Physical activity, body mass index and bone mineral density-associations in a prospective population-based cohort of women and men: the Canadian Multicentre Osteoporosis Study (CaMos)

Musculoskeletal crosstalk in chronic obstructive pulmonary disease and comorbidities: Emerging roles and therapeutic potentials

Chronic Obstructive Pulmonary Disease (COPD) is a multifaceted respiratory disorder characterized by progressive airflow limitation and systemic implications. It has become increasingly apparent that COPD exerts its influence far beyond the respiratory system, extending its impact to various organ systems. Among these, the musculoskeletal system emerges as a central player in both the pathogenesis and management of COPD and its associated comorbidities. Muscle dysfunction and osteoporosis are prevalent musculoskeletal disorders in COPD patients, leading to a substantial decline in exercise capacity and overall health. These manifestations are influenced by systemic inflammation, oxidative stress, and hormonal imbalances, all hallmarks of COPD. Recent research has uncovered an intricate interplay between COPD and musculoskeletal comorbidities, suggesting that muscle and bone tissues may cross-communicate through the release of signalling molecules, known as "myokines" and "osteokines". We explored this dynamic relationship, with a particular focus on the role of the immune system in mediating the cross-communication between muscle and bone in COPD. Moreover, we delved into existing and emerging therapeutic strategies for managing musculoskeletal disorders in COPD. It underscores the development of personalized treatment approaches that target both the respiratory and musculoskeletal aspects of COPD, offering the promise of improved well-being and quality of life for individuals grappling with this complex condition. This comprehensive review underscores the significance of recognizing the profound impact of COPD on the musculoskeletal system and its comorbidities. By unravelling the intricate connections between these systems and exploring innovative treatment avenues, we can aspire to enhance the overall care and outcomes for COPD patients, ultimately offering hope for improved health and well-being.

Sedentary behavior does not predict low BMD nor fracture-population-based Canadian Multicentre Osteoporosis Study

Sedentary behavior (SB) or sitting is associated with multiple unfavorable health outcomes. Bone tissue responds to imposed gravitational and muscular strain with there being some evidence suggesting a causal link between SB and poor bone health. However, there are no population-based data on the longitudinal relationship between SB, bone change, and incidence of fragility fractures. This study aimed to examine the associations of sitting/SB (defined as daily sitting time), areal BMD (by DXA), and incident low trauma (fragility) osteoporotic fractures (excluding hands, feet, face, and head). We measured baseline (1995-7) and 10-yr self-reported SB, femoral neck (FN), total hip (TH), and lumbar spine (L1-L4) BMD in 5708 women and 2564 men aged 25 to 80+ yr from the population-based, nationwide, 9-center Canadian Multicentre Osteoporosis Study. Incident 10-yr fragility fracture data were obtained from 4624 participants; >80% of fractures were objectively confirmed by medical records or radiology reports. Vertebral fractures were confirmed by qualitative morphological methods. All analyses were stratified by sex. Multivariable regression models assessed SB-BMD relationships; Cox proportional models were fit for fracture risk. Models were adjusted for age, height, BMI, physical activity, and sex-specific covariates. Women in third/fourth quartiles had lower adjusted FN BMD versus women with the least SB (first quartile); women in the SB third quartile had lower adjusted TH BMD. Men in the SB third quartile had lower adjusted FN BMD than those in SB first quartile. Neither baseline nor stable 10-yr SB was related to BMD change nor to incident fragility fractures. Increased sitting (SB) in this large, population-based cohort was associated with lower baseline FN BMD. Stable SB was not associated with 10-yr BMD loss nor increased fragility fracture. In conclusion, habitual adult SB was not associated with subsequent loss of BMD nor increased risk of fracture.

Risk of fractures and use of bisphosphonates in adult patients with immune thrombocytopenia-A nationwide population-based study

Corticosteroids remain the first-line treatment of immune thrombocytopenia (ITP), but increase the risk of osteoporosis and fractures. Bisphosphonates are used for the treatment of osteoporosis, but their usage among patients with ITP has not been systemically described. We investigated the risk of fractures and the use of bisphosphonates in adult patients with primary (pITP) and secondary ITP (sITP) compared with matched comparators in a nationwide registry-based cohort study. We identified 4030 patients with pITP (median age 60 years [IQR, 40-74]), 550 with sITP (median age 59 years [IQR, 43-74]) and 182 939 age-sex-matched general population comparators. All individuals were followed for incident fractures. Bisphosphonate use was estimated for calendar-years and in temporal relation to the ITP diagnosis. Adjusted cause-specific hazard ratio (csHR) for any fracture was 1.37 (95% confidence interval [CI] 1.23; 1.54) for pITP and 1.54 (1.17; 2.03) for sITP. The first-year csHR was 1.82 (1.39; 2.40) for pITP and 2.78 (1.58; 4.91) for sITP. Bisphosphonate use over calendar-years and in the early years following ITP diagnosis was higher among patients with ITP diagnosis compared with the general population. In conclusion, the risk of fractures and the use of bisphosphonates are higher in patients with ITP compared with the general population.

Exposure to Neighborhood Walkability and Residential Greenness and Incident Fracture

Importance

Emerging studies have suggested that environmental factors are associated with fracture. However, little is known about the association of neighborhood walkability and residential greenness with fracture.

Objective

To investigate the association of long-term exposure to walkability and greenness with incident fracture and explore the potential interaction effect.

Design, Setting, and Participants

This cohort study recruited participants aged 40 years or older in Ningbo, China from June 2015 to January 2018. Participants were observed for outcomes through February 2023, with data analysis conducted in March 2023.

Exposures

Neighborhood walkability was measured by a modified walkability calculation method according to a walk score tool. Residential greenness was assessed by satellite-derived normalized difference vegetation index (NDVI) within a 1000-m buffer.

Main Outcomes and Measures

Incident fracture was ascertained according to International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes via the Yinzhou Health Information System. Cox proportional hazards models were fit, with age as time scale to estimate the associations of walkability and greenness with fracture. Potential effect modification was explored by covariates, as well as the interactive effect of walkability and greenness.

Results

A total of 23 940 participants were included in this study with 13 735 being female (57.4%). The mean (SD) age at baseline was 63.4 (9.4) years. During a follow-up period of 134 638 person-years, 3322 incident fractures were documented. In the full adjusted model, every IQR increment in neighborhood walkability and residential greenness was associated with a hazard ratio (HR) of 0.88 (95% CI, 0.83-0.92) and 0.84 (95% CI, 0.80-0.89), respectively, for fracture. Furthermore, the association of greenness and fracture was greater with an increase in walkability. The HR (Q4 vs Q1) for greenness was 0.62 (95% CI, 0.46-0.82) in neighborhoods with the highest quartile of walkability.

Conclusions and Relevance

This population cohort study suggested that long-term exposure to neighborhood walkability and residential greenness were both associated with lower risk of incident fracture. The benefits of greenness increased in more walkable areas.

Bone health and prevalent fractures in women with polycystic ovary syndrome: a meta-analysis and endocrine-context pathophysiology review

INTRODUCTION

Bone health in those with Polycystic Ovary Syndrome (PCOS) is complex, but the general consensus is that cortical areal bone mineral density (aBMD) sites will be higher in PCOS than in age- and BMI-similar controls. However, spine aBMD sites may be lower, especially in non-obese PCOS. Whether or not incident fracture risk is increased in PCOS is currently controversial; no meta-analysis has yet assessed prevalent fractures.

AREAS COVERED

We assessed the bone effects of PCOS-related ovarian hormone alterations, e.g. androgen excess, tonically normal/higher estradiol, and lower-than-normal progesterone levels. We also highlighted evidence that common PCOS medications (e.g. combined hormonal contraceptives [CHC], metformin, and spironolactone) have important bone effects. In adolescents, meta-analysis of CHC showed significant negative aBMD changes. Inflammation has negative PCOS bone effects and is linked with CHC use.

