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Mesinovic J, Hurst C, Leung GKW, Ryan JR, Daly RM, Scott D. Exercise and dietary recommendations to preserve musculoskeletal health during weight loss in adults with obesity: A practical guide. Rev Endocr Metab Disord 2025:10.1007/s11154-025-09968-3. [PMID: 40434574 DOI: 10.1007/s11154-025-09968-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2025] [Indexed: 05/29/2025]
Abstract
Obesity adversely impacts musculoskeletal health, contributing to functional limitations and an increased risk for falls, fractures and disability. Weight loss can mitigate these effects, but strategies that neglect to incorporate evidence-based dietary and/or exercise approaches can exacerbate musculoskeletal and functional declines. Sustainable weight loss requires a personalised approach that prioritises adequate protein intake and essential nutrients to preserve musculoskeletal health. To enhance adherence and long-term success, dietary strategies should be practical, nutritionally balanced and cost-effective. Similarly, exercise programmes should be individually tailored and progressive, with resistance training central to any program prescribed in the context of weight loss, due to its critical role in maintaining muscle and bone mass and strength. When prescribing weight loss strategies involving lifestyle behaviour changes, clinicians must consider their patient's readiness to change. We have used the transtheoretical model of change framework as an example to identify a patient's level of readiness and provided associated motivational interviewing-based strategies to enhance adherence and engagement. This review outlines evidence-based, practical diet and exercise recommendations and behavioural strategies that can facilitate effective and sustainable weight loss, which is particularly important for at-risk populations such as older adults.
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Affiliation(s)
- Jakub Mesinovic
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood HighwayBurwood, Melbourne, VIC, 3125, Australia.
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia.
| | - Christopher Hurst
- AGE Research Group, Faculty of Medical Sciences, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
- NIHR Newcastle Biomedical Research Centre, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Cumbria Northumberland Tyne and Wear NHS Foundation Trust and Faculty of Medical Sciences Newcastle University, Newcastle Upon Tyne, UK
| | - Gloria K W Leung
- Institute for Health Transformation, Global Centre for Preventive Health and Nutrition, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Australia
| | - Jack R Ryan
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood HighwayBurwood, Melbourne, VIC, 3125, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood HighwayBurwood, Melbourne, VIC, 3125, Australia
| | - David Scott
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood HighwayBurwood, Melbourne, VIC, 3125, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Melbourne, Australia
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Cortes TM, Chae K, Foy CM, Houston DK, Beavers KM. The impact of lifestyle-based weight loss in older adults with obesity on muscle and bone health: a balancing act. Obesity (Silver Spring) 2025. [PMID: 40065568 DOI: 10.1002/oby.24229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Revised: 12/05/2024] [Accepted: 12/09/2024] [Indexed: 03/14/2025]
Abstract
Despite adverse metabolic and functional consequences of obesity (BMI ≥30 kg/m2), clinical recommendations for weight loss (WL) in older adults (65+ years) with obesity remain controversial. Reluctance stems partly from epidemiologic data demonstrating musculoskeletal tissue loss with WL and increased risk of disability and osteoporotic fracture. Randomized controlled trials in older adults complement and extend knowledge in this area showing: (1) lifestyle-based WL interventions often yield clinically meaningful (~8%-10%) WL in older adults; (2) lean mass loss is significant, although fat mass loss is preferential and physical performance is often improved, particularly when combined with aerobic and resistance training (RT); (3) bone loss is also significant, with some evidence that RT can attenuate WL-associated bone loss; and (4) fat mass regain after intervention cessation is common, yet physical performance gains appear to be maintained. Best practices for treating older adults with obesity include comprehensive assessment of baseline musculoskeletal health; patient-centered goal setting; moderate (i.e., -500 kcal/day) caloric restriction ensuring protein (1-1.2 g/kg/day), calcium (1000-1200 mg/day), and vitamin D (800-1000 IU/day) needs are met; incorporation of RT (≥2 days/week) and moderate-intensity weight-bearing aerobic training (≥150 min/week); and delivery of care by a multidisciplinary team.
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Affiliation(s)
- Tiffany M Cortes
- Division of Endocrinology and the Sam and Ann Barshop Institute for Longevity and Aging Studies, Department of Medicine, UT Health San Antonio, San Antonio, Texas, USA
- San Antonio Geriatric Research Education and Clinical Center (GRECC), South Texas Veterans Health Care System, San Antonio, Texas, USA
| | - Kacey Chae
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Colleen M Foy
- Zachary Smith Reynolds Library, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Denise K Houston
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kristen M Beavers
- Section on Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina, USA
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Jain S, Vohora D. Primary components of MCT ketogenic diet are detrimental to bone loss associated with accelerated aging and age-related neurotoxicity in mice. Bone 2025; 192:117383. [PMID: 39732448 DOI: 10.1016/j.bone.2024.117383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2024] [Revised: 12/11/2024] [Accepted: 12/23/2024] [Indexed: 12/30/2024]
Abstract
Medium chained triglycerides (MCT) ketogenic diet is being extensively investigated for its neuroprotective effects against adverse effects associated with aging and neurodegenerative disorders. Aging is a common risk factor for the development of both osteoporosis and neurological disorders. Hence, suppression of aging and age-related neurodegeneration might contribute to delaying skeletal aging. The present study was designed to investigate the effects of the primary components of the MCT diet, against bone resorption associated with D-gal-induced accelerated aging and D-gal /AlCl3-induced age-related toxicity. We report bone loss in accelerated aged mice and age-related neurotoxic mice through declined Sirtuin1 (SIRT1) expression, depleted bone turnover markers, (P1NP and β-CTX-1), low bone mineral density (BMD), and deterioration of trabecular bone microarchitecture in both the distal femur and proximal tibia bones. Administration of MCT dietary components decanoic acid and octanoic acid, led to a decrease in body weight and only octanoic acid increased serum levels of ketone body, β-hydroxybutyrate (β-HB), but both of them failed to reverse the diminishing effects on bone health associated with aging and age-related neurotoxicity. Surprisingly, decanoic acid, octanoic acid, and their combination also exhibited negative effects on trabecular bone microarchitecture and BMD in the distal femur and proximal tibia bones of healthy mice. The findings from this study provide supporting evidence on the deterioration of bone health associated with aging and age-related neurotoxicity, and the bone resorption potential of MCT dietary supplements that are being prescribed in healthy older populations and elderly persons diagnosed with neurological disorders.
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Affiliation(s)
- Shreshta Jain
- Neurobehavioral Pharmacology Laboratory, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India
| | - Divya Vohora
- Neurobehavioral Pharmacology Laboratory, Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi 110062, India.
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Beavers KM, Cortes TM, Foy CM, Dinkla L, Reyes San Martin F, Ard JD, Serra MC, Beavers DP. GLP1Ra-based therapies and DXA-acquired musculoskeletal health outcomes: a focused meta-analysis of placebo-controlled trials. Obesity (Silver Spring) 2025; 33:225-237. [PMID: 39710882 PMCID: PMC11774015 DOI: 10.1002/oby.24172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 09/13/2024] [Accepted: 09/16/2024] [Indexed: 12/24/2024]
Abstract
OBJECTIVE The objective of this study was to evaluate the effect of glucagon-like peptide-1 receptor agonist (GLP1Ra)-based therapies on change in dual-energy x-ray absorptiometry (DXA)-acquired lean mass (LM) or bone mineral density (BMD). METHODS PubMed and Web of Science were searched from database inception through January 29, 2024, for randomized, placebo-controlled trials reporting on change in DXA-acquired LM or BMD measures associated with 12+ weeks of GLP1Ra-based treatment. Of 2618 articles, 9 trials met prespecified search criteria, with 7 reporting on change in total body LM and 2 reporting on change in BMD. For LM outcomes, a hierarchical Bayesian model was used to estimate treatment mean differences. BMD outcomes were described narratively. RESULTS LM was reported in a total of 659 participants (GLP1Ra-based therapies: n = 419; placebo: n = 240), with follow-up times ranging from mean (SD) 12 to 72 (33.5) weeks. At baseline, participants were aged mean (SD) 41.7 (7.6) years, and 75% were female, with BMI values ranging from 30 to 43 kg/m2. Compared with placebo, GLP1Ra-based treatment was associated with significantly reduced total body weight (-6.9 kg; 95% credible interval [CI]: -10.7 to -3.0). GLP1Ra-based treatment was also associated with significantly reduced LM (-1.9 kg; 95% CI: -3.5 to -0.2). CONCLUSIONS Approximately 30% of body weight lost with GLP1Ra-based therapy is LM. More data are needed assessing BMD outcomes.
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Affiliation(s)
- Kristen M. Beavers
- Department of Internal MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of Health and Exercise ScienceWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | - Tiffany M. Cortes
- Division of Endocrinology, Department of MedicineUT Health San AntonioSan AntonioTexasUSA
- Sam and Ann Barshop Institute for Longevity and Aging StudiesUT Health San AntonioSan AntonioTexasUSA
- San Antonio Geriatric Research Education and Clinical Center (GRECC)South Texas Veterans Health Care SystemSan AntonioTexasUSA
| | - Colleen M. Foy
- Zachary Smith Reynolds LibraryWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | - Lauren Dinkla
- Department of Health and Exercise ScienceWake Forest UniversityWinston‐SalemNorth CarolinaUSA
| | | | - Jamy D. Ard
- Department of Epidemiology and PreventionWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Monica C. Serra
- Sam and Ann Barshop Institute for Longevity and Aging StudiesUT Health San AntonioSan AntonioTexasUSA
- San Antonio Geriatric Research Education and Clinical Center (GRECC)South Texas Veterans Health Care SystemSan AntonioTexasUSA
- Division of Geriatrics, Gerontology & Palliative MedicineUT Health San AntonioSan AntonioTexasUSA
| | - Daniel P. Beavers
- Department of Statistical SciencesWake Forest UniversityWinston‐SalemNorth CarolinaUSA
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Matsuno K, Ueda K, Saito M, Kamii M, Tsuda A, Kawabata A, Morikawa A, Okamoto A. Pilot study of the effect of surgical menopause on bone mineral density and quality in patients with gynecological malignancies. J Obstet Gynaecol Res 2025; 51:e16141. [PMID: 39530312 PMCID: PMC11635186 DOI: 10.1111/jog.16141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 10/21/2024] [Indexed: 11/16/2024]
Abstract
AIM To investigate the effects of surgical menopause on bone mineral density and bone quality because bilateral salpingo-oophorectomy for the treatment of gynecological malignancies is common even in premenopausal patients. This study is prospective one of bone mineral density and quality measurements after surgery for perimenopausal gynecologic malignancies. METHODS In 50 women who underwent surgical menopause for a diagnosis of gynecological malignancies, bone mineral density (BMD), blood levels of tartrate-resistant acid phosphatase 5b (TRACP-5b) and bone-specific alkaline phosphatase (BAP) as bone metabolism markers, and urinary pentosidine level as bone quality marker were measured before surgery and at multiple points up to 24 months after surgery. RESULTS In a group of 22 patients who did not undergo hormone replacement therapy (HRT) (HRT- group), BMD of the lumbar spine and total hip continued to decrease significantly from 6 months postoperatively. Percentages of changes in BMD progressively increased over time after surgery. TRACP-5b and urinary pentosidine levels significantly increased 6 months postoperatively compared with preoperative levels. Comparisons between 10 patients who underwent HRT (HRT+ group) and the HRT- group revealed significant reductions in the percentage of change in lumbar spine BMD only and TRACP-5b and urinary pentosidine levels 12 months postoperatively in the former group. CONCLUSIONS In this pilot study, we showed that BMD and bone-related markers are altered in patients with surgical menopause. It also suggested that HRT may reduce these influences on bone metabolism.
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Affiliation(s)
- Kanae Matsuno
- Department of Gynecology and ObstetricsThe Jikei University School of MedicineMinato‐kuTokyoJapan
| | - Kazu Ueda
- Department of GynecologyInternational University of Health and Welfare, Mita HospitalMinato‐kuTokyoJapan
| | - Mitsuru Saito
- Department of Orthopedic SurgeryThe Jikei University School of MedicineTokyoJapan
| | - Misato Kamii
- Department of Gynecology and ObstetricsThe Jikei University School of MedicineMinato‐kuTokyoJapan
| | - Akina Tsuda
- Department of Gynecology and ObstetricsThe Jikei University School of MedicineMinato‐kuTokyoJapan
| | - Ayako Kawabata
- Department of Gynecology and ObstetricsThe Jikei University School of MedicineMinato‐kuTokyoJapan
| | - Asuka Morikawa
- Department of Gynecology and ObstetricsThe Jikei University School of MedicineMinato‐kuTokyoJapan
| | - Aikou Okamoto
- Department of Gynecology and ObstetricsThe Jikei University School of MedicineMinato‐kuTokyoJapan
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Todisco P, Meneguzzo P. Understanding Bone Density Loss in Eating Disorders: Contributions of Weight Suppression and Speed of Weight Loss. J Clin Med 2024; 13:7537. [PMID: 39768458 PMCID: PMC11728306 DOI: 10.3390/jcm13247537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2024] [Revised: 12/05/2024] [Accepted: 12/09/2024] [Indexed: 01/16/2025] Open
Abstract
Background/Objectives: Eating disorders (EDs), including anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), are associated with bone density loss. Weight suppression (WS) and weight loss speed (WLS) are two critical weight-related factors that may influence bone health, yet their relationship with bone density remains underexplored. This study aimed to investigate the associations between WS, WLS, and bone density in individuals with EDs, focusing on total body and spinal bone density. Methods: We examined 270 individuals with EDs (AN: n = 187, BN: n = 57, BED: n = 26) at the onset of inpatient treatment. WS and WLS were calculated from weight history, and bone density was assessed using dual-energy X-ray absorptiometry (DXA). Regression analyses were performed separately for each diagnosis. Results: In AN, both WS and WLS were significant predictors of total (p = 0.001) and spinal (p = 0.007) bone density. WS and WLS independently predicted total bone density, with WS significantly predicting spinal bone density. In BN and BED, only WLS showed significant associations with bone density. Minimum weight was a key predictor of bone density in AN, underscoring the importance of avoiding extremely low body weight. Conclusions: WS and WLS significantly affect bone density in AN, with WLS also predicting bone density in BN and BED. These findings highlight the need to monitor weight-related factors across ED populations. In AN, avoiding extremely low body weight is crucial for preserving bone health, while in BN and BED, managing WLS is key to mitigating bone density loss.
