Body composition changes with age have gender-specific impacts on bone mineral density

Causal associations between scapular morphology and shoulder condition estimated with Bayesian statistics

BACKGROUND AND OBJECTIVE

While there is a reported correlation between shoulder condition and scapular morphology, the precise impact of typical anatomical variables remains a subject of ongoing debate. This study aimed to evaluate this causal association, by emphasizing the importance of scientific modeling before statistical analysis.

METHODS

We examined the effect of scapular anatomy on shoulder condition, and conditioning on sex, age, height, and weight. We considered the two most common pathologies: primary osteoarthritis (OA) and cuff tear arthropathy (CTA). We combined the other pathologies into a single category (OTH) and included a control category (CTRL) of adult subjects without pathology. We represented acromion and glenoid morphology by acromion angle (AA), acromion posterior angle (APA), acromion tilt angle (ATA), glenoid inclination angle (GIA), and glenoid version angle (GVA). GVA was negative for posterior orientation. These variables were automatically calculated from CT scans of 396 subjects in the 4 shoulder condition groups by a deep learning model. We applied do-calculus to assess the identifiability of the causal associations and used a multinomial logistic regression Bayesian model to estimate them. To isolate the effect of each anatomical variable on each shoulder condition, we increased it from -2 to 2 z-score while constraining all other variables to their average value, and reported the effect on shoulder condition probability as percentage points (pp) for females and males.

RESULTS

Increasing AA reduced the probability of OA by 44 pp for females and 17 pp for males while increasing the probability of CTA by 36 pp for females and 33 pp for males. Increasing APA raised the probability of OA by 15 pp for females and 4 pp for males and increased the probability of CTA by 12 pp for females and 4 pp for males. Increasing ATA increased the probability of OA by 15 pp for females but decreased it by 25 pp for males, while also raising the probability of CTA by 11 pp for females and 21 pp for males. Increasing GIA decreased the probability of OA by 55 pp for females and 23 pp for males while increasing the probability of CTA by 45 pp for females and 31 pp for males. GVA (more anterior), decreased the probability of OA by 33 pp for females and 63 pp for males. The effects of APA and ATA were less important compared to the other variables. Overall, morphological effects were more pronounced for females than for males, except for GVA's impact on OA.

CONCLUSIONS

We developed a Bayesian causal model to answer interventional questions about the scapular anatomy's effect on shoulder condition. Our results, consistent with clinical knowledge, hold promise for aiding in early pathology detection and optimizing surgical planning within clinical settings.

DXA-Measured Total and Regional Body Composition in Female Athletes with a Physical Impairment

Background/Objectives: In recent years, awareness has been growing regarding the needs of female athletes with physical impairments. Despite the importance from both health and performance perspectives of assessing body composition in this athletic population, there is limited literature focusing on this topic. This study explored whole-body and regional three-compartment body composition in female athletes with a physical impairment to assess the impact of impairment and sex on body composition parameters in this population. Methods: Twenty female athletes with a physical impairment were pair-matched by age with an able-bodied female athlete and a male athlete with a comparable physical impairment. All athletes underwent whole-body scanning with dual-energy X-ray absorptiometry. Results: Female athletes with physical impairments showed body composition changes including higher amounts of fat mass, particularly in the lower body regions. Among athletes with a physical impairment, sex showed an independent effect on whole-body composition, with females showing higher fat mass and lower lean mass and bone mineral content compared with males, especially in the legs. Conclusions: Female athletes with physical impairments had a distinct body composition profile, characterized by sex-specific distribution of body tissue at the regional level. Nutritional and training strategies aimed at optimizing body composition in female athletes with physical impairments should be specifically tailored to meet the needs of this athletic population.

Optimizing number of Raman spectra using an artificial neural network guided Monte Carlo simulation approach to analyze human cortical bone

This study presents a novel methodology for optimizing the number of Raman spectra required per sample for human bone compositional analysis. The methodology integrates Artificial Neural Network (ANN) and Monte Carlo Simulation (MCS). We demonstrate the robustness of ANN in enabling prediction of Raman spectroscopy-based bone quality properties even with limited spectral inputs. The ANN algorithms tailored to individual sex and age groups, which enhance the specificity and accuracy of predictions in bone quality properties. In addition, ANN guided MCS systematically explores the variability and uncertainty inherent in different sample sizes and spectral datasets, leading to the identification of an optimal number of spectra per sample for characterizing human bone tissues. The findings suggest that as low as 2 spectra are sufficient for biochemical analysis of bone, with R2 values between real and predicted values of v1/PO4/Amide I and ∼I1670/I1640 ratios, ranging from 0.60 to 0.89. Our results also suggest that up to 8 spectra could be optimal when balancing other factors. This optimized approach streamlines experimental workflows, reduces data and acquisition costs. Additionally, our study highlights the potential for advancing Raman spectroscopy in bone research through the innovative integration of ANN-guided probabilistic modeling techniques. This research could significantly contribute to the broader landscape of bone quality analyses by establishing a precedent for optimizing the number of Raman spectra with sophisticated computational tools. It also sets a novel platform for future optimization studies in Raman spectroscopy applications in biomedical field.

On the glow of cremated remains: long-lived green photo-luminescence of heat-treated human bones

The long-lived green luminescence of human bone (that has been heated to 600 °C for a short duration) is attributed to a carbon quantum dot material (derived from collagen) encapsulated and protected by an inorganic matrix (derived from bone apatite) and is more intense in dense rigid and crystalline parts of (healthy) human bones. The strong collagen-apatite interaction results (upon decomposition) in a protective inorganic environment of the luminescent centers allowing long-lived triplet-based emission of a carbon (quantum) dot-like material at room temperature, as well as resilience against oxidation between 550 and 650 °C. The graphitic black phase (obtained upon heating around 400 °C) is a precursor to the luminescent carbon-based material, that is strongly interacting with the crystalline inorganic matrix. Human bone samples that have been heated to 600 °C were subjected to steady-state and time-resolved spectroscopy. Excitation-emission matrix (EEM) luminescence spectroscopy revealed a broad range of excitation and emission wavelengths, indicating a heterogeneous system with a broad density of emissive states. The effect of low temperature on the heat-treated bone was studied with Cryogenic Steady State Luminescence Spectroscopy. Cooling the bone to 80 K leads to a slight increase in total emission intensity as well as an intensity increase towards to red part of the spectrum, incompatible with a defect state model displaying luminescent charge recombination in the inorganic matrix. Time-resolved spectroscopy with an Optical Multichannel Analyzer (OMA) and Time Correlated Single Photon Counting (TCSPC) of these samples showed that the decay could be fitted with a multi-exponential decay model as well as with second-order decay kinetics. Confocal Microscopy revealed distinct (plywood type) structures in the bone and high intensity-fast decay areas as well as a spatially heterogeneous distribution of green and (fewer) red emissive species. The use of the ATTO 565 dye aided in bone-structure visualization by chemical adsorption. Conceptually our data interpretation corresponds to previous reports from the material science field on luminescent powders.

Is there a causal relationship between resistin levels and bone mineral density, fracture occurrence? A mendelian randomization study

BACKGROUND

In a great many of observational studies, whether there is a relevance of resistin levels on bone mineral density (BMD) and fracture occurrence has been inconsistently reported, and the causality is unclear.

METHODS

We aim to assess the resistin levels on BMD and fracture occurrence within a Mendelian randomization (MR) analysis. Exposure and outcome data were derived from the Integrative Epidemiology Unit (IEU) Open genome wide association studies (GWAS) database. Screening of instrumental variables (IVs) was performed subject to conditions of relevance, exclusivity, and independence. Inverse variance weighting (IVW) was our primary method for MR analysis based on harmonized data. Weighted median and MR-Egger were chosen to evaluate the robustness of the results of IVW. Simultaneously, heterogeneity and horizontal pleiotropy were also assessed and the direction of potential causality was detected by MR Steiger. Multivariable MR (MVMR) analysis was used to identify whether confounding factors affected the reliability of the results.

RESULTS

After Bonferroni correction, the results showed a suggestively positive causality between resistin levels and total body BMD (TB-BMD) in European populations over the age of 60 [β(95%CI): 0.093(0.021, 0.165), P = 0.011]. The weighted median [β(95%CI): 0.111(0.067, 0.213), P = 0.035] and MR-Egger [β(95%CI): 0.162(0.025, 0.2983), P = 0.040] results demonstrate the robustness of the IVW results. No presence of pleiotropy or heterogeneity was detected between them. MR Steiger supports the causal inference result and MVMR suggests its direct effect.

CONCLUSIONS

In European population older than 60 years, genetically predicted higher levels of resistin were associated with higher TB-BMD. A significant causality between resistin levels on BMD at different sites, fracture in certain parts of the body, and BMD in four different age groups between 0-60 years of age was not found in our study.

