Physical tests for patient selection for bone mineral density measurements in postmenopausal women

Dynamic Foot Pressure During Walking: A Potential Indicator of Bone Mineral Density

BACKGROUND

Physical skeletal loading can affect the bone mineral density (BMD). This study investigated the association between BMD and dynamic foot pressure during gait.

METHODS

A total of 104 patients (mean age, 62.6 ± 12.4 years; 23 male and 81 female) who underwent dual x-ray absorptiometry and pedobarography were included. BMD values of the lumbar spine, femoral neck, and total femur were assessed. The mean and maximum pressures were measured at the hallux, lesser toes, 1st metatarsal head, 2nd and 3rd metatarsal heads, 4th and 5th metatarsal heads, midfoot, medial heel, and lateral heel. Multivariable regression analysis was performed to identify factors significantly associated with BMD.

RESULTS

The lumbar spine BMD was significantly associated with the mean pressure at the 4th and 5th metatarsal heads (p = 0.041, adjusted R 2 of model = 0.081). The femoral neck BMD was significantly associated with the maximum pressure at the 2nd and 3rd metatarsal heads (p = 0.002, adjusted R 2 = 0.213). The total femoral BMD also showed a significant association with the maximum pressure at the 2nd and 3rd metatarsal heads (p = 0.003, adjusted R 2 = 0.360).

CONCLUSIONS

Foot plantar pressure during gait was significantly associated with BMD, and could potentially be used to predict the presence of osteoporosis.

LEVEL OF EVIDENCE

Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.

Identifying characteristics and clinical conditions associated with hand grip strength in adults: the Project Baseline Health Study

Low hand grip strength (HGS) is associated with several conditions, but its value outside of the older adult population is unclear. We sought to identify the most salient factors associated with HGS from an extensive list of candidate variables while stratifying by age and sex. We used data from the initial visit from the Project Baseline Health Study (N = 2502) which captured detailed demographic, occupational, social, lifestyle, and clinical data. We applied MI-LASSO using group methods to determine variables most associated with HGS out of 175 candidate variables. We performed analyses separately for sex and age (< 65 vs. ≥ 65 years). Race was associated with HGS to varying degrees across groups. Osteoporosis and osteopenia were negatively associated with HGS in female study participants. Immune cell counts were negatively associated with HGS for male participants ≥ 65 (neutrophils) and female participants (≥ 65, monocytes; < 65, lymphocytes). Most findings were age and/or sex group-specific; few were common across all groups. Several of the variables associated with HGS in each group were novel, while others corroborate previous research. Our results support HGS as a useful indicator of a variety of clinical characteristics; however, its utility varies by age and sex.

Screening for Osteoporosis Risk Among Community-Dwelling Older Adults: A Scoping Review

BACKGROUND AND PURPOSE

Due to potential health-related consequences of osteoporosis (OP), health care providers who do not order imaging, such as physical therapists, should be aware of OP screening tools that identify individuals who need medical and rehabilitation care. However, current knowledge and guidance on screening tools is limited. Therefore, we explored OP screening tools that are appropriate and feasible for physical therapy practice, and evaluated tools' effectiveness by examining their clinimetric properties.

METHODS

A systematic search of the following databases was performed: PubMed, PEDro, PsycINFO, CINAHL, and Web of Science. Articles were included if the study population was 50 years and older, had a diagnosis of OP, if the screening tool was within the scope of physical therapy practice, and was compared to either a known diagnosis of OP or bone densitometry scan results. Included articles underwent multiple reviews for inclusion and exclusion, with each review round having a different randomly selected pair of reviewers. Data were extracted from included articles for participant demographics, outcome measures, cut-off values, and clinimetric properties. Results were categorized with positive and negative likelihood ratios (+LR/-LR) based on the magnitude of change in the probability of having or not having OP.

RESULTS

+LRs ranged from 0.15 to 20.21, with the Fracture Risk Assessment Tool (FRAX) and Study of Osteoporotic Fractures (SOF) having a large shift in posttest probability. -LRs ranged from 0.03 to 1.00, with the FRAX, Male Osteoporosis Risk Estimation Scores, Osteoporosis Self-Assessment Tool (OST), and Simple Calculated Osteoporosis Risk Estimation having a large shift in posttest probability.

CONCLUSION

Tools with moderate-large shift for both +LR and -LR recommended for use are: (1) OST; (2) FRAX; and (3) SOF. The variability in cut-off scores and clinimetric properties based on gender, age, and race/ethnicities made it impossible to provide one specific recommendation for an OP screening tool. Future research should focus on OP risk prediction among males and racial and ethnic groups.

Can the Eight Hop Test Be Measured with Sensors? A Systematic Review

Rehabilitation aims to increase the independence and physical function after injury, surgery, or other trauma, so that patients can recover to their previous ability as much as possible. To be able to measure the degree of recovery and impact of the treatment, various functional performance tests are used. The Eight Hop Test is a hop exercise that is directly linked to the rehabilitation of people suffering from tendon and ligament injuries on the lower limb. This paper presents a systematic review on the use of sensors for measuring functional movements during the execution of the Eight Hop Test, focusing primarily on the use of sensors, related diseases, and different methods implemented. Firstly, an automated search was performed on the publication databases: PubMed, Springer, ACM, IEEE Xplore, MDPI, and Elsevier. Secondly, the publications related to the Eight-Hop Test and sensors were filtered according to several search criteria and 15 papers were finally selected to be analyzed in detail. Our analysis found that the Eight Hop Test measurements can be performed with motion, force, and imaging sensors.

Effects of Circuit Resistance Training on Body Composition, Strength, and Cardiorespiratory Fitness in Middle-Aged and Older Women: A Systematic Review and Meta-Analysis

A systematic review with meta-analysis was conducted to evaluate the effects of circuit resistance training (CRT) on cardiorespiratory fitness, strength, and body composition in middle-aged and older women. Sixteen studies were included in the meta-analysis. The CRT interventions led to a significant decrease in weight, body mass index, and fat mass along with an increase in muscle mass. Significant differences were found in the fat mass and a trend to develop muscle mass when compared with the control group. CRT led to a significant increase in VO2max, walking endurance, and time to exhaustion; likewise, significant differences were observed when compared with the control group. CRT had a moderate and large favorable effect on arm, trunk, and lower limb strength. Furthermore, the increases in strength observed in the CRT were significantly greater than the changes observed in the control group. In middle-aged and older women, CRT improved cardiorespiratory fitness and strength and optimized body composition.

Physical capability, physical activity, and their association with femoral bone mineral density in adults aged 40 years and older: The Tromsø study 2015-2016

Since muscles can influence bone growth and vice versa, we examined if level of physical activity and physical capability tests can predict areal bone mineral density (aBMD). Both high activity level and good test performance were associated with higher aBMD, especially in women.

INTRODUCTION

Muscle influences bone formation and vice versa. Tests of physical capability and level of physical activity reflect various muscle qualities. We assessed the associations between total hip aBMD and physical activity as well as a range of standardized physical capability tests in an adult general population.

METHODS

A total of 3 533 women and men aged 40-84 years, participating in the population-based cross-sectional Tromsø study in Norway in 2015-2016, were included. Linear regression was used to assess associations between aBMD and physical activity and the physical capability tests grip strength, Timed Up and Go (TUG), Short Physical Performance Battery (SPPB), and standing balance. Non-linear associations were examined in cubic spline models. Standardized regression coefficients were calculated to compare effect sizes across physical capability measures.

