Low body mass index is an important risk factor for low bone mass and increased bone loss in early postmenopausal women. Early Postmenopausal Intervention Cohort (EPIC) study group

Role of active and environmental tobacco smoke on susceptibility to osteoporosis in women undergoing dual-X-ray absorptiometry

PURPOSE

Current smoking is a risk factor for osteoporosis (Op), but few data are available regarding the passive smoke impact on Op susceptibility. This cross-sectional study aimed to evaluate the association between the smoking habits and Op in community-dwelling women undergoing dual-energy X-ray absorptiometry (DXA).

METHODS

On 01/06/2018, general practitioners from "COMEGEN" Medical Cooperative, Naples, Italy, selected the medical records from the last 10 years of women who had a measurement of bone mineral density performed and simultaneously completed a questionnaire about their smoking behaviour and their cohabiters'. The binary logistic regression analysis was used to estimate the role of passive smoke on the risk of Op, adjusting for age and body mass index (BMI).

RESULTS

Among 10,616 subjects, 3942 were currently smokers [CS; mean age 69.4 ± 10.4 years; BMI 27.0 ± 4.9 kg/m2], 873 were passive smokers (PS; mean age 67.8 ± 11.6 years; BMI 27.0 ± 4.9 kg/m2) and 5781 were never smokers (NS; mean age 67.8 ± 11.6 years; body mass index (BMI) 27.0 ± 4.9 kg/m2). Of all, 8562 women (mean age 70.3 ± 10.2 yrs; BMI 27.0 ± 4.9 kg/m2) received the Op diagnosis. PS showed an increased Op risk compared to NS [odds ratio (OR) 1.38 (1.14-1.67)] and comparable to CS [OR 1.02 (0.84-1.24)].

CONCLUSION

The study results demonstrate an association between passive smoke and Op in community-dwelling women already presenting with susceptibility to Op according to Italian essential assistance levels, suggesting that passive and active smoke are equivalent Op risk factors in women.

A simulation framework to determine optimal strength training and musculoskeletal geometry for sprinting and distance running

Musculoskeletal geometry and muscle volumes vary widely in the population and are intricately linked to the performance of tasks ranging from walking and running to jumping and sprinting. As an alternative to experimental approaches, where it is difficult to isolate factors and establish causal relationships, simulations can be used to independently vary musculoskeletal geometry and muscle volumes, and develop a fundamental understanding. However, our ability to understand how these parameters affect task performance has been limited due to the high computational cost of modelling the necessary complexity of the musculoskeletal system and solving the requisite multi-dimensional optimization problem. For example, sprinting and running are fundamental to many forms of sport, but past research on the relationships between musculoskeletal geometry, muscle volumes, and running performance has been limited to observational studies, which have not established cause-effect relationships, and simulation studies with simplified representations of musculoskeletal geometry. In this study, we developed a novel musculoskeletal simulator that is differentiable with respect to musculoskeletal geometry and muscle volumes. This simulator enabled us to find the optimal body segment dimensions and optimal distribution of added muscle volume for sprinting and marathon running. Our simulation results replicate experimental observations, such as increased muscle mass in sprinters, as well as a mass in the lower end of the healthy BMI range and a higher leg-length-to-height ratio in marathon runners. The simulations also reveal new relationships, for example showing that hip musculature is vital to both sprinting and marathon running. We found hip flexor and extensor moment arms were maximized to optimize sprint and marathon running performance, and hip muscles the main target when we simulated strength training for sprinters. Our simulation results provide insight to inspire future studies to examine optimal strength training. Our simulator can be extended to other athletic tasks, such as jumping, or to non-athletic applications, such as designing interventions to improve mobility in older adults or individuals with movement disorders.

The Relation Between Osteoporosis and Bone Fractures and Health-Related Quality of Life in Post-menopausal Saudi Women in the Jazan Region: A Cross-Sectional Study

INTRODUCTION

Osteoporosis is a significant health concern, often leading to fragility fractures and severely impacting the quality of life in post-menopausal women. Studies evaluating the effects of osteoporosis and resultant fractures on health-related quality of life (HRQoL) in Saudi women are lacking. This study aimed to assess the relationship between osteoporosis and fracture and physical, psychological, social, and environmental HRQoL domains in post-menopausal Saudi women.

METHODS

In this cross-sectional study conducted in Jazan, Saudi Arabia, 158 post-menopausal Saudi women completed HRQoL surveys using the validated Arabic WHOQOL-BREF questionnaire. Data on socioeconomics, comorbidities, and fracture history were gathered. Descriptive statistics delineated sample characteristics. Analysis of variance (ANOVA) and post-hoc tests identified differences in HRQoL across socioeconomic and clinical categories. Multivariate regression analyses determined factors independently related to HRQoL.

RESULTS

Of 158 women surveyed, 39% had a history of osteoporotic fracture. Foot (35%), hand (31%), and vertebral (10%) fractures were the most frequent. Women over 70 had significantly lower physical HRQoL than those aged 45-55 (p<0.001). Unemployed and lower-income women showed poorer HRQoL across domains (p<0.01). Vertebral and hand fractures were negatively related to physical and psychological health (p<0.05). Chronic diseases like hypertension and rheumatoid arthritis reduced HRQoL (p<0.01). In regression analyses, older age, vertebral fracture, physical inactivity, long-term hormone therapy, and unemployment emerged as determinants of poorer HRQoL (p<0.05).

CONCLUSION

Osteoporosis and resultant fragility fractures, especially in vertebral and hand bones, led to substantial impairments in physical, social, psychological, and environmental HRQoL in Saudi women. Modifiable risk factors like physical inactivity and long-term hormone use also affected HRQoL. Targeted screening and multidomain interventions for disadvantaged women with osteoporosis are warranted to improve functioning and quality of life.

Skeletal muscle index together with body mass index is associated with secondary osteoporosis in patients with rheumatoid arthritis

OBJECTIVE

The objective of this study was to explore the associations of body mass index (BMI), fat mass index (FMI), skeletal mass index (SMI) and secondary osteoporosis (OP) in patients with rheumatoid arthritis (RA).

METHODS

The bone mineral density (BMD) at sites of the femur neck (Neck), total hip (Hip) and lumbar vertebrae 1-4 (L1-4) was measured by dual-energy X-ray absorptiometry. The skeletal muscle index, body fat percentage and mineral content were measured by biological electrical impedance for calculating BMI, FMI and SMI.

RESULTS

A total of 433 patient with RA and 158 healthy controls were enrolled. The BMDs at each site of the RA patients were lower compared with those of the healthy controls (p < 0.0001), and the prevalence of OP (36.1%, 160/443) and sarcopenia (65.2%, 288/443) in the RA patients were higher than those in the controls (12.7%, 20/158, p < 0.0001; 9.0%, 14/156, p < 0.0001). Significant differences in the BMD, FMI, SMI, mineral content, body fat percentage and skeletal muscle mass were found among the RA patients in the different BMI groups (p < 0.05). In RA patients with BMI < 18.5 kg/m2, the prevalence of OP in the RA patients with sarcopenia was similar to that in those without sarcopenia (44.4% vs. 66. 7%, χ2 = 0. 574, p = 0.449). In the RA patients with a normal BMI or who were overweight or obese, prevalence of OP in the RA patients with sarcopenia was significantly higher than that in the RA patients without sarcopenia (42.8% vs. 21.7%, χ2 = 10.951, p = 0.001; 61.1% vs. 13.0%, χ2 = 26.270, p < 0.0001). In the RA patients without sarcopenia, the prevalence of OP in the RA patients in the different BMI groups was different (p = 0.039). In the RA patients with sarcopenia, there was no significant difference in the prevalence of OP among the RA patients in the different BMI groups (p = 0. 128). The linear correlation analysis showed that the SMI in RA patients was positively correlated with the BMD of each site measured and BMI and FMI (p < 0.0001). However, there was a negative linear correlation between SMI and disease duration (p = 0.048). The logistic regression analysis found that SMI (OR = 0.569, p = 0.002, 95% CI 0.399-0.810), BMI (OR = 0.884, p = 0.01, 95% CI 0.805-0.971) and gender (1 = female, 2 = male) (OR = 0.097, p < 0.0001, 95% CI 0.040-0.236) were protective factors for OP in RA, while age (OR = 1.098, p < 0.0001, 95% CI 1.071-1.125) was the risk factor.

CONCLUSION

BMI and SMI are associated with the occurrence of OP in RA patients, and both SMI and BMI are important protective factors for OP secondary to RA.

Weight change patterns across adulthood in relation to osteoporosis and fracture among non-obese individuals

Weight change was an influencing factor of osteoporosis and fracture in a controversial way. Based on a nationally representative data, we found that weight change from obesity in midlife to non-obesity in late adulthood was associated with a reduction in the risk of osteoporosis and wrist fracture in male, but not in female.

INTRODUCTION

Obesity is usually recognized as a protective factor to osteoporosis and osteoporotic fracture. However, it is still unclear whether historical weight status was associated with the risk of osteoporosis and fracture. The aim of this study was to investigate the relationship between weight change patterns across adulthood and the prevalence of osteoporosis and fracture.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) with 8725 US adults aged ≥ 40 years were analyzed in this study. Weight change patterns were categorized as "stable non-obese," "obese with earlier weight gain," "obese with recent weight gain," and "revert to non-obese" based on the body mass index (BMI) at 25 years old, 10 years prior to baseline and at baseline. Body mineral density (BMD) was measured using dual x-ray absorptiometry (DXA), and osteoporosis was diagnosed based on the World Health Organization criteria. Self-reported occurrence of osteoporotic fractures were determined by questionnaires.