Bone Density by Specific Anatomic Location Using Hounsfield Samples of the Lower Extremity: A Multi-center Retrospective Analysis

Understanding bone mineral density and its effects on patient outcomes is a useful tool for lower extremity surgeons. Historically, dual-energy X-ray absorptiometry scans have been the gold standard for quantifying bone mineral density. In this study, we look at an indirect way to measure bone mineral density using Hounsfield units on computed tomography. The aim of this study is to establish normal physiological Hounsfield ranges in specific bones of the foot by analyzing Hounsfield unit measurements and determining associated factors. We hypothesize that there will be a difference in density based on age, sex, and anatomic location. Patient data from January 2010 to January 2020 were retrospectively analyzed from 2 institutions. Nine anatomic locations (calcaneus, talar body, talar head, navicular, cuboid, medial cuneiform, head of first and fifth metatarsal, and base of first proximal phalanx) were measured for bone mineral density averages. In total, 137 patients were evaluated (71 males, 66 females) with an average age of 54 years. Significant differences in density were found between the 9 anatomic locations. Age was confirmed to be a significant covariate with inverse relation to Hounsfield units, p < .001. There were no density differences between sexes at any of the locations, except the talar head, p < .001. This is the first study to our knowledge to establish normal physiological ranges of bone density on computed tomography for specific anatomic locations of the foot. This quantitative approach to bone density and the established effect of age, sex, and location is pivotal for diagnostic and preoperative planning.

Changes in Bone Turnover Markers after Osteoporotic Vertebral Compression Fractures in Males and Females

Background. To explore the normal changes in bone turnover markers (BTMs) and the correlations between the different BTMs after osteoporotic vertebral compression fracture (OVCF). Meanwhile, we explored the related differences that exist between sexes. Methods. A total of 130 OVCF patients were retrospectively reviewed. Using IBM SPSS 19.0 statistical software, the differences in the levels of BTMs and clinical parameters between sexes were assessed using Student’s unpaired $t$ test, and one-way ANOVA was used for the comparison of the three groups of samples. The correlations between P1NP, CTX, and clinical factors were assessed using Pearson’s correlation coefficient. Results. P1NP was 52.15 ng/ml within two weeks in male patients, and the level increased to 96.33 ng/ml after 12 weeks; in female patients, the increase was not as obvious as in male patients. CTX in male patients reached as much as approximately twice the initial value after 12 weeks. However, the situation in female patients was diverse. CTX was 0.58 ng/ml within two weeks and increased to 0.61 ng/ml within 2-12 weeks after the onset of OVCF. Subsequently, CTX decreased suddenly after 12 weeks. The increase in P1NP levels within 2 weeks after OVCF was significantly correlated with the levels of osteocalcin (OC) and bone-specific alkaline phosphatase (BAP). Changes in CTX within 2 weeks after OVCF were considerably related to phosphorus, 25 hydroxyvitamin D (25-OHD), OC, and BAP. Conclusion. The levels of P1NP and CTX increased differently in males and females after OVCF. The levels of OC and BAP were correlated with the levels of P1NP and CTX within 2 weeks of OVCF.

Osteotropic Effect of Parenteral Obesity in Programmed Male Rats Fed a Calorically Differentiated Diet during Growth and Development

Simple Summary

Parental obesity affects skeletal metabolism in offspring. This relationship is called “nutritional programming”. During the weaning period, they are more highly mineralized and mechanically resistant. It was interesting for us whether changing or continuing the feeding of male offspring with a standard or high-energy diet may have different metabolic effects on bone tissue. Our previous studies on females have shown that the beneficial direction of change is the replacement of the standard diet with a high-energy diet; the reduction of the caloric content of food (change from a high-energy to a properly balanced diet) leads to disorders of skeletal growth and development. In males, any change in diet inhibited skeletal development, and the bones were weaker. The most effective was the continuation of high-energy nutrition, which, in males at 49 and 90 days of age, was manifested by stronger bones. This proves that males and females react differently to a change in the caloric content of the diet during the period of growth and development.

Abstract

The experiment was undertaken to assess whether the continuation or change of the parents’ diet affects the previously programmed bone metabolism of the male offspring during its growth and development. A total of 16 male and 32 female Wistar rats were divided into groups and fed a standard (diet S) or high-energy (diet F). After the induction of obesity, the rats from groups S and F, as the parent generation, were used to obtain male offspring, which were kept with their mothers until the weaning day (21 days of age). In our earlier study, we documented the programming effects of the diet used in parents on the skeletal system of offspring measured on the weaning day. Weaned male offspring constitute one control group—parents and offspring fed the S diet. There were three experimental groups, where: parents received diet S and offspring were fed with the F diet; parents were treated with the diet F, while offspring received the S diet; and parents and offspring were fed with the diet F. The analyses were performed at 49 and 90 days of life. After sacrifice, cleaned-off soft tissue femora were assessed using peripheral quantitative computed tomography (pQCT), dual X-ray absorptiometry (DXA), and a three-point bending test. We observed that changing and continuation of nutrition, applied previously in parents, significantly influenced the metabolism of the bone tissue in male offspring, and the osteotropic effects differed, depending on the character of the nutrition modification and age. Additionally, an important conclusion of our study, regarding the previous, is that nutrition modification, affecting the metabolism of bone tissue, also depends on the sex.

Cervical endplate bone density distribution measured by CT osteoabsorptiometry and direct comparison with mechanical properties of the endplate

PURPOSE

Intervertebral device subsidence is one of the complications of anterior cervical discectomy and fusion. The biomechanical properties of vertebral bony endplate may be related to device subsidence. The aim of this study is to measure the cervical endplate bone density distribution using a novel 3D measurement method.

METHODS

Eight human cadaver cervical spines were obtained and levels C3-C7 were dissected and CT scanned. Three-dimensional (3D) CT model was created with the same 3D coordinates of the original DICOM dataset. The regional strength and stiffness of the endplate were determined by indentation testing. The indentation points were recorded by a photograph and the location of the indentation points was projected to the 3D CT model. Three-dimensional coordinates of the indentation point was obtained in the 3D space determined by the DICOM dataset. The area underneath the indentation point was calculated by a trilinear interpolation method directly. Data in HU and correlations with the indentation strength and stiffness were analysed.

RESULTS

A positive correlation was found between HU and strength (r = 0.52) and between HU and stiffness (r = 0.41). Overall, mechanical strength and stiffness and HU in the superior endplate of the caudal vertebra were lower than those in the inferior endplate of the cranial vertebra in the same intervertebral disc.

CONCLUSIONS

The mechanical properties and the HU were found to be significantly correlated, which employed a novel 3D HU measurement method, thus demonstrating potential to predict cervical endplate failure risk in a clinical setting.

Serum resistin levels as predictor of low bone mineral density in postmenopausal women

Resistin, a novel adipokine may play an important role in bone metabolism. The study is designed to discover the association of bone mineral density (BMD) with serum resistin levels, anthropometric measures and to elucidate serum resistin as a predictor of BMD in postmenopausal women. Postmenopausal women (n = 160) were recruited and divided into two groups, non-osteoporotic (n = 70) and osteoporotic (n = 90). BMD was evaluated by DXA scan. High serum resistin levels and low weight are independent contributors to low BMD and can influence BMD at lumbar spine, right femoral neck, right hip, left femoral neck, and left hip in postmenopausal women.

The disparity of measuring bone mineral content using bioimpedance and dual-energy absorptiometry in the context of hyperparathyroidism

Introduction:

Body composition is critical for the evaluation of patients with Chronic Kidney Disease (CKD) and can be obtained from either multifrequency bioelectrical impedance analysis (BIA) or dual-energy absorptiometry (DXA). Although the discrepancy between the results obtained from both methods has already been described, reasons are unknown, and might be related to secondary hyperparathyroidism, which is associated with bone loss.

Methods:

We have evaluated 49 patients (25 males and 24 females): 20 with CKD not on dialysis and 29 on maintenance hemodialysis [18 with severe hyperparathyroidism (HD-SHPT) and 11 submitted to parathyroidectomy (HD-PTX)]. All patients underwent DXA and BIA.

Results:

The median age and body mass index (BMI) were 49 years and 25.6 kg/m², respectively. Patients exhibited low bone mineral content (BMC) measured by DXA, particularly those from the HD-SHPT group. The largest BMC measurement disagreement between DXA and BIA was found in the HD-SHPT group (p=0.004). Factors independently associated with this discrepancy in BMC measurement were serum phosphate (p=0.003) and patient group (p=0.027), even after adjustments for age, BMI, and gender (adjusted r2=0.186). PTX attenuated this difference.

Discussion:

BIA should be interpreted with caution in patients with SHPT due to a loss of accuracy, which can compromise the interpretation of body composition.