EXPERT OPINION

Is fracture risk altered by PCOS? Our meta-analysis showed a 25% increased risk of prevalent fracture in PCOS versus controls; this did not reach statistical significance. Future prospective research needs to collect and evaluate ovulation characteristics, progesterone exposure, and adolescent CHC use, in addition to the complex variables that may influence risks for prevalent or incident fragility fractures and/or for cortical and cancellous aBMD values in PCOS.

Osteoporosis in COPD patients: Risk factors and pulmonary rehabilitation

Objectives

To present a review on the pathogenesis, risk factor and treatment of chronic obstructive pulmonary disease complicated with osteoporosis and provide new ideas for the diagnosis and treatment.

Data source

A systematic search is carried out using keywords as chronic obstructive pulmonary disease, osteoporosis, risk factors, and pulmonary rehabilitation.

Results

Patients with chronic obstructive pulmonary disease have a high prevalence of osteoporosis and a high risk of fracture. The mechanisms of osteoporosis in COPD patients are associated with general risk factors, such as smoking, reduced physical activity, low weight, and disease‐specific risk factors, such as systemic inflammatory, Vitamin D deficiency, use of glucocorticoid, anemia, hypoxemia, and hypercapnia. The treatment of osteoporosis in COPD emphasizes comprehensive intervention, which mainly include basic treatment and anti‐osteoporosis drugs. Noticeably, pulmonary rehabilitation program is an important part of treatment.

Conclusions

This work summarizes the pathogenesis, risk factor, prevention, and treatment of chronic obstructive pulmonary disease complicated with osteoporosis, and the latest progress of studies on chronic obstructive pulmonary disease and osteoporosis is discussed.

Effects of testosterone and exercise training on bone microstructure of rats

Background and Aim:

Male hypogonadism results from failure to produce physiological levels of testosterone. Testosterone in men is essential in masculine development, sperm production, and adult man’s health. Osteoporosis is one of the consequences of hypogonadism. Regular physical exercise and exogenous testosterone administration are frequently used to prevent or treat this condition. This study aimed to understand the effects of lifelong exercise training and testosterone levels (isolated and together) in the main bone structure parameters.

Materials and Methods:

A total of 24 rats were used and randomly divided into four groups: Control group (CG; n=6), exercised group (EG, n=6), testosterone group (TG, n=6), and testosterone EG (TEG, n=6). A micro-computed tomography equipment was used to evaluate 15 bone parameters.

Results:

Both factors (exercise training and testosterone) seem to improve the bone resistance and microstructure, although in different bone characteristics. Testosterone influenced trabecular structure parameters, namely, connectivity density, trabecular number, and trabecular space. The exercise promoted alterations in bone structure as well, although, in most cases, in different bone structure parameters as bone mineral density and medullar mineral density.

Conclusion:

Overall, exercise and testosterone therapy seems to have a synergistic contribution to the general bone structure and resistance. Further studies are warranted, comparing different individual factors, as gender, lifestyle, or testosterone protocols, to constantly improve the medical management of hypogonadism (and osteoporosis).

Anthropometric and Body Composition Measurements Related to Osteoporosis in Geriatric Population

Objective:

This study aimed to evaluate different anthropometric and body composition measurements, including weight, body mass index (BMI), body fat percentage (fat%), skeletal muscle index (SMI), a body shape index (ABSI), waist circumference (WC), and hip circumference (HC), in relation to bone mineral density.

Methods:

This is a cross-sectional study of a total of 482 patients who consulted the geriatric outpatient clinic between 2018 and 2019. Patients were evaluated with dual-energy X-ray absorptiometry. Anthropometric measurements (HC, WC, weight, BMI, and ABSI), as well as body composition analysis (fat% and SMI) by bioimpedance analysis system, were performed. The patients were evaluated with the rapid Assessment of Physical Activity Index in terms of aerobic exercise habits.

Results:

There was a significant correlation between lumbar spine (LS) T-score and SMI (r=0.36, p=0.000) and between LS T-score and weight (r=0.21, p=0.000), BMI (r=0.10, p=0.045) and WC (r=0.15, p=0.001). There was a statistically significant correlation between femur neck (FN) T-score and fat% (r=0.15, p=0.001), SMI (r=0.15, p=0.010), weight (r=0.22, p=0.000), BMI (r=0.20, p=0.000), WC (r=0.14, p=0.003), and HC (r=0.17, p=0.001). There was no statistically significant correlation between physical activity and LS T-score (n=353, r=0.08, p=0.16) and FN T-score (n=360, r=0.03, p=0.53). In multiple regression analysis, SMI contributes most in predicting FN and LS T-scores.

Conclusions:

Anthropometric measurements should be carefully selected in the geriatric population. Among the measurements, the strongest relationship was found between LS T-score and SMI.

Yoga and Bone Health

Osteoporosis is a public health problem affecting individuals globally. Yoga has been found to prevent and reverse bone loss. Yoga may result in better balance, improved posture, and greater range of motion, strength, and coordination, all factors that also mitigate the risk of falls and fractures. A 12-minute, 12-pose yoga regimen is discussed in detail. Once learned, the ongoing use of yoga is safe, without cost, and may be done lifelong.

Effect of body mass index on bone mineral density is age-specific

BACKGROUND AND AIMS

Obesity and osteoporosis are two important and growing public health problems worldwide. Body mass index (BMI) has been found to be inversely related to the risk of osteoporotic fracture. We aimed to assess the association of BMI with thoracic vertebral bone mineral density (BMD) measured from a quantitative computed tomography (QCT).

METHODS AND RESULTS

We retrospectively evaluated the data from 15,758 consecutive patients (5675 females and 10,083 males) between age 20-90 years, who underwent Coronary Artery Calcium (CAC) scoring. Quantitative data analyses of thoracic trabecular BMD (mg/cm³) was performed with a phantom system or phantomless using validated software. The gender-specific subgroup was divided based on age (<45, 45-55, 55-65, >65 yrs in females; <40,40-60,>60 yrs in Males) and weight by BMI (kg/m²) as < 25 (normal or low weight), >25 - <30 (overweight) and >30 (obesity). Analysis of variance (ANOVA) and Scheffe's post hoc procedure tested the association of body weight/BMI on BMD. A significant positive association between the body weight and BMD existed in obese population in elder groups in both genders (p < 0.05). There was no significant difference in BMD in 40-60 years in men and <55 years in women with normal or low weight compared to overweight or obese cohorts.

CONCLUSIONS

We concluded that the effect of weight on BMD is age-specific and the BMD should be monitored routinely with a cardiac CT scan in the senile population.

Physical Activity and Psychosocial Factors Associated With Risk of Future Fractures in Middle-Aged Men and Women

Identification of risk factors for fractures is important for improving public health. We aimed to identify which factors related to physical activity and psychosocial situation were associated with incident fractures among 30,446 middle-aged women and men, followed from 1991-1996 to 2016, in a prospective population-based cohort study. The association between the baseline variables and first incident fracture was assessed by Cox regression models, and significant risk factors were summed into fracture risk scores. Any first incident fracture affecting spine, thoracic cage, arms, shoulders, hands, pelvis, hips, or legs was obtained from the National Patient Register, using the unique personal identity number of each citizen. A total of 8240 subjects (27%) had at least one fracture during the follow-up of median 20.7 years. Age, female sex, body mass index, previous fracture, reported family history of fracture >50 years (all p < .001), low leisure-time physical activity (p = .018), heavy work (p = .024), living alone (p = .002), smoking (p < .001), and no or high alcohol consumption (p = .005) were factors independently associated with incident fracture. The fracture risk score (0-9 points) was strongly associated with incident fracture (p for trend <.001). Among men without risk factors, the incidence rate was 5.3/1000 person-years compared with 23.2 in men with six or more risk factors (hazard ratio [HR] = 5.5; 95% confidence interval [CI] 3.7-8.2). Among women with no risk factors, the incidence rate was 10.7 compared with 28.4 in women with six or more risk factors (HR = 3.1; 95% CI 2.4-4.0). Even moderate levels of leisure-time physical activity in middle age are associated with lower risk of future fractures. In contrast, heavy work, living alone, smoking, and no or high alcohol consumption increase the risk of fracture. Our results emphasize the importance of these factors in public health initiatives for fracture prevention. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Associations between Physical Activity, Sunshine Duration and Osteoporosis According to Obesity and Other Lifestyle Factors: A Nested Case-Control Study