RESULTS

Compared with subjects in "stable non-obese" group, obese with earlier weight gain were positively related to the increase of BMD in both genders, while elevated BMD was only observed in female of "obese with recent weight gain" group and in male of "revert to non-obese" group after multiple adjustment. Moreover, changing from the obesity to non-obesity in the 10 years period before baseline was associated with a 81.6% lower risk of osteoporosis (odds ratio (OR) 0.184, 95% confidence interval (CI) 0.037-0.914 (P = 0.039)) and a 69.8% lower risk of wrist fracture (OR 0.302, 95%CI 0.120-0.757 (P = 0.012)) in male, but not in female.

CONCLUSION

Weight change from obesity in midlife to non-obesity in late adulthood was associated with a reduction in the risk of osteoporosis and wrist fracture in male. Our findings support the importance of investigating the mechanism of weight change in different life period.

Body Mass Index and Revision Total Knee Arthroplasty: Does Cause for Revision Vary by Underweight or Obese Status?

BACKGROUND

Body mass index (BMI) impacts risk for revision total knee arthroplasty (rTKA), but the relationship between BMI and cause for revision remains unclear. We hypothesized that patients in different BMI classes would have disparate risk for causes of rTKA.

METHODS

There were 171,856 patients who underwent rTKA from 2006 to 2020 from a national database. Patients were classified as underweight (BMI < 19), normal-weight, overweight/obese (BMI 25 to 39.9), or morbidly obese (BMI > 40). Multivariable logistic regressions adjusted for age, sex, race/ethnicity, socioeconomic status, payer status, hospital geographic setting, and comorbidities were used to examine the effect of BMI on risk for different rTKA causes.

RESULTS

Compared to normal-weight controls, underweight patients were 62% less likely to undergo revision due to aseptic loosening, 40% less likely due to mechanical complications, 187% more likely due to periprosthetic fracture, 135% more likely due to periprosthetic joint infection (PJI). Overweight/obese patients were 25% more likely to undergo revision due to aseptic loosening, 9% more likely due to mechanical complications, 17% less likely due to periprosthetic fracture, and 24% less likely due to PJI. Morbidly obese patients were 20% more likely to undergo revision due to aseptic loosening, 5% more likely due to mechanical complications, and 6% less likely due to PJI.

CONCLUSION

Mechanical reasons were more likely to be the cause of rTKA in overweight/obese and morbidly obese patients, compared to underweight patients, for whom revision was more likely to be infection or fracture related. Increased awareness of these differences may promote patient-specific management to reduce complications.

LEVEL OF EVIDENCE

III.

Association between Adiposity and Bone Mineral Density in Adults: Insights from a National Survey Analysis

Adiposity and bone mineral density (BMD) are closely associated. The aim of this research was to investigate the association between BMD and adiposity measures in adults, including gynoid percent fat (GPF), android percent fat (APF), total percent fat (TPF), visceral adipose tissue percent (VAT%), and total lean mass percent (TLM%). Participants (n = 11,615) aged 18 years and older were analyzed using data from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. Associations between BMD and adiposity measures were investigated, and potential differences based on gender and age were explored. Significant negative associations were observed among TPF, APF, GPF, VAT%, and BMD in the fully adjusted models, while TLM% and BMD were positively associated. Stratifying by age and sex, TPF, GPF, and VAT% consistently demonstrated a negative correlation with BMD. In the young adult group, a TPF of 38.2% eliminated the negative correlation between BMD and TPF. Male BMD exhibited an inverted U-shaped relationship with APF, peaking at 35.6%, while a similar pattern was observed for the middle-aged group BMD and APF, with a peak at 31.7%. This large-sample research found a significant negative association between adiposity measures and BMD, providing valuable revelations regarding the intricate connection between adiposity and bone health.

Prevalence of Osteopathy in Chronic Pancreatitis: A Systematic Review and Meta-Analysis

INTRODUCTION

Individuals with chronic pancreatitis (CP) are at increased risk for nutritional complications during their clinical course. We appraised the literature to provide updated estimates of the prevalence and predictors of osteoporosis, osteopenia, and osteopathy in CP using a systematic review and meta-analysis.

METHODS

Search strategies were developed for major databases from inception through October 2021. Outcomes of interest included rates of osteopenia and osteoporosis based on dual-energy X-ray absorptiometry scans and risk factors. A random-effects model was used for analysis, and results were expressed as pooled cumulative rates along with 95% confidence interval (CI).

RESULTS

From an initial total of 1,704 identified articles, we ultimately selected 17 studies that involved 1,659 subjects (n = 1,067 men) with CP. The pooled rate of osteopathy was 58% (95% CI: 49%-67%; P < 0.001; I 2 = 91.8%). The pooled rate of osteoporosis was 18% (95% CI: 12%-23%; P < 0.001; I 2 = 86.3%), and the pooled rate of osteopenia was 39% (95% CI: 31%-48%; P < 0.001; I 2 = 91.53%). In the systematic review, factors associated with decreased bone mineral density included smoking, alcohol consumption, older age, female sex, low body mass index, decreased vitamins D and K, and fecal elastase levels.

DISCUSSION

Patients with CP have high rates of osteopathy when assessed with dual-energy X-ray absorptiometry imaging. Additional studies with longitudinal follow-up are needed to understand the observed heterogeneity, the cumulative burden of disease, and rate of bone loss in CP.

The association between serum adipokines levels with senile osteoporosis: a systematic review and meta-analysis

Objective

The clinical correlation between adipokines levels in the blood and the incidence of senile osteoporosis (SOP) has not been clearly studied. We conducted this meta-analysis to elucidate the relationship between three common adipokines levels (leptin, adiponectin, and chemerin) and the incidence of SOP.

Methods

We searched databases such as CNKI, CBM, VIP, Wanfang, PubMed, Web of Science, Embase, and the Cochrane Library to collect articles published since the establishment of the database until July 30, 2022.

Results

In total, 11 studies met the selection criteria. Our meta-analysis showed that serum leptin levels were significantly lower (mean difference [MD], -2.53, 95% CI: -3.96 to -1.10, I2 = 96%), chemerin levels were significantly higher (MD, 30.06, 95% CI: 16.71 to 43.40, I2 = 94%), and adiponectin levels were not significantly different (MD, -0.55, 95% CI: -2.26 to 1.17, P = 0.53, I2 = 98%) in SOP patients compared with healthy older individuals with normal bone mineral density (BMD). In addition, correlation analysis showed that leptin levels were positively correlated with lumbar bone mineral density (LBMD) (r = 0.36) and femoral bone mineral density (FBMD) (r = 0.38), chemerin levels were negatively correlated with LBMD (r = -0.55) and FBMD (r = -0.48), and there were significant positive correlations between leptin and adiponectin levels and body mass index (BMI) (r = 0.91 and 0.97).

Conclusions

The likelihood of having SOP was higher in older individuals with low levels of leptin and higher levels of chemerin. In addition, BMI was somewhat lower with low levels of leptin and adiponectin.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42022356469.

Nationwide Trends in Osteoporosis in Koreans With Disabilities From 2008 to 2017

This study examined the 10-year trends in the prevalence of osteoporosis according to disability grade and type compared with those without disabilities in South Korea. We linked national disability registration data with the National Health Insurance claims data. Age- and sex-standardized prevalence of osteoporosis were analyzed from 2008 to 2017 according to sex, disability type, and disability grade. Adjusted odds ratios for osteoporosis according to disability characteristics in the most recent years' data were also confirmed by multivariate analysis. Over the past decade, the prevalence of osteoporosis has increased in people with disabilities compared with people without disabilities, and the gap has gradually widened from 7% to 15%. By analysis of the most recent year data, both male and female individuals with disabilities had a higher risk of osteoporosis than those without disability (odds ratios [OR] 1.72, 95% confidence interval [CI] 1.70-1.73 in males; OR 1.28, 95% CI 1.27-1.28 in females); the multivariate-adjusted OR was especially prominent in disability related to respiratory disease (OR 2.07, 95% CI 1.93-2.21 in males; OR 1.74; 95% CI 1.60-1.90 in females), epilepsy (OR 2.16, 95% CI 1.78-2.61 in males; OR 1.71; 95% CI 1.53-1.91 in females), and physical disability types (OR 2.09, 95% CI 2.06-2.21 in males; OR 1.70; 95% CI 1.69-1.71 in females). In conclusion, the prevalence and risk of osteoporosis have increased in people with disabilities in Korea. In particular, the risk of osteoporosis increases significantly in people with respiratory diseases, epilepsy, and physical disability types. © 2023 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Exploring the Role of Urocortin in Osteoporosis

Osteoporosis is a debilitating disease that affects over 200 million people worldwide. Overactive osteoclast activity leads to micro-architectural defects and low bone mass. This culminates in fragility fractures, such as femoral neck fractures. Treatments currently available either are not completely effective or have considerable side effects; thus, there is a need for more effective treatments. The urocortin (Ucn) family, composed of urocortin 1 (Ucn1), urocortin 2 (Ucn2), urocortin 3 (Ucn3), corticotropin-releasing factor (CRF) and corticotropin-releasing factor-binding protein (CRF-BP), exerts a wide range of effects throughout the body. Ucn1 has been shown to inhibit murine osteoclast activity. This review article will aim to bridge the gap between existing knowledge of Ucn and whether it can affect human osteoclasts.

Low Bone Mineral Density and Associated Risk Factors in Elite Cyclists at Different Stages of a Professional Cycling Career

PURPOSE

This study aimed to assess the prevalence of low bone mineral density (BMD) in male and female elite cyclists at different stages of a professional cycling career and to identify potential risk factors of low BMD.

METHODS

In this cross-sectional study, 93 male and female early career, advanced career, and postcareer elite cyclists completed dual-energy x-ray absorptiometry at the hip, femoral neck, lumbar spine, and total body; blood sampling; assessment of training history and injuries; and the bone-specific physical activity questionnaire. Backward stepwise multiple regression analyses were conducted to explore associations between BMD and its potential predictors in early and advanced career (i.e., active career) cyclists.