Prospective Changes in the Distribution of Movement Behaviors Are Associated With Bone Health in the Elderly According to Variations in their Frailty Levels

Frailty is associated with poor bone health and osteoporosis, and physical activity (PA) is one of the best treatments for both pathologies in older adults. Nonetheless, because daily time is limited, how the time is distributed during the waking hours is critical. The waking hours are spent according to different movement behaviors: sedentary behaviors (SB), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). The aim of this study was to use compositional data analyses to examine the effects of the change in movement behaviors on bone health during aging in older people, related to the changes in their frailty levels. We analyzed 227 older people aged 65 to 94 (125 women and 102 men) over a 4-year period. Movement behaviors were assessed using accelerometry. Both bone mineral density (BMD) and bone mineral content (BMC) were determined using bone densitometry. The Frailty Trait Scale was used to divide the sample by frailty level evolution during aging. The R statistical system was used for the compositional data analysis and, in addition, all models were adjusted for several covariates. The changes in the distribution of all movement behaviors within a waking hour period were significantly associated with spine and femoral neck BMD changes in the subgroup with a positive change in frailty level and spine BMC in the subgroup with no change in frailty level (p ≤ .05). Likewise, MVPA relative to the change in other movement behaviors was also associated in both subgroups with higher BMD and BMC, respectively, in the same body areas (p ≤ .05). No significant associations were found in the negative change in frailty level subgroup. Older people who achieved a positive change in frailty level during a 4-year period showed higher BMD changes compared to those with no changes or increases in their frailty level. Therefore, increasing MVPA relative to the change in the other movement behaviors during a 4-year period could perhaps produce bone health improvements in the elderly that do not worsen their frailty level. © 2020 American Society for Bone and Mineral Research.

Compositional Influence of Movement Behaviors on Bone Health during Aging

INTRODUCTION AND PURPOSE

Physical activity (PA) is considered the best nonpharmacological treatment for the decrease in bone mass (BM) produced during aging. Therefore, it is essential to assess how the time spent in PA is distributed to control further changes. This work examines the relationship between movement behaviors and BM during aging, using compositional data analysis.

METHODS

We studied 227 older people 65 to 94 yr old (102 men and 125 women), divided by sex and bone status, over a period of 4 yr. Time spent in sedentary behavior (SB), light PA (LPA), and moderate to vigorous PA (MVPA), was assessed using accelerometry. BM was determined by dual-energy x-ray absorptiometry.

RESULTS

The changes in MVPA were positively associated with the rate of BM decay at spine and leg in the whole sample and men's subgroup (P ≤ 0.05). In women, the rate of BM decay at spine and Ward's triangle were negatively associated with SB changes, and BM decay at femoral neck and Ward's triangle were positively associated with LPA (P ≤ 0.05).

CONCLUSION

Increasing MVPA related to other movement behaviors produces improvements in the rate of bone change in older men, whereas to increase LPA and maintain MVPA would be the best approach to enhance BM in older women.

Sex-determining region Y (SRY) attributes to gender differences in RANKL expression and incidence of osteoporosis

Receptor activator of nuclear factor κB ligand (RANKL) plays a crucial role in bone metabolism. RANKL gene misregulation has been implicated in several bone and cancer diseases. Here, we aimed to identify novel transcription regulators of RANKL expression. We discovered that transcription factors, sex-determining region Y (SRY) and c-Myb, regulate RANKL expression. We demonstrated that c-Myb increases and male-specific SRY decreases RANKL expression through direct binding to its 5’-proximal promoter. These results are corroborated by the gene expression in human bone samples. In osteoporotic men, expression of RANKL is 17-fold higher, which correlates with the drastically reduced expression (200-fold) of Sry, suggesting that in osteoporotic men, the upregulation of RANKL is caused by a decrease of Sry. In healthy men, the expression of RANKL is 20% higher than that in healthy women. Our data suggest that gender differences in RANKL expression and bone quality could be due to the sex-specific transcription factor SRY.

A male-specific gene offers clues to diagnosis and treatment of age-related osteoporosis. Osteoporosis was known to be linked to higher expression levels of RANKL, a gene that induces bone resorption, but the details were poorly understood. Nika Lovsin at the University of Ljubljana in Slovenia and co-workers searched for the genetic switches that control RANKL levels. They found that SRY, a gene on the male-specific Y chromosome, was a strong repressor of RANKL. In bone samples from osteoporotic men, expression levels of SRY levels were low and those of RANKL were high, suggesting that in men, when SRY fails to keep the bone-resorbing RANKL in check, osteoporosis results. SRY shows promise as an osteoporosis marker in men, or for development of treatment for both genders. Future research could address what triggers decreased SRY expression in men.

Association of body composition with predicted hip bone strength among Chinese postmenopausal women: a longitudinal study

Body composition and bone strength are closely associated. How lean mass (LM) and fat mass (FM) contribute to bone strength remains ambiguous. We investigated the associations of total body LM and FM with changes in predicted hip bone strength over a period of 3 years in 1,743 postmenopausal Chinese women from the communities of Guangzhou, China. The body compositions of the women were obtained with dual-energy X-ray absorptiometry. We used the hip structure analysis program to obtain the bone parameters at the femoral neck region, including the bone mineral density (BMD), cross-sectional area (CSA), cortical thickness (CT), section modulus (SM) and buckling ratio (BR). We found the FM and LM were positive predictors for hip bone strength (β > 0, P < 0.05). The LM had a larger contribution to the BMD, CSA, CT, SM and/or their annual percent changes (βLM > βFM), while the contribution of FM to the BR and its annual percent change was higher than LM (|βFM| > |βLM|). Further analysis found that the associations of FM and LM with bone parameters were stronger in the underweight and normal weight participants (|βBMI1| > |βBMI2|). Overall, FM and LM had positive but differential effects on predicted hip bone strength, with a higher impact in the thinner participants.

Relationships between muscle mass, strength and regional bone mineral density in young men

Purpose

Although the relationship between body composition and bone mineral density (BMD) is well established, the relative contribution of appendicular lean mass (ALM) and fat mass (FM) to BMD has been rarely evaluated in young men.

Methods

We assessed 100 young men (age: 24.4±2.8 years, BMI: 23.4±2.81 kg/m²). Appendicular lean mass index (ALM/H²) (ALMI), fat mass index (FM/ H²) (FMI), percentage of body fat, BMD at lumbar spine (LS), total hip (TH), femoral neck (FN) and whole body (WB) were measured using DXA. Muscle strength was evaluated by handgrip strength. Pearson’s correlations and interactions between all variables were assessed using stepwise regression analyses.

Results

ALM index (ALMI) was positively correlated with BMD at all sites (r = 0.62 for WB p<0.05, r = 0.54 for FN p<0.05, r = 0.64 for TH p<0.05, r = 0.56 for LS p<0.05) whereas FMI was not correlated to BMD values. Stepwise regression analyses showed that ALMI produced a significant and positive influence on BMD (β = 0.07 for WB p<0.001, β = 0.04 for FN p<0.001, β = 0.06 for TH p<0.001). Conversely, FMI was negatively associated with BMD at all sites (β = -0.02 for WB p<0.001, β = - 0.03 for FN p<0.001, β = - 0.03 for TH p<0.001, β = - 0.07 for LS p<0.001). Handgrip strength and BMDs were significantly and positively associated at all sites.

Conclusions

Our data suggest that BMD was positively associated with ALMI while negatively with FMI. We confirm that ALMI is the strongest factor associated with BMD in a population of young men.

Effect of type 2 diabetes mellitus on treatment outcomes of patients with postmenopausal osteoporosis: a retrospective study

Objectives

The aim of this study is to investigate the effect of type 2 diabetes mellitus (T2DM) on the treatment outcomes of patients with postmenopausal osteoporosis (PMOP).

Material and method

Thirty-five patients who had been diagnosed as PMOP by lumbar and/or femoral neck bone mineral density screening (BMD) and who had comorbid T2DM were included in the study. Thirty-five patients who had been diagnosed as PMOP but who had no comorbidity including DM constituted the control group. Demographic features, biochemical parameters, femoral and lumbar T scores were all recorded. All patients were treated with bisphosphonate, calcium and vitamin D and the same parameters were evaluated at the end of the first and fifth year.

Results

Lumbar T scores and serum osteocalcin levels before treatment were significantly lower in the DM + PMOP group (p < 0,05). At the end of 5 years, despite the lumbar T score having increased, the femoral T score was found to be significantly lower in the DM + PMOP group. In the PMOP group, there was significant improvement in the T scores and serum osteocalcin levels following a 5-year treatment period (p < 0,05).

Conclusions

T2DM has unfavorable effects on treatment prognosis in patients with PMOP. Different risk factors of PMOP which differ in the general population maybe more important when evaluating fracture risk in patients wtih T2DM.

