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Lai B, Jiang H, Gao R, Zhou X. Association between alcohol intake and bone mineral density: results from the NHANES 2005-2020 and two-sample Mendelian randomization. Arch Osteoporos 2024; 19:21. [PMID: 38546895 DOI: 10.1007/s11657-024-01382-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
We used the data from the NHANES cross-sectional study among 14,113 participants and indicated a positive correlation between alcohol intake frequency and bone mineral density in different body sites. Mendelian randomization was conducted, and no causal relationship is significant between these two variables. The study can provide some suggestions on the daily consumption of alcohol for osteoporosis patients. PURPOSE The effect of alcohol intake on bone mineral density (BMD) remains unclear. This study explored the association and causality between alcohol intake and BMD. METHODS Based on the 2005-2020 National Health and Nutrition Examination Survey including 14,113 participants, we conducted co-variate-adjusted multilinear regression analyses to explore the association between alcohol intake levels and spine or femur BMD. To evaluate the causal association between alcohol intake frequency and bone mineral density, the inverse variance weighted approach of two-sample Mendelian randomization (MR) was used with genetic data from the Medical Research Council Integrative Epidemiology Unit (462,346 cases) for alcohol intake frequency and the Genetic Factors for Osteoporosis Consortium (28,496 cases) for lumbar spine and femur neck BMD (32,735 cases). RESULTS Compared with non-drinkers, total femur BMDs but not total spine BMD increased with daily alcohol intake in males (β = 3.63*10-2 for mild drinkers, β = 4.21*10-2 for moderate drinkers, and β = 4.26*10-2 for heavy drinkers). By contrast, the higher total spine BMD in females was related to higher alcohol intake levels (β = 2.15*10-2 for mild drinkers, β = 2.59*10-2 for moderate drinkers, and β = 3.88*10-2 for heavy drinkers). Regarding the two-sample MR results, no causal relationship was observed between alcohol intake frequency and lumbar spine BMD (odds ratio [OR] = 1.016, P = 0.789) or femur neck BMD (OR = 1.048, P = 0.333). CONCLUSION This study suggests a positive association between alcohol intake frequency and BMD, although the causal relationship was not significant.
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Affiliation(s)
- Bowen Lai
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Heng Jiang
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Rui Gao
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xuhui Zhou
- Department of Orthopedics, Changzheng Hospital, Second Military Medical University, Shanghai, China.
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Gholami F, Bahrampour N, Samadi M, Rasaei N, Yarizadeh H, Naghshi S, Mirzaei K. The association of dietary acid load (DAL) with estimated skeletal muscle mass and bone mineral content: a cross-sectional study. BMC Nutr 2023; 9:31. [PMID: 36788599 PMCID: PMC9926757 DOI: 10.1186/s40795-022-00658-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 12/21/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND & AIMS Dietary patterns that promote mild metabolic acidosis may have a negative effect on bone and muscle, and a high dietary acid load (DAL) may be detrimental to skeletal muscle mass and bone mineral content. However, the association between skeletal muscle mass and bone mineral content with dietary acid load has not been consistently reported in previous studies. The objective of the study was to evaluate the association of potential renal net acid load (PRAL) and net endogenous acid production (NEAP) with bone mineral content and skeletal muscle mass in pre-menopause women with overweight or obesity in Iran. METHOD Three hundred and ninety women with a body mass index (BMI) of 25 were included in this cross-sectional study. We used a validated 147-item semi-quantitative food frequency questionnaire (FFQ) for evaluating the dietary intake. Based on the dietary data, potential renal net acid load (PRAL) and net endogenous acid production (NEAP) were calculated. Muscle mass and bone mineral content were estimated by a bioelectrical impedance analyzer (BIA). RESULTS After controlling for potential confounders, we discovered a significant linear relationship between PRAL (β = -0.027, 95%CI = -0.049 to -0.004, P = 0.02) and NEAP (β = -0.05, 95%CI = -0.097 to -0.003, P = 0.03) and skeletal muscle mass index. However, there was no significant difference between SMM and BMC across PRAL and NEAP tertiles. CONCLUSION PRAL and NEAP were found to be inversely related to skeletal muscle mass index among overweight/obese women. Further research is required to establish whether this relationship is important for musculoskeletal health in these populations.
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Affiliation(s)
- Fatemeh Gholami
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O Box 6446, Tehran, 14155 Iran
| | - Niki Bahrampour
- grid.411463.50000 0001 0706 2472Department of Nutrition, Science and Research Branch, Islamic Azad University (SRBIAU), Tehran, Iran
| | - Mahsa Samadi
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O Box 6446, Tehran, 14155 Iran
| | - Niloufar Rasaei
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O Box 6446, Tehran, 14155 Iran
| | - Habib Yarizadeh
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O Box 6446, Tehran, 14155 Iran
| | - Sina Naghshi
- grid.411705.60000 0001 0166 0922Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O Box 6446, Tehran, 14155 Iran
| | - Khadijeh Mirzaei
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), P.O Box 6446, Tehran, 14155, Iran.
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Ebeling PR, Nguyen HH, Aleksova J, Vincent AJ, Wong P, Milat F. Secondary Osteoporosis. Endocr Rev 2022; 43:240-313. [PMID: 34476488 DOI: 10.1210/endrev/bnab028] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 02/07/2023]
Abstract
Osteoporosis is a global public health problem, with fractures contributing to significant morbidity and mortality. Although postmenopausal osteoporosis is most common, up to 30% of postmenopausal women, > 50% of premenopausal women, and between 50% and 80% of men have secondary osteoporosis. Exclusion of secondary causes is important, as treatment of such patients often commences by treating the underlying condition. These are varied but often neglected, ranging from endocrine to chronic inflammatory and genetic conditions. General screening is recommended for all patients with osteoporosis, with advanced investigations reserved for premenopausal women and men aged < 50 years, for older patients in whom classical risk factors for osteoporosis are absent, and for all patients with the lowest bone mass (Z-score ≤ -2). The response of secondary osteoporosis to conventional anti-osteoporosis therapy may be inadequate if the underlying condition is unrecognized and untreated. Bone densitometry, using dual-energy x-ray absorptiometry, may underestimate fracture risk in some chronic diseases, including glucocorticoid-induced osteoporosis, type 2 diabetes, and obesity, and may overestimate fracture risk in others (eg, Turner syndrome). FRAX and trabecular bone score may provide additional information regarding fracture risk in secondary osteoporosis, but their use is limited to adults aged ≥ 40 years and ≥ 50 years, respectively. In addition, FRAX requires adjustment in some chronic conditions, such as glucocorticoid use, type 2 diabetes, and HIV. In most conditions, evidence for antiresorptive or anabolic therapy is limited to increases in bone mass. Current osteoporosis management guidelines also neglect secondary osteoporosis and these existing evidence gaps are discussed.
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Affiliation(s)
- Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia
| | - Hanh H Nguyen
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Department of Endocrinology and Diabetes, Western Health, Victoria 3011, Australia
| | - Jasna Aleksova
- Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Amanda J Vincent
- Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria 3168, Australia
| | - Phillip Wong
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Frances Milat
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
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Chin EL, Van Loan M, Spearman SS, Bonnel EL, Laugero KD, Stephensen CB, Lemay DG. Machine Learning Identifies Stool pH as a Predictor of Bone Mineral Density in Healthy Multiethnic US Adults. J Nutr 2021; 151:3379-3390. [PMID: 34313764 DOI: 10.1093/jn/nxab266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/14/2021] [Accepted: 07/21/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND A variety of modifiable and nonmodifiable factors such as ethnicity, age, and diet have been shown to influence bone health. Previous studies are usually limited to analyses focused on the association of a few a priori variables or on a specific subset of the population. OBJECTIVE Dietary, physiological, and lifestyle data were used to identify directly modifiable and nonmodifiable variables predictive of bone mineral content (BMC) and bone mineral density (BMD) in healthy US men and women using machine-learning models. METHODS Ridge, lasso, elastic net, and random forest models were used to predict whole-body, femoral neck, and spine BMC and BMD in healthy US men and women ages 18-66 y, with a BMI (kg/m2) of 18-44 (n = 313), using nonmodifiable anthropometric, physiological, and demographic variables; directly modifiable lifestyle (physical activity, tobacco use) and dietary (via FFQ) variables; and variables approximating directly modifiable behavior (circulating 25-hydroxycholecalciferol and stool pH). RESULTS Machine-learning models using nonmodifiable variables explained more variation in BMC and BMD (highest R2 = 0.75) compared with when using only directly modifiable variables (highest R2 = 0.11). Machine-learning models had better performance compared with multivariate linear regression, which had lower predictive value (highest R2 = 0.06) when using directly modifiable variables only. BMI, body fat percentage, height, and menstruation history were predictors of BMC and BMD. For directly modifiable features, betaine, cholesterol, hydroxyproline, menaquinone-4, dihydrophylloquinone, eggs, cheese, cured meat, refined grains, fruit juice, and alcohol consumption were predictors of BMC and BMD. Low stool pH, a proxy for fermentable fiber intake, was also predictive of higher BMC and BMD. CONCLUSIONS Modifiable factors, such as diet, explained less variation in the data compared with nonmodifiable factors, such as age, sex, and ethnicity, in healthy US men and women. Low stool pH predicted higher BMC and BMD. This trial was registered at www.clinicaltrials.gov as NCT02367287.
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Affiliation(s)
- Elizabeth L Chin
- USDA ARS Western Human Nutrition Research Center, Davis, CA, USA
| | | | - Sarah S Spearman
- USDA ARS Western Human Nutrition Research Center, Davis, CA, USA
| | - Ellen L Bonnel
- USDA ARS Western Human Nutrition Research Center, Davis, CA, USA.,University of California, Davis, Davis, CA, USA
| | - Kevin D Laugero
- USDA ARS Western Human Nutrition Research Center, Davis, CA, USA.,University of California, Davis, Davis, CA, USA
| | - Charles B Stephensen
- USDA ARS Western Human Nutrition Research Center, Davis, CA, USA.,University of California, Davis, Davis, CA, USA
| | - Danielle G Lemay
- USDA ARS Western Human Nutrition Research Center, Davis, CA, USA.,University of California, Davis, Davis, CA, USA
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Juonala M, Pitkänen N, Tolonen S, Laaksonen M, Sievänen H, Jokinen E, Laitinen T, Sabin MA, Hutri-Kähönen N, Lehtimäki T, Taittonen L, Jula A, Loo BM, Impivaara O, Kähönen M, Magnussen CG, Viikari JSA, Raitakari OT. Childhood Exposure to Passive Smoking and Bone Health in Adulthood: The Cardiovascular Risk in Young Finns Study. J Clin Endocrinol Metab 2019; 104:2403-2411. [PMID: 30715377 DOI: 10.1210/jc.2018-02501] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/29/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Passive smoke exposure has been linked to the risk of osteoporosis in adults. OBJECTIVE We examined the independent effects of childhood passive smoke exposure on adult bone health. DESIGN/SETTING Longitudinal, the Cardiovascular Risk in Young Finns Study. PARTICIPANTS The study cohort included 1422 individuals followed for 28 years since baseline in 1980 (age 3 to 18 years). Exposure to passive smoking was determined in childhood. In adulthood, peripheral bone traits were assessed with peripheral quantitative CT (pQCT) at the tibia and radius, and calcaneal mineral density was estimated with quantitative ultrasound. Fracture data were gathered by questionnaires. RESULTS Parental smoking in childhood was associated with lower pQCT-derived bone sum index in adulthood (β± SE, -0.064 ± 0.023 per smoking parent; P = 0.004) in multivariate models adjusted for age, sex, active smoking, body mass index, serum 25-OH vitamin D concentration, physical activity, and parental socioeconomic position. Similarly, parental smoking was associated with lower heel ultrasound estimated bone mineral density in adulthood (β± SE, -0.097 ± 0.041 per smoking parent; P = 0.02). Parental smoking was also associated with the incidence of low-energy fractures (OR, 1.28; 95% CI, 1.01 to 1.62). Individuals with elevated cotinine levels (3 to 20 ng/mL) in childhood had lower bone sum index with pQCT (β± SE, -0.206 ± 0.057; P = 0.0003). Children whose parents smoked and had high cotinine levels (3 to 20 ng/mL) had significantly lower pQCT-derived bone sum index compared with those with smoking parents but had low cotinine levels (<3 ng/mL) (β± SE, -0.192 ± 0.072; P = 0.008). CONCLUSIONS AND RELEVANCE Children of parents who smoke have evidence of impaired bone health in adulthood.