RESULTS

In fully adjusted models, higher physical activity was positively associated with total hip aBMD in both sexes compared to a sedentary lifestyle. All tests of physical capability were associated with aBMD in women, SPPB showing the strongest association although effect sizes were too small to indicate clinically significant differences (1 point increase corresponded to an aBMD increase of 0.009 g/cm², CI = 0.005 to 0.012). In men, SPPB and its subtests were associated with aBMD with chair rises showing the strongest association (1 s increase in execution time corresponded to an aBMD decrease of 0.005 g/cm², CI = 0.008 to 0.002).

CONCLUSION

Physical activity was associated with aBMD, and tests of physical capability can account for some of the aBMD variations in adults aged 40 years and older, especially in women.

Association between movement control during one-leg standing and femoral BMD in patients with hip fractures

INTRODUCTION

Prior studies have focused only on the temporal component of one-leg standing, no reports have examined the relationship between the qualitative components of one-leg standing and femoral BMD. Thus, this study investigated whether quality (i.e., movement control) of one-leg standing also associated femoral BMD.

MATERIALS AND METHODS

A total of 80 patients with unilateral hip fracture were included in a cross-sectional study. Basic and medical information and physical functions including movement control during one-leg standing were assessed at admission and 2 weeks after surgery, respectively. Hierarchical multiple regression analysis was performed to identify predictors of femoral BMDs on the non-fractured side. Dependent variables included femoral neck and total hip BMDs in models 1 and 2, respectively.

RESULTS

Hierarchical multiple regression analysis (standardized partial regression coefficients) in model 1 identified age (- 0.18), sex (0.38), body mass index (BMI) (0.41), movement control during one-leg standing on the non-fractured side (0.19), and life-space assessment (0.17) as factors associating femoral neck BMD. Meanwhile, hierarchical multiple regression analysis (standardized partial regression coefficients) in model 2 identified age (- 0.12), sex (0.36), BMI (0.37), and movement control during one-leg standing on the non-fractured side (0.25) as factors associating total hip BMD. The coefficients of determination adjusted for degrees of freedom (R²) were 0.529 and 0.470 for models 1 and 2, respectively.

CONCLUSION

Our results suggest that improving movement control during one-leg standing may be important for maintaining and improving femoral BMD on the non-fractured side.

Measures of physical performance as a predictor of fracture risk independent of BMD: The Chungju metabolic disease cohort study

BACKGROUND

Bone mineral density (BMD) assessments alone might not be sufficient for assessing fracture risk in the whole population, and decreased balance is an important risk factor for fracture. The aim of this study was to evaluate the association between baseline physical performance and fracture risk.

METHODS

This community-based cohort study was conducted in rural areas. The follow-up examination was performed in 4015 subjects for approximately 4 years. We used the one-leg standing time (OLST) to assess static balance and the timed up-and-go test (TUGT) to assess dynamic balance. Fractures were assessed during the medical interview.

RESULTS

The participants were divided into quartile groups according to their performance level, and the lowest baseline OLST performance was associated with a 2.1-fold increased risk of major osteoporotic fracture (MOF) independent of age, gender, hip BMD, fall incidence, and lifestyle factors. The participants in the low performance quartile of baseline OLST or TUGT performance had an increased incidence of osteoporosis and falling compared to that in the participants in the highest baseline performance quartile after adjusting for covariates. Among the participants with a femoral neck T-score above -2.5, the participants with an OLST below 14 s had a 1.7-fold higher risk of MOF than the participants with an OLST of 14 s or more.

CONCLUSIONS

The measurement of static balance by the OLST predicted the risk of fracture in Korean adults independent of BMD and fall history. Our results suggest that the OLST may have clinical utility in identifying individuals at risk of fracture, especially those who might not be adequately identified by BMD measurements alone.

Hand grip strength in predicting the risk of osteoporosis in Asian adults

INTRODUCTION

There is a need for a cost-effective method to identify individuals with a high risk of osteoporosis. This study aimed to investigate the suitability of hand grip strength in predicting the risk of osteoporosis in Asian adults.

MATERIALS AND METHODS

In this cross-sectional, hospital-based study of 1007 participants, the bone mineral density of the spine and hips was evaluated using dual-energy X-ray absorptiometry according to the 2019 International Society for Clinical Densitometry official positions. Bone microarchitecture was evaluated using the trabecular bone score, and hand grip strength was measured in the dominant hand using a hand digital dynamometer.

RESULTS

Hand grip strength was significantly related to bone density and bone microarchitecture. Moreover, hand grip strength was a significant predictor of osteoporosis in both women and men. For osteoporosis prediction in women, a threshold of 21.9 kg of hand grip strength had a sensitivity of 59%, specificity of 59%, and area under the curve (AUC) of 0.61. In men, a threshold of 28.7 kg had a sensitivity of 66%, specificity of 78%, and AUC of 0.75. The optimal cutoff strengths for osteoporosis depended on age and sex.

CONCLUSION

The measurement of hand grip strength is a simple, cost-effective and an easy assessment method for identifying individuals at a high risk of osteoporosis. The cutoff strength for evaluating osteoporosis in adults is age and sex specific.

Balance and functional mobility predict low bone mineral density among postmenopausal women undergoing recent menopause with osteoporosis, osteopenia, and normal bone mineral density: A cross-sectional study

The purpose of this study was to determine whether balance and functional mobility independently predict bone mineral density (BMD) in postmenopausal women. BMD at the hip and spine was measured with dual-energy x-ray absorptiometry (DEXA). Participants were assigned into groups (i.e., osteoporosis: n=20; osteopenia: n=20; normal BMD: n=20) according to DEXA T-scores. Participants performed the single leg stance test (SLS), timed-up-and-go (TUG), and 6-meter walking test. An ordinal logistic regression was performed to determine whether the SLS, TUG, 6MWT independently predict BMD, while accounting for age, age at menopause, and body mass index. Three factors predicted low BMD: (1) less time to hold the SLS (odds ratio (OR): 0.50); (2) longer TUG time (OR: 2.85); and (3) older Age (OR: 1.31). Women with recent menopause diagnosed with osteoporosis are at a high-risk for fracture; incorporating the SLS and TUG into risk assessments may enable prompt and targeted intervention.

Decreased lower-extremity muscle performance is associated with decreased hip bone mineral density and increased estimated fracture risk in community-dwelling postmenopausal women

The present study demonstrated that the lower-extremity muscle performance in Chinese community-dwelling postmenopausal women with lower bone mineral density (BMD) was positively associated with hip BMD and negatively associated with estimated fracture risk.

PURPOSE

Postmenopausal women are at high risk for osteoporotic fractures. It has been shown that decreased lower-extremity muscle performance is associated with osteoporotic fractures. However, the relationship between muscle performance and bone mineral density in postmenopausal women is inconsistent in the literature. The present study was to investigate the relationship between lower-extremity muscle performance and BMD or estimated fracture risk in community-dwelling postmenopausal women.

