The role of hypertension in bone mineral density among males older than 50 years and postmenopausal females: evidence from the US National Health and Nutrition Examination Survey, 2005-2010

Association between red cell distribution width/serum albumin ratio and Parkinson's disease

BACKGROUND

The ratio between erythrocyte distribution width and serum albumin (RAR) has gained recognition as a novel composite biomarker for inflammatory processes, though its clinical significance in Parkinson's disease (PD) pathology requires further exploration. The purpose of this cross-sectional study was to investigate the relationship between RAR and PD.

METHODS

This epidemiologic investigation utilized data from participants enrolled in the National Health and Nutrition Examination Survey (NHANES) spanning 2003-2018. Study cohorts comprised PD-diagnosed individuals and matched controls. To elucidate the RAR-PD connection, we implemented three analytical strategies: multivariable-adjusted logistic regression models incorporating sample weights, restricted cubic spline (RCS) modeling for nonlinear relationships, and stratified analyses across demographic subgroups. Comparative assessment of inflammatory biomarkers' discriminative performance was performed through ROC curve analysis, contrasting RAR against platelet-albumin ratio (PAR) and neutrophil-albumin ratio (NAR).

RESULTS

The analysis encompassed 31,848 adults (297 PD cases; 31,551 controls) from the NHANES database. Quantitative analysis revealed elevated RAR measurements in PD subjects compared to controls [3.28 (0.04) vs. 3.09 (0.01), P < 0.001]. Following covariate adjustment in weighted regression models, multivariable-adjusted analyses identified RAR as an independent predictor (adjusted OR = 1.40, 95% CI 1.06-1.85, P = 0.018). RCS modeling revealed nonlinear RAR-PD associations, peaking at 3.48 (inverted U-shape). Comparative ROC analysis confirmed RAR's discriminative superiority over PAR and NAR in PD detection (P < 0.05).

CONCLUSIONS

As demonstrated by the research findings, RAR is strongly and independently associated with PD. RAR may serve as an indicator or screening tool for an increased risk of PD.

Association between magnesium depletion score and all-cause and cause-specific mortality in patients with diabetic kidney disease

BACKGROUND

The prognostic value of Magnesium Depletion Score (MDS) in Diabetic Kidney Disease (DKD) patients is still unclear. This study aimed to determine the associations between MDS and long-term mortality in DKD population.

METHODS

Data were obtained from the National Health and Nutrition Examination Survey (NHANES III). MDS is calculated from four specific scoring items: estimated glomerular filtration rate (eGFR), heavy drinking, use of proton pump inhibitors (PPI), and use of diuretics. Multivariate Cox proportional hazards regression models was employed to explore the association between MDS and all-cause and cause specific mortality, with emphasis on age-specific analysis.Mediation analysis explored if metabolic indices mediate the relation between MDS and mortality. Sensitive analyses were performed to check the robustness of the main findings.

RESULTS

3,179 patients with DKD were included in this study, with 1,698 females and 1,481 males. The multivariate Cox regression analyses showed higher MDS were significantly associated with the all-cause mortality of DKD population [MDS ≥ 3: adjusted hazard ratio (HR):1.932, 95% confidence interval (CI): 1.339-2.787,p < 0.001]. Meanwhile, the trend was also significant in cardiovascular mortality of the DKD population (MDS ≥ 3: HR = 3.688, 95%CI: 1.702-8.577,p < 0.001). Heavy drinking was the most influential factor among the four MDS scoring items that affects mortality outcomes. Mediation analysis showed increased MDS could slightly improve metabolic levels, but the improvement was insufficient to reverse the mortality outcome in DKD patients. Subgroup analysis manifested that the result was more applicable for patients over 60. The result of the sensitive analysis confirmed the robustness of the main conclusion.

CONCLUSIONS

Our study highlights the clinical prognostic value of MDS in predicting the survival of the DKD population, especially among patients over 60. The findings imply that reducing alcohol consumption and performing routine cardiovascular health assessments for DKD patients with MDS > 2 are important for prolonging DKD patients' survival time.