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Affiliation(s)
- Markus Juonala
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Turku, Finland
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Niina Pitkänen
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Sanna Tolonen
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | - Marika Laaksonen
- Department of Food and Nutrition, University of Helsinki, Helsinki, Finland
| | | | - Eero Jokinen
- Department of Pediatric Cardiology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Tomi Laitinen
- Department of Clinical Physiology, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Matthew A Sabin
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
- Royal Children's Hospital, Parkville, Victoria, Australia
| | - Nina Hutri-Kähönen
- Department of Pediatrics, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Faculty of Medicine and Health Technology, Finnish Cardiovascular Research Center- Tampere, Tampere University, Tampere, Finland
| | | | - Antti Jula
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland
| | - Britt-Marie Loo
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland
- Joint Clinical Biochemistry Laboratory of University of Turku and Turku University Hospital, Turku, Finland
| | - Olli Impivaara
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Turku, Finland
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Costan G Magnussen
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Jorma S A Viikari
- Department of Medicine, University of Turku and Division of Medicine, Turku University Hospital, Turku, Finland
| | - Olli T Raitakari
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
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Hickey M, Trainer A, Braat S, Davey MA, Krejany E, Wark J. What Happens After Menopause? (WHAM): protocol for a prospective, multicentre, age-matched cohort trial of risk-reducing bilateral salpingo-oophorectomy in high-risk premenopausal women. BMJ Open 2017; 7:e018758. [PMID: 29138210 PMCID: PMC5695307 DOI: 10.1136/bmjopen-2017-018758] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Women at high inherited risk of ovarian cancer are advised to undergo risk-reducing bilateral salpingo-oophorectomy (RRBSO) at age 40-45 years or when their families are complete. Most women are premenopausal at this age, so RRBSO will induce surgical menopause. Despite the clear benefits of RRBSO for cancer risk reduction, much less is known about the impact on non-cancer outcomes that contribute to health and well-being and inform surveillance and management strategies. METHODS AND ANALYSIS This will be a multicentre, prospective cohort study of 105 premenopausal high-risk women undergoing RRBSO and an age-matched comparison group of 105 premenopausal women not planning oophorectomy or pregnancy in the next 2 years. The aim of this study is to measure the impact of RRBSO on sexual function (primary outcome) at 24 months in high-risk premenopausal women compared with the comparison group. Secondary outcomes include menopausal symptoms and menopause-related quality of life, mood, sleep quality, markers of cardiovascular disease and pre-diabetes, bone density and markers of bone turnover, and the impact of hormone replacement therapy use on these outcomes. Data analysis methods will include logistic and linear regression using general estimating equations accounting for the repeated outcome measurements within each participant. ETHICS AND DISSEMINATION The study has been approved by institutional ethics committees at each participating centre. Findings will be disseminated through peer-reviewed publications and conference presentations, and national and international networks of centres managing high-risk women, and will inform national and international clinical guidelines. TRIAL REGISTRATION NUMBER The pre-results protocol for this trial is registered with the Australian New Zealand Clinical Trials Registry (anzctr.org.au; registration no: ACTRN12615000082505).
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Affiliation(s)
- Martha Hickey
- Department of Obstetrics and Gynaecology, The Royal Women’s Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Alison Trainer
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sabine Braat
- Melbourne Clinical and Translational Sciences (MCATS), Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Efrosinia Krejany
- Gynaecology Research Centre, The Royal Women’s Hospital, Parkville, Victoria, Australia
| | - John Wark
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Department of Bone and Mineral Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Shiek Ahmad B, Petty SJ, Gorelik A, O'Brien TJ, Hill KD, Christie JJ, Sambrook PN, Wark JD. Bone loss with antiepileptic drug therapy: a twin and sibling study. Osteoporos Int 2017; 28:2591-2600. [PMID: 28589417 DOI: 10.1007/s00198-017-4098-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022]
Abstract
UNLABELLED Changes in areal bone mineral density (aBMD) and other predictors of bone loss were evaluated in 48 same-sex twin/age-matched sibling pairs discordant for antiepileptic drug (AED) use. AED users had reduced BMD at the hip regions. Prolonged AED users had greater aBMD loss, predicting a higher risk of bone fragility. INTRODUCTION To investigate the longitudinal associations of bone mineral measures with antiepileptic drug (AED) use, including enzyme-inducing (EIAED) and non-enzyme-inducing (NEIAED) types, and other predictors of bone loss in a study of 48 same-sex twin/age-matched sibling pairs (40 female, 8 male) discordant for AED use. METHODS Using dual-energy X-ray absorptiometry (DXA), areal bone mineral density (aBMD) and content (BMC) at the hip regions, forearm, lumbar spine, and whole body were measured twice, at least 2 years apart. The mean within-pair difference (MWPD), MWPD%, and mean annual rate of aBMD change were adjusted for age, weight, and height. Predictors of bone loss were evaluated. RESULTS AED users, compared to non-users, at baseline and follow-up, respectively, had reduced aBMD at the total hip (MWPD% 3.8, 4.4%), femoral neck (4.7, 4.5%), and trochanter regions (4.1, 4.6%) (p < 0.05). For the whole cohort, the annual rate of change in all aBMD/BMC (p > 0.05) regions did not differ within pairs. Nevertheless, EIAED users had greater aBMD loss than non-users (n = 20 pairs) at the total hip (1.7 vs. 0.3%, p = 0.013) and whole body regions (0.7% loss vs. 0.1% BMD gain, p = 0.019), which was not found in NEIAED-discordant pairs (n = 16). AED use >20 years predicted higher aBMD loss at the forearm (p = 0.028), whole body (p = 0.010), and whole body BMC (p = 0.031). CONCLUSIONS AED users had reduced aBMD at the hip regions. Prolonged users and EIAED users had greater aBMD loss, predicting a higher risk of bone fragility. Further prospective studies of AED effects on bone microarchitecture are needed.
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Affiliation(s)
- B Shiek Ahmad
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Level 4, Clinical Sciences Building, Parkville, Victoria, 3050, Australia
- Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - S J Petty
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Level 4, Clinical Sciences Building, Parkville, Victoria, 3050, Australia
| | - A Gorelik
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Level 4, Clinical Sciences Building, Parkville, Victoria, 3050, Australia
- Melbourne EpiCentre, The Royal Melbourne Hospital, Parkville, Victoria, 3050, Australia
| | - T J O'Brien
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Level 4, Clinical Sciences Building, Parkville, Victoria, 3050, Australia
| | - K D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, 6845, Australia
| | - J J Christie
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Level 4, Clinical Sciences Building, Parkville, Victoria, 3050, Australia
| | - P N Sambrook
- Department of Medicine, Royal North Shore Hospital, The University of Sydney, Sydney, New South Wales, 2006, Australia
| | - J D Wark
- Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Level 4, Clinical Sciences Building, Parkville, Victoria, 3050, Australia.
- The Royal Melbourne Hospital Bone and Mineral Service, Parkville, Victoria, 3050, Australia.
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Munteanu SE, Menz HB, Wark JD, Christie JJ, Scurrah KJ, Bui M, Erbas B, Hopper JL, Wluka AE. Hallux Valgus, By Nature or Nurture? A Twin Study. Arthritis Care Res (Hoboken) 2017; 69:1421-1428. [DOI: 10.1002/acr.23154] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 10/12/2016] [Accepted: 11/15/2016] [Indexed: 12/31/2022]
Affiliation(s)
| | | | - John D. Wark
- University of Melbourne and Royal Melbourne Hospital; Parkville Victoria Australia
| | - Jemma J. Christie
- University of Melbourne and Royal Melbourne Hospital; Parkville Victoria Australia
| | | | - Minh Bui
- University of Melbourne; Parkville Victoria Australia
| | - Bircan Erbas
- La Trobe University; Melbourne Victoria Australia
| | | | - Anita E. Wluka
- Monash University and Alfred Hospital; Melbourne Victoria Australia
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Senderovich H, Tang H, Belmont S. The Role of Exercises in Osteoporotic Fracture Prevention and Current Care Gaps. Where Are We Now? Recent Updates. Rambam Maimonides Med J 2017; 8:RMMJ.10308. [PMID: 28786812 PMCID: PMC5548111 DOI: 10.5041/rmmj.10308] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The primary non-pharmacological management recommended for patients with osteoporosis (OP) is exercise, but whether it should be high-force, resistive, or other means can be obscure. OBJECTIVE To describe the role of exercises in osteoporotic fracture prevention, identify effects and potential risks of high-force exercises, detect the optimal exercises to combat OP, and explore the challenges that might arise from interventions. METHODS A search on MEDLINE and Cochrane databases was conducted on the role of exercises in preventing osteoporotic fractures from 1989 onwards, leading to 40 results, including op-ed pieces, qualitative studies, randomized clinical trials (RCTs) (n=5), and RCT follow-up studies (n=1). Articles deemed relevant to the objectives were analyzed and summarized. Data on effects of vitamin D and calcium supplementation were later gathered from different sources as well. RESULTS High-intensity, resistive strength training provided the maximum benefit in increasing bone mineral density (BMD) levels, muscle mass, and reduction in fractures, while posture and balance exercises only improved mobility. High-force exercises did not increase fractures and were associated with increases in BMD. Interventions including exercises, vitamin D, and calcium intake had limited effect when used as single interventions, while vitamin D and calcium may potentially cause increases of cardiovascular events. CONCLUSION A long-term regular exercise program designed to improve postural stability, mobility, and mechanical efficiency, alongside an increased vitamin D and dietary calcium intake, is most effective in preventing OP and reducing osteoporotic fractures.