METHODS

Two hundred forty-seven postmenopausal women aged 50-85 years were recruited in the study. The short physical performance battery (SPPB) tool including the chair stand test (CST), gait speed test (GST), and balance test (BT) was used to determine lower-extremity functioning and the CST, GST, BT, and SPPB total scores were recorded. The BMD of lumbar spine (LSBMD), femoral neck (FNBMD), and total hip (THBMD) were measured by dual-energy X-ray absorptiometry (DXA), and the vertebral fracture was confirmed by lateral spine X-rays radiographs. In addition, patients' 10-year estimated major osteoporotic fracture risk (MOFR) and hip fracture risk (HFR) were assessed by the Fracture Risk Assessment Tool (FRAX). Linear regression analysis was used to analyze the association between muscle performance and BMD.

RESULTS

The CST, GST, and SPPB total scores were positively associated with LSBMD, THBMD, and FNBMD before adjustment for age, height, and weight. The SPPB total score was positively associated with FNBMD and THBMD, but not with LSBMD after adjustment for age, height, and weight. The BT score was positively associated with FNBMD and THBMD, but not with LSBMD before and after adjustment for age, height, and weight. Moreover, the CST, GST, BT, and SPPB scores were negatively associated with the FRAX score.

CONCLUSION

The lower-extremity muscle performance in community-dwelling postmenopausal women is positively associated with FNBMD and THBMD and negatively associated with the FRAX score.

Impacts of combined osteopenia/osteoporosis and sarcopenia on balance and quality of life in older adults

OBJECTIVE

Combined osteopenia/osteoporosis and sarcopenia is a major public health problem for old adults. In this study, we aimed to evaluate the impacts of combined osteopenia/osteoporosis with sarcopenia on balance and quality of life in patients older than 65 years.

METHODS

In this sudy, 77 patients with sarcopenia, who were older than 65 years, were included. The diagnosis of sarcopenia was made according to the diagnostic criteria developed by The European Working Group on Sarcopenia in Older People (EWGSOP). Bone densitometry was performed to screen for osteoporosis or osteopenia. The balance was assessed with the anterior-posterior stability index (APSI), medial-lateral stability index (MLSI), and the general stability index (OSI), which were calculated using a Biodex Stability System device (BSS). The quality of life was assessed using SF-36.

RESULTS

Patients with sarcopenia were included in this study. Of them, 40 had osteoporosis and 37 had osteopenia. The measures of balance and the OSI, APSI, and MLSI values were low in both groups of patients, but they were statistically significantly lower in the sarcopenia with osteoporosis group compared to the sarcopenia with osteopenia group (p=0.01; p=0.002; p=0.04, respectively). The quality of life was lower in all sub-categories of SF-36, excluding the mental health when sarcopenia was accompanied by osteoporosis compared to the joint occurrence of sarcopenia with osteopenia (p<0.05).

CONCLUSION

Our study suggests that the joint occurrence of osteoporosis with sarcopenia is associated with a risk of balance loss, a decrease in quality of life, and a potentially increased fracture risk in older adults.

Evaluation of Relationships between Menopause Onset Age and Bone Mineral Density and Muscle Strength in Women from South-Western Poland

INTRODUCTION

The onset of the menopause entails numerous changes, both physical and mental, in the functioning of the bodies of women. Moreover, the early menopause increases the risk of occurrence of many civilization-related diseases. Major factors contributing to health deficits include lowered bone mineral density and sarcopenia, which can result in serious functional limitations and the acceleration of ageing processes in the body. The aim of this study was to determine how the menopause onset age is linked with bone mineral density and the strength of selected muscles of the limbs and the trunk. Material and Methods. 756 women aged 50-80 years were subjected to tests. The subjects were divided into three groups: (I) from 50 to 59 years, (II) from 60 to 69 years, and (III) from 70 to 79 years. Each of the women specified the age when her final menstrual period occurred. On this basis, groups of women with (1) the early menopause-before the 50th year of life-and (2) with the late menopause-after the 50th year of life-were distinguished. Bone mineral density (BMD), dominant hand grip strength, knee extensor and flexor strength, and functional upper and lower body muscle strength were determined in each of the women.

RESULTS

The test results indicate differences in levels of muscle strength and BMD between the 50-year-old early- and late-menopausal women. The late-menopausal women score better motor ability test results and higher BMD values. The differences decrease in the groups of 60-year-old women, whereas the 70-year-old early- and late-menopausal women score similar results.

CONCLUSIONS

A higher percentage of women with a lowered bone mass and a lower strength level was found in the group of early-menopausal subjects. The rate of decline in hand grip strength, the functional efficiency of the upper and lower limbs, and BMD is faster in the late-menopausal women, whereby the two groups of 70-year-old women score similar test results.

Muscle strength is associated with bone health independently of muscle mass in postmenopausal women: the Japanese population-based osteoporosis study

There are conflicting reports on whether muscle strength is associated with bone mineral density (BMD) independently of muscle mass. Here, we examined the association between muscle strength and BMD in a representative population of Japanese women. Cross-sectional data from 680 postmenopausal women, who were participants in the 15th-year follow-up survey of the Japanese Population-based Osteoporosis cohort study, were analyzed. Areal BMD (aBMD) at the femoral neck and lumbar spine, whole-body bone mineral density, and appendicular skeletal muscle mass (ASM, kg) were measured by dual-energy X-ray absorptiometry. The ASM index (ASMI, kg/m²) was calculated as ASM divided by height squared (m²). Grip strength (kg) was measured as an indicator of muscle strength. Grip strength showed significantly (P < 0.05) positive relationships with aBMDs at several skeletal sites after adjusting for ASMI and age (standardized partial regression coefficient (β) = 0.102 at femoral neck, β = 0.126 at lumbar spine). Adjusted means of aBMD at the femoral neck and lumbar spine showed significant increasing trends from the lowest to highest tertile of grip strength. Our findings indicate that muscle strength is associated with aBMD at several sites independently of muscle mass in Japanese postmenopausal women. Thus, postmenopausal women with strong muscle strength tend to have a healthy bone status regardless of muscle size.

Changes in health parameters in older lay volunteers who delivered a lifestyle-based program to frail older people at home

OBJECTIVE

To measure health effects in lay volunteers who made home visits consisting of social interaction, nutritional and physical exercise interventions to pre-frail and frail older people (trial registration ClinicalTrials.gov, NCT01991639).

METHODS

After baseline, participants were followed-up at 12 (V1) and 24 (V2) weeks. A one-repetition maximum (1-RPM) and handgrip were measured with the Concept2®DYNO and a dynamometer. The Physical Activity Scale for the Elderly was used to assess physical activity, and Food Frequency Questionnaire and the Mediterranean Diet Adherence Screener for nutrition. Additionally, quality of life (QoL) was measured with the World Health Organization (WHO) quality of life brief questionnaire and anthropometric measurements were performed using bioelectrical impedance analysis.

RESULTS

Handgrip values significantly increased from 32.14 ± 7.94 kg to 33.69 ± 6.72 kg at V1 and 34.36 ± 6.96 kg at V2. The 1‑RPM on the leg press showed a significant increase from 72.47 ± 25.37 kg to 78.12 ± 23.77 kg and 80.85 ± 27.99 kg, respectively. We observed a significant decrease of protein intake from 0.38 ± 0.26 g/kgBW/day to 0.32 ± 0.19 g/kgBW/day and 0.26 ± 0.16 g/kgBW/day, respectively. There were no changes in physical activity, QoL and anthropometric measurements.