Higher Magnesium Depletion Score Increases the Risk of All-cause and Cardiovascular Mortality in Hypertension Participants

The magnesium depletion score (MDS) is a novel index utilized for evaluating body magnesium status. The present study intended to explore the association of MDS with mortality among hypertension (HTN) participants. In this cohort study, we utilized data from the National Health and Nutrition Examination Survey (NHANES) covering the years 2003 to 2018. MDS levels were categorized into three groups (lower: MDS = 0-1; middle: MDS = 2; higher: MDS = 3-5). Kaplan-Meier curves were employed to illustrate survival differences between groups with varying MDS levels. The relationship between MDS and mortality was assessed through weighted multivariate Cox regression models. Subgroup analyses, along with sensitivity analyses, were also conducted to further explore and validate the findings. This study encompassed 12,485 participants, recording 2537 all-cause deaths and 707 cardiovascular deaths. The Kaplan-Meier curves revealed that the higher MDS group had the highest rates of all-cause and cardiovascular death. (P < 0.001). Controlling for all confounding variables, participants belonging to the higher MDS group demonstrated a substantially elevated risk of mortality in comparison to the lower MDS group (all-cause mortality: hazard ratio (HR) = 1.31, 95% confidence interval (CI) 1.10-1.54; cardiovascular mortality: HR = 1.63, 95% CI 1.19-2.22). There were no interaction factors found in subgroup analyses that affected the relationship between MDS and mortality, except for cardiovascular disease. The findings were confirmed to be robust through further sensitivity analyses. Higher MDS levels independently predict an elevated risk of mortality among US adults with HTN. Therefore, MDS may serve as a cost-effective and widely available prognostic marker for HTN.

The Association between Magnesium Depletion Score and Hypertension in US Adults: Evidence from the National Health and Nutrition Examination Survey (2007-2018)

The magnesium depletion score (MDS) emerges as a new valuable predictor of the body's magnesium status index. This study aims to explore the link between MDS and hypertension (HTN) using the National Health and Nutrition Examination Survey (NHANES) data. A total of 9708 participants from NHANES (2007-2018) were enrolled to investigate MDS's connection with HTN. HTN was defined based on clinical guidelines. MDS classification (low, 0-1; middle, 2; high, 3-5) relied on alcohol consumption, diuretic use, proton-pump inhibitor (PPI) usage, and kidney disease. Multivariable logistic regression assessed MDS-HTN association. Subsequent analyses included interaction tests, subgroups, and sensitivity analysis. Each unit increase in MDS correlated with an 87% higher HTN risk (OR, 1.87; 95% CI, 1.64-2.13) after adjusting for confounders. High MDS participants exhibited significantly elevated HTN risk compared to low MDS counterparts (OR, 8.31; 95% CI, 4.81-14.36), with a significant trend across MDS groups (p < 0.001). Subgroup analyses supported a consistent positive correlation. Sensitivity analysis confirmed a robust association. The results indicated a positive correlation between MDS and the risk of developing HTN in US adults.

Analysis of the impact of underlying diseases in the elderly on postoperative re-fractures after osteoporotic compression fractures

BACKGROUND

Postoperative refracture of osteoporotic compression fractures in the elderly due to underlying illnesses is a complicated matter involving several variables. A multidisciplinary approach involving orthopedics, geriatrics, endocrinology, and rehabilitation medicine is necessary for an investigation of these issues. investigating the impact of older patients' underlying medical conditions on the refracture of osteoporotic compression fractures following surgery.

METHODS

A retrospective analysis was conducted on 2383 patients between August 2013 and August 2023. 550 patients with comorbid geriatric underlying diseases were screened, 183 patients underwent refractories, and 367 patients were classified as non-refractories. The patients were then divided into two groups: those undergoing refractories and those not, and the underlying diseases of the patients in both groups were examined using ROC curves and unifactorial and multifactorial logistic regression analyses.

RESULTS

Among the patients gathered, the frequency of re-fracture was 33.3%. A statistically significant difference was observed when re-fracture was linked to patients with long-term alcohol consumption, operated vertebrae ≤ 1, hypertension, COPD, diabetes mellitus, stroke sequelae, conservative treatment of coronary heart disease, trauma, mental abnormality, scoliosis, and chronic renal disease. Having hypertension decreased the risk of re-fracture (P = 0.018, OR = 0.548), while alcohol intake ≥ 10years (P = 0.003, OR = 2.165), mental abnormality (P < 0.001, OR = 4.093), scoliosis (P < 0.001, OR = 6.243), chronic kidney disease (P = 0.002, OR = 2.208), and traumatic injuries (P = 0.029, OR = 3.512) were the risk factors examined in a binary logistic regression analysis. The results of multiple linear stepwise regression analysis indicated that re-fracture was more influenced by scoliosis.