Effect of selective serotonin reuptake inhibitors on bone mineral density: a systematic review and meta-analysis

Our work is the first systematic meta-analysis to investigate the effect of selective serotonin reuptake inhibitor (SSRI) medication on bone mineral density. Through meta-analyzed 11 studies, our findings suggested that compared with nonusers, use of SSRIs was significantly associated with lumbar spine BMD reduction, particularly for old people. The use of selective serotonin reuptake inhibitors (SSRIs) has already been associated with bone mass loss. Their effects on bone mineral density (BMD) for the different bone sections have, however, thus been inconsistent. Here, we aim to assess the effects of SSRIs on BMD using a meta-analysis. We searched PubMed, Scopus, ISI Web of Knowledge, the Cochrane Library, and PsycINFO for all English-written studies investigating the effects of SSRIs on BMD and published before November 2017. BMD was compared between non-SSRI users and SSRI users using a random-effect model with standardized mean differences (SMD) and 95% confidence intervals (CIs). Furthermore, subgroup analyses were performed based on study design, age, and sex in order to find the origins of high heterogeneity. Eleven studies met the inclusion criteria and were used for the meta-analysis. Our study demonstrated that the use of SSRIs was significantly associated with lower BMD values (SMD - 0.40; 95% CI - 0.79 to 0.00; p = 0.05) and BMD Z-scores (SMD - 0.28; 95% CI - 0.50 to - 0.05; p = 0.02) of the lumbar spine, but not of the total hip and femoral neck. In addition, SSRI use was associated with a greater bone loss in older people. SSRI use is a risk factor of lower BMD of the lumbar spine, especially for older people. Future studies into the relationship between SSRI use and bone metabolism and bone mass need to be conducted with larger sample sizes for both men and women at different bone sites.

Analysis of the associations among Helicobacter pylori infection, adiponectin, leptin, and 10-year fracture risk using the fracture risk assessment tool: A cross-sectional community-based study

Helicobacter pylori (H. pylori) infection may induce inflammatory cytokines or adipokines that influence bone turnover and bone fracture risk. This study aimed to evaluate the association among H. pylori infection, adipokines, and 10-year fracture risk using the Fracture Risk Assessment Tool scale. From August 2013 to February 2016, a community-based cohort was surveyed by Keelung Chang-Gung Memorial Hospital. Subjects were included if they were older than 40 years and not pregnant. All participants underwent a standardized questionnaire survey, physical examination, urea breath test, and blood tests. A total of 2,689 participants (1,792 women) were included in this cross-sectional study. In both sexes, participants with a high fracture risk were older and had higher adiponectin values than participants without a high fracture risk (mean age, female: 72.9 ± 5.6 vs. 55.8 ± 7.3 years, P < 0.0001; male: 78.9 ± 4.7 vs. 58.1 ± 8.9 years, P < 0.001) (adiponectin, female: 10.8 ± 6.3 vs. 8.7 ± 5.2 ng/ml, P < 0.001; male: 9.7 ± 6.1 vs. 5.5 ± 3.8 ng/ml, P < 0.001). Adiponectin was correlated with high fracture risk in both sexes, but H. pylori infection and leptin was not. In logistic regression analysis, adiponectin could not predict high fracture risk when adjusting the factor of body mass index (BMI) in men group. In conclusion, H. pylori infection and leptin could not predict 10-year fracture risk in either sex. Adiponectin was correlated with bone fracture risk in both sexes and the correlation might be from the influence of BMI.

Cement technique correlates with tuberosity healing in hemiarthroplasty for proximal humeral fracture

BACKGROUND

Tuberosity healing correlates with clinical outcomes after hemiarthroplasty for 4-part proximal humeral fractures (4PHFs). We seek to examine variables that affect tuberosity healing.

METHODS

This was a retrospective comparative study. At 1 year postoperatively, patients who underwent hemiarthroplasty for 4PHFs were divided into 2 groups: those with anatomically healed tuberosities and those with tuberosity nonunion. The primary variables included time between injury and surgery, prosthesis fenestration, cement mantle classification, and both vertical and horizontal tuberosity reduction. Secondary demographic factors included age, gender, osteoporosis status, diabetes status, and smoking status.

RESULTS

There were 84 individuals who met the inclusion criteria: 37 (44%) had anatomically healed tuberosities, and 47 (56%) did not. Individuals with anatomic healing had cement near or under the tuberosities 32% of the time, whereas individuals with nonunion or resorption had cement near the tuberosities 66% of the time (P = .002). There was no association between tuberosity healing and fenestration of the humeral stem (P = .84). Anatomic reduction between tuberosities was associated with healing (P <.001), whereas greater tuberosity-to-head height was not (P = .25). There were no significant differences in age, osteoporosis status, smoking status, diabetes status, or time to surgery between groups. Male patients had nearly double the rate of healing (P = .03).

DISCUSSION AND CONCLUSION

The classification and effect of cement technique on tuberosity healing have not previously been described. We suggest limiting cementation to a minimum of 5 mm below the level of the tuberosity fracture. The ideal candidate for hemiarthroplasty for a 4PHF is a male patient with anatomic tuberosity reduction and limited use of cement.

Influence of High-Fat Diet on Bone Tissue: An Experimental Study in Growing Rats

BACKGROUND

The relationship between obesity and bone tissue remains contradictory, especially when the effect of high-fat diet is assessed in experimental models. The aim of this study was to evaluate the effects of high-fat diet on bone metabolism of growing rats.

METHODS

Twenty weaned female Wistar rats were equally divided into two groups: SD (standard diet) and HFD (high-fat diet with 60 % of energy as fat). After five weeks of the two diets, the rats were euthanized, and the liver, blood and bones extracted. The liver was analysed for malondialdehyde (MDA) and reduced glutathione (GSH) concentrations. Blood was analysed by the ELISA method for osteoprotegerin (OPG) and tumour necrosis factor ligand superfamily member 11 (TNFSF11/RANKL). The bone tissue was analysed by dual-energy X-ray absorptiometry (DXA), mechanical tests, computed microtomography, histological quantitative analysis and scanning electron microscopy. The gene expressions of PPAR-γ Runx-2, RANKL and Cathepsin-K were also evaluated.

RESULTS

HFD caused an increase in the MDA concentration, indicating oxidative stress. It also increased the expression of PPAR-γ, which is the gene that is related to adipocyte differentiation. There was an increase in BMD of the tibia of animals fed with the HFD, but other microstructural and mechanical properties were maintained unaltered. In addition, there were no changes in the gene expressions related to the differentiation of osteoblasts and osteoclasts, as well as no changes to the biochemical markers of bone formation and bone resorption.

CONCLUSION

Liver and gene parameters are changed in response to the HFD. However, although there was an increase in BMD, the microstructure and function of the bone did not change after a 5-week HFD.

Association of Protein Intake with Bone Mineral Density and Bone Mineral Content among Elderly Women: The OSTPRE Fracture Prevention Study

It has been hypothesized that high protein intakes are associated with lower bone mineral content (BMC). Previous studies yield conflicting results and thus far no studies have undertaken the interaction of body mass index (BMI) and physical activity with protein intakes in relation to BMC and bone mineral density (BMD).

OBJECTIVE

To evaluate the associations of dietary total protein (TP), animal protein (AP) and plant protein (PP) intakes with BMC and BMD and their changes. We tested also the interactions of protein intake with, obesity (BMI ≤30 vs. >30 kg/m2) and physical activity level (passive vs. active). Design/ Setting: Prospective cohort study (Osteoporosis Risk-Factor and Fracture-Prevention Study). Participants/measures: At the baseline, 554 women aged 65-72 years filled out a 3-day food record and a questionnaire covering data on lifestyle, physical activity, diseases, and medications. Intervention group received calcium 1000 mg/d and cholecalciferol 800 IU for 3 years. Control group received neither supplementation nor placebo. Bone density was measured at baseline and year 3, using dual energy x-ray absorptiometry. Multivariable regression analyses were conducted to examine the associations between protein intake and BMD and BMC.

RESULTS

In cross-sectional analyses energy-adjusted TP (P≤0·029) and AP (P≤0·045) but not PP (g/d) were negatively associated with femoral neck (FN) BMD and BMC. Women with TP≥1·2 g/kg/body weight (BW) (Ptrend≤0·009) had lower FN, lumbar spine (LS) and total BMD and BMC. In follow-up analysis, TP (g/kg/BW) was inversely associated with LS BMD and LS BMC. The detrimental associations were stronger in women with BMI<30 kg/m2. In active women, TP (g/kg/BW) was positively associated with LS BMD and FN BMC changes.

CONCLUSIONS

This study suggests detrimental associations between protein intake and bone health. However, these negative associations maybe counteracted by BMI>30 kg/m2 and physical activity.

