Correlation analysis between risk factors, BMD and serum osteocalcin, CatheK, PINP, β-crosslaps, TRAP, lipid metabolism and BMI in 128 patients with postmenopausal osteoporotic fractures

Association of serum osteocalcin with bone microarchitecture and muscle mass in Beijing community-dwelling postmenopausal women

BACKGROUND

Osteoporosis is a systemic skeletal disease with increasing bone fragility and prone to fracture. Osteocalcin (OC), as the most abundant non collagen in bone matrix, has been extensively used in clinic as a biochemical marker of osteogenesis. Two forms of OC were stated on circulation, including carboxylated osteocalcin (cOC) and undercarboxylated osteocalcin (ucOC). OC was not only involved in bone mineralization, but also in the regulation of muscle function.

OBJECTIVE

This study explored the relationship between serum OC, cOC, ucOC levels and bone mineral density (BMD), bone microarchitecture, muscle mass and physical activity in Chinese postmenopausal women.

METHOD

216 community-dwelling postmenopausal women were randomized enrolled. All subjects completed biochemical measurements, including serum β-isomer of C-terminal telopeptides of type I collagen (β-CTX), N-terminal propeptide of type 1 procollagen (P1NP), alkaline phosphatase (ALP), OC, cOC and ucOC. They completed X-ray absorptiometry (DXA) scan to measure BMD, appendicular lean mass (ALM) and trabecular bone score (TBS). They completed high resolution peripheral quantitative CT (HR-pQCT) to assess peripheral bone microarchitectures.

RESULTS

Serum OC, cOC and ucOC were elevated in osteoporosis postmenopausal women. In bone geometry, serum ucOC was positively related with total bone area (Tt.Ar) and trabecular area(Tb.Ar). In bone volumetric density, serum OC and ucOC were negatively associated with total volume bone mineral density (Tt.vBMD) and trabecular volume bone mineral density (Tb.vBMD). In bone microarchitecture, serum OC and ucOC were negatively correlative with Tb.N and Tb.BV/TV, and were positively correlated with Tb.Sp. Serum OC and ucOC were positively associated with Tb.1/N.SD. Serum OC was negatively related with Tb.Th. Serum ucOC was positively associated with ALM. The high level of serum OC was the risk factor of osteoporosis. ALM was the protective factor for osteoporosis.

CONCLUSION

All forms of serum OC were negatively associated with BMD. Serum OC and ucOC mainly influenced microstructure of trabecular bone in peripheral skeletons. Serum ucOC participated in modulating both bone microstructure and muscle mass.

Correlation between bone density, bone metabolism markers with lipid metabolism markers and body mass index

PURPOSE

We aimed to explore the relationship between bone mineral density (BMD), bone metabolism markers, and blood lipid-related indicators, body mass index (BMI) in elderly individuals.

METHODS

A retrospective analysis was conducted on 710 patients. Patients' gender, age, height, weight, bone density values, T-scores, bone metabolism markers (including serum N-terminal propeptide of type I collagen (s-PINP), serum C-terminal telopeptide of type I collagen (s-CTX) and 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) and lipid-related indicators (including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG) and Castelli index 1 (TC/HDL-C index) and Castelli index 2 (LDL-C/HDL-C index) were recorded. Correlations between variables were analyzed, and patients were grouped according to gender and T-score for intergroup comparisons.

RESULTS

HDL-C negatively correlates with BMD and s-CTX. TG, Castelli index, and BMI positively correlate with BMD. BMI negatively correlates with s-PINP. 1,25(OH)2D3 negatively correlates with TC, LDL-C, and Castelli index. LDL-C positively correlates with BMD in males, and TC negatively correlates with s-PINP. In females, HDL-C negatively correlates with BMD, and s-CTX positively correlates with Castelli index. 1,25(OH)2D3 negatively correlates with TC, LDL-C, and Castelli index. TG and Castelli index were higher in normal bone mass group, while HDL-C is higher in the osteoporosis group. TG and BMI positively predicted bone mass density, while HDL-C negatively predicted bone mass density.

CONCLUSIONS

HDL-C may have a predictive role in osteoporosis, particularly in women. The likelihood of osteoporosis is lower in individuals with high BMI or hyperlipidemia. Some lipid metabolism markers can be used to predict osteoporosis, and further research is needed.

Plasma serotonin precursors and metabolite are correlated with bone mineral density and bone turnover markers in patients with postmenopausal osteoporosis

BACKGROUND

Serotonin (5-HT) precursors regulate bone remodeling. This study aims to investigate the correlation of plasma 5-HT precursors and metabolite with bone mineral density (BMD) and bone turnover markers in postmenopausal osteoporosis (PMOP) patients.