CONCLUSIONS

Hypertensive disorders were protective factors against the formation of re-fracture, while alcohol intake usage for more than ten years, psychological abnormalities, scoliosis, chronic kidney disease, and trauma were risk factors. Scoliosis had the highest influence on re-fracture.

Interrelationships among metabolic syndrome, bone-derived cytokines, and the most common metabolic syndrome-related diseases negatively affecting bone quality

Metabolic syndrome (MetS), as a set of medical conditions including hyperglycemia, hypertension, abdominal obesity, and dyslipidemia, represents a highly prevalent disease cluster worldwide. The individual components of MetS together increase the risk of MetS-related disorders. Recent research has demonstrated that bone, as an endocrine organ, releases several systemic cytokines (osteokines), including fibroblast growth factor 23 (FGF23), lipocalin 2 (LCN2), and sclerostin (SCL). This review not only summarizes current knowledge about MetS, osteokines and the most common MetS-related diseases with a detrimental impact on bone quality (type 2 diabetes mellitus: T2DM; cardiovascular diseases: CVDs; osteoporosis: OP), but also provides new interpretations of the relationships between osteokines and individual components of MetS, as well as between osteokines and MetS-related diseases mentioned above. In this context, particular emphasis was given on available clinical studies. According to the latest knowledge, FGF23 may become a useful biomarker for obesity, T2DM, and CVDs, as FGF23 levels were increased in patients suffering from these diseases. LCN2 could serve as an indicator of obesity, dyslipidemia, T2DM, and CVDs. The levels of LCN2 positively correlated with obesity indicators, triglycerides, and negatively correlated with high-density lipoprotein (HDL) cholesterol. Furthermore, subjects with T2DM and CVDs had higher LCN2 levels. SCL may act as a potential biomarker predicting the incidence of MetS including all its components, T2DM, CVDs, and OP. Elevated SCL levels were noted in individuals with T2DM, CVDs and reduced in patients with OP. The aforementioned bone-derived cytokines have the potential to serve as promising predictors and prospective treatment targets for MetS and MetS-related diseases negatively affecting bone quality.

Association between hypertension and osteoporosis: a population-based cross-sectional study

BACKGROUND

Current evidence suggests that metabolic dysregulation is inextricably linked to both hypertension and osteoporosis, but the correlation between hypertension and osteoporosis is still unclear. Therefore, in this study, we explored the correlation between hypertension and osteoporosis.

METHODS

A total of 37,807 participants from the National Health and Nutrition Examination Survey (1999-2010, 2013-2014, 2017-2018) were enrolled in this population-based cross-sectional study. Hypertension was considered an exposure factor and osteoporosis was considered an outcome factor. Logistic regression and subgroup analysis were used to assess the association between hypertension and osteoporosis.

RESULTS

A total of 2,523 participants, with a mean age of 68.65 ± 12.21 years, suffered from osteoporosis, and 86.2% were female. Participants with osteoporosis had a greater prevalence of hypertension than participants without osteoporosis (p < 0.001). Participants with hypertension also had a greater prevalence of osteoporosis than participants without hypertension (p < 0.001). Univariate logistic regression analysis indicated that hypertension was associated with osteoporosis (OR: 2.693, 95% CI: 2.480-2.924, p < 0.001). Multivariate logistic regression analysis with a fully adjusted model indicated that hypertension was strongly associated with osteoporosis (OR: 1.183, 95% CI: 1.055-1.327, p = 0.004). Subgroup analysis revealed that the associations between hypertension and osteoporosis were significant in the younger than 60 years, male sex, diabetes subgroup and hypercholesterolemia subgroup (p < 0.05).

CONCLUSION

Hypertension was independently associated with osteoporosis in the general population.

