontal disease in Korean male adults, and we suggest that the periodontal health of male may benefit from reduction of coffee consumption.

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Key Words Collapse

MESH Headings

• Adult
• Aged
• Coffee
• Cross-Sectional Studies
• Feeding Behavior
• Female
• Humans
• Male
• Middle Aged
• Nutrition Surveys
• Odds Ratio
• Periodontal Diseases/epidemiology
• Periodontal Index
• Periodontitis/diagnosis
• Periodontitis/epidemiology
• Prevalence
• Republic of Korea/epidemiology
• Risk
• Risk Factors
• Social Class
• Young Adult

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Grants

• National Research Foundation

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Affiliation(s)

Kyungdo Han Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Eunkyung Hwang Bangmok College of General Education, Myongji University, Seoul, Republic of Korea
Jun-Beom Park Department of Periodontics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea

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Excessive Consumption of Green Tea as a Risk Factor for Periodontal Disease among Korean Adults

This study was performed to assess the relationship between the amount of green tea that is consumed and periodontitis. It is based on data obtained from the Korea National Health and Nutrition Examination Survey, conducted between 2008 and 2010. A community periodontal index equal to code 3 was defined as moderate periodontitis, and code 4 was defined as severe periodontitis (n = 16,726). Consumption of green tea less than one cup per day was associated with a decreased prevalence of periodontal disease among Korean adults. The association between the consumption of green tea and periodontal disease was independent of various potential confounding factors, such as age, sex, body mass index, smoking, drinking, exercise, metabolic syndrome, frequency of tooth brushing per day, use of secondary oral products, the number of dental examination per year, diabetes, hypertension, and white blood cell count. Adjusted odds ratio and 95% confidence interval of no consumption was 1.360 (1.156, 1.601) when participants with consumption of two times per week ≤ x < 7 times per week was considered as a reference. However, consumption of one or more cups per day increased the prevalence of moderate and severe periodontitis. In conclusion, excessive consumption of green tea may be considered as a risk factor for periodontal disease among Korean adults.

Association between temporomandibular disorders and obesity

Psychological stress can induce altered eating patterns, and studies have indicated that there is a correlation between temporomandibular disorder (TMD) and psychological stress. This study investigated the relationship between TMD and body mass index (BMI) in a large representative sample of the South Korean population using data from the Korea National Health and Nutrition Examination Survey (KNHANES). Men and women with TMD showed decreased prevalence of abdominal obesity. Women with TMD had lower age, lower BMI, lower metabolic syndromic waist circumference, lower prevalence of metabolic syndrome, and lower prevalence of diabetes compared with the group without TMD. However, males with TMD didn't show any statistically significant difference between BMI, and metabolic syndromic waist circumference compared with the group without TMD, although there were similar tendencies in the female subject groups. Overall, TMD was associated with decreased BMI and abdominal obesity in women.

Plasma osteoprotegerin levels are inversely associated with nonalcoholic fatty liver disease in patients with type 2 diabetes: A case-control study in China

OBJECTIVE

Osteoprotegerin (OPG), a soluble member of the tumor necrosis factor (TNF) receptor superfamily, is a decoy receptor for the receptor activator of nucleus factor-κB ligand (RANKL) and TNF-related apoptosis-inducing ligand (TRAIL). OPG has an effect on systemic insulin sensitivity and glucose homeostasis. The objective of this study was to evaluate the relationship between plasma osteoprotegerin (OPG) levels and nonalcoholic fatty liver disease (NAFLD) in patients with type 2 diabetes.

MATERIALS/METHODS

A case-control study was performed with 746 patients with type 2 diabetes. Of the study population, 367 patients had B-mode ultrasound-proven NAFLD and 379 were controls. The plasma OPG levels were measured using ELISA methods. NAFLD was diagnosed by hepatic ultrasound after the exclusion of alcohol abuse and other liver diseases.

RESULTS

The OPG levels were significantly decreased in patients with NAFLD (2.3±1.1μg/L vs. 2.8±1.3μg/L, p=3.75×10(5)) compared to controls. Pearson correlation analysis showed that the OPG levels were associated with age and systolic blood pressure (both p<0.05). The participants in the lowest OPG quartile had a significantly increased risk for NAFLD (OR=3.49, 95% CI 1.86-6.94) after adjusting for potential cofounders.

CONCLUSIONS

The plasma OPG level is negatively associated with NAFLD independent of potential cofounders.

Oral health behaviors and bone mineral density in South Korea: the 2008-2010 Korean National Health and Nutrition Examination Survey

The purpose of this study was to examine the association between oral health behaviors and bone mineral density (BMD) by using data from the Korean National Health and Nutrition Examination Survey conducted in 2008-2010. We included 6,620 subjects (3,140 men aged more than 50 years and 3,480 postmenopausal women). BMD was measured at three sites-namely, the lumbar spine, total femur, and femur neck. Oral health behaviors were assessed by use of a self-administered questionnaire in the Korean National Health and Nutrition Examination Survey. After adjustment for all covariates, BMD of the lumbar spine and femur neck tended to increase as the frequency of tooth brushing increased in men (p trend = 0.020 and p trend = 0.028, respectively). Women using secondary oral products had increased lumbar spine BMD compared with women who did not use secondary oral products. However, after adjustment for all covariates, no significant relationship was observed between BMD and the use of secondary oral products. As the frequency of tooth brushing and the number of secondary oral products used increased, the prevalence of osteoporosis decreased. The frequency of tooth brushing is associated with increased lumbar spine and femur neck BMD in South Korean men.