METHODS

The age, body mass index (BMI), and years since menopause (YSM) were documented for 348 postmenopausal women in normal/osteopenia/osteoporosis (OP) groups, with lumbar spine and femoral neck BMD measured. Serum bone turnover markers (PINP/β-CTX) and plasma 5-HT, 5-HT precursors (Trp/5-HTP) and metabolite (5-HIAA) were measured by ELISA. OP patients were allocated to high/low expression groups following ROC analysis of 5-HT/Trp/5-HTP/5-HIAA. The relationship of plasma 5-HT/Trp/5-HTP/5-HIAA, BMD, and bone turnover markers with PMOP was analyzed using logistic regression analysis. The correlation of plasma 5-HT/Trp/5-HTP/5-HIAA with BMD and bone turnover markers was analyzed using Pearson's correlation analysis, followed by logistic regression analysis of the relationship between plasma 5-HT/Trp/5-HTP/5-HIAA and BMD, bone turnover markers and PMOP.

RESULTS

BMI, YSM, BMD and PINP, and β-CTX levels differed among groups. Levels of plasma 5-HT precursors/metabolite were increased in OP patients. Individuals with high 5-HT precursors/metabolite levels had low BMD and high PINP/β-CTX levels. The 5-HT precursors/metabolite negatively-correlated with BMD and positively-correlated with PINP/β-CTX. BMI, YSM, BMD, and PINP/β-CTX/Trp/5-HTP/5-HT related to PMOP and were independent risk factors for OP.

CONCLUSION

Plasma 5-HT precursors and metabolite negatively-correlate with BMD and positively-correlate with PINP/β-CTX in PMOP patients. Peripheral 5-HT precursors and metabolite level may be a new direction of treatment of PMOP and bone metabolism-related disorders.

Association of the visceral adiposity index with femur bone mineral density and osteoporosis among the U.S. older adults from NHANES 2005-2020: a cross-sectional study

Background

The visceral adiposity index (VAI) is a marker of abdominal fat distribution and adipose tissue function. However, the association between VAI and femur bone mineral density (BMD) and osteoporosis is unclear among the U.S. older adults.

Methods

Cross-sectional data for adults aged 60 years and older from the 2007-2020 National Health and Nutrition Examination Survey (NHANES) were included. Multivariable linear and logistic regression were used to evaluate the association between VAI and femur BMD and osteoporosis. We used the smooth curve fitting to address nonlinearity. Moreover, a two-piecewise linear regression model was used to explain the nonlinearity further.

Results

The findings of the multivariable logistic regression models showed that as the VAI value increased by one unit, the prevalence of osteoporosis decreased by 1.2% after adjusting for covariates associated with osteoporosis. The multivariable linear regression models demonstrated that VAI was positively correlated with femur BMD. Further analysis revealed an inverted L-shaped and inverted U-shaped relationship between VAI and femur BMD at different sites.

Conclusions

Our findings indicated that an increased VAI is independently linked to a higher prevalence of osteoporosis among the U.S. older adults. Further analysis reveals that once VAI reaches a certain threshold, femur BMD no longer increases and may even decrease. This suggests that a moderate accumulation of visceral fat may be beneficial for bone health, while excessive visceral fat could potentially have detrimental effects.

Low BMI, blood calcium and vitamin D, kyphosis time, and outdoor activity time are independent risk factors for osteoporosis in postmenopausal women

Aim

To explore the risk factors of osteoporosis in postmenopausal women in China.

Method

This study collected all patient data from January 2014 to December 2015. Basic information and questionnaires were collected from 524 postmenopausal women in Sanya and Hainan Province. The questionnaire was administered to the enrolled participants by endocrinologists. Biochemical parameters were measured using fasting blood samples, and bone density was measured by dual energy X-ray absorptiometry at the department of radiology of Hainan hospital, PLA General Hospital. Participants with an R-value of ≤-2.5 were diagnosed with osteoporosis. After deleting missing values for each factor, 334 participants were divided into the osteoporosis (n=35) and non-osteoporosis (n=299) groups according to the R-values.

Results

The participants had a median age of 60.8 years (range: 44-94 years). Among the 334 postmenopausal women included in this study, 35 (10.5%) were diagnosed with osteoporosis. Univariate analysis showed statistically significant differences in age, BMI, type of work, alkaline phosphatase, years of smoking, blood calcium levels, kyphosis, fracture, and asthma between the two groups (P<0.05). In addition, multivariate logistic analysis showed that age (odds ratio [OR]: 1.185, 95% confidence interval [CI]: 1.085-1.293, P<0.001) and kyphosis times (OR:1.468, 95% CI: 1.076-2.001, P=0.015) were positively correlated with postmenopausal osteoporosis, whereas BMI (OR: 0.717, 95% CI: 0.617-0.832, P<0.001), blood calcium levels (OR: 0.920, 95% CI: 0.854-0.991, P=0.027), vitamin D levels (OR: 0.787, 95% CI: 0.674-0.918, P=0.002), and outdoor activity time (OR: 0.556, 95% CI: 0.338-0.915, P=0.021) were negatively correlated with postmenopausal osteoporosis.

Conclusion

Low BMI, blood calcium and vitamin D levels, kyphosis time, and outdoor activity time are independent risk factors for osteoporosis in postmenopausal women.