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Affiliation(s)
- Helen Senderovich
- Geriatrics & Palliative Care & Pain Medicine, Baycrest Health Sciences, Assistant Professor, University of Toronto, Department of Family and Community Medicine, Division of Palliative Care, Toronto, Canada
- To whom correspondence should be addressed. E-mail:
| | - Henry Tang
- Baycrest Health Sciences, Toronto, Canada
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Prior JC, Hitchcock CL, Vigna YM, Seifert-Klauss V. Premenopausal Trabecular Bone Loss is Associated with a Family History of Fragility Fracture. Geburtshilfe Frauenheilkd 2016; 76:895-901. [PMID: 27582584 DOI: 10.1055/s-0042-103751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Although a fragility fracture family history (FFFH+) has repeatedly been shown to be associated with lower bone mineral density (BMD), its relationship to human BMD change is unclear. Animal research, however, documented that different purebred strains within rodent species have wide ranges in rates of bone acquisition during growth as well as in change post-ovariectomy. Our objective was to compare the rate of premenopausal spinal trabecular BMD change between women with and without a general family history of fragility fracture. PARTICIPANTS AND METHODS Healthy premenopausal community women participated in prospective observational studies at two academic medical research centres: Vancouver, Canada (n = 66) and Munich, Germany (n = 20). The primary outcome was annual spinal BMD change, measured by quantitative computed tomography (QCT). The two studies employed similar methodologies for assessing QCT and FFFH. RESULTS Volunteer community participants had a mean age of 36.0 (SD, 6.9) years, body mass index 22.5 (2.4) and baseline QCT of 150.2 (22.5) mg/cm3 trabecular bone. The rates of BMD change were similar in both cities: - 3.5 (5.1)/year Vancouver, - 2.0 (3.4)/year Munich (95 % CI of difference: - 3.9, 0.9). Over a third of the women (31 of the 86, 36 %) reported FFFH+. Those with and without a FFFH were similar in demographics, nutrition, exercise, menstrual cycle and luteal phase lengths and physiological measures (serum calcium, osteocalcin and estradiol). However, women with FFFH+ lost trabecular BMD more rapidly: FFFH+, - 4.9 (5.0), FFFH-, - 2.2 (4.4) mg/cm3/year (95 % CI diff - 0.7 to - 4.8, F1.83 = 7.88, p = 0.006). FFFH+ explained 7.7 % of the variance in QCT volumetric trabecular spinal bone change/year in these healthy premenopausal women. CONCLUSION This study shows for the first time that having a history of a fragility fracture in a family member is associated with a greater rate of premenopausal spinal trabecular bone loss.
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Affiliation(s)
- J C Prior
- Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada; Dept. of Medicine, University of British Columbia, Vancouver, BC, Canada; Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - C L Hitchcock
- Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - Y M Vigna
- Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - V Seifert-Klauss
- Frauenklinik und Poliklinik, Gynecologic Endocrinology and Interdisciplinary Osteoporosis Center (IOZ), Klinikum rechts der Isar, TUM Munich, Germany
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Lean Mass and Body Fat Percentage Are Contradictory Predictors of Bone Mineral Density in Pre-Menopausal Pacific Island Women. Nutrients 2016; 8:nu8080470. [PMID: 27483314 PMCID: PMC4997383 DOI: 10.3390/nu8080470] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/12/2016] [Accepted: 07/22/2016] [Indexed: 01/10/2023] Open
Abstract
Anecdotally, it is suggested that Pacific Island women have good bone mineral density (BMD) compared to other ethnicities; however, little evidence for this or for associated factors exists. This study aimed to explore associations between predictors of bone mineral density (BMD, g/cm2), in pre-menopausal Pacific Island women. Healthy pre-menopausal Pacific Island women (age 16–45 years) were recruited as part of the larger EXPLORE Study. Total body BMD and body composition were assessed using Dual X-ray Absorptiometry and air-displacement plethysmography (n = 83). A food frequency questionnaire (n = 56) and current bone-specific physical activity questionnaire (n = 59) were completed. Variables expected to be associated with BMD were applied to a hierarchical multiple regression analysis. Due to missing data, physical activity and dietary intake factors were considered only in simple correlations. Mean BMD was 1.1 ± 0.08 g/cm2. Bone-free, fat-free lean mass (LMO, 52.4 ± 6.9 kg) and age were positively associated with BMD, and percent body fat (38.4 ± 7.6) was inversely associated with BMD, explaining 37.7% of total variance. Lean mass was the strongest predictor of BMD, while many established contributors to bone health (calcium, physical activity, protein, and vitamin C) were not associated with BMD in this population, partly due to difficulty retrieving dietary data. This highlights the importance of physical activity and protein intake during any weight loss interventions to in order to minimise the loss of muscle mass, whilst maximizing loss of adipose tissue.
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Hakami T, O'Brien TJ, Petty SJ, Sakellarides M, Christie J, Kantor S, Todaro M, Gorelik A, Seibel MJ, Yerra R, Wark JD. Monotherapy with Levetiracetam Versus Older AEDs: A Randomized Comparative Trial of Effects on Bone Health. Calcif Tissue Int 2016; 98:556-65. [PMID: 26842957 DOI: 10.1007/s00223-016-0109-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 01/07/2016] [Indexed: 10/22/2022]
Abstract
Long-term anti-epileptic drug (AED) therapy is associated with increased fracture risk. This study tested whether substituting the newer AED levetiracetam has less adverse effects on bone than older AEDs. An open-label randomized comparative trial. Participants had "failed" initial monotherapy for partial epilepsy and were randomized to substitution monotherapy with levetiracetam or an older AED (carbamazepine or valproate sodium). Bone health assessments, performed at 3 and 15 months, included areal bone mineral density (aBMD) and content at lumbar spine (LS), total hip (TH), forearm (FA), and femoral neck (FN), radial and tibial peripheral quantitative computed tomography and serum bone turnover markers. Main outcomes were changes by treatment group in aBMD at LS, TH, and FA, radial and tibial trabecular BMD and cortical thickness. 70/84 patients completed assessments (40 in levetiracetam- and 30 in older AED group). Within-group analyses showed decreases in both groups in LS (-9.0 %; p < 0.001 in levetiracetam vs. -9.8 %; p < 0.001 in older AED group), FA (-1.46 %; p < 0.001 vs. -0.96 %; p < 0.001, respectively) and radial trabecular BMD (-1.46 %; p = 0.048 and -2.31 %; p = 0.013, respectively). C-terminal telopeptides of type I collagen (βCTX; bone resorption marker) decreased in both groups (-16.1 %; p = 0.021 vs. -15.2 %; p = 0.028, respectively) whereas procollagen Ι N-terminal peptide (PΙNP; bone formation marker) decreased in older AED group (-27.3 %; p = 0.008). The treatment groups did not differ in any of these measures. In conclusion, use of both levetiracetam and older AEDs was associated with bone loss over 1 year at clinically relevant fracture sites and a reduction in bone turnover.
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Affiliation(s)
- Tahir Hakami
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, 4th Floor Clinical Sciences Building Royal Parade, The Royal Melbourne Hospital, Parkville, 3050, VIC, Australia
- Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Terence J O'Brien
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, 4th Floor Clinical Sciences Building Royal Parade, The Royal Melbourne Hospital, Parkville, 3050, VIC, Australia
| | - Sandra J Petty
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, 4th Floor Clinical Sciences Building Royal Parade, The Royal Melbourne Hospital, Parkville, 3050, VIC, Australia
| | - Mary Sakellarides
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, 4th Floor Clinical Sciences Building Royal Parade, The Royal Melbourne Hospital, Parkville, 3050, VIC, Australia
| | - Jemma Christie
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, 4th Floor Clinical Sciences Building Royal Parade, The Royal Melbourne Hospital, Parkville, 3050, VIC, Australia
| | - Susan Kantor
- Bone Densitometry Unit, The Royal Melbourne Hospital, Melbourne, Australia
| | - Marian Todaro
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, 4th Floor Clinical Sciences Building Royal Parade, The Royal Melbourne Hospital, Parkville, 3050, VIC, Australia
| | - Alexandra Gorelik
- The Melbourne EpiCentre, The Royal Melbourne Hospital, Melbourne, Australia
| | - Markus J Seibel
- Bone Research Program, ANZAC Research Institute, The University of Sydney, Sydney, Australia
| | - Raju Yerra
- Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia
| | - John D Wark
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, 4th Floor Clinical Sciences Building Royal Parade, The Royal Melbourne Hospital, Parkville, 3050, VIC, Australia.
- Bone & Mineral Medicine, The Royal Melbourne Hospital, Melbourne, Australia.
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He H, Liu Y, Tian Q, Papasian CJ, Hu T, Deng HW. Relationship of sarcopenia and body composition with osteoporosis. Osteoporos Int 2016; 27:473-82. [PMID: 26243357 DOI: 10.1007/s00198-015-3241-8] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 07/07/2015] [Indexed: 01/08/2023]
Abstract
UNLABELLED The purpose of the study is to investigate the relationship between sarcopenia and body composition and osteoporosis in cohorts of three different races with a total of 17,891 subjects. Lean mass and grip strength were positively associated with bone mineral densities (BMDs). Subjects with sarcopenia were two times more likely to have osteoporosis compared with normal subjects. INTRODUCTION The relationship between sarcopenia and osteoporosis is not totally clear. First, the present study assessed this relationship by using two different definitions for sarcopenia. Second, we examined the associations of body composition (including muscle mass as a major and important component) and muscle strength on regional and whole-body BMDs. METHODS In total, 17,891 subjects of African American, Caucasian, and Chinese ethnicities were analyzed. Sarcopenia was defined by relative appendicular skeletal muscle mass (RASM) cut points and also by the definition of the European Working Group on Sarcopenia in Older People (low RASM plus low muscle function). Multiple regression analyses were conducted to examine the association of fat mass, lean mass (including muscle mass), and grip strength with regional and whole-body BMDs. Multivariate logistic regression analysis was performed to explore the association between sarcopenia and osteopenia/osteoporosis. RESULTS BMDs were positively associated with lean mass and negatively associated with fat mass, after controlling for potential confounders. Grip strength was significantly associated with higher BMDs. Each standard deviation (SD) increase in RASM resulted in a ~37 % reduction in risk of osteopenia/osteoporosis (odds ratio (OR) = 0.63; 95 % confidence interval (CI) = 0.59, 0.66). Subjects with sarcopenia defined by RASM were two times more likely to have osteopenia/osteoporosis compared with the normal subjects (OR = 2.04; 95 % CI = 1.61, 2.60). Similarly, subjects with sarcopenia (low muscle mass and low grip strength) were ~1.8 times more likely to have osteopenia/osteoporosis than normal subjects (OR = 1.87; 95 % CI = 1.09, 3.20). CONCLUSIONS High lean mass and muscle strength were positively associated with BMDs. Sarcopenia is associated with low BMD and osteoporosis.
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Affiliation(s)
- H He
- Center of Genomics and Bioinformatics, Tulane University, New Orleans, LA, 70118, USA
- Department of Biostatistics and Bioinformatics, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2001, New Orleans, LA, 70112, USA
| | - Y Liu
- Center of Genomics and Bioinformatics, Tulane University, New Orleans, LA, 70118, USA
- Department of Biostatistics and Bioinformatics, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2001, New Orleans, LA, 70112, USA
| | - Q Tian
- Center of Genomics and Bioinformatics, Tulane University, New Orleans, LA, 70118, USA
- Department of Biostatistics and Bioinformatics, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2001, New Orleans, LA, 70112, USA
| | - C J Papasian
- Department of Basic Medical Sciences, University of Missouri-Kansas City, Kansas City, MO, 64110, USA
| | - T Hu
- Department of Epidemiology, Tulane University, New Orleans, LA, 70112, USA
| | - H-W Deng
- Center of Genomics and Bioinformatics, Tulane University, New Orleans, LA, 70118, USA.
- Department of Biostatistics and Bioinformatics, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal St., Suite 2001, New Orleans, LA, 70112, USA.
