Anemia is related to osteoporosis in Chinese type 2 diabetic patients

Relationship between anemia, hemoglobin level and risk of osteosarcopenia in community-dwelling older adults: the Bushehr Elderly Health (BEH) program

This study investigates the relationship between anemia, hemoglobin levels, and osteosarcopenia risk in older adults. Analyzing data from 2,398 participants in the Bushehr Elderly Health program, the research reveals that anemia significantly increases osteosarcopenia risk. The findings suggest that routine hemoglobin screening and anemia treatment could help prevent osteosarcopenia in the elderly population.

PURPOSE

In the older adult population, osteosarcopenia, defined as having both sarcopenia and osteopenia, is a recent concern. In this study, we aimed to evaluate anemia as a common condition in the older adult population and osteosarcopenia. Given that anemia can contribute to musculoskeletal decline through impaired oxygen delivery and metabolic dysfunction, we hypothesized that lower hemoglobin levels and anemia may be significant risk factors for osteosarcopenia. This study aims to investigate this potential relationship in an elderly population.

METHODS

This cross-sectional study was conducted on men and women ≥ 60 years, based on the second phase of the Bushehr elderly health (BEH) program. Osteopenia/osteoporosis was defined as a t-score ≤-1.0 standard deviation below the mean values of a young healthy adult and sarcopenia was defined based on the revised edition of the European Working Group on Sarcopenia in Older People (EWGSOP2) based on the Iranian cut-off point. Anemia is defined as 12 for women and 13 g/dl for men. We calculated odds ratios (OR), 95% confidence intervals (95% CI), and adjusted OR (AOR) using univariate and adjusted multivariate logistic regression.

RESULTS

Among 2398 who enrolled, 534 (22.27%) of participants had osteosarcopenia. The mean level of hemoglobin (Hgb) was 14.49 ± 1.73, and 219 participants (9.13%) were diagnosed with anemia. Participants with osteosarcopenia were more likely to be older, have lower body mass index, suffer from frailty syndrome and cognitive disorder, and have anemia. Moreover, analysis showed lower levels of Hgb were associated with osteosarcopenia (AOR = 0.89, 95% CI: 0.82-0.96) and anemia almost increase 1.5 times risk of osteosarcopenia (AOR = 1.55, 95% CI: 1.05-2.30).

CONCLUSION

The results of this study indicate that anemia dramatically increased the risk of osteosarcopenia. Routine Hgb screening and treatment of anemia might prevent the older adult population from osteosarcopenia.

Correlation between serum hemoglobin levels and bone mineral density in adults: A cross-sectional study

Serum hemoglobin plays an important role in bone metabolism. However, the association between serum hemoglobin levels and bone mineral density (BMD) remains unclear. Therefore, this study aimed to explore the relationship between serum hemoglobin levels and lumbar spine BMD in adults. We conducted a cross-sectional study by utilizing data from the National Health and Nutrition Examination Survey from 2011 to 2018. The serum hemoglobin level was examined as an independent variable, while the lumbar spine BMD was utilized as the dependent variable. Weighted multivariate linear regression models and stratified analysis by age, sex, and race/ethnicity were applied after controlling for confounding factors to assess the relationship between serum hemoglobin levels and the lumbar spine BMD. Additionally, smooth curve fitting and threshold effect analyses were utilized to depict the nonlinear relationship between the 2 variables. A total of 11,658 participants (6004 men and 5654 women) aged ≥ 18 years were included in this study. When the serum hemoglobin level was represented as a continuous variable and fully adjusted in the regression model, the hemoglobin level was significantly negatively correlated with the lumbar spine BMD (β = -0.0035, 95% confidence interval: -0.0065 to -0.0004, P = .024555); this significant negative correlation persisted when the serum hemoglobin level was transformed into a categorical variable, except in the Q2 group (β = -0.0046, 95% confidence interval: -0.0142 to -0.0050, P = .348413). When different confounding factors were used including sex, age, and race/ethnicity, the stratified subgroups exhibited a negative correlation between the serum hemoglobin level and the lumbar spine BMD. Additionally, smooth curve fitting and threshold effect analyses showed a negative correlation between the serum hemoglobin level and the lumbar spine BMD, with a saturation effect at 15 g/dL. Our findings demonstrated an association between hemoglobin levels and the lumbar spine BMD in adults, characterized by a nonlinear relationship. Thus, monitoring the serum hemoglobin level could aid in the early detection of risks associated with bone metabolic disorders such as osteoporosis.