(1) Background: The purpose of the study was to evaluate the associations between physical activity (PA), sunshine duration (SD) and the occurrence of osteoporosis according to lifestyle status. (2) Methods: Data from the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) collected from 2009 to 2015 were used. Osteoporosis (n = 19,351) and control (n = 38,702) participants were matched in a 1:2 ratio according to age, sex, income, and region of residence. PA was classified as moderate- to high-intensity PA (MHPA) or low-intensity PA (LPA) based on the International Physical Activity Questionnaire (IPAQ). SD was classified as short (≤6 h) or long (>6 h). Conditional logistic regression was used to calculate the odds ratios (ORs) with 95% confidence intervals (CIs) of MHPA and long SD for the occurrence of osteoporosis. Subgroup analyses were performed according to SD (or PA), obesity, smoking, and alcohol consumption. (3) The adjusted OR of MHPA for osteoporosis was 0.90 (95% CI = 0.87-0.94). The results were consistent in the age/sex, SD, obesity, smoking, and alcohol consumption subgroups, but not the <60-year-old male and underweight subgroups. The adjusted OR of long SD for osteoporosis was 0.96 (95% CI = 0.93-1.00). The findings were consistent in the <60-year-old female, obese, nonsmoker, and <1 time a week alcohol consumption subgroups. (4) Conclusions: We suggest that both higher intensity of PA and long SD could decrease the risk of osteoporosis. Specifically, PA could decrease the risk of osteoporosis in individuals with most characteristics except male sex or underweight. Long SD could decrease the risk of osteoporosis in young females, obese individuals, nonsmokers, and individuals with lower alcohol consumption.

Intensity Matters for Musculoskeletal Health: A Cross-Sectional Study on Movement Behaviors of Older Adults from High-Income Scottish and Low-Income South African Communities

This study aimed to investigate differences in physical activity (PA) patterns and the associations between objectively measured 24-h movement behaviors and musculoskeletal measures (muscle strength, muscle mass, physical performance, and bone mineral density) in a high-income and a low-income community. This cross-sectional study recruited independent living older adults aged 60-85 years from high-income Scottish (n = 150) and low-income South African (n = 138) settings. Participants completed demographic and health questionnaires, and testing included body composition and bone mineral density (dual energy X-ray absorptiometry), physical performance (grip strength, gait speed), and PA (accelerometry). Participants accumulated similar amounts of weekly total PA, however, the Scottish cohort engaged in more moderate-to-vigorous intensity PA (MVPA) and sedentary behavior (SB), while the South African cohort spent more time sleeping and in light intensity PA (LPA). From compositional data analysis, more time spent in MVPA relative to the other movement behaviors was positively associated with higher muscle mass (p < 0.001) and strength (p = 0.001) in the Scottish cohort. Conversely, more time spent in MVPA was associated with faster gait speed (p < 0.001) and greater hip bone mineral density (p = 0.011) in the South African cohort. Our findings confirm the beneficial role of MVPA in both high- and low-income cohorts, however, the relationship MVPA had with components of musculoskeletal health in older adults differed between settings.

Higher-Impact Physical Activity Is Associated With Maintenance of Bone Mineral Density But Not Reduced Incident Falls or Fractures in Older Men: The Concord Health and Aging in Men Project

High-impact physical activities with bone strains of high magnitude and frequency may benefit bone health. This study aimed to investigate the longitudinal associations between changes in loading intensities and application rates, estimated from self-reported physical activity, with bone mineral density (BMD) changes over 5 years and also with incident falls over 2 years and long-term incident fractures in community-dwelling older men. A total of 1599 men (mean age 76.8 ± 5.4 years) from the Concord Health and Aging in Men Project (CHAMP) were assessed at baseline (2005-2007) and at 2- and 5-year follow-up. At each time point, hip and lumbar spine BMD were measured by dual-energy X-ray absorptiometry, and physical activity energy expenditure over the past week was self-reported via the Physical Activity Scale for the Elderly (PASE) questionnaire. Sum effective load ratings (ELRs) and peak force were estimated from the PASE questionnaire, reflecting the total and highest loading intensity and application rate of physical activities, respectively. Participants were contacted every 4 months over 2 years to self-report falls and over 6.0 ± 2.2 years for fractures. Hip fractures were ascertained by data linkage for 8.9 ± 3.6 years. Compared with sum ELR and PASE scores, peak force demonstrated the greatest standardized effect size for BMD maintenance at the spine (β = 9.77 mg/cm² ), total hip (β = 14.14 mg/cm² ), and femoral neck (β = 13.72 mg/cm² ) after adjustment for covariates, including PASE components (all p < .01). Only PASE scores were significantly associated with reduced falls risk (standardized incident rate ratio = 0.90, 95% confidence interval 0.81-1.00, p = .04). All physical activity measures were significantly associated with reduced incident fractures in univariate analyses, but none remained significant after multivariable adjustments. Older men who engaged in physical activity of high and rapid impact maintained higher BMD, while higher energy expenditure was associated with reduced falls risk. Coupling traditional physical activity data with bone loading estimates may improve understanding of the relationships between physical activity and bone health. © 2020 American Society for Bone and Mineral Research (ASBMR).

Cross-Cultural Adaptation and Validation of Nigerian (Igbo) Version of the Physical Activity Scale for the Elderly

OBJECTIVES

To cross-culturally adapt and validate the Physical Activity Scale for the Elderly (PASE) into Igbo culture.

METHODS

The English version of the PASE (E-PASE) was translated into Igbo, harmonized, back-translated, subjected to expert panel review, and pretested. The final Igbo version of PASE (I-PASE), the E-PASE, and the International Physical Activity Questionnaire were then administered to consecutively recruited 109 consenting Igbo older adults. Data were analyzed using frequency, percentage, mean, standard deviation, Mann-Whitney U test, Spearman rank-order correlation, and Cronbach's alpha at .05 level of significance.

RESULTS

All items on the E-PASE were retained on the I-PASE but some modifications were made. The I-PASE had poor internal consistency coefficient (α = .66), poor-to-excellent item, and total score known-group validity (ρ = .24-1.00) and moderate convergent validity (ρ = .50).

CONCLUSION

The I-PASE is a valid, reliable, and culturally specific tool for assessing PA among Igbo older adults.

Bone Mineral Density in Severely Obese Women: Health Risk and Health Protective Risk Factors in Three Different Bone Sites

Factors associated with bone mineral density (BMD) are poorly known in severely obese individuals i.e., a body mass index (BMI) > 35 kg/m2. The objectives of this study were to describe the bone health profile of severely obese Brazilian women, to identify the health risk and health protective factors for BMD in this group and to assess whether these factors vary according to three different bone sites. BMD was assessed using dual-energy X-ray absorptiometry (DXA). This study analyzed baseline data from 104 women who had an average BMI of 43.7 ± 4.5 kg/m2 and presented the following BMD status: 1.283 ± 0.094 g/cm2 for total body, 1.062 ± 0.159 g/cm2 for vertebral column and 1.195 ± 0.134 g/cm2 for hip. They took part in the "Effect of nutritional intervention and olive oil in severe obesity" randomized clinical trial (DieTBra Trial). The risk factors negatively associated with lower BMD were age ≥50 years for the three bone sites i.e., total body, vertebral column and hip. Smoking for total body BMD (p = 0.045); BMI ≥ 50kg/m2 for vertebral column and hip; menopause for hip; high C-reactive protein (CRP) levels (p = 0.049), insufficient zinc (p = 0.010) and previous fracture for vertebral column (p = 0.007). The protective factors positively associated with BMD were physical activity (≥150 min/week (p = 0.001)) for hip; type 2 diabetes mellitus (DM2) (p < 0.0001) total body and adequate vitamin D levels from food consumption (p = 0.039) for vertebral column. A BMI ≥ 50 kg/m2 was a risk factor for lower BMD. The findings showed that protective and risk factors varied by bone site. The original study is registered with ClinicalTrials.gov. (protocol number: NCT02463435).

