Changes in bone mineral density of the proximal femur and spine with aging. Differences between the postmenopausal and senile osteoporosis syndromes

A Micro-CT Based Cadaveric Study Investigating Bone Density Changes During Hip Arthroplasty Surgery

The impact of broaching and uncemented implantation on bone density during total hip arthroplasty (THA) remains unclear. Previous studies have typically examined extracted bone sections, which may not directly correlate with outcomes in human hip systems. This study aimed to evaluate bone density changes resulting from broaching and uncemented implantation using micro-computed tomography (μCT) on cadaveric samples. An in-house density calibration phantom (DCP) was developed by validating the densities of polymer inserts through mass and volume measurements. Its performance was then evaluated using lamb bone in comparison with a commercial DCP (QRM-50124). The sensitivity of density predictions to μCT scan parameters was also evaluated with the lamb bone. Additionally, density predictions from medical-CT and μCT scans were compared using the in-house DCP. Finally, uncemented THA procedures were performed on three cadaveric femurs, each undergoing three μCT scans at various surgical stages to assess changes in bone density. The density predictions obtained using the in-house DCP achieved an accuracy of ±0.097 g/cc compared to QRM-50124, with a precision of ±0.052 g/cc. The sensitivity to changes in μCT scan parameters was ±0.022 g/cc. Notably, density predictions from medical-CT and μCT scans were similar, particularly in cortical bone. Broaching and implantation led to an average increase in bone density of 0.137 g/cc, which was attributed to the accumulation of bone debris around the bone-implant interface. This accumulation raised the bone volume fraction, ranging from 3.31% to 20.69%, which acts as an autograft. These measurements have been made for the first time using a µCT and an in-house DCP.

Calycosin alleviates ovariectomy-induced osteoporosis by promoting BMSCs autophagy via the PI3K/Akt/mTOR pathway

Calycosin, the main extract from the traditional Chinese medicine (TCM) Astragalus membranaceus, has demonstrated anti-osteoporotic properties in ovariectomized (OVX) mice. However, the specific pathways through which it prevents osteoporosis remain unexplored. This study aimed to investigate the pathways by which calycosin promotes autophagy in bone marrow mesenchymal stem cells (BMSCs) and alleviates ovariectomy-induced osteoporosis. Mice were divided into three groups: sham, OVX, and OVX + calycosin. Following a 12-week intervention period, assessments included analysis of bone microstructure, serum concentrations of LC3II and ALP, and evaluation of Trap expression in femoral tissue. Immunohistochemical staining was used to assess the expression levels of PI3K, Runx2, and Beclin-1 in bone tissue. Additionally, levels of Runx2, ALP, p-PI3K, PI3K, mTOR, p-mTOR, Beclin-1, and ULK1 were analyzed. Osteogenic differentiation of BMSCs was evaluated using ALP and Alizarin red staining. OVX significantly impaired BMSCs osteogenic differentiation, resulting in bone loss. In contrast, calycosin increased bone mass, promoted osteogenesis, and reduced cancellous bone loss. Parameters, such as BMD, BV/TV, Tb.N, and Tb.Th, were significantly higher in the OVX + calycosin group compared to the OVX group. Additionally, Tb.Sp was notably reduced in the OVX + calycosin group. Calycosin also upregulated levels of Runx2, ALP, p-PI3K, p-mTOR, ULK1, and Beclin-1. In cellular studies, calycosin promoted BMSCs osteogenesis under OVX conditions; however, this effect was inhibited by LY294002. Calycosin effectively combats bone loss and improves bone structure. Its mechanism likely involves the promotion of autophagy in osteoblasts, thereby stimulating BMSC osteogenic differentiation. This effect may be mediated through the PI3K/Akt/mTOR pathway. These findings suggest that calycosin has the potential to serve as an alternative therapy for treating osteoporosis.

The impact of bone mineral density on the risk of falling: evidence from genetic correlation and Mendelian randomization analysis

BACKGROUND

Falls are the most common consequence of low bone mineral density (BMD). However, due to limitations inherent in observational studies, the causal relationship between the two remains unestablished.

METHODS

This study utilized Mendelian Randomization (MR) analysis to explore the causal relationship between BMD and the risk of falling, incorporating linkage disequilibrium score (LDSC) regression for genetic correlation assessment. The primary method was inverse-variance weighted (IVW), supplemented with sensitivity analyses and the causal analysis using summary effect estimates (CAUSE) to address heterogeneity and pleiotropy biases.

RESULTS

LDSC analysis indicated significant genetic correlations between BMD at various sites and falling risk (rg range: -0.82 to 0.76, all P < 0.05). IVW analysis, with False Discovery Rate (FDR) correction, showed a protective causal effect of total body BMD (OR = 0.85, 95% CI 0.82-0.88, P = 7.63 × 10-17, PFDR = 1.91 × 10-16), femoral neck BMD (OR = 0.81, 95% CI 0.75-0.88, P = 3.33 × 10-7, PFDR = 5.55 × 10-7), lumbar spine BMD (OR = 0.85, 95% CI 0.79-0.91, P = 9.56 × 10-7, PFDR = 1.20 × 10-6), and heel BMD (OR = 0.82, 95% CI 0.79-0.81, P = 1.69 × 10-39, PFDR = 8.45 × 10-39) on falling risk. No causal relationship was found for forearm BMD (OR = 1.02, 95% CI 0.94-1.11, P = 0.64, PFDR = 0.64). Replication datasets and CAUSE analysis provided causal evidence consistent with the main findings.

CONCLUSION

The study established a causal relationship between BMD at four different sites and the risk of falling, highlighting potential areas for targeted prevention strategies.

Evaluation of Functional Components of Lactobacillus plantarum AR495 on Ovariectomy-Induced Osteoporosis in Mice And RAW264.7 Cells

Osteoporosis is a disease characterized by abnormal bone metabolism, where bone resorption outpaces bone formation. In this study, we investigated the key functional components of Lactobacillus plantarum AR495 in mitigating ovariectomy (OVX)-induced osteoporosis in mice. The results indicated that both Lactobacillus plantarum AR495 and its fermentation broth significantly reduced urinary calcium and deoxypyridinoline (DPD) levels in the mice. These interventions inhibited bone resorption and improved trabecular bone architecture by modulating the nuclear factor κB (RANK)/RANK ligand (RANKL)/osteoprotegerin (OPG) signaling pathway. Additionally, the L. plantarum AR495 and fermentation broth groups inhibited the RANKL/TRAF-6 and TLR4/MYD88 pathways, leading to enhanced bone metabolism, improved intestinal barrier function, and reduced intestinal inflammation. In vitro experiments revealed that AR495 fermentation supernatant fractions larger than 100 kDa and those between 50-100 kDa significantly decreased the activity of the osteoclast marker TRAP, regulated the expression of the TLR4/MYD88 pathway, and inhibited osteoclast formation, thereby alleviating the OVX-induced osteoporosis phenotype. These findings suggest that these components may be primary functional elements of L. plantarum AR495 in the treatment of osteoporosis.

Variant load of mitochondrial DNA in single human mesenchymal stem cells

Heteroplasmic mitochondrial DNA (mtDNA) variants accumulate as humans age, particularly in the stem-cell compartments, and are an important contributor to age-related disease. Mitochondrial dysfunction has been observed in osteoporosis and somatic mtDNA pathogenic variants have been observed in animal models of osteoporosis. However, this has never been assessed in the relevant human tissue. Mesenchymal stem cells (MSCs) are the progenitors to many cells of the musculoskeletal system and are critical to skeletal tissues and bone vitality. Investigating mtDNA in MSCs could provide novel insights into the role of mitochondrial dysfunction in osteoporosis. To determine if this is possible, we investigated the landscape of somatic mtDNA variation in MSCs through a combination of fluorescence-activated cell sorting and single-cell next-generation sequencing. Our data show that somatic heteroplasmic variants are present in individual patient-derived MSCs, can reach high heteroplasmic fractions and have the potential to be pathogenic. The identification of somatic heteroplasmic variants in MSCs of patients highlights the potential for mitochondrial dysfunction to contribute to the pathogenesis of osteoporosis.

