High Prevalence of Osteoporosis and Morphometric Vertebral Fractures in Indian Males Aged 60 Years and Above: Should Age for Screening Be Lowered?

Integration analysis of lncRNA and mRNA expression data identifies DOCK4 as a potential biomarker for elderly osteoporosis

BACKGROUND

We aimed to identify some potential biomarkers for elderly osteoporosis (OP) by integral analysis of lncRNA and mRNA expression data.

METHODS

A total of 8 OP cases and 5 healthy participants were included in the study. Fasting peripheral venous blood samples were collected from individuals, and total RNA was extracted. RNA-seq library was prepared and sequenced on the Illumina HiSeq platform. Differential gene expression analysis was performed using "DESeq2" package in R language. Functional enrichment analysis was conducted using the "clusterProfiler" package, and the cis- and trans-regulatory relationships between lncRNA and target mRNA were analyzed by the lncTar software. A protein-protein interaction (PPI) network was constructed using the STRING database, and hub genes were identified through the MCODE plugin in Cytoscape.

RESULTS

We identified 897 differentially expressed lncRNAs (DELs) and 1366 differentially expressed genes (DEGs) between normal and OP samples. After co-expression network analysis and cis-trans regulatory genes analysis, we identified 69 candidate genes regulated by lncRNAs. Then we further screened 7 genes after PPI analysis. The target gene DOCK4, trans-regulated by two lncRNAs, was found to be significantly upregulated in OP samples. Additionally, 4 miRNAs were identified as potential regulators of DOCK4. The potential diagnostic value of DOCK4 and its two trans-regulatory lncRNAs was supported by ROC analysis, indicating their potential as biomarkers for OP.

CONCLUSION

DOCK4 is a potential biomarker for elderly osteoporosis diagnostic. It is identified to be regulated by two lncRNAs and four miRNAs.

Global prevalence of osteoporosis among the world older adults: a comprehensive systematic review and meta-analysis

BACKGROUND

Osteoporosis is one of the most common bone system diseases that is associated with an increased risk of bone fractures and causes many complications for patients. With age, the prevalence of this disease increases so that it has become a serious problem among the elders. In this study, the prevalence of osteoporosis among elders around the world is examined to gain an understanding of its prevalence pattern.

METHODS

In this systematic review and meta-analysis, articles that have focused on prevalence of osteoporosis in the world's elders were searched with these key words, such as Prevalence, Osteoporosis, Elders, Older adult in the Science Direct, Embase, Scopus, PubMed, Web of Science (WoS) databases and Google Scholar search engine, and extracted without time limit until March 2020 and transferred to information management software (EndNote). Then, duplicate studies were eliminated and the remaining studies were evaluated in terms of screening, competence and qualitative evaluation based on inclusion and exclusion criteria. Data analysis was performed with Comprehensive Meta-Analysis software (Version 2) and Begg and Mazumdar test was used to check the publication bias and I² test was used to check the heterogeneity.

RESULTS

In a review of 40 studies (31 studies related to Asia, 5 studies related to Europe and 4 studies related to America) with a total sample size of 79,127 people, the prevalence of osteoporosis in the elders of the world; 21.7% (95% confidence interval: 18.8-25%) and the overall prevalence of osteoporosis in older men and women in the world, 35.3% (95% confidence interval: 27.9-43.4%), 12.5% (95% confidence interval: 9.3-16.7%) was reported. Also, the highest prevalence of osteoporosis in the elders was reported in Asia with; 24.3% (95% confidence interval: 20.9-28.1%).

CONCLUSION

The results of the present study showed that the prevalence of osteoporosis in the elders and especially elders' women is very high. Osteoporosis was once thought to be an inseparable part of elders' lives. Nowadays, Osteoporosis can be prevented due to significant scientific advances in its causes, diagnosis, and treatment. Regarding the growing number of elderly people in the world, it is necessary for health policy-makers to think of measures to prevent and treat osteoporosis among the elders.

The global prevalence of osteoporosis in the world: a comprehensive systematic review and meta-analysis

BACKGROUND

Osteoporosis affects all sections of society, including families with people affected by osteoporosis, government agencies and medical institutes in various fields. For example, it involves the patient and his/her family members, and government agencies in terms of the cost of treatment and medical care. Providing a comprehensive picture of the prevalence of osteoporosis globally is important for health policymakers to make appropriate decisions. Therefore, this study was conducted to investigate the prevalence of osteoporosis worldwide.

METHODS

A systematic review and meta-analysis were conducted in accordance with the PRISMA criteria. The PubMed, Science Direct, Web of Science, Scopus, Magiran, and Google Scholar databases were searched with no lower time limit up till 26 August 2020. The heterogeneity of the studies was measured using the I2 test, and the publication bias was assessed by the Begg and Mazumdar's test at the significance level of 0.1.

RESULTS

After following the systematic review processes, 86 studies were selected for meta-analysis. The sample size of the study was 103,334,579 people in the age range of 15-105 years. Using meta-analysis, the prevalence of osteoporosis in the world was reported to be 18.3 (95% CI 16.2-20.7). Based on 70 studies and sample size of 800,457 women, and heterogenicity I2: 99.8, the prevalence of osteoporosis in women of the world was reported to be 23.1 (95% CI 19.8-26.9), while the prevalence of osteoporosis among men of the world was found to be 11.7 (95% CI 9.6-14.1 which was based on 40 studies and sample size of 453,964 men.). The highest prevalence of osteoporosis was reported in Africa with 39.5% (95% CI 22.3-59.7) and a sample size of 2989 people with the age range 18-95 years.