CONCLUSION

The findings indicate that projects involving aging healthy volunteers may have additional limited health benefits.

Low physical performance determined by chair rising test muscle mechanography is associated with prevalent fragility fractures

This study examined associations between physical performance assessed by chair rising test muscle mechanography and DXA T-score as well as body composition in a large patient cohort. Next to various significant interrelationships between these muscle and bone parameters, lower physical performance was associated with prevalent fragility fractures.

PURPOSE

Although the interaction between muscle and bone has been demonstrated in various aspects, the clinical focus in the diagnosis of musculoskeletal disorders mainly lies on the skeletal assessments. Accordingly, the association between muscle function, bone mineral density (BMD), and fragility fractures remains to be further elucidated with a feasible muscle assessment in a clinical setting.

METHODS

Patient data (2076 patients, 1538 women, 538 men) were evaluated retrospectively from a large dual energy X-ray absorptiometry (DXA) database as well as from chair rising test (CRT) that was performed on a muscle mechanograph. To determine potential predictors of the CRT time and maximum force, a multivariate regression analysis was performed including age, DXA T-score, and body composition indices. Furthermore, CRT results were compared between non-fracture and fracture cases.

RESULTS

We determined independent predictors for CRT time such as age, femoral DXA T-score, and total fat mass, whereas CRT force was only influenced by total lean mass. Both women and men with previous fragility fractures displayed a longer CRT time (women p = 0.009, men p = 0.001) and lower CRT force (women p < 0.001, men p < 0.001) than those with no fractures, while no clear differences in CRT results could be detected between normal BMD, osteopenia, and osteoporosis based on DXA T-scores.

CONCLUSIONS

Our study demonstrates that in addition to the associations between chair rising time and femoral T-score assessed by DXA, low muscle strength is associated with previous fragility fractures.

Reference values for hand grip strength in the South Korean population

Objective

To establish reference values for hand grip strength (HGS) in a healthy Korean population and to identify the dependent anthropometric variables that affect HGS.

Methods

Based on the sixth Korea National Health and Nutrition Examination Survey from 2014 to 2015, we analyzed the HGS data of 7,969 South Koreans. Individuals with specific chronic diseases and who reported poor subjective health status were excluded to ensure a healthy population sample. Means with standard deviations (SDs) and 95% confidence intervals were calculated for each 5-year interval starting from 10 years of age. To determine the relationship between HGS and anthropometric variables, we performed correlation analyses between HGS and height, weight, and body mass index (BMI). Additionally, based on these findings, the cut-off value for low HGS was presented by deriving -2SD values of healthy young adults as recommended by the European Working Group on Sarcopenia in Older People.

Results

The mean age and BMI of men and women were 38.3 and 38.2 years and 23.8 and 22.4 kg/m², respectively. Mean HGS of the dominant hand in men and women was 39.5 and 24.2 kg, respectively. The peak in HGS was at 35–39 years of age, after which HGS decreased in both sexes. HGS was significantly correlated with height, weight, and BMI. The cut-off values for weak HGS were < 28.9 and < 16.8 kg in men and women, respectively.

Conclusion

These results provide useful reference values to assess HGS in patients who undergo hand surgery or who have various diseases that affect HGS. Moreover, a cut-off value for low HGS may help in defining sarcopenia among the Korean population.

Walking balance is mediated by muscle strength and bone mineral density in postmenopausal women: an observational study

BACKGROUND

Depletion of ovarian hormone in postmenopausal women has been associated with changes in the locomotor apparatus that may compromise walking function including muscle atrophy/weakness, weight gain, and bone demineralization. Therefore, handgrip strength (HGS), bone mineral density (BMD) and body composition [percentage body fat mass (%BFM), fat mass (FM), Fat-free mass (FFM) and body mass index (BMI)], may significantly vary and predict WB in postmenopausal women. Consequently, the study sought to 1. Explore body composition, BMD and muscle strength differences between premenopausal and postmenopausal women and 2. Explore how these variables [I.e., body composition, BMD and muscle strength] relate to WB in postmenopausal women.

METHOD

Fifty-one pre-menopausal (35.74 + 1.52) and 50 postmenopausal (53.32 + 2.28) women were selected by convenience sampling and studied. Six explanatory variables (HGS, BMD, %BFM, FFM, BMI and FM) were explored to predict WB in postmenopausal women: Data collected were analyzed using multiple linear regression, ANCOVA, independent t-test and Pearson correlation coefficient at p < 0.05.

RESULT

Postmenopausal women had higher BMI(t = + 1.72; p = 0.04), %BFM(t = + 2.77; p = .003), FM(t = + 1.77; p = 0.04) and lower HGS(t = - 3.05; p = 0.001),compared to the premenopausal women. The predicted main effect of age on HGS was not significant, F(1, 197) = 0.03, p = 0.06, likewise the interaction between age and %BFM, F(1, 197) = 0.02, p = 0.89; unlike the predicted main effect of %BFM, F(1, 197) = 10.34, p = .002, on HGS. HGS was the highest predictor of WB (t = 2.203; β=0.3046) in postmenopausal women and combined with T-score right big toe (Tscorert) to produce R² = 0.11;F (2, 47)=4.11;p = 0.02 as the best fit for the predictive model. The variance (R²) change was significant from HGS model (R² = 0.09;p = 0.03) to HGS + Tscorert model (R² = 0.11;p = 0.02). The regression model equation was therefore given as: WB =5.4805 + 0.1578(HGS) + (- 1.3532) Tscorert.

CONCLUSION

There are differences in body composition suggesting re-compartmentalization of the body, which may adversely impact the (HGS) muscle strength in postmenopausal women. Muscle strength and BMD are associated with WB, although, only contribute to a marginal amount of the variance for WB. Therefore, other factors in addition to musculoskeletal health are necessary to mitigate fall risk in postmenopausal women.

Effect of Yoga Based Lifestyle Intervention on Patients With Knee Osteoarthritis: A Randomized Controlled Trial

Objective: To investigate the effect of integrated approach of yoga therapy (IAYT) intervention in individual with knee Osteoarthritis. Design: Randomized controlled clincial trail. Participants: Sixty-six individual prediagnosed with knee osteoarthritis aged between 30 and 75 years were randomized into two groups, i.e., Yoga (n = 31) and Control (n = 35). Yoga group received IAYT intervention for 1 week at yoga center of S-VYASA whereas Control group maintained their normal lifestyle. Outcome measures: The Falls Efficacy Scale (FES), Handgrip Strength test (left hand LHGS and right hand RHGS), Timed Up and Go Test (TUG), Sit-to-Stand (STS), and right & left extension and flexion were measured on day 1 and day 7. Results: There were a significant reduction in TUG (p < 0.001), Right (p < 0.001), and Left Flexion (p < 0.001) whereas significant improvements in LHGS (p < 0.01), and right extension (p < 0.05) & left extension (p < 0.001) from baseline in Yoga group. Conclusion: IAYT practice showed an improvement in TUG, STS, HGS, and Goniometer test, which suggest improved muscular strength, flexibility, and functional mobility. CTRI Registration Number: http://ctri.nic.in/Clinicaltrials, identifier CTRI/2017/10/010141.