The Association between Trunk Body Composition and Spinal Bone Mineral Density in Korean Males versus Females: a Farmers' Cohort for Agricultural Work-Related Musculoskeletal Disorders (FARM) Study

The purpose of this study was proposed to identify the association of trunk body composition with spinal bone mineral density (BMD) in Korean male and female farmers. A total of 523 Korean farmers (259 males, 44 premenopausal females, and 220 postmenopausal females) were recruited. Computed tomography scans were acquired at the mid-L4 vertebral level, and total trunk muscle mass (TMM, cm³), back muscle mass (BMM), and abdominal wall muscle mass (AMM), total trunk fat mass (TFM), visceral fat mass (VFM), and subcutaneous fat mass (SFM) were assessed. Spinal BMD (g/cm²) was estimated from dual-energy X-ray absorptiometry at the L4 level. In terms of muscle mass, spinal BMD was significantly correlated with all the components of the trunk muscle mass (r = 0.171-0.360; P < 0.05, P < 0.001) in female farmers, while only with AMM (r = 0.181; P < 0.01) in male farmers. In terms of fat mass, spinal BMD was significantly correlated with all components of the trunk fat mass (r = 0.142-0.424; P < 0.05, P < 0.001) in male and premenopausal female farmers, while only with VFM (r = 0.132; P < 0.05) in postmenopausal females. Adjusted multivariate regression analysis showed that AMM in male and post-menopausal female farmers was closely associated with spinal BMD. There may be positive associations between trunk muscle and fat mass and spinal BMD with sexual dimorphism, and abdominal wall muscle mass was an explanatory variable closely related to spinal BMD in Korean farmers. Registered at the Clinical Research Information Service (CRIS, http://cris.nih.go.kr), number KCT0000829.

Association of sarcopenia and physical activity with femur bone mineral density in elderly women

PURPOSE

This study examined the association of femur bone mineral density (BMD) with body composition and physical activity in elderly women.

METHODS

This was a cross sectional study involving 119 women with mean age of 73.1±5.5 years. Body composition parameters including body mass index (BMI), percent of body fat (%BF), appendicular skeletal muscle mass (ASM) index and femur BMD was measured by dual-energy X-ray absorptiometry (DXA). Physical activity was assessed by the uniaxial accelerometer for 7 consecutive days including weekends. Based on femur BMD T-scores, subjects were classified as optimal group, osteopenia group, and osteoporosis group. Based on ASM index, subjects were classified as normal group and sarcopenia group. According to WHO recommendations of physical activity for elderly, the subjects were classified as active group or inactive group. Logistic regression analyses were used to determine the odds ratio (OR) for osteopenia and osteoporosis.

RESULTS

There were linear decreases for body composition parameters including weight (P=.023), BMI (P=.039), lean mass (P=.032), ASM index (P=.007) and physical activity parameters including daily of step (P<.001), low intensity physical activity (P<.001), moderate intensity physical activity (P=.001) across femur BMD levels. Compared to the normal group (OR=1), the sarcopenia group had a significantly higher OR (OR=4.823; P=.042), and the inactive group had a significantly higher OR (OR=5.478; P=.005) having osteopenia and osteoporosis when compared to the active group (OR=1).

CONCLUSION

The findings of this study suggested that physical activity along with a healthy nutrition should be promoted as a preventive strategy against osteopenia and osteoporosis in elderly women.

Osteocalcin as a hormone regulating glucose metabolism

The number of patients with osteoporosis and diabetes is rapidly increasing all over the world. Bone is recently recognized as an endocrine organ. Accumulating evidence has shown that osteocalcin, which is specifically expressed in osteoblasts and secreted into the circulation, regulates glucose homeostasis by stimulating insulin expression in pancreas and adiponectin expression in adipocytes, resulting in improving glucose intolerance. On the other hand, insulin and adiponectin stimulate osteocalcin expression in osteoblasts, suggesting that positive feedforward loops exist among bone, pancreas, and adipose tissue. In addition, recent studies have shown that osteocalcin enhances insulin sensitivity and the differentiation in muscle, while secreted factors from muscle, myokines, regulate bone metabolism. These findings suggest that bone metabolism and glucose metabolism are associated with each other through the action of osteocalcin. In this review, I describe the role of osteocalcin in the interaction among bone, pancreas, brain, adipose tissue, and muscle.

Change in incidence of hip fracture in Gwangju City and Jeonnam Province, Korea, over 20 years

This study determined the incidence of hip fractures in Gwangju city and Jeonnam province of Korea in 2011 and compared it with the rates in the same area in 1991 and 2001.

INTRODUCTION

This study determined the incidence of hip fracture in Gwangju city and Jeonnam province in Korea in 2011 and compared it with the rates in the same area in 1991 and 2001, with the aim of identifying any changes in 2011.

METHODS

Korea Health Insurance Review Agency patient data from Gwangju city and Jeonnam province for the period 2011 January 1 to December 31 was analyzed. All claims and records of patients ≥ 50 years of age with a diagnosis of fracture of the neck of the femur, pertrochanteric fracture, and hip fracture-related surgeries including open reduction and internal fixation, closed reduction and osteosynthesis, total hip replacement, or bipolar hemiarthroplasty were analyzed. Population figures were obtained from the Korea National Statistical Office. Age- and sex-specific annual incidences were calculated. The 2011 data was compared with published data from 1991 to 2001.

RESULTS

There were 1590 hip fractures in 2011, representing a crude incidence of 14.0/10,000. The incidence was 9.7/10,000 in males and 17.5/10,000 in females. The number of hip fractures and fracture incidence was 247 and 3.3/10,000 in 1991 and 1152 and 13.3/10,000 in 2001, respectively. There was a fourfold increase of fracture incidence between 1991 and 2001. Thereafter, the number of fractures increased only by 5.2 %. However, the number of arthroplasties done increased significantly.

CONCLUSIONS

The incidence of fractures increased considerably between 1991 and 2001, with less increase in the ensuing 10 years.

Aged-Related Changes in Body Composition and Association between Body Composition with Bone Mass Density by Body Mass Index in Chinese Han Men over 50-year-old

OBJECTIVES

Aging, body composition, and body mass index (BMI) are important factors in bone mineral density (BMD). Although several studies have investigated the various parameters and factors that differentially influence BMD, the results have been inconsistent. Thus, the primary goal of the present study was to further characterize the relationships of aging, body composition parameters, and BMI with BMD in Chinese Han males older than 50 years.

METHODS

The present study was a retrospective analysis of the body composition, BMI, and BMD of 358 Chinese male outpatients between 50 and 89 years of age that were recruited from our hospital between 2009 and 2011. Qualified subjects were stratified according to age and BMI as follows: 50-59 (n = 35), 60-69 (n = 123), 70-79 (n = 93), and 80-89 (n = 107) years of age and low weight (BMI: < 20 kg/m2; n = 21), medium weight (20 ≤ BMI < 24 kg/m2; n = 118), overweight (24 ≤ BMI < 28 kg/m2; n = 178), and obese (BMI ≥ 28 kg/m2; n = 41). Dual-energy X-ray absorptiometry (DEXA) was used to assess bone mineral content (BMC), lean mass (LM), fat mass (FM), fat-free mass (FFM), lumbar spine (L1-L4) BMD, femoral neck BMD, and total hip BMD. Additionally, the FM index (FMI; FM/height2), LM index (LMI; LM/height2), FFM index (FFMI; [BMC+LM]/height2), percentage of BMC (%BMC; BMC/[BMC+FM+LM] × 100%), percentage of FM (%FM; FM/[BMC+FM+LM] × 100%), and percentage of LM (%LM; LM/(BMC+FM+LM) × 100%) were calculated. Osteopenia or osteoporosis was identified using the criteria and T-score of the World Health Organization.

RESULTS

Although there were no significant differences in BMI among the age groups, there was a significant decline in height and weight according to age (p < 0.0001 and p = 0.0002, respectively). The LMI and FFMI also declined with age (both p < 0.0001) whereas the FMI exhibited a significant increase that peaked in the 80-89-years group (p = 0.0145). Although the absolute values of BMC and LM declined with age (p = 0.0031 and p < 0.0001, respectively), there was no significant difference in FM. In terms of body composition, there were no significant differences in %BMC but there was an increase in %FM (p < 0.0001) and a decrease in %LM (p < 0.0001) with age. The femoral neck and total hip BMD significantly declined with age (p < 0.0001 and p = 0.0027, respectively) but there were no differences in L1-L4. BMD increased at all sites (all p < 0.01) as BMI increased but there were declines in the detection rates of osteoporosis and osteopenia (both p < 0.001). A logistic regression revealed that when the medium weight group was given a BMI value of 1, a decline in BMI was an independent risk factor of osteoporosis or osteopenia, while an increase in BMI was a protective factor for BMD. At the same time, BMD in L1-L4 exhibited a significant positive association with FMI (p = 0.0003) and the femoral neck and total hip BMDs had significant positive associations with FFMI and LMI, respectively (both p < 0.0001).

CONCLUSIONS

These data indicate that LMI and FFMI exhibited significant negative associations with aging in Chinese Han males older than 50 years, whereas FMI had a positive association. BMD in the femoral neck and total hip declined with age but an increased BMI was protective for BMD. LMI and FFMI were protective for BMD in the femoral neck and total hip.