Anti-inflammatory, antiosteoporotic, and bone protective effect of hydroxysafflor yellow A against glucocorticoid-induced osteoporosis in rats

Osteoporosis is a common condition worldwide, affecting millions of people. Women are more commonly affected than men, and the risk increases with age. Inflammatory reaction plays a crucial role in the expansion of osteoporosis. Osteoporosis is characterized by a gradual decline in bone density and bone tissue quality, which increases fragility and raises the risk of fractures. We scrutinized the anti-osteoporosis effect of hydroxysafflor yellow A (HYA) against glucocorticoid-induced osteoporosis (GIOP) in rats. In-silico study was carried out on EGFR receptor (PDBID: 1m17), Estrogen Alpha (PDB id: 2IOG), MTOR (PDB id: 4FA6), RANKL (PDB id: 1S55), and VEGFR2 (PDB id: 1YWN) protein. For this investigation, Sprague-Dawley (SD) rats were used, and they received an oral dose of HYA (5, 10, and 20 mg/kg, b.w.) along with a subcutaneous injection of dexamethasone (0.1 mg/kg/day) to induce osteoporosis. The biomechanical, bone parameters, antioxidant, cytokines, inflammatory, nutrients, hormones, and urine parameters were estimated. HYA treatment significantly suppressed the body weight and altered the organ weight. HYA treatment remarkably suppressed the level of alkaline phosphatase, acid phosphatase, and improved the level of bone mineral density (total, proximal, mild, and dis). HYA treatment restored the level of calcium (Ca), phosphorus (P), estradiol (E2), and parathyroid hormone near to the normal level. HYA treatment remarkably altered the level of biomechanical parameters, antioxidant, cytokines, urine, and inflammatory parameters. HYA treatment altered the level of osteoprotegerin (OPG), receptor activator of nuclear factor kappa beta (RANKL) and RANKL/OPG ratio. The result clearly showed the anti-osteoporosis effect of HYA against GIOP-induced osteoporosis in rats via alteration of antioxidant, cytokines, inflammatory, and bone protective parameters.

Association between psychological stress and mandibular condyle structure: an analytical cross-sectional study

OBJECTIVE

The potential influence of psychological factors on temporomandibular joint disorders has been clinically documented. To date, all research examining the impact of psychological stress on the temporomandibular joint has been conducted on animals. This study aims to explore the relationship between psychological stress and the structure of the human mandibular condyle.

METHODS

This cross-sectional study was performed on individuals, who were referred to the radiology division of 5th Azar Hospital for head and neck Computed Tomography (CT) scans. All participants completed a perceived stress questionnaire to determine their level of stress. Bone density and cortical bone thickness were measured as indicators of mandibular condyle structure. Based on multi-slice CT scan data, bone density was calculated in the anterior, middle, and posterior mandibular condyle. The cortical bone thickness was also measured at the anterior and posterior mandibular condyle. Statistical analysis was performed in R 4.0.2 software.

RESULTS

Seventy individuals, aged 18-59 years, participated in this study. The CT scans revealed a decrease in Hounsfield units (HU) and bone mineral density (BMD) in both the anterior and posterior regions. However, in the high-stress group, there was no significant difference in cortical bone thickness in the anterior and posterior regions of the condyle, nor in HU and BMD in the middle region of the condyle. An inverse correlation was observed between BMD and perceived stress in the anterior, middle, and posterior regions of both condyles.

CONCLUSION

The current findings indicate that recent psychological stress is associated with changes in the structure of the condyle.

The specificities, influencing factors, and medical implications of bone circadian rhythms

Physiological processes within the human body are regulated in approximately 24-h cycles known as circadian rhythms, serving to adapt to environmental changes. Bone rhythms play pivotal roles in bone development, metabolism, mineralization, and remodeling processes. Bone rhythms exhibit cell specificity, and different cells in bone display various expressions of clock genes. Multiple environmental factors, including light, feeding, exercise, and temperature, affect bone diurnal rhythms through the sympathetic nervous system and various hormones. Disruptions in bone diurnal rhythms contribute to the onset of skeletal disorders such as osteoporosis, osteoarthritis and skeletal hypoplasia. Conversely, these bone diseases can be effectively treated when aimed at the circadian clock in bone cells, including the rhythmic expressions of clock genes and drug targets. In this review, we describe the unique circadian rhythms in physiological activities of various bone cells. Then we summarize the factors synchronizing the diurnal rhythms of bone with the underlying mechanisms. Based on the review, we aim to build an overall understanding of the diurnal rhythms in bone and summarize the new preventive and therapeutic strategies for bone disorders.

OsteoMac: A new player on the bone biology scene

The knowledge of bone biology has undergone major advances in recent decades. In bone, resorbing osteoclasts have classically been described as tissue-resident macrophages, however, it is currently known that a new subtype of macrophages, called OsteoMacs, are specialised bone-resident macrophages, which, depending on certain conditions, may play an important role not only in bone homeostasis, but also in promoting pro-anabolic functions or in creating an inflammatory environment. There is growing evidence that these osteal macrophages may influence the development of bone-loss diseases. It is essential to understand the biological bases underlying bone physiological processes to search for new therapeutic targets for bone-loss diseases, such as osteoporosis, rheumatoid arthritis, or even periodontal disease. This narrative review provides an update on the origin, characterisation, and possible roles of osteoMacs in bone biology. Finally, the potential clinical applications of this new cell in bone-loss disorders are discussed.

Cortical and trabecular mechanical properties in the femoral neck vary differently with changes in bone mineral density

Graphical Abstract.

Cortical bone thickness on preoperative CT scans as predictor of bone quality in distal femur fractures: a retrospective study in Caucasians

AIM

Distal femur fractures (DFF) are rare, but associated with high complication rates and mortality, particularly in patients with osteoporosis. To improve preoperative assessment, we analyzed if cortical bone thickness on CT and AP radiographs is associated with clinical parameters of bone quality.

METHODS

Retrospective single-center study of adult patients presenting at a level-one trauma center, with a DFF between 2011 and 2020. Clinical parameters for bone quality, such as age, sex, body mass index (BMI), energy impact level of trauma, and known history of osteoporosis, were assessed. Mean cortical bone thickness (CBTavg) on AP radiograph was determined using a previously published method. Cortical thickness on CT scan was measured at 8 and 14 cm proximal to the articular surface of the lateral condyle.

RESULTS

71 patients (46 females) between 20 and 100 years were included in the study. Cortical thickness determined by CT correlated significantly with CBTavg measurements on AP radiograph (Spearman r = 0.62 to 0.80; p < 0.001). Cortical thickness was inversely correlated with age (Spearman r = - 0.341 to - 0.466; p < 0.001) and significantly associated with trauma impact level and history of osteoporosis (p =  < 0.001). The CT-based values showed a stronger correlation with the clinical parameters than those determined by AP X-ray.

CONCLUSION

Our results showed that cortical thickness of the distal femur correlates with clinical parameters of bone quality and is therefore an excellent tool for assessing what surgical care should be provided. Interestingly, our findings indicate that cortical thickness on CT is more strongly correlated with clinical data than AP radiograph measurements.

Is Regional Bone Mineral Density the Differentiating Factor Between Femoral Neck and Femoral Trochanteric Fractures?

Background Osteoporosis is globally recognized as a prevalent bone disease, and proximal femoral fractures constitute a serious complication associated with it. In recent years, the frequency of hip fractures has increased rapidly, with ramifications that extend into the social and economic aspects of both patients' lives and healthcare systems. The primary goal of this study is to discover whether bone mineral density (BMD) in specific regions of the hip could be related to femoral neck or trochanteric fractures. Methodology This prospective cohort study employed dual-energy X-ray absorptiometry (DEXA) measurements on 70 individuals with proximal femoral fractures. The participants sought treatment at the emergency department of our unit for hip fractures and adhered to our predefined eligibility criteria. These criteria primarily included (i) age exceeding 60 years and (ii) a diagnosis of either femoral neck or trochanteric fracture attributed to (iii) a low-energy lateral fall and (iv) a previously established state of complete ambulation before the occurrence of the fracture. In this context, we recorded the BMD of the hip, as well as the BMD values of the upper and lower halves of the neck, trochanteric region, and diaphysis. For the comparison of the categorical variables, Pearson's χ2 criterion was used, whereas Student's t-test was applied for the comparison of means of quantitative variables across fracture types. Results No statistical differences were identified when comparing regional BMDs and T-scores with the fracture type. This conclusion was also reconfirmed concerning age, gender, and Tonnis classification. Only a moderate correlation was observed, demonstrating lower values of regional BMDs in women compared to men. Conclusions The inability of our study to establish a direct correlation between BMD measurements across diverse areas of the proximal femur underlines the imperative need for subsequent investigations. These studies should not only integrate more precise techniques for measuring and mapping the BMD of different hip regions but should also encompass a comprehensive examination that would consider both intrinsic and extrinsic characteristics of the proximal femur.

Melatonin and bone-related diseases: an updated mechanistic overview of current evidence and future prospects

PURPOSE

Bone diseases account for an enormous cost burden on health systems. Bone disorders are considered as age-dependent diseases. The aging of world population has encouraged scientists to further explore the most effective preventive modalities and therapeutic strategies to overcome and reduce the high cost of bone disorders. Herein, we review the current evidence of melatonin's therapeutic effects on bone-related diseases.

METHODS

This review summarized evidences from in vitro, in vivo, and clinical studies regarding the effects of melatonin on bone-related diseases, with a focus on the molecular mechanisms. Electronically, Scopus and MEDLINE®/PubMed databases were searched for articles published on melatonin and bone-related diseases from inception to June 2023.