Association between bone mass as assessed by quantitative ultrasound and physical function in elderly women: The Fujiwara-kyo study

Objectives

This study aimed to investigate differences in physical function by bone mass category as assessed by speed of sound, and the association between bone mass and physical function in Japanese elderly women.

Methods

Participants (≥65 years, n = 954) were divided into the osteoporosis, osteopenia, and normal groups based on speed of sound values, and physical function parameters were compared among groups. In addition, the predictive ability of physical function for low bone mass was determined by area under the curve analysis. Data were collected in 4 cities in Nara, Japan, in 2007 or 2008.

Results

All physical functions were significantly lower in the osteoporotic group than in the normal group. Lower bone mass was associated with poor muscle strength and physical function after adjusting for age, height and weight. In addition, one-leg standing time and 10-m gait time were predictive of low bone mass (osteopenia and osteoporosis levels, respectively). Elderly women with low physical function, especially those with a short one-leg standing time, should be suspected of having decreased bone mass.

Conclusions

Measurements of physical function can effectively identify elderly women with low bone mass at an early stage without the need for bone mass measurements. In particular, one-leg standing time and 10-m gait time were good predictors of low bone mass, and is easy to measure, low-cost, and can be self-measured. These findings will be helpful in the prevention and treatment of osteoporosis.

Diagnostic devices for osteoporosis in the general population: A systematic review

INTRODUCTION

A diagnostic gap exists in the current dual photon X-ray absorptiometry (DXA) based diagnostic approach to osteoporosis. Other diagnostic devices have been developed, but no comprehensive review concerning the applicability of these diagnostic devices for population-based screening have been performed.

MATERIAL AND METHODS

A systematic review of Embase, Medline and the Cochrane Central Register for Controlled Trials was performed for population-based studies that focused on technical methods that could either indicate bone mineral density (BMD) by DXA, substitute for DXA in prediction of fracture risk, or that could have an incremental value in fracture prediction in addition to DXA. Quality of included studies was rated by QUADAS 2.

RESULTS

Many other technical devices have been tested in a population-based setting. Five studies aiming to indicate BMD and 17 studies aiming to predict fractures were found. Overall, the latter studies had higher methodological quality. The highest number of studies was found for quantitative ultrasound (QUS). The ability to indicate BMD or predict fractures was moderate to minor for all examined devices, using reported area under the curve (AUC) of Receiver Operating Characteristic curves values as standard.

CONCLUSIONS

Of the methods assessed, only QUS appears capable of perhaps replacing DXA as standalone examination in the future whilst radiographic absorptiometry could provide important information in areas with scarcity of DXA. QUS may be of added value even after DXA has been performed. Evaluation of proposed cutoff-values from population-based studies in separate population-based cohorts is still lacking for most examination devices.

The Relationship of Physical Activity and Anthropometric and Physiological Characteristics to Bone Mineral Density in Postmenopausal Women

The aim of this study is to investigate the relationship of physical activity and anthropometric and physiological characteristics to bone mineral density (BMD) in postmenopausal women. Ninety-seven postmenopausal women with an average age of 50.71 ± 6.86 yr were selected to participate in this study. After completing consent forms and the questionnaire on physical activity, the amounts of calcium and 25-hydroxyvitamin D levels in participants' blood were measured by blood tests. The BMDs of the subjects in the lumbar spine (L2-L4) and hip were measured by dual-energy X-ray absorptiometry device and the results were recorded. Also, anthropometric characteristics including height, weight, body fat percentage, body mass index, waist-to-hip ratio (WHR), digit ratio (2D:4D), skeletal muscle mass index, hand and calf circumferences and physiological parameters, including handgrip strength, quadriceps isotonic extension strength and balance of the subjects, were measured. The results showed that the 2D:4D ratio and skeletal muscle mass index had a significantly positive relationship with BMD of the lumbar spine (p ≤ 0.05) and the hip (p ≤ 0.05). Also, there was a negative relationship between the BMD of lumbar spine and hip and WHR (p ≤ 0.05). Moreover, there was a positive relationship between the calf circumferences and lumbar spine BMD (p ≤ 0.05). Contrary to this, there was no significant relationship between the calf circumference and the hip BMD, and between hand circumference with lumbar spine and hip BMD (p > 0.05). Results of physiological indices showed a significant positive relationship between physical activity, handgrip strength, quadriceps isotonic extension strength, standing on 1 foot with the lumbar spine and hip BMD (p ≤ 0.05). But the relationship was not observed between BMD and the ability to squat down on the floor (p > 0.05). Based on these results, it seemed that we can use some physiological and anthropometric indices that are important determinants of BMD and risk of osteoporosis in postmenopausal women.

Gender- and age-group-specific associations between physical performance and bone mineral density, falls, and osteoporotic fractures in Koreans: the Chungju Metabolic Disease Cohort study

Several factors increase the risk of fragility fracture, including low bone mineral density, falls, and poor physical performance. The associations among these factors have been investigated; however, most of the subjects of previous studies were either elderly men or elderly women, and the associations were controversial. The aim of this study was to evaluate the associations between physical performance and bone mineral density, and the history of falls and fractures, stratified by gender and age group. We analyzed 5368 subjects who were aged 50 years or older, including 1288 younger men (younger than 70 years), 1615 younger women (younger than 70 years), 1087 older men (70 years or older), and 1378 older women (70 years or older). We used the one-leg standing time (OLST) for assessing static balance and the timed up-and-go test (TUGT) for assessing dynamic balance. The subjects in the worst performance quartile for the OLST were more likely to have osteoporosis than those in the best performance quartile. Additionally, women who had experienced a fracture during the past 2 years were 1.68 times more likely to be in the worst performance quartile for the OLST than women without a previous fracture. Although the TUGT time was not associated with either the incidence of osteoporosis or the fracture history, the odds ratios for falling were 1.51 and 1.28 as the TUGT time increased by one standard deviation in younger men and younger women, respectively. The findings of the present study show that the OLST was associated with the incidence of osteoporosis and previous fracture and that the TUGT time was associated with the incidence of falling.

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.

Association between bone mass and functional capacity among elderly people aged 80 years and over

Objective

Analyzed the association of bone mass with the functional capacity of elderly aged 80 or more.

Methods

The sample consisted of 93 elderly aged 80 and 91 years (83.2±2.5 years) being 61 women (83.3±2.7 years) and 32 men (83.1±2.2 years) living in the city of Presidente Prudente – São Paulo/Brazil. The assessment of bone mass was realized by absorptiometry dual-energy X-ray (DXA), where have been measured values bone mineral content (BMC) and bone mineral density (BMD) of the femur and spine (L1–L4). The functional capacity was evaluated by means of walking speed tests, static equilibrium and strength of lower limbs contained in the questionnaire Wellness Health and Aging (SABE). The variables of bone mass and functional capacity were categorized according to the median values and score tests, respectively. For statistical analysis we carried out the chi-square test, the software used was SPSS (13.0) and the significance level was set at 5%.

Results

Elderly male with higher performance in the functional tests showed higher femur BMC compared to lower performance, result not found when evaluated women.

Conclusion

Thus, the bone of the femur for the oldest old male is associated with functional capacity. The constant assessment of the bone mineral mass and practive of physical activity throughout life would be measures to prevent falls in the elderly.