Osteopenia is associated with glycemic levels and blood pressure in Chinese postmenopausal women: a cross-sectional study

The aim of present study was to explore the relationships between osteopenia and dyslipidemia, glycemic levels or blood pressure in postmenopausal Chinese women. A total of 4080 women aged 42-85 years were enrolled in this cross-sectional study, which was nested in an ongoing longitudinal (REACTION) study. Calcaneus quantitative ultrasound (QUS) was performed and QUS T score was calculated to assess bone mineral density. Osteopenia was defined as a T score ≤-1.0. The relationship between osteopenia and dyslipidemia, glycemic levels or blood pressure was investigated. The prevalence of osteopenia was significantly lower in subjects with systolic blood pressure (SBP) ≥140 mmHg, fasting blood glucose (FBG) ≥8.0 mmol/L, postprandial blood glucose (PBG) ≥15.0 mmol/L, hemoglobin A1c (HbA1C) 6.5-7.5 %, HbA1C ≥7.5 %. These relationships remained significant after controlling for multiple factors. Moreover, significant trend between osteopenia and SBP, FBG, PBG and HbA1C was observed in women. In contrast, no significant associations between osteopenia and diastolic blood pressure (DBP), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) were found, and no significant trend relationship between osteopenia and DBP, TC, TG, HDL-C, LDL-C was found in postmenopausal Chinese women. The present study showed a relationship between SBP, FBG, PBG, HbA1C and osteopenia in postmenopausal Chinese women, while no significant relationship was observed between dyslipidemia, DBP and osteopenia, even after controlling for multiple confounding factors.

Osteoporosis epidemiology 2013: implications for diagnosis, risk assessment, and treatment

PURPOSE OF REVIEW

To summarize the recently published studies that provide insights into the changing epidemiology of osteoporosis and fractures.

RECENT FINDINGS

The main themes reviewed are fracture outcomes; trends in fractures rates; fracture risk assessment and monitoring; atypical femoral fractures; male osteoporosis; falls and physical activity; and sarcopenia, obesity, and metabolic syndrome.

SUMMARY

Osteoporotic fractures were found to have long-term consequences on excess mortality (10 years) and economic costs (5 years). The large burden of nonhip nonvertebral fractures has been underestimated. Divergent (but mostly declining) trends in fracture rates were confirmed in several cohorts from around the world. This has significant implications for healthcare planners and clinicians responsible for the care of individuals with osteoporosis, and also impacts on the calibration of fracture prediction tools. Although fracture prediction tools differ in their complexity, performance characteristics are similar when applied to the general population. Large, high-quality comparative studies with different case mixes are needed. Fracture probability does not appear to be responsive enough to support goal-directed treatment at this time. A consensus on the diagnosis of osteoporosis in men has emerged, based upon the same absolute bone density cutoff for both men and women. Finally, a plethora of new data highlight the importance of falls, physical activity, and body composition as contributors to skeletal health.

Association between alcohol consumption and periodontal disease: the 2008 to 2010 Korea National Health and Nutrition Examination Survey

BACKGROUND

A positive association has been reported between alcohol and periodontal disease. Therefore, this study is conducted to assess the relationship between alcohol intake and severity of periodontal disease in a large probability sample of the Korean population using the Korea National Health and Nutrition Examination Survey (KNHANES).

METHODS

Data from KNHANES, conducted between 2008 and 2010 by the Division of Chronic Disease Surveillance under the Korea Centers for Disease Control and Prevention and the Korean Ministry of Health and Welfare, were used for this study. The presence of periodontal treatment needs according to demographic variables and anthropometric and hematologic characteristics of the participants are presented as means with their standard errors. Multivariate logistic regression analyses were used to assess the associations of periodontal treatment needs with the amount of alcohol intake and other variables including smoking and the number of times of toothbrushing per day.

RESULTS

An association between drinking alcohol and periodontal treatment needs could be seen in men after adjustment for variables. Adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) in males were 1.271 (1.030 to 1.568) for heavy drinkers after controlling for age, smoking, body mass index, exercise, education, income, white blood cell count, diabetes, hypertension, metabolic syndrome, and number of toothbrushing episodes per day (model 3). Adjusted ORs and their 95% CIs in males were 1.569 (1.284 to 1.916) for alcohol use disorders identification test (AUDIT) level ≥20 in model 3. ORs increased with the increase in alcohol consumption levels and AUDIT levels. Statistically significant correlations between drinking and periodontal treatment needs could not be seen in female heavy drinkers or female drinkers with AUDIT levels ≥20.

CONCLUSIONS

Men with higher alcohol intake were more likely to have a higher prevalence of treatment needs regardless of their age, socioeconomic factors, systemic conditions (including diabetes, hypertension, and metabolic syndrome), and number of times of toothbrushing per day in multivariable adjusted models. By contrast, in women, alcohol intake was not independently associated with periodontal treatment needs. Alcohol consumption was discovered to be a potential risk indicator for periodontal treatment needs in men in this study.