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Chest Low-Dose Computed Tomography for Early Lung Cancer Diagnosis as an Opportunity to Diagnose Vertebral Fractures in HIV-Infected Smokers, an ANRS EP48 HIV CHEST Substudy. J Acquir Immune Defic Syndr 2015; 69:299-305. [PMID: 26058045 DOI: 10.1097/qai.0000000000000599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To estimate the prevalence of vertebral fractures on chest low-dose computed tomography (LDCT) in HIV-infected smokers. METHODS Cross-sectional study of vertebral fractures visualized on chest LDCT from a multicenter prospective cohort evaluating feasibility of chest LDCT for early lung cancer diagnosis in HIV-infected subjects. Subjects were included if 40 years or older, had been active smokers within the last 3 years of at least 20 pack-years, and had a CD4 T-lymphocyte nadir cell count <350 per microliter and an actual CD4 T-cell count >100 cells per microliter. Spinal reconstructed sagittal planes obtained from chest axial native acquisitions were blindly read by a musculoskeletal imaging specialist. Assessment of the fractured vertebra used Genant semiquantitative method. The study end point was the prevalence of at least 1 vertebral fracture. RESULTS Three hundred ninety-seven subjects were included. Median age was 49.5 years, median smoking history was 30 pack-years, median last CD4 count was 584 cells per microliter, and median CD4 nadir count was 168 cells per microliter; 90% of subjects had a viral load below 50 copies per milliliter. At least 1 fracture was visible in 46 (11.6%) subjects. In multivariate analysis, smoking ≥40 packs-years [OR = 2.5; 95% CI: (1.2 to 5.0)] was associated with an increased risk of vertebral fracture, while HIV viral load <200 copies per milliliter [OR = 0.3; 95% CI: (0.1 to 0.9)] was protective. CONCLUSIONS Prevalence of vertebral fractures on chest LDCT was 11.6% in this high-risk population. Smoking cessation and early introduction of antiretroviral therapy for prevention of vertebral fractures could be beneficial. Chest LDCT is an opportunity to diagnose vertebral fractures.
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Sudjaritruk T, Puthanakit T. Adverse bone health among children and adolescents growing up with HIV. J Virus Erad 2015. [DOI: 10.1016/s2055-6640(20)30506-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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16
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Petty SJ, Kantor S, Lawrence KM, Berkovic SF, Collins M, Hill KD, Makovey J, Sambrook PN, O'Brien TJ, Wark JD. Weight and fat distribution in patients taking valproate: a valproate-discordant gender-matched twin and sibling pair study. Epilepsia 2014; 55:1551-7. [PMID: 25124647 DOI: 10.1111/epi.12745] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Chronic treatment with valproate (VPA) is commonly associated with weight gain, which potentially has important health implications, in particular increased central fat distribution. We utilized a VPA-discordant same-sex, twin and matched sibling pair study design to primarily examine for differences in fat distribution between patients with epilepsy treated with VPA compared to their matched twin or sibling control. Weight, blood pressure, and leptin levels were assessed. METHODS Height, weight, waist and hip measurements, exercise, blood pressure (BP), and serum leptin levels were measured. Body composition was measured using dual-energy x-ray absorptiometry (DXA). Abdominal fat was expressed as a percentage of the abdominal region (AFat%); and of whole body fat (WBF); (AFat%WBF). Mean within-pair differences were assessed (VPA-user and nonuser). Restricted maximum likelihood (REML) linear mixed model analysis was fitted to examine associations of anthropometrics, zygosity, gender, menopausal status, VPA dose and duration, with weight and AFat%. RESULTS We studied 19 pairs of VPA-discordant, gender-matched (five male, 14 female) twins and siblings. Mean (standard deviation, SD) duration of therapy for VPA users was 11.0 (7.4) years. There were no statistically significant within-pair differences in age, height, weight, body mass index (BMI), BP, leptin level, WBF, AFat%, or AFat%WBF. For pairs in which VPA-user was treated for >11 years there were statistically significant mean within-pair differences in AFat%, (+7.1%, p = 0.03, n = 10 pairs), mean BP (+11.0 mm Hg, p = 0.006, n = 8 pairs); but not in AFat%WBF. VPA duration was positively associated with weight (estimate +0.98 kg/per year of VPA, p = 0.03); VPA treatment duration and dose were not significantly associated with AFat%. SIGNIFICANCE This study demonstrated a relationship between long-term VPA use and abdominal adiposity (AFat%), which could have significant health implications. We recommend ongoing monitoring of weight, BMI, and blood pressure for patients taking VPA.
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Affiliation(s)
- Sandra J Petty
- Department of Medicine, Melbourne Brain Centre, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Department of Medicine, St Vincent's Hospital, The University of Melbourne, Fitzroy, Victoria, Australia; Ormond College, Parkville, Victoria, Australia
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Age, Weight and Body Mass Index Effect on Bone Mineral Density in Postmenopausal Women. HEALTH SCOPE 2014. [DOI: 10.5812/jhs.14075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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18
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Montazerifar F, Karajibani M, Alamian S, Sandoughi M, Zakeri Z, Dashipour AR. Age, Weight and Body Mass Index Effect on Bone Mineral Density in Postmenopausal Women. HEALTH SCOPE 2014. [DOI: 10.17795/jhealthscope-14075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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19
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Replogle RA, Li Q, Wang L, Zhang M, Fleet JC. Gene-by-diet interactions influence calcium absorption and bone density in mice. J Bone Miner Res 2014; 29:657-65. [PMID: 23955923 PMCID: PMC10591522 DOI: 10.1002/jbmr.2065] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 07/10/2013] [Accepted: 07/29/2013] [Indexed: 12/14/2022]
Abstract
Dietary calcium (Ca) intake is needed to attain peak bone mineral density (BMD). Habitual low Ca intake increases intestinal Ca absorption efficiency to protect bone mass, but the mechanism controlling, and the impact of genetics on, this adaptive response is not clear. We fed 11 genetically diverse inbred mouse lines a normal (0.5%) or low (0.25%) Ca diet from 4 to 12 weeks of age (n = 8 per diet per line) and studied the independent and interacting effects of diet and genetics on Ca and bone metabolism. Significant genetic variation was observed in all bone, renal, and intestinal phenotypes measured including Ca absorption. Also, adaptation of Ca absorption and bone parameters to low dietary Ca was significantly different among the lines. Ca absorption was positively correlated to femur BMD (r = 0.17, p = 0.02), and distal femur bone volume/tissue volume (BV/TV) (r = 0.34, p < 0.0001). Although Ca absorption was correlated to 1,25 dihydroxyvitamin D (1,25(OH)2 D) (r = 0.35, p < 0.0001), the adaptation of Ca absorption to low Ca intake did not correlate to diet-induced adaptation of 1,25(OH)2 D across the 11 lines. Several intestinal proteins have been proposed to mediate Ca absorption: claudins 2 and 12, voltage gated Ca channel v1.3 (Cav1.3), plasma membrane Ca ATPase 1b (PMCA1b), transient receptor potential vanilloid member 6 (TRPV6), and calbindin D9k (CaBPD9k). Only the mRNA levels for TRPV6, CaBPD9k, and PMCA1b were related to Ca absorption (r = 0.42, 0.43, and 0.21, respectively). However, a significant amount of the variation in Ca absorption is not explained by the current model and suggests that novel mechanisms remain to be determined. These observations lay the groundwork for discovery-focused initiatives to identify novel genetic factors controlling gene-by-diet interactions affecting Ca/bone metabolism.
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Affiliation(s)
- Rebecca A Replogle
- Department of Nutrition Science, Purdue University, West Lafayette, IN, USA
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Welch AA, MacGregor AJ, Minihane AM, Skinner J, Valdes AA, Spector TD, Cassidy A. Dietary fat and fatty acid profile are associated with indices of skeletal muscle mass in women aged 18-79 years. J Nutr 2014; 144:327-34. [PMID: 24401817 DOI: 10.3945/jn.113.185256] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Age-related loss of skeletal muscle mass results in a reduction in metabolically active tissue and has been related to the onset of obesity and sarcopenia. Although the causes of muscle loss are poorly understood, dietary fat has been postulated to have a role in determining protein turnover through an influence on both inflammation and insulin resistance. This study was designed to investigate the cross-sectional relation between dietary fat intake, as dietary percentage of fat energy (PFE) and fatty acid profile, with indices of skeletal muscle mass in the population setting. Body composition [fat-free mass (FFM; in kg)] and the fat-free mass index (FFMI; kg FFM/m(2)) was measured by using dual-energy X-ray absorptiometry in 2689 women aged 18-79 y from the TwinsUK Study and calculated according to quintile of dietary fat (by food-frequency questionnaire) after multivariate adjustment. Positive associations were found between the polyunsaturated-to-saturated fatty acid (SFA) ratio and indices of FFM, and inverse associations were found with PFE, SFAs, monounsaturated fatty acids (MUFAs), and trans fatty acids (TFAs) (all as % of energy). Extreme quintile dietary differences for PFE were -0.6 kg for FFM and -0.28 kg/m(2) for FFMI; for SFAs, MUFAs, and TFAs, these were -0.5 to -0.8 kg for FFM and -0.26 to -0.38 kg/m(2) for FFMI. These associations were of a similar magnitude to the expected decline in muscle mass that occurs over 10 y. To our knowledge, this is the first population-based study to demonstrate an association between a comprehensive range of dietary fat intake and FFM. These findings indicate that a dietary fat profile already associated with cardiovascular disease protection may also be beneficial for conservation of skeletal muscle mass.
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Affiliation(s)
- Ailsa A Welch
- Norwich Medical School, University of East Anglia, Norwich, UK
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El Badri D, Rostom S, Bouaddi I, Hassani A, Chkirate B, Amine B, Hajjaj-Hassouni N. Effect of body composition on bone mineral density in Moroccan patients with juvenile idiopathic arthritis. Pan Afr Med J 2014; 17:115. [PMID: 25120859 PMCID: PMC4119437 DOI: 10.11604/pamj.2014.17.115.1838] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 08/31/2012] [Indexed: 01/06/2023] Open
Abstract
Introduction The link between bone mass and body composition is widely recognized, but only few works were selectively performed on subjects with juvenile idiopathic arthritis. The aim of our study was to investigate the effect of body composition on bone mineral density (BMD) in Moroccan patients with juvenile idiopathic arthritis. Methods Thirty three children with juvenile idiopathic arthritis (JIA) were included in a cross-sectional study. The diagnosis of JIA was made according to the criteria of the International League of Association of Rheumatology (ILAR). Body mass index (BMI) was calculated from the ratio of weight/height2(kg/m2). Pubertal status was determined according to the Tanner criteria. Bone status, body composition and bone mineral content (BMC) were analyzed by using dual-energy X-ray absorptiometry (DXA). BMD was assessed at the lumbar spine (L1-L4) and at total body in (g/cm2). Total body fat tissue mass (FTM) and lean tissue mass (LTM) were also analyzed by DXA and expressed in kilograms. In children, low BMD was defined as a Z-score less than -2 and osteoporosis was defined as a Z-score less than -2 with a fracture history. Results A cross-sectional study was conducted in 33 Moroccan patients with JIA aged between 4 and 16 years, Fat mass was not related to bone density; in contrast, BMD was positively associated to LTM in total body(r = =0.41, p= 0.04) but not in lumbar spine (r = 0.29, p= 0.17). There exist significant correlation between BMC and BMD in total body (r = 0.51, p = 0.01). Conclusion This study suggests that the LTM is a determining factor of the BMD during adolescence. Other studies with a broader sample would be useful to confirm this relation.
