Association between Bone Mineral Density and Nutritional Status, Body Composition and Bone Metabolism in Older Adults

Predictive Value of Preoperative Nutritional Risk Index for Screw Loosening After Lumbar Interbody Fusion in Elderly Patients With Lumbar Spine Diseases

OBJECTIVE

Pedicle screw loosening is one of the common complications in elderly patients undergoing transforaminal lumbar interbody fusion (TLIF) for lumbar spine disease. Malnutrition, prevalent among elderly patients, has been shown to be associated with increased complications. The Geriatric Nutritional Risk Index (GNRI) serves as a simple indicator of nutritional status. However, the relationship between malnutrition, particularly GNRI, and pedicle screw loosening has not been adequately investigated. This study aims to investigate the relationship between GNRI and pedicle screw loosening following TLIF to guide the perioperative nutritional management of patients and prevent postoperative complications.

METHODS

A retrospective review was conducted on clinical data from patients who underwent single-level TLIF between 2014 and 2022. Data collection encompassed patient demographics, preoperative laboratory parameters, surgery-related data, perioperative radiographic data, and patient-reported outcomes were comprehensively documented. All patients were followed up for a minimum of 12 months. The relationship between GNRI and pedicle screw loosening was evaluated by univariate and multivariate Cox regression analysis, restricted cubic spline (RCS) analysis, receiver operating characteristic (ROC) analysis, and Kaplan-Meier survival analysis.

RESULTS

A total of 426 patients were included in the study. The rate of pedicle screw loosening rate was 16.4% at a minimum follow-up of 12 months. Patients with pedicle screw loosening exhibited significantly lower GNRI (89.0 ± 8.0 vs. 99.2 ± 9.3, p < 0.001) and volumetric bone mineral density measured by quantitative computed tomography (QCT-vBMD) (84.2 [interquartile range (IQR) 79.6-92.2] vs. 104.0 [IQR 88.2-126.0] mg/cm3, p < 0.001) compared with those in the non-loosening group. Multivariate Cox regression analysis identified sex (hazard ratio [HR] 1.433, 95% confidence interval [CI] 0.714-2.876, p = 0.027), age (HR 1.062, 95% CI 1.014-1.113, p = 0.012), GNRI (HR 0.841, 95% CI 0.711-0.994, p = 0.043), and QCT-vBMD (HR 0.982, 95% CI 0.967-0.997, p = 0.019) as independent risk factors for screw loosening. RCS analysis showed that GNRI was negatively correlated with screw loosening (p < 0.0001). The area under the curve (AUC) for the GNRI in predicting pedicle screw loosening was 0.794, with a cut-off value of 95.590 (sensitivity, 85.7%; specificity 65.2%). Kaplan-Meier survival analysis identified that the lower-level GNRI group exhibited a higher cumulative incidence of screw loosening (log-rank test, p < 0.0001).

CONCLUSION

The GNRI was an independent risk factor for postoperative screw loosening in elderly patients undergoing TLIF for lumbar spine disease. Preoperative GNRI may potentially serve as a valuable tool in predicting postoperative screw loosening in elderly patients undergoing TLIF.

Impact of dietary nutrition regimens based on body composition analysis on bone metabolism in Alzheimer's disease patients

BACKGROUND

Body composition analysis (BCA) is primarily used in the management of conditions such as obesity and endocrine disorders. However, its potential in providing nutritional guidance for patients with Alzheimer's disease (AD) remains relatively unexplored.

AIM

To explore the clinical efficacy of BCA-based dietary nutrition scheme on bone metabolism in AD patients.

METHODS

This retrospective study included 96 patients with AD complicated by osteoporosis who were admitted to The Third Hospital of Quzhou between January 2023 and December 2024. Based on data from previous similar studies, the patients were randomly assigned to either a routine diet (RD) group (n = 48) or a personalized nutrition (PN) group (n = 48). The RD group received conventional dietary guidance, while the PN group received individualized diet intervention measures based on human BCA. The intervention period lasted for 12 weeks. Bone mineral density (BMD), body mass index (BMI), muscle mass, mineral content, osteocalcin, 25-hydroxyvitamin D, procollagen type I N-terminal propeptide (PINP), beta C-terminal telopeptide of type I collagen (β-CTX), and serum calcium were measured and compared between the two groups before and 12 weeks after the intervention.