RESULTS

The findings demonstrated that melatonin has beneficial effect in bone- and cartilage-related disorders such as osteoporosis, bone fracture healing, osteoarthritis, and rheumatoid arthritis, in addition to the control of sleep and circadian rhythms.

CONCLUSION

A number of animal and clinical studies have indicated that various biological effects of melatonin may suggest this molecule as an effective therapeutic agent for controlling, diminishing, or suppressing bone-related disorders. Therefore, further clinical studies are required to clarify whether melatonin can be effective in patients with bone-related diseases.

Relationship between site-specific bone mineral density in the proximal femur and instability of proximal femoral fractures: A retrospective study

BACKGROUND

Proximal femoral fractures can occur in patients with osteoporosis. However, the relationship between bone mineral density (BMD) of the proximal femur and fracture type and instability remains unclear. This study aimed to determine whether there is a relationship between the site-specific BMD of the proximal femur and the instability of proximal femoral fracture.

HYPOTHESIS

The instability of proximal femoral fractures is related to the site-specific BMD of the proximal femur.

PATIENTS AND METHODS

Using dual-energy X-ray absorptiometry (DEXA), the BMD on the non-fractured side was retrospectively examined in 252 women who underwent surgery for proximal femoral fracture at our hospital. The BMD was measured at three sites: the femoral neck (neck), trochanter (trochanter), and intertrochanteric region (inter). The BMD at several sites was compared between the femoral neck and trochanteric fractures. Femoral neck fractures were classified into the displaced and non-displaced types, and trochanteric fractures were classified into stable and unstable types. A comparative analysis was conducted for each proximal femur site and fracture type.

RESULTS

Both total and site-specific BMDs were lower in trochanteric fractures than in femoral neck fractures. No difference was observed between BMD and displaced or non-displaced femoral neck fractures. However, the BMD of the intertrochanteric region was lower in unstable trochanteric fractures (0.57±0.12g/cm2) than in stable trochanteric fractures (0.61±0.11g/cm2) [p<0.05].

DISCUSSION

Several factors, including the patient's age and the bone component of each region, may influence the lower BMD in trochanteric fractures. In trochanteric fractures, the site-specific BMD of the proximal femur may predict the type of fracture and the degree of instability, especially in those with low BMD at the intertrochanteric site. The study findings suggest that a decrease in the BMD of the intertrochanteric region of femoral trochanteric fractures, which is thought to be involved in instability, is associated with fracture type instability.

LEVEL OF EVIDENCE

III, retrospective study.

A study of the influence of genetic variance and sex on the density and thickness of the calvarial bone in collaborative cross mice

BACKGROUND

Bone microarchitecture is affected by multiple genes, each having a small effect on the external appearance. It is thus challenging to characterize the genes and their specific effect on bone thickness and porosity. The purpose of this study was to assess the heritability and the genetic variation effect, as well as the sex effect on the calvarial bone thickness (Ca.Th) and calvarial porosity (%PoV) using the Collaborative Cross (CC) mouse population.

METHODS

In the study we examined the parietal bones of 56 mice from 9 lines of CC mice. Morphometric parameters were evaluated using microcomputed tomography (μCT) and included Ca.Th and %PoV. We then evaluated heritability, genetic versus environmental variance and the sex effect for these parameters.

RESULTS

Our morphometric analysis showed that Ca.Th and %PoV are both significantly different among the CC lines with a broad sense heritability of 0.78 and 0.90, respectively. The sex effect within the lines was significant in line IL111 and showed higher values of Ca.Th and %PoV in females compared to males. In line IL19 there was a borderline sex effect in Ca.Th in which males showed higher values than females.

CONCLUSIONS

These results stress the complexity of sex and genotype interactions controlling Ca.Th and %PoV, as the skeletal sexual dimorphism was dependent on the genetic background. This study also shows that the CC population is a powerful tool for establishing the genetic effect on these traits.

Epigenetic regulation of bone remodeling and its role in the pathogenesis of primary osteoporosis

Discovery of molecular mechanisms of primary osteoporosis development is fundamental to understand the pathogenesis of musculoskeletal diseases in general and for identifying key links in the genetic and epigenetic regulation of bone remodelling genes. The number of identified molecular genetic markers for osteoporosis is increasing but there is a need to describe their functional interactions. These interactions have been determined to be associated with the control of expression of a number of transcription factors and the differentiation of mesenchymal stem cells through the pathway of osteoblastogenesis or adipogenesis, and monocytic precursors through the pathway of osteoclastogenesis. The results of epigenetic studies have significantly increased the understanding of the role of post-translational modifications of histones, DNA methylation and RNA interference in the osteoporosis pathogenesis and in bone remodelling. However, the knowledge should be systematised and generalised according to the results of research on the role of epigenetic modifiers in the development of osteoporosis, and the influence of each epigenetic mechanism on the individual links of bone remodelling during ontogenesis of humans in general, including the elderly, should be described. Understanding which mechanisms and systems are involved in the development of this nosology is of interest for the development of targeted therapies, as the possibility of using microRNAs to regulate genes is now being considered. Systematisation of these data is important to investigate the differences in epigenetic marker arrays by race and ethnicity. The review article analyses references to relevant reviews and original articles, classifies information on current advances in the study of epigenetic mechanisms in osteoporosis and reviews the results of studies of epigenetic mechanisms on individual links of bone remodelling.

Correlation between sedentary activity, physical activity and bone mineral density and fat in America: National Health and Nutrition Examination Survey, 2011-2018

We compared the relationship between sedentary activity (SA) and physical activity (PA) with bone mineral density (BMD) and body fat percentage in the United States and found a negative association between SA and BMD and a positive association with body fat percentage. A positive association between PA and BMD and a negative association with body fat percentage. SA and PA are associated with changes in skeletal parameters and body fat percentage, and we aimed to investigate and compare the relationship between SA, PA and bone mineral density (BMD) and body fat percentage in men and women. We assessed the relationship between SA, PA and BMD and body fat percentage in 9787 Americans aged 20-59 years (mean age 38.28 ± 11.39 years) from NHANES 2011-2018. BMD and body fat percentage were measured by dual-energy X-ray bone densitometry (DXA). We used multiple linear regression models to examine the relationships between SA, PA and lumbar spine BMD and total body fat percentage, adjusted for a large number of confounding factors. After adjusting for race/ethnicity, age, alcohol and smoking behavior, body mass index (BMI), total protein, blood calcium, blood uric acid, cholesterol, blood phosphorus, vitamin D, and blood urea nitrogen, SA was negatively associated with lumbar spine BMD (β = - 0.0011 95% CI - 0.0020 to - 0.0002, P = 0.022), and SA was positively associated with total fat percentage (β = PA was positively associated with lumbar BMD (β = 0.0046 95% CI 0.0010 to 0.0082, P = 0.012) and there was a negative association between PA and body fat percentage (β = - 1.177 95% CI - 1.326 to -1.027, P < 0.001). Our results show that physical activity is a key component of maintaining bone health in both men and women and is strongly associated with lower body fat percentages. Sedentary activity is negatively correlated with bone density and is strongly associated with an increase in body fat percentage. Healthcare policy makers should consider reducing sedentary activity and increasing physical activity when preventing osteoporosis and obesity.

Bone Mineral Density Reference Values in 18- to 95-Year-Old Population in Lombardy Region, Italy

The aim of this study is to assess the bone mineral density (BMD) and T-score reference values in a population from 18 to 95 years old in Lombardy region, Italy. This study also investigates the association between BMD values and body mass index (BMI) divided by gender and age. The evaluation of BMD was analyzed by T-score and BMD in each site, femur, and column. A total of 10,503 patients (9,627 females and 876 males, 65.04±12.18 years) have been enrolled in this study. The women hip femur reference values associated with a situation of osteopenia highlighted in-line with the class of age of 45 to 55 years were: mean values: -1.3132 T-score; 95% confidence interval (CI): -1.3600 to -1.2664 and of osteoporosis from the class of age 85 to 95 years, mean values: -2.6591 T-score, 95% CI: -2.7703 to -2.5479. The men hip femur reference values associated with a situation of osteopenia highlighted in-line with the class of age of 45 to 55 years were: mean values: 1.2986 T-score; 95% CI: -1.5454 to -1.0518. A positive association between BMI and the two sites of BMD was recorded (p > .05). This study provides an Italian overview of national and regional reference values about the BMD and T-score values divided by age and gender as reference values for clinicians for a correct assessment and monitoring.

(S)-Equol Is More Effective than (R)-Equol in Inhibiting Osteoclast Formation and Enhancing Osteoclast Apoptosis, and Reduces Estrogen Deficiency-Induced Bone Loss in Mice

BACKGROUND

Equol, a metabolite of daidzein, binds to the estrogen receptor with greater affinity than daidzein and exhibits various biological properties. It exists as an enantiomer, either (S)-equol or (R)-equol.