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Affiliation(s)
- Patrizia Todisco
- Eating Disorder Unit, Casa di Cura “Villa Margherita”—KOS Group, 36057 Arcugnano, Italy;
| | - Paolo Meneguzzo
- Department of Neuroscience, University of Padova, 35122 Padova, Italy
- Padova Neuroscience Center, University of Padova, 35122 Padova, Italy
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Kuang C, Shang J, Ma M, Huang S, Yan B, Zhong Y, Guan B, Gong J, Liu F, Chen L. Risk factors and clinical prediction models for osteoporosis in pre-dialysis chronic kidney disease patients. Ren Fail 2024; 46:2361802. [PMID: 38874080 PMCID: PMC11182074 DOI: 10.1080/0886022x.2024.2361802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/24/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Osteoporosis in pre-dialysis chronic kidney disease (CKD) patients has been overlooked, and the risk factors of osteoporosis in these patients have not been adequately studied. OBJECTIVE To identify risk factors for osteoporosis in pre-dialysis CKD patients and develop predictive models to estimate the likelihood of osteoporosis. METHODS Dual-energy X-ray absorptiometry was used to measure bone mineral density, and clinical examination results were collected from 326 pre-dialysis CKD patients. Binary logistic regression was employed to explore the risk factors associated with osteoporosis and develop predictive models. RESULTS In this cohort, 53.4% (n = 174) were male, 46.6% (n = 152) were female, and 21.8% (n = 71) were diagnosed with osteoporosis. Among those diagnosed with osteoporosis, 67.6% (n = 48) were female and 32.4% (n = 23) were male. Older age and low 25-(OH)-Vitamin D levels were identified as risk factors for osteoporosis in males. For females, older age, being underweight, higher bone alkaline phosphatase (NBAP), and advanced CKD (G5) were significant risk factors, while higher iPTH was protective. Older age, being underweight, and higher NBAP were risk factors for osteoporosis in the G1-4 subgroup. In the G5 subgroup, older age and higher NBAP increased the risk, while high 25-(OH)-Vitamin D or iPTH had protective effects. Nomogram models were developed to assess osteoporosis risk in pre-dialysis patients based on gender and renal function stage. CONCLUSION Risk factors for osteoporosis vary by gender and renal function stages. The nomogram clinical prediction models we constructed may aid in the rapid screening of patients at high risk of osteoporosis.
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Affiliation(s)
- Chaoying Kuang
- Nephrology Department, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, China
| | - Jingjie Shang
- Nuclear Medicine, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, China
| | - Mingming Ma
- Nephrology Department, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, China
| | - Shengling Huang
- Nephrology Department, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, China
| | - Bing Yan
- Nephrology Department, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, China
| | - Yuzhen Zhong
- Nephrology Department, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, China
| | - Baozhang Guan
- Nephrology Department, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, China
| | - Jian Gong
- Nuclear Medicine, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, China
| | - Fanna Liu
- Nephrology Department, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, China
| | - Liangmei Chen
- Nephrology Department, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou, Guangdong, China
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Stefanakis K, Kokkorakis M, Mantzoros CS. The impact of weight loss on fat-free mass, muscle, bone and hematopoiesis health: Implications for emerging pharmacotherapies aiming at fat reduction and lean mass preservation. Metabolism 2024; 161:156057. [PMID: 39481534 DOI: 10.1016/j.metabol.2024.156057] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2024] [Revised: 10/28/2024] [Accepted: 10/28/2024] [Indexed: 11/02/2024]
Abstract
Similar to bariatric surgery, incretin receptor agonists have revolutionized the treatment of obesity, achieving up to 15-25 % weight loss in many patients, i.e., at a rate approaching that achieved with bariatric surgery. However, over 25 % of total weight lost from both surgery and pharmacotherapy typically comes from fat-free mass, including skeletal muscle mass, which is often overlooked and can impair metabolic health and increase the risk of subsequent sarcopenic obesity. Loss of muscle and bone as well as anemia can compromise physical function, metabolic rate, and overall health, especially in older adults. The myostatin-activin-follistatin-inhibin system, originally implicated in reproductive function and subsequently muscle regulation, appears to be crucial for muscle and bone maintenance during weight loss. Activins and myostatin promote muscle degradation, while follistatins inhibit their activity in states of negative energy balance, thereby preserving lean mass. Novel compounds in the pipeline, such as Bimagrumab, Trevogrumab, and Garetosmab-which inhibit activin and myostatin signaling-have demonstrated promise in preventing muscle loss while promoting fat loss. Either alone or combined with incretin receptor agonists, these medications may enhance fat loss while preserving or even increasing muscle and bone mass, offering a potential solution for improving body composition and metabolic health during significant weight loss. Since this dual therapeutic approach could help address the challenges of muscle and bone loss during weight loss, well-designed studies are needed to optimize these strategies and assess long-term benefits. For the time being, considerations like advanced age and prefrailty may affect the choice of suitable candidates in clinical practice for current and emerging anti-obesity medications due to the associated risk of sarcopenia.
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Affiliation(s)
- Konstantinos Stefanakis
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michail Kokkorakis
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Christos S Mantzoros
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Section of Endocrinology, Boston VA Healthcare System, Harvard Medical School, Boston, MA, USA.
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van Roessel IMAA, Gorter JE, Bakker B, van den Heuvel-Eibrink MM, Lequin MH, van der Lugt J, Meijer L, Schouten-van Meeteren AYN, van Santen HM. Bone health in childhood low-grade glioma: an understudied problem. Endocr Connect 2024; 13:e240224. [PMID: 39140359 PMCID: PMC11466249 DOI: 10.1530/ec-24-0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 08/14/2024] [Indexed: 08/15/2024]
Abstract
Objective Children with a supratentorial midline low-grade glioma (LGG) may be at risk for impaired bone health due to hypothalamic-pituitary dysfunction, obesity, exposure to multiple treatment modalities, and/or decreased mobility. The presence of impaired bone health and/or its severity in this population has been understudied. We aimed to identify the prevalence and risk factors for bone problems in children with supratentorial midline LGG. Materials and methods A retrospective study was performed in children with supratentorial midline (suprasellar or thalamic) LGG between 1 January 2003 and 1 January 2022, visiting the Princess Máxima Center for Pediatric Oncology. Impaired bone health was defined as the presence of vertebral fractures and/or very low bone mineral density (BMD). Results In total, 161 children were included, with a median age at tumor diagnosis of 4.7 years (range: 0.1-17.9) and a median follow-up of 6.1 years (range: 0.1-19.9). Five patients (3.1%) had vertebral fractures. In 99 patients, BMD was assessed either by Dual Energy X-ray Absorptiometry (n = 12) or Bone Health Index (n = 95); 34 patients (34.3%) had a low BMD (≤ -2.0). Impaired visual capacity was associated with bone problems in multivariable analysis (OR: 6.63, 95% CI: 1.83-24.00, P = 0.004). Conclusion In this retrospective evaluation, decreased BMD was prevalent in 34.3% of children with supratentorial midline LGG. For the risk of developing bone problems, visual capacity seems highly relevant. Surveillance of bone health must be an aspect of awareness in the care and follow-up of children with a supratentorial midline LGG. Significance statement Patients with supratentorial midline LGG may encounter various risk factors for impaired bone health. Bone problems in survivors of childhood supratentorial midline LGG are, however, understudied. This is the first paper to address the prevalence of bone problems in this specific patient population, revealing visual problems as an important risk factor. Diencephalic syndrome historyand/or weight problems associated with hypothalamic dysfunction were related to bone problems in univariate analyses. The results of this study can be used in the development of guidelines to adequately screen and treat these patients to subsequently minimizing bone problems as one of the endocrine complications.
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Affiliation(s)
- I M A A van Roessel
- Department of Pediatric Neuro-oncology, Princess Máxima Center, Heidelberglaan, CS Utrecht, The Netherlands
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center, Lundlaan, EA Utrecht, The Netherlands
| | - J E Gorter
- Department of Pediatric Neuro-oncology, Princess Máxima Center, Heidelberglaan, CS Utrecht, The Netherlands
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center, Lundlaan, EA Utrecht, The Netherlands
| | - B Bakker
- Department of Pediatric Neuro-oncology, Princess Máxima Center, Heidelberglaan, CS Utrecht, The Netherlands
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center, Lundlaan, EA Utrecht, The Netherlands
| | - M M van den Heuvel-Eibrink
- Princess Máxima Center, Heidelberglaan, CS Utrecht, The Netherlands
- Wilhelmina Children’s Hospital, University Medical Center, Lundlaan, EA Utrecht, The Netherlands
| | - M H Lequin
- Department of Radiology, Princess Máxima Center, Heidelberglaan, CS Utrecht, The Netherlands
- Department of Radiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J van der Lugt
- Department of Pediatric Neuro-oncology, Princess Máxima Center, Heidelberglaan, CS Utrecht, The Netherlands
| | - L Meijer
- Department of Pediatric Neuro-oncology, Princess Máxima Center, Heidelberglaan, CS Utrecht, The Netherlands
| | | | - H M van Santen
- Department of Pediatric Neuro-oncology, Princess Máxima Center, Heidelberglaan, CS Utrecht, The Netherlands
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital, University Medical Center, Lundlaan, EA Utrecht, The Netherlands
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Kim HJ, Choi SA, Gu MS, Ko SY, Kwon JH, Han JY, Kim JH, Kim MG. Effects of Glucagon-Like Peptide-1 Receptor Agonist on Bone Mineral Density and Bone Turnover Markers: A Meta-Analysis. Diabetes Metab Res Rev 2024; 40:e3843. [PMID: 39311048 DOI: 10.1002/dmrr.3843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/19/2024] [Accepted: 09/04/2024] [Indexed: 10/15/2024]
Abstract
AIMS Glucagon-like peptide-1 receptor agonist (GLP-1RA) may promote bone formation, but conversely, they could also weaken bones due to the reduction in mechanical load associated with weight loss. However, the clinical effects in humans have not been clearly demonstrated. This meta-analysis aimed to evaluate whether GLP-1RAs affect BMD and bone turnover markers. MATERIAL AND METHODS PubMed, Embase, and Scopus were searched on June 13, 2024. The eligibility criteria were: (1) human studies, (2) receiving a GLP-1RA for more than 4 weeks, (3) an untreated control group or a placebo group, (4) reporting of at least one BMD or bone turnover marker, and (5) an RCT design. The risk of bias was assessed using the Cochrane risk of bias 2 tool. Fixed- or random-effects meta-analysis was performed according to heterogeneity. RESULTS Seven studies were included in the meta-analysis. GLP-1RAs did not significantly change BMD in the femoral neck (mean difference [MD], 0.01 g/cm2; 95% CI, -0.01-0.04 g/cm2), in the total hip (MD, -0.01 g/cm2; 95% CI, -0.02-0.01 g/cm2), and in the lumbar spine (MD, 0 g/cm2; 95% CI, -0.02-0.02 g/cm2). C-terminal telopeptide of type 1 collagen (CTX), a bone resorption marker, significantly increased after GLP-1RA treatment (MD, 0.04 μg/L; 95% CI, 0.01-0.07 μg/L). GLP-1RAs did not significantly change bone formation markers such as procollagen type 1 N-terminal propeptide, bone-specific alkaline phosphatase, osteocalcin. CONCLUSIONS GLP-1RA did not affect BMD and bone formation markers. However, GLP-1RAs led to a significant increase in CTX.
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Affiliation(s)
- Hee-Ju Kim
- College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea
| | - Seo-A Choi
- College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea
| | - Min-Sun Gu
- College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea
| | - Seo-Yeong Ko
- College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea
| | - Jae-Hee Kwon
- Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
| | - Ja-Young Han
- Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
| | - Jae Hyun Kim
- School of Pharmacy and Institute of New Drug Development, Jeonbuk National University, Jeonju, Republic of Korea
| | - Myeong Gyu Kim
- College of Pharmacy, Ewha Womans University, Seoul, Republic of Korea
- Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
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11
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Lowe MR, Singh S, Rosenbaum M, Mayer L. Physiological, body composition, and body mass measures show that a developmental measure of weight suppression is more valid than the traditional measure. Int J Eat Disord 2024; 57:1599-1608. [PMID: 38597163 PMCID: PMC11949195 DOI: 10.1002/eat.24210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE The traditional measure of weight suppression (TWS; the difference between an individual's highest past weight at adult height and current weight), has been associated with many psychological, behavioral and biological variables in those with eating disorders. A new measure of weight suppression, called developmental weight suppression (DWS), corrects two major problems in the original measure. Initial research indicates that DWS represents a superior operationalization of the construct weight suppression was originally designed to measure (Lowe [1993, Psychol Bull, 114: 100]). This study is the first to examine the relation between both WS measures and weight history, body composition and a variety of metabolic hormones. METHODS Data were collected in 91 women with bulimia nervosa (BN) or BN-spectrum disorders. RESULTS Both weight suppression indices were related to multiple hormones. However, multiple regression analyses showed that the independent effects of DWS differed from the independent effects of TWS in that only DWS was negatively related to: (1) current z-BMI, (2) body fat percentage, and (3) insulin, leptin, T3 free, and TSH. This differential pattern also occurred when results were corrected for multiple comparisons. DISCUSSION Findings provide stronger biological support for the construct validity of DWS than TWS and suggest that: (1) from the perspective of individuals with BN, high DWS embodies success at food restriction and weight loss, (2) elevated DWS may trap individuals with BN in a powerful biobehavioral bind, and (3) DWS is the preferred measure of weight suppression in future research on eating disorders. PUBLIC SIGNIFICANCE Most individuals with bulimia nervosa lose substantial weight in the process of developing their disorder. Such weight suppression is related to many characteristics of those with the eating disorder bulimia nervosa. This study shows why a new measure of weight suppression, based on an individual's growth during development, is more biologically valid than the traditional measure of weight suppression.