RESULTS

With a mean Z -score of -0.3 ± 0.8, -1.5 ± 1.0, and -1.0 ± 0.9, low BMD ( Z -score < -1) at the lumbar spine was present in 27%, 64%, and 50% of the early, advanced, and postcareer elite male cyclists, respectively. Lumbar spine Z -scores of -0.9 ± 1.0, -1.0 ± 1.0, and 0.2 ± 1.4 in early, advanced, and postcareer elite female cyclists, respectively, indicated low BMD in 45%, 45%, and 20% of these female subpopulations. Regression analyses identified body mass index, fracture incidence, bone-specific physical activity, and triiodothyronine as the main factors associated with BMD.

CONCLUSIONS

Low BMD is highly prevalent in elite cyclists, especially in early career females and advanced career males and females. These low BMD values may not fully recover after the professional cycling career, given the substantial prevalence of low BMD in retired elite cyclists. Exploratory analyses indicated that low BMD is associated with low body mass index, fracture incidence, lack of bone-specific physical activity, and low energy availability in active career elite cyclists.

New Insights into Calorie Restriction Induced Bone Loss

Caloric restriction (CR) is now a popular lifestyle choice due to its ability in experimental animals to improve lifespan, reduce body weight, and lessen oxidative stress. However, more and more emerging evidence suggests this treatment requires careful consideration because of its detrimental effects on the skeletal system. Experimental and clinical studies show that CR can suppress bone growth and raise the risk of fracture, but the specific mechanisms are poorly understood. Reduced mechanical loading has long been thought to be the primary cause of weight loss-induced bone loss from calorie restriction. Despite fat loss in peripheral depots with calorie restriction, bone marrow adipose tissue (BMAT) increases, and this may play a significant role in this pathological process. Here, we update recent advances in our understanding of the effects of CR on the skeleton, the possible pathogenic role of BMAT in CR-induced bone loss, and some strategies to mitigate any potential side effects on the skeletal system.

Use of the Osteoporosis Self-Assessment Tool as a Screening Tool for Osteoporosis in Saudi Postmenopausal Women

BACKGROUND

Osteoporosis is commonly referred to as the "silent disease," as bone loss is gradual and asymptomatic. In older women and men, osteoporosis can lead to increased bone fragility, thus increasing the risk of fractures. These fractures are associated with healthcare costs, physical disabilities, impaired quality of life, and mortality. Therefore, the study's main objective was to assess the applicability of the osteoporosis self-assessment tool (OST) in predicting osteoporosis in Saudi postmenopausal women who are 60 years of age and older and to give a thorough understanding of how such a method can aid in the early diagnosis of osteoporosis in Saudi Arabia and give physicians enough time to treat it.  Methods: This study was done at King Abdulaziz Medical City, Riyadh, Saudi Arabia, where we included postmenopausal Saudi women 60 years of age and older who took the bone mineral density (BMD) test in the family medicine department. The approximate target population in this group, between the years 2016 and 2022, was 2969 patients. All data was taken from the BestCare database at King Abdulaziz Medical City in Riyadh. Data were typed in an Excel sheet (Redmond, USA), then transferred to the R Studio software. The data collection method was chart review, so no informed consent was needed from patients. Names and medical record numbers were not stored.  Results: The study included 2969 participants. According to the bone mineral density (BMD) T score results, 490 participants (16.5%) were normal, 1746 participants (58.8%) had osteopenia, and 733 participants (24.7%) suffered from osteoporosis. BMD T scores for normal, osteopenia, and osteoporosis participants were -0.6 (-0.9, -.3), -1.8 (-2.1), and -3 (-3.5, -2.7), consecutively. Estimated OSTI scores for those patients were 2 (0, 4), 1 (-2, 3), and -1 (-4, 1), consecutively. According to the OSTI score for normal participants, 4.29% were classified as being at high risk of osteoporosis. A high risk of osteoporosis was identified in 0.74% of those with osteopenia. 27.83% of osteoporosis patients were classified as being at high risk of osteoporosis. To differentiate normal individuals from those with osteopenia, the cutoff value with optimal sensitivity was 3.5. At such a cutoff value, the test sensitivity was 81.04%. To differentiate normal participants from those with osteoporosis, the cutoff value with optimal sensitivity was 2.5. At such a cutoff value, the test sensitivity was 86.49%. To differentiate osteopenia from osteoporosis patients, the cutoff threshold with optimal sensitivity was 1.5. At such a threshold, sensitivity was 78.44%.  Conclusion: OSTA is a simple and validated tool that can identify subjects at increased risk of osteoporosis. Its use could facilitate a more cost-effective use of BMD; by avoiding measurements in low-risk groups.

Adipopenia is associated with osteoporosis in community-dwelling non-underweight adults independent of sarcopenia

The effect of fat deficit on bone metabolism is understudied. This study showed that low body fat percent (adipopenia) in non-underweight community adults was associated with elevated odds of osteoporosis independent of low lean mass, highlighting potential clinical importance of adipopenia as an osteoporosis risk factor particularly in older adults.

PURPOSE

Although underweight is risk factor for osteoporosis, the association of low body fat percent (adipopenia) with osteoporosis in non-underweight adults remains unclear.

METHODS

Among individuals aged ≥ 50 years with body mass index ≥ 18.5 kg/m² in the Korean National Health and Nutrition Examination Survey 2008-2011, appendicular lean mass (ALM) and body fat percent (BFP) were measured using dual-energy x-ray absorptiometry. Low lean mass was defined as ALM/height² < 7.0 kg/m² and < 5.4 kg/m² in men and women, respectively. Osteoporosis was defined as a bone mineral density (BMD) T-score ≤ -2.5 at the lumbar spine, femoral neck, or total hip. Participants were grouped into adipopenia (BFP < 17% in men; < 30%, in women; 1 standard deviation below the mean), normal, and obesity (BFP > 30% in men; > 40% in women) groups.

RESULTS

Of the 5,830 participants (women 50.2%, mean age 63.9 years), 793 had adipopenia. The adipopenia group had a higher prevalence of osteoporosis (31%) than the normal (21%) or obesity groups (27%; p < 0.001). The presence of adipopenia was associated with 61% elevated odds of prevalent osteoporosis (p < 0.001) independent of low lean mass and covariates, which remained robust using different thresholds for adipopenia. Individuals with adipopenia and low lean mass had 3.5-fold elevated odds of osteoporosis compared to those with normal lean mass and fat percent. The association between adipopenia and osteoporosis was stronger in older women compared to middle-aged women (OR 1.93 vs. 0.99, P for interaction = 0.023).

CONCLUSION

Adipopenia was associated with osteoporosis in non-underweight adults, independent of low lean mass and covariates.

Effects of obesity on talar micro- and macro-morphology

The addition of information regarding obesity status to the forensic anthropological biological profile could significantly contribute to the identification of human skeletal remains since over 40% of the U.S. adult population is currently obese. This study examines the differences in talar shape and trabecular bone structure between obese and non-obese individuals. A sample of 20 obese and 20 non-obese divided evenly by sex was selected from the Texas State University Donated Skeletal Collection. Tali were imaged using x-ray computed tomography (voxel size: 28-38.7 μm). Image stacks were processed to produce binary images as well as trabecular thickness and spacing maps. Landmark-based geometric morphometric analyses were conducted to quantify shape variation. Shape coordinates were used to locate 100 geometrically homologous volumes of interest within each talus. Bone volume fraction, trabecular thickness, and trabecular spacing were extracted at each volume of interest. Within each sex, a one-way ANCOVA was used to determine if significant differences exist between obese and non-obese individuals in trabecular bone after controlling for age. The size of the talus as well as subtle aspects of shape were found to distinguish the sexes. The results further indicate that bone volume fraction significantly differs between obese and non-obese males. In females, bone volume fraction is correlated with age but does not differ between obese and non-obese. The study demonstrates that bone microstructure is a promising approach to estimating body mass or body mass index category but age effects diminish the potential for the talus to be used alone.

High-Dose Intravenous Steroid Treatment Seems to Have No Long-Term Negative Effect on Bone Mineral Density of Young and Newly Diagnosed Multiple Sclerosis Patients: A Pilot Study

High-dose intravenous steroid treatment (HDIST) represents the first choice of treatment for multiple sclerosis (MS) relapses. Chronic oral glucocorticoid (GC) administration correlates with bone loss whereas data regarding HDIST in MS are still conflicting. Twenty-five newly diagnosed MS patients (NDMSP) (median age: 37 years) were prospectively studied for the effects of HDIST on bone mineral density (BMD) and bone metabolism. Patients received 1000 mg methylprednisolone intravenously every day for 5 days followed by oral prednisolone tapering over 21 days. Bone metabolism indices were determined prior to GC, on days 2, 4, 6, and 90, and at months 6, 12, 18, and 24 post GC therapy. Femoral, lumbar-spine BMD, and whole-body measurement of adipose/lean tissue were assessed prior to GC-administration and then every six months. Ten patients completed the study. N-terminal-propeptide-procollagen-type-1 and bone-specific alkaline phosphatase showed a significant increase at day-90 (p < 0.05). A transient non-significant fall of BMD was observed at 6 months after GC-administration, which subsequently appeared to be restored. We conclude that HDIST seems not to have long-term negative effects on BMD, while the observed transient increase of bone formation markers probably indicates a high bone turnover phase to GC-administration. Additional prospective studies with larger sample size are needed.

Diabetes Mellitus Type 2 Patients with Abdominal Obesity Are Prone to Osteodysfunction: A Cross-Sectional Study

Introduction

The interaction between diabetes, obesity, and bone metabolism was drawing increasing public attention. However, the osteometabolic changes in diabetes mellitus type 2 (T2DM) patients with abdominal obesity have not been fully revealed. This study is aimed at investigating the association between abdominal obesity indices and bone turnover markers among T2DM participants.

Methods

4351 subjects were involved in the METAL study. Abdominal obesity indices included neck, waist, and hip circumference, visceral adiposity index (VAI), lipid accumulation product (LAP), waist-to-hip ratio (WHR), and Chinese visceral adiposity index (CVAI). They were applied to elucidate the nexus between β-C-terminal telopeptide (β-CTX), osteocalcin (OC), and intact N-terminal propeptide of type I collagen (P1NP).