RESULTS

No significant differences were observed between groups in terms of age, sex, height, BMI, or other baseline data (P > 0.05). In both groups, BMI did not show significant changes after the intervention (P > 0.05), whereas muscle mass and mineral content were significantly increased (P < 0.05). After the intervention, BMI in the PN group did not differ significantly from that of the RD group, but muscle mass and mineral content were significantly higher in the PN group (P < 0.05). After the intervention, a higher proportion of patients in the PN group had a T score > -1 compared to the RD group (P < 0.05). The mini-mental state examination (MMSE) score was similar in both groups before the intervention. However, 12 weeks after the intervention, the MMSE score in the PN group was significantly higher than that in the RD group (P < 0.05). In both groups, the MMSE score significantly increased 12 weeks post-intervention compared to pre-intervention levels (P < 0.05). Before the intervention, the levels of osteocalcin, serum calcium, PINP, β-CTX, and 25-hydroxyvitamin D were not significantly different between the two groups (P > 0.05). After 12 weeks of intervention, the PN group exhibited higher levels of osteocalcin, serum calcium, and 25-hydroxyvitamin D, as well as lower levels of PINP and β-CTX, compared to the RD group (P < 0.05). In both groups, osteocalcin, serum calcium, and 25-hydroxyvitamin D levels were significantly higher, while PINP and β-CTX levels were significantly lower after 12 weeks of intervention compared to baseline (P < 0.05).

CONCLUSION

The human BCA-based dietary nutrition regimen plays a crucial role in improving BMD and bone metabolism, with effects that surpass those of conventional nutrition strategies. The findings of this study provide strong evidence for the nutritional management of AD patients.

Evaluation of bone mineral density and its influencing factors in patients infected with HIV under antiretroviral therapy

BACKGROUND

Reduced Bone Mineral Density (BMD) has been linked to Human Immunodeficiency Virus (HIV) infection and treatment. There is a lack of information regarding the osteoporosis status of middle-aged patients with HIV in Iran, despite the fact that Antiretroviral Therapy (ART) is widely accessible.

OBJECTIVE

The purpose of this cross-sectional study was to assess the BMD status and low BMD risk factors in patients with HIV under ART living in Iran.

METHODS

Data were collected from individuals diagnosed with HIV aged 30-50, receiving ART for at least 6 months. Dual-energy X-ray absorptiometry scans assessed BMD in femoral neck, total hip, and lumbar regions. Pearson's correlation coefficients identified relationships between BMD and demographic and laboratory predictors. Univariable and multivariable logistic regression models assessed predictors of low lumbar BMD.

RESULTS

Among 80 HIV-infected individuals (mean age: 41.1 ± 5.6 years, 60.4% male), 15% exhibited low BMD in the lumbar spine and 3.75% in the femoral neck. Serum phosphate levels were negatively correlated with BMD across the femoral neck, total hip, and lumbar regions (e.g., lumbar BMD: r = -0.24, p = 0.03). Parathyroid hormone (PTH) showed negative correlations with femoral neck and total hip BMD (r = -0.26, p = 0.01; r = -0.29, p = 0.01, respectively). Estradiol positively correlated with lumbar BMD in females (r = 0.36, p = 0.04), and BMI positively correlated with BMD in all regions (e.g., lumbar: r = 0.41, p = 0.001). Testosterone was inversely associated with the odds of lumbar low BMD (OR [95% CI] = 0.79 [0.62-0.96], p = 0.02). Duration of HIV or treatment, CD4 levels, and viral load were not significantly associated with BMD.

CONCLUSION

This study highlights the multifactorial nature of BMD changes in individuals living with HIV. By identifying correlations between metabolic, hormonal, and disease-related factors and bone health, our findings bring attention to an often-overlooked aspect of HIV management, that is patients with HIV may benefit from routine BMD screening, as it could help identify early risks of low BMD.

Increased response of postmenopausal bone to interval walking training depends on baseline bone mineral density

PURPOSE

To examine the hypothesis that an increase in response of postmenopausal bone to interval walking training (IWT) depends on baseline bone mineral densities (BMDs).