New normative values for handgrip strength: results from the UK Biobank

OBJECTIVES

To develop normative values for right and left handgrip strength after stratification for confounders like gender, age, and height.

DESIGN

Cross-sectional, descriptive.

SETTING

General population.

PARTICIPANTS

A total of 502,713 people living in the United Kingdom.

INTERVENTION

None.

MEASUREMENTS

Handgrip strength was measured using a Jamar hydraulic hand dynamometer, which is considered to be an accurate instrument to measure handgrip strength. In addition, self-reported chronic conditions and ethnic background were registered, and lung function was assessed using spirometry.

RESULTS

After exclusion of all individuals with missing data, a nonwhite ethnic background, the presence of 1 or more self-reported conditions, and/or an obstructive lung function (defined as FEV1/FVC <0.7), new normative values for right and left handgrip strength were derived from 224,830 and 224,852 individuals (54.2% women; age: 55.0 [8.0] years; height: 169.0 [9.2] cm; body mass index: 26.9 [4.4] kg/m(2)) with a nonobstructed spirometry (FEV1: 3.0 [0.8] L). Men were stronger than women. Moreover, significant associations were found between handgrip strength and height, and between handgrip strength and age. Finally, percentiles 5, 10, 25, 50, 75, 90, and 95 were calculated for right and left handgrip strength, after stratification for gender, age, and height.

CONCLUSION

The UK Biobank dataset provided the opportunity to determine new normative values for handgrip strength in men and women aged 39 to 73 years. These normative values take into consideration age, height, and measurement side. Therefore, these new normative handgrip strength values are of broad clinical interest.

Are changes in bone mineral density different between groups of early rheumatoid arthritis patients treated according to a tight control strategy with or without prednisone if osteoporosis prophylaxis is applied?

Addition of 10 mg prednisone daily to a methotrexate-based tight control strategy does not lead to bone loss in early rheumatoid arthritis (RA) patients receiving preventive treatment for osteoporosis. A small increase in lumbar bone mineral density (BMD) during the first year of treatment was recorded, regardless of use of glucocorticoids.

INTRODUCTION

This study aims to describe effects on BMD of treatment according to EULAR guidelines with a methotrexate-based tight control strategy including 10 mg prednisone daily versus the same strategy without prednisone in early RA patients who received preventive therapy for osteoporosis.

METHODS

Early RA patients were included in the CAMERA-II trial: a randomized, placebo-controlled, double-blind 2-year trial, in which effects of addition of 10 mg prednisone daily to a methotrexate-based tight control strategy were studied. All patients received calcium, vitamin D and bisphosphonates. Disease activity was assessed every 4 weeks. Radiographs of hands and feet and dual-energy X-ray absorptiometry of lumbar spine and left hip were performed at baseline and after 1 and 2 years of treatment.

RESULTS

BMD increased significantly over time in both treatment groups at the lumbar spine with a mean of 2.6% during the first year (p<0.001), but not at the hip; at none of the time points did BMD differ significantly between the prednisone and placebo group. Higher age and lower weight at baseline and higher disease activity scores during the trial, but not glucocorticoid therapy, were associated with lower BMD at both the lumbar spine and the hip in mixed-model analyses.

CONCLUSION

Addition of 10 mg prednisone daily to a methotrexate-based tight control strategy does not lead to bone loss in early RA patients on bisphosphonates. A small increase in lumbar BMD during the first year of treatment was found, regardless of use of glucocorticoids.

Longitudinal elastic properties and porosity of cortical bone tissue vary with age in human proximal femur

Tissue level structural and mechanical properties are important determinants of bone strength. As an individual ages, microstructural changes occur in bone, e.g., trabeculae and cortex become thinner and porosity increases. However, it is not known how the elastic properties of bone change during aging. Bone tissue may lose its elasticity and become more brittle and prone to fractures as it ages. In the present study the age-dependent variation in the spatial distributions of microstructural and microelastic properties of the human femoral neck and shaft were evaluated by using acoustic microscopy. Although these properties may not be directly measured in vivo, there is a major interest to investigate their relationships with the linear elastic measurements obtained by diagnostic ultrasound at the most severe fracture sites, e.g., the femoral neck. However, before the validity of novel in vivo techniques can be established, it is essential to understand the age-dependent variation in tissue elastic properties and porosity at different skeletal sites. A total of 42 transverse cross-sectional bone samples were obtained from the femoral neck (Fn) and proximal femoral shaft (Ps) of 21 men (mean±SD age 47.1±17.8, range 17-82years). Samples were quantitatively imaged using a scanning acoustic microscope (SAM) equipped with a 50MHz ultrasound transducer. Distributions of the elastic coefficient (c33) of cortical (Ct) and trabecular (Tr) tissues and microstructure of cortex (cortical thickness Ct.Th and porosity Ct.Po) were determined. Variations in c33 were observed with respect to tissue type (c33Tr<c33Ct), location (c33(Ct.Ps)=37.7GPa>c33(Ct.Fn)=35.3GPa>c33(Tr.Ps)=33.8GPa>c33(Tr.Fn)=31.9GPa), and cadaver age (R(2)=0.28-0.46, p<0.05). Regional variations in porosity were found in the neck (superior 13.1%; inferior 6.1%; anterior 10.1%; posterior 8.6%) and in the shaft (medial 9.5%; lateral 7.7%; anterior 8.6%; posterior 12.0%). In conclusion, significant variations in elastic coefficients were detected between femoral neck and shaft as well as between the quadrants of the cross-sections of neck and shaft. Moreover, an age-related increase in cortical porosity and a stiffening of the bone tissue were observed. These findings may explain in part the increase in susceptibility to suffer low energy fractures during aging and highlight the potential of ultrasound in clinical osteoporosis diagnostics.

Poor bone microarchitecture in older men with impaired physical performance--the STRAMBO study

In 810 men ≥ 60 years, poor physical performance of lower limbs was associated with lower areal bone mineral density (aBMD) of total hip and poor bone microarchitecture at the distal tibia (assessed by HR-pQCT). Men who reported falls had lower hip aBMD and lower cortical density at the distal tibia.

INTRODUCTION

The aim of this study was to assess the association between bone microarchitecture and physical performance in older men.

METHODS

Volumetric bone mineral density (vBMD) and bone microarchitecture were assessed in 810 men ≥ 60 years at the distal radius and tibia by high resolution pQCT. aBMD was measured at the spine, hip, whole body, and distal radius by dual energy X-ray absorptiometry. Clinical tests included chair stands and tests of static and dynamic balance. We calculated a composite score summarizing abilities and time required to perform the tests.

RESULTS

In multivariable models, men who failed in ≥ one test had lower total hip aBMD than men who accomplished all the tests. They had lower total vBMD (Tt.vBMD), cortical thickness (Ct.Th), trabecular vBMD (Tb.vBMD), and more heterogenous trabecular distribution (Tb.Sp.SD) at the distal tibia (p < 0.05). Men who failed in ≥ two tests had lower aBMD at the total hip, femoral neck, and trochanter as well as lower Tt.vBMD, cortical vBMD (Ct.vBMD), Ct.Th and trabecular number (Tb.N), and higher Tb.Sp.SD at the distal tibia (p  <  0.05). Men in the lowest quartile of the composite score had lower aBMD (total hip, distal radius), lower Tb.vBMD and Tb.N at the distal radius, and lower Tt.vBMD, Ct.vBMD, Ct.Th, Tb.vBMD, and Tb.N, and higher Tb.Sp.SD at the distal tibia compared with the highest quartile. In multivariables models, men reporting falls had lower total hip aBMD and lower distal tibia Ct.vBMD (p  <  0.01).