Impact of metabolic syndrome on bone mineral density in men over 50 and postmenopausal women according to U.S. survey results

Metabolic Syndrome (MetS) and bone mineral density (BMD) have shown a controversial link in some studies. This research aims to study their association in males over 50 and postmenopausal females using National Health and Nutrition Examination Survey (NHANES) data. Postmenopausal females and males over 50 were included in the study. MetS was defined by the National Cholesterol Education Program Adult Treatment Panel III guidelines. BMD values were measured at the thoracic spine, lumbar spine, and pelvis as the primary outcome. Weighted multivariate general linear models have been employed to explore the status of BMD in patients with MetS. Additionally, interaction tests and subgroup analyses were conducted. Utilizing the NHANES database from 2003 to 2006 and 2011-2018, we included 1924 participants, with 1029 males and 895 females. In postmenopausal women, after adjusting for covariates, we found a positive correlation between MetS and pelvic (β: 0.030 [95%CI 0.003, 0.06]) and thoracic (β: 0.030 [95%CI 0.01, 0.06]) BMD, though not for lumbar spine BMD (β: 0.020 [95%CI - 0.01, 0.05]). In males over 50 years old, MetS was positively correlated with BMD in both Model 1 (without adjusting for covariates) and Model 2 (considering age and ethnicity). Specifically, Model 2 revealed a positive correlation between MetS and BMD at the pelvis (β: 0.046 [95%CI 0.02, 0.07]), thoracic spine (β: 0.047 [95%CI 0.02, 0.07]), and lumbar spine (β: 0.040 [95%CI 0.02, 0.06]). Subgroup analysis demonstrated that the relationship between MetS and BMD remained consistent in all strata, underscoring the stability of the findings. In postmenopausal women, after adjusting for all covariates, a significant positive correlation was observed between MetS and BMD in the pelvis and thoracic spine, whereas this correlation was not significant for lumbar spine BMD. Conversely, in males, positive correlations between MetS and BMD at the lumbar spine, thoracic spine, and pelvis were identified in Model 2, which adjusted for age and ethnicity; however, these correlations disappeared after fully adjusting for all covariates. These findings highlight the potential moderating role of gender in the impact of MetS on BMD.

Changes in Blood Pressure is Associated with Bone Loss in US Adults: A Cross-Sectional Study from NHANES 2005-2018

Hypertension and osteoporosis are common geriatric diseases, sharing similar risk factors. This study aims to investigate this association and explore relatively mixed variables. Our study included 12,787 eligible participants from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. Included participants had valid data on hypertension and osteoporosis, without tumors, liver diseases, gout or thyroid diseases. We explored the association between hypertension and osteoporosis by logistic regression and examined blood pressure and BMD/BMC by linear and non-linear regression. Moreover, we used machine learning models to predict the importance of various factors in the occurrence of osteoporosis and evaluated causality by mendelian randomization. Our study found that osteoporosis is significantly associated with hypertension [OR 2.072 (95% CI 2.067-2.077), p < 0.001]. After adjusting for co-variances, the association remained significant [OR 1.223 (95% CI 1.220-1.227), p < 0.001]. Our study showed that osteoporosis is positively associated with hypertension in the US population. A variety of factors influence this relationship. Specific regulatory mechanisms and confounding factors need to be further investigated.

The association of lipid metabolism with bone metabolism and the role of human traits: a Mendelian randomization study

Background

The impact of lipid metabolism on bone metabolism remains controversial, and the extent to which human traits mediate the effects of lipid metabolism on bone metabolism remains unclear.

Objective

This study utilized mendelian randomization to investigate the effects of blood lipids on bone mineral density (BMD) at various skeletal sites and examined the mediating role of human traits in this process.

Methods

We leveraged genetic data from large-scale genome-wide association studies on blood lipids (n=1,320,016), forearm bone mineral density (FA-BMD) (n=10,805), lumbar spine bone mineral density (LS-BMD) (n=44,731), and femoral neck bone mineral density (FN-BMD) (n=49,988) to infer causal relationships between lipid and bone metabolism. The coefficient product method was employed to calculate the indirect effects of human traits and the proportion of mediating effects.

Results

The results showed that a 1 standard deviation(SD) increase in HDL-C, LDL-C and TC was associated with a decrease in LS-BMD of 0.039 g/cm2, 0.045 g/cm2 and 0.054 g/cm2, respectively. The proportion of mediating effects of systolic blood pressure (SBP) on HDL-C to LS-BMD was 3.17%, but suppression effects occurred in the causal relationship of LDL-C and TC to LS-BMD. Additionally, the proportion of mediating effects of hand grip strength (HGS) on the TC to LS-BMD pathway were 6.90% and 4.60% for the left and right hands, respectively.

Conclusion

In conclusion, a negative causal relationship was established between lipid metabolism and bone metabolism. Our results indicated that SBP and HGS served as mediators for the effects of lipid metabolism on bone metabolism.