Results

Abdominal obesity indices were strongly negatively associated with β-CTX and OC. Among males, five indices were negatively correlated with β-CTX (BMI, WC, LAP, WHR, and CVAI) and OC (BMI, NC, WC, WHR, and CVAI). There were no significant associations with P1NP. Among females, all eight indices were negatively associated with β-CTX. Seven indices were negatively related to OC (BMI, NC, WC, HC, LAP, WHR, and CVAI). The VAI was negatively correlated with P1NP.

Conclusions

The present study demonstrated that in T2DM, abdominal obesity had an obviously negative correlation with bone metabolism. Abdominal obesity indices were significantly negatively associated with skeletal destruction (β-CTX) and formation (OC). In routine clinical practice, these easily obtained indices could be used as a preliminary screening method and relevant factors for osteodysfunction incidence risk at no additional cost and may be of particular value for postmenopausal women in T2DM populations.

The relationship between sarcopenia-related measurements and osteoporosis: The SARCOP study

As muscle and bone are closely-related, we have explored the association between sarcopenia-related measurements and bone mineral density (BMD) (and osteoporosis) in postmenopausal women. Grip strength, anterior thigh muscle thickness and chair stand test were found to be related with BMD. Additionally, grip strength < 22 kg increased the odds ratio of osteoporosis 1.6 times.

INTRODUCTION

As muscle and bone are two closely related tissues, we aimed to investigate the association between sarcopenia-related measurements (i.e., sonographic anterior thigh muscle thickness, grip strength, chair stand test (CST), gait speed) and clinical factors, lumbar/femoral BMD, and the presence of osteoporosis (OP) in postmenopausal women.

METHODS

Community dwelling postmenopausal women from two physical and rehabilitation medicine outpatient clinics were consecutively included in this cross-sectional study. Demographic data, age, weight, height, education/exercise status, smoking, and comorbidities were registered. BMD measurements were performed from lumbar vertebrae (L1-4) and femoral neck using dual energy X-ray absorptiometry (DXA). A T-score of ≤ -2.5 SD in the lumbar vertebrae (L1-L4) and/or femoral neck was accepted as OP. Anterior thigh muscle thickness (MT) at the midthigh level was measured sonographically using a linear probe. Grip strength was measured from the dominant side. Physical performance was assessed by CST and gait speed.

RESULTS

Among 546 postmenopausal women, 222 (40.7%) had OP. Among sarcopenia-related parameters, grip strength and anterior thigh MT were positively associated with lumbar vertebral BMD. CST performance was positively associated with femoral neck BMD. After adjusting for confounding factors, low grip strength (< 22 kg) increased 1.6 times the risk of OP.

CONCLUSION

Loss of muscle mass/function (i.e., sarcopenia) can coexist with loss of trabecular and cortical bone. To this end, grip strength and anterior thigh MT seem to be associated with the lumbar vertebral BMD, while CST is associated with the femoral neck BMD. Lastly, low grip strength might have an association with postmenopausal OP.

Maternal vitamin D levels correlate with fetal weight and bone metabolism during pregnancy: a materno-neonatal analysis of bone metabolism parameters

OBJECTIVES

Vitamin D plays an essential role in neonatal skeletal development and maternal weight gain during pregnancy. We aim to study the association between vitamin D status, maternal weight, and materno-neonatal bone metabolism parameters.

METHODS

From January to June 2017, we conducted this cross-sectional study among 103 pregnant women (21-42 years old) and their singletons. The levels of serum 25-(OH)D, PTH, P1NP, OC, and CTX were measured for mothers and neonates (cord blood). Serum vitamin D and OC were measured using chemiluminescence and two-site immunoradiometric assay, respectively. Meanwhile, P1NP, CTX, and PTH were measured by ELISA.

RESULTS

The average serum vitamin D levels from mothers were 15.1 ng/mL during pregnancy and 16.2 ng/mL in the umbilical cord. At baseline, vitamin D deficient mothers were more likely to have higher PTH (36.4 vs. 18 pg/mL; p=0.029) and lower P1NP levels (90 vs. 92.5 ng/mL; p=0.026). Also, vitamin D deficient status was associated with lower fetal weight (3,293 vs. 3,358 g; p=0.019). Maternal weight was significantly correlated with P1NP (65.86 vs. 109.35; p=0.001) and OC (14.52 vs. 18.24; p=0.038), as well as cord vitamin D level (13.31 vs. 18.46; p=0.039) among normal vs. overweight women. No significant differences were found for the correlation between maternal weight and fetal parameters except for fetal weight which significantly increased with the increase in maternal weight (overweight vs. obese women=3,280 vs. 3,560; p=0.06).

CONCLUSIONS

Maternal vitamin D status is associated with maternal and neonatal bone metabolism parameters as well as maternal and neonatal weight.

Gout as a risk factor for osteoporosis: A Korean population-based study

Uric acid acts as both an antioxidant and a pre-oxidant that induces oxidative stress; thus, it plays a paradoxical role in inflammation. However, the effect of gout, a hallmark of hyperuricemia, on osteoporosis remains unclear. Therefore, this study aimed to investigate the association between gout and osteoporosis. This retrospective cohort study used data from the Korean National Health Insurance Service Database. In total, 628,565 participants who were diagnosed with gout and prescribed medications for gout for at least 90 days were selected. The control cohort included patients with no history of gout or use of gout medication. Age and sex 1:1 propensity score matching and Cox proportional hazards models were used to investigate risk factors for osteoporosis. In total, 305,810 patients with gout met the inclusion criteria. Compared with the control group, both men and women with gout showed an increased incidence rate ratio of osteoporosis. In the stratified analysis by age, patients with gout showed an increased incidence rate ratio for osteoporosis in all age groups, except for those over 80 years of age (P < .001). Gout showed an increased hazard ratio of 1.48 (95% CI: 1.45-1.51, P < .001). The female sex has also been identified as a risk factor for osteoporosis. Patients in their 70s had the highest HR. Gout is significantly associated with the risk of osteoporosis. In particular, the results of this study showed that the incidence of osteoporosis increased up to four times in male patients in their 20s with gout compared to without gout.

Load-to-strength ratio at the radius is higher in adolescent and young adult females with obesity compared to normal-weight controls

BACKGROUND

Among adolescents with extremity fractures, individuals with obesity have greater representation compared with individuals of normal-weight, despite having higher areal and volumetric bone mineral density (aBMD, vBMD) than their normal-weight counterparts. The relative increase in BMD in individuals with obesity may thus be insufficient to support the greater force generated upon falling. The load-to-strength ratio is a biomechanical approach for assessing the risk of fracture by comparing applied force to bone strength, with higher load-to-strength ratios indicating higher fracture risk.

OBJECTIVE

To assess the load-to-strength ratio at the distal radius in adolescent and young adult females with severe obesity (OB) compared with normal-weight healthy controls (HC). We hypothesized that OB have a higher load-to-strength ratio compared to HC.

METHODS

We examined bone parameters in 65 girls 14-21 years old: 33 OB and 32 HC. We used dual-energy X-ray absorptiometry (DXA) to assess body composition, high resolution peripheral quantitative CT (HR-pQCT) to estimate vBMD, and microfinite element analysis (μFEA) to assess bone strength at the distal radius. To quantify fracture risk, we computed the load-to-strength ratio, where the numerator is defined as the load applied to the outstretched hand during a forward fall and the denominator is the bone strength, as estimated by μFEA.

RESULTS

Although OB had higher total vBMD than HC (368.3 vs. 319.9 mgHA/cm3, p = 0.002), load-to-strength ratio at the radius was greater in OB than HC after controlling for age and race (0.66 vs. 0.54, p < 0.0001). In OB, impact force and load-to-strength ratio were associated negatively with % lean mass (r = -0.49; p = 0.003 and r = -0.65; p < 0.0001 respectively) and positively with visceral fat (r = 0.65; p < 0.0001 and r = 0.36; p = 0.04 respectively).

CONCLUSIONS

Adolescent and young adult females with obesity have higher load-to-strength ratio at the distal radius due to higher forces applied to bone in a fall combined with incomplete adaptation of bone to increasing body weight. This is differentially affected by lean mass, fat mass, and visceral fat mass.

Does vitamin D supplementation improve bone health, body composition and physical performance beyond endurance exercise in patients with type 2 diabetes: A secondary analysis of randomized controlled trial

This study aimed to assess the effects of a 12-week vitamin D and endurance exercise intervention on bone health, body composition and physical performance among patients with type 2 diabetes. Totally, 61 patients were randomly assigned to vitamin D (VDG), exercise (EG), vitamin D and exercise intervention (VEG), and control (CG) groups. Bone health (bone mineral density, BMD; bone mineral content, BMC), body composition and physical performance were measured before and after the intervention. Dual energy X-ray absorptiometry was used to assess bone health and body composition. There were no additive effects of vitamin D beyond exercise were observed. Vitamin D supplementation had significant effects on maintaining bone health compared with their counterpart Total (BMC, EG + CG: 2,719.9 ± 70.0 vs. 2,670.1 ± 65.6; VDG + VEG: 2,610.9 ± 88.2 vs. 2,605.3 ± 84.8; trunk BMC, 870.2 ± 26.8 vs. 836.3 ± 23.7; 824.8 ± 29.5 vs. 822.1 ± 27.8; spine BMD, 1.15 ± 0.03 vs. 1.11 ± 0.02; 1.09 ± 0.03 vs. 1.09 ± 0.02) were observed. Exercise had a main effect on the reduction of total and trunk BF%. Patients in EG had a decreased BMC, while it was alleviated in VEG after intervention. Although no additive effect of vitamin D supplementation beyond exercise training, the supplementation had a potential effect on the prevention of bone loss induced by exercise only.