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Affiliation(s)
- Michael R. Lowe
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
| | - Simar Singh
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, Pennsylvania, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Michael Rosenbaum
- Department of Pediatrics and Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Laurel Mayer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
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12
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Xin Z, Xu H, Zhang X, Samelson EJ, Kiel DP, Liu CT. Association of bone fracture with 30-year body mass index (BMI) trajectories: findings from the Framingham Heart Study : Bone fracture and 30-year BMI trajectories. Osteoporos Int 2024; 35:1205-1212. [PMID: 38587675 PMCID: PMC11488984 DOI: 10.1007/s00198-024-07068-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/14/2024] [Indexed: 04/09/2024]
Abstract
A knowledge gap exists in associating later life's osteoporotic fracture and middle adulthood's BMI trajectories. We observed an association showing those transitioning from overweight to normal weight face a higher fracture risk in late adulthood, emphasizing the potential benefits of maintaining a stable BMI to reduce late-life fractures. PURPOSE Numerous studies on the relationship between obesity and fractures have relied on body mass index (BMI) at a single time point, yielding inconclusive results. This study investigated the association of BMI trajectories over middle adulthood with fracture risk in late adulthood. METHODS This prospective cohort study analyzed 1772 qualified participants from the Framingham Original Cohort Study, with 292 (16.5%) incident fractures during an average of 17.1-year follow-up. We constructed BMI trajectories of age 35-64 years based on latent class mixed modeling and explored their association with the risk of fracture after 65 years using the Cox regression. RESULTS The result showed that compared to the BMI trajectory Group 4 (normal to slightly overweight; see "Methods" for detailed description), Group 1 (overweight declined to normal weight) had a higher all-fracture risk after age 65 (hazard ratio [HR], 2.22, 95% CI, 1.13-4.39). The secondary analysis focusing on lower extremity fractures (pelvis, hip, leg, and foot) showed a similar association pattern. CONCLUSIONS This study suggested that people whose BMI slightly increased from normal weight to low-level overweight during 30 years of middle adulthood confer a significantly lower risk of fracture in later life than those whose BMI declined from overweight to normal weight. This result implies the potentially beneficial effects of avoiding weight loss to normal weight during middle adulthood for overweight persons, with reduced fracture risk in late life.
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Affiliation(s)
- Zihao Xin
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave, Third Floor, Boston, MA, 02118, USA
| | - Hanfei Xu
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave, Third Floor, Boston, MA, 02118, USA
| | - Xiaoyu Zhang
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave, Third Floor, Boston, MA, 02118, USA
| | - Elizabeth J Samelson
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Douglas P Kiel
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave, Third Floor, Boston, MA, 02118, USA.
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13
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Aydin Ozturk P, Arac E, Ozturk U, Arac S. Estimation of bone mineral density with hounsfield unit measurement. Br J Neurosurg 2024; 38:464-467. [PMID: 33629886 DOI: 10.1080/02688697.2021.1888877] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Although dual-energy x-ray absorptiometry (DXA) remains the gold standard for the measurement of bone mineral density (BMD), degenerative spine and spinal instrumentation yields inaccurate results, warranting the need for optional methods. METHODS Surgical options depend on the BMD of the patients, and to accommodate this need, we compared Hounsfield unit (HU) measurements obtained from computed tomography (CT) scans with the T-scores obtained from DXA scans to inquire whether HU measurements can screen for BMD. In this study, we also evaluated the relationship between body mass index and spontaneous fractures. RESULTS Based on the findings described in this study, we provide evidence that HU measurements obtained from CT scans can predict BMD. CONCLUSIONS This, therefore, allows HU measurements to be used as an effective diagnostic method in lieu of DXA scans when deciding on appropriate management of therapy for patients with spinal instrumentation or degenerative spines.
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Affiliation(s)
- Pınar Aydin Ozturk
- Department of Neurosurgery, University of Health Sciences, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Esref Arac
- Department of Internal Medicine, University of Health Sciences, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Unal Ozturk
- Department of Neurology, University of Health Sciences, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Songul Arac
- Department of Emergency Medicine and First Aid, University of Health Sciences, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
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14
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Swann SA, King EM, Prior JC, Berger C, Mayer U, Pick N, Campbell AR, Côté HCF, Murray MCM. Longitudinal Assessment of Bone Mineral Density in Women Living With and Without HIV Across Reproductive Phases. J Acquir Immune Defic Syndr 2024; 95:197-206. [PMID: 37963371 DOI: 10.1097/qai.0000000000003336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/10/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Women living with HIV commonly experience low areal bone mineral density (BMD), but whether this is affected by low ovarian hormonal states (prolonged amenorrhea or menopause) is unknown. We compared rates of BMD loss between women living with HIV and HIV-negative control women and investigated its association with low ovarian hormonal states. SETTING Women living with HIV were enrolled from Vancouver Canada and controls from 9 Canadian sites. METHODS This longitudinal analysis included age-matched women living with HIV in the Children and Women: AntiRetrovirals and Markers of Aging cohort and controls in the population-based Canadian Multicentre Osteoporosis Study. Rate of change/year in BMD at the total hip and lumbar spine (L1-L4) between 3 and 5 years was compared between groups, adjusting for sociodemographic and clinical variables. RESULTS Ninety-two women living with HIV (median [interquartile range] age: 49.5 [41.6-54.1] years and body mass index: 24.1 [20.7-30.8] kg/m 2 ) and 278 controls (age: 49.0 [43.0-55.0] years and body mass index: 25.8 [22.9-30.6] kg/m 2 ) were included. Total hip BMD loss was associated with HIV (β: -0.003 [95% CI: -0.006 to -0.0001] g/cm 2 /yr), menopause (β: -0.007 [-0.01 to -0.005] g/cm 2 /yr), and smoking (β: -0.003 [-0.006 to -0.0002] g/cm 2 /yr); BMD gain was linked with higher body mass index (β: 0.0002 [0.0007-0.0004] g/cm 2 /yr). Menopause was associated with losing L1-L4 BMD (β: -0.01 [-0.01 to -0.006] g/cm 2 /yr). Amenorrhea was not associated with BMD loss. CONCLUSIONS HIV and menopause negatively influenced total hip BMD. These data suggest women living with HIV require hip BMD monitoring as they age.
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Affiliation(s)
- Shayda A Swann
- Experimental Medicine, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada
| | - Elizabeth M King
- Women's Health Research Institute, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Jerilynn C Prior
- Women's Health Research Institute, Vancouver, Canada
- Centre for Menstrual Cycle and Ovulation Research (CeMCOR), Endocrinology and Metabolism, University of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Claudie Berger
- CaM os National Coordinating Centre, McGill University, Montreal, Canada
| | - Ulrike Mayer
- Women's Health Research Institute, Vancouver, Canada
| | - Neora Pick
- Women's Health Research Institute, Vancouver, Canada
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, Canada
| | - Amber R Campbell
- Women's Health Research Institute, Vancouver, Canada
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Hélène C F Côté
- Experimental Medicine, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Centre for Blood Research, University of British Columbia, Vancouver, Canada; and
- Edwin S.H. Leong Healthy Aging Program, University of British Columbia, Vancouver, Canada
| | - Melanie C M Murray
- Experimental Medicine, University of British Columbia, Vancouver, Canada
- Women's Health Research Institute, Vancouver, Canada
- Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, Canada
- Edwin S.H. Leong Healthy Aging Program, University of British Columbia, Vancouver, Canada
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15
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Song J, Zhao J, Liu T, Li Y, Dang X, Wang W. Prevalence and Risk Factors of Osteoporosis in a Chinese Population: A Cross-Sectional Study in Xi'an, Shaanxi Province, China. Med Sci Monit 2023; 29:e942346. [PMID: 38142297 PMCID: PMC10753858 DOI: 10.12659/msm.942346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/24/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Osteoporosis is a systemic chronic disease characterized by bone mineral density (BMD) reduction. This study aimed to assess the prevalence of osteoporosis and fracture risks in northwestern China and investigate the related anthropometric risk factors. MATERIAL AND METHODS Between July 2022 and August 2022, 1429 participants (1295 females, 134 males) with measured BMD were recruited to participate in this cross-sectional study. Data on height, weight, and T score were collected. Spearman's correlation and multiple linear regression analysis were used to investigate the relationships between various demographic factors and BMD and the 10-year risk of major osteoporotic fracture (MO) and hip fracture (HP). RESULTS The overall prevalence of osteoporosis in northwest China was 42.34%, with 44.56% in females and 20.90% in males. Age negatively affects females' T scores (r=-0.304, P<0.05), and height positively influences both sexes' T scores (r=0.059 P<0.05). Age (r=0.148, P<0.05) and height were positive predictors of MO (r=0.027, P<0.05), while weight was a negative predictor (r=-0.035, P<0.05). The conclusion for HP was consistent with that of MO, except for the T score, which was a positive predictor of HP (r=0.014, P<0.05). CONCLUSIONS The prevalence of osteoporosis in northeast China is high. The association between anthropometric parameters and osteoporosis in adults in northwest China is different between sexes.
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16
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Pan C, Wu Y, Hu S, Li K, Liu X, Shi Y, Lin W, Wang X, Shi Y, Xu Z, Wang H, Chen H. Polystyrene microplastics arrest skeletal growth in puberty through accelerating osteoblast senescence. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 322:121217. [PMID: 36746288 DOI: 10.1016/j.envpol.2023.121217] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/01/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
Polystyrene microplastics (PS-MPs) have attracted worldwide attention to their massive accumulation in terrestrial and aquatic ecosystems. It has been demonstrated that MPs are easily to accumulate in organs and exert toxic effects. However, their exposure risk to the skeleton remains unknown. In this study, we observed PS-MPs accumulation in both the long bones and axial bones, leading to reduced body length, as well as femur and tibia length. PS-MPs treated mice exhibited redundant skeletal growth and impaired trabecular bone micro-architecture, which is due to the suppressed osteogenic ability as the number of osteoblasts decreased significantly in PS-MPs treated mice. In histological analysis, we observed the accumulation of senescent osteoblasts in the bone trabecula of PS-MPs treated mice, as well as the impaired autophagy with decreased autophagosome and reduced autophagy-related proteins in the senescent osteoblasts. Re-establishing autophagy effectively reversed the senescent phenotype in osteoblasts and ameliorated PS-MPs induced skeletal growth arrest. Hence, our study reveals the detrimental role of PS-MPs in skeletal growth in puberty through accelerating osteoblast senescence, which may be alleviated by reactivating the autophagy. This study provides new evidence of the PS-MPs on health threats and the potential therapeutic targets to reverse it.
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Affiliation(s)
- Chun Pan
- Department of Orthopedics, Affiliated Hospital of Yangzhou University, Yangzhou, China; Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
| | - Yin Wu
- Department of Orthopedics, Affiliated Hospital of Yangzhou University, Yangzhou, China; Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
| | - Sihan Hu
- Huashan Hospital, Fudan University, Shanghai, China
| | - Ke Li
- Department of Orthopedics, Affiliated Hospital of Yangzhou University, Yangzhou, China; Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
| | - Xiangyu Liu
- Department of Orthopedics, Affiliated Hospital of Yangzhou University, Yangzhou, China; Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
| | - Yu Shi
- Department of Orthopedics, Affiliated Hospital of Yangzhou University, Yangzhou, China; Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
| | - Wenzheng Lin
- Department of Orthopedics, Affiliated Hospital of Yangzhou University, Yangzhou, China; Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
| | - Xinglong Wang
- Department of Orthopedics, Affiliated Hospital of Yangzhou University, Yangzhou, China; Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
| | - Yujie Shi
- Department of Orthopedics, Affiliated Hospital of Yangzhou University, Yangzhou, China; Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
| | - Zhuobin Xu
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
| | - Huihui Wang
- Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China
| | - Hao Chen
- Department of Orthopedics, Affiliated Hospital of Yangzhou University, Yangzhou, China; Institute of Translational Medicine, Medical College, Yangzhou University, Yangzhou, China.
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17
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Vorlet J, Carrard I. Barriers and facilitators of intuitive eating in postmenopausal women: A qualitative study. Health Psychol Open 2023; 10:20551029231157515. [PMID: 36814441 PMCID: PMC9940212 DOI: 10.1177/20551029231157515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
This qualitative descriptive research explored barriers and facilitators of the intuitive eating (IE) implementation process, as experienced by six postmenopausal women classified as 'overweight' or 'obese'. The data was analysed using deductive and inductive thematic analysis and six themes were identified. IE implementation included developing scepticism about weight loss diets, dealing with hunger and satiety cues, making nutritious food choices for one's body, struggling with emotional eating, learning to accept one's body and challenging weight stigma and sociocultural norms of beauty and thinness. IE allowed women to develop a more peaceful relationship with their diet, and was accepted as a welcome alternative to dieting.
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Affiliation(s)
- Jeanne Vorlet
- Metabolic Center, Intercantonal Hopital De La Broye Site Payerne, Switzerland,Jeanne Vorlet, Metabolic Center, Hopital Intercantonal De La Broye, Payerne/Estavayer-le-Lac, Addiction Suisse, Avenue Louis-Ruchonnet 141003, Lausanne, Switzerland.
| | - Isabelle Carrard
- Department of Nutrition and Dietetics, HES-SO Genève, Switzerland
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18
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Huang CF, Mao TY, Hwang SJ. The Effects of Switching from Dipeptidyl Peptidase-4 Inhibitors to Glucagon-Like Peptide-1 Receptor Agonists on Bone Mineral Density in Diabetic Patients. Diabetes Metab Syndr Obes 2023; 16:31-36. [PMID: 36760582 PMCID: PMC9843232 DOI: 10.2147/dmso.s389964] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/22/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Diabetes increases the risk of fragility fractures. As a result, when choosing a diabetes treatment, whether the drug affects bone density should be taken into account. The goal of this study was to determine how switching from dipeptidyl peptidase-4 inhibitors (DPP-4i) to glucagon-like peptide-1 receptor agonists (GLP-1RA) influenced bone mineral density (BMD) in diabetic patients. PATIENTS AND METHODS In this retrospective cohort study, diabetic patients with osteoporosis or osteopenia who used DPP-4i but not anti-osteoporosis medications were divided into two groups: those who switched to GLP-1RA (n = 132) and those who did not (control group, n = 133). We compared changes in glycemic control and BMD with and without conversion from DPP-4i to GLP-1RA. RESULTS Prior to switching, there was no difference between the groups in terms of age, gender, glycosylated hemoglobin (HbA1c), or BMD. HbA1c was 8.7% in the participants (mean age 62.7 years, 17.4% female). Despite the fact that there was no difference in femoral neck BMD, the GLP-1RA group had a greater decrease in lumbar spine BMD (-0.028 g/cm2 versus -0.019 g/cm2, p = 0.041) than the control group. Furthermore, HbA1c levels in the GLP-1RA-treated group were considerably lower than in the control group (7.5% versus 8.0%, p = 0.027). CONCLUSION While switching to GLP-1RA improves glycemic control, it appears to have a less favorable effect on bone density than continuing DPP-4i. More research is needed, however, to determine whether diabetic patients with low bone density should be switched from DPP-4i to GLP-1RA.
