Progressive loss of bone in the femoral neck in elderly people: longitudinal findings from the Dubbo osteoporosis epidemiology study

Can we screen opportunistically for low bone mineral density using CT scans of the shoulder and artificial intelligence?

OBJECTIVE

To evaluate whether the CT attenuation of bones seen on shoulder CT scans could be used to predict low bone mineral density (BMD) (osteopenia/osteoporosis), and to compare the performance of two machine learning models to predict low BMD.

METHODS

In this study, we evaluated 194 patients aged 50 years or greater (69.2 ± 9.1 years; 170 females) who underwent unenhanced shoulder CT scans and dual-energy X-ray absorptiometry within 1 year of each other between January 1, 2010, and December 31, 2021. The CT attenuation of the humerus, glenoid, coracoid, acromion, clavicle, first, second, and third ribs was obtained using 3D-Slicer. Support vector machines (SVMs) and k-nearest neighbours (kNN) were used to predict low BMD. DeLong test was used to compare the areas under the curve (AUCs).

RESULTS

A CT attenuation of 195.4 Hounsfield Units of the clavicle had a sensitivity of 0.577, specificity of 0.781, and AUC of 0.701 to predict low BMD. In the test dataset, the SVM had sensitivity of 0.686, specificity of 1.00, and AUC of 0.857, while the kNN model had sensitivity of 0.966, specificity of 0.200, and AUC of 0.583. The SVM was superior to the CT attenuation of the clavicle (P = .003) but not better than the kNN model (P = .098).

CONCLUSION

The CT attenuation of the clavicle was best for predicting low BMD; however, a multivariable SVM was superior for predicting low BMD.

ADVANCES IN KNOWLEDGE

SVM utilizing the CT attenuations at many sites was best for predicting low BMD.

Vitamin D Status and Longitudinal Changes in Body Composition in Patients with Chronic Obstructive Pulmonary Disease - A Prospective Observational Study

Background

Alterations in body weight and composition are common in patients with chronic obstructive pulmonary disease (COPD) and are independent predictors for morbidity and mortality. Low vitamin D status is also more prevalent in patients with COPD compared to controls and has been related to lower lung function, muscle atrophy and impaired musculoskeletal function. This study aimed to evaluate the association between vitamin D levels and status with body composition (BC), as well as with its changes over time.

Patients and Methods

Patients with COPD and controls without COPD, participating in the Individualized COPD Evaluation in relation to Ageing (ICE-Age) study, a prospective observational study, were included. Plasma 25-hydroxyvitamin D (25(OH)D) was measured at baseline and BC was measured by dual-energy X-ray absorptiometry scan, at baseline and after two years of follow-up. Multiple linear regression analyses were performed to assess the relationships between 25(OH)D (nmol/l) and longitudinal changes in BMI, fat-free mass index (FFMI), fat mas index (FMI) and bone mineral density (BMD).

Results

A total of 192 patients with COPD (57% males, mean ± SD age, 62 ± 7, FEV1, 49 ± 16% predicted) and 199 controls (45% males, mean ± SD age 61 ± 7) were included in this study. Vitamin D levels were significantly lower in patients with COPD (64 ± 26 nmol/L, 95% CI 60-68 nmol/L versus 75 ± 25 nmol/L, 95% CI 72-79 nmol/L) compared to controls. Both patients and controls presented a significant decline in FFMI and T-score hip, but vitamin D level or status did not determine differences in BC or changes in BC over time in either COPD or controls.

Conclusion

Vitamin D status was not associated with BC or longitudinal changes in BC. However, vitamin D insufficiency and low BMD were more prevalent in patients with COPD compared to controls.

Dementia exacerbates periodontal bone loss in females

BACKGROUND

Periodontitis is a chronic inflammatory disease defined by the pathologic loss of the periodontal ligament and alveolar bone in relation to aging. Although clinical cohort studies reported that periodontitis is significantly elevated in males compared to females, emerging evidence indicates that females with dementia are at a greater risk for periodontitis and decreased alveolar bone.

OBJECTIVE

This study aimed to evaluate whether dementia is a potential sex-dependent risk factor for periodontal bone loss using an experimental model of periodontitis induced in the triple transgenic (3x-Tg) dementia-like mice and clinical samples collected from senior 65 plus age patients with diagnosed dementia.

MATERIALS AND METHODS

We induced periodontitis in dementia-like triple-transgenic (3x-Tg) male and female mice and age-matched wild-type (WT) control mice by ligature placement. Then, alveolar bone loss and osteoclast activity were evaluated using micro-CT and in situ imaging assays. In addition, we performed dental examinations on patients with diagnosed dementia. Finally, dementia-associated Aβ42 and p-Tau (T181) and osteoclastogenic receptor activator of nuclear factor kappa-Β ligand (RANKL) in gingival crevicular fluid (GCF) collected from mice and clinical samples were measured by enzyme-linked immunosorbent assay (ELISA).

RESULTS

Alveolar bone loss and in situ osteoclast activity were significantly elevated in periodontal lesions of 3x-Tg females but not males, compared to wild-type control mice. In addition, we also observed that the probing pocket depth (PPD) was also significantly elevated in female patients with dementia. Using ELISA assay, we observed that females had elevated levels of osteoclastogenic RANKL and dementia-associated Aβ42 and p-Tau (T181) in the GCF collected from experimental periodontitis lesions and clinical samples.

CONCLUSION

Altogether, we demonstrate that females with dementia have an increased risk for periodontal bone loss compared to males.

No changes in bone mineral density following total knee arthroplasty using an all-polyethylene tibial component

PURPOSE

Polyethylene particles produced from metal-backed tibial (MBT) implants are understood to contribute to bone loss and component loosening. This, along with advanced surgical techniques, improved materials and increasing costs, has renewed interest in all-polyethylene tibias (APTs). We investigated peri-APT bone mineral density (BMD) in patients, expecting to find no differences between two post-operative values.

METHODS

Patients over 65 years, with BMI ≤ 37.5 kg/m2 and no previous joint replacements were recruited to have computer-navigated total knee arthroplasty using an APT. The study cohort (n = 27) had mean age of 71.9 (SD 4.35) and BMI of 31.2 (SD 3.8). The BMD examinations were performed 6 weeks and 18 months post-operatively. Six regions of interest (ROI) were identified on anterior/posterior and lateral dual-energy X-ray absorptiometry scans. For each ROI, BMD relative differences (RDs) were determined between limbs and RDs at the two time points were compared.

RESULTS

No differences were found between the RDs for any ROI. No revisions or complications were reported. At 18 months post-operatively, 79.2% of the cohort were very satisfied or satisfied with the outcome of their surgery and Oxford Knee Scores improved significantly compared to pre-operatively (p < 0.001). Mean knee range of motion was 102° (SD 10.7°), and mean leg alignment was 2.0° valgus (1-6°valgus).

CONCLUSION

Results from BMD analysis suggest that implants were well fixated without compromising function. We believe that using APTs with computer navigation is a viable cheaper option to MBTs for patients who are less active, have lower BMI and good bone quality.

QCT-based 3D finite element modeling to assess patient-specific hip fracture risk and risk factors

Early assessment of hip fracture risk may play a critical role in designing preventive mechanisms to reduce the occurrence of hip fracture in geriatric people. The loading direction, clinical, and morphological variables play a vital role in hip fracture. Analyzing the effects of these variables helps predict fractures risk more accurately; thereby suggesting the critical variable that needs to be considered. Hence, this work considered the fall postures by varying the loading direction on the coronal plane (α) and on the transverse plane (β) along with the clinical variables-age, sex, weight, and bone mineral density, and morphological variables-femoral neck axis length, femoral neck width, femoral neck angle, and true moment arm. The strain distribution obtained via finite element analysis (FEA) shows that the angle of adduction (α) during a fall increases the risk of fracture at the greater trochanter and femoral neck, whereas with an increased angle of rotation (β) during the fall, the FRI increases by ∼1.35 folds. The statistical analysis of clinical, morphological, and loading variables (αandβ) delineates that the consideration of only one variable is not enough to realistically predict the possibility of fracture as the correlation between individual variables and FRI is less than 0.1, even though they are shown to be significant (p<0.01). On the contrary, the correlation (R2=0.48) increases as all variables are considered, suggesting the need for considering different variables fork predicting FRI. However, the effect of each variable is different. While loading, clinical, and morphological variables are considered together, the loading direction on transverse plane (β) has high significance, and the anatomical variabilities have no significance.