(Patho)physiology of cross-sex hormone administration to transsexual people: the potential impact of male-female genetic differences

There is a limited body of knowledge of desired and undesired effects of cross-sex hormones in transsexual people. Little attention has been given to the fact that chromosomal configurations, 46,XY in male-to-female transsexuals subjects (MtoF) and 46,XX in female-to-male transsexual subjects (FtoM), obviously, remain unchanged. These differences in their genomes cause sex differences in the functions of cells. This study reviews sex differences in metabolism/cardiovascular pathology, immune mechanisms, bone (patho)physiology and brain functions and examines whether they are, maybe partially, determined by genetic mechanisms rather than by (cross-sex) hormones. There do not appear to be major genetic impacts on the changes in bone physiology. Also immune functions are rather unaffected and the evidence for an increase of autoimmune disease in MtoF is preliminary. Brain functions of transsexuals may have differed from controls before cross-sex hormones; they do undergo shifts upon cross-sex hormone treatment, but there is no evidence for changes in sex-specific brain disease. The prevalence of cardiovascular disease is higher in MtoF receiving oestrogens than in FtoM receiving androgens. While type of oestrogen and route of administration might be significant, it is reasonable to speculate that nonhormonal/genetic factors play a role.

Associations between fat distribution and volumetric bone mineral density in Chinese adults

The aim of this study was to explore the association between fat distribution and volumetric bone mineral density (vBMD) in Chinese Adults. Using a cross-sectional investigation of 867 participants including 521 women and 346 men from China, vBMD and subcutaneous adipose tissue (SCAT) or visceral adipose tissue (VAT) were measured accordingly by quantitative computed tomography. The peak vBMD values of the spine were observed at ages 30-39 years in women and at ages 20-29 years in men. In women, the peak values of VAT and SCAT were observed, respectively, at ages ≥ 70 years and at the age range of 60-69 years. In men, the peak values of VAT and SCAT were observed, respectively, at ages ≥ 70 years and at ages 30-39 years. Using the correlation tests, there was no correlation between SCAT and vBMD in both genders. Most relationships between VAT and BMD were negative (r = -0.204, P < 0.01, in premenopausal women; r = -0.150, P < 0.05, in postmenopausal women; and r = -0.181, P < 0.05, in middle-aged men). After multiple linear regression analysis, no correlations were observed. There appears to be no correlation between fat distribution and vBMD in Chinese adults, and further studies are needed to explore associations between fat distribution and vBMD.

The relationship between body fat and bone mineral density in Korean men and women

Previous studies of the effects of body fat on bone mineral density (BMD) have shown conflicting results depending on the age, sex, and menopausal status of the subjects. The purpose of the present study was to investigate the effects of body fat on BMD using data from the Fifth Korea National Health and Nutrition Examination Survey, which was conducted in 2010. Our data were drawn from a relevant population within the survey's range of participants, yielding a total of 4,138 subjects aged 20-93 years (1,133 men <50 years, 946 men ≥ 50 years, 1,332 premenopausal women, and 727 postmenopausal women). Percent body fat, fat mass (FM), lean mass (LM), and BMD of the total hip, lumbar spine, and arm were measured in the original survey using dual-energy X-ray absorptiometry. Relationships between FM and BMD were evaluated using multiple linear regression analyses. LM was the strongest determinant of BMD. Although FM also showed a significant positive correlation, even after adjusting for LM, with total hip and lumbar spine BMD in men ≥ 50 years and pre- and postmenopausal women, this positive correlation was not observed in the arm. In an analysis of obese and non-obese subgroups, the positive correlation between FM and BMD disappeared in obese subjects. Furthermore, FM and BMD exhibited a negative correlation in premenopausal obese women. These results suggest that FM contributes to BMD primarily through mechanical loading. FM, then, is not beneficial and may be detrimental to bone health in obese people.

Relationships between serum omentin-1, body fat mass and bone mineral density in healthy Chinese male adults in Changsha area

PURPOSE

The present study is firstly designed to identify the relationship between serum omentin-1 concentration, body fat mass and bone mineral density in healthy Chinese male adults in Changsha city.

METHODS

A total of 219 (20-80 years old) healthy subjects were enrolled in this cross-sectional study. Serum omentin-1, adiponectin, leptin, resistin and bone turn over biochemical markers were measured with enzyme-linked immunosorbent assay. Bone mineral density (BMD) and fat body composition were determined using dual-energy-X-ray absorptiometry.

RESULTS

Serum omentin-1 levels in the overweight subjects were significantly lower than those of the subjects with normal weight (p < 0.05). Omentin-1 was negatively correlated with weight (r = -0.418), body mass index (BMI, r = -0.419), waist circumference (r = -0.402), waist-to-hip ratio (WHR, r = -0.355), fat body mass (FBM, r = -0.430), fat % (r = -0.408), trunk fat (-0.431). However, after controlling for age, BMI and FBM, no significant correlation was noticed between omentin-1 and BMD at different skeletal sites. Pearson's correlation coefficients and partial correlation coefficients after adjustment showed no significant correlations between omentin-1 and bone turn over biochemical markers, including bone-specific alkaline phosphatase and bone cross-linked N-terminal telopeptides of type I collagen. Multiple line stepwise regression analysis revealed that FBM, WHR, adiponectin were important variables affecting omentin-1. Moreover, lean tissue mass was the most important factor affecting BMD and explained 10.5-14.7 % of the variance. Omentin-1, leptin and resistin were not the predictors of BMD.

CONCLUSIONS

Serum omentin-1 was negatively correlated with FBM and BMI in healthy Chinese male adults, It was not significantly correlated with bone turnover biochemical markers. Omentin-1 may exert ambiguous effects on BMD, which maybe caused by the complex interactions among adipokines, hormonal activity, and body composition and bone metabolism.

Relationship of lean body mass with bone mass and bone mineral density in the general Korean population

We investigated association of lean body mass with bone mass (BM) and bone mineral density (BMD) according to gender and menopausal status in the general Korean population. Participants included 4,299 males and 5,226 females who were 20 years of age or older from the fourth and fifth Korea National Health and Nutritional Examination Surveys (2009-2010). Dual-energy X-ray absorptiometry was used for measurement of BMD and body composition. BMD was measured in the femur and lumbar spine. Appendicular skeletal muscle mass (ASM) was defined as the sum of the lean soft tissue masses for the arms and legs. Analysis was performed after categorizing participants into four groups (males <50 years, males ≥ 50 years, premenopausal females, and postmenopausal females). In males, the highest ASM was observed in the 20-29-year group and then showed a gradual decrease as age increased, and BM and BMD showed similar patterns of change, while in females, ASM, BMD, and BM reached the peak level in the 40-49-year group and then decreased. In multiple regression analysis, after adjusting for confounding factors, the results showed an independent association of ASM with an increase in BM and BMD (P < 0.05). After adjusting for confounding factors, total fat mass showed a significant association with BM (P < 0.05). These aforementioned relationships were commonly observed on both femur and lumbar spine in every group. Lean body mass showed an independent association with increased BM and BMD, regardless of gender, age in men, and menopausal status in women.

Relationships between serum adipocyte hormones (adiponectin, leptin, resistin), bone mineral density and bone metabolic markers in osteoporosis patients

The purpose of this study was to investigate the relationship between fasting serum leptin, adiponectin and resistin levels and bone mineral density (BMD) in osteoporosis patients and a non-osteoporosis control group. We studied 81 non-diabetic osteoporosis patients (92 % female, 8 % male; mean age 54.5 ± 15.5 years and body mass index [BMI] 28.2 ± 4.6) and 120 non-diabetic individuals with normal BMD as controls (86 % female, 14 % male; mean age 39.7 ± 10.4 years and BMI 28.8 ± 4.4). BMD was studied by dual-energy X-ray absorptiometry from the lumbar spine (L1-L4) and femoral neck and fasting blood samples were taken for biochemical measurement of fasting blood glucose, leptin, adiponectin and resistin. Fasting levels of plasma adiponectin had a significant negative correlation with BMD of the femoral neck and lumbar spine in the osteoporosis group (r = -0.478, P = 0.003, r = -0.513, P = 0.023) but not in the non-osteoporosis group (r = -0.158, P = 0.057, r = -0.23, P = 0.465). Fasting plasma levels of resistin were significantly correlated only with femur BMD in the osteoporosis group, and not significantly correlated with lumbar spine BMD (r = -0.244, P = 0.048 vs r = 0.276, P = 0.56). Leptin did not have a significant correlation with BMD in either the osteoporosis or non-osteoporosis groups (P > 0.05). Adiponectin had a significant negative correlation with BMD of the lumbar spine and femoral neck. The correlation between leptin and resistin are not inconclusive.

Bone metabolism and adipokines: are there perspectives for bone diseases drug discovery?

INTRODUCTION

Over the past 20 years, the idea that white adipose tissue (WAT) is simply an energy depot organ has been radically changed. Indeed, present understanding suggests WAT to be an endocrine organ capable of producing and secreting a wide variety of proteins termed adipokines. These adipokines appear to be relevant factors involved in a number of different functions, including metabolism, immune response, inflammation and bone metabolism.

AREAS COVERED

In this review, the authors focus on the effects of several adipose tissue-derived factors in bone pathophysiology. They also consider how the modification of the adipokine network could potentially lead to promising treatment options for bone diseases.