OBJECTIVES

We have previously shown that the inhibitory effect of (S)-equol on bone fragility is stronger than that of racemic equol in ovariectomized (OVX) mice; however, the effect of (R)-equol has not been elucidated. The aim of this study was to compare the activities of equol enantiomers on bone metabolism in vitro and in vivo.

METHODS

Bone marrow cells (BMCs) and RAW 264.7 cells were treated with equol enantiomers. The number of osteoclasts and caspase-3/7 activity were measured. We examined the effect of equol enantiomers on osteoblast differentiation in MC3T3-E1 cells. In vivo, 8-wk-old female ddY mice were assigned to 4 groups: sham-operated (sham), OVX, OVX + 0.5 mg/d of (S)-equol (S-eq), and OVX + 0.5 mg/d of (R)-equol (R-eq). Four weeks after the intervention, femoral bone mineral density (BMD) and osteoclastic gene expression were analyzed, along with concentrations of equol enantiomers in the serum and tissues.

RESULTS

(S)-equol and (R)-equol inhibited osteoclast differentiation in BMCs (97% and 60%, P < 0.05) and RAW 264.7 cells (83% and 68%, P < 0.05). (S)-equol promoted apoptosis of mature osteoclasts by inducing caspase-3/7 activity (29%, P < 0.05) and enhanced osteoblast differentiation (29%, P < 0.05). In OVX mice, BMD was ameliorated in (S)-equol-treated mice (11%, P < 0.05), but not in (R)-equol-treated mice. The concentrations of (S)-equol were greater than those of (R)-equol in the serum, tibia, liver, and kidney (by 148%, 80%, 22%, and 139%, respectively).

CONCLUSIONS

These results suggest that (S)-equol is more effective than (R)-equol in inhibiting osteoclast formation and enhancing osteoclast apoptosis in vitro, supporting the beneficial effect of (S)-equol to reduce estrogen deficiency-induced bone loss in OVX mice.

Correlation of serum cornitine levels with bone mineral density among Indian male tobacco users

It is of interest to assess levels of serum cornitine in male tobacco users and also find its correlation with bone mineral density. Assessment for serum cotinine levels was done using commercially available Enzyme Linked Immunosorbent Assay (ELISA Kit). While bone mineral density was measured using bone densitometry through ultrasound in the wrist region. Karl Pearson's coefficient was used to assess correlation between BMD values and serum cotinine (ng/ml) levels. Inter group BMD association was measured using Chi square test. The present study showed that the first 3 groups had a low BMD level compared to control group, indicative of osteopenia. BMD values were lesser for chewers from group II as compared to smokers from group I and individuals using both smoked and smokeless form of tobacco from Group III. In group III (both forms of tobacco), osteopenic individuals were more. Thus, data shows effect of tobacco usage on bone mineral density. Smokeless form of tobacco has relatively serious effects on bone density.

Detecting respiratory chain defects in osteoblasts from osteoarthritic patients using imaging mass cytometry

Osteoporosis is a skeletal disease which is characterised by reduced bone mass and microarchitecture, with a subsequent loss of strength that predisposes to fragility and risk of fractures. The pathogenesis of falling bone mineral density, ultimately leading to a diagnosis of osteoporosis is incompletely understood but the disease is currently thought to be multifactorial. Humans are known to accumulate mitochondrial mutations and respiratory chain deficiency with age and mounting evidence suggests that this may indeed be the overarching cause intrinsic to the changing phenotype in advancing age and age-related disease. Mitochondrial mutations are detectable from the age of about 30 years onwards. Mitochondria contain their own genome which encodes 13 essential mitochondrial proteins and accumulates somatic variants at up to 10 times the rate of the nuclear genome. Once the concentration of any pathogenic mitochondrial genome variant exceeds a threshold, respiratory chain deficiency and cellular dysfunction occur. The Polg^D257A/D257A mouse model is a knock-in mutant that expresses a proof-reading-deficient version of PolgA, a nuclear encoded subunit of mtDNA polymerase. These mice are a useful model of age-related accumulation of mtDNA mutations in humans since their defective proof-reading mechanism leads to a mitochondrial DNA mutation rate 3-5 times higher than in wild-type mice. These mice showed enhanced levels of age-related osteoporosis along with respiratory chain deficiency in osteoblasts. To explore whether respiratory chain deficiency is also seen in human osteoblasts, we developed a protocol and analysis framework for imaging mass cytometry in bone tissue sections to analyse osteoblasts in situ. By comparing bone tissue sampled at one timepoint from femoral neck of 10 older healthy volunteers aged 40-85 with samples from young patients aged 1-19, we have identified complex I defect in osteoblasts from 6 out of 10 older volunteers, complex II defect in 2 out of 10 older volunteers, complex IV defect in 1 out of 10 older volunteers and complex V defect in 4 out of 10 older volunteers. These observations are consistent with findings from the Polg^D257A/D257A mouse model and suggest that respiratory chain deficiency, as a consequence of the accumulation of age-related pathogenic mitochondrial DNA mutations, may play a significant role in the pathogenesis of human age-related osteoporosis.

Blood Lead Level Is Negatively Associated With Bone Mineral Density in U.S. Children and Adolescents Aged 8-19 Years

CONTEXT

The relationship of lead (Pb) exposure with bone health in children and adolescents remains controversial.

OBJECTION

We aimed to investigate the association of blood lead levels (BLL) with bone mineral density (BMD) in American children and adolescents using data from the National Health and Nutrition Examination Survey (NHANES), 2005-2010.

METHODS

We analyzed 5,583 subjects aged 8-19 years (mean age, 13.49 ± 3.35 years) from the NHANES 2005-2010. BLL was tested using inductively coupled plasma mass spectrometry. BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine, total femur, and femur neck. Multivariate linear regression models were used to explore the association between BLL and BMD, adjusting for age, gender, race/ethnicity, poverty income ratio (PIR), body mass index (BMI), serum calcium, and serum phosphorus.

RESULTS

BLL was negatively correlated with BMD at different sites of interest in children and adolescents. For every 1mg/dl increase in BLL, the BMD of the total spine, total hip, and femoral neck decreased by 0.011 g/cm², 0.008 g/cm², and 0.006 g/cm². In addition, Pb affected the lumbar spine more than the femur. The effect estimates were stronger in girls than boys at the lumbar spine (P for interaction= 0.006). This negative association remained significant in American children and adolescents after excluding individuals with BLL more than 3.5 ug/dl.

CONCLUSION

Our study indicates that BLL is negatively correlated with BMD at different sites of interest in children and adolescents aged 8-19 years, even in the reference range. More research is needed to elucidate the relationships between Pb and bone health in children and adolescents, including specific mechanisms and confounding factors like race/ethnicity, gender, and age.

The pathophysiology of osteoporosis in obesity and type 2 diabetes in aging women and men: The mechanisms and roles of increased bone marrow adiposity

Osteoporosis is defined as a systemic skeletal disease characterized by decreased bone mass and micro-architectural deterioration leading to increased fracture risk. Osteoporosis incidence increases with age in both post-menopausal women and aging men. Among other important contributing factors to bone fragility observed in osteoporosis, that also affect the elderly population, are metabolic disturbances observed in obesity and Type 2 Diabetes (T2D). These metabolic complications are associated with impaired bone homeostasis and a higher fracture risk. Expansion of the Bone Marrow Adipose Tissue (BMAT), at the expense of decreased bone formation, is thought to be one of the key pathogenic mechanisms underlying osteoporosis and bone fragility in obesity and T2D. Our review provides a summary of mechanisms behind increased Bone Marrow Adiposity (BMA) during aging and highlights the pre-clinical and clinical studies connecting obesity and T2D, to BMA and bone fragility in aging osteoporotic women and men.

Preoperative bone assessment by bone mineral density and bone turnover in patients undergoing total knee arthroplasty

Background

The preoperative overall bone quality in patients undergoing total knee arthroplasty (TKA) might influence the development of postoperative bone-derived complications. This study was performed to simultaneously evaluate the baseline bone mineral density (BMD) and bone turnover in these patients.

Methods

We prospectively measured the lumbar spine, total hip, and femoral neck BMD using dual-energy X-ray absorptiometry (DXA) in 214 patients (239 knees; women, 199 knees; men, 40 knees) 1 day preoperatively. Women were stratified into three age groups: <70 years (60s), <80 years (70s), and ≥80 years (80s). We assessed bone turnover using the urinary level of N-telopeptide (NTx) normalized to creatinine (NTx/Cre).