The effect of voluntary wheel running on the antioxidant status is dependent on sociability conditions

Voluntary wheel running is widely used as a physical activity (PA) model in rodents, but most studies investigate the beneficial effects of this intervention in socially isolated mice. Social isolation stress (SIS) is associated with vulnerability to oxidative stress and reduced mitochondrial activity. Thus, the aim of this study was to investigate the effects of free access to a running wheel for 21 days on the various markers of the cellular redox/antioxidant status as well as mitochondrial function of mice subjected to SIS or maintained in groups of 3 in the homecage. SIS increased thiobarbituric acid reactive substance (TBARS) levels in the cerebral cortex, and PA intervention was not able to reverse such alteration. PA reduced TBARS levels in the liver of grouped mice and gastrocnemius of socially isolated mice. PA increased nonprotein thiol (NPSH) levels in the cerebral cortex of grouped mice. Furthermore, socially isolated mice presented lower glutathione peroxidase (GPx) activity in the cerebellum and gastrocnemius, and glutathione reductase (GR) activity in the cerebral cortex and liver. By contrast, SIS induced higher GPx activity in the cerebral cortex and heart. PA reduced GPx (cerebral cortex) and GR (cerebral cortex and liver) activities of socially isolated mice. SIS caused higher activity of mitochondrial complexes I and II in the cerebral cortex, and the PA paradigm was not able to alter this effect. Interestingly, the PA produced antidepressant-like effect at both SIS and control groups. In conclusion, the results showed the influence of SIS for the effects of PA on the antioxidant status, but not on the mitochondrial function and emotionality.

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PA intervention produces antioxidant responses dependent on sociability conditions.

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SIS induces mitochondria function and antioxidant defense abnormalities.

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Running produces antidepressant-like behavior and does not change the ambulation.

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The distance travelled on the running wheel is correlated with immobility time in the TST.

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The lipoperoxidation index is negatively correlated with time spent on the running wheel.

Determinants of Bone Health in Older Adults

Objective:

The objective of this study was to determine the predictors of bone health in older adults.

Methods:

A total of 313 subjects older than 65 years (mean age 74.2±6.4 years, 70.6% female) were included in the study. Demographic characteristics of participants such as gait speed, handgrip strength, level of physical activity (using Rapid Assessment of Physical Activity-RAPA scale), vitamin D levels, T scores of femur neck (FN) and lumbar spine (LS) were recorded.

Results:

Based on FN, 40.7% of participants had normal T scores whereas 46.2% and 13.1% of them were osteopenic and osteoporotic, respectively. FN was correlated with age (r:-0.184, p<0.001), BMI (r:0.269, p<0.001), and handgrip strength (r:0.149, p:0.009) in addition to the aerobic subscale of RAPA (RAPA-aerobic) (r:-0.133, p:0.02). Similarly, the LS was correlated with female gender (r:-0.207, p<0.001), age (r:0.136, p:0.016), body mass index (BMI) (r:0.246, p<0.001) and handgrip strength (r:0.217, p<0.001). The predictors of bone health were decided upon using multiple logistic regression analysis. The deterministic model consisted of age, gender, BMI, height, weight, handgrip strength, gait speed, RAPA-aerobic and vitamin D. For LS dependent variable, the overall model was significant (F:10.149, p<0.001). However, only two variables were significant predictors in the model ie. weight (β:0.389, p<0.001) and handgrip strength (β=0.186, p<0.001). Similarly for independent variable of FN, the overall model was significant (F:6.525, p<0.001) and only two variables were significant predictors: weight (β:0.371, p<0.001) and RAPA-Aerobic (β:0.148, p:0.009).

Conclusion:

Lower levels of body weight, participation in aerobic activity and handgrip strength might be risk factors for deterioration of bone health in older adults.

Evaluation of Physical Activity in Moroccan Postmenopausal Women with Osteoporotic Vertebral Fractures

Introduction: The purpose of our study is to compare between physical activity (PA) in postmenopausal women with osteoporotic vertebral fractures and healthy women and to evaluate the relationship between PA and clinical and paraclinical parameters related to osteoporotic fracture. Methods: A case-control cross- sectional study, which included 128 postmenopausal women with densitometric osteoporosis as defined by Worlds Health Organization, with at least one radiological vertebral fracture. Physical activity was assessed by the International Physical Activity Questionnaire (IPAQ) short version with three items: vigorous, moderate activity and walking. Bone mineral density (BMD) and X-rays were performed in all patients. The controls were healthy women included in a randomized order in the general population, they were matched for age. Results: 128 patients with a mean age of 61.01± 8.40 years were included. 100 controls were included with a mean age of 60.61 ± 8.25 years. The patients had a median age of menopausal of 48.90 years [48-50], were osteoporotic in 49.2% and had osteopenia in 34.9%. 84 patients had a current back pain, and an average of three vertebral fracture with a median Genant score of 3.02[1-23]. There was no significant difference between the subjects of our study for total PA. However, vigorous-intensity activity and walking were significantly different between the two groups (p<0.05). Three independent factors were associated with a reduction of total physical activity: age, Genant score and physical function (for all p<0.05). In multivariate analysis, a significant association between total physical activity and age (p=0.003), trochanter BMD (p=0.01), Genant score (p=0.02) and physical function (2nd domain QUALEFFO) (p=0.01) persisted. Conclusion: In Moroccan postmenopausal women with osteoporotic vertebral fractures, PA is decreased with the severity of vertebral fractures and with the increasing age. Keywords: Physical activity, osteoporosis, vertebral fractures, postmenopausal women, Morocco

Objectively-measured sedentary time, habitual physical activity and bone strength in adults aged 62 years: the Newcastle Thousand Families Study

BACKGROUND

The influence of sedentary time and habitual physical activity on the bone health of middle aged adults is not well known.

METHODS

Bone mineral density (BMD) and hip bone geometry were evaluated in 214 men (n = 92) and women (n = 112) aged 62.1 ± 0.5 years from the Newcastle Thousand Families Study birth cohort. Accelerometry was used to measure physical activity (PA) and sedentary time over 4 days. Regression models were adjusted for clinical risk factor covariates.

RESULTS

Men were more sedentary than women (P < 0.05), and sedentary time was negatively associated with spine BMD in men, with 84 minutes more sedentary time corresponding to 0.268 g.cm-2 lower BMD (β = -0.268; P = 0.017). In men, light PA and steps/day were positively associated with bone geometry and BMD. Steps/day was positively associated with bone geometry and femur BMD in women, with a positive difference of 1415 steps/day corresponding to 0.232 g.cm-2 greater BMD (β = 0.232, P = 0.015).

CONCLUSIONS

Sedentary time was unfavourably associated with bone strength in men born in North East England at age 62 years. Higher volumes of light PA, and meeting the public health daily step recommendations (10 000 steps/day) was positively associated with bone health in both sexes.

Age at attainment of peak bone mineral density and its associated factors: The National Health and Nutrition Examination Survey 2005-2014

Osteoporosis is a major public health problem worldwide. Lower peak bone mineral density (BMD) in youth may be the single most important factor leading to the development of osteoporosis in the elderly. Using cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2005-2014, we included 18,713 individuals with complete and valid data on femoral neck, total hip and lumbar spine BMD. Generalized additive models were used to estimate the age at attainment of peak BMD and 95% confidence intervals (95%Cls); model covariates were sex, race, body mass index (BMI) and we also examine factors potentially affecting age at attainment of peak BMD. This study clearly stated that age at attainment of peak femoral neck, total hip and lumbar spine BMD were 20.5 years, 21.2 years and 23.6 years in males, and 18.7 years, 19.0 years and 20.1 years in females, respectively and age at attainment of peak BMD varied by skeletal sites and sex. The study also found that females achieved peak femoral neck, total hip and lumbar spine BMD earlier than males (all P < 0.001); race and BMI were not associated with the age at attainment of peak BMD (all P > 0.05). These results suggested that improving bone health among individuals before 20 years old may be useful for reducing future risk of osteoporosis and osteoporotic fractures.