CONCLUSION

In older men, poor physical performance is associated with lower hip aBMD and poor bone microarchitecture (mainly at the distal tibia).

Alcohol consumption and bone mineral density in elderly women

OBJECTIVE

Findings regarding alcohol consumption and bone mineral density (BMD) in elderly women have been inconsistent. The objective of the present study was to explore the association of alcohol intake with BMD in elderly women.

DESIGN

This cohort study included women from the population-based Kuopio Osteoporosis Risk Factor and Prevention - Fracture Prevention Study (OSTPRE-FPS). Alcohol intake and potential confounders were assessed at baseline and after 3 years of follow-up using a lifestyle questionnaire. In addition, an FFQ was distributed in the third year to measure dietary intake, including alcohol. Women underwent BMD measurements at the femoral neck and lumbar spine at baseline and after 3 years of follow-up.

SETTING

Kuopio Province, Finland.

SUBJECTS

Three hundred elderly women (mean age 67·8 years) who provided both BMD measurements and FFQ data.

RESULTS

Alcohol consumption estimated from the FFQ and lifestyle questionnaire was significantly associated with BMD at both measurement sites after adjustment for potential confounders, including lifestyle and dietary factors (P < 0·05). Using the FFQ, women drinking >3 alcoholic drinks/week had significantly higher BMD than abstainers, 12·0 % at the femoral neck and 9·2 % at the lumbar spine. Results based on the lifestyle questionnaire showed higher BMD values for all alcohol-consuming women at the femoral neck and for women drinking 1-3 alcoholic beverages/week at the lumbar spine, compared with non-users.

CONCLUSIONS

The results from OSTPRE-FPS suggest that low to moderate alcohol intake may exert protective effects on bone health in elderly women.

Functional fitness and bone mineral density in the elderly

Bone quality has been associated with genetic factors and several environmental influences. This study suggests that although functional fitness should be considered in clinical assessments of bone health, body composition appears to have a higher relevance in the explanation of bone health/strength in older people.

PURPOSE

This study aims to describe the association between functional fitness (FF), other constitutive factors, and bone health/strength in a large community-dwelling sample of elderly active Portuguese.

METHODS

This cross-sectional study included 401 males and 401 females aged 60-79 years old. Bone mineral density (BMD) of the total body, lumbar spine (LS), and hip region was determined by dual-energy X-ray absorptiometry (DXA). In addition, femur strength index (FSI) was determined. FF was assessed using the Senior Fitness Test. Demographic information and a health history were obtained by telephone interview through questionnaire.

RESULTS

Aerobic endurance and body strength were positively related with hip BMD region in males (0.10 < r < 0.16; p < 0.01-0.05) and females (0.13 < r < 0.28; p < 0.01). No significant correlation was found between any FF test and LS BMD, except for upper-body strength in females. After controlling for other constitutive predictors (sex, age, height, body mass (BM), total fat mass (TFM), and total lean tissue mass (TLTM)), FF had a minor contribution only in prediction of BMD at multisites and FSI. The total explained variance for all determinants was moderate (R² = 0.35 for femoral neck (FN) BMD, R² = 0.27 for LS BMD, R² = 0.49 total body BMD, and R² = 0.22 for FSI).

CONCLUSIONS

Sex, age, height, BM, TLTM, and TFM entered as the most significant contributors for BMD and FSI. Although FF parameters are typically considered in clinical assessments of bone health/strength in older people, body composition appears to have a higher relevance in the explanation of BMD and strength.

Impact of a new sarco-osteopenia definition on health-related quality of life in a population-based cohort in Northern Europe

Sarcopenia has been shown to be a marker of falling; therefore, combining osteopenia and sarcopenia could identify a frailer, higher-fracture-risk population. We aimed to define sarco-osteopenia (SOP) in a population-based healthy young sample using both muscle functional and quantitative parameters and assessing the impact of this definition on health-related quality of life. A population sample of 304 patients aged 25-70 yr was analyzed with a Lunar DPX-IQ dual-energy X-ray absorptiometry machine (GE Healthcare, Pollards Wood, UK), and their health-related quality of life was assessed with the Short-Form-36 (SF-36) questionnaire. SOP was defined as bone mineral density (BMD) -1 standard deviation (SD) and height-adjusted appendicular muscle mass -2 SD and/or grip strength -2 SD less than the mean values of 77 young individuals in the population sample (age: 25-39 yr). Our proposed SOP definition identifies 3-9% of the population older than 40 yr as sarco-osteopenic. These individuals also show markedly lower scores in the role-physical (p=0.01), vitality (p=0.03), and role-emotional (p=0.02) subscales of the SF-36 questionnaire. No difference in the quality of life was observed between osteopenic individuals and those with normal BMD. The new definition identifies a population with significant decrements in health-related quality of life.

Different involutionary changes in bone mineral density with age in three skeletal sites in healthy Polish women

The aim of the study was to estimate the differences in bone mineral density (BMD) at three skeletal sites, with regard to age and menopausal status. The study was conducted between 2001 and 2006 in the Polish city of Wrocław and the sample was comprised of 440 healthy female inhabitants aged 40-88years. The measurements of bone mineral density were taken at three sites: femoral neck, Ward's triangle and trochanter major. Two bone mineral density characteristics were used in further analysis: absolute measure of bone mineral density (BMD) expressed in g/(100mm)(2), and % of BMD of the peak value calculated for young adults (20-45, USA reference population). Pre- and postmenopausal status was defined according to occurrence of menstruation within the last 60days. The changes in bone mineral density with age showed significantly different patterns in different skeletal sites. While the decrease in bone mineral density in the femoral neck and Ward's triangle were parallel and gradual, the changes in trochanter major were very small and between the age groups 51-55 and 71-75, nearly unnoticeable. A comparison between pre- and postmenopausal women aged 46-55, showed a significant effect of menopausal status. The average bone mineral densities in the three skeletal sites were higher in premenopausal than in postmenopausal women. The highest value of bone mineral density was found in the femoral neck, significantly lower in Ward's triangle, and a little lower (non-significantly) in the trochanter major than in the Ward's triangle. Postmenopausal women had a little higher BMD value in the trochanter major than in the Ward's triangle site.

Similarities in acquired factors related to postmenopausal osteoporosis and sarcopenia

Postmenopausal population is at increased risk of musculoskeletal impairments. Sarcopenia and osteoporosis are associated with significant morbidity and social and health-care costs. These two conditions are uniquely linked with similarities in pathophysiology and diagnostic methods. Uniform diagnostic criteria for sarcopenia are still evolving. Postmenopausal sarcopenia and osteoporosis share many environmental risk- and preventive factors. Moreover, geriatric frailty syndrome may result from interaction of osteoporosis and sarcopenia and may lead to increased mortality. The present paper reviews the factors in evolution of postmenopausal sarcopenia and osteoporosis.