Results

The prevalence of osteoporosis as assessed by DXA (T-score of ≤ -2.5) was 22% in women and 5% in men. A decline in BMD with aging was found in the hip but not in the lumbar spine with significant differences among ages. Women showed a higher NTx/Cre level than men (p = 0.033). An NTx/Cre level suggesting a high fracture risk (>56.5 mmol BCE/mmol Cre) was present in 54% of women and 35% of men (p = 0.037). No significant differences were found in this prevalence among age groups in women. Seventeen percent of women and 0% of men had both osteoporosis and a high fracture risk simultaneously (p = 0.002). The proportion of women in this category was lower in the 60s than 70s age group (p = 0.019).

Conclusions

Preoperative bone health screening before TKA might be necessary for women aged ≥70 years to prevent complications caused by perioperative poor bone condition.

All-cause mortality risk in aged femoral intertrochanteric fracture patients

Introduction

The 1-year mortality rate after femoral intertrochanteric fracture is higher than that of femoral neck fracture, which also belongs to hip fracture (Cui et al. in Arch Osteoporos 14(1):55, 2019). With the application of the concept of co-management model of orthopedics and geriatrics, the short-term and long-term mortality of all types of hip fractures has decreased (Van Heghe et al. in Calcif Tissue Int, 2021, https://doi.org/10.1007/s00223-021-00913-5). However, the mortality of Chinese femoral intertrochanteric fracture patients under this model has not been reported in the literatures.

Aim

This paper aims to study the risk factors of postoperative all-cause mortality in aged patients with femoral intertrochanteric fracture under the co-management model of orthopedics and geriatrics.

Materials and methods

This is a single-center prospective cohort study based on the real world, under the co-management of orthopedics and geriatrics, 363 patients aged ≥ 65 years with femoral intertrochanteric fracture were enrolled and followed up for 2–3 years; 52 patients were lost to follow up. Age, gender, body mass index (BMI), history of comorbidities, hip Bone Mineral Density (BMD), fracture history, 25(OH)D level, hemoglobin level, anti-osteoporosis treatment were risk factors to be tested. Kaplan–Meier survival curves and multivariate Cox proportional hazards models were constructed to analyze the impact of factors on all-cause mortality.

Results

(1) Most of the dead patients were older (the mean age was 83.4 years, compared with 79.8 years for surviving patients), with more complications and without anti-osteoporosis medication; gender, pre-fracture history, BMI, total hip BMD, hemoglobin, 25(OH)D had no difference between the dead and the living patients. (2) Elderly patients with Intertrochanteric fracture can benefit from the early treatment of Zoledronic Acid (within 3 days after the operation).

Conclusion

Under the co-management of orthopedics and geriatrics, to Chinese patients with Femoral Intertrochanteric fracture, Doctors should pay more attention to their age and chronic disease, and give anti-osteoporosis treatment if allowed.

Evaluating the reliability and readability of online information on osteoporosis

OBJECTIVE

Internet usage for obtaining health-related information is widely popular among patients. However, there are still concerns about the reliability and comprehensibility of online information. The purpose of this study is to investigate the reliability and readability of osteoporosis-related websites.

METHODS

On April 2, 2020, we searched the term "osteoporosis" on Google (https://www.google.com). We evaluated the first 200 uniform resource locators (URLs) in the query results regarding typology, the Journal of the American Medical Association (JAMA) scores, Health on the Net Foundation Code of conduct (HONcode) certification, Flesch-Kincaid Grade (FKG), and Simple Measure of Gobbledygook (SMOG) scores. The JAMA scoring system and HONcode stamp were used for assessing the reliability, whereas FKG and SMOG scores were used to assess the readability of online information.

RESULTS

Of the 151 analyzed websites, 57 (37.7%) were classified as highly reliable, and 19 (12.6%) were assigned with HONcode certification. The average FKG scores (8.81 ± 2.21) and SMOG scores (7.63 ± 1.81) were below the recommended grade, which is considered as easily readable. High reliable information was found to have higher readability scores, thereby representing the difficulty of readability. We observed a weak correlation between the increased reliability of information and decreased readability.

CONCLUSION

Osteoporosis-related content on the internet generally has low reliability. High-reliable information is available online in scientific published materials, health portals, and news. Although the readability of the overall material is acceptable, the high-reliable websites still require high literacy and comprehension skills.

Assessment of total and regional bone mineral density using bioelectrical impedance vector analysis in elderly population

This study aimed to investigate the relationship between bone mineral density (BMD) and height-adjusted resistance (R/H), reactance (Xc/H) and phase angle (PhA). A total of 61 male and 64 female subjects aged over 60 years were recruited from middle Taiwan. The R and Xc were measured using Bodystat Quadscan 4000 at a frequency of 50 kHz. BMD at the whole body, L2-L4 spine, and dual femur neck (DFN), denoted as BMDTotal, BMDL2-L4, and BMDDFN, were calculated using a Hologic DXA scanner. The R-Xc graph was used to assess vector shift among different levels of BMD. BMD was positively correlated with Xc/H and negatively correlated with R/H (p < 0.001). The General Linear Model (GLM) regression results were as follows: BMDTotal = 1.473-0.002 R/H + 0.007 Xc/H, r = 0.684; BMDL2-L4 = 1.526-0.002 R/H + 0.012 Xc/H, r = 0.655; BMDDFN = 1.304-0.002 R/H + Xc/H, r = 0.680; p < 0.0001. Distribution of vector in the R-Xc graph was significantly different for different levels of BMDTotal, BMDL2-L4 and BMDDFN. R/H and Xc/H were correlated with BMD in the elderly. The linear combination of R/H and Xc/H can effectively predict the BMD of the whole body, spine and proximal femur, indicating that BIVA may be used in clinical and home-use monitoring tool for screening BMD in the elderly in the future.

Delivering computationally-intensive digital patient applications to the clinic: An exemplar solution to predict femoral bone strength from CT data

BACKGROUND AND OBJECTIVE

Whilst fragility hip fractures commonly affect elderly people, often causing permanent disability or death, they are rarely addressed in advance through preventive techniques. Quantification of bone strength can help to identify subjects at risk, thus reducing the incidence of fractures in the population. In recent years, researchers have shown that finite element models (FEMs) of the hip joint, derived from computed tomography (CT) images, can predict bone strength more accurately than other techniques currently used in the clinic. The specialised hardware and trained personnel required to perform such analyses, however, limits the widespread adoption of FEMs in clinical contexts. In this manuscript we present CT2S (Computed Tomography To Strength), a system developed in collaboration between The University of Sheffield and Sheffield Teaching Hospitals, designed to streamline access to this complex workflow for clinical end-users.

METHODS

The system relies on XNAT and makes use of custom apps based on open source software. Available through a website, it allows doctors in the healthcare environment to benefit from FE based bone strength estimation without being exposed to the technical aspects, which are concealed behind a user-friendly interface. Clinicians request the analysis of CT scans of a patient through the website. Using XNAT functionality, the anonymised images are automatically transferred to the University research facility, where an operator processes them and estimates the bone strength through FEM using a combination of open source and commercial software. Following the analysis, the doctor is provided with the results in a structured report.

RESULTS

The platform, currently available for research purposes, has been deployed and fully tested in Sheffield, UK. The entire analysis requires processing times ranging from 3.5 to 8 h, depending on the available computational power.

CONCLUSIONS

The short processing time makes the system compatible with current clinical workflows. The use of open source software and the accurate description of the workflow given here facilitates the deployment in other centres.

Population-based, three-dimensional analysis of age- and sex-related femur shaft geometry differences

This study deals with differences of femoral geometric focus on the bowing and width. Analysis using three-dimensional skeletonization showed increase of femoral bowing and femur width over life (more in women), and widening of the medullary canal only in women after 50 years old, not in men.

INTRODUCTION

The changes in femur geometry that occur with aging and lead to fragility or insufficiency fracture remain unclear. The role of the lower limb geometry, including the femur and femoral bowing, has become a point of discussion, especially in atypical femur fracture. This study aimed to analyze femur shaft geometry using three-dimensional skeletonization.

METHODS

We acquired computed tomography images of both femurs obtained. A total of 1400 age- and sex-stratified participants were enrolled and were divided into subgroups according to age (by decade) and sex. The computed tomography images were used to produce 3-dimensional samplings of anatomical elements of the human femur using reconstruction and parametrization from these datasets. The process of skeletonization was conducted to obtain compact representation of the femur. With the skeletonization, we were able to compare all parameters according to age and sex.

RESULTS

The femur length was 424.4 ± 28.6 mm and was longer in men (P < 0.001). The minimum diameter of the medullary canal was 8.9 ± 2.0 mm. The radius of curvature (ROC) was 906.9 ± 193.3 mm. Men had a larger femur length, femur outer diameter, and the narrowest medullary diameter (P < 0.001, respectively). Women had significantly smaller ROC (P < 0.001). ROC decreased by 19.4% in men and 23.6% in women between the ages of 20 to 89 years. Femur width increased over life by 11.4% in men and 24.5% in women. Between the ages of 50 and 89 years, the medullary canal appears to have increased by 32.7% in women.