Inverse association between low-density lipoprotein cholesterol and bone mineral density in young- and middle-aged people: The NHANES 2011–2018

Objectives

Low-density lipoprotein cholesterol (LDL-C) plays an essential part in bone metabolism. However, the correlation between LDL-C levels and bone mineral density (BMD) is still controversial. This study aimed to explore the relationship between LDL-C levels and lumbar BMD in young- and middle-aged people.

Methods

We conducted a cross-sectional study comprising 4,441 participants aged 20–59 from the National Health and Nutrition Examination Survey (NHANES). LDL-C levels and lumbar BMD were used as independent and dependent variables, respectively. We evaluated the correlation between LDL-C levels and lumbar BMD through a weighted multivariate linear regression model. We performed a subgroup analysis of the relationship between LDL-C levels and lumbar BMD based on age, gender, and body mass index (BMI).

Results

After adjusting for confounding factors, LDL-C levels were negatively correlated with lumbar BMD. In subgroup analyses stratified by gender, this negative association was statistically significant in men and women. In the subgroup analysis stratified by age, a negative connection existed in people aged 30–49 years. In the subgroup analysis divided by BMI, there was an inverse correlation in overweight people (25 ≤ BMI &lt; 30).

Conclusions

Our research observed an inverse association between LDL-C levels and lumbar BMD in young- and middle-aged people, especially in people aged 30–49 years and who are overweight. Close monitoring of BMD and early intervention may be required for these people.

Changes in bone mineral density after bariatric surgery in patients of different ages or patients with different postoperative periods: a systematic review and meta-analysis

To assess changes in bone mineral density (BMD) following bariatric surgery (BS) in patients with different bone sites, postoperative periods and ages. Twenty-two studies were included. Femoral neck (FN) BMD decreased after surgery (MD, - 0.05 g/cm², CI - 0.10 to - 0.01, P = 0.03). Postoperative BMD decreased more in the FN and lumbar spine (LS) of patients older than 40 (FNBMD, - 0.07 g/cm², CI - 0.13 to - 0.00, P = 0.04; LSBMD, - 0.03 g/cm², CI - 0.05 to - 0.00, P = 0.02) or patients with a postoperative time of greater than 12 months (FNBMD, - 0.06 g/cm², CI - 0.12 to - 0.01, P = 0.03; LSMD, - 0.04 g/cm², CI - 0.09 to 0.01, P = 0.12); therefore, post-BS bone loss should be monitored among patients in these groups. Longer follow-ups are needed to determine whether BMD changes or stabilizes.

Prevalence and Risk Factors of Discordance Between Hip and Spinal Bone Mineral Density Among Saudi Subjects

Background

Discordance between hip and spine on dual-energy x-ray absorptiometry is a well-known problem in diagnosing osteoporosis. The prevalence and risk factors of this problem have not been studied in the Saudi population. The objective of this study was to document this discordance in our population and its possible risk factors.

Materials and methods

We analyzed data obtained from subjects who had dual x-ray absorptiometry (DXA) between January 2021 and December 2021 at King Khalid University Hospital, Riyadh, Saudi Arabia. Subjects with the following conditions were excluded: secondary osteoporosis, patients taking anti-osteoporotic agents, patients on steroids or hormonal replacement therapy, hyperparathyroidism, hypoparathyroidism, and chronic renal disease. A total of 1388 patients satisfied our inclusion criteria. World Health Organization (WHO) criteria for diagnosis were implemented. Major discordance was defined as osteoporosis in one site and normal in the other. Minor discordance was defined as a difference of no more than one World Health Organization diagnostic class between two sites. Bivariate statistical analysis was achieved using appropriate statistical tests (chi-square, student’s t-test, one-way analysis of variance, and Pearson’s correlation), based on the type of study and outcome variables. A p-value of < 0.05 and 95% CI were used to report the statistical significance and precision of results.

Results

A total of 1388 subjects were analyzed, of which, 1196 (86%) were females with a mean age of 58.8 (13.8 SD) and 192 were males with a mean age of 58 (18.0 SD). Lumbar osteoporosis was found in 312 (22.5%) participants while hip osteoporosis was reported in 73 (5.3%) of the participants. Major discordance was documented in 85 (6.1%) of all participants (6.3% of the male and 6.1% of the female patients). All of these subjects had lumbar spine osteoporosis with normal hip bone mineral density (BMD). Minor discordance was found in 591 patients (42.6%). Obesity (BMI > 30) was found to be a risk factor for both major (2.10-11.6, 95% CI) and minor (2.5-11.4, 95% CI) discordance.

Conclusion

Discordance between hip and spine BMD is common among Saudi subjects. Lumbar spine osteoporosis with normal hip BMD caused this discordance in our subjects. Obesity could be responsible for the occurrence of this discordance. Mechanisms may include higher rate of turnover in spine, technical artifacts in the measurements of lumbar spine BMD, or due to the effects of weight loading. Caution should be exercised when interpreting DXA results, especially in obese subjects.

Genetic Diagnostics in Routine Osteological Assessment of Adult Low Bone Mass Disorders

CONTEXT

Many different inherited and acquired conditions can result in premature bone fragility/low bone mass disorders (LBMDs).

OBJECTIVE

We aimed to elucidate the impact of genetic testing on differential diagnosis of adult LBMDs and at defining clinical criteria for predicting monogenic forms.

METHODS

Four clinical centers broadly recruited a cohort of 394 unrelated adult women before menopause and men younger than 55 years with a bone mineral density (BMD) Z-score < -2.0 and/or pathological fractures. After exclusion of secondary causes or unequivocal clinical/biochemical hallmarks of monogenic LBMDs, all participants were genotyped by targeted next-generation sequencing.

RESULTS

In total, 20.8% of the participants carried rare disease-causing variants (DCVs) in genes known to cause osteogenesis imperfecta (COL1A1, COL1A2), hypophosphatasia (ALPL), and early-onset osteoporosis (LRP5, PLS3, and WNT1). In addition, we identified rare DCVs in ENPP1, LMNA, NOTCH2, and ZNF469. Three individuals had autosomal recessive, 75 autosomal dominant, and 4 X-linked disorders. A total of 9.7% of the participants harbored variants of unknown significance. A regression analysis revealed that the likelihood of detecting a DCV correlated with a positive family history of osteoporosis, peripheral fractures (> 2), and a high normal body mass index (BMI). In contrast, mutation frequencies did not correlate with age, prevalent vertebral fractures, BMD, or biochemical parameters. In individuals without monogenic disease-causing rare variants, common variants predisposing for low BMD (eg, in LRP5) were overrepresented.

CONCLUSION

The overlapping spectra of monogenic adult LBMD can be easily disentangled by genetic testing and the proposed clinical criteria can help to maximize the diagnostic yield.

Should Q-CT Be the Gold Standard for Detecting Spinal Osteoporosis?

STUDY DESIGN

Prospective comparative study.

OBJECTIVE

Refinement of the guidelines for screening of osteoporosis and considering quantitative computed tomography (Q-CT) for detecting spinal osteoporosis.

SUMMARY OF BACKGROUND DATA

Spinal osteoporosis is often underestimated and under-evaluated due to either lack of availability of the diagnostic modality or lack of awareness about the possibility of overestimation by dual X-ray absorptiometry (DXA) scan. There is a need for reconsidering osteoporosis evaluation with a site specific and patient specific inclination.

METHODS

Post-menopausal women that underwent bone mineral density (BMD) evaluation from January-2018 to December-2020 with either Q-CT or DXA were evaluated. Comparison studies of the distribution of age and T-scores of the bone densities obtained from the two study groups: age-matched, sex-matched, and common skeletal site of interest (L1-4 vertebrae) were performed. Mann-Whitney U test, correlation and regression analyses were performed and bell curves were plotted.

RESULTS

Of the 718 women evaluated, 447 underwent Q-CT and 271 underwent DXA. There was no significant difference among the age distribution of the two study groups (P-value > 0.05). The mean and mode T-scores obtained by Q-CT and DXA were found to be -2.71, -3.8 and -1.63, -1.7 respectively. A highly significant difference in the T-scores was observed in the Q-CT and DXA groups (P-value < 0.0001). Among those who were screened by Q-CT, 58.16% were osteoporotic, 37.58% were osteopenic, and 4.25% were normal. The respective percentages in the DXA group were 30.63%, 49.82%, and 19.55%.

CONCLUSION

Q-CT provides more precise estimation of cancellous bone mineral density than DXA. With the reliance on DXA for spinal BMD estimation being questionable, new standards have to be established for spinal osteoporosis evaluation. Q-CT can be a better alternative to replace DXA as the gold standard for the evaluation of spinal osteoporosis.Level of Evidence: 2.

Risk factors of vertebral re-fracture after PVP or PKP for osteoporotic vertebral compression fractures, especially in Eastern Asia: a systematic review and meta-analysis

Objective

Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat osteoporotic vertebral compression fractures (OVCF), but the risk of vertebral re-fracture after PVP/PKP remains controversial. This study aims to investigate the incidence and risk factors of vertebral re-fracture after PVP/PKP.

Methods

Relevant literatures published up to November 2021 were collected from PubMed, Embase and Web of Science. A meta-analysis was performed to extract data associated with risk factors of SVCF following the PRISMA guidelines. Also, pooled odds ratio (OR) or weighted mean difference (WMD) with 95% confidence interval (CI) was calculated.