Follow-up Bone Mineral Density Testing: 2023 Official Positions of the International Society for Clinical Densitometry

Dual-energy X-ray absorptiometry (DXA) is the gold standard method for measuring bone mineral density (BMD) which is most strongly associated with fracture risk. BMD is therefore the basis for the World Health Organization's densitometric definition of osteoporosis. The International Society for Clinical Densitometry (ISCD) promotes best densitometry practices and its official positions reflect critical review of current evidence by domain experts. This document reports new official positions regarding follow-up DXA examinations based on a systematic review of literature published through December 2022. Adoption of official positions requires consensus agreement from an expert panel following a modified RAND protocol. Unless explicitly altered by the new position statements, prior ISCD official positions remain in force. This update reflects increased consideration of the clinical context prompting repeat examination. Follow-up DXA should be performed with pre-defined objectives when the results would have an impact on patient management. Testing intervals should be individualized according to the patient's age, sex, fracture risk and treatment history. Incident fractures and therapeutic approach are key considerations. Appropriately ordered and interpreted follow-up DXA examinations support diagnostic and therapeutic decision making, thereby contributing to excellent clinical care. Future research should address the complementary roles of clinical findings, imaging and laboratory testing to guide management.

Mineral Supplements in Ageing

With advancing age, achievement of dietary adequacy for all nutrients is increasingly difficult and this is particularly so for minerals. Various factors impede mineral acquisition and absorption including reduced appetite, depressed gastric acid production and dysregulation across a range of signalling pathways in the intestinal mucosa. Minerals are required in sufficient levels since they are critical for the proper functioning of metabolic processes in cells and tissues, including energy metabolism, DNA and protein synthesis, immune function, mobility, and skeletal integrity. When uptake is diminished or loss exceeds absorption, alternative approaches are required to enable individuals to maintain adequate mineral levels. Currently, supplementation has been used effectively in populations for the restoration of levels of some minerals like iron, zinc, and calcium, but these may not be without inherent challenges. Therefore, in this chapter we review the current understanding around the effectiveness of mineral supplementation for the minerals most clinically relevant for the elderly.

Plant-derived natural medicines for the management of osteoporosis: A comprehensive review of clinical trials

Background

Osteoporosis is a chronic and systemic skeletal disease that is defined by low bone mineral density (BMD) along with an increase in bone fragility and susceptibility to fracture. This study aimed to overview clinical evidence on the use of herbal medicine for management of osteoporosis.

Methods

Electronic databases including Pubmed, Medline, Cochrane library, and Scopus were searched until November 2022 for any clinical studies on the efficacy and/or safety of plant-derived medicines in the management of osteoporosis.

Results

The search yielded 57 results: 19 on single herbs, 16 on multi-component herbal preparations, and 22 on plant-derived secondary metabolites. Risk of fracture, bone alkaline phosphatase, BMD, and specific bone biomarkers are investigated outcomes in these studies. Medicinal plants including Acanthopanax senticosus, Actaea racemosa, Allium cepa, Asparagus racemosus, Camellia sinensis, Cissus quadrangularis, Cornus mas, Nigella sativa, Olea europaea, Opuntia ficus-indica, Pinus pinaster, Trifolium pretense and phytochemicals including isoflavones, ginsenoside, Epimedium prenyl flavonoids, tocotrienols are among plant-derived medicines clinically investigated on osteoporosis. It seems that multi-component herbal preparations were more effective than single-component ones; because of the synergistic effects of their constituents. The investigated herbal medicines demonstrated their promising results in osteoporosis via targeting different pathways in bone metabolism, including balancing osteoblasts and osteoclasts, anti-inflammatory, immunomodulatory, antioxidant, and estrogen-like functions.

Conclusion

It seems that plant-derived medicines have beneficial effects on bone and may manage osteoporosis by affecting different targets and pathways involved in osteoporosis; However, Future studies are needed to confirm the effectiveness and safety of these preparations.

Longitudinal changes in bone mineral density during perimenopausal transition: the Vietnam Osteoporosis Study

Based on the prospective cohort of the Vietnam Osteoporosis Study, we show that bone loss occurred before menopause, and that the loss accelerated in the first 5 years post-menopause.

PURPOSE

To define the change in bone mineral density (BMD) among women during the menopausal transition.

METHODS

The study involved 1062 women aged 40-59 who were participants of the population-based prospective Vietnam Osteoporosis Study. BMD at the femoral neck (FN), lumbar spine (LS), and whole body scan was measured by DXA. Each woman has had two BMD measurements separated by approximately 2 years, and the rate of BMD change was calculated for each woman. Multivariable linear regression models were used to quantify the association between body composition parameters and the rate of BMD change.

RESULTS

At FN, there were 3 phases of BMD change: a slight decline before the age of 45-49 (average loss of 0.51%/year); a substantial decline between the ages of 49 and 54 (average loss of 1.39%/year); and then slowed down between the ages of 54 and 59 (average loss of 0.31%/year). The same trend was also observed at LS: a slight decline (- 0.56%/year) among women aged 45-49; then a significant decline between the ages of 50 and 54 (- 1.33%/year); but then slowed down at - 0.31%/year after the age of 55. Changes in BMD were not significantly associated with changes in lean mass or fat mass.

CONCLUSIONS

Although bone loss occurred before menopause, the loss accelerated in the early perimenopausal transition (45-50 years of age). This finding suggests that screening for osteoporosis in women should be considered at the age of 45.

Comparative evaluation of radiographic morphologic parameters for predicting subsequent contralateral fragility hip fracture

PURPOSE

Subsequent contralateral fragility hip fracture (SCHF) is one of the most serious conditions in osteoporotic patients due to high morbidity and mortality. This study aimed to investigate the predictive ability of radiographic morphologic parameters for SCHF in patients diagnosed with unilateral fragility hip fractures.

METHODS

We conducted a retrospective observational study of unilateral fragility hip fracture patients between April 2016 and December 2021. Radiographic morphologic parameters, including canal-calcar ratio (CCR), cortical thickness index (CTI), canal-flare index (CFI), and morphological cortical index (MCI), were measured from patients' contralateral proximal femur anteroposterior radiographic study to evaluate the risk of SCHF. Multivariable logistic regression analysis was employed to determine the adjusted predictive ability of the radiographic morphologic parameters.

RESULTS

Of the included 459 patients, 49 (10.7%) experienced SCHF. All radiographic morphologic parameters demonstrated excellent performance in predicting SCHF. After being adjusted by patients' age, BMI, visual impairment status, and dementia, CTI revealed the greatest adjusted odds ratio for SCHF of 35.05 (95% CI 7.34 to 167.39, p < 0.001) followed by CFI (OR = 13.32; 95% CI 6.50 to 27.32, p < 0.001), MCI (OR = 5.60; 95% CI 2.84 to 11.04, p < 0.001), and CCR (OR = 4.50; 95% CI 2.32 to 8.72, p < 0.001).

CONCLUSION

CTI demonstrated the greatest odds ratio for SCHF, followed by CFI, MCI, and CCR. These radiographic morphologic parameters could provide a preliminary prediction for SCHF in elderly patients presenting with unilateral fragility hip fractures.

Statistical analysis of biomechanical properties and size of the sternum and its fracture risk in a Japanese sample

OBJECTIVE

Sternal fractures can have life-threatening complications. To understand chest injury mechanisms, sufficient data regarding the mechanical properties and structure of the sternum are required. The aim of this study was to examine the mechanical properties and size of the sternum in a Japanese forensic sample.

MATERIALS AND METHODS

Sterna were obtained from 120 Japanese dead bodies of known age and sex. The sample thickness (ST) and the sample width (SW) were measured using a computed tomographic image. Three-point-bending tests were conducted using a three-point-bending apparatus to assess the fracture load (FL) of the sample. Then, the flexural strength (FS) was calculated and the natural logarithm of FL (ln FL) and FS (ln FS) were also calculated.

RESULTS

The values of ST, ln FL, and ln FS for male samples were significantly greater than those for female samples. Both ln FL and ln FS had significant negative correlations with age regardless of sex; the Pearson product-moment correlation coefficients were larger for female samples than for male samples. Although age was significantly negatively correlated with SW in female samples, there was no significant correlation between age and SW in male samples. No significant correlations were found between age and ST regardless of sex.

CONCLUSION

This is the first study to present quantitative data on the biomechanical properties of the sternum. Because of the smaller sternal strength of elderly women, it is especially important for them to avoid the risk of sternal fractures.