Exploring the pharmacological mechanism of Xianlingubao against diabetic osteoporosis based on network pharmacology and molecular docking: An observational study

Xianlinggubao formula (XLGB), is a traditional Chinese compound Medicine that has been extensively used in osteoarthritis and aseptic osteonecrosis, but its curative effect on diabetic osteoporosis (DOP) and its pharmacological mechanisms remains not clear. The aim of the present study was to investigate the possible mechanism of drug repurposing of XLGB in DOP therapy. We acquired XLGB active compounds from the traditional Chinese medicine systems pharmacology and traditional Chinese medicines integrated databases and discovered potential targets for these compounds by conducting target fishing using the traditional Chinese medicine systems pharmacology and Swiss Target Prediction databases. Gene Cards and Online Mendelian Inheritance in Man® database were used to identify the DOP targets. Overlapping related targets between XLGB and DOP was selected to build a protein-protein interaction network. Next, the Metascape database was utilized to enrich the Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathways. In addition, Auto-Dock Vina software was used to verify drug and target binding. In total, 48 hub targets were obtained as the candidate targets responsible for DOP therapy. The anti-DOP effect mediated by XLGB was primarily centralized on the advanced glycation end products (AGEs)-receptor for AGE signaling pathway in diabetic complications and osteoclast differentiation. In addition, AKT serine/threonine kinase 1, tumor necrosis factor, Interleukin-6, vascular endothelial growth factor A and peroxisome proliferator activated receptor gamma, which were considered as potential therapeutic targets. Furthermore, molecular docking results confirm the credibility of the predicted therapeutic targets. This study elucidates that XLGB may through regulating AGEs formation and osteoclast differentiation as well as angiogenesis and adipogenesis against DOP. And this study provides new promising points to find the exact regulatory mechanisms of XLGB mediated anti-DOP effect.

Hemoglobin is associated with BMDs and risk of the 10-year probability of fractures in patients with type 2 diabetes mellitus

Purpose

This study aimed to investigate the associations between hemoglobin (HGB) levels and bone mineral density (BMD) and fracture risk in type 2 diabetes mellitus(T2DM) population of different ages.

Method

This cross-sectional study included 641 patients with T2DM (57.9% males). BMD of the femoral neck (FN), total hip (TH), and lumbar spine (LS) were measured using dual-energy X-ray absorptiometry. The 10-year probability of fracture was assessed using a fracture risk assessment tool (FRAX). HGB and other biochemical indices were measured in a certified laboratory at our hospital. Statistical analysis was performed using SPSS 26.0 and R language (R version 4.1.0). Generalized additive models (GAMs) were used to identify the associations between HGB and BMD and fracture risk.

Results

Patients with osteoporosis have lower HGB levels than the non-osteoporotic population and lower FN BMD in patients with anemia than in the non-anemic population. In patients with T2DM, there was sex- and age-related variability in the correlation between HGB levels and BMDs and fracture risk. In older men, HGB level was an independent determinant of BMD and was positively correlated with FN and TH BMD. In non-older women, HGB level was an independent determinant of BMD and fracture risk, positively associated with BMDs and negatively associated with 10-year probability of fracture risk. GAMs revealed a positive linear association between HGB level and BMDs in non-older female patients but not in older male patients.

Conclusion

Our study provides a new perspective on the association of HGB level and BMDs with fracture risk. Relatively high HGB levels are a protective factor for bone quality in patients with T2DM. However, the bone-protective effect of HGB is influenced by age and sex and persists only in older men and non-older women with T2DM.

Risk Genetic Variants (IL-10) for Osteoporosis in Han Population from Northwest China

Background

Osteoporosis (OP) is a common metabolic bone disease characterized by loss of bone mass. IL-10 is considered to be a powerful immune and inflammatory suppressor. This study aimed to assess association between genetic loci in IL-10 and susceptibility to OP.

Methods

Association analysis between IL-10 genetic loci and OP risk through SNPStats online software. FPRP analysis (false-positive report probability) verified whether the positive results were noteworthy findings. Linkage disequilibrium (LD) and haplotype analysis were completed by Haploview 4.2 and SNPStats. Multi-factor dimensionality reduction (MDR) was used to assess interaction of SNP-SNP in susceptibility to OP.

Results

Allele "G" of IL-10-rs1554286 (OR = 1.21, p = 0.013), allele "C" of IL-10-rs1518111 (OR = 1.22, p = 0.011), allele "C" of IL-10-rs3024490 (OR = 1.20, p = 0.018), and allele "G" of IL-10-rs1800871 (OR = 1.21, p = 0.015) were risk factors for OP. In females, smoking, drinking, or aging ≤60 years old participants, the above genetic loci are also significantly associated with the increased risk of OP. FPRP analysis showed that all positive results are noteworthy findings. There are significant differences in serum levels of uric acid, mean hemoglobin concentration, or mean hemoglobin among different genotypes of IL-10 gene loci. MDR showed that four loci model composed rs1554286, rs1518111, rs3021094, and rs1800871 is the best model for predicting OP risk.