A study on bone mass density using dual energy X-ray absorptiometry: Does high body mass index have protective effect on bone density in obese patients?

Background:

Osteoporosis is known as reduction of bone density, which is diagnosed using dual-energy X-ray absorptiometry. Although some studies have shown high body mass index (BMI) as a protective factor for osteoporosis and fracture risks, some other studies demonstrated obesity as a risk factor for osteoporosis. The aim of this study is to evaluate the relationship between BMI and bone mineral density (BMD) in premenopausal and postmenopausal females. Furthermore, we determined the correlation between BMI and fracture risk in postmenopausal females.

Materials and Methods:

In this study, we evaluated the relationship between the age and BMI with 10-year probability fracture risk (estimated using fracture risk assessment tool) and BMD in the L1–L4 spine and femoral neck. Data were collected from BMD center, Askariye Hospital, Isfahan, Iran, from May 2016 to July 2017.

Results:

The study consisted of 1361 individuals, including 305 premenopausal females and 1056 postmenopausal females. The results showed a statistically significant increase of BMD (P < 0.001) and a decrease of fracture risk (β = −0.158, R² = 0.518) with an increase of BMI in postmenopausal females. Moreover, lumbar spine and femoral neck BMD were significantly higher in individuals with BMI ≥30 than in those with BMI <25 in both premenopausal and postmenopausal females (P < 0.001). In addition, older postmenopausal females indicated significantly lower L1–L4 BMD (r = −0.280, P < 0.05) and femoral neck BMD (r = −0.358, P < 0.05).

Conclusion:

The results showed a positive correlation between BMI and BMD of the spine and femoral neck which did not differ by menopausal status. However, there was a correlation between BMI and fracture risk in postmenopausal females.

Association Between Diet, Physical Activity and Body Mass Index, Fat Mass Index and Bone Mineral Density of Soldiers of the Polish Air Cavalry Units

Research from recent years indicates a problem of excessive body weight among soldiers, who, due to the kind of work carried out, should possess good health and fitness levels. The aim of the study was to determine the association between diet and physical activity and the nutritional status of soldiers of the Polish Air Cavalry Units. One hundred and twenty male soldiers (aged 28 ± 5 years) completed a questionnaire (food frequency questionnaire, long-form International Physical Activity Questionnaire). Body composition was determined by bioelectrical impedance analysis, and bone calcification of the forearm was assessed by the DXA (Dual Energy X-ray Absorptiometry) densitometric method. This study confirmed the association between both the diet and physical activity and body mass index (BMI), fat mass index (FMI), and bone mineral density (BMD) expressed as T-score. Significant negative correlations were found between BMI and the frequency of consumption of cereal products, meat products and fish, and nonalcoholic beverages, between FMI and cereal products, and between BMD T-score and meat products and fish, fat, nuts, and grains, sweets and snacks, and nonalcoholic beverages. Physical activity expressed as metabolic equivalent (MET-minutes/week) negatively correlated with FMI (but not BMI) and positively correlated with the BMD T-score. This study confirmed numerous irregularities in eating behavior and in nutritional status indices; therefore, there is a need for nutritional education and further monitoring of both dietary behaviors and nutritional status of soldiers.

Determinants of Bone Health Status in a Multi-Ethnic Population in Klang Valley, Malaysia

Background and objectives: Studies on osteoporosis risk factors are limited in Malaysia, so this study assesses the factors associated with bone health assessed using dual-energy X-ray absorptiometry (DXA) among Malaysians aged ≥40 years. Subjects and Methods: Data on demography, medical history, dietary and lifestyle practices of 786 Malaysians (51.4% women) aged ≥40 years recruited in Klang Valley were obtained. Their body composition and bone health were determined using DXA. The association between risk factors and bone health status was assessed using binary logistic regression. Results: The prevalence of suboptimal bone health and osteoporosis was higher in women (59.4% and 16.1%) than men (40.8% and 8.4%). Overall, the predictors of suboptimal bone health and osteoporosis among the subjects were increased age and higher fat mass. Lower monthly income was positively associated with osteoporosis. Being menopausal was a risk factor for both suboptimal bone health and osteoporosis in women. Women with no formal education were more likely to get osteoporosis. Being a smoker and Chinese were positively related to suboptimal bone health among men. Meanwhile, predictors of osteoporosis among men were regular alcohol and dairy product consumption, higher fat mass and having a tertiary education. Conclusions: This study calls for immediate and effective interventions for middle-aged and elderly populations with risk factors to halt the progression of bone loss.

The Impact of Aerobic Exercise on Female Bone Health Indicators

Introduction:

Females usually suffer from bone health problems, particularly with aging. Aerobic exercise has been shown to have health benefits for females.

Aim:

The main objective of this study was to investigate the impact of aerobic exercise on female bone health by measuring serum trace elements and bone metabolism markers.

Methods:

Prospective interventional study was conducted at rehabilitation clinics in Royal Medical Services, Jordan. A total of 65 female participants were included. Participants were assigned into three groups: control group (N = 20), osteopenic group (N = 22), and osteoporotic group (N = 23). A standard aerobic exercise protocol was followed for 12 weeks. Endurance exercise protocol involved three sessions weekly for 60 minutes each. At basal level and after the experiment, the following parameters were assessed: body mass index (BMI), bone-specific alkaline phosphatase (BAP), T-score, bone mineral density (BMD), and calcium. The analysis of data was carried out using SPSS version 21. The difference in means was computed based on t-test. Significance was considered at p < 0.05.

Results:

Aerobic training exercise improved the levels of all parameters in all groups for both sexes significantly, including BMI, BAP, T-score, BMD, and calcium (p < 0.05).

Conclusion:

Aerobic training exercise improves bone health and restores the hemostasis of bone tissue by restoring bone biomarkers, including BAP and calcium.

Association between lifestyle and pathologic fractures in patients admitted to surgery departments of selected hospitals affiliated to Alborz University of Medical Sciences in 2014-2015

Background and Purpose:

Health professions that previously focused on treatment of patients are now focusing on prevention and health provision by improving lifestyle and eliminating factors that somehow have a negative impact on human health. Some people have strong skeleton genetically, but others do not. So far, medical science has not been able to change the genetic characteristics of individuals; however, lifestyles can be changed to reach the maximum bone mass. The aim of this study was to investigate the association between lifestyle and pathologic fractures in patients admitted to surgery departments of selected Hospitals in 2014–2015.

Materials and Methods:

In this descriptive (correlational) study, using the Cochran sampling formula, 350 patients with fractures were selected by stratified sampling in surgery departments of selected hospitals affiliated to Alborz University of Medical Sciences. Data were collected using the standard lifestyle questionnaire, which was validated through the test–retest method. The qualitative data of this project were analyzed using SPSS 20 software at a significance level of 0.05.

Results:

Most of the subjects were in the age group of 72–85 years which included 103 (26.8%) people. In all, 187 (48.6%) subjects were male and 198 (51.4%) subjects were female. A total of 83 (21.6%) participants were in the healthy group, 123 (32.0%) subjects were in the osteoporosis group, 113 (29.3%) subjects were in the bone infection group, and 66 (17.1%) individuals were in the general bone disease group.

Conclusion:

All studied components including smoking, physical activity, and nutrition directly affect pathologic fractures.

Estimation of Prevalence of Osteoporosis Using OSTA and Its Correlation with Sociodemographic Factors, Disability and Comorbidities

Osteoporosis is a growing concern for an aging society. The study aimed to estimate the prevalence of older adults who were at risk of osteoporosis and explore factors associated with osteoporosis. The relationship between the risk of osteoporosis, chronic conditions and disability was also explored. We hypothesized that respondents with high risk index of osteoporosis would be associated with greater disability. Participants aged 60 years and above (N = 2565) who were representative of Singapore’s multiethnic population were recruited. The Osteoporosis Self-Assessment Tool for Asians (OSTA) was used to classify the risk of osteoporosis. Information on sociodemographic details and chronic diseases were collected, while severity of disability was measured using the World Health Organization Disability Assessment Schedule 2.0. The overall prevalence of the respondents who were at risk of osteoporosis was 52%. Those belonging to an older age, Chinese, female, never married or widowed, lower education and retired were associated with a higher risk of osteoporosis. A diagnosis of diabetes or hypertension was a protective factor against the risk of osteoporosis. High risk of osteoporosis was not associated with disability. Our findings highlighted specific factors associated with the risk of osteoporosis that could be useful for the prevention of osteoporosis and fractures.