Lifetime Smoking History and Prevalence of Osteoporosis and Low Bone Density in U.S. Adults, National Health and Nutrition Examination Survey 2005-2010

Background: Osteoporosis is common among older adults. Women are more likely to have osteoporosis than men. The prevalence varies with race/ethnicity, with the highest prevalence observed among non-Hispanic, Asian women. Prior studies identified a negative association between smoking and bone mineral density (BMD). The association between smoking and osteoporosis has not been investigated according to race/ethnicity. Materials and Methods: We included 4,226 U.S. adults aged 50 years or older with complete information on smoking history, BMD, and other independent variables from the 2005-2010 National Health and Nutrition Examination Surveys. Design-based multinomial logistic regression was utilized to estimate prevalence odds ratios (POR) of osteoporosis (T-score ≤ -2.5) and of low bone density (T-score between -1.0 and -2.5) in relation to lifetime smoking pack-years, stratified by sex and race/ethnicity. Results: Participants were 61.5 (standard error 0.21) years old on average and 48% women (n = 2,027). Among women, a smoking history ≥30 pack-years was positively associated with osteoporosis (POR: 2.40; 95% confidence interval [CI]: 1.42-4.06). Similar POR were observed among non-Hispanic White, non-Hispanic Black, and Mexican American women. However, POR for ≥30 pack-years and low bone density were positive but not statistically significant. Among men, null associations of smoking history, osteoporosis, and low bone density were observed, except for a positive association of ≥30 pack-years and low bone density among non-Hispanic Black men. Conclusion: Osteoporosis was twice as prevalent among women who smoked ≥30 pack-years than among women who never smoked, regardless of race/ethnicity. Smoking history and osteoporosis were not associated among men.

Apparent "Rapid Loss" After Short-Interval Bone Density Testing in Menopausal Women Is Usually a Measurement Artifact

CONTEXT

Medication may be considered when bone mineral density (BMD) loss is reported as "excessive."

OBJECTIVE

We hypothesized that the rate of BMD change between 2 serial tests demonstrates higher random variability at shorter vs longer intervals, misclassifying some women as "rapid losers."

METHODS

This retrospective observational cohort study in Manitoba, Canada included women aged > 55 years without osteoporosis medications or glucocorticoids. Using paired baseline (1998-2016) and repeat (2001-2018) BMD measurements, we estimated the distribution of annualized change (first to second BMD) at spine, hip, and femoral neck stratified by testing interval (2-2.9, 3-3.9,...9-9.9, ≥ 10.0 years). "Rapid annual bone loss" was defined as exceeding the 95th percentile for decreases from all measurement pairs. Odds ratios (OR) for rapid loss were estimated using regression models adjusted for age and clinical covariates.

RESULTS

From 7126 paired BMD measurements, mean annualized change was constant yet standard deviations in BMD change were > 2-fold greater with intervals of 2 to 2.9 years vs ≥ 10 years(P < 0.001). "Rapid annual loss" was seen in ~10% of short-interval tests vs < 1% of long-interval tests. ORs for "rapid loss" progressively declined with increasing testing interval (spine 15.3 [4.8-48.9], total hip 9.3 [4.4-19.5], femoral neck 18.7 [6.8-51.3] for a 2- to 2.9-year testing interval; referent ≥ 10 years).

CONCLUSION

There is a wider apparent range in annualized BMD loss with short-interval testing which greatly attenuates over longer intervals. BMD reports of "rapid loss" across shorter testing intervals likely reflect an artifact of BMD measurement error and should not be used as an indication for antifracture medication initiation.

Osteoporosis knowledge and health beliefs among middle-aged men and women in the Southern United States

Context

The most common skeletal disease, osteoporosis, causes bone fragility due to decreased bone mass and bone microarchitecture destruction. The health belief model is often applied to asymptomatic, prevention-related diseases such as osteoporosis. Steps to mitigate the insidious nature of osteoporosis, including education, motivation, and monitoring of bone mineral density, must begin at an earlier age.

Objectives

This study evaluates the knowledge and health beliefs surrounding osteoporosis in a population of males and females 35–50 years old to determine sex-based differences in osteoporosis knowledge and beliefs and to assess the correlation between perceptions and health motivation.

Methods

Participants (81 males, 92 females) completed two questionnaires: the Osteoporosis Knowledge Test and the Osteoporosis Health Belief Scale. Descriptive statistics were performed along with Pearson product-moment correlation analysis to determine the relationships between the variables. Sex-based differences were calculated utilizing independent t-tests.

Results

We discovered a statistically significant negative correlation between the barriers to exercise and health motivation (−0.434, p < 0.001) and a statistically significant positive correlation between the benefits of exercise and health motivation (0.385, p < 0.001). However, there was not a statistically significant correlation between health motivation with the following: the benefits of calcium, susceptibility, and the seriousness of osteoporosis. Between males and females, there was a statistically significant difference in exercise and calcium knowledge, susceptibility, and the benefits of both exercise and calcium (p < 0.05).

Conclusions

Males and females 35–50 years old perceive themselves to have a low susceptibility to osteoporosis. They do not consider osteoporosis a serious disease and have little motivation to mitigate its inception or progression. Their perceptions show that barriers to exercise impact health motivation more than the perceived benefits of exercise.

Age-Related Changes in Trabecular Bone Score and Bone Mineral Density in Chinese Men: A Cross-Sectional and Longitudinal Study

Purpose

This study was designed to explore age-related changes in trabecular bone score (TBS) and bone mineral density (BMD) in Chinese men through cross-sectional and longitudinal studies.

Patients and Methods

We included adult men who had at least twice TBS and BMD examinations in our hospital between January 2013 and December 2020. All men were divided into an age subgroup per 10 years, comparing differences in baseline lumbar spine (LS) TBS and BMD at various parts between each age group and analyzing age-related changes in TBS and BMD during follow-up.

Results

Baseline data showed that in men aged 36 to 85 years, BMD in the hip region showed a decreasing trend with age (P for trend < 0.01). However, TBS reached a high value around the age of 50, after which it decreased with age (P for trend = 0.03). During a mean follow-up of 3 years, the average annual change rate at TBS was −0.17% in men aged 36 to 85 years, with the fastest decrease rate −1.08% at 66 to 75 years (P < 0.05). The mean annual rate of change in LS BMD in different age subgroups increased with age (P for trend = 0.001). There was no significant decrease in mean annual change in BMD in hip regions.

Conclusion

In men aged 36~85 years, the trend of TBS was inconsistent with BMD. Men experience a high value of LS TBS around age 50, later than the commonly believed age of peak BMD, which may reflect developmental differences between bone microstructure and bone minerals. The TBS may be used as a better indicator of changes in bone strength than BMD in adult men at short-term follow-up. The rapid loss of TBS at age 66 to 75 may have implications for the prevention and medication of osteoporosis in men.

Integrative analysis of genetic and clinical risk factors for bone loss in a Korean population

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.

Sexual Dimorphism in Differentiating Osteoclast Precursors Demonstrates Enhanced Inflammatory Pathway Activation in Female Cells

Sexual dimorphism of the skeleton is well documented. At maturity, the male skeleton is typically larger and has a higher bone density than the female skeleton. However, the underlying mechanisms for these differences are not completely understood. In this study, we examined sexual dimorphism in the formation of osteoclasts between cells from female and male mice. We found that the number of osteoclasts in bones was greater in females. Similarly, in vitro osteoclast differentiation was accelerated in female osteoclast precursor (OCP) cells. To further characterize sex differences between female and male osteoclasts, we performed gene expression profiling of cultured, highly purified, murine bone marrow OCPs that had been treated for 3 days with macrophage colony-stimulating factor (M-CSF) and receptor activator of NF-κB ligand (RANKL). We found that 125 genes were differentially regulated in a sex-dependent manner. In addition to genes that are contained on sex chromosomes, transcriptional sexual dimorphism was found to be mediated by genes involved in innate immune and inflammatory response pathways. Furthermore, the NF-κB-NFATc1 axis was activated earlier in female differentiating OCPs, which partially explains the differences in transcriptomic sexual dimorphism in these cells. Collectively, these findings identify multigenic sex-dependent intrinsic difference in differentiating OCPs, which results from an altered response to osteoclastogenic stimulation. In humans, these differences could contribute to the lower peak bone mass and increased risk of osteoporosis that females demonstrate relative to males. © 2021 American Society for Bone and Mineral Research (ASBMR).