METHODS

Two hundred and thirty-four postmenopausal women (64±5 (SD) yr) with no medication for osteoporosis performed 5-month IWT, repeating fast and slow walking at ≥70% and ~40% peak aerobic capacity, respectively, for 3 minutes each per set, ≥5 sets/day, ≥4 days/week. They were recruited from those who had performed IWT ≥6 months before participating in the study so that their physical fitness and lifestyle-related disease symptoms had almost reached a steady state at the time of their participation. We measured BMDs for the lumbar spine (LS), bilateral femoral neck (FN), and bilateral total hip (TH) by dual-energy X-ray absorptiometry (DXA) before and after the intervention. We used a multiple regression analysis to identify significant independent factors for increasing BMDs after the intervention as baseline physical characteristics, exercise intensity, and exercise time during IWT were the candidates. For any bone site where the independent factor identified was singular, we analyzed the relationship between the identified factor vs increases in BMD after the intervention (ΔBMD) by the locally weighted scatterplot smoothing (LOWESS) method.

RESULTS

Almost all subjects completed the designated protocol with minimal adverse events. We found that significant determinants for increasing BMDs were the baseline BMDs for all bone sites, as well as age and body mass index for TH (all, P<0.02). Furthermore, the LOWESS trendline between ΔBMDs vs the baseline BMDs, divided equally into 10 bins for LS and FN, respectively, showed that ΔBMD responses (Y) were attenuated as the baseline BMDs (X) increased in the lower 4 bins and then showed a flat line (Y = ~0) in the remaining higher 6 bins for LS and FN. When the lower 4 bins and the higher 6 bins of the baseline BMD were pooled, respectively, BMDs significantly increased by 1.8% and 1.0% in the lower groups for LS and FN, respectively (both, P<0.001) while not in the higher groups after the intervention (both, P>0.3).

CONCLUSIONS

IWT may be of benefit with minimal adverse events to postmenopausal women, although the effects were greater in those with lower baseline BMDs.

TRIAL REGISTRATION

UMIN000047428. https://rctportal.niph.go.jp/s/detail/um?trial_id=UMIN000047428#.

Causal relationships between body mass index, low-density lipoprotein and bone mineral density: Univariable and multivariable Mendelian randomization

SUMMARY

Utilizing the Mendelian randomization technique, this research clarifies the putative causal relationship between body mass index (BMI) andbone mineral density (BMD), and the mediating role of low-density lipoprotein (LDL). The implications of these findings present promising opportunities for enhancing our understanding of complex bone-related characteristics and disorders, offering potential directions for treatment and intervention.

OBJECTIVE

The objective of this study is to examine the correlation between BMI and BMD, while exploring the intermediary role of LDL in mediating the causal impact of BMI on BMD outcomes via Mendelian randomization.

METHODS

In this study, we employed genome-wide association study (GWAS) data on BMI, LDL, and BMD to conduct a comparative analysis using both univariate and multivariate Mendelian randomization.

RESULTS

Our study employed a two-sample Mendelian randomization design. Considering BMI as the exposure and BMD as the outcome, our results suggest that BMI may function as a potential protective factor for BMD (β = 0.05, 95% CI 1.01 to 1.09, P = 0.01). However, when treating LDL as the exposure and BMD as the outcome, our findings indicate LDL as a risk factor for BMD (β = -0.04, 95% CI 0.92 to 0.99, P = 0.04). In our multivariate Mendelian randomization (MVMR) model, the combined influence of BMI and LDL was used as the exposure for BMD outcomes. The analysis pointed towards a substantial protective effect of LDL on BMD (β = 0.08, 95% CI 0.85 to 0.97, P = 0.006). In the analysis of mediation effects, LDL was found to mediate the relationship between BMI and BMD, and the effect was calculated at (β = 0.05, 95% CI 1.052 to 1.048, P = 0.04).

CONCLUSION

Our findings suggest that BMI may be considered a protective factor for BMD, while LDL may act as a risk factor. Moreover, LDL appears to play a mediatory role in the causal influence of BMI on BMD.

Bone metabolism factors in predicting the risk of osteoporosis fracture in the elderly

OBJECTIVE

Osteoporosis (OS) is a systemic bone disease characterized by low bone mass and bone microstructure damage. This study.

METHODS

According to the T value, 88 elderly fracture patients were grouped as the control group (without OS, 43 cases) and observation group (with T value <-2.5, which could be diagnosed as OS, 45 cases). The content of boney containing protein (BGP), total type 1 collagen amino terminal extender peptide (TPINP), β-Crosslaps (β-CTX), parathyroid hormone (PTH) and insulin-like growth factors-1 (IGF-1) was compared. Multivariate logistic regression was adopted to analyze the correlation between biochemical indexes and the occurrence of senile OS fracture and the related risk factors. The diagnostic value in the elderly was analyzed by receiver operating characteristic (ROC) curve.