CONCLUSION

This geometry analysis demonstrated that femoral bowing and femoral width increased related to aging, and that the medullary canal widened after the age of 50 years in women. This cross-sectional study revealed important age- and sex-related differences in femur shaft geometry that occur with aging.

Hormonal and Metabolic Changes of Aging and the Influence of Lifestyle Modifications

Increased life expectancy combined with the aging baby boomer generation has resulted in an unprecedented global expansion of the elderly population. The growing population of older adults and increased rate of age-related chronic illness has caused a substantial socioeconomic burden. The gradual and progressive age-related decline in hormone production and action has a detrimental impact on human health by increasing risk for chronic disease and reducing life span. This article reviews the age-related decline in hormone production, as well as age-related biochemical and body composition changes that reduce the bioavailability and actions of some hormones. The impact of hormonal changes on various chronic conditions including frailty, diabetes, cardiovascular disease, and dementia are also discussed. Hormone replacement therapy has been attempted in many clinical trials to reverse and/or prevent the hormonal decline in aging to combat the progression of age-related diseases. Unfortunately, hormone replacement therapy is not a panacea, as it often results in various adverse events that outweigh its potential health benefits. Therefore, except in some specific individual cases, hormone replacement is not recommended. Rather, positive lifestyle modifications such as regular aerobic and resistance exercise programs and/or healthy calorically restricted diet can favorably affect endocrine and metabolic functions and act as countermeasures to various age-related diseases. We provide a critical review of the available data and offer recommendations that hopefully will form the groundwork for physicians/scientists to develop and optimize new endocrine-targeted therapies and lifestyle modifications that can better address age-related decline in heath.

Phosphorescence of thermally altered human bone

Bone has photoluminescent characteristics that can aid the analysis of thermally altered human skeletal remains as part of the forensic anthropological investigation. Photoluminescence stands collectively for fluorescence and phosphorescence. Because the difference in lifetime between fluorescence and phosphorescence is usually in the range of nano- to microseconds, it is only possible to visually determine whether bone phosphoresces when the lifetime is long enough to be observed. For this study, a distinction was made between long-decay and short-decay phosphorescence. So far, it was unknown whether (thermally altered) human bone emits long-decay phosphorescence after being illuminated and, thus, whether phosphorescence contributes to the observed photoluminescence. If so, whether the observable phosphorescence is dependent on temperature, exposure duration, surrounding medium, bone type, skeletal element, and excitation light and could aid the temperature estimation of heated bone fragments. In this study, bone samples were subjected to heat in the range of from room temperature to 900 °C for various durations in either air or adipose as surrounding medium. In addition, different skeletal elements of a human cadaver were recollected after cremation in a crematorium. Both sample collections were illuminated with light of different bandwidths and visually inspected for phosphorescence and photoluminescence. The samples were scored by means of a scoring index for the intensity of long-decay phosphorescence and photographically documented. The results show that thermally altered human bone fragments do phosphoresce. The observed phosphorescence is more dependent on temperature than on exposure duration, surrounding medium or skeletal element. Of the used wavelength bands, ultraviolet light provided the most temperature-related information, showing changes in both phosphorescence intensity and emission spectrum. Long-decay phosphorescence and fluorescence with short-decay phosphorescence coincide; however, there are also temperature-dependent differences. It is therefore concluded that phosphorescence contributes to the observable photoluminescence and that the visibly observable phosphorescent characteristics can aid the temperature estimation of cremated human skeletal fragments.

Moderate SMFs attenuate bone loss in mice by promoting directional osteogenic differentiation of BMSCs

Background

Osteoporosis is a common metabolic bone disease without effective treatment. Bone marrow-derived mesenchymal stem cells (BMSCs) have the potential to differentiate into multiple cell types. Increased adipogenic differentiation or reduced osteogenic differentiation of BMSCs might lead to osteoporosis. Whether static magnetic fields (SMFs) might influence the adipo-osteogenic differentiation balance of BMSCs remains unknown.

Methods

The effects of SMFs on lineage differentiation of BMSCs and development of osteoporosis were determined by various biochemical (RT-PCR and Western blot), morphological (staining and optical microscopy), and micro-CT assays. Bioinformatics analysis was also used to explore the signaling pathways.

Results

In this study, we found that SMFs (0.2–0.6 T) inhibited the adipogenic differentiation of BMSCs but promoted their osteoblastic differentiation in an intensity-dependent manner. Whole genomic RNA-seq and bioinformatics analysis revealed that SMF (0.6 T) decreased the PPARγ-mediated gene expression but increased the RUNX2-mediated gene transcription in BMSCs. Moreover, SMFs markedly alleviated bone mass loss induced by either dexamethasone or all-trans retinoic acid in mice.

Conclusions

Taken together, our results suggested that SMF-based magnetotherapy might serve as an adjunctive therapeutic option for patients with osteoporosis.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s13287-020-02004-y.

Comparison of hip subregion bone mineral density to the type of proximal femur fracture

Beta values of the intertrochanteric fracture group were about twice as high as those of the femoral neck fracture group. These results can be used to increase the awareness of proximal hip fracture among physicians and improve treatments and outcomes.

PURPOSE

To compare the BMD of the femoral neck region and the intertrochanteric region between the femoral neck fracture group and the intertrochanteric fracture group.

METHODS

We did a retrospective review of radiographs of the proximal femoral fractures in patients registered from 2010 to 2017. A total of 329 patients were classified into the femoral neck fracture group (group A, n = 162) and the femur intertrochanteric fracture group (group B, n = 167). We did intergroup comparisons of age, sex, BMI (body mass index), and bone mineral density (BMD) of the neck and intertrochanteric region, adjusting for age. We did multiple logistic regression analysis among these parameters.

RESULTS

The BMD of the femoral neck and intertrochanteric was statistically significantly different between the two groups (p < 0.001), and the BMD of the femur intertrochanteric was also significantly different between the two groups (p < 0.001). BMD of both regions in the intertrochanteric fracture group was lower than that of the femoral neck fracture group. In linear regression analysis, the beta values of the intertrochanteric fracture group were about twice as high as those of the femoral neck fracture group.

CONCLUSION

In linear regression analysis, the beta values of the intertrochanteric fracture group were about twice as high as those of the femoral neck fracture group.

Augmented oxidative stress and reduced mitochondrial function in ageing goat testis

Recently, there is a significant increase in the commercial use of goat products. Nevertheless, there are very few reports on the characterization of redox biomarkers and mitochondrial function in the goat testis. Therefore, in this study we studied the markers of oxidative stress and mitochondrial functions in the goat testis during the process of ageing. Alterations in the markers of oxidative stress/redox biomarkers (contents of reactive oxygen species, nitrite, lipid peroxide, protein carbonyl, glutathione and activities of glutathione peroxidase, monoamine oxidase) and mitochondrial function (Complex‐I and Complex‐IV activities) were elucidated during the process of ageing. Augmented oxidative stress and decreased mitochondrial function were prominent during ageing in the goat testis. Ageing can lead to induction of oxidative stress and decreased production of ATP; however, the prooxidants generated must be effectively removed from the body by the innate antioxidant defence system to minimize the damage to the host tissue. Conversely, the antioxidants cannot completely scavenge the excessive amount of reactive oxygen species produced during ageing or pathological conditions leading to significant cell death and tissue damage. Thus, the use of effective and potent antioxidants in the feed could significantly reduce oxidative stress and improve mitochondrial function, resulting in enriched goat health.

Screening osteoporotic femoral neck without measuring bone mineral density with the use of tartrate resistant acid phosphatase-5b and serum-creatinine-to-cystatin C ratio in Japanese postmenopausal women

BACKGROUND

Screening osteoporosis in Japanese postmenopausal women is an important subject for preventing bone fragility fracture (BFF). Measuring bone mineral density (BMD) is included in the criteria for osteoporosis diagnosis. However, it has not gained popularity.

METHODS

BMD of lumbar spine (LS) and femoral neck (FN) were measured, the serum creatinine-to-cystatin C ratio (Cr/CysC), tartrate-resistant acid phosphatase-5b (TRACP-5b), body mass index (BMI) were also simultaneously measured. These subjects had no potential secondary osteoporosis factors or concomitant drug administration for osteoporosis (pSubjects; primary subjects). Best subsets regression analysis (BeStR) was evaluated for determining the statistically significant factors, and multivariate regression analysis (MLR) was used to assess the correlation of these factors with BMD at each part. Relationship between osteoporotic criteria whether T score≤-2.5 and each factor was also evaluated at each part with binary logistic regression analysis (BLR). Cut-off index (COI) at each part was determined, and sensitivity and specificity were evaluated in pSubjects and in subjects with whom potential secondary osteoporosis factors were included (sSubjects).