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Affiliation(s)
- Chun-Feng Huang
- Division of Family Medicine, En Chu Kong Hospital, New Taipei City, Taiwan, Republic of China
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
- Department of Leisure Services Management, Chaoyang University of Technology, Taichung, Taiwan, Republic of China
| | - Tso-Yen Mao
- Department of Leisure Services Management, Chaoyang University of Technology, Taichung, Taiwan, Republic of China
- Correspondence: Tso-Yen Mao, Department of Leisure Services Management, Chaoyang University of Technology, 168, Jifeng E. Road, Wufeng District, 413, Taichung, Taiwan, Republic of China, Tel +886 4 23323000 #7453, Fax +886 4 23742363, Email
| | - Shinn-Jang Hwang
- Division of Family Medicine, En Chu Kong Hospital, New Taipei City, Taiwan, Republic of China
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, Republic of China
- Shinn-Jang Hwang, En Chu Kong Hospital, 399, Fuxing Road, Sanxia District, 237, New Taipei City, Taiwan, Republic of China, Tel +886 2 26723456, Fax +886 2 2671-9537, Email
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Althunibat OY, Saghir SAM, Aladaileh SH, Rawadieh A. The impact of weight loss diet programs on anemia, nutrient deficiencies, and organ dysfunction markers among university female students: A cross-sectional study. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2023. [DOI: 10.29333/ejgm/12675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Practicing restricted weight loss diet programs (WLDPs) without proper supervision can result in nutritional deficiency, which can lead to the development of several nutritional disorders. The current cross-sectional study aimed to investigate the impact of WLDPs practiced by university female students on the prevalence of micronutrient deficiencies, anemia, and organs dysfunction, and to assess the association of identified anomalies with dieting practices and dietary habits of university female students. A total of 185 (105 dieting and 80 non-dieting) volunteers’ female students at Al-Hussein Bin Talal University participated in this study. After the participants answered a questionnaire, blood samples were collected for hematological and biochemical analysis, and the body mass index (BMI) was determined. The results show that there were no significant differences between dieting and non-dieting groups in biochemical markers of kidney and liver functions as well as serum levels of copper, zinc, and folate. On the other hand, dieting participants exhibited significantly lower level of hemoglobin, serum ferritin, iron, and vitamin B12 than encounter group (p<0.05). Attempting WLDPs significantly increased the prevalence of anemia (46.7%), iron deficiency (57.1%), and iron deficiency anemia (IDA) (41.9%), comparing to non-dieting students (28.7%, 33.8%, and 15.0%, respectively) (p<0.005). Chi-square test showed that the development of anemia among dieting girls was significantly dependence of several factors including BMI category, source and duration of the diet programs, and skipping breakfast (p<0.05). In conclusion, young girls attempting WLDPs without professional guidance are more prone to the risk of nutrients deficiencies and the development nutritional disorders like IDA. An educational program should be employed to teach young females on when and how to adopt healthy WLDPs.
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Affiliation(s)
- Osama Y. Althunibat
- Department of Medical Analysis, Princess Aisha Bint Al-Hussein College of Nursing and Medical Sciences, Al-Hussein Bin Talal University, Ma’an, JORDAN
| | - Sultan Ayesh Mohammed Saghir
- Department of Medical Analysis, Princess Aisha Bint Al-Hussein College of Nursing and Medical Sciences, Al-Hussein Bin Talal University, Ma’an, JORDAN
| | - Saleem Hmoud Aladaileh
- Department of Medical Analysis, Princess Aisha Bint Al-Hussein College of Nursing and Medical Sciences, Al-Hussein Bin Talal University, Ma’an, JORDAN
- Department of Biology, College of Science, Al-Hussein Bin Talal University, Ma’an, JORDAN
| | - Atikah Rawadieh
- Department of Medical Analysis, Princess Aisha Bint Al-Hussein College of Nursing and Medical Sciences, Al-Hussein Bin Talal University, Ma’an, JORDAN
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Zheng B, Zheng Y, Zhang Y, Huang L, Shen X, Zhao F, Yan S. Precedence of Bone Loss Accompanied with Changes in Body Composition and Body Fat Distribution in Patients with Type 2 Diabetes Mellitus. J Diabetes Res 2023; 2023:6753403. [PMID: 37102158 PMCID: PMC10125744 DOI: 10.1155/2023/6753403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 03/05/2023] [Accepted: 03/16/2023] [Indexed: 04/28/2023] Open
Abstract
Methods A total of 596 patients with T2DM, including 308 male and 288 female patients, were included in the follow-up study; the median follow-up time was 2.17 years. We calculated the difference between the endpoint and the baseline of each body composition index and the annual rate. The research participants were divided into the increased body mass index (BMI) group, stable BMI group, and decreased BMI group. Some confounding factors were adjusted, such as BMI, fat mass index (FMI), muscle mass index (MMI), muscle/fat mass ratio (M/F), trunk fat mass index (TFMI), appendicular skeletal muscle mass index (ASMI), and appendicular skeletal muscle mass/trunk fat mass ratio (A/T). Results The linear analysis showed that ΔFMI and ΔTFMI were negatively correlated with the change in femoral neck BMD (ΔFNBMD) and ΔMMI, ΔASMI, ΔM/F, and ΔA/T were positively correlated with ΔFNBMD. The risk of FNBMD reduction in patients with increased BMI was 56.0% lower than that in patients with decreased BMI; also, the risk in patients with stable M/F was 57.7% lower than that in patients with decreased M/F. The risk in the A/T increase group was 62.9% lower than that in the A/T decrease group. Conclusions A reasonable muscle/fat ratio is still beneficial to maintaining bone mass. Maintaining a certain BMI value is conducive to maintaining FNBMD. Simultaneously, increasing the proportion of muscle mass and reducing fat accumulation can also prevent FNBMD loss.
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Affiliation(s)
- Biao Zheng
- Department of Endocrinology, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Department of Endocrinology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
- Clinical Research Center for Metabolic Diseases of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Fujian Key Laboratory of Glycolipid and Bone Mineral Metabolism, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Diabetes Research Institute of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Yuxin Zheng
- Department of Endocrinology, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Department of Endocrinology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
- Clinical Research Center for Metabolic Diseases of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Fujian Key Laboratory of Glycolipid and Bone Mineral Metabolism, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Diabetes Research Institute of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Yongze Zhang
- Department of Endocrinology, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Department of Endocrinology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
- Clinical Research Center for Metabolic Diseases of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Fujian Key Laboratory of Glycolipid and Bone Mineral Metabolism, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Diabetes Research Institute of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Lingning Huang
- Department of Endocrinology, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Department of Endocrinology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
- Clinical Research Center for Metabolic Diseases of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Fujian Key Laboratory of Glycolipid and Bone Mineral Metabolism, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Diabetes Research Institute of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Ximei Shen
- Department of Endocrinology, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Department of Endocrinology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
- Clinical Research Center for Metabolic Diseases of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Fujian Key Laboratory of Glycolipid and Bone Mineral Metabolism, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Diabetes Research Institute of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Fengying Zhao
- Department of Endocrinology, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Department of Endocrinology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
- Clinical Research Center for Metabolic Diseases of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Fujian Key Laboratory of Glycolipid and Bone Mineral Metabolism, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Diabetes Research Institute of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
| | - Sunjie Yan
- Department of Endocrinology, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Department of Endocrinology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou 350212, China
- Clinical Research Center for Metabolic Diseases of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Fujian Key Laboratory of Glycolipid and Bone Mineral Metabolism, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Diabetes Research Institute of Fujian Province, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
- Metabolic Diseases Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou 350005, China
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Zhang Z, Zhang Z, Pei L, Zhang X, Li B, Meng Y, Zhou X. How high-fat diet affects bone in mice: A systematic review and meta-analysis. Obes Rev 2022; 23:e13493. [PMID: 35822276 DOI: 10.1111/obr.13493] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 06/18/2022] [Accepted: 06/19/2022] [Indexed: 11/29/2022]
Abstract
High-fat diet (HFD) feeding for mice is commonly used to model obesity. However, conflicting results have been reported on the relationship between HFD and bone mass. In this systematic review and meta-analysis, we synthesized data from 80 articles to determine the alterations in cortical and trabecular bone mass of femur, tibia, and vertebrae in C57BL/6 mice after HFD. Overall, we detected decreased trabecular bone mass as well as deteriorated architecture, in femur and tibia of HFD treated mice. The vertebral trabecula was also impaired, possibly due to its reshaping into a more fragmentized pattern. In addition, pooled cortical thickness declined in femur, tibia, and vertebrae. Combined with changes in other cortical parameters, HFD could lead to a larger femoral bone marrow cavity, and a thinner and more fragile cortex. Moreover, we conducted subgroup analyses to explore the influence of mice's sex and age as well as HFD's ingredients and intervention period. Based on our data, male mice or mice aged 6-12 weeks old are relatively susceptible to HFD. HFD with > 50% of energy from fats and intervention time of 10 weeks to 5 months are more likely to induce skeletal alterations. Altogether, these findings supported HFD as an appropriate model for obesity-associated bone loss and can guide future studies.
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Affiliation(s)
- Zheng Zhang
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University (Naval Medical University), Shanghai, People's Republic of China
| | - Zhanrong Zhang
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University (Naval Medical University), Shanghai, People's Republic of China
| | - Lei Pei
- Department of Emergency, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xiaozhou Zhang
- College of Letters & Science, University of California Berkeley, Berkeley, California, USA
| | - Boyuan Li
- Fountain Valley School of Colorado, Colorado Springs, Colorado, USA
| | - Yichen Meng
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University (Naval Medical University), Shanghai, People's Republic of China
| | - Xuhui Zhou
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University (Naval Medical University), Shanghai, People's Republic of China
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22
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Saghir SAM, Althunibat OY, Aladaileh SH, Alrawadeh A, Al-Areefi M, Alghonmeen RD, Alkhawaldeh A'AMA, Obaidat HM. Distribution and association of weight-loss diet programs with body mass index and health status among students at Al-Hussein Bin Talal University, Jordan. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2022. [DOI: 10.29333/ejgm/12424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ou X, Chen M, Xu L, Lin W, Huang H, Chen G, Wen J. Changes in bone mineral density after bariatric surgery in patients of different ages or patients with different postoperative periods: a systematic review and meta-analysis. Eur J Med Res 2022; 27:144. [PMID: 35934692 PMCID: PMC9358806 DOI: 10.1186/s40001-022-00774-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 07/23/2022] [Indexed: 11/10/2022] Open
Abstract
To assess changes in bone mineral density (BMD) following bariatric surgery (BS) in patients with different bone sites, postoperative periods and ages. Twenty-two studies were included. Femoral neck (FN) BMD decreased after surgery (MD, - 0.05 g/cm2, CI - 0.10 to - 0.01, P = 0.03). Postoperative BMD decreased more in the FN and lumbar spine (LS) of patients older than 40 (FNBMD, - 0.07 g/cm2, CI - 0.13 to - 0.00, P = 0.04; LSBMD, - 0.03 g/cm2, CI - 0.05 to - 0.00, P = 0.02) or patients with a postoperative time of greater than 12 months (FNBMD, - 0.06 g/cm2, CI - 0.12 to - 0.01, P = 0.03; LSMD, - 0.04 g/cm2, CI - 0.09 to 0.01, P = 0.12); therefore, post-BS bone loss should be monitored among patients in these groups. Longer follow-ups are needed to determine whether BMD changes or stabilizes.
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Affiliation(s)
- Xiaodan Ou
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Mingguang Chen
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.,Department of Cardiac Intensive Care Unit, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Lizhen Xu
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Wei Lin
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Huibin Huang
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
| | - Gang Chen
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China
| | - Junping Wen
- Department of Endocrinology, Key Laboratory of Endocrinology, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China.
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Lee J, Han K, Park SH, Kim MK, Lim DJ, Yoon KH, Kang MI, Lee SH. Associations of variability in body weight and glucose levels with the risk of hip fracture in people with diabetes. Metabolism 2022; 129:155135. [PMID: 35032546 DOI: 10.1016/j.metabol.2022.155135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 01/06/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Diabetes is associated with a high risk of fragility fracture. However, there are controversies regarding the effect of fluctuations in metabolic parameters on the risk of fracture. We aimed to investigate the associations of body weight or glucose variability or their combination with the risk of hip fracture in people with diabetes. METHODS A population-based cohort study with 480,539 subjects over 40 years who had undergone three or more health examinations was performed. The degree of variability was evaluated using variability independent of the mean (VIM, 100 × standard deviation / meanbeta), coefficient of variation (CV), and average real variability (ARV, average of the absolute differences between consecutive values). High variability was defined as having values in the highest quartile. Cox proportional hazards models were used to estimate the risk of hip fracture. RESULTS There were 2834 hip fracture events (0.59%) during the mean follow-up of 8.1 years. After multivariable adjustment for age, sex, alcohol consumption, smoking, regular exercise, income, glucose, body mass index, hemoglobin, estimated glomerular filtration rate, diabetes duration, diabetes treatment with multiple agents, and osteoporosis, the HRs (95% CI) of hip fracture were 1.36 (1.24-1.50) and 1.29 (1.16-1.43) for high body weight VIM and high glucose VIM, respectively. The HR (95% CI) of both high VIM group was 1.63 (1.44-1.83), suggesting an additive effect of variabilities in body weight and glucose. The results were consistent when using CV and ARV and in various sensitivity analyses. CONCLUSIONS High variability in body weight and glucose levels is associated with an increased incidence rate and risk of hip fracture in people with diabetes.