RESULTS

The levels of BGP, TPINP, β-CTX, PTH and IGF-1 were elevated, and the level of IGF-1 was decreased in the observation group compared with the control group (P < 0.05). The elevated content of BGP, TPINP, β-CTX and PTH, and the decreased expression of IGF-1 were influencing factors for OS fractures in the elderly (P < 0.05). The sensitivity and specificity to predict the occurrence of OS fractures in the elderly were 91.70% and 90.50%, respectively. The AUC of combined detection was 0.976 (95% CI: 0.952-1.000), which was memorably higher than single indicator detection (P < 0.05). Among 45 patients, 32 cases had good prognosis and 13 had poor prognosis. In comparison with the good prognosis group, the content of BGP, TPINP, β-CTX and PTH were sensibly higher, the level of IGF-1 was prominently lower, and the proportion of fracture history was much higher in poor prognosis group (P < 0.05). Fracture history, BGP, TPINP, β-CTX, PTH and IGF-1 were independent risk factors for poor prognosis of elderly OS fractures (P < 0.05).

CONCLUSION

Bone metabolism factors were associated with poor prognosis of OS in the elderly. The combined detection had higher diagnostic value in calculating the risk of OS fracture in the elderly than single indicator detection.

Predictive value of anthropometric measurements in survival and free walking ability of geriatric hip fractures after surgery

BACKGROUND

We aimed to explore the predictive value of anthropometric measurements in survival and free walking ability of geriatric hip fractures after surgery.

METHODS

Eight common anthropometric measurements, including arm circumference (AC), waist circumference (WC), thigh circumference (TC), calf circumference (CC), biceps skinfold (BS), triceps skinfold (TS), suprailiac skinfold (SIS), and subscapular skinfold (SSS), were included to identify their predictive value in survival and free walking ability of geriatric hip fractures. The results of anthropometric measurements were compared between patients with different outcomes. Cox and logistics models were established to further identify the predictive value of anthropometric measurements.

RESULTS

Comparison among groups indicated that individuals with different outcomes may have significantly different anthropometric measurements. In the Cox analyses based on all individuals, all models proved that the patients with higher AC, as well as CC and BS, may have a lower risk of 1-year mortality. Similarly, in the logistics analysis, AC, CC, and BS were proven to have strong predictive ability for 6-month and 1-year mortality in females and overall individuals. However, the predictive value of the eight common anthropometric measurements in free walking ability is not significant.

CONCLUSION

AC, CC, and BS may have strong predictive ability for 6-month and 1-year mortality in all individuals and females.

The Association between High Preoperative MRI-based Vertebral Bone Quality (VBQ) Score and Titanium Mesh Cage Subsidence after Anterior Cervical Corpectomy and Fusion

OBJECTIVE

Recently, the MRI-based vertebral bone quality (VBQ) score has been shown to correlate with Hounsfeld units (HU) value, dual-energy X-ray absorptiometry (DEXA) T-score and predict osteoporotic fractures. Preoperative cervical HU value is an independent correlative factor for early titanium mesh cage (TMC) subsidence after anterior cervical corpectomy and fusion (ACCF). However, to date the direct association between cervical VBQ score and TMC subsidence has not been studied. This study aims to investigate the predictive effect of cervical VBQ score derived from sagittal non-contrast-enhanced T1-weighted MRI on the early TMC subsidence after ACCF.

METHODS

Patients who underwent one-level ACCF from January 2016 to January 2020 were included. We retrospectively collected baseline data on age, sex, body mass index (BMI), disease type, level of surgery and radiology parameters. The cervical VBQ score was measured using preoperative non-contrast-enhanced T1-weighted MRI. Univariate and multivariate logistic regression analysis were performed to screen the independent risk factors of TMC subsidence. The receiver operating characteristic (ROC) curve and area under curve (AUC) were performed to assess the predictive ability of TMC subsidence based on the cervical VBQ score. Spearman correlation analysis was used to determine the correlations between the cervical VBQ score and TMC subsidence.