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Affiliation(s)
- Dalal El Badri
- Department of Rheumatology, EL Ayachi Hospital, University Hospital of Rabat-Sale, 11000, Sale, Morocco
| | - Samira Rostom
- Department of Rheumatology, EL Ayachi Hospital, University Hospital of Rabat-Sale, 11000, Sale, Morocco
| | - Ilham Bouaddi
- Department of Rheumatology, EL Ayachi Hospital, University Hospital of Rabat-Sale, 11000, Sale, Morocco
| | - Asmae Hassani
- Department of Rheumatology, EL Ayachi Hospital, University Hospital of Rabat-Sale, 11000, Sale, Morocco
| | - Bouchra Chkirate
- Department of Pediatrics, children's Hospital, University Hospital of Rabat-Sale, 11000, Rabat, Morocco
| | - Bouchra Amine
- Department of Rheumatology, EL Ayachi Hospital, University Hospital of Rabat-Sale, 11000, Sale, Morocco
| | - Najia Hajjaj-Hassouni
- Department of Rheumatology, EL Ayachi Hospital, University Hospital of Rabat-Sale, 11000, Sale, Morocco
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Shin D, Kim S, Kim KH, Park SM. Importance of fat mass and lean mass on bone health in men: the Fourth Korean National Health and Nutrition Examination Survey (KNHANES IV). Osteoporos Int 2014; 25:467-74. [PMID: 23779082 DOI: 10.1007/s00198-013-2412-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 06/03/2013] [Indexed: 12/28/2022]
Abstract
UNLABELLED This study was aimed to evaluate the association between body composition and bone health. High lean mass and low fat mass have protective effects on bone health in men representative of the national population. INTRODUCTION The aim of this study was to evaluate the association between body composition (fat mass and lean mass) and bone health in men. METHODS Totally, 3,945 men (age ≥ 20 years) from the fourth Korean National Health and Nutrition Examination Survey of 2008-2009 (KNHANES IV) were included in this study. Body composition and bone mineral densities (BMDs) were measured using dual energy X-ray absorptiometry. Osteopenia or osteoporosis was identified on the basis of the World Health Organization T-score criteria. RESULTS Multiple linear regression analyses showed that BMDs of the whole body, femoral neck, and lumbar spine were positively associated with lean mass and negatively associated with fat mass, after controlling for body weight and other potential confounders. Subjects with more fat mass or less lean mass, categorized according to quartiles of fat mass and lean mass, had higher odds of having osteopenia or osteoporosis, as shown by multivariable logistic regression (P for trend <0.001). CONCLUSIONS High lean mass and low fat mass have protective effects on bone health in a population of Korean adult men. Fat mass appears to exert a detrimental effect on BMD, in contrast with the positive weight-bearing effect. Body composition seems to be a more important determinant for bone health than simple body weight.
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Affiliation(s)
- D Shin
- Jangseong Public Health Center, Jangseong, South Korea
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Welch AA, MacGregor AJ, Minihane AM, Skinner J, Valdes AA, Spector TD, Cassidy A. Dietary fat and fatty acid profile are associated with indices of skeletal muscle mass in women aged 18-79 years. J Nutr 2014. [PMID: 24401817 DOI: 10.3945/jn.113.185256\] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Age-related loss of skeletal muscle mass results in a reduction in metabolically active tissue and has been related to the onset of obesity and sarcopenia. Although the causes of muscle loss are poorly understood, dietary fat has been postulated to have a role in determining protein turnover through an influence on both inflammation and insulin resistance. This study was designed to investigate the cross-sectional relation between dietary fat intake, as dietary percentage of fat energy (PFE) and fatty acid profile, with indices of skeletal muscle mass in the population setting. Body composition [fat-free mass (FFM; in kg)] and the fat-free mass index (FFMI; kg FFM/m(2)) was measured by using dual-energy X-ray absorptiometry in 2689 women aged 18-79 y from the TwinsUK Study and calculated according to quintile of dietary fat (by food-frequency questionnaire) after multivariate adjustment. Positive associations were found between the polyunsaturated-to-saturated fatty acid (SFA) ratio and indices of FFM, and inverse associations were found with PFE, SFAs, monounsaturated fatty acids (MUFAs), and trans fatty acids (TFAs) (all as % of energy). Extreme quintile dietary differences for PFE were -0.6 kg for FFM and -0.28 kg/m(2) for FFMI; for SFAs, MUFAs, and TFAs, these were -0.5 to -0.8 kg for FFM and -0.26 to -0.38 kg/m(2) for FFMI. These associations were of a similar magnitude to the expected decline in muscle mass that occurs over 10 y. To our knowledge, this is the first population-based study to demonstrate an association between a comprehensive range of dietary fat intake and FFM. These findings indicate that a dietary fat profile already associated with cardiovascular disease protection may also be beneficial for conservation of skeletal muscle mass.
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Affiliation(s)
- Ailsa A Welch
- Norwich Medical School, University of East Anglia, Norwich, UK
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Welch AA, MacGregor AJ, Minihane AM, Skinner J, Valdes AA, Spector TD, Cassidy A. Dietary Fat and Fatty Acid Profile Are Associated with Indices of Skeletal Muscle Mass in Women Aged 18–79 Years. J Nutr 2014. [DOI: 10.3945/jn.113.185256 or 1=1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ailsa A. Welch
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | | | - Jane Skinner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Anna A. Valdes
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Tim D. Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Aedin Cassidy
- Norwich Medical School, University of East Anglia, Norwich, UK
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Abstract
Age-related muscle loss impacts on whole-body metabolism and leads to frailty and sarcopenia, which are risk factors for fractures and mortality. Although nutrients are integral to muscle metabolism the relationship between nutrition and muscle loss has only been extensively investigated for protein and amino acids. The objective of the present paper is to describe other aspects of nutrition and their association with skeletal muscle mass. Mechanisms for muscle loss relate to imbalance in protein turnover with a number of anabolic pathways of which the mechanistic TOR pathway and the IGF-1–Akt–FoxO pathways are the most characterised. In terms of catabolism the ubiquitin proteasome system, apoptosis, autophagy, inflammation, oxidation and insulin resistance are among the major mechanisms proposed. The limited research associating vitamin D, alcohol, dietary acid–base load, dietary fat and anti-oxidant nutrients with age-related muscle loss is described. Vitamin D may be protective for muscle loss; a more alkalinogenic diet and diets higher in the anti-oxidant nutrients vitamin C and vitamin E may also prevent muscle loss. Although present recommendations for prevention of sarcopenia focus on protein, and to some extent on vitamin D, other aspects of the diet including fruits and vegetables should be considered. Clearly, more research into other aspects of nutrition and their role in prevention of muscle loss is required.
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Jordan S, Lim L, Berecki-Gisolf J, Bain C, Seubsman SA, Sleigh A, Banks E. Body mass index, physical activity, and fracture among young adults: longitudinal results from the Thai cohort study. J Epidemiol 2013; 23:435-42. [PMID: 24077339 PMCID: PMC3834281 DOI: 10.2188/jea.je20120215] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background We investigated risk factors for fracture among young adults, particularly body mass index (BMI) and physical activity, which although associated with fracture in older populations have rarely been investigated in younger people. Methods In 2009, 4 years after initial recruitment, 58 204 Thais aged 19 to 49 years were asked to self-report fractures incident in the preceding 4 years. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% CIs for associations of fracture incidence with baseline BMI and physical activity. Results Very obese women had a 70% increase in fracture risk (OR = 1.73, 95% CI 1.21–2.46) as compared with women with a normal BMI. Fracture risk increased by 15% with every 5-kg/m2 increase in BMI. The effects were strongest for fractures of the lower limbs. Frequent purposeful physical activity was also associated with increased fracture risk among women (OR = 1.52, 95% CI 1.12–2.06 for 15 episodes/week vs none). Neither BMI nor physical activity was associated with fracture among men, although fracture risk decreased by 4% with every additional 2 hours of average sitting time per day (OR = 0.96, 95% CI 0.93–0.99). Conclusions The increase in obesity prevalence will likely increase fracture burden among young women but not young men. While active lifestyles have health benefits, our results highlight the importance of promoting injury prevention practices in conjunction with physical activity recommendations, particularly among women.
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Affiliation(s)
- Susan Jordan
- School of Population Health, University of Queensland
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Bjørnerem Å, Bui QM, Ghasem-Zadeh A, Hopper JL, Zebaze R, Seeman E. Fracture risk and height: an association partly accounted for by cortical porosity of relatively thinner cortices. J Bone Miner Res 2013; 28:2017-26. [PMID: 23520013 DOI: 10.1002/jbmr.1934] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 02/25/2013] [Accepted: 03/12/2013] [Indexed: 11/08/2022]
Abstract
Taller women are at increased risk for fracture despite having wider bones that better tolerate bending. Because wider bones require less material to achieve a given bending strength, we hypothesized that taller women assemble bones with relatively thinner and more porous cortices because excavation of a larger medullary canal may be accompanied by excavation of more intracortical canals. Three-dimensional images of distal tibia, fibula, and radius were obtained in vivo using high-resolution peripheral quantitative computed tomography (HRpQCT) in a twin study of 345 females aged 40 to 61 years, 93 with at least one fracture. Cortical porosity <100 µm as well as >100 µm, and microarchitecture, were quantified using Strax1.0, a new algorithm. Multivariable linear and logistic regression using generalized estimating equation (GEE) methods quantified associations between height and microarchitecture and estimated the associations with fracture risk. Each standard deviation (SD) greater height was associated with a 0.69 SD larger tibia total cross-sectional area (CSA), 0.66 SD larger medullary CSA, 0.50 SD higher medullary CSA/total CSA (i.e., thinner cortices relative to the total CSA due to a proportionally larger medullary area), and 0.42 SD higher porosity (all p < 0.001). Cortical area was 0.45 SD larger in absolute terms but 0.50 SD smaller in relative terms. These observations were confirmed by examining trait correlations in twin pairs. Fracture risk was associated with height, total CSA, medullary CSA/total CSA, and porosity in univariate analyses. In multivariable analyses, distal tibia, medullary CSA/total CSA, and porosity predicted fracture independently; height was no longer significant. Each 1 SD greater porosity was associated with fracture; odds ratios (ORs) and 95% confidence intervals (CIs) are as follows: distal tibia, OR = 1.55 (95% CI, 1.11-2.15); distal fibula, OR = 1.47 (95% CI, 1.14-1.88); and distal radius, OR = 1.22 (95% CI, 0.96-1.55). Taller women assemble wider bones with relatively thinner and more porous cortices predisposing to fracture.
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Welch AA, MacGregor AJ, Skinner J, Spector TD, Moayyeri A, Cassidy A. A higher alkaline dietary load is associated with greater indexes of skeletal muscle mass in women. Osteoporos Int 2013; 24:1899-908. [PMID: 23152092 DOI: 10.1007/s00198-012-2203-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 09/12/2012] [Indexed: 12/15/2022]
Abstract
UNLABELLED Conservation of muscle mass is important for fall and fracture prevention but further understanding of the causes of age-related muscle loss is required. This study found a more alkaline diet was positively associated with muscle mass in women suggesting a role for dietary acid-base load in muscle loss. INTRODUCTION Conservation of skeletal muscle is important for preventing falls and fractures but age-related loss of muscle mass occurs even in healthy individuals. However, the mild metabolic acidosis associated with an acidogenic dietary acid-base load could influence loss of muscle mass. METHODS We investigated the association between fat-free mass (FFM), percentage FFM (FFM%) and fat-free mass index (FFMI, weight/height²), measured using dual-energy X-ray absorptiometry in 2,689 women aged 18-79 years from the TwinsUK Study, and dietary acid-base load. Body composition was calculated according to quartile of potential renal acid load and adjusted for age, physical activity, misreporting and smoking habit (FFM, FFMI also for fat mass) and additionally with percentage protein. RESULTS Fat-free mass was positively associated with a more alkalinogenic dietary load (comparing quartile 1 vs 4: FFM 0.79 kg P < 0.001, FFM% 1.06 % <0.001, FFMI 0.24 kg/m² P = 0.002), and with the ratio of fruits and vegetables to potential acidogenic foods. CONCLUSIONS We observed a small but significant positive association between a more alkaline diet and muscle mass indexes in healthy women that was independent of age, physical activity and protein intake equating to a scale of effect between a fifth and one half of the observed relationship with 10 years of age. Although protein is important for maintenance of muscle mass, eating fruits and vegetables that supply adequate amounts of potassium and magnesium are also relevant. The results suggest a potential role for diet in the prevention of muscle loss.
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Affiliation(s)
- A A Welch
- Department of Nutrition, Norwich Medical School, University of East Anglia, NR4 7TJ Norwich, UK.