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Affiliation(s)
- Jeongmin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Republic of Korea
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea
| | - Sang Hyun Park
- Department of Medical Statistics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Mee Kyoung Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 07345, Republic of Korea
| | - Dong-Jun Lim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kun-Ho Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Moo-Il Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Seung-Hwan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; Department of Medical Informatics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
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25
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Hofbauer LC, Busse B, Eastell R, Ferrari S, Frost M, Müller R, Burden AM, Rivadeneira F, Napoli N, Rauner M. Bone fragility in diabetes: novel concepts and clinical implications. Lancet Diabetes Endocrinol 2022; 10:207-220. [PMID: 35101185 DOI: 10.1016/s2213-8587(21)00347-8] [Citation(s) in RCA: 202] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 12/12/2022]
Abstract
Increased fracture risk represents an emerging and severe complication of diabetes. The resulting prolonged immobility and hospitalisations can lead to substantial morbidity and mortality. In type 1 diabetes, bone mass and bone strength are reduced, resulting in up to a five-times greater risk of fractures throughout life. In type 2 diabetes, fracture risk is increased despite a normal bone mass. Conventional dual-energy x-ray absorptiometry might underestimate fracture risk, but can be improved by applying specific adjustments. Bone fragility in diabetes can result from cellular abnormalities, matrix interactions, immune and vascular changes, and musculoskeletal maladaptation to chronic hyperglycaemia. This Review summarises how the bone microenvironment responds to type 1 and type 2 diabetes, and the mechanisms underlying fragility fractures. We describe the value of novel imaging technologies and the clinical utility of biomarkers, and discuss current and future therapeutic approaches that protect bone health in people with diabetes.
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Affiliation(s)
- Lorenz C Hofbauer
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine III, and Center for Healthy Aging, University Medical Center, Technische Universität Dresden, Dresden, Germany.
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Richard Eastell
- Department of Oncology and Metabolism, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - Serge Ferrari
- Service and Laboratory of Bone Diseases, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Morten Frost
- Molecular Endocrinology Laboratory and Steno Diabetes Centre Odense, Odense University Hospital, Odense, Denmark
| | - Ralph Müller
- Institute of Biomechanics, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Andrea M Burden
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | | | - Nicola Napoli
- RU of Endocrinology and Diabetes, Campus Bio-Medico University of Rome and Fondazione Policlinico Campus Bio-Medico, Rome, Italy; Division of Bone and Mineral Diseases, Washington University in St Louis, St Louis, MO, USA
| | - Martina Rauner
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine III, and Center for Healthy Aging, University Medical Center, Technische Universität Dresden, Dresden, Germany
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26
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Avdeeva VA, Suplotova LA, Rozhinskaya LY. Effects of bariatric surgery on bone metabolism: focusing on vitamin D. OBESITY AND METABOLISM 2022; 19:116-122. [DOI: 10.14341/omet12702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
The main goal of bariatric surgery is weight loss due to fundamental differential changes in the anatomical and physiological characteristics of the gastrointestinal tract. At the same time, one of the most frequent complications of obesity surgery, especially operations associated with malabsorption, is vitamin D deficiency. Patients with obesity initially have a wide range of predisposing factors for metabolic diseases of the skeleton due to lifestyle problems. Nutrient deficiencies with high-calorie diets and a sedentary lifestyle with a tendency to wear clothing that covers most of the skin — reduces serum 25 (OH) D levels. In addition, the situation is aggravated by a decrease in the bioavailability of 25 (OH) D due to its sequestration in adipose tissue and its complete inaccessibility to the central blood flow. The consequences of bariatric surgery — a decrease in the amount of skin and malabsorption can aggravate the existing deficiency. As a result of a decrease in the level of 25 (OH) D and subsequent hypocalcemia and secondary hyperparathyroidism, negatively affect the state of bone health. The presented literature review is devoted to the problems of obesity surgery and vitamin D deficiency. The main focus is on bone metabolism associated with bariatric surgery, the causes of pre and postoperative vitamin D deficiency are discussed, and recommendations for its treatment after obesity surgery are given.
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Yazdanpanah Z, Beigrezaei S, Mohseni-Takalloo S, Soltani S, Rajaie SH, Zohrabi T, Kaviani M, Forbes SC, Baker JS, Salehi-Abargouei A. Does exercise affect bone mineral density and content when added to a calorie-restricted diet? A systematic review and meta-analysis of controlled clinical trials. Osteoporos Int 2022; 33:339-354. [PMID: 34643754 DOI: 10.1007/s00198-021-06187-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
The effects of exercise in conjunction with weight-loss diets on bone health are mixed. Our objective was to systematically review and meta-analyze controlled clinical trials in adults investigating the addition of exercise to a weight-loss diet compared with a calorie-matched weight-loss diet without exercise on bone measures. Online databases including PubMed/MEDLINE, EMBASE, ISI (Web of Science), Scopus, and Google Scholar were searched up to April 2021 with no restriction. A random effects model was used to calculate the overall estimates. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Fourteen eligible controlled clinical trials were included in the systematic review. The meta-analysis revealed that, compared to weight-loss diets alone, the addition of exercise did not improve total body bone mineral density (BMD) [weighted mean difference (WMD) = 0.002 g/cm2, P = 0.62, n = 8], lumbar BMD (WMD = 0.007 g/cm2, P = 0.44, n = 9), total hip BMD (WMD = 0.015 g/cm2, P = 0.14, n = 4) and total bone mineral content (BMC) (WMD = - 11.97 g, P = 0.29, n = 7). Subgroup analysis revealed that resistance exercise in conjunction with hypocaloric diets positively affects total BMD compared to an energy restrictive diet alone (WMD = 0.01 g/cm2, P = 0.003, n = 3). Overall, it appears that only resistance exercise beneficially affects total BMD during a calorie-restricted diet in adults. Further well-controlled and long-term clinical trials are still needed to confirm these results. PROSPERO registration number: CRD42020173434.
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Affiliation(s)
- Zeinab Yazdanpanah
- Department of Nutrition, Faculty of Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, PO Code 8915173160 , Yazd, Iran
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sara Beigrezaei
- Department of Nutrition, Faculty of Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, PO Code 8915173160 , Yazd, Iran
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sahar Mohseni-Takalloo
- Department of Nutrition, Faculty of Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, PO Code 8915173160 , Yazd, Iran
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- Noncommunicable Diseases Research Center, Bam University of Medical Sciences, Bam, Iran
| | - Sepideh Soltani
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Seyede Hamide Rajaie
- Department of Nutrition, Faculty of Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, PO Code 8915173160 , Yazd, Iran
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Tayebeh Zohrabi
- Department of Nutrition, Faculty of Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, PO Code 8915173160 , Yazd, Iran
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mojtaba Kaviani
- School of Nutrition and Dietetics, Faculty of Pure & Applied Science, Acadia University, Wolfville, NS, Canada
| | - Scott C Forbes
- Department of Physical Education Studies, Faculty of Education, Brandon University, Brandon, MB, Canada
| | - Julien S Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Amin Salehi-Abargouei
- Department of Nutrition, Faculty of Health, School of Public Health, Shahid Sadoughi University of Medical Sciences, PO Code 8915173160 , Yazd, Iran.
- Nutrition and Food Security Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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28
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Gandhi GY, Mooradian AD. Clinical Considerations for Insulin Therapy in Older Adults with Type 1 Diabetes. Drugs Aging 2021; 39:23-37. [PMID: 34664212 DOI: 10.1007/s40266-021-00900-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 02/07/2023]
Abstract
Type 1 diabetes represents an autoimmune condition with a strong inherited background, and its incidence is increasing worldwide. About 25% of such cases are diagnosed in adulthood, some even as late as the ninth decade of life. The number of older adults with type 1 diabetes is increasing due to improvements in care and decreased mortality rate. However, there is a lack of clinical trials in people older than 70 years of age with type 1 diabetes complicated with comorbidities, frailty, and dependency. The management of type 1 diabetes and the goals of therapy should be individualized based on the patient's health status and life expectancy. In healthier older adults, insulin treatment regimens (multiple daily insulin injections or insulin pump therapy) that approximate the normal physiology of insulin secretion should be used to achieve lower glycemic goals, while reducing the risk of hypoglycemia with frequent glucose monitoring (preferably using continuous glucose monitoring systems). For frail individuals with poor health, simpler insulin regimens and less stringent glycemic targets would be more appropriate. Poor cognition, vision and hearing, impaired mobility, depression, and chronic pain can interfere with complex insulin regimens. In these individuals, the principal goals of therapy are to reduce the acute effects of hyperglycemia, minimize hypoglycemia risk, and optimize quality of life. The newer insulin preparations and technological advances in insulin delivery and blood glucose monitoring have enhanced the management of type 1 diabetes in all age groups.
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Affiliation(s)
- Gunjan Y Gandhi
- Division of Endocrinology, Department of Medicine, University of Florida College of Medicine-Jacksonville, 653-1 West 8th Street, 4th Floor-LRC, Jacksonville, FL, 32209, USA
| | - Arshag D Mooradian
- Division of Endocrinology, Department of Medicine, University of Florida College of Medicine-Jacksonville, 653-1 West 8th Street, 4th Floor-LRC, Jacksonville, FL, 32209, USA.
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29
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The Effect of Caloric Restriction with and without n-3 PUFA Supplementation on Bone Turnover Markers in Blood of Subjects with Abdominal Obesity: A Randomized Placebo-Controlled Trial. Nutrients 2021; 13:nu13093096. [PMID: 34578973 PMCID: PMC8465881 DOI: 10.3390/nu13093096] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/20/2022] Open
Abstract
Weight loss contributes to an increased risk of hip fracture, especially in postmenopausal women. Omega-3 polyunsaturated fatty acid (n-3 PUFA) supplementation could diminish the adverse effect of weight loss on bone health. The aim of this randomized, placebo-controlled, double-blind parallel trial was to investigate the effect of caloric restriction and n-3 PUFA supplement intake on osteogenic markers (carboxylated osteocalcin (Gla-OC); procollagen I N-terminal propeptide (PINP)), as well as a bone resorption marker (C-terminal telopeptide of type I collagen (CTX-I)) in a serum of 64 middle aged individuals (BMI 25-40 kg/m2) with abdominal obesity. Bone remodeling, metabolic and inflammatory parameters and adipokines were determined before and after 3 months of an isocaloric diet (2300-2400 kcal/day) or a low-calorie diet (1200 kcal/day for women and 1500 kcal/day for men) along with n-3 PUFA (1.8 g/day) or placebo capsules. CTX-I and adiponectin concentrations were increased following 7% weight loss independently of supplement use. Changes in CTX-I were positively associated with changes in adiponectin level (rho = 0.25, p = 0.043). Thus, an increase in serum adiponectin caused by body weight loss could adversely affect bone health. N-3 PUFAs were without effect.
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Cherukuri L, Kinninger A, Birudaraju D, Lakshmanan S, Li D, Flores F, Mao SS, Budoff MJ. Effect of body mass index on bone mineral density is age-specific. Nutr Metab Cardiovasc Dis 2021; 31:1767-1773. [PMID: 33934946 DOI: 10.1016/j.numecd.2021.02.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 01/05/2023]
Abstract
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.
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Affiliation(s)
- Lavanya Cherukuri
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - April Kinninger
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Divya Birudaraju
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Suvasini Lakshmanan
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Dong Li
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Ferdinand Flores
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Song S Mao
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA
| | - Matthew J Budoff
- Lundquist Institute for Biomedical Innovation at Harbor UCLA Medical Center, Torrance, CA, USA.
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Lee JH, Park J, Kim JH, Choi JY, Choi HJ, Ku EJ, Hong AR, Shin CS, Cho NH. Integrative analysis of genetic and clinical risk factors for bone loss in a Korean population. Bone 2021; 147:115910. [PMID: 33722773 DOI: 10.1016/j.bone.2021.115910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The relative contribution of genetic and clinical factors for bone loss is not well known. This study aimed to investigate the annualized percentage change in total hip bone mineral density (BMD) and the genetic and clinical risk factors for bone loss in a Korean prospective cohort study over a 6-year period. METHODS We included 645 men aged ≥50 years and 683 postmenopausal women who had repeated BMD testing between 2007 and 2014. The association between covariates and annualized percentage change in hip BMD was analyzed through the multivariate linear regression analysis. A total of 2614 single-nucleotide polymorphisms (SNPs) from 23 known BMD-related candidate genes and genome-wise association study were investigated. RESULTS Hip bone loss increased more rapidly in women than in men with advancing age. Hip bone loss in men increased with lean mass (LM) loss (%/year) (P < 0.001) and current smoking (P = 0.024) and decreased with increasing waist circumference (WC) (P < 0.001), alcohol consumption (P = 0.049), and increase in red blood cell counts (P = 0.031). Decreasing WC (P = 0.009), LM loss (%/year) (P < 0.001), and years since menopause ≤ 3 years (P = 0.003) significantly correlated with hip bone loss in women aged 45-59 years. Hip bone loss in women aged ≥60 years increased with advancing age (P = 0.012), alcohol consumption (P = 0.028), LM loss (%/year) (P = 0.031), and fat mass loss (%/year) (P < 0.001) and decreased with increasing WC (P = 0.025). LRP5 rs498830 (β = 0.127, P = 0.007) and TNFSF11 rs7325635 (β = 0.146, P = 0.001) were the top SNPs related to hip bone loss in men and postmenopausal women, respectively. However, none of the SNPs were associated with hip bone loss after Benjamini-Hochberg adjustment. CONCLUSION In this study, decreasing WC and LM were significant risk factors for hip bone loss in both men and women. Those factors were also identified that had sex-specific or age-specific effects on hip bone loss. None of the SNPs were associated with hip bone loss after multiple testing adjustments. The understanding of the modifiable factors contributing to bone loss has been broadened, and this may have implications such as in developing individualized preventive strategy. Further studies are needed to better predict the risk for bone loss in men and women.