Results

A total of 23 studies, encompassing 9372 patients with OVCF, met the inclusion criteria. 1255 patients (13.39%) suffered re-fracture after PVP/PKP surgery. A total of 22 studies were from Eastern Asia and only 1 study was from Europe. Female sex (OR = 1.34, 95%CI 1.09–1.64, P = 0.006), older age (WMD = 2.04, 95%CI 0.84–3.24, P = 0.001), lower bone mineral density (BMD, WMD = − 0.38, 95%CI − 0.49–0.26, P < 0.001) and bone cement leakages (OR = 2.05, 95% CI 1.40–3.00, P < 0.001) increased the risk of SVCF. The results of subgroup analysis showed the occurrence of re-fracture was significantly associated with gender (P = 0.002), age (P = 0.001) and BMD (P < 0.001) in Eastern Asia. Compared with the unfractured group, anterior-to-posterior vertebral body height ratio (AP ratio, WMD = 0.06, 95%CI 0.00–0.12, P = 0.037) and visual analog scale score (VAS, WMD = 0.62, 95%CI 0.09–1.15, P = 0.022) were higher in the refracture group, and kyphotic angle correction ratio (Cobb ratio, WMD = − 0.72, 95%CI − 1.26–0.18, P = 0.008) was smaller in Eastern Asia. In addition, anti-osteoporosis treatment (OR = 0.40, 95% CI 0.27–0.60, P < 0.001) could be a protective factor.

Conclusion

The main factors associated with re-fracture after PVP/PKP are sex, age, bone mineral density, AP ratio, Cobb ratio, VAS score, bone cement leakage and anti-osteoporosis treatment, especially in Eastern Asia.

Association between body mass index, bone bending strength, and BMD in young sedentary women

The rationale was to determine whether body mass index (BMI) is a predictor of bone bending strength and bone mineral density (BMD) in young sedentary women. Results show that BMI is not a predictor of bone bending strength and that young women with low BMI also have low BMD.

INTRODUCTION

The purpose of this study was to determine whether body mass index (BMI) is a predictor of tibial or ulnar bending strength and bone mineral density (BMD) in sedentary women.

METHODS

Sedentary women (n = 34), age 19-27 years, with low BMI (LBMI < 18.5 kg/m², n = 16), and normal or high BMI (NHBMI between 18.5 and 29.9 kg/m², n = 18) participated as study subjects. Study outcomes included tibial and ulnar bending strength (EI in Nm²) using a non-invasive mechanical response tissue analyzer (MRTA); BMD and bone mineral content (BMC) of the whole body (WB), femoral neck (FN), total hip (TH), lumbar spine 1-4 (LS1-4), and ulna; and bone turnover biomarkers.

RESULTS

The LBMI group have lower (p < 0.01) body weight [group difference (Δ) = 32.0%], lean mass (LM) (Δ = 23.1%), fat mass (FM) (Δ = 77.2%), and tibial bending strength (Δ = 22.0%), compared to the NHBMI. The LBMI group also have lower (all p < 0.025) BMC in WB (Δ = 19.9%), FN (Δ = 20.1%) and TH (Δ = 19.0%), compared to the NHMBI, not in BMD results. Multivariate regression analysis shows that significant predictors of tibial bending strength are tibia length (adjusted R² = .341), age (adjusted R² = .489), ulna BMD (adjusted R² = .536), and LM (adjusted R² = .580). BMI was positively correlated with tibial EI (p < 0.05), height, weight, FM, LM, body fat% (all p < 0.01), and BMD of WB, FN, TH, and LS 1-4 (p < 0.05 or < 0.01).

CONCLUSIONS

Our results show that BMI is not a significant predictor of tibial or ulnar bending strength in young sedentary women.

Age-Related Changes in Bone Density, Microarchitecture, and Strength in Postmenopausal Black and White Women: The SWAN Longitudinal HR-pQCT Study

Higher fracture risk in White versus Black women is partly explained by lower BMD and worse bone microarchitecture in White women. However, whether rates of decline in bone density, microarchitecture and strength differ between postmenopausal Black and White women is unknown. Further, factors that influence rates of age-related bone microarchitecture deterioration remain ill-defined. Thus, over 6.7 years, longitudinal changes were measured in peripheral volumetric bone mineral density (vBMD), microarchitecture, and strength at the distal radius and tibia using HR-pQCT in postmenopausal Black (n = 80) and White (n = 137) women participating in the Study of Women's Health Across the Nation. It was assessed whether age-related changes in vBMD and microarchitecture were influenced by body weight, body composition, and/or weight change. It was found that at the radius, where White women appeared to have slightly greater rates of loss in total vBMD, cortical bone volume, and porosity than Black women, those differences were attenuated after adjusting for clinical covariates. At the tibia, Black and White women had similar rates of bone loss. Independent of race and other clinical covariates, women with the lowest baseline body weight experienced the greatest decline in total and trabecular vBMD at the radius. Furthermore, women who lost weight over the follow-up period had higher rates of bone loss, particularly at the tibia, compared with those who maintained or gained weight. Higher baseline total body fat mass was also protective of bone loss at both the radius and tibia. In conclusion, these findings indicate that lower fracture risk among postmenopausal Black women is not caused by slower rates of bone deterioration, and highlight the importance for postmenopausal women to avoid lower body weight and excessive weight loss to avert rapid bone loss and subsequent fractures. © 2021 American Society for Bone and Mineral Research (ASBMR).

The Saturation Effect of Obesity on Bone Mineral Density for Older People: The NHANES 2017-2020

INTRODUCTION

Previous studies have shown that obesity has a positive effect on bone mineral density (BMD). However, excessive obesity is harmful to health, especially in older adults. In addition, it is unclear what body mass index (BMI) and waist circumference (WC) to maintain for the most beneficial BMD in older adults.

METHODS

Multivariate logistic regression models were used to investigate the association between BMI, WC, and femoral neck BMD using the most recent data from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). Fitting smoothing curves and saturation effects analysis were also used to determine the association of nonlinear relationships between BMI, WC, and femoral neck BMD.

RESULTS

The analysis included a total of 2,903 adults. We discovered that BMD and WC were positively linked to femoral neck BMD. The favorable associations of BMI and WC with femoral neck BMD were maintained in all subgroup analyses stratified by sex and race, except among Mexican Americans. Furthermore, smoothing curve fitting revealed that the link between BMI and BMD was not only a linear connection, and that there was a saturation point. The BMI saturation value in the femoral neck BMD was 24.3 (kg/m²), according to the saturation effect analysis.

CONCLUSIONS

In persons over the age of 50, our research found a positive relationship between obesity and BMD, and we also found a saturation value between BMI and BMD. According to this study, maintaining BMI at a moderate level (about 24.3 kg/m²) would result in an optimal balance between BMI and BMD in adults over 50 years of age.

The Influence of Obesity, Ovariectomy, and Greenshell Mussel Supplementation on Bone Mineral Density in Rats

Obesity is considered to impair long-term health by disturbing multiple physiological functions. However, it remains a controversial issue as to whether obesity has beneficial or detrimental effects on bone health in postmenopausal women. The aims of this study were to investigate the relationships between obesity and bone mineral density (BMD) under conditions of ovarian hormone deficiency in an animal model and to evaluate the potential health benefits of Greenshell mussel (GSM) on bone health. A total of 144 adult female Sprague-Dawley rats were fed from age 12 weeks on one of four diets (normal [ND]; ND + GSM; high fat/high sugar [HF/HS]; HF/HS + GSM; n = 36 per diet). At age 20 weeks, after a dual-energy X-ray absorptiometry (DXA) scan, 12 of the rats on each diet underwent ovariectomy (OVX) and the remaining rats were left intact. Twelve of the intact rats in each diet group were culled at age 26 weeks (short-term cohort). The remaining rats were culled at age 48 weeks (long-term cohort). Rats were DXA scanned before cull, then various fat pads were dissected. The results revealed that HF/HS rats and OVX rats dramatically increased body weight and fat deposition in correlation with leptin. In the long-term cohort, vertebral spine BMD rapidly declined after OVX. At termination, the OVX rats had decreased plasma bone turnover markers of CTX-1 and TRAP when compared with sham rats. Significantly higher BMD was found in OVX rats fed the HF/HS diet compared with ND, but this difference was not recapitulated in intact rats. BMD of right femur was significantly increased 5% to 10% by GSM in the short-term cohort. The data demonstrated that obesity can be beneficial by increasing BMD in OVX rats, and this may extrapolate to postmenopausal women as adipocyte-produced estrogen may slightly compensate for the reduction in ovarian hormones. Finally, the data showed that GSM may be beneficial to bone health by increasing BMD accrual. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

Obesity and Bone: A Complex Relationship

There is a large literature on the relationship between obesity and bone. What we can conclude from this review is that the increase in body weight causes an increase in BMD, both for a mechanical effect and for the greater amount of estrogens present in the adipose tissue. Nevertheless, despite an apparent strengthening of the bone witnessed by the increased BMD, the risk of fracture is higher. The greater risk of fracture in the obese subject is due to various factors, which are carefully analyzed by the Authors. These factors can be divided into metabolic factors and increased risk of falls. Fractures have an atypical distribution in the obese, with a lower incidence of typical osteoporotic fractures, such as those of hip, spine and wrist, and an increase in fractures of the ankle, upper leg, and humerus. In children, the distribution is different, but it is not the same in obese and normal-weight children. Specifically, the fractures of the lower limb are much more frequent in obese children. Sarcopenic obesity plays an important role. The authors also review the available literature regarding the effects of high-fat diet, weight loss and bariatric surgery.

Regulatory SNP of RREB1 is Associated With Bone Mineral Density in Chinese Postmenopausal Osteoporosis Patients

Postmenopausal osteoporosis (PMO) is the most common bone disorder in elderly Chinese women. Although genetic factors have been shown to have a pivotal role in PMO, studies on genetic loci associated with PMO in Chinese individuals are still lacking. We aimed to identify SNPs that contribute to PMO in Chinese individuals by conducting a genome-wide association study (GWAS). Bone mineral density (BMD) of postmenopausal Chinese women was assessed. Participants with T-score < -2.5 standard deviations (n = 341) were recruited and divided into a discovery group (n = 150) and a replication group (n = 191). GWAS was performed, with T-score as the quantitative trait, using linear regression. Our results revealed that an SNP cluster upstream of RREB1 showed a trend of association with BMD in Chinese PMO patients. The leading SNP of the cluster was rs475011 (p _combined = 1.15 × 10^-6, beta = 0.51), which is a splicing quantitative trait locus (sQTL) of RREB1. This association was further supported by data from the UK Biobank (UKBB; p = 9.56 × 10^-12). The high BMD-associated allele G of rs475011 is related to a high intron excision ratio. This SNP may increase BMD by upregulating mature RREB1 mRNA, based on data from the Genotype-Tissue Expression (GTEx) database. We identified BMD-associated SNPs that regulate RREB1 in Chinese PMO patients. Future functional experiments are needed to further link rs475011, RREB1, and PMO in Chinese individuals.