Reference values for bone metabolism in a Japanese cohort survey randomly sampled from a basic elderly resident registry

The aim of this study was to provide definitive reference values for bone mineral density (BMD) and bone turnover markers in the general elderly population. Registered citizens of 50 to 89 years old were targeted for this survey. After random sampling from the resident registry of Obuse town, we established eight groups based on age (50 s, 60 s, 70 s, and 80 s) and gender. A total of 411 people were enrolled. We used a dual-energy x-ray absorptiometry device to measure and evaluate BMD. The bone formation marker bone alkaline phosphatase (BAP) was measured as a bone turnover marker. Bone quality marker pentosidine, and bone resorption markers including urinary total deoxypyridinoline (DPD), tartrate-resistant acid phosphatase 5b (TRACP-5b), 25-hydroxyvitamin D (25[OH]D), and whole parathyroid hormone (PTH) were also measured as bone turnover markers. Sixty-three people (15.3%) were diagnosed as osteoporosis. BMD decreased with age in the femoral neck and total hip. On the other hand, there was no characteristic change with age in the lumber spine. As for bone markers, pentosidine and DPD increased with aging, although 25(OH)D, whole PTH, and BAP showed no characteristic associations with gender and aging. In terms of the relationship between low BMD and bone markers, there was a significant independent association between low BMD and TRACP-5b in females. In conclusions, hip BMD decreased with aging in men and women. However, there was no characteristic decline with aging in the lumbar spine. All bone markers showed no significant independent characteristics associated with age or gender in a multivariate analysis model, except for a significant association between low BMD and TRACP-5b in females. TRACP-5b was a potentially useful marker for the detection of low BMD.

Osteoporosis in Men: A Review of an Underestimated Bone Condition

Osteoporosis is called the 'silent disease' because, although it does not give significant symptoms when it is not complicated, can cause fragility fractures, with serious consequences and death. Furthermore, the consequences of osteoporosis have been calculated to weigh heavily on the costs of health systems in all the countries. Osteoporosis is considered a female disease. Actually, the hormonal changes that occur after menopause certainly determine a significant increase in osteoporosis and the risk of fractures in women. However, while there is no doubt that women are more exposed to osteoporosis and fragility fractures, the literature clearly indicates that physicians tend to underestimate the osteoporosis in men. The review of the literature done by the authors shows that osteoporosis and fragility fractures have a high incidence also in men; and, furthermore, the risk of fatal complications in hip fractured men is higher than that for women. The authors report the evidence of the literature on male osteoporosis, dwelling on epidemiology, causes of osteoporosis in men, diagnosis, and treatment. The analysis of the literature shows that male osteoporosis is underscreened, underdiagnosed, and undertreated, both in primary and secondary prevention of fragility fractures.

Do polyunsaturated fatty acids protect against bone loss in our aging and osteoporotic population?

Age-related bone loss is inevitable in both men and women and there will soon be more people of extreme old age than ever before. Osteoporosis is a common chronic disease and as the proportion of older people, rate of obesity and the length of life increases, a rise in age-related degenerating bone diseases, disability, and prolonged dependency is projected. Fragility fractures are one of the most severe complications associated with both primary and secondary osteoporosis and current treatment strategies target weight-bearing exercise and pharmacological intervention, both with limited long-term success. Obesity and osteoporosis are intimately interrelated, and diet is a variable that plays a significant role in bone regeneration and repair. The Western Diet is characterized by its unhealthy components, specifically excess amounts of saturated fat intake. This review examines the impact of saturated and polyunsaturated fatty acid consumption on chronic inflammation, osteogenesis, bone architecture, and strength and explores the hypothesis that dietary polyunsaturated fats have a beneficial effect on osteogenesis, reducing bone loss by decreasing chronic inflammation, and activating bone resorption through key cellular and molecular mechanisms in our aging population. We conclude that aging, obesity and a diet high in saturated fatty acids significantly impairs bone regeneration and repair and that consumption of ω-3 polyunsaturated fatty acids is associated with significantly increased bone regeneration, improved microarchitecture and structural strength. However, ω-6 polyunsaturated fatty acids were typically pro-inflammatory and have been associated with an increased fracture risk. This review suggests a potential role for ω-3 fatty acids as a non-pharmacological dietary method of reducing bone loss in our aging population. We also conclude that contemporary amendments to the formal nutritional recommendations made by the Food and Nutrition Board may be necessary such that our aging population is directly considered.

Adverse Effects of High-Dose Vitamin D Supplementation on Volumetric Bone Density Are Greater in Females than Males

Three years of high-dose vitamin D supplementation (400 IU, 4000 IU, 10,000 IU) in healthy vitamin D-sufficient individuals aged 55 to 70 years (serum 25(OH)D 30-125 nmol/L at baseline), resulted in a negative dose-response relationship for bone density and strength. This study examined whether response differed between males and females. A total of 311 participants (53% male) were randomized to 400 IU (male = 61, female = 48), 4000 IU (male = 51, female = 49), or 10,000 IU (male = 53, female = 49) daily vitamin D₃ . Participants were scanned with high-resolution peripheral quantitative computed tomography (HR-pQCT) to measure total volumetric BMD (TtBMD) at baseline, 6, 12, 24, and 36 months. Finite element analysis estimated bone strength. Balance, physical function, and clinical biochemistry parameters were also assessed. Constrained linear mixed effects models determined time-by-treatment group-by-sex interactions. Baseline, 3-month, and 3-year levels of 25(OH)D were 76.3, 76.7, and 77.4 nmol/L (400 IU); 81.3, 115.3, and 132.2 (4000 IU); and 78.4, 188.0, and 144.4 (10,000 IU), respectively. There were significant time-by-treatment group-by-sex interactions for TtBMD at the radius (p = .002) and tibia (p = .005). Treatment with 4000 IU or 10,000 IU compared to 400 IU resulted in TtBMD losses in females, but this was not observed with males. After 3 years, females lost 1.8% (400 IU), 3.8% (4000 IU), and 5.5% (10,000 IU), whereas males lost 0.9% (400 IU), 1.3% (4000 IU), and 1.9% (10,000 IU) at the radius. At the tibia, losses in TtBMD were smaller, but followed a similar trend. There were no significant bone strength interactions. Vitamin D supplementation with 4000 IU or 10,000 IU, compared with 400 IU daily, resulted in greater losses of TtBMD over 3 years in healthy vitamin D-sufficient females, but not males. These results are clinically relevant, because vitamin D supplementation is widely administered to postmenopausal females for osteoporosis prevention. Our findings do not support a benefit of high-dose vitamin D supplementation for bone health, and raise the possibility of harm for females. © 2020 American Society for Bone and Mineral Research (ASBMR).

Regular Supplementation With Resveratrol Improves Bone Mineral Density in Postmenopausal Women: A Randomized, Placebo-Controlled Trial

Resveratrol, a naturally occurring polyphenol in red grapes and berries, can act as a phytoestrogen. It has been shown to improve both systemic and cerebral circulatory functions, possibly through activation of endothelial estrogen receptors. in vitro and in vivo studies in rodent models also indicate a bone-protective role for resveratrol, particularly in ovariectomized rat models that mimic postmenopausal osteoporosis caused by estrogen deficiency. Hypothesizing a circulatory benefit of resveratrol in bone tissue, we investigated whether resveratrol supplementation could improve bone health in postmenopausal women. The Resveratrol for Healthy Aging in Women (RESHAW) trial was a 24-month randomized, double-blind, placebo-controlled, two-period crossover intervention conducted to evaluate the effects of resveratrol (75 mg twice daily) on cognition, cerebrovascular function, bone health, cardiometabolic markers, and well-being in postmenopausal women. After 12 months of supplementation with resveratrol versus placebo, there were positive effects on bone density in the lumbar spine (+0.016 ± 0.003 g/cm² ) and neck of femur (+0.005 ± 0.002 g/cm² ), which were accompanied by a 7.24% reduction in C-terminal telopeptide type-1 collagen levels, a bone resorption marker, compared with placebo. The increase in bone mineral density in the femoral neck resulted in an improvement in T-score (+0.070 ± 0.018) and a reduction in the 10-year probability of major and hip fracture risk. The magnitude of improvement was higher in women with poor bone health biomarker status. Importantly, the improvement in femoral neck T-score with resveratrol correlated with improvement in perfusion. Our subanalysis also revealed that the bone-protective benefit of resveratrol was greater in participants who supplemented with vitamin D plus calcium. Regular supplementation with 75 mg of resveratrol twice daily has the potential to slow bone loss in the lumbar spine and femoral neck, common fracture sites in postmenopausal women without overt osteoporosis. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.

Osteoporosis, osteomalacia, and hip fracture: A case study from the Terry collection

OBJECTIVE

This case study describes a perimortem hip fracture in a documented individual from the Robert J. Terry Skeletal Collection. The purpose of this paper is to comprehend how co-occurring conditions contributed to fracture risk and to understand the effect of the injury on this individual.

MATERIALS AND METHODS

A 73-year-old female from the Terry Collection with a fracture of the left proximal femur was assessed macroscopically, and images were taken with a Keyence VHX-2000 digital microscope. Documentation concerning the individual's history and contemporary treatment of hip fractures was explored.