RESULTS

BMI and Cr/CysC had a significant influence on BMD at the LS with BeStR, whereas only BMI demonstrated significant correlation with BMD both with MLR and BLR, with 22.7 of COI and sensitivity and specificity of 48.7% and 94.7%, respectively, in pSubjects with 60 and 49.1% and 87.5%, respectively, in sSubjects with 83. At the FN, Cr/CysC, BMI, and TRACP-5b significantly influenced BMD, whereas all these factors demonstrated significant correlation with BMD. Cr/CysC and TRACP-5b demonstrated significant correlation with T score≤-2.5 in BLR. With COI that was made in combination with these factors and subjects' age, sensitivity and specificity were 67.7% and 82.4%, respectively, in pSubjects and 55.8% and 82.8%, respectively, in sSubjects.

CONCLUSIONS

These results suggested that BMI, TRACP-5b, and Cr/CysC may be realistic surrogate markers for screening osteoporosis in Japanese postmenopausal women.

The NLRP3 Inflammasome as a Critical Actor in the Inflammaging Process

As a consequence of the considerable increase in the human lifespan over the last century, we are experiencing the appearance and impact of new age-related diseases. The causal relationships between aging and an enhanced susceptibility of suffering from a broad spectrum of diseases need to be better understood. However, one specific shared feature seems to be of capital relevance for most of these conditions: the low-grade chronic inflammatory state inherently associated with aging, i.e., inflammaging. Here, we review the molecular and cellular mechanisms that link aging and inflammaging, focusing on the role of the innate immunity and more concretely on the nucleotide-binding oligomerization domain (NOD)-like receptor family pyrin domain containing 3 (NLRP3) inflammasome, as well as how the chronic activation of this inflammasome has a detrimental effect on different age-related disorders.

Computer-aided diagnosis systems for osteoporosis detection: a comprehensive survey

Computer-aided diagnosis (CAD) has revolutionized the field of medical diagnosis. They assist in improving the treatment potentials and intensify the survival frequency by early diagnosing the diseases in an efficient, timely, and cost-effective way. The automatic segmentation has led the radiologist to successfully segment the region of interest to improve the diagnosis of diseases from medical images which is not so efficiently possible by manual segmentation. The aim of this paper is to survey the vision-based CAD systems especially focusing on the segmentation techniques for the pathological bone disease known as osteoporosis. Osteoporosis is the state of the bones where the mineral density of bones decreases and they become porous, making the bones easily susceptible to fractures by small injury or a fall. The article covers the image acquisition techniques for acquiring the medical images for osteoporosis diagnosis. The article also discusses the advanced machine learning paradigms employed in segmentation for osteoporosis disease. Other image processing steps in osteoporosis like feature extraction and classification are also briefly described. Finally, the paper gives the future directions to improve the osteoporosis diagnosis and presents the proposed architecture. Graphical abstract.

Correlation of Bone Mineral Density with Pulmonary Function in Advanced Duchenne Muscular Dystrophy

BACKGROUND

A relationship between bone mineral density (BMD) and physical function has been revealed in the general population and various diseases. However, there is a lack of research investigating the correlation between BMD and respiratory function, one of few measurable physical parameters in patients with advanced Duchenne muscular dystrophy (DMD).

OBJECTIVE

To determine whether pulmonary function parameters, including respiratory muscle strength, are related to BMD.

DESIGN

Retrospective observational study.

SETTING

A tertiary university hospital.

PATIENTS

DMD patients who were over 20 years of age, nonambulatory, and supported by mechanical ventilators.

METHODS

The patients' age, weight, and pulmonary function as well as the BMD of the first and the fourth lumbar vertebra were assessed. Pulmonary function includes forced vital capacity (FVC), unassisted and assisted peak cough flow (UPCF and APCF), maximal expiratory pressure (MEP), and maximal inspiratory pressure (MIP).

MAIN OUTCOME MEASURES

A bivariate correlation for BMD and other pulmonary parameters was calculated, and hierarchical regression analysis was used to determine predictors of spine Z-score.

RESULTS

It was observed that the decrease in the spine BMD was not significantly correlated with age. However, the body mass index (BMI) and all parameters of pulmonary function were correlated with BMD. Partial correlation analysis adjusted by BMI showed that UPCF and APCF were powerful predictors of spine BMD.

CONCLUSIONS

The BMD of the lumbar spine correlated with BMI and PCF in patients with DMD at an advanced stage.

Compositional Influence of Movement Behaviors on Bone Health during Aging

INTRODUCTION AND PURPOSE

Physical activity (PA) is considered the best nonpharmacological treatment for the decrease in bone mass (BM) produced during aging. Therefore, it is essential to assess how the time spent in PA is distributed to control further changes. This work examines the relationship between movement behaviors and BM during aging, using compositional data analysis.

METHODS

We studied 227 older people 65 to 94 yr old (102 men and 125 women), divided by sex and bone status, over a period of 4 yr. Time spent in sedentary behavior (SB), light PA (LPA), and moderate to vigorous PA (MVPA), was assessed using accelerometry. BM was determined by dual-energy x-ray absorptiometry.

RESULTS

The changes in MVPA were positively associated with the rate of BM decay at spine and leg in the whole sample and men's subgroup (P ≤ 0.05). In women, the rate of BM decay at spine and Ward's triangle were negatively associated with SB changes, and BM decay at femoral neck and Ward's triangle were positively associated with LPA (P ≤ 0.05).

CONCLUSION

Increasing MVPA related to other movement behaviors produces improvements in the rate of bone change in older men, whereas to increase LPA and maintain MVPA would be the best approach to enhance BM in older women.

Pisidium coreanum Inhibits Multinucleated Osteoclast Formation and Prevents Estrogen-Deficient Osteoporosis

Mollusks have served as important sources of human food and medicine for a long time. Raw Pisidium coreanum, a freshwater bivalve of the phylum Mollusca, is used in traditional therapies in parts of Asia. However, the therapeutic effects of Pisidium coreanum on bone diseases are not known. We investigated the functional roles of Pisidium coreanum in osteoporotic bone diseases. Pisidium coreanum inhibited the differentiation of bone marrow-derived monocytic cells into mature osteoclasts in vitro. The ovariectomized mice that received oral administration of Pisidium coreanum showed improvements in both trabecular and cortical bones. This preventive activity of Pisidium coreanum against bone loss was due to limited osteoclast maturation with reduced osteoclast surface extent in trabecular bone tissue. The formation of large multinucleated osteoclasts in vitro was significantly decreased in response to Pisidium coreanum, consistent with the reduced expression levels of osteoclast markers and fusion-related genes, such as NFATc1, p65, integrinαvβ3, DC-STAMP, OC-STAMP, Atp6v0d2, FAK, CD44, and MFR. These data suggest that Pisidium coreanum inhibits osteoclast differentiation by negatively regulating the fusion of mononuclear osteoclast precursors. Thus, our data demonstrate the ability of Pisidium coreanum to effectively prevent estrogen-deficient osteoporosis through inhibition of multinucleated osteoclast formation.

Estradiol and Follicle-Stimulating Hormone as Predictors of Onset of Menopause Transition-Related Bone Loss in Pre- and Perimenopausal Women

The menopause transition (MT) may be an opportunity for early intervention to prevent rapid bone loss. To intervene early, we need to be able to prospectively identify pre- and perimenopausal women who are beginning to lose bone. This study examined whether estradiol (E2), or follicle-stimulating hormone (FSH), measured in pre- and perimenopausal women, can predict significant bone loss by the next year. Bone loss was considered significant if bone mineral density (BMD) decline at the lumbar spine (LS) or femoral neck (FN) from a pre- or early perimenopausal baseline to 1 year after the E2 or FSH measurement was greater than the least detectable change. We used data from 1559 participants in the Study of Women's Health Across the Nation and tested E2 and FSH as separate predictors using repeated measures modified Poisson regression. Adjusted for MT stage, age, race/ethnicity, and body mass index, women with lower E2 (and higher FSH) were more likely to lose BMD: At the LS, each halving of E2 and each doubling of FSH were associated with 10% and 39% greater risk of significant bone loss, respectively (p < 0.0001 for each). At the FN, each halving of E2 and each doubling of FSH were associated with 12% (p = 0.01) and 27% (p < 0.001) greater risk of significant bone loss. FSH was more informative than E2 (assessed by the area under the receiver-operator curve) at identifying women who were more versus less likely to begin losing bone, especially at the LS. Prediction was better when hormones were measured in pre- or early perimenopause than in late perimenopause. Tracking within-individual change in either hormone did not predict onset of bone loss better than a single measure. We conclude that measuring FSH in the MT can help prospectively identify women with imminent or ongoing bone loss at the LS. © 2019 American Society for Bone and Mineral Research.