The Impact of Physical Activity on the Health of Young Adult Survivors of Childhood Cancer: An Exploratory Analysis

Purpose: Physical activity (PA) habits of young adult survivors of childhood cancer (SCC) have not been well-characterized, and it is unclear whether PA has a relationship with the health status of young adult SCC. The objective of this study was to determine PA participation of young adult SCC and examine associations between PA participation and late adverse effects of treatment. Methods: A retrospective chart review, including SCC enrolled in the McMaster AfterCare program, was performed. Patient characteristics, health outcomes, and PA information were abstracted. Multivariable logistic regression models were used to examine associations in this exploratory analysis. Results: We identified 253 young adult SCC, 240 of whom had sufficient information on PA participation to determine a Leisure Score Index (LSI). Of these, 45% reported adequate PA (LSI ≥24) and 26% reported no PA (LSI = 0). Significant associations between PA and bone mineral density (p = 0.03), blood pressure (p = 0.04), triglycerides (p = 0.05), and high-density lipoprotein cholesterol (p < 0.01) were demonstrated. Conclusions: The majority of young adult SCC in this cohort reported inadequate PA, despite ongoing healthy active living counseling. We identified associations between PA and bone mineral density as well as lipid profile in this group, which suggest that PA may mitigate risk of sequelae of cancer treatment. Strategies to improve young adult SCC engagement in PA are required.

Status of bone health and association of socio-demographic characteristics with Bone Mineral Density in Pakistani Females

Background & Objective:

The “silent thief” of bone osteoporosis is associated with various modifiable factors, identifying these factors is important in decreasing the prevalence of this highly prevalent disease. Therefore, this study was planned to identify these risk factors for osteoporosis in premenopausal and postmenopausal Pakistani women.

Methods:

A total of 1205 pre and postmenopausal females between the ages of 20 to 80 years were selected. Detailed history about the socio-demographic characteristics including age, education, profession, marital and resident status was recorded. Medical and gynecological history was also taken after informed consent Bone health of females was assessed using calcaneal ultrasound bone densitometer. SPSS 22.0 was used to analyze data.

Results:

Univariate analysis showed that age (30-39 yrs, and 60-69 yrs), occupation (housewives) and education (secondary and primary education, illiterate) were significantly associated with low bone mass density (LBMD). Multivariate analysis showed that age 30-39 years (OR=0.25 95%CI 0.13 – 0.49), age 40-49 years (OR=0.30 95%CI 0.15 – 0.59), age 50-59 years (OR=0.42 95%CI 0.22 – 0.79), primary education (OR=3.83, 95%CI 2.30 - 6.38) and illiteracy (OR=3.83 95%CI 2.52 – 5.82), were significantly associated with LBMD. The prevalence of osteopenia and osteoporosis was 29.8%, 27.2%, respectively, while 43% subjects had normal BMD.

Conclusion:

It is concluded that, within Pakistani population, the prevalence of osteopenia is high even at an early age group and the odds of having LBMD are more in less educated or illiterate women.

Factors Influencing Bone Mineral Density Among Adults of Delhi: A Gender Differential

Objective: The aim of the study was to find out the risk factor of bone mineral density (BMD).

Methodology: Cross-sectional data were collected on 233 participants (males and females) with age ranging from 20 to 70 years. The subjects were divided into two groups consisting of young adults of 20–45 years and older adults of >45 years. The BMD was calculated by a heel ultrasonic test. Each subject was measured for various adiposity markers like body fat, body mass index, body shape index (BSI), body adiposity index and lifestyle parameters.

Results: BSI was found to be higher among older adults in both males and females. The risk of osteoporosis and osteopenia was also seen to be significantly higher among older adults of >45 years ( p < 0.001). Various factors like age ( p < 0.001), milk intake status ( p < 0.05), education ( p < 0.01), occupation ( p < 0.05) and body adiposity index ( p < 0.05) were found to be risks for osteoporosis and osteopenia.

Conclusion: In our study, BMD was found to be highly correlated with age, and the risk of osteopenia and osteoporosis increased as age increased. Illiteracy, milk consumption status, homemakers and higher body adiposity were also identified as risk factors for developing osteopenia and osteoporosis.

The Impact of Movement Behaviors on Bone Health in Elderly with Adequate Nutritional Status: Compositional Data Analysis Depending on the Frailty Status

The aim of this study was to determine the relationship between bone mass (BM) and physical activity (PA) and sedentary behavior (SB) according to frailty status and sex using compositional data analysis. We analyzed 871 older people with an adequate nutritional status. Fried criteria were used to classify by frailty status. Time spent in SB, light intensity PA (LPA) and moderate-to-vigorous intensity PA (MVPA) was assessed from accelerometry for 7 days. BM was determined by dual-energy X-ray absorptiometry (DXA). The combined effect of PA and SB was significantly associated with BM in robust men and women (p ≤ 0.05). In relation to the other behaviors, SB was negatively associated with BM in robust men while BM was positively associated with SB and negatively with LPA and MVPA in robust women. Moreover, LPA also was positively associated with arm BM (p ≤ 0.01). Finally, in pre-frail women, BM was positively associated with MVPA. In our sample, to decrease SB could be a good strategy to improve BM in robust men. In contrast, in pre-frail women, MVPA may be an important factor to consider regarding bone health.

Physical activity as measured by accelerometer in NHANES 2005-2006 is associated with better bone density and trabecular bone score in older adults

In an analysis of NHANES 2005-2006, older, but not younger, women and men with higher levels of physical activity had higher TBS, total hip T-score, and femoral neck T-score. Even modest levels of physical activity may be a crucial component of bone health maintenance.

PURPOSE

Physical activity is associated with improved bone parameters in adolescence, but it is not clear if this persists into adulthood. Further, it is unclear how low levels of physical activity as measured by accelerometer may impact bone parameters.

METHODS

We analyzed data from subjects from NHANES 2005-2006 over the age of 20 who had accelerometry and bone mineral density (BMD) testing. We analyzed women and men separately and grouped by over or under 50 years of age: 484 younger women, 486 older women, 604 younger men, and 609 older men. Moderate-to-vigorous physical activity (MVPA) was categorized as low (less than 5 min daily), intermediate (5-20 min daily), or high (at least 20 min daily).

RESULTS

Among younger women and men, there was no significant relationship between MVPA and BMD or trabecular bone score (TBS). Conversely, older women with intermediate and high MVPA had higher TBS (1.360 ± 0.008 and 1.377 ± 0.009 vs 1.298 ± 0.010, p < 0.001), total hip T-score (- 1.02 ± 0.13 and - 0.90 ± 0.09 vs. - 1.51 ± 0.08, p < 0.01), and femoral neck T-score than women with low MVPA, respectively. Similarly, older men with high MVPA had higher TBS, total hip T-score, and femoral neck T-score than men with intermediate and low MVPA.

CONCLUSIONS

Older, but not younger, women and men with higher levels of activity had higher BMD and TBS. Benefits were noted with as little as 5-20 min of daily physical activity. Our results suggest that physical activity is a crucial component of bone health maintenance.