RESULTS

Assessment demonstrated impaction of fractured elements occurred as a result of the inferior displacement of the femoral head into the femoral neck. Eburnation and hinge fractures are present on the fracture margins. Bending deformities of the sacrum, sternum, and ribs indicate underlying osteomalacia. No evidence of surgical intervention was observed.

CONCLUSIONS

Both osteomalacia and osteoporosis contributed to overall fracture risk in this case, which demonstrates how complex underlying factors can interact to increase the probability of fracture, and influence post-fracture mortality.

SIGNIFICANCE

This report is the first case study, to date, of a healing hip fracture in which the circumstances of the fracture and the medical history of the individual are known.

LIMITATIONS

To fully investigate osteoporosis, bone mineral density for this individual should be compared with others in the collection.

SUGGESTIONS FOR FURTHER RESEARCH

The effect of co-occurring conditions on fracture risk should be explored in the wider Terry Collection, and in other skeletal collections.

Effects of peptide–calcium complexes from sunflower seeds and peanuts on enhancing bone mineral density

Hydrolysed proteins from sunflower seed and peanut were separated by ultrafiltration. Results showed that 1–3 kDa sunflower seed peptide (SSP4) and ≥10 kDa peanut peptide (PP1) fractions had the highest Ca‐binding capacity of 104.80 and 124.74 mg g−1, respectively. After Ca binding, scanning electron microscopy results showed that the loose sheet‐like structure of SSP4 and PP1 transformed into a granular structure. Fourier‐transform infrared spectroscopy results showed that carboxyl and amide groups were involved in Ca binding. Growing male mice were assigned to eight groups: control, CaCO3 and six experimental groups (low, medium and high doses for each SSP4‐Ca and PP1‐Ca). Apparent Ca absorption rate, bone mineral density (BMD), bone surface microstructure and biomechanical index and serum biochemical index were evaluated. Animal experiment results indicated that SSP4‐Ca and PP1‐Ca can improve Ca bioavailability; effectively enhance BMD and structure; and promote Ca absorption. The peptide–Ca complexes were absorbed better than CaCO3 and promoted Ca accumulation in the bone. PP1‐Ca was better than SSP4‐Ca in promoting calcium absorption and enhancing BMD.

Association of bone mineral density with the development of knee osteoarthritis in men and women: a cross-sectional study using the fourth and fifth Korea National Health and Nutrition Examination Surveys

Bone mineral density (BMD) and osteoarthritis (OA) were correlated but the relationship was varied according to sex. An association between lumbar spine and femur neck BMDs and OA showed a positive relation in women, while lumbar spine and pelvis BMDs in men were associated with OA with a negative relation.

PURPOSE

The purpose of this study was to evaluate the association of BMD in various body parts in conjunction with the presence or severity of radiographic knee osteoarthritis (KOA) in relation to sex.

METHODS

This study was a cross-sectional analysis using Korea National Health and Nutrition Examination Surveys. KOA was graded using the Kellgren-Lawrence (KL) grading system. Radiographic KOA was defined as a KL grade 2 or higher. The associations between KOA and BMD in certain body parts (femur, pelvis, lumbar, lower leg, and whole-body) were assessed. BMD was measured using dual-energy X-ray absorptiometry. The BMD of each body part was divided into quartiles and the relationship between KOA and BMD was examined according to sex.

RESULTS

BMD did not show a significant tendency according to KL grade in either sex. In men, the severity of KL grade have a statistically significant relationship with total femur (R² = 0.303, p < 0.05), femur neck (R² = 0.257, p < 0.05), lumbar (R² = 0.137, p < 0.05), and pelvis BMD (R² = 0.185, p < 0.05). In women, total femur (R² = 0.466, p < 0.05), lumbar (R² = 0.316, p < 0.05), pelvis (R² = 0.343, p < 0.05), and lower leg BMD (R² = 0.133, p < 0.05) were associated with the severity of KL grade. When the BMD was divided into quartiles, lumbar (p < 0.05) and pelvis BMD (p < 0.05) in men had statistically significant association with knee OA as BMD decreased. In women, femur neck (p < 0.05) and lumbar BMD (p < 0.05) were significantly associated with knee OA as BMD increased.

CONCLUSION

The relationship between BMD and OA severity varied according to sex. In women, there was a positive association between femur neck and lumbar BMD and OA, while BMD of the lumbar and pelvis in men was negatively correlated with OA.

LEVEL OF EVIDENCE

Cohort study, III.

Bone Control of Muscle Function

Bone and muscle represent a single functional system and are tightly connected to each other. Indeed, diseases characterized by alterations of muscle physiology have effects on bone remodeling and structure and vice versa. Muscle influence on bone has been deeply studied, and recent studies identified irisin as new molecule involved in this crosstalk. Muscle regulation by bone needs to be extensively investigated since in the last few years osteocalcin was recognized as a key molecule in the bone–muscle interaction. Osteocalcin can exist in two forms with different degrees of carboxylation. The undercarboxylated form of osteocalcin is a hormone released by the bone matrix during the osteoclast bone resorption and can bind its G-protein coupled receptor GPRC6A expressed in the muscle, thus regulating its function. Recently, this hormone was described as an antiaging molecule for its ability to regulate bone, muscle and cognitive functions. Indeed, the features of this bone-related hormone were used to test a new therapeutic approach for sarcopenia, since injection of osteocalcin in older mice induces the acquirement of physical abilities of younger animals. Even if this approach should be tested in humans, osteocalcin represents the most surprising molecule in endocrine regulation by the skeleton.

Enjoyment and acceptability of different exercise modalities to improve bone health in young adult women

ISSUE ADDRESSED

Osteoporosis presents a serious public health issue and physical activity is recognised as the most effective modifiable risk factor for the condition. The reasons behind physical activity participation, however, are complex. We therefore aimed to explore the experiences related to a bone-targeted exercise intervention, determine enjoyment and acceptability of each exercise mode, and identify barriers and facilitators to osteogenic exercise for young adult women.

METHODS

The present study was conducted within the Osteoporosis Prevention Through Impact and Muscle-loading Approaches to Exercise (OPTIMA-Ex) trial, a three-arm RCT comparing musculoskeletal outcomes from two supervised, high-intensity, exercise programs (impact and resistance training) with an unsupervised low-intensity exercise control. A mixed-methods approach was used, including quality of life and physical activity enjoyment questionnaires and qualitative analysis of semi-structured interviews.

RESULTS

All groups had improvements in the 'mental health' domain of the quality of life measure; however, the two supervised exercise groups had greater levels of physical activity enjoyment. The qualitative analysis revealed that overall the trial activities were positively, yet the two supervised groups had 'richer' exercise experiences. Motivations for participation, barriers to physical activity and desired continuation of participation differed between all three groups.

CONCLUSIONS

Findings suggest that bone-targeted exercise interventions for young adult women must address perceived time demands and environmental barriers to participation in order to maximise compliance and adherence. SO WHAT?: As physical activity is the most effective lifestyle strategy to improve bone health and young adulthood an important window for its augmentation, increasing convenience, accessibility and understanding of osteoporosis preventative behaviours in this demographic is vital.

Stroke Prevents Exercise-induced Gains in Bone Microstructure But Not Composition in Mice

Ischemic stroke induces rapid loss in bone mineral density up to 13 times greater than during normal aging, leading to markedly increased risk of fracture. Little is known about skeletal changes following stroke beyond density loss. In this study we use a mild-moderate middle cerebral artery occlusion model to determine the effects of ischemic stroke without bedrest on bone microstructure, dynamic bone formation, and tissue composition. Twenty-seven 12-week-old male C57Bl/6J mice received either a stroke or sham surgery and then either received daily treadmill exercise or remained sedentary for four weeks. All mice were ambulatory immediately following stroke, and limb coordination during treadmill exercise was unaffected by stroke, indicating similar mechanical loading across limbs for surgery groups. Stroke did not directly detriment microstructure, but exercise only stimulated adaptation in sham group, not stroke group, with increased bone volume fraction and trabecular thickness in the sham distal femoral metaphysis. Stroke differentially decreased cortical area in the affected limb relative to the unaffected limb of the distal femoral metaphysis, and endosteal bone formation rate in the affected tibial diaphysis. Although exercise failed to improve bone microstructure following stroke, exercise increased mineral-to-matrix content in stroke but not sham. Together, these results show that stroke inhibits exercise-induced changes to femoral microstructure but not tibial composition, even without changes to gait. Similarly, affected-unaffected limb differences in cortical bone structure and bone formation rate in ambulatory mice show that stroke affects bone health even without bedrest.