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Myong JP, Kim HR, Choi SE, Koo JW. Dose-related effect of urinary cotinine levels on bone mineral density among Korean females. Osteoporos Int 2013; 24:1339-46. [PMID: 22890363 DOI: 10.1007/s00198-012-2107-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 07/05/2012] [Indexed: 10/28/2022]
Abstract
UNLABELLED To evaluate the dose-dependent relationship between smoking and bone mineral density (BMD), the present study used the BMD dataset of the Korean National Health and Nutrition Examination Survey IV (KNHANES IV). The linearity of BMD for urinary cotinine levels was demonstrated with statistical significance in postmenopausal females. INTRODUCTION It is well established that smoking is an important lifestyle risk factor for bone health (bone loss, osteoporosis, and fracture). However, several studies demonstrated conflicting evidence for a dose-dependent relationship between smoking and bone health. To evaluate the dose-dependent relationship between smoking and BMD, the present study estimated dose-related effects of smoking (urinary cotinine level) on BMD at various sites (femur neck, total femur, and lumbar spine) in females with controlling menopausal status. METHODS The present study used the BMD dataset of the KNHANES IV, which was performed in 2008 and 2009. A total of 4,260 pre- and postmenopausal females were included in the present study. Dose-response relationships between BMD and urinary cotinine levels were estimated using analysis of covariance in pre-menopausal females and postmenopausal females, respectively. RESULTS In postmenopausal females, the regression coefficients for BMD with urinary cotinine levels were -0.006, -0.006, and -0.008 (g/cm2 per ng/ml) at femur neck, total femur, and lumbar spine, respectively (p value<0.05). Thus, the linearity of BMD for urinary cotinine levels was demonstrated with statistical significance in postmenopausal females. CONCLUSION Our findings suggested a significant dose-related effect of urinary cotinine level with BMD at femur neck, total femur, and lumbar spine among postmenopausal females.
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Affiliation(s)
- J-P Myong
- Department of Preventive Medicine, Center for Occupational and Environmental Medicine, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero Seocho-gu, Seoul, 137-701, Republic of Korea
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Bone mineral density and body composition of adult premenopausal women with three levels of physical activity. J Osteoporos 2013; 2013:953271. [PMID: 23533948 PMCID: PMC3596914 DOI: 10.1155/2013/953271] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 01/26/2013] [Accepted: 01/28/2013] [Indexed: 01/22/2023] Open
Abstract
Weight-bearing and resistance physical activities are recommended for osteoporosis prevention, but it is unclear whether an intensity level above current recommendations has a positive effect on adult premenopausal women. Body composition and bone mineral density (BMD) by DXA were compared in three groups of women as follows: Sedentary, Maintenance exercise, and federated Sport Team (n = 16 for each group). Physical activity was estimated from the International Physical Activity Questionnaire (IPAQ). The groups did not differ in age, height, weight, or body mass index. Bone mineral content and non-fat soft tissue mass were higher and fat mass was lower in the Sport Team group than in the other groups. The same was true for BMD of total skeleton, lumbar spine, femoral neck, and total hip. A test for linear trend of body composition and BMD showed significant results when including all three groups. Simple and multiple regression analyses showed significant associations between physical activity level (or alternatively, years of participation in programmed physical activity) and bone mass measures at all sites except for the middle third of radius. It is concluded that a level of physical activity higher than that usually recommended benefits bone health in adult premenopausal women.
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Abstract
OBJECTIVE Findings regarding alcohol consumption and bone mineral density (BMD) in elderly women have been inconsistent. The objective of the present study was to explore the association of alcohol intake with BMD in elderly women. DESIGN This cohort study included women from the population-based Kuopio Osteoporosis Risk Factor and Prevention - Fracture Prevention Study (OSTPRE-FPS). Alcohol intake and potential confounders were assessed at baseline and after 3 years of follow-up using a lifestyle questionnaire. In addition, an FFQ was distributed in the third year to measure dietary intake, including alcohol. Women underwent BMD measurements at the femoral neck and lumbar spine at baseline and after 3 years of follow-up. SETTING Kuopio Province, Finland. SUBJECTS Three hundred elderly women (mean age 67·8 years) who provided both BMD measurements and FFQ data. RESULTS Alcohol consumption estimated from the FFQ and lifestyle questionnaire was significantly associated with BMD at both measurement sites after adjustment for potential confounders, including lifestyle and dietary factors (P < 0·05). Using the FFQ, women drinking >3 alcoholic drinks/week had significantly higher BMD than abstainers, 12·0 % at the femoral neck and 9·2 % at the lumbar spine. Results based on the lifestyle questionnaire showed higher BMD values for all alcohol-consuming women at the femoral neck and for women drinking 1-3 alcoholic beverages/week at the lumbar spine, compared with non-users. CONCLUSIONS The results from OSTPRE-FPS suggest that low to moderate alcohol intake may exert protective effects on bone health in elderly women.
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Park JH, Song YM, Sung J, Lee K, Kim YS, Kim T, Cho SI. The association between fat and lean mass and bone mineral density: the Healthy Twin Study. Bone 2012; 50:1006-11. [PMID: 22306928 DOI: 10.1016/j.bone.2012.01.015] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 01/19/2012] [Accepted: 01/20/2012] [Indexed: 01/29/2023]
Abstract
The potential beneficial effects of increased body weight on bone mineral density (BMD) conflict with the adverse effects of obesity on various health outcomes, necessitating more specific evaluations of the association between each body component and BMD. In the present study, we evaluated associations of lean mass (LM) and fat mass (FM) with BMD in a Korean sample consisting of a total of 1782 men and women whose mean (standard deviation) age was 43.2 (12.6) years. They were selected from the Healthy Twin Study, a nationwide Korean twin and family study. BMD, FM and LM were measured using dual-energy X-ray absorptiometry. Quantitative genetic analysis and linear mixed analysis were performed with respect to familial relationships and a wide range of probable covariates. Linear mixed analysis revealed that BMD was positively associated with both FM and LM at each region of BMD measurement (whole body, spine, arms, and legs) in men, premenopausal women, and postmenopausal women. However, the association with BMD was stronger for LM than FM. Both LM and FM had positive genetic correlations with BMD at each region, although the correlation with BMD tended to be stronger for LM than FM. Together, these findings suggest that increased LM, rather than FM, is more beneficial for BMD in the Korean population and warrants further study of the common genetic determinants of BMD and body composition.
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Affiliation(s)
- Joo-Hyun Park
- Health Care Center, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
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Effects of exercise on bone density and falls risk factors in post-menopausal women with osteopenia: A randomised controlled trial. J Sci Med Sport 2012; 15:102-9. [DOI: 10.1016/j.jsams.2011.08.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 08/10/2011] [Accepted: 08/12/2011] [Indexed: 11/22/2022]
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Sudhagoni RG, Wey HE, Djira GD, Specker BL. Longitudinal effects of fat and lean mass on bone accrual in infants. Bone 2012; 50:638-42. [PMID: 22154840 DOI: 10.1016/j.bone.2011.11.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 11/04/2011] [Accepted: 11/16/2011] [Indexed: 11/18/2022]
Abstract
There are conflicting reports on the influence of lean and fat mass on bone accrual during childhood. No infant's studies have been reported that describe the influence of changes in body composition with changes in bone accrual during the first year of life. The objective of this research was to test the hypothesis that greater gains in lean mass will have a positive effect on bone mineral content (BMC) accrual, while greater gains in fat mass will have a negative effect on BMC accrual in infants. Longitudinal data from 3 previous infant studies were used. Linear mixed models, adjusting for age, sex, dietary calcium, and length were used to investigate longitudinal and cross-sectional associations between total body BMC and lean and fat mass in the individual studies and in a combined analysis. In both individual and combined analyses, we found that lean and fat mass were positively associated with whole body BMC accrual (all, P<0.001). The cross-sectional association of BMC and dietary calcium was negative in one study (P<0.05). No differences in BMC change between sexes were observed in three studies. Our results showed positive cross-sectional and longitudinal associations between total body BMC and lean mass in infants. In contradiction to our hypothesis for fat mass, we found a positive cross-sectional and longitudinal association between total body BMC and fat mass in infants.
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Affiliation(s)
- Ramu G Sudhagoni
- Ethel Austin Martin Program in Human Nutrition, South Dakota State University, Brookings, SD 57007, USA
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Bjørnerem Å, Ghasem-Zadeh A, Bui M, Wang X, Rantzau C, Nguyen TV, Hopper JL, Zebaze R, Seeman E. Remodeling markers are associated with larger intracortical surface area but smaller trabecular surface area: a twin study. Bone 2011; 49:1125-30. [PMID: 21872686 DOI: 10.1016/j.bone.2011.08.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 08/02/2011] [Accepted: 08/10/2011] [Indexed: 11/24/2022]
Abstract
All postmenopausal women become estrogen deficient but not all remodel their skeleton rapidly or lose bone rapidly. As remodeling requires a surface to be initiated upon, we hypothesized that a volume of mineralized bone assembled with a larger internal surface area is more accessible to being remodeled, and so decayed, after menopause. We measured intracortical, endocortical and trabecular bone surface area and microarchitecture of the distal tibia and distal radius in 185 healthy female twin pairs aged 40 to 61 years using high-resolution peripheral quantitative computed tomography (HR-pQCT). We used generalized estimation equations to analyze (i) the trait differences across menopause, (ii) the relationship between remodeling markers and bone surface areas, and (iii) robust regression to estimate associations between within-pair differences. Relative to premenopausal women, postmenopausal women had higher remodeling markers, larger intracortical and endocortical bone surface area, higher intracortical porosity, smaller trabecular bone surface area and fewer trabeculae at both sites (all p<0.01). Postmenopausal women had greater deficits in cortical than trabecular bone mass at the distal tibia (-0.98 vs. -0.12 SD, p<0.001), but similar deficits at the distal radius (-0.45 vs. -0.39 SD, p=0.79). A 1 SD higher tibia intracortical bone surface area was associated with 0.22-0.29 SD higher remodeling markers, about half the 0.53-0.67 SD increment in remodeling markers across menopause (all p<0.001). A 1 SD higher porosity was associated with 0.20-0.30 SD higher remodeling markers. A 1 SD lower trabecular bone surface area was associated with 0.15-0.18 SD higher remodeling markers (all p<0.01). Within-pair differences in intracortical and endocortical bone surface areas at both sites and porosity at the distal tibia were associated with within-pair differences in some remodeling markers (p=0.05 to 0.09). We infer intracortical remodeling may be self perpetuating by creating intracortical porosity and so more bone surface for remodeling to occur upon, while remodeling upon the trabecular bone surface is self limiting because it removes trabeculae with their surface.
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Abstract
The greatest cause of preventable morbidity and mortality is smoking, and one of the often-underappreciated effects of smoking is profound bone loss. The existing clinical paradigm for smoking is that there is a low turnover osteoporosis. This review highlights findings from recent clinical trials and animal research demonstrating either support or conflict with the existing paradigm. Clinically, it is noted that markers of bone formation are often normal in smokers; these clinical findings conflict with well-conducted animal research demonstrating that carcinogens acting on the aryl hydrogen receptor can significantly reduce osteoblast formation and function. Regarding bone resorption, highlights from recent clinical studies suggest that bone remodeling is increased in smokers. Directly contradicting this enhanced osteoclastogenesis are several animal studies all demonstrating significant inhibition of osteoclast formation and function upon exposure to smoke carcinogens. Future research is needed to clarify whether smoking is truly a low bone remodeling osteoporosis, or an osteoclast-driven bone destruction, with inappropriately normal bone formation.