The Effectiveness of Physical Exercise on Bone Density in Osteoporotic Patients

Physical exercise is considered an effective means to stimulate bone osteogenesis in osteoporotic patients. The authors reviewed the current literature to define the most appropriate features of exercise for increasing bone density in osteoporotic patients. Two types emerged: (1) weight-bearing aerobic exercises, i.e., walking, stair climbing, jogging, and Tai Chi. Walking alone did not appear to improve bone mass; however it is able to limit its progressive loss. In fact, in order for the weight-bearing exercises to be effective, they must reach the mechanical intensity useful to determine an important ground reaction force. (2) Strength and resistance exercises: these are carried out with loading (lifting weights) or without (swimming, cycling). For this type of exercise to be effective a joint reaction force superior to common daily activity with sensitive muscle strengthening must be determined. These exercises appear extremely site-specific, able to increase muscle mass and BMD only in the stimulated body regions. Other suggested protocols are multicomponent exercises and whole body vibration. Multicomponent exercises consist of a combination of different methods (aerobics, strengthening, progressive resistance, balancing, and dancing) aimed at increasing or preserving bone mass. These exercises seem particularly indicated in deteriorating elderly patients, often not able to perform exercises of pure reinforcement. However, for these protocols to be effective they must always contain a proportion of strengthening and resistance exercises. Given the variability of the protocols and outcome measures, the results of these methods are difficult to quantify. Training with whole body vibration (WBV): these exercises are performed with dedicated devices, and while it seems they have effect on enhancing muscle strength, controversial findings on improvement of BMD were reported. WBV seems to provide good results, especially in improving balance and reducing the risk of falling; in this, WBV appears more efficient than simply walking. Nevertheless, contraindications typical of senility should be taken into account.

Does coffee drinking have beneficial effects on bone health of Taiwanese adults? A longitudinal study

Background

Results from studies investigating the association between coffee consumption and osteoporosis or bone mineral density (BMD) have been inconsistent. This longitudinal study was performed to assess the effect of coffee drinking on bone health of Taiwanese adults.

Methods

Data were retrieved from the Li-Shin (Landseed) Hospital in Taoyuan City. In 2006, 6152 participants completed a questionnaire on coffee drinking and other lifestyle factors. In 2014, 5077 of them were followed up. Nonetheless, a total of 2395 participants with incomplete data were excluded. The final analyses included 2682 participants comprising 1195 men and 1487 women (706 premenopausal and 781 postmenopausal). T-scores were derived from the osteo-sono assessment index (OSI) which is a surrogate of BMD. Coffee drinking was categorized as “no, medium, and high” based on the number of cups that were consumed per week in both 2006 and 2014.

Results

In general, medium and high coffee drinking were associated with higher T-scores. However, significant results were observed only among high drinkers (β = 0.158; P = 0.0038). Nonetheless, the test for linear trend was significant (P = 0.0046). After stratification by sex, medium and high coffee drinking were associated with higher T-scores. However, significant results were prominent only among high male drinkers (β = 0.237; P = 0.0067) and the test for trend was significant (P = 0.0161). Based on menopausal status, coffee drinking was associated with higher T-scores. Nevertheless, significant results were found only among premenopausal women (β = 0.233; P = 0.0355 and β = 0.234; P = 0.0152 for medium and high coffee drinking, respectively. The test for linear trend was significant (P = 0.0108).

Conclusion

Coffee drinking was significantly associated with higher T-scores hence, a lower risk of osteoporosis in men and premenopausal women.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6168-0) contains supplementary material, which is available to authorized users.

Associations between sedentary time, physical activity and bone health among older people using compositional data analysis

INTRODUCTION

Aging is associated with a progressive decrease in bone mass (BM), and being physical active is one of the main strategies to combat this continuous loss. Nonetheless, because daily time is limited, time spent on each movement behavior is co-dependent. The aim of this study was to determine the relationship between BM and movement behaviors in elderly people using compositional data analysis.

METHODS

We analyzed 871 older people [395 men (76.9±5.3y) and 476 women (76.7±4.7y)]. Time spent in sedentary behavior (SB), light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA), was assessed using accelerometry. BM was determined by bone densitometry (DXA). The sample was divided according to sex and bone health indicators.

RESULTS

The combined effect of all movement behaviors (PA and SB) was significantly associated with whole body, leg and femoral region BM in the whole sample (p≤0.05), with leg and pelvic BM (p<0.05) in men and, with whole body, arm and leg BM (p<0.05) in women. In men, arm and pelvic BM were negatively associated with SB and whole body, pelvic and leg BM were positively associated with MVPA (p≤0.05). In women, whole body and leg BM were positively associated with SB. Arm and whole body BM were positively associated and leg BM was negatively associated with LPA and arm BM was negatively associated with MVPA (p≤0.05). Women without bone fractures spent less time in SB and more in LPA and MVPA than the subgroup with bone fractures.

CONCLUSION

We identified that the positive effect of MVPA relative to the other behaviors on bone mass is the strongest overall effect in men. Furthermore, women might decrease bone fracture risk through PA increase and SB reduction, despite the fact that no clear benefits of PA for bone mass were found.

Different associations of sufficient and vigorous physical activity with BMI in Northwest China

Physical activity (PA) plays an important role in maintaining a healthy weight. To develop targeted strategies that encourage physical activity, knowledge of associations between intensity of physical activity (PA) levels and body mass index (BMI) is essential. We aimed to examine the relationship between sufficient and vigorous PA and BMI distribution among adults in northwest China using quantile regression. We conducted a cross-sectional study in Shaanxi Province in 2013, using proportional probability sampling. BMI was calculated using measured height and weight. The Global Physical Activity Questionnaire was used to define and measure sufficient and vigorous PA. Associations of sufficient/vigorous PA and BMI were modelled using quantile regression. Mean BMI was 24.18 ± 3.51 and BMI distribution with age showed an inverse U shape. A total 9045 (88.97%) participants demonstrated sufficient PA and 3119 (30.68%) reported vigorous PA. After adjusting for relevant sociodemographic, dietary, and lifestyle parameters in quantile regression modelling, sufficient PA was positively associated with BMI score distribution from the 1st to 30th quantile, with β from 0.32 (95% confidence interval (CI): 0.07 to 0.63) to 0.85 (95% CI: 0.40 to 1.19). Vigorous PA was negatively associated with BMI score distribution from the 30th to 93th quantiles, with β from -0.18 (95% CI: -0.31 to -0.02) to -0.81 (95% CI: -1.10 to -0.45). Sufficient PA was positively associated with underweight and normal weight whereas vigorous PA was negatively associated with overweight and obesity.

Protein and bone health across the lifespan

Bone health is determined by the rate of accrual in early life, followed by the rate of age-associated bone loss. Dietary protein intake might have a role in bone health across both of these phases via pleiotropic mechanistic pathways. Herein we summarise the pathways through which protein may exert either a positive or negative influence on bone. In the introduction, we describe the acid-ash hypothesis, which states that a high-protein intake may lead to an acidic residue that must be neutralised through the leaching of calcium and other minerals from the bone, subsequently leading to demineralisation and bone weakening. Conversely, and as described in the 'Against: mechanisms through which protein may negatively impact bone' section, protein intake may act to strengthen the bone by stimulating the activity of various anabolic hormones and growth factors, or by optimising muscle mass and functionality, which itself has an osteogenic influence. The net effect of these contrasting pathways is described in the 'For: mechanisms through which protein may positively impact bone' section, where a number of meta-analyses have demonstrated that higher protein intakes have a small positive impact on bone mass and fracture risk. Sometimes higher than recommended protein intakes are advised, e.g. during the earlier and later phases of the lifespan or during reduced energy availability. We conclude that protein is an essential nutrient for bone health, although further research is required to clarify the mechanistic pathways through which it exerts its influence, along with the clarification of the quantities, food sources and timing to allow for the optimisation of this protective influence and ultimately a reduction in fracture risk.

Management of Reduced Bone Mineral Density in HIV: Pharmacological Challenges and the Role of Exercise

Low bone mineral density is becoming more common among people living with HIV following the use of current antiretroviral therapy drugs such as tenofovir. Although pharmacological therapies used to treat low bone mineral density are associated with adverse effects and may increase the pill burden in people living with HIV who are already burdened by antiretroviral therapy drugs, non-pharmacological strategies to prevent and treat reduced bone mineral density resulting from antiretroviral therapy drugs in people living with HIV have not been fully explored. Despite evidence that exercise is effective in increasing bone mineral density, effects of exercise on low bone mineral density resulting from antiretroviral therapy drugs in HIV infected individuals are still unknown. This review highlights gaps in the strategies used to manage reduced bone mineral density resulting from antiretroviral therapy drugs and focuses on exercise as an alternative or adjunctive strategy.