Relationship between bone turnover markers and the heel stiffness index measured by quantitative ultrasound in post-menopausal Japanese women

Background: Osteoporosis in women is a serious health problem. The relationships between biochemical markers of bone turnover and bone mineral density (BMD) in women have been reported, but no study has examined relationships between tartrate-resistant acid phosphatase-5b (TRACP-5b) or bone-specific alkaline phosphatase (BAP) and bone mass measured by quantitative ultrasound (QUS) in Japanese post-menopausal women. Aim: To investigate the serum TRACP-5b and BAP levels and to determine their associations with the heel stiffness index measured by QUS in post-menopausal women. Subjects and methods: The subjects were 510 post-menopausal women who were invited to participate in periodic health examinations in 2011-2013 (the Unzen Study). The heel stiffness index (bone mass) was measured by QUS. Serum samples were collected and TRACP-5b and BAP levels were measured. Results: Multiple regression analysis showed that a higher log (TRACP-5b) was correlated with a lower stiffness index (p = 0.014) and log (BAP) was not correlated with stiffness index after adjusting for covariates (p = 0.136). Conclusion: Higher rates of bone resorption are associated with a lower stiffness index in Japanese post-menopausal women. These results may indicate that high bone resorption affects bone mass more than bone formation, resulting in a low bone mass.

Proximal humeral internal locking plate combined with a custom neutral-position shoulder and elbow sling for proximal humerus fractures: A randomized study

OBJECTIVES

The aim of this study was to investigate the effectiveness of the proximal humeral internal locking system (PHILOS) plate combined with a custom neutral-position shoulder and elbow sling for proximal humerus fractures.

METHODS

A total of 112 patients with proximal humerus fractures were assigned randomly into 2 groups. Group A (n = 56) was treated by open reduction and internal fixation (ORIF) with a PHILOS plate; group B (n = 56) was treated by ORIF with a PHILOS plate in combination with the use of a custom neutral-position shoulder and elbow sling for 30 days after surgery. The incidence of internal fixation failure, the Constant-Murley shoulder assessment, and Visual Analogue Scale (VAS) score were recorded and analyzed.

RESULTS

Patients included were followed up for an average of 15 months (range, 6-24 months). No significant differences were observed in mean VAS scores and mean Constant-Murley shoulder assessment scores at 1-day preoperative and postoperative day 3 between groups A and B. However, mean VAS scores and mean Constant-Murley shoulder assessment in group B were significantly improved when compared with group A at postoperative day 30 and the final follow-up. No cases of postoperative infection, loss of reduction, PHILOS break, or vascular nerve injury occurred in either group.

CONCLUSIONS

Proximal humerus fractures treated with the combination of the PHILOS and custom neutral-position shoulder and elbow sling for 30 days after operation was associated with a lower incidence of internal fixation failure. There was no increase in adverse events compared with open reduction and internal fixation with a PHILOS plate alone.

Age-related osseointegration of a short hip stem: a clinical and radiological 24 months follow-up

PURPOSE

The purpose of this study was to examine potential differences between patients under and over 60 years who underwent a total short hip stem arthroplasty in a 24-month follow-up in a clinical setting.

METHODS

Sixty seven patients were included in this prospective study and divided in two groups. In the younger cohort 39 patients ≤ 59 years and in the older cohort 28 patients ≥ 60 years were included. Clinical and radiological examinations of the patients took place preoperatively, postoperatively and after 3, 6, 12 and 24 months. The Harris Hip Score (HHS) was raised as clinical examination. Changes of bone mass density (BMD), stress shielding, reactive lines, spot welds and sclerosing were examined as radiological analysis.

RESULTS

The HHS improved from 53.6 ± 8.2 preoperative to 93.2 ± 9.6 in the younger cohort and for the older cohort from 57.6 ± 14.8 to 94.1 ± 7.6 after 24 months. BMD growth was detectable in regions of interest (ROI) 3 and 6 for both groups. Different results between the cohorts could only be detected in ROIs 4 and 5. The older cohort showed a loss of BMD of 5.95% in ROI 4 and 3.17% in ROI 5 after 24 months, whereas the younger cohort showed no loss of BMD in both ROIs.

CONCLUSIONS

No significant differences or any influences of osseointegration and clinical outcome of the short hip stem for both groups were detectable. Lower losses (ROIs 1 and 2) and higher growths (ROIs 3, 4, 5) were discovered in younger patients and the HHS improved in both groups. Reasons for this result could be age, sex or the level of activity of the patients, but in both groups the short hip stem shows comparable results in clinical as well as in radiological examination. We conclude that the short hip stem seems to be an adequate treatment also for older patients.

Longitudinal changes in bone mineral density, bone mineral content and bone area at the lumbar spine and hip in postmenopausal women, and the influence of abdominal aortic calcification

Longitudinal studies often report that spine bone mineral density (BMD), measured by DXA, is stable in older adults, which has been attributed to osteophyte development and the presence of aortic calcification. A decline in projected spine area as a result of loss of intervertebral disc height might also contribute to higher BMD. We utilised data from 297 postmenopausal women (mean 73 years) who had DXA measurements of the lumbar spine, total hip and femoral neck 5 years apart, and abdominal aortic calcification scoring from vertebral morphometry. BMD declined by -4.4% at the total hip and -3.9% at the femoral neck (p < 0.001), but did not change at the spine (-0.5%, p = 0.12). In contrast, bone mineral content (BMC) declined by -4.0% at the total hip, -2.5% at the femoral neck and -1.7% at the spine (all p < 0.001). Bone area increased by 0.5% at the hip and 1.6% at the femoral neck but declined by -1.2% at the spine (all p < 0.001). 43% of the cohort had abdominal aortic calcification (AAC) present at baseline. The presence of AAC at baseline was not related to changes in BMD or BMC at the total hip or femoral neck, nor to BMD at the spine. However, women with AAC present had a smaller loss of BMC at the spine than those without (-0.8% versus -2.4%, p = 0.03). AAC score increased more over 5 years among those with AAC at baseline than those without (0.28 versus 0.16, p = 0.036). Thus, the stability of spine BMD is the result of both a loss of projected bone area (as a result of intervertebral disc changes and/or a decrease in projected area of the vertebral bodies) and the effects of aortic calcification. Future clinical trials should consider assessing changes in spine BMC as a more informative index of spine mineral status.

Integrating Individuals With Stroke Into Cardiac Rehabilitation Following Traditional Stroke Rehabilitation: Promoting a Continuum of Care

Following stroke, people are at high risk for repeat strokes and for complications related to coronary artery disease (CAD). Indeed, stroke and CAD share many of the same risk factors. Unfortunately, patients become sedentary after stroke, which leads to cardiorespiratory deconditioning as well as muscle atrophy and weakness that in turn leads to deterioration in metabolic, cardiorespiratory, and functional health. Access to intensive secondary prevention programs with structured exercise components that include both aerobic and resistance training can help to prevent and reverse these health hazards. Traditional stroke rehabilitation programs face many barriers to providing exercise programming early post-stroke, such as lack of available therapy time and short length of stay, lack of equipment for exercise and assessments, and concerns for patient safety related to cardiac status. Building a partnership between traditional stroke rehabilitation programs and cardiac rehabilitation by operationalizing an automatic referral process has the potential to affect secondary prevention of stroke and cardiovascular risk significantly. It could also mitigate the tremendous burden on patients and their family members. This is an easily identified group that can achieve significant gains over multiple domains of recovery with the targeted exercise and risk-factor modification components offered by comprehensive cardiac rehabilitation programs.

Prediction of changes in bone mineral density in the elderly: contribution of "osteogenomic profile"

The contribution of genetic variants to longitudinal bone loss has not been well documented. We constructed an "osteogenomic profile" based on 62 BMD-associated genetic variants and showed that the profile was significantly associated with bone loss, independently from baseline BMD and age. The osteogenomic profile can help predict bone loss in an individual.

INTRODUCTION

The rate of longitudinal bone loss (ΔBMD) is a risk factor for fracture. The variation in ΔBMD is partly determined by genetic factors. This study sought to define the association between an osteogenomic profile and ΔBMD.

METHODS

The osteogenomic profile was created from 62 BMD-associated SNPs from genome-wide association studies (GWAS) that were genotyped in 1384 elderly men and women aged 60+ years. Weighted genetic risk scores (GRS) were constructed for each individual by summing the products of the number of risk alleles and the sex-specific regression coefficients [associated with BMD from GWAS]. ΔBMD, expressed as annual percent change-in-BMD, was determined by linear regression analysis for each individual who had had at least two femoral neck BMD measurements.

RESULTS

The mean ΔBMD was - 0.65% (SD 1.64%) for women and - 0.57% (SD 1.40%) for men, and this difference was not statistically significant (P = 0.32). In women, each unit increase in GRS was associated with 0.21% (SE 0.10) higher ΔBMD at the femoral neck (P = 0.036), and this association was independent of baseline BMD and age. In logistic regression analysis, each unit increase of GRS was associated with 41% odds (95%CI: 1.07-1.87) of rapid bone loss (ΔBMD ≤ - 1.2%/year; mean of rapid loss group = - 2.2%/year). There was no statistically significant association between ΔBMD and GRS in men.