The Saturation Effect of Body Mass Index on Bone Mineral Density for People Over 50 Years Old: A Cross-Sectional Study of the US Population

Background: Previous studies had revealed that Body Mass Index (BMI) positively affected Bone Mineral Density (BMD). However, an excessively high BMI was detrimental to health, especially for the elderly. Moreover, it was elusive how much BMI was most beneficial for BMD in older adults to maintain.

Objective: To investigate whether there was a BMI saturation effect value that existed to maintain optimal BMD.

Methods: A cross-sectional study was conducted using the datasets of the National Health and Nutrition Examination Survey (NHANES) 2005–2006, 2007–2008, 2009–2010, 2013–2014, and 2017–2018. After adjusting for covariates, an analysis of the association between BMI and BMD in different femoral regions (Total femur, Femoral neck, Trochanter, Intertrochanter, and Ward's triangle) and lumbar spine regions (Total spine, L1, L2, L3, and L4) in the whole population was performed using the multivariate linear regression models, smoothing curve fitting, and saturation effects analysis models. Then, subgroup analyses were performed according to gender, age, and race.

Results: A total of 10,910 participants (5,654 males and 5,256 females) over 50 years were enrolled in this population-based study. Multivariate linear regression analyses in the population older than 50 years showed that BMI was positively associated with femoral BMD and lumbar spine BMD (P < 0.001, respectively). Smoothing curve fitting showed that the relationship between BMI and BMD was not simply linear and that a saturation value existed. The saturation effect analysis showed that the BMI saturation value was 26.13 (kg/m²) in the total femur, 26.82 (kg/m²) in the total spine, and showed site-specificity in L1 (31.90 kg/m²) and L2 (30.89 kg/m²). The saturation values were consistent with the whole participants in males, while there was high variability in the females. BMI saturation values remained present in subgroup analyses by age and race, showing specificity in some age (60–70 years old) groups and in some races.

Conclusions: Our study showed a saturation value association between BMI and BMD for people over 50 years old. Keeping the BMI in the slightly overweight value (around 26 kg/m²) might reduce other adverse effects while obtaining optimal BMD.

Factors associated with TBS worse than BMD in non-osteoporotic elderly population: Bushehr elderly health program

BACKGROUND

Bone mineral density (BMD) and trabecular bone score (TBS) are moderately correlated. TBS is sometimes used as an adjuvant to BMD in the fracture risk assessment. Some individuals with normal BMD or osteopenia, have more degraded TBS. We aimed to identify factors associated with TBS worse than BMD in the non-osteoporotic elderly population.

METHODS

The study subjects were selected from 2384 women and men aged ≥60 years participating in the second stage of the Bushehr Elderly Health program, a population-based prospective cohort study in Iran. The BMDs of different sites and the lumbar spine texture were measured using dual-energy X-ray absorptiometry and the TBS algorithm, respectively. Subjects were categorized based on their BMD and TBS status. Logistic regression was performed to identify the factors associated with "TBS worse than BMD" in non-osteoporotic individuals.

RESULTS

Of 1335 participants included in the study, 112 of 457 women, and 54 of 878 men had worse TBS than BMD. In multivariable analysis, TBS worse than BMD in women was statistically significantly associated with years since menopause (OR: 1.04 (1.00-1.07)) and waist circumference (OR: 1.09 (1.05-1.14)). However, in men, the condition was statistically significantly associated with waist circumference (OR: 1.10 (1.03-1.17)), current smoking (OR: 2.54 (1.10-5.84)), and HDL-C (OR: 1.03 (1.00-1.06)).

CONCLUSION

The results of the study show that higher waist circumference is associated with more degraded TBS than BMD in both men and women. Years passed since menopause and current smoking, respectively in women and men, were associated with more degraded TBS. Considering TBS values in older individuals with higher waist circumference, or a history of smoking despite normal BMDs might help more accurate assessment of bone health. However, further studies are required to confirm the benefit.

Association of lifestyle factors with osteoporosis and fracture in postmenopausal women: a Japanese cohort study

OBJECTIVE

Osteoporosis is a major risk factor for fracture later in life; however, few studies have examined the association of lifestyle factors with osteoporosis and fracture. This study aimed to identify factors associated with osteoporosis and fracture in postmenopausal women.

METHODS

We evaluated the association between baseline characteristics and outcomes (diagnosis of osteoporosis or incidence of fracture) in 4,427 postmenopausal women who participated in the Kyushu University Fukuoka Cohort Study on lifestyle-related diseases (baseline: February 2004 to August 2007; follow-up: February 2010 to December 2012). Among the women, 626 were diagnosed as having osteoporosis without a fracture, 294 sustained a fracture without a diagnosis of osteoporosis, and 137 were diagnosed with both osteoporosis and fracture during the average 5.3-year follow-up period; the remaining 3,370 participants were not diagnosed with osteoporosis or did not sustain a fracture. The association between lifestyle factors and the occurrence of osteoporosis and fracture was evaluated using logistic regression analysis.

RESULTS

Skipping breakfast was associated negatively with osteoporosis without fracture (odds ratio [OR] = 0.40, P = 0.009) but positively with fracture without osteoporosis (OR = 2.30, P = 0.0009). Glycated hemoglobin A1c levels were associated negatively with osteoporosis without fracture (OR = 0.81, P = 0.0003) but positively with fracture without osteoporosis (OR = 1.18, P = 0.03). Parental history of fracture and extraversion personality trait were both associated with fracture without osteoporosis.

CONCLUSIONS

Osteoporosis and fracture showed different association patterns with lifestyle factors, and no factors were correlated with an increase in both osteoporosis and fracture.

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

BACKGROUND AND AIMS

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

METHODS AND RESULTS

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

CONCLUSIONS

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

Risk Factors Associated With Foot and Ankle Insufficiency Fractures in Postmenopausal Sedentary Women

BACKGROUND

Insufficiency fractures occur in bones with low elastic resistance. In contrast to stress fractures, which affect normal bones and have been extensively studied, insufficiency fractures of the foot and ankle have been the subject of little research. The objective of this study was to identify risk factors associated with the development of foot and ankle insufficiency fractures.

METHODS

The study included 55 postmenopausal sedentary women with foot and ankle insufficiency fractures and 51 women in the control group. The data collected were the fracture site, body mass index, use of corticosteroids, T scores of the femur and lumbar spine measured by bone densitometry, and serum 25-OH vitamin D level. The calcaneal pitch (CP), talar-first metatarsal, and metatarsus adductus (MA) angles were measured on radiographs.

RESULTS

In 49 patients (89%), fractures occurred in the metatarsals. All metatarsals were affected, and the most common fracture site was the base of the fifth metatarsal, with 21 cases (33%). Twenty patients (36%) in the study group reported chronic use of corticosteroids and had lower bone mineral density levels than controls (P < .05). The factors associated with fracture development (P < .05) were the CP and MA angles and low lumbar bone mineral density.

CONCLUSION

Insufficiency fractures in this population were associated with low bone mineral density and unfavorable biomechanical characteristics such as pes cavus and metatarsus adductus.

LEVEL OF EVIDENCE

Level IIIB, case-control study.

The Gut Microbiome Is Altered in Postmenopausal Women With Osteoporosis and Osteopenia

Osteoporosis and its precursor osteopenia are common metabolic bone diseases in postmenopausal women. A growing body of evidence suggests that the gut microbiota is involved in the regulation of bone metabolism; however, there are few studies examining how gut microbiomes in osteoporosis and osteopenia may differ from those in healthy individuals. The aim of this study was to characterize the diversity, composition, and functional gene potential of the gut microbiota of healthy, osteopenic, and osteoporotic women. Body composition, bone density, and fecal metagenomes were analyzed in 86 postmenopausal women. The women were classified as healthy, osteopenic, or osteoporotic based on T-scores. The taxonomic and functional gene compositions of the microbiome were analyzed using shotgun metagenomic sequencing. Both osteoporotic and osteopenic taxonomic compositions were found to be significantly different from healthy participants. Linear discriminant-analysis effect-size analyses identified that healthy participants had more unclassified Clostridia and methanogenic archaea (Methanobacteriaceae) than in both osteoporotic and osteopenic participants. Bacteroides was found to be more abundant in osteoporosis and osteopenia groups. Some KEGG pathways, including carbohydrate metabolism, biosynthesis of secondary metabolites, and cyanoamino acid metabolism, were found to be more abundant in both osteoporosis and osteopenia. These results show that osteoporosis and osteopenia alter the gut microbiome of postmenopausal women and identify potential microbial taxonomic and functional pathways that may be involved in this disease. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.

Prophylaxis of Pain and Fractures within Feet in the Course of Osteoporosis: The Issue of Diagnosing

Background

Considering the enormous risk of fractures in the course of osteoporosis in the area of the feet, an important aspect of prophylaxis is periodic and, in special cases, ongoing monitoring of defects and deformations as well as pressure distribution. The purpose of this article is to indicate the role of the examination of posture and pressure distribution during standing, postural balance, and gait, in the prevention of fatigue fractures in the course of osteoporosis, based on the literature review and examples of patients.