Conclusion

IL-10-rs1554286, -rs1518111, -rs3021094, and -rs1800871 are risk factors for susceptibility to OP.

Association of hemoglobin levels with bone mineral density for adults over 18 years of age: a cross-sectional study

The overall objective of this study was to determine the association between hemoglobin (HGB) and bone mineral density (BMD) in the lumbar and thoracic spine of adults aged ≥ 18 years. This cross-sectional study utilized the non-institutionalized US population from the National Health and Nutrition Survey (NHANES) as the sample source. A multiple linear regression model was used to assess the relationship between HGB and BMD in the lumbar and thoracic spine, with analysis of subgroups conducted according to sex and race. Smooth curve fitting was performed to explore the potential nonlinear relationship. When nonlinearity was found, we further constructed a weighted two-piecewise linear regression model and used a recursive algorithm to calculate the inflection point. After accounting for relevant confounding variables, HGB was found to be negatively associated with lumbar spine BMD in multiple regression models. However, in the subgroup analyses stratified by sex and race, the relationship between HGB and thoracic spine BMD and lumbar spine BMD was only found in women and other races and races that were not recorded. In Non-Hispanic Asian subjects, the relationship between HGB and BMD in the lumbar spine and thoracic spine showed a U-shaped curve. In addition, the relationship between HGB and BMD in the lumbar spine formed an inverted U-shaped curve among participants in other races and those whose race was not reported. Our study shows that HGB has a non-linear relationship with lumbar and thoracic BMD. Further studies are required to elucidate the mechanisms underlying this association.

Association Between Hemoglobin Levels and Osteoporosis in Chinese Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

PURPOSE

To explore the relationship between hemoglobin levels and osteoporosis and the risk factors for osteoporosis in patients with type 2 diabetes mellitus (T2DM).

PATIENTS AND METHODS

A cross-sectional study was conducted in 495 T2DM adults. Medical data were collected from electronic medical records.

RESULTS

T2DM patients with osteoporosis had significant lower hemoglobin levels (P < 0.001). Spearman correlation analysis and logistic regression analysis showed that age, female, body mass index (BMI), smoking, drinking and hemoglobin levels were significantly associated with osteoporosis in T2DM patients (all P < 0.05). After adjustment for BMI, diabetic duration, estimated glomerular filtration rate (eGFR), smoking and drinking, a significant association between hemoglobin levels and osteoporosis was observed in T2DM males aged 50 years and older (odds ratio [OR] = 0.978, 95% confidence interval [CI]: 0.958-0.998, P = 0.030). Compared to Q3 groups with normal hemoglobin levels, Q1 groups with anemia had an odd of osteoporosis increased 2.9-fold in T2DM men after adjustment for age, BMI, diabetic duration, eGFR, smoking and drinking (P = 0.032).

CONCLUSION

Hemoglobin levels were associated with the presence of osteoporosis in T2DM men, especially in those aged 50 years and older.

HemoglobinA1c Is a Risk Factor for Changes of Bone Mineral Density: A Mendelian Randomization Study

BACKGROUND

As a valuable blood glucose measurement, HemoglobinA1c (HbA1c) is of great clinical value for diabetes. However, in previous observational studies, studies on its effect on bone mineral density (BMD) have different results. This study aimed to use Mendelian randomization (MR) to assess the effect of HbA1c on bone mineral density and fracture risk, and try to further explore whether this association was achieved through glycemic or non-glycemic factors.

METHODS

Take HbA1c measurement as exposure, and BMD estimated from quantitative heel ultrasounds (eBMD) and bone fractures as outcomes. Two-Sample MR Analysis was conducted to assess the causal effect of HbA1C on heel BMD and risk fracture. Then, we performed the analysis using two subsets of these variants, one related to glycemic measurement and the other to erythrocyte indices.

RESULTS

Genetically increased HbA1C was associated with the lower heel eBMD [odds ratio (OR) 0.91 (95% CI 0.87, 0.96) per %-unit, P = 3 × 10-4(IVW)]. Higher HbA1C was associated with lower heel eBMD when using only erythrocytic variants [OR 0.87 (0.82, 0.93), P=2× 10-5(IVW)]; However, when using only glycemic variants, this casual association does not hold. In further MR analysis, we test the association of erythrocytic traits with heel eBMD.

CONCLUSION

Our study revealed the significant causal effect of HbA1c on eBMD, and this causal link might achieve through non-glycemic pathways (erythrocytic indices).