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Affiliation(s)
- Ji Hyun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, VHS Medical Center, Seoul, Republic of Korea
| | - JooYong Park
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji-Yeob Choi
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyung Jin Choi
- Department of Anatomy, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eu Jeong Ku
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Chungbuk National University hospital, Cheongju Si, Republic of Korea
| | - A Ram Hong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Internal Medicine, Chonnam National University Medical School, Chonnam, Republic of Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam H Cho
- Department of Preventive Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
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Napoli N, Incalzi RA, De Gennaro G, Marcocci C, Marfella R, Papalia R, Purrello F, Ruggiero C, Tarantino U, Tramontana F, Conte C. Bone fragility in patients with diabetes mellitus: A consensus statement from the working group of the Italian Diabetes Society (SID), Italian Society of Endocrinology (SIE), Italian Society of Gerontology and Geriatrics (SIGG), Italian Society of Orthopaedics and Traumatology (SIOT). Nutr Metab Cardiovasc Dis 2021; 31:1375-1390. [PMID: 33812734 DOI: 10.1016/j.numecd.2021.01.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 02/08/2023]
Abstract
Bone fragility is one of the possible complications of diabetes, either type 1 (T1D) or type 2 (T2D). Bone fragility can affect patients of different age and with different disease severity depending on type of diabetes, disease duration and the presence of other complications. Fracture risk assessment should be started at different stages in the natural history of the disease depending on the type of diabetes and other risk factors. The risk of fracture in T1D is higher than in T2D, imposing a much earlier screening and therapeutic intervention that should also take into account a patient's life expectancy, diabetes complications etc. The therapeutic armamentarium for T2D has been enriched with drugs that may influence bone metabolism, and clinicians should be aware of these effects. Considering the complexity of diabetes and osteoporosis and the range of variables that influence treatment choices in a given individual, the Working Group on bone fragility in patients with diabetes mellitus has identified and issued recommendations based on the variables that should guide screening of bone fragility and management of diabetes and bone fragility: (A)ge, (B)MD, (C)omplications, (D)uration of disease, & (F)ractures (ABCD&F). Consideration of these parameters may help clinicians identify the best time for screening, the appropriate glycaemic target and anti-osteoporosis drug for patients with diabetes at risk of or with bone fragility.
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Affiliation(s)
- Nicola Napoli
- Unit of Endocrinology and Diabetes, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy; Division of Bone and Mineral Diseases, Washington University in St. Louis, St. Louis, MO, USA.
| | - Raffaele A Incalzi
- Unit of Geriatrics, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Giovanni De Gennaro
- Diabetes Center, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudio Marcocci
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rocco Papalia
- Unit of Orthopedic and Trauma Surgery, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Francesco Purrello
- Department of Clinical and Experimental Medicine, University of Catania, 95100 Catania, Italy; Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - Carmelinda Ruggiero
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, Faculty of Medicine and Surgery, "Tor Vergata" University of Rome, Rome, Italy; Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - Flavia Tramontana
- Unit of Endocrinology and Diabetes, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Caterina Conte
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy; Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy
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Lobene AJ, Panda S, Mashek DG, Manoogian ENC, Hill Gallant KM, Chow LS. Time-Restricted Eating for 12 Weeks Does Not Adversely Alter Bone Turnover in Overweight Adults. Nutrients 2021; 13:nu13041155. [PMID: 33807284 PMCID: PMC8065778 DOI: 10.3390/nu13041155] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 11/16/2022] Open
Abstract
Weight loss is a major focus of research and public health efforts. Time-restricted eating (TRE) is shown to be effective for weight loss, but the impact on bone is unclear. Short-term TRE studies show no effect on bone mineral density (BMD), but no study has measured bone turnover markers. This secondary analysis examined the effect of 12 weeks of TRE vs. unrestricted eating on bone turnover and BMD. Overweight and obese adults aged 18–65 y (n = 20) were randomized to TRE (ad libitum 8-h eating window) or non-TRE. Serum N-terminal propeptide of type I collagen (P1NP), cross-linked N-telopeptide of type I collagen (NTX), and parathyroid hormone (PTH) levels were measured and dual-energy X-ray absorptiometry (DXA) scans were taken pre- and post-intervention. In both groups, P1NP decreased significantly (p = 0.04) but trended to a greater decrease in the non-TRE group (p = 0.07). The treatment time interaction for bone mineral content (BMC) was significant (p = 0.02), such that BMC increased in the TRE group and decreased in the non-TRE group. Change in P1NP was inversely correlated with change in weight (p = 0.04) overall, but not within each group. These findings suggest that TRE does not adversely affect bone over a moderate timeframe. Further research should examine the long-term effects of TRE on bone.
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Affiliation(s)
- Andrea J. Lobene
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA;
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE 19713, USA
- Correspondence:
| | - Satchidananda Panda
- Salk Institute for Biological Studies, La Jolla, CA 92037, USA; (S.P.); (E.N.C.M.)
| | - Douglas G. Mashek
- Department of Biochemistry, Molecular Biology and Biophysics, University of Minnesota, Minneapolis, MN 55455, USA;
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, MN 55455, USA;
| | | | - Kathleen M. Hill Gallant
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA;
- Department of Food Science and Nutrition, University of Minnesota, St. Paul, MN 55108, USA
| | - Lisa S. Chow
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, MN 55455, USA;
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Caloric Intake in Renal Patients: Repercussions on Mineral Metabolism. Nutrients 2020; 13:nu13010018. [PMID: 33374582 PMCID: PMC7822489 DOI: 10.3390/nu13010018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/15/2020] [Accepted: 12/19/2020] [Indexed: 12/22/2022] Open
Abstract
The aim of this paper is to review current knowledge about how calorie intake influences mineral metabolism focussing on four aspects of major interest for the renal patient: (a) phosphate (P) handling, (b) fibroblast growth factor 23 (FGF23) and calcitriol synthesis and secretion, (c) metabolic bone disease, and (d) vascular calcification (VC). Caloric intake has been shown to modulate P balance in experimental models: high caloric intake promotes P retention, while caloric restriction decreases plasma P concentrations. Synthesis and secretion of the phosphaturic hormone FGF23 is directly influenced by energy intake; a direct correlation between caloric intake and FGF23 plasma concentrations has been shown in animals and humans. Moreover, in vitro, energy availability has been demonstrated to regulate FGF23 synthesis through mechanisms in which the molecular target of rapamycin (mTOR) signalling pathway is involved. Plasma calcitriol concentrations are inversely proportional to caloric intake due to modulation by FGF23 of the enzymes implicated in vitamin D metabolism. The effect of caloric intake on bone is controversial. High caloric intake has been reported to increase bone mass, but the associated changes in adipokines and cytokines may as well be deleterious for bone. Low caloric intake tends to reduce bone mass but also may provide indirect (through modulation of inflammation and insulin regulation) beneficial effects on bone. Finally, while VC has been shown to be exacerbated by diets with high caloric content, the opposite has not been demonstrated with low calorie intake. In conclusion, although prospective studies in humans are needed, when planning caloric intake for a renal patient, it is important to take into consideration the associated changes in mineral metabolism.
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Qian BB, Chen Q, Li L, Yan CF. Association between combined treatment with SGLT2 inhibitors and metformin for type 2 diabetes mellitus on fracture risk: a meta-analysis of randomized controlled trials. Osteoporos Int 2020; 31:2313-2320. [PMID: 32780153 DOI: 10.1007/s00198-020-05590-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/04/2020] [Indexed: 02/06/2023]
Abstract
UNLABELLED This study analyzed the effects of combination therapy with sodium-glucose transporter-2 inhibitors (SGLT2is) and metformin on fracture risk. Summarizing available randomized controlled trials, we found that SGLT2is combined with metformin therapy did not influence fracture risk compared with metformin monotherapy or other comparators in patients with T2DM. INTRODUCTION No study is available evaluating the association between sodium-glucose transporter-2 inhibitors (SGLT2is) in combination with metformin use and fracture risk. Our study aimed to investigate the fracture risk of combination therapy with SGLT2is and metformin in patients with type 2 diabetes mellitus (T2DM). METHODS PubMed, Embase, ClinicalTrials.gov site, and the Cochrane Library databases were scrutinized for all eligible randomized controlled trials (RCTs). The summarized odds ratios (ORs) and their 95% confidence intervals (CI) were calculated using Review Manager 5.3 software. RESULTS A total of 25 RCTs involving 19,500 participants with T2DM were included in our studies. There were 88 fracture cases in the SGLT2is in combination with metformin therapy group and 79 in the control group. SGLT2is combined with metformin use did not influence fracture risk compared with metformin monotherapy or other comparators in patients with T2DM (OR = 0.97, 95% CI 0.71-1.32). After stratification by drug type, follow-up time, control regimen, and type of fracture, the upshots were still stable. CONCLUSION SGLT2is and metformin combination therapy did not influence fracture risk compared with metformin monotherapy or other comparators in patients with T2DM. PROSPERO REGISTRATION NUMBER CRD42020168435.
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Affiliation(s)
- B-B Qian
- Department of Endocrinology, Northern Jiangsu People's Hospital, The Second Clinical College of Dalian Medical University, Yangzhou, 225001, Jiangsu, China
| | - Q Chen
- Department of Endocrinology, Northern Jiangsu People's Hospital, The Second Clinical College of Dalian Medical University, Yangzhou, 225001, Jiangsu, China
| | - L Li
- Department of Endocrinology, Northern Jiangsu People's Hospital, The Second Clinical College of Dalian Medical University, Yangzhou, 225001, Jiangsu, China
| | - C-F Yan
- Department of Endocrinology, Northern Jiangsu People's Hospital, The Second Clinical College of Dalian Medical University, Yangzhou, 225001, Jiangsu, China.
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Subasinghe HWAS, Lekamwasam S, Ball P, Morrissey H, Waidyaratne E. Estimating regional bone mineral density-based T-scores using clinical information; tools validated for postmenopausal women in Sri Lanka. Osteoporos Sarcopenia 2020; 6:122-128. [PMID: 33102805 PMCID: PMC7573505 DOI: 10.1016/j.afos.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/23/2020] [Accepted: 08/29/2020] [Indexed: 11/26/2022] Open
Abstract
Objectives This study aims to develop and validate a country specific osteoporosis risk assessing tool for Sri Lankan postmenopausal women. Methods Community-dwelling postmenopausal women were enrolled to development (n = 602) and validation (n = 339) samples. Clinical risk factors (CRFs) of osteoporosis were assessed. Bone mineral densities (BMD) of femoral neck, total hip and lumbar spine were assessed by dual energy X-ray absorptiometry (DXA) scan. Radial ultrasound (US) bone scan was done. Linear regression analysis was performed in development sample considering regional BMDs as dependent and CRFs as independent variables. Regression equations were developed to estimate regional BMDs using best predictive CRFs. Sensitivity, specificity, positive and negative predictive values (PPV and NPV) were assessed to validate the new tools. Results Age, body weight and US T-scores showed positive correlations with BMDs of all 3 sites. Two osteoporosis risk assessing tools (OPRATs) were developed as OPRAT-1 and OPRAT-2. Prevalence of osteoporosis, in the validation sample was 74.3%. Sensitivity were high in both tools (OPRAT-1 and OPRAT-2; 83.2% and 82.5%) while specificity were moderate (44.8% for both). PPV of OPRAT-1 and OPRAT-2 were 79.5% and 81.2%. Both tools showed moderate NPV (OPRAT-1 and OPRAT-2; 51% and 47%). Conclusions Both OPRAT-1 and OPRAT-2 have high performance in screening postmenopausal women in Sri Lanka for risk of osteoporosis. OPRAT-2 is more convenient and can be used in any healthcare setting with limited resources to identify women who will be benefitted by DXA. OPRAT-1 can be used if the radial US facility is available.
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Affiliation(s)
| | | | - Patrick Ball
- School of Pharmacy, University of Wolverhampton, United Kingdom
| | - Hana Morrissey
- School of Pharmacy, University of Wolverhampton, United Kingdom
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Effectiveness of SaBang- DolGi Walking Exercise Program on Physical and Mental Health of Menopausal Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186935. [PMID: 32972007 PMCID: PMC7558547 DOI: 10.3390/ijerph17186935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 12/16/2022]
Abstract
Objective: We investigated the effectiveness of a 12-week SaBang-DolGi walking exercise program on the physical and mental health of menopausal women and aimed to provide the basic data needed to develop health promotion programs for the active and healthy aging of menopausal women. Materials and methods: The participants comprised 40 women aged 50–65 years who were divided into two randomly selected groups in training sessions (exercising group, n = 21 and control group, n = 19). A physical (grip, muscle and endurance) test and mental health test (simple mental health test II) were conducted using questionnaires with the aim of examining subjects’ physical and mental health before and after exercise. Results: After the intervention, the participants experienced positive changes in the physical dimension, with significant enhancements particularly in mental well-being and menopause-related health and subdomains. Controlled and regular exercise for 12 weeks was significantly correlated with a positive change in vitality and mental health. Conclusions: We found that the SaBang-DolGi walking exercise program helps to promote the physical and mental health of menopausal women who are exposed to the various stresses and depressions that accompany physical deterioration; the program was found to encourage active and healthy aging.
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Patel D. Glycaemic and non-glycaemic efficacy of once-weekly GLP-1 receptor agonists in people with type 2 diabetes. J Clin Pharm Ther 2020; 45 Suppl 1:28-42. [PMID: 32910489 PMCID: PMC7540306 DOI: 10.1111/jcpt.13224] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/10/2020] [Indexed: 12/14/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may confer a range of benefits for people with type 2 diabetes (T2D), which is reflected through their position within diabetes treatment guidelines. The objective of this narrative review is to explore the efficacy data of once-weekly (QW) GLP-1 RAs in terms of glycaemic control, body weight reduction, cardiovascular (CV) outcomes and potential renal protective effects to assist pharmacists and other healthcare professionals (HCPs) in treatment discussions with patients. METHODS This a narrative review focused on 31 clinical trials involving the Phase 3 clinical programmes of the QW GLP-1 RAs dulaglutide, exenatide extended-release (ER) and semaglutide subcutaneous (s.c.). RESULTS AND DISCUSSION The clinical trials were divided by their comparator arms and examined for trends. All QW GLP-1 RAs were superior to placebo for reductions in glycated haemoglobin (HbA1c ) and body weight. Data regarding QW GLP-1 RAs versus metformin were limited, likely due to metformin's use as the first-line pharmacologic for T2D. In the robust head-to-head trials of QW versus QW GLP-1 RAs, semaglutide s.c. was superior to both dulaglutide and exenatide ER regarding HbA1c and body weight; however, QW versus once-daily GLP-1 RA trials had mixed results depending on the comparators. Finally, in QW GLP-1 RA versus insulin trials, all QW GLP-1 RAs were as effective as insulin, particularly when hypoglycaemia and body weight were also considered. CV outcome trials demonstrated benefits in major adverse CV events and renal outcomes for semaglutide and dulaglutide. WHAT IS NEW AND CONCLUSION This review collates recently published data and previously published Phase 3 results to allow pharmacists and other HCPs to understand all of the efficacy data available and the corresponding impact on treatment guidelines. QW GLP-1 RAs are emerging as important therapeutic options for people with T2D as they offer a spectrum of benefits extending beyond glycaemic control, but it is important to be aware of their efficacy differences when prescribing and discussing them with patients.