CK2.3, a Mimetic Peptide of the BMP Type I Receptor, Increases Activity in Osteoblasts over BMP2

Bone is one of the most important organs in the human body. It provides structure, function, and protection for other vital organs; therefore, bone maintenance and homeostasis are critical processes. As humans age, their bone mineral density decreases, which leads to diseases like osteoporosis. This disease affects one in two women and one in five men aged 50 and over. As the aging population increases, the interest and significance of studying this debilitating bone disease becomes more relevant. Current therapeutic products for osteoporosis have many side effects and can be taken for a limited number of years. Most therapeutic products only focus on decreasing bone resorption, not increasing bone formation. Bone morphogenetic protein 2 is an essential growth factor that drives osteoblast differentiation and activity and is essential for bone formation. However, usage in the clinic is unsuccessful due to several side effects. Recently, a signaling disparity in bone marrow stromal cells within the bone morphogenetic protein pathway that led to decreased bone morphogenetic protein 2 responsiveness was identified in patients diagnosed with osteoporosis. However, it is unclear how other cell populations, especially osteoblasts, which are key players in bone remodeling, are affected and whether the bone morphogenetic protein pathway is affected during osteoporosis. Our research group designed a novel peptide, casein kinase 2.3, that acts downstream of the bone morphogenetic receptor type Ia and increases bone mineralization in murine cells and primary bovine osteoblasts. The aim of the study presented here was to compare the responsiveness of osteoblasts to bone morphogenetic protein 2 and casein kinase 2.3, especially in patients diagnosed with osteoporosis. Mature osteoblasts were extracted from patients diagnosed with osteoporosis or osteoarthritis from Christiana Care Hospital in Newark, Delaware. They were stimulated with either bone morphogenetic protein 2 or casein kinase 2.3, and their effect on osteoblast activity was determined. The osteoporotic patients showed no mineralization response to bone morphogenetic protein 2 stimulation, while the osteoarthritis patients significantly responded to bone morphogenetic protein 2 stimulation. Furthermore, markers for osteoblast activity were increased by casein kinase 2.3, which was in sharp contrast to bone morphogenetic protein 2. This further supports a major bone morphogenetic protein signaling disparity in both the elderly and those suffering with osteoporosis. Both patient types did significantly respond to casein kinase 2.3. Further analysis of the bone morphogenetic protein pathway could lead to new therapeutic products for osteoporosis.

The effect of boundary and loading conditions on patient classification using finite element predicted risk of fracture

BACKGROUND

Osteoporotic proximal femoral fractures associated to falls are a major health burden in the ageing society. Recently, bone strength estimated by finite element models emerged as a feasible alternative to areal bone mineral density as a predictor of fracture risk. However, previous studies showed that the accuracy of patients' classification under their risk of fracture using finite element strength when simulating posterolateral falls is only marginally better than that of areal bone mineral density. Patients tend to fall in various directions: since the predicted strength is sensitive to the fall direction, a prediction based on certain fall directions might not be fully representative of the physical event. Hence, side fall boundary conditions may not be completely representing the physical event.

METHODS

The effect of different side fall boundary and loading conditions on a retrospective cohort of 98 postmenopausal women was evaluated to test models' ability to discriminate fracture and control cases. Three different boundary conditions (Linear, Multi-point constraints and Contact model) were investigated under various anterolateral and posterolateral falls.

FINDINGS

The stratification power estimated by the area under the receiver operating characteristic curve was highest for Contact model (0.82), followed by Multi-point constraints and Linear models with 0.80. Both Contact and MPC models predicted high strains in various locations of the proximal femur including the greater trochanter, which has rarely reported previously.

INTERPRETATION

A full range of fall directions and less restrictive displacement constraints can improve the finite element strength ability to classify patients under their risk of fracture.

Childhood Lead Exposure and Adult Neurodegenerative Disease

Millions of Americans now entering midlife and old age were exposed to high levels of lead, a neurotoxin, as children. Evidence from animal-model and human observational studies suggest that childhood lead exposure may raise the risk of adult neurodegenerative disease, particularly dementia, through a variety of possible mechanisms including epigenetic modification, delayed cardiovascular and kidney disease, direct degenerative CNS injury from lead remobilized from bone, and lowered neural and cognitive reserve. Within the next ten years, the generation of children with the highest historical lead exposures, those born in the 1960s, 1970s, and 1980s, will begin to enter the age at which dementia symptoms tend to emerge. Many will also enter the age in which lead stored in the skeleton may be remobilized at greater rates, particularly for women entering menopause and men and women experiencing osteoporosis. Should childhood lead exposure prove pro-degenerative, the next twenty years will provide the last opportunities for possible early intervention to forestall greater degenerative disease burden across the aging lead-exposed population. More evidence is needed now to characterize the nature and magnitude of the degenerative risks facing adults exposed to lead as children and to identify interventions to limit long-term harm.

Colourimetric analysis of thermally altered human bone samples

At this moment, no method is available to objectively estimate the temperature to which skeletal remains have been exposed during a fire. Estimating this temperature can provide crucial information in a legal investigation. Exposure of bone to heat results in observable and measurable changes, including a change in colour. To determine the exposure temperature of experimental bone samples, heat related changes in colour were systemically studied by means of image analysis. In total 1138 samples of fresh human long bone diaphysis and epiphysis, varying in size, were subjected to heat ranging from room temperature to 900 °C for various durations and in different media. The samples were scanned with a calibrated flatbed scanner and photographed with a Digital Single Lens Reflex camera. Red, Green, Blue values and Lightness, A-, and B-coordinates were collected for statistical analysis. Cluster analysis showed that discriminating thresholds for Lightness and B-coordinate could be defined and used to construct a model of decision rules. This model enables the user to differentiate between seven different temperature clusters with relatively high precision and accuracy. The proposed decision model provides an objective, robust and non-destructive method for estimating the exposure temperature of heated bone samples.

Influence of Habitual Physical Behavior - Sleeping, Sedentarism, Physical Activity - On Bone Health in Community-Dwelling Older People

Sedentary behavior (SB) has emerged as an independent public-health risk and may contribute to the lower bone mineral density (BMD) in old (>60 years of age) than young adults. The purpose of this study was to quantify SB and habitual physical behavior (PB) in community-dwelling older adults and how this correlates with BMD. In 112 relatively healthy and independent-living individuals aged 72.5 ± 6.4 years, BMD, PB and SB were determined using dual energy X-ray absorptiometry and 7-day three-dimensional accelerometry, respectively. In men, only healthy and osteopenic BMDs were found, whereas in women, osteoporotic BMD classifications also occurred. Our sample spent ∼61%, 7%, 12% and 19% of daily waking hours in SB, standing, LIPA [light intensity physical activity (PA)] and MVPA (medium-to-vigorous intensity PA), respectively. In men, after accounting for covariates (BMI, total fat, android:gynoid ratio), sleeping (hours/day), number of breaks in SB, number of SB ≥ 5 min, number of PA bouts, total duration of PA bouts (min), mean PA bouts duration (min), LIPA (%PA bout time) and MVPA (%PA bout time) were all predictors of BMD. In women, after accounting for covariates (age, BMI, total fat, android:gynoid ratio), SB (hours/day), SB (% waking hours), LIPA (hours/day), LIPA (% waking hours), MVPA (% waking hours) and number of short SB (i.e., <5 min), total time spent in PA (min) significantly correlated with BMD. In conclusion, the PB predictors of bone health in older persons include: night time sleeping duration, number of short bouts of SB, number and duration of bouts of PA relative to total waking hours. While radar graphs of PB patterns for healthy, osteopenic, osteoporotic individuals highlighted significant differences in PB between them, they were not consistent with the expectations from the Mechanostat Theory: i.e., more loading leads to better bone. Rather, our results suggest that a balance of activities must be maintained across the PB spectrum, where certain PB parameters are especially impactful in each sex, supporting the recently coined multifactorial-based variations in the Mechanostat threshold.

Altered morpho-functional features of bones in autoimmune disease-prone BXSB/MpJ- Yaa mice

IMPACT STATEMENT

Bone disease, such as osteoporosis and rheumatoid arthritis, increases because of the progression of an aging society. Autoimmune disease are important and predisposing factors for the pathogenesis of the bone disease; however, the pathological mechanism is unclear. We have demonstrated that systemic autoimmune disease in BXSB/MpJ- Yaa is closely associated with the morpho-functional abnormalities of bones including bone marrow and has complicated pathology. The abnormalities are characterized by altered regulations of serum calcium, anemia tendency, and hematopoiesis with increased WBCs and decreased PLs, short length and low mass of long bones, imbalance in the populations of osteoclasts and osteoblasts, and increased expression of candidate genes for causing and/or exacerbating their phenotypes. Therefore, BXSB/MpJ- Yaa serves as a model to elucidate bone phenotypes in systemic autoimmune disease that would be affected by the factors in the bone as well as the other immune and/or mineral metabolism organs both in human and experimental medicine.