CONCLUSION

According to the medical, economic, and social burden of osteoporosis, providing a robust and comprehensive estimate of the prevalence of osteoporosis in the world can facilitate decisions in health system planning and policymaking, including an overview of the current and outlook for the future; provide the necessary facilities for the treatment of people with osteoporosis; reduce the severe risks that lead to death by preventing fractures; and, finally, monitor the overall state of osteoporosis in the world. This study is the first to report a structured review and meta-analysis of the prevalence of osteoporosis worldwide.

High prevalence of osteoporosis in patients undergoing spine surgery in China

Background

With the increase in life expectancy, a large number of patients with osteoporosis (OP) are undergoing spine surgery, which may adversely affect the surgical success rate. The prevalence of OP varies in different regions, and no data are available that represent the prevalence of OP among Chinese patients over 50 years of age who are undergoing spine surgery. It was the first multicenter study to assess OP in these patients. Aiming to obtain comprehensive data, this study combined bone mineral density (BMD) measurements and visual radiography assessment (VRA) to analyze the prevalence of OP in patients aged > 50 years who underwent spine surgery.

Methods

Data from 1,856 patients aged over 50 years undergoing spine surgery who resided in northern, central, and southern China were reviewed between 2018 and 2019. Based on the perioperative BMD and X-ray data, we calculated the prevalence of OP in this special population according to sex, age, and spine degenerative disease.

Results

A total of 1,245 patients (678 females and 567 males) were included in the study. The prevalence of OP diagnosed by BMD was 52.8 % in females and 18.7 % in males. When we combined with BMD and VRA, the prevalence of OP increased from 52.8 to 65.9 % in females and from 18.7 to 40.6 % in males. Although OP was more severe in females than in males, a significant difference in the rate of vertebral fracture (VF) was not observed between females and males with a normal BMD and osteopenia (females vs. males: aged 50–59 years, P = 0.977; 60–69 years, P = 0.302; >70 years, P = 0.172). Similarly, no significant difference in the vertebral fracture rate was observed within different age groups of patients with a normal BMD and osteopenia (females: P = 0.210; males, P = 0.895). The incidence of OP in patients with degenerative scoliosis was higher than that in the remaining patients (females: 63.6 % vs. 42.4 %, P = 0.018; males: 38.9 % vs. 13.8 %, P = 0.004).

Conclusions

A high prevalence of OP was identified in patients aged > 50 years undergoing spine surgery, especially in patients whose primary diagnosis was degenerative scoliosis. BMD and VRA evaluations should be included in the clinical routine for these patients prior to surgery.

Integrating Muscle Health in Predicting the Risk of Asymptomatic Vertebral Fracture in Older Adults

Background: The utility of muscle health for predicting asymptomatic vertebral fracture (VF) is uncertain. We aimed to determine the effects of muscle health on bone quantity and quality in the older adults and to integrate these factors into a predictive model for VF. Methods: We prospectively recruited participants with a body mass index <37 kg/m². The total lean mass (TLM), appendicular skeletal muscle index, presence of sarcopenia, and bone mineral density were determined by dual-energy X-ray absorptiometry, and bone quality by the trabecular bone score (TBS). VF was diagnosed based on spine radiography. Results: A total of 414 females and 186 males were included; 257 participants had VF. Lower TLM was significantly associated with poorer bone quantity and quality in both males and females. A low TBS (OR: 11.302, p = 0.028) and sarcopenia (Odds ratio (OR): 2.820, p = 0.002) were significant predictors of VF in males, but not bone quantity. Moreover, integrating TBS and sarcopenia into the predictive model improved its performance. Conclusions: Although TLM was associated with bone quantity and quality in both sexes, sarcopenia and a low TBS were significant predictors of asymptomatic VF only in male participants.

Prevalence and risk factors of morphometric vertebral fracture in apparently healthy osteopenic postmenopausal Thai women

OBJECTIVE

To determine the prevalence of and risk factors for morphometric vertebral fracture (VF) in apparently healthy postmenopausal women with osteopenia.

METHODS

This cross-sectional study included 490 postmenopausal Thai women with osteopenia. All had no known history of low-trauma fracture, no underlying diseases, or history of taking medications that affect bone metabolism. Morphometric VFs were assessed by thoracolumbar spine x-rays, using the Genant semiquantitative method, and interpreted independently by three radiologists.

RESULTS

Mean age of participants was 59.9 ± 7.8 years and mean body mass index was 24.3 ± 3.4 kg/m2. Morphometric VFs were present in 29% (142/490) of women (grade 1: 62.0%, grade 2: 19.3%, and grade 3: 18.7%). Of these, 4.9% were aged 50 years or less, 40.1% were aged 50-59 years, 38% were aged 60-69 years, and 16.9% were aged over 70 years. Age and the Fracture Risk Assessment Tool (FRAX) scores for hip and major osteoporotic fracture, with or without bone mineral density, were positively correlated with VF. No differences in fracture prevalence among those with various degrees of osteopenia. Applying the current guidelines for VF screening results in discoveries of less than a half of osteopenic women who have had morphometric VF.

CONCLUSIONS

Almost one third of apparently healthy postmenopausal women with osteopenia had morphometric VF. Advancing age and greater FRAX scores were associated with higher prevalence of morphometric VF.