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Xuan R, Song Y, Baker JS, Gu Y. The Evaluation of Bone Mineral Density based on Age and Anthropometric Parameters in Southeast Chinese Adults: A Cross-Sectional Study. Med Sci Monit 2020; 26:e923603. [PMID: 32799215 PMCID: PMC7448692 DOI: 10.12659/msm.923603] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Osteoporosis is a chronic skeletal disease characterized by a reduction in bone density, resulting in high death rates and high costs among patients worldwide. This study investigated the associations among age, anthropometric parameters and bone mineral density (BMD) in southeast Chinese adults and evaluated the characteristics of southeast Chinese adults at high risk of osteoporosis. MATERIAL AND METHODS This study enrolled 424 female and 265 male volunteers. Height, weight and BMD were measured, and body mass index (BMI) was calculated. Based on their BMD T-scores, female and male participants were divided into groups with osteoporosis (OG1) and osteopenia (OG2) and a normal group (NG). RESULTS The findings revealed no significant correlations between BMD and anthropometric parameters in either gender. However, a significant negative correlation was noted between BMD and age in the female participants, and a significant positive correlation was observed between BMD and age in the male participants. Multiple comparisons between groups revealed that women in the OG1 and OG2 groups were significantly older than those in the NG group. CONCLUSIONS Age, anthropometric parameters and BMD correlate differently between groups and genders in southeast Chinese adults.
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Affiliation(s)
- Rongrong Xuan
- The Affiliated Hospital of Medical School, Ningbo University, Ningbo, Zhejiang, China (mainland)
| | - Yang Song
- Faculty of Sports Science, Ningbo University, Ningbo, Zhejiang, China (mainland)
| | - Julien S Baker
- Department of Sport, and Physical Education, Hong Kong Baptist University, Hong Kong, Hong Kong
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, Zhejiang, China (mainland)
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Santarossa A, Gibson TWG, Kerr C, Monteith GJ, Durzi T, Gowland S, Verbrugghe A. Body composition of medium to giant breed dogs with or without cranial cruciate ligament disease. Vet Surg 2020; 49:1144-1153. [PMID: 32357267 DOI: 10.1111/vsu.13434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 02/08/2020] [Accepted: 03/25/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the body composition of dogs with or without cranial cruciate ligament (CCL) disease. STUDY DESIGN Cross-sectional. ANIMALS Adult dogs in which CCL disease was diagnosed (n = 30) and adult dogs without clinical signs of orthopedic disease (n = 30). METHODS Body weight, body condition score, and muscle condition score (MCS) were recorded. Body composition of the whole body and pelvic limbs were assessed by dual-energy x-ray absorptiometry. Body condition score, whole body, and pelvic limb body composition measurements were compared by using general linear mixed-model analysis of variance. Muscle condition score between groups was assessed by using a Mann-Whitney U test, while paired data were analyzed by using a Wilcoxon signed-rank test. RESULTS Body fat percentage (P < .0001) was higher in affected dogs (38.78% ± 1.40) than in control dogs (27.49% ± 1.24). Affected dogs had lower MCS (1.90 ± 0.13, P < .0001) compared with control dogs (2.77 ± 0.08). The affected pelvic limb of affected dogs contained less lean soft tissues (P < .0001) but more fat (P = .0451) compared with the contralateral pelvic limb. CONCLUSION Dogs with CCL disease were overweight compared with the control group. CLINICAL SIGNIFICANCE Dogs that are overweight may be predisposed to developing CCL disease. Body composition changes in the pelvic limbs should be considered when managing the care of these dogs.
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Affiliation(s)
- Amanda Santarossa
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Thomas W G Gibson
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Carolyn Kerr
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Gabrielle J Monteith
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Tiffany Durzi
- Smith Lane Animal Hospital at Hill's Pet Nutrition Primary Healthcare Centre, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Shannon Gowland
- Smith Lane Animal Hospital at Hill's Pet Nutrition Primary Healthcare Centre, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Adronie Verbrugghe
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Economos CD, Hennessy E, Chui K, Dwyer J, Marcotte L, Must A, Naumova EN, Goldberg J. Beat osteoporosis - nourish and exercise skeletons (BONES): a group randomized controlled trial in children. BMC Pediatr 2020; 20:83. [PMID: 32093625 PMCID: PMC7038625 DOI: 10.1186/s12887-020-1964-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 02/07/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Lifelong healthy habits developed during childhood may prevent chronic diseases in adulthood. Interventions to promote these habits must begin early. The BONES (Beat Osteoporosis - Nourish and Exercise Skeletons) project assessed whether early elementary school children participating in a multifaceted health behavior change, after-school based intervention would improve bone quality and muscular strength and engage in more bone-strengthening behaviors. METHODS The 2-year BONES (B) intervention included bone-strengthening physical activity (85 min/week), educational materials (2 days/week), and daily calcium-rich snacks (380 mg calcium/day) delivered by after-school program leaders. BONES plus Parent (B + P) included an additional parent education component. From 1999 to 2004, n = 83 after-school programs (N = 1434 children aged 6-9 years) in Massachusetts and Rhode Island participated in a group randomized trial with two intervention arms (B only, n = 25 programs; B + P, n = 33) and a control arm (C, n = 25). Outcome measures (primary: bone quality (stiffness index of the calcaneus) and muscular strength (grip strength and vertical jump); secondary: bone-strengthening behaviors (calcium-rich food knowledge, preference, and intake; and physical activity level (metabolic equivalent time (MET) score, and weight-bearing factor (WBF) score)) were recorded at baseline, and after years one and two. Analyses followed an intent-to-treat protocol, and focused on individual subjects' trajectories along the three time points adjusting for baseline age and race via a mixed-effects regression framework. Analyses were performed with and without sex stratification. RESULTS Children in B + P increased bone stiffness compared to C (p = 0.05); No significant changes were observed in muscle strength, food knowledge, or vertical jump. Children in B + P showed significant improvement in their MET and WBF scores compared to C (p < 0.01) with a stronger effect in boys in both B and B + P (all p < 0.01). CONCLUSION After-school programs, coupled with parental engagement, serving early elementary school children are a potentially feasible platform to deliver bone-strengthening behaviors to prevent osteoporosis in adulthood, with some encouraging bone and physical activity outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT00065247. Retrospectively registered. First posted July 22, 2003.
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Affiliation(s)
- Christina D. Economos
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Erin Hennessy
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Kenneth Chui
- Tufts University School of Medicine, Boston, MA USA
| | - Johanna Dwyer
- Frances Stern Nutrition Center, Tufts Medical Center, Boston, MA USA
- Jean Mayer USDA Human Nutrition Research Center on Aging and Tufts University School of Medicine, Boston, MA USA
- Office of Dietary Supplements, National Institutes of Health, Bethesda, MD USA
| | | | - Aviva Must
- Tufts University School of Medicine, Boston, MA USA
| | - Elena N. Naumova
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Jeanne Goldberg
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA 02111 USA
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Vitamin D and Indices of Bone and Carbohydrate Metabolism in Postmenopausal Women Subjected to a 12-Week Aerobic Training Program-The Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031074. [PMID: 32046257 PMCID: PMC7037101 DOI: 10.3390/ijerph17031074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/14/2020] [Accepted: 02/04/2020] [Indexed: 01/08/2023]
Abstract
The purpose of this study was to assess the effect of Nordic walking training on the indices of bone and carbohydrate metabolism in relation to 25(OH)D levels in postmenopausal women that were subjected to the outdoor systematic physical activity. The study was performed in 10 postmenopausal women, who participated in a 12-week Nordic walking exercise program, taking place during spring months (March to June). Anthropometric and biochemical parameters were measured before and after the training program. Serum concentrations of 25-hydroksycholekalciferol (25(OH)D), parathyroid hormone (PTH), insulin, glucose, osteocalcin (OC), C-terminal telopeptide of type I collagen (CTX), and calcium were determined. After the Nordic walking exercise program, a significant increase in the serum levels of 25(OH)D and CTX and a decrease in body mass, body mass index (BMI), fat mass, and PTH concentrations were observed. The findings of the present study suggest that 25(OH)D, as important metabolic regulator, plays a role in the modification of bone markers’ responses after the outdoor training program, independent of the physical activity effects.
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Abstract
PURPOSE OF REVIEW Obesity in the older adult is a burgeoning health epidemic that leads to increased morbidity, disability, and institutionalization. This review presents a brief overview of geriatric-specific consequences of obesity by highlighting the risks and benefits of intentional weight loss. RECENT FINDINGS Intentional weight loss reduces the extent of adiposity-related illnesses, yet the approach in older adults is fraught with challenges. Interventions combining caloric restriction and physical exercise (aerobic and resistance) maximize fat loss and minimize loss of muscle and bone. Interventions are also effective at improving physical function, reducing medication burden, and improving symptomatic osteoarthritis in this population. Approaches can mitigate the risks of isolated caloric restriction on muscle and bone in a safe and effective manner. Effective weight loss strategies should be considered in older adults. While there are potential risks, practical clinical approaches can minimize the potential harms while maximizing their benefits.
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Affiliation(s)
- Peter R DiMilia
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH, USA
- Collaboratory for Implementation Science at Dartmouth, Lebanon, NH, USA
| | - Alexander C Mittman
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - John A Batsis
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
- Dartmouth Centers for Health and Aging, Dartmouth College, Hanover, NH, USA.
- Collaboratory for Implementation Science at Dartmouth, Lebanon, NH, USA.
- Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
- Section of Weight & Wellness, Department of Medicine, Dartmouth-Hitchcock, Lebanon, NH, USA.
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Nilsen OA, Ahmed LA, Winther A, Christoffersen T, Thrane G, Evensen E, Furberg AS, Grimnes G, Dennison E, Emaus N. Body Weight and Body Mass Index Influence Bone Mineral Density in Late Adolescence in a Two-Year Follow-Up Study. The Tromsø Study: Fit Futures. JBMR Plus 2019; 3:e10195. [PMID: 31667452 PMCID: PMC6808229 DOI: 10.1002/jbm4.10195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/15/2019] [Accepted: 03/02/2019] [Indexed: 01/01/2023] Open
Abstract
Determinants of bone acquisition in late adolescence and early adulthood are not well‐described. This 2‐year follow‐up study explored the associations of body weight (BW), body mass index (BMI), and changes in weight status with adolescent bone accretion in a sample of 651 adolescents (355 girls and 296 boys) between 15 and 19 years of age from The Tromsø Study: Fit Futures. This Norwegian population‐based cohort study was conducted from 2010 to 2011 and was repeated from 2012 to 2013. We measured femoral neck, total hip, and total body bone mineral content and areal bone mineral density (aBMD) by dual‐energy X‐ray absorptiometry. We measured height, BW, calculated BMI (kg/m
2), and collected information on lifestyle at both surveys. Mean BMI (SD) at baseline was 22.17 (3.76) and 22.18 (3.93) in girls and boys, respectively. Through multiple linear regression, baseline BW and BMI were positively associated with ∆aBMD over 2 years of follow‐up at all skeletal sites in boys (
p < 0.05), but not in girls. ∆BW and ∆BMI predicted ∆aBMD and ∆BMC in both sexes, but the strength of the associations was moderate. Individuals who lost weight during follow‐up demonstrated a slowed progression of aBMD accretion compared with those gaining weight, but loss of BW or reduction of BMI during 2 years was not associated with net loss of aBMD. In conclusion, our results confirm that adequate BW for height in late adolescence is important for bone health. Associations between change in weight status and bone accretion during follow‐up were moderate and unlikely to have any clinical implication on adolescents of normal weight. Underweight individuals, particularly boys, are at risk of not reaching optimal peak bone mass and could benefit from an increase in BMI. © 2019 The Authors. JBMR Plus is published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
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Affiliation(s)
- Ole Andreas Nilsen
- Department of Health and Care Sciences The Arctic University of Norway Tromsø Norway
| | - Luai Awad Ahmed
- Department of Health and Care Sciences The Arctic University of Norway Tromsø Norway
| | - Anne Winther
- Division of Neurosciences, Orthopedics and Rehabilitation Services University Hospital of North Norway Tromsø Norway
| | - Tore Christoffersen
- Department of Health and Care Sciences The Arctic University of Norway Tromsø Norway.,Department of Health and Care Sciences Finnmark Hospital Trust, Alta Norway
| | - Gyrd Thrane
- Department of Health and Care Sciences The Arctic University of Norway Tromsø Norway
| | - Elin Evensen
- Department of Clinical Research University Hospital of North Norway, Tromsø, Norway, and Department of Health and Care Sciences, The Arctic University of Norway Tromsø Norway
| | - Anne-Sofie Furberg
- Department of Community Medicine The Arctic University of Norway Tromsø Norway.,Department of Microbiology and Infection Control Division of Internal Medicine University Hospital of North Norway Tromsø Norway
| | - Guri Grimnes
- Division of Internal Medicine University Hospital of North Norway, Tromsø, Norway, and Endocrine Research Group, Department of Clinical Medicine, The Arctic University of Norway Tromsø Norway
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Unit, Southampton UK and Victoria University Wellington New Zealand
| | - Nina Emaus
- Department of Health and Care Sciences The Arctic University of Norway Tromsø Norway
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Wright CS, Li J, Campbell WW. Effects of Dietary Protein Quantity on Bone Quantity following Weight Loss: A Systematic Review and Meta-analysis. Adv Nutr 2019; 10:1089-1107. [PMID: 31301138 PMCID: PMC6855958 DOI: 10.1093/advances/nmz058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/09/2019] [Accepted: 05/17/2019] [Indexed: 01/02/2023] Open
Abstract
Research supports the hypothesis that higher total protein intake during weight loss promotes retention of lean soft tissue, but the effect of dietary protein quantity on bone mass, a lean hard tissue, is inconsistent. The purpose of this systematic review and meta-analysis was to assess the effect of dietary protein quantity [higher protein (HP): ≥25% of energy from protein or ≥1.0 g · kg body wt-1 · d-1; normal protein (NP): <25% of energy from protein or <1.0 g · kg body wt-1 · d-1] on changes in bone mineral density (BMD) and content (BMC; total body, lumbar spine, total hip, femoral neck) following a prescribed energy restriction. We hypothesized that an HP diet would attenuate the loss of BMD/BMC following weight loss in comparison to an NP diet. Two researchers systematically and independently screened 2366 publications from PubMed, Cochrane, Scopus, CINAHL, and Web of Science Core Collection and extracted data from 34 qualified publications. Inclusion criteria included the following: 1) healthy subjects ≥19 y; 2) a prescribed energy restriction; 3) measurements of total protein intake, BMD, and BMC; and 4) an intervention duration of ≥3 mo. Data from 10 of the 34 publications with 2 groups of different total protein intakes were extracted and used to conduct a random-effects model meta-analysis. A majority of publications (59%) showed a decrease in bone quantity following active weight loss, regardless of total protein intake. Statistically, the loss of total BMD (P = 0.016; weighted mean difference: +0.006 g/cm2; 95% CI: 0, 0.011 g/cm2) and lumbar spine BMD (P = 0.019; weighted mean difference: +0.017 g/cm2; 95% CI: 0.001, 0.033 g/cm2) was attenuated with an HP versus an NP weight-loss diet. However, the clinical significance is questionable given the modest weighted mean difference and study duration. Higher total protein intake does not exacerbate but may attenuate the loss of bone quantity following weight loss.