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Affiliation(s)
- Carol Yan
- University of Pennsylvania, Philadelphia, PA 19104, USA
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Holmberg T, Bech M, Curtis T, Juel K, Grønbæk M, Brixen K. Association between passive smoking in adulthood and phalangeal bone mineral density: results from the KRAM study--the Danish Health Examination Survey 2007-2008. Osteoporos Int 2011; 22:2989-99. [PMID: 21170642 DOI: 10.1007/s00198-010-1506-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 11/22/2010] [Indexed: 11/30/2022]
Abstract
UNLABELLED The study investigates an association between phalangeal bone mineral density (BMD) and self-reported passive smoking using data on 15,038 persons (aged 18-95 years), who underwent a BMD scan in the Danish KRAM study. BMD was significantly lower in persons exposed to long-term passive smoking in their home during adulthood. INTRODUCTION Smoking is associated with decreased bone mineral density (BMD) and increased risk of osteoporotic fractures. This study aimed to investigate a possible association between BMD at the phalangeal bones and self-reported passive smoking. METHODS The study included a cohort of 15,544 men and women aged 18-95 years, who underwent a BMD scan in the Danish KRAM study. BMD scans of the middle phalanges of the second, third and fourth digits of the non-dominant hand were performed with a compact radiographic absorptiometry system (Alara MetriScan®). Also, height, weight and body fat percentage were measured and 96.7% (n = 15,038) of the participants answered a self-reported questionnaire with information on passive smoking, other lifestyle factors, education, etc. The association between passive smoking and BMD was examined using multiple linear regression analysis. RESULTS A total of 39.1% (n = 5,829) of the participants had been exposed to passive smoking in adulthood at home. BMD was significantly lower in subjects exposed to passive smoking, 0.343 vs. 0.331 g/cm(2); p < 0.01 (unadjusted) and 0.339 vs. 0.337 g/cm(2); p < 0.05 (adjusted for age, gender, height and weight, and smoking). Multiple linear regression analysis showed that exposure to passive smoking for more than 20 years in adulthood at home was significantly related to BMD when adjusted for potential confounders (men, β = -4.4 × 10(-3); r = -0.05; p < 0.01 and women, β = -2.3 × 10 (-3); r = -0.03; p < 0.05). This relationship was also seen in the group of never smokers (β = -3.3 × 10(-3); r = -0.03; p = 0.01). CONCLUSION Our study supports a potential negative effect of long-term passive smoking in adulthood at home on phalangeal BMD.
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Affiliation(s)
- T Holmberg
- National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, 2, 1353, Copenhagen K, Denmark.
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Fairweather-Tait SJ, Skinner J, Guile GR, Cassidy A, Spector TD, MacGregor AJ. Diet and bone mineral density study in postmenopausal women from the TwinsUK registry shows a negative association with a traditional English dietary pattern and a positive association with wine. Am J Clin Nutr 2011; 94:1371-5. [PMID: 21940596 DOI: 10.3945/ajcn.111.019992] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The effect of diet on bone mineral density (BMD) remains controversial, mainly because of difficulties in isolating dietary factors from the confounding influences of age, lifestyle, and genetic factors. OBJECTIVE The aim of this study was to use a novel method to examine the relation between BMD and diet. DESIGN A co-twin control study design with linear regression modeling was used to test for associations between BMD and habitual intakes of calcium, vitamin D, protein, and alcohol plus 5 previously identified dietary patterns in postmenopausal women from the TwinsUK registry. This approach exploited the unique matching of twins to provide an estimate of an association that was not confounded by age, genetic background, or shared lifestyle. RESULTS In >2000 postmenopausal women (BMD data on 1019, 1218, and 1232 twin pairs at the hip neck, hip, and spine, respectively), we observed a positive association between alcohol intake (from wine but not from beer or spirits) and spine BMD (P = 0.01) and a negative association with a traditional 20th-century English diet at the hip neck (P = 0.01). Both associations remained borderline significant after adjustment for mean twin-pair intakes (P = 0.04 and P = 0.055, respectively). Other dietary patterns and intakes of calcium, vitamin D, and protein were unrelated to BMD. CONCLUSION Our results showed that diet has an independent but subtle effect on BMD; wine intake was positively associated with spine BMD, whereas a traditional (20th-century) English diet had a negative association with hip BMD.
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McNaughton SA, Wattanapenpaiboon N, Wark JD, Nowson CA. An energy-dense, nutrient-poor dietary pattern is inversely associated with bone health in women. J Nutr 2011; 141:1516-23. [PMID: 21653576 DOI: 10.3945/jn.111.138271] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Measures of dietary patterns have been increasingly used to capture the complex nature of dietary intake. Few studies have investigated the impact of specific dietary patterns on bone health. Areal bone mineral density (BMD) at the lumbar spine and total hip and total body bone mineral content (BMC) were measured using DXA in Australian women aged 18-65 y (n = 527). Dietary patterns were assessed using a 4-d food diary and factor analysis. Scores were calculated based on the amount of each food consumed in the pattern and the weightings determined by factor analysis. Analysis was conducted using generalized estimating equation methods. Factor analysis revealed 5 dietary patterns. Pattern 1 (high consumption of refined cereals, soft drinks, fried potatoes, sausages and processed meat, vegetable oils, beer, and takeaway foods and low consumption of other vegetables, vegetable dishes, tea, coffee, fruit, wholegrain breads, and breakfast cereals) were significantly inversely associated with total body BMC (g) [β = -15.4 (95% CI -27.4, -3.3), adjusted for age, height, physical activity, smoking, education, energy, and calcium intake]. Pattern 4 (high consumption of legumes, seafood, seeds, nuts, wine, rice and rice dishes, other vegetables, and vegetable dishes and low consumption of bacon and ham) were directly associated with BMD at both sites and total body BMC in adjusted models [BMC (g): β = 15.2 (95% CI 2.84, 27.6), fully adjusted model]. The remaining dietary patterns were not consistently associated with BMD or BMC. This study identified specific dietary patterns associated with BMD and total body BMC among women and provides evidence that will contribute to potential food-based strategies for improving bone health.
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Affiliation(s)
- Sarah A McNaughton
- Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria 3125, Australia
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Kim T, Sung J, Song YM, Lee K, Cho SI. Sex difference between body composition and weight-bearing bone mineral density in Korean adult twins: healthy twin study. Calcif Tissue Int 2011; 88:495-502. [PMID: 21479597 DOI: 10.1007/s00223-011-9483-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 03/06/2011] [Indexed: 01/12/2023]
Abstract
We performed a monozygotic (MZ) cotwin-control study using the MZ twin pair difference in bone mineral density (BMD) to assess the relationship between body composition and BMD at weight-bearing sites. This study controlled for common genetic factors and applied only to environmental factors, using 185 MZ twin pairs aged 30-50 years (140 male subjects, 230 female subjects). As expected, total lean mass (TLM) was greater in males and total fat mass (TFM) was greater in females. In male twins, TLM was associated with BMD at the legs, pelvis, and spine, with percent BMD increases of 0.41 (95% confidence interval [CI] 0.17-0.64), 0.62 (95% CI 0.35-0.89), and 0.27 (95% CI 0.01-0.54) for every 1 kg. In female twins, TFM was associated with BMD at the legs and pelvis, with percent BMD increases of 0.10 (95% CI 0.03-0.17) and 0.10 (95% CI 0.02-0.18) for every 1 kg. The results support the hypothesis that skeletal muscle and bone mass in middle-aged men are linked. In contrast, this association was not shown in women, and the impact of TFM on BMD was significant. Therefore, there were sex differences in the relationship of body composition on BMD.
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Affiliation(s)
- Taehun Kim
- Department of Epidemiology, Graduate School of Public Health, Seoul National University, South Korea
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Bogl LH, Latvala A, Kaprio J, Sovijärvi O, Rissanen A, Pietiläinen KH. An investigation into the relationship between soft tissue body composition and bone mineral density in a young adult twin sample. J Bone Miner Res 2011; 26:79-87. [PMID: 20658559 PMCID: PMC3179317 DOI: 10.1002/jbmr.192] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The purpose of this study was to investigate the relationship of fat mass (FM) and lean mass (LM) with bone mineral density (BMD) independent of genetic effects. We also assessed the extent to which genetic and environmental influences explain the associations between these phenotypes. Body composition and BMD were measured using dual-energy X-ray absorptiometry in 57 monozygotic and 92 same-sex dizygotic twin pairs, aged 23 to 31 years, chosen to represent a wide range of intrapair differences in body mass index (BMI; 0 to 15.2 kg/m(2)). Heritability estimates were adjusted for height and gender. In multiple linear regression analysis, intrapair differences in both FM and LM were independently associated with intrapair differences in BMD at most skeletal sites after adjustment for gender and differences in height. Within monozygotic and dizygotic pairs, LM was a significantly stronger predictor of whole-body BMD than FM (p < .01). Additive genetic factors explained 87% [95% confidence interval (CI) 80%-91%), 81% (95% CI 70%-88%), and 61% (95% CI 41%-75%) of the variation in whole-body BMD, LM, and FM, respectively. Additive genetic factors also accounted for 69% to 88% of the covariance between LM and BMD and for 42% to 72% of the covariance between FM and BMD depending on the skeletal site. The genetic correlation between LM and whole-body BMD (r(g) = 0.46, 95% CI 0.32-0.58) was greater than that of FM and whole-body BMD (r(g) = 0.25, 95% CI 0.05-0.42). In conclusion, our data indicate that peak BMD is influenced by acquired body weight as well as genetic factors. In young adulthood, LM and BMD may have more genes in common than do FM and BMD.
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Affiliation(s)
- Leonie H Bogl
- The Finnish Twin Cohort Study, Department of Public Health, University of Helsinki, Helsinki, Finland.
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DÜRSTELER-MACFARLAND KENNETHM, KOWALEWSKI ROLAND, BLOCH NICOLE, WIESBECK GERHARDA, KRAENZLIN MARIUSE, STOHLER RUDOLF. Patients on injectable diacetylmorphine maintenance have low bone mass. Drug Alcohol Rev 2010; 30:577-82. [DOI: 10.1111/j.1465-3362.2010.00242.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Waltman NL, Twiss JJ, Ott CD, Gross GJ, Lindsey AM, Moore TE, Berg K, Kupzyk K. The effect of weight training on bone mineral density and bone turnover in postmenopausal breast cancer survivors with bone loss: a 24-month randomized controlled trial. Osteoporos Int 2010; 21:1361-9. [PMID: 19802506 DOI: 10.1007/s00198-009-1083-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 09/10/2009] [Indexed: 10/20/2022]
Abstract
SUMMARY This study examined whether 24 months of weight training exercises enhanced the effectiveness of risedronate, calcium, and vitamin D in maintaining or improving bone mineral density (BMD) in 223 postmenopausal breast cancer survivors. Subjects who were > or =50% adherent to exercise had no improvement in BMD but were less likely to lose BMD. INTRODUCTION This study examined whether (1) postmenopausal breast cancer survivors (BCS) with bone loss taking 24 months of risedronate, calcium, and vitamin D had increased bone mineral density (BMD) at the total hip, femoral neck, L1-L4 spine, total radius and 33% radius, and decreased bone turnover; (2) subjects who also participated in strength/weight training (ST) exercises had greater increases in BMD and greater decreases in bone turnover; and (3) subjects who also exercised were more likely to preserve (at least maintain) BMD. METHODS Postmenopausal BCS (223) were randomly assigned to exercise plus medication or medication only groups. Both groups received 24 months of 1,200 mg of calcium and 400 IU of vitamin D daily and 35 mg of risedronate weekly, and the exercise group additionally had ST exercises twice weekly. RESULTS After 24 months, women who took medications without exercising had significant improvements in BMD at the total hip (+1.81%) and spine (+2.85%) and significant decreases in Alkphase B (-8.7%) and serum NTx (-16.7%). Women who also exercised had additional increases in BMD at the femoral neck (+0.29%), total hip (+0.34%), spine (+0.23%), total radius (+0.30%), and additional decreases in Alkphase B (-2.4%) and Serum NTx (-6.5%). Additional changes in BMD and bone turnover with exercise were not significant. Subjects who were > or =50% adherent to exercise were less likely to lose BMD at the total hip (chi-square [1] = 4.66, p = 0.03) and femoral neck (chi-square [1] = 4.63, p = 0.03). CONCLUSION Strength/weight training exercises may prevent loss of BMD in postmenopausal BCS at risk for bone loss.