RESULTS

A total of 134 patients who underwent one-level ACCF were included in this study, and 46 (34.33%) patients had TMC subsidence. Univariable analyses demonstrated that the age, TMC placement depth and VBQ score were associated with subsidence. The cervical VBQ score in the subsidence group was significantly higher than that in the no subsidence group (3.75 ± 0.45 vs. 3.20 ± 0.42, p < 0.001). The multivariate logistic regression analysis proved that the higher VBQ score (odds ratio[OR] = 13.563, 95% confidence interval [CI] 4.968 - 37.031, p < 0.001) was the only variable that significantly predicted subsidence. Using a VBQ score cutoff value of 3.445, the cervical VBQ score yielded a sensitivity of 69.6% and a specificity of 85.2% with an AUC of 0.810 to differentiate patients with subsidence and with no subsidence.

CONCLUSION

Preoperative higher cervical VBQ score is an independent risk factor for TMC subsidence after ACCF. The cervical VBQ score may be a valuable tool for assisting in distinguishing the presence of TMC subsidence.

Correlation between bone mineral density and bone metabolic markers in postmenopausal women with osteoporotic fractures at different C-terminal telopeptide of type 1 collagen levels: a retrospective analysis study

OBJECTIVE

This study aimed to analyze the correlation between bone mineral density (BMD) and bone resorption markers in postmenopausal women with osteoporosis fractures and identify risk factors for second fractures.

METHODS

This retrospective analysis of 1,239 older women with fractures with a median age of 70 years who attended Shanghai General Hospital from January 2007 to December 2016, included a first fracture group (1,008 cases) and a second fractures group (231 cases). The risk factors for fractures were analyzed by comparing these groups on clinical characteristics, BMD, and bone metabolism markers stratified by quartiles of serum C-terminal telopeptide of type 1 collagen (CTX). Binary logistic regression analysis was used to identify risk factors for second fractures.

RESULTS

In the whole sample, BMD was negatively correlated with age and serum osteocalcin and positively correlated with body mass index (BMI). In women with first fractures, those in the highest quartile of serum CTX had the lowest spine and hip BMD. Second fractures were significantly associated with BMI, lower spine and hip BMD, and higher serum osteocalcin but not CTX. Binary logistic regression analysis showed that high BMI (odds ratio [OR], 1.08 [95% CI, 1.03-1.14]; P = 0.001), low lumbar BMD (OR, 0.24 [95% CI, 0.07-0.82]; P = 0.023), low total hip BMD (OR, 0.05 [95% CI, 0.00-0.88]; P = 0.041), and lack of antiosteoporosis treatment (OR, 2.71 [95% CI, 2.71-4.08]; P < 0.001) were independent risk factors for second fractures.

CONCLUSIONS

In older women with fractures, BMD was significantly lower in women with second fractures than in those with first fractures. Higher levels of serum CTX and osteocalcin, which indicates increased bone resorption, were negatively correlated with BMD. In women with a first fracture, serum CTX higher than 605 pg/mL was negatively correlated with BMD, whereas no correlation was found between different CTX and BMD in women with second fractures. High BMI and low BMD as well as not receiving antiosteoporosis treatment were independent risk factors for second fractures.

Determinant factors of bone health after long-term of Roux-en-Y gastric bypass surgery: A cross-sectional study

OBJECTIVES

The aim of this study was to evaluate bone health and the potential influencing factors of bone metabolism disorders in adults ≥5 y after Roux-en-Y gastric bypass (RYGB) surgery.

METHODS

In this cross-sectional study, patients who were ≥5 y post-RYGB were invited. Bone health considered as bone mineral content (BMC) and bone mineral density (BMD) in this study was assessed by dual x-ray absorptiometry. We also assessed 25-hydroxy-vitamin D concentrations, individual ultraviolet B radiation levels, serum ionized calcium, alkaline phosphatase, parathyroid, anthropometric, and body composition.

RESULTS

The study evaluated 104 adults (90% women; 49.6 ± 9.1 y old; postoperative period 8.7 ± 2.2 y). Lumbar and femoral BMC and BMD were positively correlated to body mass index (BMI), appendicular lean mass (ALM), and negatively to %excess of weight loss (EWL). Femoral BMD was negatively correlated to age, and both femoral BMD and BMC were positively correlated to weekly exposed body part score. Sex, age, BMI, ALM, and weekly exposed body part score explained 35% and 54% of the total variance of femoral BMD and BMC, respectively.