CONCLUSIONS

We conclude that the osteogenomic profile constructed from BMD-associated genetic variants is modestly associated with long-term changes in femoral neck BMD in women, but not in men.

Age-related mechanical strength evolution of trabecular bone under fatigue damage for both genders: Fracture risk evaluation

Bone tissue is a living composite material, providing mechanical and homeostatic functions, and able to constantly adapt its microstructure to changes in long term loading. This adaptation is conducted by a physiological process, known as "bone remodeling". This latter is manifested by interactions between osteoclasts and osteoblasts, and can be influenced by many local factors, via effects on bone cell differentiation and proliferation. In the current work, age and gender effects on damage rate evolution, throughout life, have been investigated using a mechanobiological finite element modeling. To achieve the aim, a mathematical model has been developed, coupling both cell activities and mechanical behavior of trabecular bone, under cyclic loadings. A series of computational simulations (ABAQUS/UMAT) has been performed on a 3D human proximal femur, allowing to investigate the effects of mechanical and biological parameters on mechanical strength of trabecular bone, in order to evaluate the fracture risk resulting from fatigue damage. The obtained results revealed that mechanical stimulus amplitude affects bone resorption and formation rates, and indicated that age and gender are major factors in bone response to the applied loadings.

Cigarette smoking and hip volumetric bone mineral density and cortical volume loss in older adults: The AGES-Reykjavik study

This study aimed to explore the relationships of several indicators of cigarette smoking habits (smoking status, pack-years, age at smoking initiation and smoking cessation) with quantitative computed tomographic (QCT)-derived proximal femur bone measures (trabecular vBMD, integral vBMD and the ratio of cortical to total tissue volume (cvol/ivol)) and with subsequent change in these measures over the next five years. A total of 2673 older adults (55.9% women), aged 66-92 years at baseline from the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study, who had two QCT scans of the hip were studied. In multivariable linear regression models, compared to never-smokers, current smokers had lower cvol/ivol at baseline and former-smokers had poorer measures on all outcomes (lower trabecular vBMD, integral vBMD and cvol/ivol), even when adjusted for several potential confounders. Further, among former smokers, those with higher pack-years had worse bone outcomes and those with longer duration since smoking cessation had better bone health at baseline. Analyses of change in bone measures revealed that compared to never-smokers, current smokers had significantly greater loss of trabecular vBMD, integral vBMD, and cvol/ivol. The regression models included adjustment for sex, age, education, and baseline body mass index, creatinine, % weight change from age 50, 25OHD, physical activity level, high-sensitive C-Reactive protein levels, alcohol and coffee consumption, history of diabetes mellitus, arthritis, and respiratory diseases. In conclusion, both current and former smoking showed adverse associations with bone health assessed with QCT. Results suggest that current smoking in particular may aggravate the rate of bone loss at older age and highlight implications for targeting this risk factor in populations that present higher smoking prevalence and vulnerability to bone fragility.

Relationship between bone turnover markers and the heel stiffness index measured by quantitative ultrasound in middle-aged and elderly Japanese men

The aim of the present study was to investigate the age-related patterns and the relationships between serum levels of tartrate-resistant acid phosphatase-5b (TRACP-5b) or bone-specific alkaline phosphatase (BAP), and the heel stiffness index measured by quantitative ultrasound (QUS) in 429 Japanese men, with special emphasis on 2 age groups (40-59 years and 60 years or over). The heel stiffness index (bone mass) was measured by QUS. Serum samples were collected, and TRACP-5b and BAP levels were measured. The stiffness index was significantly decreased with age. Log (TRACP-5b) was significantly increased with age, but Log (BAP) was stable. Generalized linear models showed that higher levels of Log (TRACP-5b) and Log (BAP) were correlated with a lower stiffness index after adjusting for covariates in men aged 60 years or over, but not in men aged 40 to 59 years. In conclusion, higher rates of bone turnover markers were associated with a lower stiffness index only in elderly men. These results may indicate a different mechanism of low bone mass among different age groups of men.

Amount of smoking, pulmonary function, and bone mineral density in middle-aged Korean men: KNHANES 2008-2011

Smoking induces bone loss; however, data on the relationship between smoking history and bone mineral density (BMD) are lacking. Age and pulmonary function can affect BMD. We investigated the relationships among pack-years (PYs) of smoking, pulmonary function, and BMD in middle-aged Korean men (50-64 years old). This cross-sectional study used data from the Korean National Health and Nutrition Examination Survey, 2008-2011. All participants underwent BMD measurements using dual energy X-ray absorptiometry and pulmonary function tests using standardized spirometry. In total, 388 never-smokers and 1088 ever-smokers were analyzed. The number of PYs of smoking was negatively correlated with total hip BMD (r = -0.088; P = 0.004) after adjusting for age, height, and weight. Ever-smokers were classified into 3 groups according to PYs of smoking. The highest tertile (n = 482) exhibited significantly lower total hip bone mass than the lowest tertile (n = 214) after adjusting for confounding factors (age, height, weight, forced expiratory volume in 1 s (FEV₁), alcohol consumption, physical activity, and vitamin D levels) that could affect bone metabolism (P = 0.003). In conclusion, smoking for >30 PYs was significantly associated with low hip BMD after adjusting for pulmonary function in middle-aged Korean men. Long-term smoking may be a risk factor for bone loss in middle-aged men independent of age, height, weight, and pulmonary function.

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

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Fragility Fractures & Their Impact on Older People

Osteoporotic fractures, in particular hip and vertebral, are a major health burden worldwide. The majority of these fractures occur in the elderly population, resulting in one of the most important causes of mortality and disability in older ages. Their cost for societies is enormous and is forecast to steadily increase over the coming decades globally. Low bone mineral density (BMD) remains a key preventable risk factor for fractures. Screening and treatment of individuals with high risk of fracture is cost-effective. Predictive tools including clinical risk factors, minimisation of falls risk and public authorities' support to create Fracture Liaison Services are paramount strategies.

Effect of periodontitis on the development of osteoporosis: results from a nationwide population-based cohort study (2003-2013)

Background

The prevalence of osteoporosis associated with the aging process is anticipated to increase along with the rising aging population. Periodontitis that the most common chronic infections of humankind is considered the risk factor for osteoporosis. The aim of this study was to identify the association between osteoporosis and periodontitis using a population-based cohort.

Methods

The case group was defined as patients diagnosed with periodontitis and treated with subgingival curettage, root conditioning, periodontal flap operation, bone grafting for alveolar bone defects, and guided tissue regeneration. Case and control groups matched for gender, age, household income, type of social security, disability, and residential area were generated. A Cox proportional hazard model was constructed to examine the difference in the development of osteoporosis between the case and control groups. The final sample included 13,464 participants.

Results

The incidence of osteoporosis was 1.1% in males and 15.8% in females during a 10-year period. The risk factors for osteoporosis in males were increasing age and Charlson Comorbidity Index score. Periodontitis was not associated with the development of osteoporosis in males. The risk factors for osteoporosis in females were increasing age, body mass index, Charlson Comorbidity Index score, diabetes, and periodontitis. Women with periodontitis were more likely to also develop osteoporosis (HR: 1.22, 95% CI: 1.01–1.48).

Conclusions

Periodontitis has an effect on the development of osteoporosis in females. Managing good teeth is required for the prevention and delay of osteoporosis. This includes dental examinations, regular cleanings and gum treatment.

Dietary calcium intake and rate of bone loss in men

A high Ca intake has been recommended for osteoporosis prevention; however, little research has examined the relationship between dietary Ca and bone health in men. We examined associations between dietary Ca intake, bone mineral density (BMD) and change in BMD at the total body, hip and spine over 2 years in a cohort of men (mean age 57 years, BMI 26 kg/m2) from a trial. Data from the total cohort (n 323) were used in the analysis of Ca intake and BMD at baseline, and data from the placebo group (n 99) were used in the longitudinal analysis of Ca intake and change in BMD. Parathyroid hormone (PTH) and the markers of bone turnover serum total alkaline phosphatase activity, serum C-telopeptide and serum procollagen type-1 N-terminal propeptide were measured in a subset of participants at baseline (n 150), and associations with dietary Ca at baseline were examined. Mean Ca intake was 870 mg/d. Baseline BMD was not related to dietary Ca intake at any site, before or after adjustment for covariables. Similarly, bone loss over 2 years was not related to Ca intake at any site, before or after adjustment. Dietary Ca intake was inversely correlated with PTH at baseline (r −0·19, P=0·02), but was not associated with the markers of bone turnover. BMD and rates of bone loss were unrelated to Ca intake in these men. This suggests that strategies to increase Ca intake are unlikely to impact on the prevalence of and morbidity from male osteoporosis.