The Paradoxical Association of Lipids with Survival and Walking Ability of Hip Fractures in Geriatric Patients After Surgery: A 1-Year Follow-Up Study

Background

We aimed to explore the association between lipids and the survival and walking ability of hip fractures in geriatric patients after surgery.

Methods

Restricted cubic spline (RCS) was established to explore the nonlinear relationship between lipids and 1-year mortality of hip fractures, and the cut-off points were also determined by RCS. Then, the patients were divided into three groups: low, middle, and high levels of LDL-c. Then, the survival and walking ability of patients from different groups were compared, and the Cox regression and Logistics regression were used to identify the relationships between lipids and the survival and walking ability of hip fractures.

Results

The patients with middle levels of LDL-c had a significantly high survival probability than those with low or high levels of LDL-c (p < 0.001). The patients with low levels of LDL-c and with high levels of LDL-c may have a poor prognosis compared with patients with middle levels of LDL-c in 6-month mortality, 6-month free walking ability, 1-year mortality, and 1-year free walking ability (All p < 0.05).

Conclusion

Low and high levels of LDL-c may both relate to the poor survival and walking ability of hip fractures.

Validation of Three Tools for Estimating the Risk of Primary Osteoporosis in an Elderly Male Population in Beijing

Purpose

This cross-sectional study estimated three clinical tools including the Osteoporosis Self-Assessment Tool for Asians (OSTA), Body Mass Index (BMI), and Beijing Friendship Hospital Osteoporosis Self-assessment Tool for Elderly Male (BFH-OSTM) for identifying primary osteoporosis and found optimal cut-off values in an elderly Han Beijing male population.

Materials and Methods

We conducted a cross-sectional study, enrolling 400 community-dwelling elderly Han Beijing males aged ≥50 from 8 medical institutions. Osteoporosis was diagnosed as a T-score of -2.5 standard deviations or lower than that of the average young adult in different diagnostic criteria [lumbar spine (L1-L4), femoral neck, total hip, WHO]. BFH-OSTM, OSTA, and BMI were assessed for predicting OP by receiver operating characteristic (ROC) curves. Sensitivity, specificity, and areas under the ROC curves (AUC) were determined. Ideal thresholds for the omission of screening BMD were proposed.

Results

The prevalence of osteoporosis ranged from 9.25% to 19.0% according to different diagnostic criteria. The present study indicated the highest discriminating ability was BFH-OSTM in different criteria. The AUCs of OSTA and BMI were 0.748 and 0.770 in WHO criteria, which suggested limiting predictive value for identifying OP in elderly Beijing males. The AUC of BFH-OSTM to predict OP based on WHO criteria was 0.827, yielding a sensitivity of 65.8% and specificity of 82.7%, respectively. With a cost of missing 6.5% of osteoporosis patients, BFH-OSTM could reduce 73.5% of participants in screening BMD tests.

Conclusion

BFH-OSTM may be a simple and effective tool for identifying OP in the elderly male population in Beijing to omit BMD screening reasonably.

Clinical application of the fracture risk assessment tool in the general population and its correlation with bone turnover markers

Objective: To compare the risk of osteoporotic fractures between the urban and urban-rural fringe populations in southern China and to explore the effect of bone turnover markers on fracture risk. Methods: Epidemiological investigations were conducted in the urban and urban-rural fringe areas of southern China in June 2018. Residents aged 40 years and over who signed informed consent forms were included. Physical examination and questionnaire collection were completed. Bone turnover markers (BTMs) including osteocalcin (OC) and beta cross-linked C-telopeptide of type 1 collagen (β-CTX) were tested. Bone mineral density (BMD) of the femoral neck and lumbar vertebrae 1-4 were measured using dual energy X-ray absorptiometry. Fracture risk assessment tool (FRAX) values were calculated to show the probability of major osteoporotic fracture (PMOF) and probability of hip fracture (PHF) over the next 10 years. Results: A total of 1,051 participants were included in this study, including 553 in the urban areas and 498 in the urban-rural fringe areas. The average PMOF and PHF were 3.4 (2.3-5.4) % and .6 (.3-1.5) %, respectively. Compared with that in the urban populations, the femoral neck BMD in the urban-rural fringe populations was lower and FRAX values were generally higher, especially for women. FRAX values in various populations were mainly negatively correlated with lumbar and femoral neck BMD and were positively correlated with β-CTX; meanwhile, only PHF was negatively correlated with OC. After adjusting for sex, elevated β-CTX levels significantly increased the risk of high PMOF in various populations and increased the risk of high PHF in the urban-rural fringe populations. In particular, the risks of increased PMOF and PHF could increase by as much as 33 times and 19.5 times, respectively, in the urban-rural fringe areas. Conclusion: The urban-rural fringe populations in Southern China may be at risk of osteoporotic fracture. In addition to being related to BMD, the FRAX value also correlates with some BTMs. Combining FRAX with BMD, and BTMs may better predict the fracture risk.