Methods

The manuscript consists of two parts; it has a review-analytical character. The first part reviews the literature. The data were obtained using the MEDLINE (PubMed), as well as Cochrane and Embase databases. The database review was carried out focusing mainly on English-language publications, while taking into account the topicality of scientific and research works in the area of osteoporosis. The problem of multiaspects in the area of bone density was pointed out. Considering the above, in the second part, the authors analyzed 11 exemplary patients with osteoporosis, referring to the assessment of foot and lower limb defects using traditional posturological methods and including pedobarography to diagnostic procedures that are used in the assessment of pressure distribution, standing and moving, and an attempt to balance.

Results

Analysis of the research and scientific literature proved the lack of unambiguous diagnostic procedures of the locomotor system recommended for the prevention of fatigue fractures in the course of osteoporosis. The main diagnostic recommendations are imaging tests (most often X-ray), which are recommended in the case of specific clinical symptoms. The analysis of exemplary patients with osteoporosis showed numerous disorders in the distribution of pressure in the plantar part of the feet, which are related, among other things, with their individual defects and lower limbs.

Conclusions

Detailed posture diagnostics and gait estimation, along with the analysis of pressure distribution within the feet are a very important aspect of the prevention of structural degradation and fatigue fractures within the feet. An important postulate for further research and scientific work is the elaboration of the procedures that will serve the preventive diagnostics of the locomotor system, aimed at early detection of threats of fatigue fractures.

Investigating the impact of captivity and domestication on limb bone cortical morphology: an experimental approach using a wild boar model

The lack of bone morphological markers associated with the human control of wild animals has prevented the documentation of incipient animal domestication in archaeology. Here, we assess whether direct environmental changes (i.e. mobility reduction) could immediately affect ontogenetic changes in long bone structure, providing a skeletal marker of early domestication. We relied on a wild boar experimental model, analysing 24 wild-born specimens raised in captivity from 6 months to 2 years old. The shaft cortical thickness of their humerus was measured using a 3D morphometric mapping approach and compared with 23 free-ranging wild boars and 22 pigs from different breeds, taking into account sex, mass and muscle force differences. In wild boars we found that captivity induced an increase in cortical bone volume and muscle force, and a topographic change of cortical thickness associated with muscular expression along a phenotypic trajectory that differed from the divergence induced by selective breeding. These results provide an experimental proof of concept that changes in locomotor behaviour and selective breeding might be inferred from long bones morphology in the fossil and archaeological record. These trends need to be explored in the archaeological record and further studies are required to explore the developmental changes behind these plastic responses.

The Relationship Between Body Mass Index and Bone Mineral Density: A Mendelian Randomization Study

Body mass index (BMI) is closely associated with bone mineral density (BMD) in both men and women. However, the relationship between BMI and BMD varies according to different studies. Using SNPs strongly associated with BMI in 336,107 individuals, we conducted a two-sample Mendelian randomization study to identify whether and to what extent BMD at different skeletal sites was affected by BMI. A power calculation was also performed. We found that BMI may causally increase lumbar BMD (β 0.087; 95% CI 0.025 to 0.149; P = 0.006) and heel calcaneus BMD (β 0.120; 95% CI 0.082 to 0.157; P = 1 × 10^-7). The associations of BMI with forearm and femoral neck BMD were not statistically significant. Our study suggested that higher BMI plays a causal role in increasing BMD and the effects are similar across the skeleton. BMI was causally and positively associated with lumbar and heel calcaneus BMD. However, no statistically significant effects were observed for BMI on femoral neck or forearm BMD.

Incidence and predictors of fractures in older adults with and without obesity defined by body mass index versus body fat percentage

PURPOSE

The aim of this study was to determine and compare risk factors associated with incident fractures in older adults with and without obesity, defined by both body mass index (BMI) and body fat percentage.

METHODS

1,099 older adults (mean ± standard deviation age = 63.0 ± 7.5) years, participated in this prospective cohort study. Obesity status at baseline was defined by BMI (≥30 kg/m²) obtained by anthropometry and body fat percentage (≥30% for men and ≥40% for women) assessed by dual-energy X-ray absorptiometry (DXA). Total hip and lumbar spine areal bone mineral density (aBMD) were assessed by DXA up to five years. Incident fractures were self-reported up to 10 years.

RESULTS

Prevalence of obesity was 28% according to BMI and 43% according to body fat percentage. Obese older adults by BMI, but not body fat percentage, had significantly higher aBMD at the total hip and spine compared with non-obese (both p-value<0.05). Obese older adults by body fat percentage had significantly higher likelihood of all incident fractures (OR: 1.71; CI:1.08, 2.71) and non-vertebral fractures (OR: 1.88; CI:1.16, 3.04) compared with non-obese after adjusting for confounders. Conversely, obese older adults by BMI had a significantly lower likelihood (OR: 0.54; CI:0.31, 0.94) of non-vertebral fractures although this was no longer significant after adjustment for total hip aBMD (all p-value > 0.05). Mediation analysis confirmed that aBMD meditated the effects of BMI, but not body fat percentage, on all incident fractures. Higher baseline falls risk score was the only consistent predictor of increased likelihood of incident fracture in obese individuals only, according to both BMI and body fat percentage (both p-value<0.05).

CONCLUSIONS

Obesity defined by body fat percentage is associated with increased likelihood of incident fractures in community-dwelling older adults, whereas those who are obese according to BMI have reduced likelihood of incident fracture which appears to be explained by higher aBMD. Falls risk assessment may improve identification of obese older adults at increased risk of incident fractures.

Optimal body mass index for minimizing the risk for osteoporosis and type 2 diabetes

BACKGROUND/AIMS

Body mass index (BMI) is positively associated with bone mineral density and type 2 diabetes. We investigated an optimal BMI range for osteoporosis and type 2 diabetes.

METHODS

This cross-sectional study used data from the Korea National Health and Nutrition Examination Survey (KNHANES), 2008 to 2011. We included 3,774 men aged > 50 years and 4,982 postmenopausal women. Logistic regression models were applied to elucidate each BMI category's osteoporosis and diabetes risks.

RESULTS

The prevalence of osteoporosis was 9.0% for men and 40.8% for women. The prevalence of type 2 diabetes in men was 19.7% and in women was 15.5%. In men with BMI > 25 kg/m2, the osteoporosis risk did not further increase as BMI increased. In women, BMI was linearly associated with osteoporosis risk without a plateau. In both men and women, higher BMI was associated with a higher type 2 diabetes risk. Men with a BMI of 23.0 to 24.9 kg/m2 harbored about a 30% lower osteoporosis risk than and a similar diabetes risk to those with a BMI of 21.0 to 22.9 kg/m2. In women with a BMI of 23.0 to 24.9 kg/m2, the adjusted odds ratio for osteoporosis was 0.72 (95% confidence interval, 0.59 to 0.87); the diabetes risk was not higher than in those with a BMI of 21.0 to 22.9 kg/m2.

CONCLUSION

For Korean men aged > 50 years and postmenopausal women, a BMI of 23.0 to 24.9 kg/m2 was the optimal range for minimizing osteoporosis and type 2 diabetes risks simultaneously.

Fractures in patients with rheumatoid arthritis and end-stage renal disease

Having rheumatoid arthritis (RA) or end-stage renal disease (ESRD) can lead to fractures. RA independently increases the risk of hip or other femur fracture in dialysis patients. Use of corticosteroids is a potentially modifiable risk factor for fractures among persons with RA and ESRD on dialysis.

PURPOSE

Rheumatoid arthritis (RA) and end-stage renal disease (ESRD) both independently increase fracture risk; however, how RA and ESRD interplay to affect fracture risk is unknown. We aim to determine the association of RA with fracture in ESRD and identify risk factors for fracture in patients with RA and ESRD.

METHODS

A retrospective cohort study was conducted using the United States Renal Data System (USRDS) to identify ESRD adults with and without a history of RA who initiated dialysis in 2005-2008. International Classification of Diseases, 9th Revision (ICD-9) codes were used to identify fractures following start of dialysis. Risk for incident fracture was compared between those with and without RA. Potential risk factors for fracture among persons with RA and ESRD were analyzed.

RESULTS

There were 754 persons with ESRD and RA, of whom 126 (17%) had any incident fracture. In multivariable adjusted final models, among ESRD patients, RA was an independent risk factor for hip/femur fracture (RR 1.28, 95% CI 1.01-1.64). Among persons with RA and ESRD, in final models, only corticosteroid use was a significant risk factor for both any incident (RR 2.00, 95% CI 1.40-2.87) and hip/femur (RR 1.97, 95% CI 1.24-3.11) fracture. Those with higher body mass index had a lower relative risk of hip/femur fracture (RR 0.95, 95% CI 0.91-0.99).

CONCLUSION

Among ESRD patients, those with RA have a 28% increased risk for hip or other femur fracture. Use of corticosteroids is a potentially modifiable risk factor for fractures among persons with RA and ESRD.

A phase 1 pooled PK/PD analysis of bone resorption biomarkers for odanacatib, a Cathepsin K inhibitor

To develop a framework for evaluating the resorption effects of Cathepsin K (CatK) inhibitors and to inform dose regimen selection, a pharmacokinetic/pharmacodynamic (PK/PD) model for odanacatib (ODN) was developed based upon data from Phase 1 studies. Pooled PK/PD data from 11 studies (N = 249) were fit reasonably to a population inhibitory sigmoid E_max model. Body weight on E₀ (baseline uNTx/Cr, urinary N-terminal telopeptide normalized by creatinine) and age on E_max (fractional inhibition of the biomarker response) were significant covariates for biomarker response. Simulations of typical osteoporosis patients (by age, sex and weight) indicated minimal differences between sexes in concentration-uNTx/Cr relationship. There was no evidence that regimen (daily vs. weekly dosing) influenced the PK/PD relationship of resorption inhibition for odanacatib. PK/PD models based on data from odanacatib (ODN) Phase 1 studies demonstrated that uNTx/Cr was an appropriate bone resorption biomarker for assessment of the effects of a CatK inhibitor. The models also identified the determinants of response in the PK/PD relationship for ODN (body weight on E₀ and age on E_max).