CONCLUSIONS

The present findings suggested that older age, lower BMI, higher %EWL, lower ALM, and lower weekly body part exposure score are important determinants in lowering BMD and BMC parameters in long-term post-bariatric surgery individuals, rather than serum 25-hydroxy-vitamin D and parathyroid.

Cochlear promontory anatomy relevant to development of subendosteal and transpromontory electrodes using 192-section ultra-high resolution temporal bone CT imaging

Objective

To characterize normative adult ranges for cochlear promontory thickness relevant to the development of subendosteal and transpromontory electrodes to rehabilitate various neurotologic disorders.

Patients

Adults (≥18 years).

Intervention

In vivo radiologic assessment using a 192-slice CT scanner (Force-192; Siemens Healthcare) with ultrahigh-resolution scan mode combined and iterative reconstruction.

Main Outcome Measure

Cochlear promontory thickness.

Results

Among 48 included patients (96 ears), the mean (SD) age was 56 (18) years (range 25-94) and included 25 (52%) women. Of that 12 patients (25%) had osteopenia (n = 6) or osteoporosis (n = 6). The mean (SD) body mass index was 28 (5) kg/m2. The mean (SD) promontory thickness for the 96 temporal bones under study was 1.22 (0.24) mm (range 0.55-1.85). There was not a statistically significant association between age and promontory thickness (correlation coefficient .08; p = .44). Promontory thickness was significantly greater for men than women (mean 1.28 vs. 1.17 mm; p = .03) and increased with increasing body mass index (correlation coefficient .30; p = .004). Last, promontory thickness was significantly less for patients with osteopenia or osteoporosis compared with those without these conditions (mean 1.09 vs. 1.27 mm; p = .002).

Conclusions

Cochlear promontory thickness can vary by almost 1.5 mm across patients and is significantly associated with patient sex, body mass index, and comorbid osteopenia/osteoporosis. Subendosteal and transpromontory electrode placement techniques must account for this degree of variability.

Level of Evidence

IV.

Socioeconomic status influences on bone mineral density in American men: findings from NHANES 2011-2020

The association between socioeconomic status (SES) and bone mineral density (BMD) in men remains controversial. We showed that SES was positively associated with BMD in American men. Confounding factors like race/ethnicity and age could affect the association.

INTRODUCTION

Based on the data from the National Health and Nutrition Examination Survey (NHANES), 2011-2020, this article aims to investigate the association of SES (poverty income ratio (PIR) and education level) with the BMD in American men.

METHODS

We evaluated the association of SES with BMD in 4446 men aged ≥ 20 years (mean age, 41.0 ± 13.4 years) from the NHANES 2011-2020. BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine. We used multivariate linear regression models to examine the relationship between SES and total spine BMD, adjusted for a large range of confounding factors.

RESULTS

Compared with other PIR quarters, individuals in the highest quarter of PIR were more likely to be older and white and had fewer smoking or drinking behaviors. After adjusting for race/ethnicity, age, drinking and smoking behavior, body mass index (BMI), total protein, serum calcium, serum uric acid, cholesterol, serum phosphorus, and blood urea nitrogen, PIR was positively correlated with total spine BMD (β = 0.004 95% CI: 0.001-0.007, P = 0.006). Individuals with the highest degree (college degree or above) had a 0.057 g/cm² greater BMD than that of the lowest degree (less than 9th grade) (β = 0.057 95% CI: 0.037-0.077, P < 0.001).

CONCLUSIONS

Our study indicates that SES was positively associated with the lumbar BMD among American men. Clinicians, healthcare providers, and policymakers should consider the unequal SES of men when implementing osteoporosis prevention and treatment strategies.

Body Surface Area (BSA) is a Better Osteoporosis Associated Anthropometric Parameter Than Other Anthropometric Parameters in Elderly Population

Body surface area (BSA) is widely used for adjusting drug dose, while few studies have yet systematically evaluated its association with osteoporosis and compared its advantage with other anthropometric parameters in osteoporotic risk prediction. A total of 10,021 Chinese individuals aged over 65 years were enrolled in our study. Bone mineral density (BMD) was measured, and demographic information was also collected. Pearson correlation analysis, receiver operating characteristic (ROC) curves and predictive analysis were performed to assess the clinical practice of BSA for osteoporosis. BSA had the strongest correlation with BMD (0.544, p &lt; 0.001) compared with conventional anthropometric indices. Besides, BSA had the highest power in osteoporosis prediction, with an area under the curve (AUC) reaching 0.81. After incorporating BSA into the osteoporosis risk prediction model, the AUC improved from 0.82 to 0.83 (p &lt; 0.01). We found BSA provided additional diagnostic value beyond conventional anthropometric information with continuous and category NRIs were 30.40% (p &lt; 0.01) and 3.29% (p &lt; 0.01), respectively, and the IDI was 1.85% (p &lt; 0.01). BSA was positively associated with osteoporosis and showed superior discriminative ability for osteoporosis risk prediction compared with other anthropometric parameters in the Chinese elderly population.