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Affiliation(s)
- Christian S Wright
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Jia Li
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
| | - Wayne W Campbell
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
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46
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Dessordi R, Santana RDC, Navarro AM. Influence of antiretroviral therapy on bone metabolism of patients with chronic hepatitis B: a review. Rev Soc Bras Med Trop 2019; 52:e20180441. [PMID: 31596347 DOI: 10.1590/0037-8682-0441-2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 08/21/2019] [Indexed: 11/21/2022] Open
Abstract
Hepatitis B is a major public health problem worldwide and associated with significant mortality. To prevent or delay the deleterious effects of chronic infection by the hepatitis B virus, patients should be carefully followed, and antiviral therapy indicated according to specific recommendations. Currently, available drugs inhibit viral replication and slow or stop the progression of inflammation and fibrosis of the liver. However, the drugs for oral use in the treatment of hepatitis B, jointly referred to as nucleoside/nucleotide analogs, are indicated for prolonged use and have potential side effects. The reduction in bone mineral density was associated with the use of tenofovir, already evaluated in patients infected with HIV because the drug is also part of the therapeutic arsenal for this viral infection. There are few studies on the effects of tenofovir in patients with mono hepatitis B. Therefore, this literature review proposes to examine how hepatitis B acts in the body and the mechanisms by which antiretroviral drugs (especially tenofovir) can affect bone metabolism.
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Affiliation(s)
- Renata Dessordi
- Universidade Estadual Paulista "Júlio de Mesquita Filho", Programa de Pós-Graduação Stricto Sensu em Alimentos e Nutrição, São Paulo, SP, Brasil.,Universidade Estadual Paulista, Faculdade de Ciências Farmacêuticas do Estado de São Paulo, Departamento de Alimentos e Nutrição, São Paulo, SP, Brasil
| | - Rodrigo de Carvalho Santana
- Universidade de São Paulo, Escola de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Ribeirão Preto, SP, Brasil
| | - Anderson Marliere Navarro
- Universidade Estadual Paulista, Faculdade de Ciências Farmacêuticas do Estado de São Paulo, Departamento de Alimentos e Nutrição, São Paulo, SP, Brasil.,Universidade de São Paulo, Escola de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Ribeirão Preto, SP, Brasil
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47
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Komrakova M, Rechholtz C, Pohlmann N, Lehmann W, Schilling AF, Wigger R, Sehmisch S, Hoffmann DB. Effect of alendronate or 8-prenylnaringenin applied as a single therapy or in combination with vibration on muscle structure and bone healing in ovariectomized rats. Bone Rep 2019; 11:100224. [PMID: 31516917 PMCID: PMC6728878 DOI: 10.1016/j.bonr.2019.100224] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 08/19/2019] [Accepted: 08/26/2019] [Indexed: 12/17/2022] Open
Abstract
Bisphosphonate alendronate (ALN), phytoestrogen 8-prenylnaringenin (8-PN) and the whole body vibration exert a favorable effect on osteoporotic bone. However, the impact of these treatments and the combination of pharmacological therapies with biomechanical stimulation on muscle and bone has not yet been explored in detail. The effect of ALN and 8-PN and their combination with the vibration (Vib) on skeletal muscle and bone healing was investigated in ovariectomized (Ovx) rats. Three-month old rats were Ovx (n = 78), or left intact (Non-Ovx; n = 12). Five weeks after Ovx, all rats were treated according to the group assignment (n = 12/13): 1) Non-Ovx; 2) Ovx; 3) Ovx + Vib; 4) Ovx + ALN; 5) Ovx + ALN + Vib; 6): Ovx + 8-PN; 7) Ovx + 8-PN + Vib. Treatments with ALN (0.58 mg/kg BW, in food), 8-PN (1.77 mg/kg BW, daily s.c. injections) and/or with vertical vibration (0.5 mm, 35 Hz, 1 g, 15 min, 2×/day, 5×/week) were conducted for ten weeks. Nine weeks after Ovx, all rats underwent bilateral tibia osteotomy with plate osteosynthesis and were sacrificed six weeks later. Vibration increased fiber size and capillary density in muscle, enlarged callus area and width, and decreased callus density in tibia, and elevated alkaline phosphatase in serum. ALN and ALN + Vib enhanced capillarization and lactate dehydrogenase activity in muscle. In tibia, ALN slowed bone healing, ALN + Vib increased callus width and density, enhanced callus formation rate and expression of osteogenic genes. 8-PN and 8-PN + Vib decreased fiber size and increased capillary density in muscle; callus density and cortical width were reduced in tibia. Vibration worsened 8-PN effect on bone healing decreasing the callus width and area. Our data suggest that Vib, ALN, 8-PN, or 8-PN + Vib do not appear to aid bone healing. ALN + Vib improved bone healing; however application is questionable since single treatments impaired bone healing. Muscle responds to the anti-osteoporosis treatments and should be included in the evaluation of the drugs. Vibration (Vib) was beneficial for muscle structure, it tended to interfere with early bone healing. Alendronate (ALN) enhanced capillary density and metabolism in muscle, slowed bone healing. 8-Prenylnaringenin (8-PN) had favorable effects on muscle, for bone healing it was disadvantageous. 8PN + Vib further worsened 8-PN effect on bone, ALN + Vib improved bone healing. Muscles respond to anti-osteoporosis treatments, their analysis should be included in the evaluation of drugs.
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Affiliation(s)
- M Komrakova
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Robert-Koch Str. 40, 37075 Goettingen, Germany
| | - C Rechholtz
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Robert-Koch Str. 40, 37075 Goettingen, Germany
| | - N Pohlmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Robert-Koch Str. 40, 37075 Goettingen, Germany
| | - W Lehmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Robert-Koch Str. 40, 37075 Goettingen, Germany
| | - A F Schilling
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Robert-Koch Str. 40, 37075 Goettingen, Germany
| | - R Wigger
- Department of Animal Sciences, University of Goettingen, Albrecht-Thaer-Weg 3, 37075 Goettingen, Germany
| | - S Sehmisch
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Robert-Koch Str. 40, 37075 Goettingen, Germany
| | - D B Hoffmann
- Department of Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Goettingen, Robert-Koch Str. 40, 37075 Goettingen, Germany
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Gallo S, Charbonnel B, Goldman A, Shi H, Huyck S, Darekar A, Lauring B, Terra SG. Long-term efficacy and safety of ertugliflozin in patients with type 2 diabetes mellitus inadequately controlled with metformin monotherapy: 104-week VERTIS MET trial. Diabetes Obes Metab 2019; 21:1027-1036. [PMID: 30614616 PMCID: PMC6593724 DOI: 10.1111/dom.13631] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/20/2018] [Accepted: 01/04/2019] [Indexed: 01/05/2023]
Abstract
AIM To evaluate the long-term efficacy and safety of ertugliflozin in adults with type 2 diabetes mellitus inadequately controlled on metformin. MATERIALS AND METHODS A 104-week Phase III, randomized double-blind study with a 26-week placebo-controlled period (Phase A) and a 78-week period (Phase B) where blinded glimepiride was added to non-rescued placebo participants with fasting fingerstick glucose ≥6.1 mmol/L. Results through week 104 are reported. RESULTS Mean (standard error) change in HbA1c from baseline was -0.7% (0.07) and -1.0% (0.07) at week 52; -0.6% (0.08) and -0.9% (0.08) at week 104 for ertugliflozin 5 and 15 mg. At week 52, 34.8% and 36.6% participants had HbA1c <7.0%, and 24.6% and 33.7% at week 104, for ertugliflozin 5 and 15 mg. Ertugliflozin reduced fasting plasma glucose (FPG), body weight and systolic blood pressure (SBP) from baseline through week 104. The incidence of female genital mycotic infections (GMIs) was higher with ertugliflozin, and symptomatic hypoglycaemia was lower for ertugliflozin versus placebo/glimepiride. Minimal bone mineral density (BMD) changes were observed, similar to placebo/glimepiride, except at total hip where reduction in BMD was greater with ertugliflozin 15 mg versus placebo/glimepiride: difference in least squares means (95% CI) -0.50% (-0.95, -0.04) at week 52 and -0.84% (-1.44, -0.24) at week 104. CONCLUSIONS Ertugliflozin maintained improvements from baseline in HbA1c, FPG, body weight and SBP through week 104. Ertugliflozin was well tolerated, with non-clinically relevant changes in BMD. Compared with placebo/glimepiride, ertugliflozin increased female GMIs, but reduced the incidence of symptomatic hypoglycaemia. ClinicalTrials.gov Identifier: NCT02033889.
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49
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Sinclair AJ, Abdelhafiz AH, Forbes A, Munshi M. Evidence-based diabetes care for older people with Type 2 diabetes: a critical review. Diabet Med 2019; 36:399-413. [PMID: 30411402 DOI: 10.1111/dme.13859] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2018] [Indexed: 12/22/2022]
Abstract
In our ageing society diabetes imposes a significant burden in terms of the numbers of people with the condition, diabetes-related complications including disability, and health and social care expenditure. Older people with diabetes can represent some of the more complex and difficult challenges facing the clinician working in different settings, and the recognition that we have only a relatively small (but increasing) evidence base to guide us in diabetes management is a limitation of our current approaches. Nevertheless, in this review we attempt to explore what evidence there is to guide us in a comprehensive scheme of treatment for older adults, often in a high-risk clinical state, in terms of glucose lowering, blood pressure and lipid management, frailty care and lifestyle interventions. We strive towards individualized care and make a call for action for more high-quality research using different trial designs.
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Affiliation(s)
- A J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich, UK
| | | | | | - M Munshi
- Harvard Medical School and Joslin Clinic, Boston, MA, USA
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50
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Metzger CE, Swift SN, Baek K, De Souza MJ, Bloomfield SA. Fat and Lean Mass Predict Bone Mass During Energy Restriction in Sedentary and Exercising Rodents. Front Physiol 2018; 9:1346. [PMID: 30356821 PMCID: PMC6190840 DOI: 10.3389/fphys.2018.01346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 09/06/2018] [Indexed: 01/25/2023] Open
Abstract
Energy restriction (ER) causes bone loss, but the impact of exercise during ER is less understood. In this study, we examined the impact of metabolic hormones and body composition on both total body bone mineral content (BMC) and local (proximal tibia) volumetric bone mineral density (vBMD) during short- (4 weeks) and long-term (12 weeks) ER with and without exercise in adult female rats. Our first goal was to balance energy between sedentary and exercising groups to determine the impact of exercise during ER. Second, we aimed to determine the strongest predictors of bone outcomes during ER with energy-matched exercising groups. Methods: Female Sprague–Dawley rats were divided into three sedentary groups (ad libitum, –20% ER, and –40% ER) and three exercising groups (ad libitum, –10% ER, and –30% ER). Approximately a 10% increase in energy expenditure was achieved via moderate treadmill running (∼60–100 min 4 days/week) in EX groups. n per group = 25–35. Data were analyzed as a 2 × 3 ANOVA with multiple linear regression to predict bone mass outcomes. Results: At 4 weeks, fat and lean mass and serum insulin-like growth factor-I (IGF-I) predicted total body BMC (R2 = 0.538). Fat mass decreased with ER at all levels, while lean mass was not altered. Serum IGF-I declined in the most severe ER groups (–40 and –30%). At 12 weeks, only fat and lean mass predicted total body BMC (R2 = 0.718). Fat mass declined with ER level regardless of exercise status and lean mass increased due to exercise (+5.6–6.7% vs. energy-matched sedentary groups). At the same time point, BMC declined with ER, but increased with exercise (+7.0–12.5% vs. energy-matched sedentary groups). None of our models predicted vBMD at the proximal tibia at either time point. Conclusion: Both fat and lean mass statistically predicted total body BMC during both short- and long-term ER. Fat and lean mass decreased with ER, while lean mass increased with EX at each energy level. Measures that predicted total body skeletal changes did not predict site-specific changes. These data highlight the importance of maintaining lean mass through exercise during periods of ER.
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Affiliation(s)
- Corinne E Metzger
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
| | - Sibyl N Swift
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
| | - Kyunghwa Baek
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
| | - Mary Jane De Souza
- Department of Kinesiology, Pennsylvania State University, State College, PA, United States.,Department of Physiology, Pennsylvania State University, State College, PA, United States
| | - Susan A Bloomfield
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
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