Hand Grip Strength: age and gender stratified normative data in a population-based study

BACKGROUND

The North West Adelaide Health Study is a representative longitudinal cohort study of people originally aged 18 years and over. The aim of this study was to describe normative data for hand grip strength in a community-based Australian population. Secondary aims were to investigate the relationship between body mass index (BMI) and hand grip strength, and to compare Australian data with international hand grip strength norms.

METHODS

The sample was randomly selected and recruited by telephone interview. Overall, 3 206 (81% of those recruited) participants returned to the clinic during the second stage (2004-2006) which specifically focused on the collection of information relating to musculoskeletal conditions.

RESULTS

Following the exclusion of 435 participants who had hand pain and/or arthritis, 1366 men and 1312 women participants provided hand grip strength measurement. The study population was relatively young, with 41.5% under 40 years; and their mean BMI was 28.1 kg/m2 (SD 5.5). Higher hand grip strength was weakly related to higher BMI in adults under the age of 30 and over the age of 70, but inversely related to higher BMI between these ages. Australian norms from this sample had amongst the lowest of the hand grip strength of the internationally published norms, except those from underweight populations.

CONCLUSIONS

This population demonstrated higher BMI and lower grip strength in younger participants than much of the international published, population data. A complete exploration of the relationship between BMI and hand grip strength was not fully explored as there were very few participants with BMI in the underweight range. The age and gender grip strength values are lower in younger adults than those reported in international literature.

Body fat distribution is associated with lumbar spine bone density independently of body weight in postmenopausal women

OBJECTIVE

To assess the association between the body fat distribution and axial bone mineral density (BMD) in postmenopausal women with or without hormone replacement therapy (HRT).

DESIGN

Cross-sectional population-based study.

SETTING

University of Eastern Finland, Bone and Cartilage Research Unit, Kuopio, Finland.

POPULATION

198 postmenopausal women, mean age 67.5 (1.9 SD), mean BMI 27.1 (3.9 SD).

METHODS

Regional body composition and BMD assessed by dual X-ray absorptiometry (DXA, Prodigy).

MAIN OUTCOME MEASURES

Spinal and Femoral BMD.

RESULTS

Out of the body composition parameters, FM was the main determinant of postmenopausal bone mass. Only the lumbar spine (L2-L4) BMD, not the femoral neck BMD, was positively associated with the trunk FM. Positive trends for association were revealed between the spinal BMD and the trunk FM regardless of the use of HRT. Adjustments did not change the results.

CONCLUSIONS

Higher trunk fat mass was associated with the spinal BMD, but not with the hip BMD in postmenopausal women, irrespective of the HRT use. In addition to biological factors, uncertainties related to DXA measurements in patients with varying body mass may contribute to this phenomenon.

Relationship of Physical Performance with Body Composition and Bone Mineral Density in Individuals over 60 Years of Age: A Systematic Review

The purpose of this review was to examine the relationship between physical performance and body composition measurements, including fat/muscle mass and bone mineral density (BMD) in individuals ≥60 years of age. Various measurements used to assess body composition, BMD, and physical performance (PP) were discussed as well. Medline/PubMed, CINAHL, and SCIE were used to identify articles. After limiting the search for age and kind of physical performance measures, 33 articles were evaluated. Higher fat mass was associated with poorer physical performance while higher muscle mass was a predictor of better physical performance, especially in the lower extremities. Additionally, evidence showed that higher muscle fat infiltration was a determinant of poorer physical performance. BMD was shown to be a good predictor of physical performance although the relationship was stronger in women than in men. Developing standardized methods for PP measurements could help in further investigation and conclusions of its relationship with body composition.

Associations between short one-leg standing time and speed of sound of calcaneal bone in a general population: the Shimanami Health Promoting Program (J-SHIPP) study

AIM

Loss of bone mass is a major cause of fracture in the elderly. One-leg standing (OLS) time has been postulated to be predictive of reduced bone mass. Here, we conducted a cross-sectional study to clarify whether OLS time measurements are associated with the speed of sound (SOS) of calcaneal bone independent of muscle mass in the lower extremity, a major confounding factor for the association, in a community-dwelling population of middle-aged to elderly subjects.

METHODS

The study subjects consisted of 770 apparently healthy middle-aged to elderly community-residents. Quantitative assessment of calcaneal bone was done using a quantitative ultrasound technique. OLS time with eyes open was measured with a maximum time of 60 s. Femoral muscle cross-sectional area (CSA) was measured from a computed tomography image.

RESULTS

Subjects who could not stand 60 s on one leg (n = 192) showed significantly lower SOS (1487 +/- 20, 1501 +/- 24 m/s, P < 0.001). In addition, femoral muscle CSA was positively associated with SOS (male, r = 0.148, P < 0.01; female, r = 0.204, P < 0.001). However, multiple regression analysis adjusted for age, sex and muscle CSA identified short OLS time less than 60 s as an independent determinant of SOS in both male (P < 0.001) and female (P < 0.05) subjects. OLS time was significantly associated with posturograph-measured mobility of the center of gravity. However, multiple regression analysis showed no significant correlation between balance impairment and SOS (P > 0.1).

CONCLUSION

OLS time less than 60 s was significantly associated with reduced SOS independent of age, sex and muscle mass in the lower extremity.

Correlates and predictors of self-rated health and ambulatory status among elderly women - Cross-sectional and 10 years population-based cohort study

AIM

To investigate the correlates and predictors of self-rated health (SRH) and self-reported ambulatory status (AMB) among elderly women.

SUBJECTS AND METHODS

A random sample of 1620 postmenopausal women aged 53-66 years in 1994 was selected from Osteoporosis Risk Factor and Prevention (OSTPRE) - study cohort in Finland. SRH and AMB were assessed in baseline (1994) and after 10-year follow-up (2004). A prognostic model was developed to predict the probability of good 10-year SRH and AMB.

RESULTS

Full AMB was correlated with and predicted by good SRH (OR=4.3, p<0.001). Good quality of life (QoL) was both correlate and predictor of good 10-year SRH (OR=2.0, p<0.001) and full AMB (OR=2.6, p<0.001). Low BMI was associated with good SRH (OR=0.97, p<0.049) and full AMB (OR=0.92, p<0.001), good grip strength with good SRH (OR=2.7, p<0.001) and ability to squat down with full AMB (OR=1.7, p=0.002). Cardiovascular diseases, arthritis and back pain were common significant negative correlates (p<0.001) of baseline AMB and SRH out of variety of chronic diseases with significant association with either one. The significant (p<0.05) baseline predictors in final prognostic model for good 10-year SRH included baseline AMB and SRH, QoL, age, BMI, grip strength and psychiatric diseases (C-index=0.81) and for full 10-year AMB ability to squat, baseline AMB and SRH, QoL, BMI, hypertension and arthritis (C-index=0.81). These risk scores had better predictive power in comparison to that of baseline SRH and AMB alone (p<0.001 in univariate Z-score test).

CONCLUSIONS

Among elderly women AMB is strongly linked to SRH. SRH and AMB are affected mostly by musculoskeletal, cardiovascular and psychiatric diseases as well as body anthropometry, muscle strength and subjective QoL. The present study provides a novel algorithm for predicting probability of full AMB and good SRH in postmenopausal women.