Environmental and personal factors for osteoporosis or osteopenia from a large health check-up database: a retrospective cohort study in Taiwan

Background

Osteoporosis is an important public health issue in aging societies because of its associated morbidity, mortality, and decreased quality of life. The study aims to identify the association of low bone mineral density, including osteoporosis and osteopenia, with environmental and personal factors.

Methods

The data of participants aged ≥ 20 years with multiple visits were obtained from a health check-up database in Taiwan from 2008 to 2016. Multivariable logistic regressions were performed to identify the selected factors associated with low bone mineral density for multiple visit data.

Results

A total of 194,910 participants with 359,943 visits were included in this study. The prevalence of low bone mineral density (BMD) in the study population was 10.6% (n = 20.615). Older women, ever and current smokers (odds ratio (OR) = 1.04 [95% confidence interval (CI) = 1.01, 1.08]), or participants who were underweight (OR = 1.72 [1.64, 1.81]), consumed a vegetarian diet (OR = 1.32 [1.25, 1.39]), or had higher triglyceride levels (OR = 1.04 [1.01, 1.06]) were significantly associated with a higher risk of low BMD. Participants who had higher educational years (OR = 0.43 [0.41, 0.46]), higher physical activity (OR = 0.93 [0.89, 0.97]), appropriate sleep duration and better quality (OR = 0.98 [0.97, 0.99]), dairy intake (≥ 1 slice of yogurt or cheese/week, OR = 0.97 [0.95, 0.99]), higher uric acid (OR = 0.93 [0.91, 0.95]), higher walkability (OR = 0.997 [0.995,0.999]), and higher solar radiation exposure (OR = 0.997 [0.97,0.99]) were significantly associated with a lower risk of low BMD.

Conclusion

Interventions in different directions, such as having better health behaviors, increasing sun exposure, and residing in a highly walkable environment, are beneficial for reducing the risk of low BMD.

Incidence and treatment of intracapsular femoral neck fractures in Germany

INTRODUCTION

Intracapsular femoral neck fractures are one of the most common fractures in Germany. Nevertheless, the epidemiology and treatment modalities are not described comprehensively. For this reason, this study highlights the epidemiology of femoral neck fractures in different age groups and summarizes treatment strategies within the period from 2009 to 2019 based on nationwide data.

MATERIALS AND METHODS

In this retrospective cohort study all cases of intracapsular femoral neck fractures (ICD-10: S72.0) between 2009 and 2019 in Germany were analyzed with regard to epidemiology, incidence and treatment. Operation and procedure classification system (OPS)- codes in combination with intracapsular femoral neck fracture as main diagnosis were taken to investigation. Data was provided by the Federal Statistical Office of Germany (Destatis).

RESULTS

A total of 807,834 intracapsular femoral neck fractures with a mean incidence of 110.0 per 100,000 inhabitants annually was detected within eleven years. In 68.8% of all fractures patients were female. Most patients were older than 70 years (82.4%), and 56.7% were older than 80 years. The overall increase of fracture numbers between 2009 and 2019 was 23.2%. Joint replacement has been most often performed (80.4%). Hemiarthroplasty (56.8%) and total hip arthroplasty (22.8%) were the most common procedures with an increase of 27.1 and 38.6%, respectively. The proportion of cemented hemiarthroplasties was 86.2% while 51.3% of all total hip arthroplasties were totally or partially cemented. Osteosyntheses were mainly conducted using dynamic compression screws (34.0%), conventional screws (31.3%) and nails (22.2%).

CONCLUSION

The incidence of intracapsular femoral neck fractures in Germany has been increasing continuously within the last decade. In particular, patients over 80 years suffered predominantly from this type of fracture. The majority was treated with a joint replacement procedure, mainly cemented hemiarthroplasty.