EXPERT OPINION

There are currently substantial developments being made in the understanding of the interplay between bone metabolism and the metabolic system. These insights could potentially lead to the development of new treatment strategies and interventions with the aim of successful outcomes in many people affected by bone disorders. Specifically, future research should look into the intimate mechanisms regulating peripheral and central activity of adipokines as it has potential for novel drug discovery.

Gender-specific associations between physical functioning, bone quality, and fracture risk in older people

The aim of this study was to investigate which parameters of physical functioning are associated with bone quality and fracture risk and whether gender-specific differences exist within these associations. We studied 1,486 participants of the Longitudinal Aging Study Amsterdam. As measures of physical functioning, handgrip strength, physical performance, and level of physical activity were assessed. To assess bone quality, broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured at baseline using quantitative ultrasound and bone mineral density (BMD) at baseline and after 3 years by dual-energy X-ray absorptiometry. In addition, fracture incidence over 6 years was assessed. After adjustment for confounders (age, serum 25[OH]D, smoking, and body weight), in men, physical performance was positively related to BUA, SOS, and BMD cross-sectionally and to BMD longitudinally. Using Cox proportional hazards model, in men higher handgrip strength and physical performance were associated with reduced fracture risk after adjustment for confounders (hazard ratio [HR] 0.96, 95 % confidence interval [CI] 0.92-0.99, and HR 0.89, 95 % CI 0.80-0.98, respectively). In women, a moderate level of physical activity was related to reduced fracture risk (HR 0.57, 95 % CI 0.33-0.99). In conclusion, in men, higher handgrip strength and physical performance are related to higher bone quality and reduced fracture risk, whereas in women, a moderate to high level of physical activity is associated with reduced fracture risk. These measurements may contribute to the identification of individuals at high fracture risk. Both the causality of and explanations for gender-specific differences in these relationships remain subject to further studies.

The effect of gonadal status on body composition and bone mineral density in transfusion-dependent thalassemia

Patients with transfusion-dependent thalassemia have abnormal growth, hormonal deficits, and increased bone loss. We investigated the relationship between skeletal muscle mass, fat mass, and bone mineral density in adult subjects with transfusion-dependent thalassemia based on their gonadal status. Our findings show that hypogonadism attenuates the strength of the muscle-bone relationship in males but strengthens the positive correlation of skeletal muscle mass and fat mass in female subjects.

INTRODUCTION

Transfusion-dependent thalassemia is associated with a high prevalence of fractures. Multiple hormonal complications, in particular hypogonadism, can lead to changes in body composition and bone mineral density (BMD). We investigated for the first time the relationship between skeletal muscle mass (SMM), fat mass, and BMD in adult subjects with transfusion-dependent thalassemia based on their gonadal status.

METHODS

A retrospective cohort study of 186 adults with transfusion-dependent thalassemia was analyzed. Body composition and BMD were measured using dual energy X-ray absorptiometry. The association between skeletal muscle, fat, and BMD was investigated through uni-, multi-, and stepwise regression analyses after adjusting for multicollinearity. SMM was derived using the formula, SMM = 1.19 × ALST-1.65, where ALST is equivalent to the sum of both arm and leg lean tissue mass.

RESULTS

There were 186 subjects, males (43.5 %) and females (56.5 %), with a median age of 36.5. Hypogonadism was reported in 44.4 % of males and 44.7 % of females. SMM and BMD were positively correlated and strongest in eugonadal males (0.36 ≤ R (2) ≤ 0.59), but the association was attenuated in hypogonadal males. SMM (0.27 ≤ R (2) ≤ 0.69) and total fat mass (0.26 ≤ R (2) ≤ 0.55) were positively correlated with BMD in hypogonadal females, but the correlation was less pronounced in eugonadal females. Leg lean tissue mass and arm lean tissue mass in males and females, respectively, were most highly correlated to BMD in the stepwise regression analysis.

CONCLUSION

Hypogonadism attenuates the strength of the muscle-bone relationship in males but strengthens the positive correlation of skeletal muscle mass and fat mass in female subjects. This study supports the notion that exercise is important for maintaining BMD and the need to optimize treatment of hypogonadism in patients with transfusion-dependent thalassemia.

A path model of sarcopenia on bone mass loss in elderly subjects

OBJECTIVE

Aging is associated with decreases in muscle mass, strength, power (sarcopenia) and bone mineral density (BMD). The aims of this study were to investigate in elderly the role of sarcopenia on BMD loss by a path model, including adiposity, inflammation, and malnutrition associations.

METHODS

Body composition and BMD were measured by dual X-ray absorptiometry in 159 elderly subjects (52 male/107 female; mean age 80.3 yrs). Muscle strength was determined with dynamometer. Serum albumin and PCR were also assessed. Structural equations examined the effect of sarcopenia (measured by Relative Skeletal Muscle Mass, Total Muscle Mass, Handgrip, Muscle Quality Score) on osteoporosis (measured by Vertebral and Femoral T-scores) in a latent variable model including adiposity (measured by Total Fat Mass, BMI, Ginoid/Android Fat), inflammation (PCR), and malnutrition (serum albumin).

RESULTS

The sarcopenia assumed a role of moderator in the adiposity-osteoporosis relationship. Specifically, increasing the sarcopenia, the relationship adiposity-osteoporosis (β: -0.58) decrease in intensity. Adiposity also influences sarcopenia (β: -0.18). Malnutrition affects the inflammatory and the adiposity states (β: +0.61, and β: -0.30, respectively), while not influencing the sarcopenia. Thus, adiposity has a role as a mediator of the effect of malnutrition on both sarcopenia and osteoporosis. Malnutrition decreases adiposity; decreasing adiposity, in turn, increase the sarcopenia and osteoporosis.

CONCLUSIONS

This study suggests such as in a group of elderly sarcopenia affects the link between adiposity and BMD, but not have a pure independent effect on osteoporosis.

Age-related changes in body composition and their relationship with bone mineral density decreasing rates in central south Chinese postmenopausal women

The purpose of this work is to investigate the age-related changes in body composition and their relationship with bone mineral density decreasing rates (BDR) in central south Chinese postmenopausal women. BDR is the percentage of bone mineral density (BMD) decreasing value relative to the peak bone mass. A cross-sectional study was conducted on 779 healthy postmenopausal women, aged 50-77. Lumbar spine, total hip, and femoral neck BMD and body composition were measured by dual-energy X-ray absorptiometry. In women under 65, lean mass levels showed a stable downward trend, and were significantly higher than those of the 65-70 and >70 age groups; however, the fat mass levels showed no significant difference between the age groups. After controlling for age, age at menopause, and height, both fat mass and lean mass positively correlated with BDR at the lumbar1-4 spine, the femoral neck and the total hip. When BDR at the lumbar1-4 spine was used as the dependent variable, a higher R (2) change and partial R (2) were seen in fat mass than the age, age at menopause or lean mass, indicating that fat mass was the most significant determinant of BDR at this site. When BDR at the femoral neck or total hip was used as the dependent variable, respectively, lean mass was a more significant determinant than that of fat mass. We found that with advancing age, lean mass begins to decrease in women aged over 65 years, but fat mass levels show no significant difference between the age groups. Both fat mass and lean mass positively correlate with BDR, with site-specific differences. Fat mass is the most significant determinant of BDR at the lumbar spine, whereas lean mass is the most significant determinant of BDR at the femoral neck and total hip.

Effect of fat mass and lean mass on bone mineral density in postmenopausal and perimenopausal Thai women

BACKGROUND

The purpose of this study was to investigate the association between fat mass, lean mass, and bone mineral density (BMD) in postmenopausal and perimenopausal Thai women.

METHODS

A cross-sectional study was conducted in 1579 healthy Thai women aged 40-90 years. Total body, lumbar spine, total femur, and femoral neck BMD and body composition were measured by dual x-ray absorptiometry. To evaluate the associations between fat mass and lean mass and various measures of BMD, multivariable linear regression models were used to estimate the regression coefficients for fat mass and lean mass, first in separate equations and then with both fat mass and lean mass in the same equation.

RESULTS

Among the study population, 1448 subjects (91.7%) were postmenopausal and 131 (8.3%) were perimenopausal. In postmenopausal women, after controlling for age, height, and duration of menopause, both fat mass and lean mass were positively correlated with BMD when they were analyzed independently of each other. When included in the same equation, both fat mass and lean mass continued to show a positive effect, but lean mass had a significantly greater impact on BMD than fat mass at all regions except for total body. Lean mass but not fat mass had a positive effect on BMD at all skeletal sites except the lumbar spine, after controlling for age and height in perimenopausal women.

CONCLUSION

Lean mass had a significant beneficial effect on BMD in both postmenopausal and perimenopausal women and can be considered as one of the determinants of bone mass. The effect of the fat mass was related to menopausal status, but only demonstrated a positive impact in perimenopausal women.