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Affiliation(s)
- N L Waltman
- Lincoln Division, University of Nebraska Medical Center College of Nursing, Lincoln, NE USA.
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Abstract
Although it has been repeatedly suggested that low bone mineral density (BMD) is disproportionately prevalent among patients with depressive disorders, so far depression has not been officially acknowledged as a risk factor for osteoporosis. In a recent meta-analysis comparing depressed with nondepressed individuals we report that BMD is lower in depressed than nondepressed subjects. The association between depression and BMD is stronger in women than men, and in premenopausal than postmenopausal women. Only women psychiatrically diagnosed for major depression display significantly low BMD; women diagnosed by self-rating questionnaires do not. Using a mouse model for depression, we demonstrate a causal relationship between depressive-like behavior and bone loss. The depression-induced bone loss is associated with increases in skeletal norepinephrine and serum corticosterone levels. Bone loss, but not the depressive behavior, could be prevented by a beta-blocker. Hence, depression appears as a significant risk factor for low BMD, causing bone loss through stimulation of the sympathetic nervous system.
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Affiliation(s)
- Itai A Bab
- Bone Laboratory, The Hebrew University of Jerusalem, Jerusalem, Israel.
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Tamaki J, Iki M, Sato Y, Kajita E, Kagamimori S, Kagawa Y, Yoneshima H. Smoking among premenopausal women is associated with increased risk of low bone status: the JPOS Study. J Bone Miner Metab 2010; 28:320-7. [PMID: 19830380 DOI: 10.1007/s00774-009-0129-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 09/15/2009] [Indexed: 11/24/2022]
Abstract
The impact of smoking on peak bone density has not been conclusively established. We examined how smoking exposure influences bone mineral density (BMD) or the risk of low bone status in premenopausal women. We conducted a baseline survey with a representative sample of Japanese women in 1996. The effect of current and former smokers (ever-smoker) was investigated with 789 premenopausal women aged 20-40 years. The multiple regression with stepwise method was used to identify significant determinants for BMD or the risk of low bone status (T-score < -1) with age, height, weight, calcium intake, coffee consumption, exercise habits, level of daily activity, parity >or= 1, and smoking as explanatory variables. The smoking effect was determined after adjusting for age, height, weight, and significant variables in the multiple regression with stepwise method. Ever-smoker was significantly associated with decreased lumbar BMD adjusted for age, height, and weight. The odds ratio of an ever-smoker for low bone status at the lumbar spine was 2.03 (95% CI 1.12, 5.82) adjusted for age, height, weight, and parity. The odds ratio for low bone status at the lumbar spine was 1.59 (95% CI 0.65, 3.91) and 2.55 (95% CI 1.12, 5.82) in those with less than 3 pack-years of tobacco use and in those with 3 or more pack-years of tobacco use, respectively. These values were adjusted for age, height, weight, and parity using a never-smoker as a reference. Cumulative smoking exposure may be associated with increased risk of low bone status among premenopausal women.
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Affiliation(s)
- Junko Tamaki
- Department of Public Health, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan
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Zhang J, Chen F, Yun F, Chen J. Low level nicotine: a novel approach to reduce osteoporosis incidence. Med Hypotheses 2010; 74:1067-8. [PMID: 20106602 DOI: 10.1016/j.mehy.2009.12.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2009] [Accepted: 12/16/2009] [Indexed: 11/24/2022]
Abstract
Osteoporosis is a serious health problem worldwide and leads to a significant burden on society. Unfortunately, efforts to control osteoporosis are largely unsuccessful. Lowering an individual's risk for osteoporosis must focus not only on treatment but also on modification of risk factors. One of the common risk factors is smoking tobacco. Here, we review the clinical evidence on nicotine consumption and osteoporosis, and propose a possible protective mechanism. It should be note that there is no strong clinical evidence that proves nicotine is detrimental. Studies also indicated that the prime criminal for osteoporosis is smoking not nicotine. Moreover, low level nicotine has preventive efforts on osteoporosis by stimulating osteoblasts proliferation and differentiation. We present a hypothesis that low level nicotine may be a novel approach to reduce osteoporosis incidence.
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Affiliation(s)
- Jun Zhang
- Department of Orthopaedics, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, China.
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Yirmiya R, Bab I. Major depression is a risk factor for low bone mineral density: a meta-analysis. Biol Psychiatry 2009; 66:423-32. [PMID: 19446797 DOI: 10.1016/j.biopsych.2009.03.016] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 02/25/2009] [Accepted: 03/13/2009] [Indexed: 01/18/2023]
Abstract
BACKGROUND The role of depression as a risk factor for low bone mineral density (BMD) and osteoporosis is not fully acknowledged, mainly because the relevant literature is inconsistent and because information on the mechanisms mediating brain-to-bone signals is rather scanty. METHODS Searching databases and reviewing citations in relevant articles, we identified 23 studies that quantitatively address the relationship between depression and skeletal status, comparing 2327 depressed with 21,141 nondepressed individuals. We subjected these studies to meta-analysis, assessing the association between depression and BMD as well as between depression and bone turnover markers. RESULTS Overall, depressed individuals displayed lower BMD than nondepressed subjects, with a composite weighted mean effect size (d) of -.23 (95% confidence interval: -.33 to -.13; p < .001). The association between depression and BMD was similar in the spine, hip, and forearm. It was stronger in women (d = -.24) than men (d = -.12) and in premenopausal (d = -.31) than postmenopausal (d = -.12) women. Only women individually diagnosed for major depression by a psychiatrist with DSM criteria displayed significantly low BMD (d = -.36); women diagnosed by self-rating questionnaires did not (d = -.06). Depressed subjects had increased urinary levels of bone resorption markers (d = .52). CONCLUSIONS The present findings portray depression as a significant risk factor for low BMD. Premenopausal women who are psychiatrically diagnosed with major depression are particularly at high-risk for depression-associated low BMD. Hence, periodic BMD measurements and antiosteoporotic prophylactic and curative measures are strongly advocated for these patients.
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Affiliation(s)
- Raz Yirmiya
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem 91905, Israel.
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Petty SJ, Hill KD, Haber NE, Paton LM, Lawrence KM, Berkovic SF, Seibel MJ, O'Brien TJ, Wark JD. Balance impairment in chronic antiepileptic drug users: a twin and sibling study. Epilepsia 2009; 51:280-8. [PMID: 19674052 DOI: 10.1111/j.1528-1167.2009.02254.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Patients taking antiepileptic drugs (AEDs) have an increased incidence of fractures. This study investigated chronic AED use and physical contributors to falls risk using an AED-discordant, twin and sibling matched-pair approach, and assessed clinically relevant subgroups: AED polytherapy; longer-duration AED; and falls history. METHODS Twenty-nine same-sex (mean age 44.9 years, 59% female), ambulatory, community-dwelling twin and sibling pairs, discordant for AED exposure (and AED-indication), were recruited. Validated clinical and laboratory tests of strength, gait, and balance were performed. Relevant AED levels, and fasting serum samples for 25-hydroxyvitamin D (25OHD), 1,25-dihydroxyvitamin D [1,25(OH)(2)D], and immunoreactive parathyroid hormone (iPTH) levels were taken. RESULTS There were significant mean within-pair differences in tests of static and dynamic balance, with the AED user having poorer balance function than the AED nonuser. No difference was seen in lower limb strength or gait measures. Increased duration of AED therapy and AED polytherapy were independent predictors of increased sway. No significant within-pair differences were seen in fasting serum levels of 1,25(OH)(2)D, 25OHD and iPTH after Bonferroni correction. DISCUSSION Balance performance is impaired in AED users compared to their matched nonuser siblings. Pairs where the AED users took AED polytherapy, or had a longer duration of AED use, had more impaired balance performance. These balance deficits may contribute to the increased rate of fractures in this population.
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Affiliation(s)
- Sandra J Petty
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
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McGough P, Bigrigg A. Effect of depot medroxyprogesterone acetate on bone density in a Scottish industrial city. EUR J CONTRACEP REPR 2009; 12:253-9. [PMID: 17763264 DOI: 10.1080/13625180701475640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine if long-term users of depot medroxyprogesterone acetate injectable contraception (DMPA) were more likely than their peers to have low bone density. DESIGN Cross-sectional observational study. SETTING The Domiciliary Family Planning Service, Glasgow, Scotland. SUBJECTS Clients of the Domiciliary Service who had used DMPA for contraception for longer than 5 years (mean 12 years) were invited to participate and select their own control, a friend or relative who had never used this method of contraception. MAIN OUTCOME MEASURES Bone density measured at the hip and lumbar spine by dual X-ray absorptiometry (DXA). RESULTS DMPA users had a significantly lower bone density than controls, 12-13% less at both hip and lumbar spine. This difference remained even when controlling for parity, smoking, family history of kyphosis or hip fracture, and body mass index. CONCLUSIONS DMPA significantly decreases bone density in a group of long-term users with significant social deprivation. The long-term significance of this remains uncertain.
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Ness KK, Leisenring WM, Huang S, Hudson MM, Gurney JG, Whelan K, Hobbie WL, Armstrong GT, Robison LL, Oeffinger KC. Predictors of inactive lifestyle among adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Cancer 2009; 115:1984-94. [PMID: 19224548 DOI: 10.1002/cncr.24209] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND : Participation in physical activity is important for childhood cancer survivors, because inactivity may compound cancer/treatment-related late effects. However, some survivors may have difficulty participating in physical activity, and these individuals need to be identified so that risk-based guidelines for physical activity, tailored to specific needs, can be developed and implemented. The objectives of the current study were to document physical activity patterns in the Childhood Cancer Survivor Study (CCSS) cohort, to compare the physical activity patterns with siblings in the CCSS and with a population-based sample from the Behavioral Risk Factor Surveillance System, and to evaluate associations between diagnosis, treatment, and personal factors in terms of the risk for an inactive lifestyle. METHODS : Percentages of participation in recommended physical activity were compared among survivors, siblings, and population norms. Generalized linear models were used to evaluate the associations between cancer diagnosis and therapy, sociodemographics, and the risk for an inactive lifestyle. RESULTS : Participants included 9301 adult survivors of childhood cancer and 2886 siblings. Survivors were less likely than siblings (46% vs 52%) to meet physical activity guidelines and were more likely than siblings to report an inactive lifestyle (23% vs 14%). Medulloblastoma (35%) and osteosarcoma (27%) survivors reported the highest levels of inactive lifestyle. Treatments with cranial radiation or amputation were associated with an inactive lifestyle as were being a woman, black race, older age, lower educational attainment, underweight or obese status, smoking, and depression. CONCLUSIONS : Childhood cancer survivors were less active than a sibling comparison group or an age- and sex-matched population sample. Survivors who are at risk for an inactive lifestyle should be considered high priority for developing and testing of intervention approaches. Cancer 2009. (c) 2009 American Cancer Society.
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Affiliation(s)
- Kirsten K Ness
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
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