25-hydroxyvitamin D insufficiency and inflammation increase cardiovascular risk in older people

PURPOSE

The objective of this study was to identify an association between serum levels of 25(OH) D, inflammation and cardiovascular disease risk in older adults.

METHODS

This was a cross-sectional study, with older adults of both sexes, investigating variables on lifestyle, anthropometric assessments (weight, height, waist circumference, BMI), and systemic arterial hypertension (systolic blood pressure, SBP, and diastolic blood pressure DBP), serum levels of 25(OH)D, serum high-sensitive C-reactive protein (hs-CRP), serum lipid profile and fasting blood glucose. Cardiovascular disease risk was assessed using the global risk score for cardiovascular events, the Framingham criteria.

RESULTS

The sample consisted of 124 participants, 50.8% of whom were at high risk for cardiovascular events. Older adults with 25(OH)D insufficiency presented higher levels of blood sugar (p < 0.01), LDL-c (p = 0.03) SBP (p < 0.01) and hs-CRP (p < 0 0.01). When grouped by serum concentrations hs-CRP, it was observed that higher hs-CRP levels were associated with higher blood glucose (p = 0.02), SBP (p = 0.04) and lower HDL-c concentrations (p = 0.02). It was also observed that 25(OH)D insufficiency increased the chance of a high risk for cardiovascular events by 2.8 times (OR = 2.80; p = 0.01), which with high hs-CRP concentrations increased to 4.75 times (OR = 4.75; p < 0.01).

CONCLUSION

Low concentrations of 25(OH)D and the presence of inflammation in older adults are associated with a high risk for cardiovascular diseases.

The Relationship between Body Composition and Bone Mineral Density of Female Workers in A Unit of Tai’an

Objective. To explore the relationship between body composition and bone mineral density (BMD) of female workers in a university of Tai’an. Methods. This study randomly selected 90 female employees in a university of Tai’an. The body composition was monitored by body composition analyzer (inbody770), and the lumbar bone mineral density was monitored by dual energy X-ray absorptiometry (BMD model). The data were analyzed by SPSS 22.0 statistical software. Results. With the increasing of body mass index (BMI), BMD of female lumbar spines 1-4 (L1-4) increased gradually. Spearman correlation analysis showed that BMI, skeletal muscle mass, upper limb muscle mass, trunk muscle mass, lower limb muscle mass, and whole-body phase angle were positively correlated with L1-4BMD. Age was negatively correlated with L1-4BMD. Linear regression analysis showed that age was a negative factor of L1-4BMD, and skeletal muscle mass was a protective factor of abnormal bone mass, especially lower limb muscle mass. Conclusions. Lower limb muscle mass is a protective factor of female BMD. Strengthening physical exercise to improve lower limb muscle mass is conducive to the prevention of female osteoporosis.

Individually tailored nutritional guidance improved dietary intake of older family caregivers: a randomized controlled trial

PURPOSE

Older family caregivers (FCs) are vulnerable to insufficient dietary intake and risk of malnutrition. The aim of this study was to assess the impact of individually tailored nutritional guidance on the dietary intake and nutritional status of older FCs and their care recipients' (CRs') nutritional status.

METHODS

This study was a randomized controlled 6-month nutrition intervention in Eastern Finland. The inclusion criteria for FCs were having a home-living CR aged 65 or above and a valid care allowance. The exclusion criterion was CR receiving end-of-life care at baseline. Participants were randomly assigned to an intervention (FCs n = 63, CRs n = 59) and a control (FCs n = 50, CRs n = 48) group. Individually tailored nutritional guidance targeted to FCs was given to an intervention group by a clinical nutritionist. The main outcomes were dietary intake (3-day food record).

RESULTS

After the 6-month intervention, 63 FCs and 59 CRs in the intervention group and 50 FCs and 48 CRs in the control group were analyzed. In the intervention group of FCs, the intakes of protein, riboflavin, calcium, potassium, phosphorus, and iodine differed significantly (p < 0.05) compared to the control group. In addition, the intake of vitamin D supplementation improved in the intervention group of the FCs and CRs (p < 0.001).

CONCLUSION

Individually tailored nutrition guidance improves the intake levels of crucial nutrients, such as the intake levels of protein, vitamin D, and calcium of the FCs. Further studies are warranted to optimize the methods to improve the nutrition of FCs. Registration number of Clinical Trials: ClinicalTrials.gov NCT04003493 (1 July 2019).