Grip strength is a predictor of bone mineral density among adolescent combat sport athletes

The aim of this study was firstly to investigate the correlation between bone parameters and grip strength (GS) in hands, explosive legs power (ELP), and hormonal parameters; second, to identify the most determinant variables of bone mineral density (BMD) among adolescent combat sport athletes. Fifty combat sport athletes aged 17.1 ± 0.2 year were compared with 30 sedentary subjects matched for age, height, and pubertal stage. For all subjects, the BMD in deferent sites associated with anthropometric parameters were measured by dual-energy X-ray absorptiometry. The growth hormone (GH) and testosterone (TESTO) concentrations were tested. The GS in dominant (GSDA) and nondominant arms (GSNDA) and ELP were evaluated. All BMD measured were greater in athletes than in sedentary group (p<0.01). The GS and ELP showed higher values in athletes than in sedentary group (p<0.01). The BMD in all sites were correlated with weight, but without correlation with height. The GSNDA and ELP were significantly correlated with BMD of both spine and legs. The GH was correlated with the BMD of whole body and spine (p<0.05). The TESTO was only correlated with BMD of the arms (p<0.01). The best predictor of BMD measurements is GSNDA. This study has proved the osteogenic effect of combat sports practice, especially judo and karate kyokushinkai. Therefore, children and adolescent should be encouraged to participate in combat sport. Moreover, it suggested that the best model predicting BMD in different sites among adolescent combat sports athletes was the GSNDA.

Muscle strength and body composition are clinical indicators of osteoporosis

We examined the role of muscle strength, lean tissue distribution, and overall body composition as indicators of osteoporosis (OP) in a pooled sample of 979 Finnish postmenopausal women (mean age 68.1 years) from the Kuopio Osteoporosis Risk Factor and Prevention study. Bone mineral density (BMD) at the femoral neck (FN) and total body composition were assessed by dual-energy X-ray absorptiometry scans. The women (n = 979) were divided into three groups according to WHO criteria, based on FN BMD T score: normal (n = 474), osteopenia (n = 468), and OP (n = 37). Soft tissue proportions, fat mass index (FMI, fat/height²), lean mass index (LMI, lean/height²), and appendicular skeletal muscle mass (ASM, (arms + legs)/height²) were calculated. Handgrip and knee extension strength measurements were made. OP subjects had significantly smaller LMI (p = 0.001), ASM (p = 0.001), grip strength (p < 0.0001), and knee extension strength (p < 0.05) but not FMI (p > 0.05) compared to other subjects. Grip and knee extension strength were 19 and 16 % weaker in OP women compared to others, respectively. The area under the receiver operating characteristic curve was 69 % for grip and 71 % for knee extension strength. In tissue proportions only LMI showed predictive power (63 %, p = 0.016). An overall linear association of LMI (R² = 0.007, p = 0.01) and FMI (R² = 0.028, p < 0.001) with FN BMD remained significant. In the multivariate model, after adjusting for age, grip strength, leg extension strength, FMI, LMI, number of medications, alcohol consumption, current smoking, dietary calcium intake, and hormone therapy, grip strength (adjusted OR = 0.899, 95 % CI 0.84-0.97, p < 0.01), leg extension strength (OR = 0.998, 95 % CI 0.99-1, p < 0.05), and years of hormone therapy (OR = 0.905, 95 % CI 0.82-1, p < 0.05) remained as significant determinants of OP. Muscle strength tests, especially grip strength, serve as an independent and useful tool for postmenopausal OP risk assessment. In addition, lean mass contributes to OP in this age group. Muscle strength and lean mass should be considered separately since both are independently associated with postmenopausal BMD.

Soft tissue composition and the risk of low bone mineral density: the Fourth Korea National Health And Nutrition Examination Survey (KNHANES IV-3), 2009

The effects of total fat mass (FM) and total lean mass (LM) on total bone mineral density (BMD) were examined using the Fourth Korea National Health and Nutrition Examination Survey, 2009. FM, LM, and BMD were measured by DXA in a population-based sample of 6,762 Koreans, aged 19-93 (1,613 men < 50 years, 1,400 men ≥ 50 years, 2,120 premenopausal women, and 1,629 postmenopausal women). After adjusting for confounders (age, height, education, economic status, physical activity, smoking, alcohol use, serum vitamin D, medical history [diabetes, dyslipidemia, rheumatoid arthritis, and osteoporosis], family history of osteoporosis, multivitamin use, dietary intake [energy, calcium, and sodium], age at menarche, age at menopause, and hormone replacement therapy) and FM, higher LM was associated with a lower odds ratio for being in the group-specific lowest quintile of BMD (low BMD) in all groups. The odds for low BMD increased with higher FM in multivariate-adjusted analyses in men < 50 years, but this was not significant in other groups. Total BMD decreased with a decrease in the LM quintile across all FM subgroups in men of all ages, in the lower two subgroups of FM quintile in premenopausal women, and in the middle subgroup of FM quintile in postmenopausal women. In conclusion, higher LM was associated with a lower risk of low BMD in both genders, while higher FM was associated with a higher risk of low BMD for men < 50 years but not for women and men ≥ 50 years. The combined effects of LM and FM on BMD were gender- and menopause status-specific.

Effect of age and disease on bone mass in Japanese patients with schizophrenia

BACKGROUND

There have been a limited number of studies comparing bone mass between patients with schizophrenia and the general population. The aim of this study was to compare the bone mass of schizophrenia patients with that of healthy subjects in Japan.

METHODS

We recruited patients (n = 362), aged 48.8 ± 15.4 (mean ± SD) years who were diagnosed with schizophrenia or schizoaffective disorder based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Bone mass was measured using quantitative ultrasound densitometry of the calcaneus. The osteosono-assessment index (OSI) was calculated as a function of the speed of sound and the transmission index. For comparative analysis, OSI data from 832 adults who participated in the Iwaki Health Promotion Project 2009 was used as representative of the general community.

RESULTS

Mean OSI values among male schizophrenic patients were lower than those in the general population in the case of individuals aged 40 and older. In females, mean OSI values among schizophrenic patients were lower than those in the general community in those aged 60 and older. In an analysis using the general linear model, a significant interaction was observed between subject groups and age in males.

CONCLUSIONS

Older schizophrenic patients exhibit lower bone mass than that observed in the general population. Our data also demonstrate gender and group differences among schizophrenic patients and controls with regard to changes in bone mass associated with aging. These results indicate that intervention programs designed to delay or prevent decreased bone mass in schizophrenic patients might be tailored according to gender.

Dietary pattern and bone density changes in elderly women: a longitudinal study

OBJECTIVE

Few data are available on the effect of the diet in general on bone health. The objective of this study was to identify dietary patterns and to evaluate the association between such patterns and bone mineral density (BMD) changes over time.

METHODS

We analyzed a sample of women aged ≥65 years participating in the InCHIANTI Study. BMD was evaluated using computed tomography of the tibia and nutritional intake using the EPIC questionnaire. We used a cluster analysis to identify patterns of dietary intake. The clusters were compared with respect to nutritional intake; risk factors for osteoporosis; comorbidity; total, trabecular, and cortical BMD; and BMD changes over 6 years.

RESULTS

The sample size was 434, with a mean age of 75.2 years (SD, 7.01 years; range, 65-94 years). Based on dietary variables, 2 clusters were identified with a marked difference in energy intake (30 kcal/kg of ideal body weight [IBW] in cluster 1 vs 44 kcal/kg IBW in cluster 2). We found no meaningful differences between clusters with regard to nondietary risk factors for osteoporosis, BMD measured at baseline, and changes in BMD over the 6-year follow-up; cluster 2 showed a greater increase in cortical BMD (+30.2 mg/cm(3) vs +16.7 mg/cm(3)). Members of cluster 2 were less likely to have a lower cortical BMD increase (adjusted odds ratio, 0.452; 95% confidence interval, 0.215-0.950).

CONCLUSIONS

Cortical BMD increases more in participants eating a diet exceeding the RDA for macronutrients. Cortical BMD may be more sensitive to diet and dietary interventions than trabecular bone.

Leptin, fat mass, and bone mineral density in healthy pre- and postmenopausal women

The purpose was to examine relationships between age, fat mass, and bone mineral density (BMD) with resting leptin levels in premenopausal and postmenopausal women. Young (aged 18-30 yr, n=30) and estrogen-deficient postmenopausal (aged 55-75 yr, n=43) women were recruited. Total body and segmental fat mass and bone-free lean body mass (BFLBM) and total body, lumbar spine, and proximal femur BMD were assessed using dual-energy X-ray absorptiometry. Serum-resting, fasted leptin levels were measured by Immunoradiometric Assay (IRMA), and leptin-to-fat mass ratios were calculated. Young and older women had similar amounts of BFLBM, but older women had greater (p<0.05) amounts of fat mass and 35% higher leptin levels. Age differences in leptin concentrations were no longer significant after controlling for fat mass. Older women had significantly (p<0.05) lower hip BMD values. Age was negatively related (r=-0.29, p<0.05) to leptin:trunk fat ratio. Increases in fat mass, not menopause per se, contributes to higher leptin levels in older women. Relationships between leptin and BMD may be age dependent.