Bone turnover predicts change in volumetric bone density and bone geometry at the radius in men

Peripheral quantitative computed tomography scans of the distal and midshaft radius were performed in 514 European men aged 40-79 years at baseline and a median of 4.3 years later. Age-related changes in volumetric bone mineral density (vBMD) and bone geometry were greater in men with higher biochemical markers of bone turnover at baseline.

INTRODUCTION

This study aimed to determine prospective change in bone density and geometry at the radius in men and examine the influence of bone turnover markers and sex hormones on that change.

METHODS

Men aged 40-79 years were recruited from population registers in Manchester (UK) and Leuven (Belgium). At baseline, markers of bone formation (P1NP and osteocalcin) and resorption (β-cTX and ICTP) were assessed. Total and bioavailable testosterone and oestradiol were also measured. Peripheral quantitative computed tomography (pQCT) was used to scan the radius at distal and midshaft sites at the baseline assessment and a median of 4.3 years later.

RESULTS

Five hundred fourteen men, mean (SD) age of 59.6 (10.5) years, contributed to the data. At the midshaft site, there was a significant decrease in mean cortical vBMD (-0.04 %/year), bone mineral content (BMC) (-0.1 %/year) and cortical thickness (-0.4 %/year), while total and medullary area increased (+0.5 and +2.4 %/year respectively). At the distal radius, total vBMD declined (-0.5 %/year) and radial area increased (+0.6 %/year). Greater plasma concentrations of bone resorption and formation markers were associated with greater decline in BMC and cortical area at the midshaft and total vBMD at the distal site. Increased bone resorption was linked with an increase in total and medullary area and decrease in cortical thickness at the midshaft. Sex hormone levels were unrelated to change in pQCT parameters.

CONCLUSIONS

Age-related changes in vBMD and bone geometry are greater in men with higher biochemical markers of bone turnover at baseline. Sex hormones have little influence on change in pQCT parameters.

Expression of RANKL by peripheral neutrophils and its association with bone mineral density in COPD

BACKGROUND AND OBJECTIVE

Osteoporosis is a major co-morbidity of COPD, but the mechanistic links between diseases of the lung and the bone remain elusive. Human neutrophils express the osteoclast activation factor RANKL (receptor activator of NF-kB ligand) and act directly on osteoclasts to promote bone loss. Given that neutrophils are key effector cells in the pathogenesis of COPD, these same cells, by expressing RANKL, may be involved in osteoporosis of COPD.

METHODS

We enrolled 59 male patients with COPD, 32 smokers with normal lung function and 25 healthy non-smokers of the same gender as controls. The expression of RANKL on peripheral neutrophils was detected by flow cytometry. The plasma concentrations of pro-inflammatory cytokines were measured by ELISA. We analysed the association of RANKL ⁺ neutrophils with bone mineral density (BMD), lung function and the levels of cytokines.

RESULTS

RANKL ⁺ neutrophils in the blood of COPD patients were increased as compared to smokers and healthy controls, and the percentage of RANKL ⁺ neutrophils was higher in patients with low BMD as compared to those with normal BMD. The percentage of RANKL ⁺ neutrophils showed negative correlations with BMD and forced expiratory volume in 1 s (FEV1) % predicted. Further analysis showed that activated neutrophils were increased and expressed a higher level of RANKL in COPD patients. Plasma levels of IL-1β, IL-6 and IL-8 were increased in COPD patients and correlated with RANKL expression by neutrophils.

CONCLUSION

Our results show that RANKL-expressing neutrophils are increased in male patients with COPD and associated with BMD and lung function, suggesting that these cells may play a role in osteoclastogenesis in COPD.

Changes in bone mineral density over time by body mass index in the health ABC study

Obesity appears protective against osteoporosis in cross-sectional studies. However, results from this longitudinal study found that obesity was associated with bone loss over time. Findings underscore the importance of looking at the longitudinal relationship, particularly given the increasing prevalence and duration of obesity among older adults.

INTRODUCTION

Cross-sectional studies have found a positive association between body mass index (BMI) and bone mineral density (BMD), but little is known about the longitudinal relationship in US older adults.

METHODS

We examined average annual rate of change in BMD by baseline BMI in the Health, Aging, and Body Composition Study. Repeated measurement of BMD was performed with dual-energy X-ray absorptiometry (DXA) at baseline and years 3, 5, 6, 8, and 10. Multivariate generalized estimating equations were used to predict mean BMD (femoral neck, total hip, and whole body) by baseline BMI (excluding underweight), adjusting for covariates.

RESULTS

In the sample (n = 2570), 43 % were overweight and 24 % were obese with a mean baseline femoral neck BMD of 0.743 g/cm(2), hip BMD of 0.888 g/cm(2), and whole-body BMD of 1.09 g/cm(2). Change in total hip or whole-body BMD over time did not vary by BMI groups. However, obese older adults lost 0.003 g/cm(2) of femoral neck BMD per year more compared with normal weight older adults (p < 0.001). Femoral neck BMD change over time did not differ between the overweight and normal weight BMI groups (p = 0.74). In year 10, adjusted femoral neck BMD ranged from 0.696 g/cm(2) among obese, 0.709 g/cm(2) among normal weight, and 0.719 g/cm(2) among overweight older adults.

CONCLUSIONS

Findings underscore the importance of looking at the longitudinal relationship between body composition and bone mineral density among older adults, indicating that high body mass may not be protective for bone loss over time.

A 7-Year Longitudinal Trial of the Safety and Efficacy of a Vitamin/Mineral Enhanced Plant-Sourced Calcium Supplement

OBJECTIVES

The objective of this study was to examine the safety and efficacy of a vitamin-mineral enhanced plant-sourced calcium AlgaeCal calcium (AC) in female consumers who had taken the supplement from 1 to 7 years.

METHODS

Consumers who had completed at least one dual-energy x-ray absorptiometry (DEXA) bone mineral density (BMD) scan (N = 172) and/or blood chemistry test (N = 30) and purchased AC from 1 to 7 years were contacted and offered complimentary repeat tests. Safety and efficacy were examined by annualized changes in a 45-measurement blood chemistry panel and changes in BMD.

RESULTS

No adverse effects or safety concerns were found in any of the annualized within-group annualized changes in the 45 blood chemistries or in between-group changes in a similar control group (n = 5070) who completed the same measurements. With regard to BMD, consistent and statistically significant within-group increases were found for the 7-year study period and when compared to expected BMD changes in 3 large databases or the combination (N = 25,885) of the 3 databases. Data from this study suggest that AC supplement was associated with a significant annualized and linear increase in BMD of 1.04% per year, 7.3% over the 7-year study period. These results stand in marked contrast to normative or expected changes of -0.4%/y from 3 different databases or in a combination of all 3 databases (N = 16,289).

CONCLUSIONS

No evidence was found in cardiovascular risk as measured by adverse changes in blood lipids, nor was any evidence found of a diminished efficacy over the 7-year study period because gains in BMD were consistent and linear over the 7-year study period, averaging 1.04% per year over the 7-year study. The results are also consistent with earlier short-term studies suggesting that this supplement can facilitate significant increases in total body BMD in contrast to studies suggesting that calcium supplements can only slow down age-related declines in BMD.

Relationship Between Urinary Cross-Linked N-Telopeptide of Type-I Collagen and Heel Stiffness Index Measured by Quantitative Ultrasound in Middle-Aged and Elderly Men

The aim of the present study was to investigate the age-related patterns and the relationship between levels of urinary cross-linked N-telopeptide of type-I collagen (NTx) and heel stiffness index measured by quantitative ultrasound (QUS) in men with a special reference to age groups of aged 40 to 59 years and ≥60 years.A total of 379 men participated in this study. Heel stiffness index (bone mass) was measured by QUS. Spot urine samples were collected, and urinary NTx was measured. The values were corrected for creatinine (Cre) concentration.Stiffness index was significantly lower in men aged ≥60 years compared with men aged 40 to 59 years (P < 0.0001). There was no significant difference of Log (NTx/Cre) by 10-year age groups. Multiple regression analysis showed that higher level of urinary NTx/Cre was significantly correlated with lower stiffness index after adjusting for age and body mass index in men aged ≥60 years, but not in men aged 40 to 59 years.Higher rates of bone resorption were associated with lower stiffness index only in elderly men. Our results may indicate a different mechanism of low bone mass among different age groups.