Bone Density and Cross-sectional Geometry of the Proximal Femur Are Bilaterally Elevated in Elite Cricket Fast Bowlers

The skeleton of a cricket fast bowler is exposed to a unique combination of gravitational and torsional loading in the form of substantial ground reaction forces delivered through the front landing foot, and anterior-posterior shear forces mediated by regional muscle contractions across the lumbo-pelvic region. The objectives of this study were to compare the hip structural characteristics of elite fast bowlers with recreationally active age-matched controls, and to examine unilateral bone properties in fast bowlers. Dual-energy X-ray absorptiometry of the proximal femur was performed in 26 elite male fast bowlers and 26 normally active controls. Hip structural analysis (GE Lunar; enCORE version 15.0) determined areal bone mineral density (BMD) of the proximal femur, and cross-sectional area, section modulus (Z), cross-sectional moment of inertia, and femoral strength index at the narrow region of the femoral neck. Mean femoral neck and trochanter BMD were greater in fast bowlers than in controls (p <0.001). All bone geometry properties, except for cross-sectional moment of inertia, were superior in fast bowlers (p <0.05) following adjustment for height and lean mass. There were no asymmetries in BMD or bone geometry when considering leg dominance of the fast bowlers (p > 0.05). Elite fast bowlers have superior bone characteristics of the proximal femur, with results inferring enhanced resistance to axial compression (cross-sectional area), and bending (Z) forces, and enhanced strength to withstand a fall impact as indicated by their higher femoral strength index. No asymmetries in hip bone properties were identified, suggesting that both torsional and gravitational loading offer significant osteogenic potential.

Exercise Early and Often: Effects of Physical Activity and Exercise on Women's Bone Health

In 2011 over 1.7 million people were hospitalized because of a fragility fracture, and direct costs associated with osteoporosis treatment exceeded 70 billion dollars in the United States. Failure to reach and maintain optimal peak bone mass during adulthood is a critical factor in determining fragility fracture risk later in life. Physical activity is a widely accessible, low cost, and highly modifiable contributor to bone health. Exercise is especially effective during adolescence, a time period when nearly 50% of peak adult bone mass is gained. Here, we review the evidence linking exercise and physical activity to bone health in women. Bone structure and quality will be discussed, especially in the context of clinical diagnosis of osteoporosis. We review the mechanisms governing bone metabolism in the context of physical activity and exercise. Questions such as, when during life is exercise most effective, and what specific types of exercises improve bone health, are addressed. Finally, we discuss some emerging areas of research on this topic, and summarize areas of need and opportunity.

Effects of Body Mass Index on Bone Loading Due to Physical Activity

The aim of the current study was to compare bone loading due to physical activity between lean, and overweight and obese individuals. Fifteen participants (lower BMI group: BMI < 25 kg/m², n = 7; higher BMI group: 25 kg/m² < BMI < 36.35 kg/m², n = 8) wore a tri-axial accelerometer on 1 day to collect data for the calculation of bone loading. The International Physical Activity Questionnaire (short form) was used to measure time spent at different physical activity levels. Daily step counts were measured using a pedometer. Differences between groups were compared using independent t-tests. Accelerometer data revealed greater loading dose at the hip in lower BMI participants at a frequency band of 0.1-2 Hz (P = .039, Cohen's d = 1.27) and 2-4 Hz (P = .044, d = 1.24). Lower BMI participants also had a significantly greater step count (P = .023, d = 1.55). This corroborated with loading intensity (d ≥ 0.93) and questionnaire (d = 0.79) effect sizes to indicate higher BMI participants tended to spend more time in very light activity, and less time in light and moderate activity. Overall, participants with a lower BMI exhibited greater bone loading due to physical activity; participants with a higher BMI may benefit from more light and moderate level activity to maintain bone health.

Modifiable lifestyle factors associated with osteoporosis in Korean men: a case-control study

The prevention, education, and treatment of osteoporosis are all recognized as important components in men as well as women. This study revealed that the lifestyle factors associated with male osteoporosis included being underweight and being a current smoker. Being overweight or obese and having a regular exercise habit were negatively associated with male osteoporosis.

PURPOSE

Osteoporosis is a significant health problem in Korea and worldwide. Although osteoporosis is less prevalent in males than in females, the fracture-related mortality rate is higher in males than in females. The aim of this study was to investigate the relationship of modifiable lifestyle factors in males with osteoporosis.

METHODS

A case-control study was performed in men who visited a single university hospital for a medical check-up between August 2003 and July 2016. Patients were classified in the case group according to the World Health Organization (WHO) Osteoporosis Criteria. The control group was created by matching patients according to age and check-up date. Lifestyle factors were evaluated by a self-assessment questionnaire. Multivariate conditional logistic regression was used to examine the association between lifestyle factors and male osteoporosis with age stratification at 50 years.

RESULTS

A total of 1304 subjects were included in this analysis, 326 of whom were in the case group and 978 of whom were in the control group. Within their age group, subjects with osteoporosis were more often underweight (odds ratio [OR] = 2.35, 95% confidence interval [CI], 1.11-4.98) or more often current smokers (2.22, 1.50-3.28) than control subjects. The subjects who were overweight (0.45, 0.32-0.64), obese (0.19, 0.13-0.27), had an irregular exercise habit (0.64, 0.43-0.94), or had a regular exercise habit (0.40, 0.28-0.57) were more likely to have normal bone status. Alcohol drinking habit had no significant association with male osteoporosis.

CONCLUSIONS

Several modifiable lifestyle factors were associated with male osteoporosis. Current smokers at any age and underweight men below age 50 were more likely to have osteoporosis, whereas men who were overweight, obese, or had a regular exercise habit were more likely to have normal bone status, regardless of age.

A small amount of precisely measured high-intensity habitual physical activity predicts bone health in pre- and post-menopausal women in UK Biobank

Background

Physical inactivity is a highly modifiable risk factor for the development of osteoporosis but, due to a lack of research that has precisely and objectively meaured physical activity (PA) relevant to bone, the specific contribution that PA can make to bone health is poorly understood. This study examined whether a more precise measure of PA relelvant to bone was associated with meaures of bone health in pre- and post-menopausal women in UK Biobank.

Methods

Time spent at intensities specific to bone health [≥750 milli-gravitational units (mg) and ≥1000 mg] were analysed from raw tri-axial acceleration data averaged over 1-second epochs from 7-day monitoring of habitual PA using accelerometry-based activity monitors (100 Hz; AX3, Axivity, UK) of 1218 pre- and 1316 post-menopausal healthy women. In a cross-sectional analysis, associations between categories of time (<1, 1-2 and ≥2 minutes) spent above the intensity thresholds and calcaneal quantitative ultrasound measures of bone health (bone mineral density T-score, BMDT-score; speed of sound, SOS; and broadband ultrasound attenuation, BUA) were examined.

Results

Compared with <1 minute, spending 1-2 or ≥2 minutes/day at intensities ≥1000 mg in pre-menopausal and ≥750 mg in post-menopausal women was positively associated with BMDT-score, SOS and BUA.

Conclusion

Brief bursts of high-intensity PA relevant to bone health can be captured by applying bone-specific thresholds of intensity to raw tri-axial accelerations averaged over 1-second epochs. Accumulating 1-2 minutes/day of high-intensity PA, equivalent to running in pre-menopausal women and slow jogging in post-menopausal women, is associated with better bone health.

Prescribing Physical Activity for the Prevention and Treatment of Osteoporosis in Older Adults

Osteoporosis is an age-related disease, characterised by low bone mineral density (BMD) and compromised bone geometry and microarchitecture, leading to reduced bone strength. Physical activity (PA) has potential as a therapy for osteoporosis, yet different modalities of PA have varying influences on bone health. This review explores current evidence for the benefits of PA, and targeted exercise regimes for the prevention and treatment of osteoporosis in older adults. In particular, the outcomes of interventions involving resistance training, low- and high-impact weight bearing activities, and whole-body vibration therapy are discussed. Finally, we present recommendations for future research that may maximise the potential of exercise in primary and secondary prevention of osteoporosis in the ageing population.