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Constant C, Aubin CE, Kremers HM, Garcia DVV, Wyles CC, Rouzrokh P, Larson AN. The use of deep learning in medical imaging to improve spine care: A scoping review of current literature and clinical applications. NORTH AMERICAN SPINE SOCIETY JOURNAL 2023; 15:100236. [PMID: 37599816 PMCID: PMC10432249 DOI: 10.1016/j.xnsj.2023.100236] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 06/14/2023] [Indexed: 08/22/2023]
Abstract
Background Artificial intelligence is a revolutionary technology that promises to assist clinicians in improving patient care. In radiology, deep learning (DL) is widely used in clinical decision aids due to its ability to analyze complex patterns and images. It allows for rapid, enhanced data, and imaging analysis, from diagnosis to outcome prediction. The purpose of this study was to evaluate the current literature and clinical utilization of DL in spine imaging. Methods This study is a scoping review and utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology to review the scientific literature from 2012 to 2021. A search in PubMed, Web of Science, Embased, and IEEE Xplore databases with syntax specific for DL and medical imaging in spine care applications was conducted to collect all original publications on the subject. Specific data was extracted from the available literature, including algorithm application, algorithms tested, database type and size, algorithm training method, and outcome of interest. Results A total of 365 studies (total sample of 232,394 patients) were included and grouped into 4 general applications: diagnostic tools, clinical decision support tools, automated clinical/instrumentation assessment, and clinical outcome prediction. Notable disparities exist in the selected algorithms and the training across multiple disparate databases. The most frequently used algorithms were U-Net and ResNet. A DL model was developed and validated in 92% of included studies, while a pre-existing DL model was investigated in 8%. Of all developed models, only 15% of them have been externally validated. Conclusions Based on this scoping review, DL in spine imaging is used in a broad range of clinical applications, particularly for diagnosing spinal conditions. There is a wide variety of DL algorithms, database characteristics, and training methods. Future studies should focus on external validation of existing models before bringing them into clinical use.
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Affiliation(s)
- Caroline Constant
- Orthopedic Surgery AI Laboratory, Mayo Clinic, 200 1st St Southwest, Rochester, MN, 55902, United States
- Polytechnique Montreal, 2500 Chem. de Polytechnique, Montréal, QC H3T 1J4, Canada
- AO Research Institute Davos, Clavadelerstrasse 8, CH 7270, Davos, Switzerland
| | - Carl-Eric Aubin
- Polytechnique Montreal, 2500 Chem. de Polytechnique, Montréal, QC H3T 1J4, Canada
| | - Hilal Maradit Kremers
- Orthopedic Surgery AI Laboratory, Mayo Clinic, 200 1st St Southwest, Rochester, MN, 55902, United States
| | - Diana V. Vera Garcia
- Orthopedic Surgery AI Laboratory, Mayo Clinic, 200 1st St Southwest, Rochester, MN, 55902, United States
| | - Cody C. Wyles
- Orthopedic Surgery AI Laboratory, Mayo Clinic, 200 1st St Southwest, Rochester, MN, 55902, United States
- Department of Orthopedic Surgery, Mayo Clinic, 200, 1st St Southwest, Rochester, MN, 55902, United States
| | - Pouria Rouzrokh
- Orthopedic Surgery AI Laboratory, Mayo Clinic, 200 1st St Southwest, Rochester, MN, 55902, United States
- Radiology Informatics Laboratory, Mayo Clinic, 200, 1st St Southwest, Rochester, MN, 55902, United States
| | - Annalise Noelle Larson
- Orthopedic Surgery AI Laboratory, Mayo Clinic, 200 1st St Southwest, Rochester, MN, 55902, United States
- Department of Orthopedic Surgery, Mayo Clinic, 200, 1st St Southwest, Rochester, MN, 55902, United States
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Vilpunaho T, Karinkanta S, Sievänen H, Kopra J, Kröger H, Rikkonen T. Predictive ability of a self-rated fall risk assessment tool in community-dwelling older women. Aging Clin Exp Res 2023; 35:1205-1212. [PMID: 37145268 DOI: 10.1007/s40520-023-02423-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/24/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Falls are a substantial health problem among older adults. An accessible and reliable tool for assessing individual fall risk is needed. AIMS The predictive ability of a one-page self-rated fall risk assessment form (KaatumisSeula® [KS]) was evaluated among older women in its current form. METHODS A subsample (n = 384) of community-living older women (aged 72-84 years) participating in the Kuopio Fall Prevention Study (KFPS) completed the KS form. Participants' falls were prospectively registered for 12 months with SMS messages. Their group status and form-based fall risk category were compared to the verified fall events during the KFPS intervention. Negative binomial regression and multinomial regression analyses were used. Physical performance measurements (single leg stance, leg extension strength and grip strength) were used as covariates. RESULTS During the follow-up, 43.8% of women fell at least once. Among the fallers, 76.8% had at least one self-determined injurious fall, and 26.2% had falls requiring medical attention. According to KS, 7.6% of the women had low fall risk, 75.0% moderate, 15.4% substantial, and only 2.1% high fall risk. Women in the "moderate fall risk" group had 1.47-fold (95% CI 0.74-2.91; nonsignificant), in "substantial fall risk" 4.00-fold (1.93-8.3; p < 0.001) and in "high fall risk" 3.00-fold (0.97-9.22; nonsignificant) higher risk of falls compared to the "low fall risk" group. Performance in physical tests did not account for future falls. CONCLUSIONS The KS form proved to be a feasible tool for self-administered fall risk assessment with moderate predictive ability. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02665169, date of first registration 27/01/2016.
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Affiliation(s)
- Tommi Vilpunaho
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Yliopistonranta 1B, P.O. Box 1627, 70211, Kuopio, Finland.
| | - Saija Karinkanta
- The UKK Institute for Health Promotion Research, Tampere, Finland
- The Social Insurance Institution of Finland, Research Unit, Tampere, Finland
| | - Harri Sievänen
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - Juho Kopra
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Yliopistonranta 1B, P.O. Box 1627, 70211, Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Yliopistonranta 1B, P.O. Box 1627, 70211, Kuopio, Finland
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Toni Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU), Surgery, Institute of Clinical Medicine, University of Eastern Finland (UEF), Yliopistonranta 1B, P.O. Box 1627, 70211, Kuopio, Finland
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Moilanen A, Kopra J, Kröger H, Sund R, Rikkonen T, Sirola J. Characteristics of Long-Term Femoral Neck Bone Loss in Postmenopausal Women: A 25-Year Follow-Up. J Bone Miner Res 2022; 37:173-178. [PMID: 34668233 PMCID: PMC9298425 DOI: 10.1002/jbmr.4444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/31/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022]
Abstract
The aim of this study was to monitor long-term changes in bone mineral density (BMD) after menopause and factors affecting BMD. The study population consisted of a random sample of 3222 women from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) study, of which 62.1% were postmenopausal at the beginning of the study. This group of women underwent dual-energy X-ray absorptiometry (DXA) measurements at the femoral neck every 5 years from baseline (in 1989) up to 25-year follow-up. They also responded to risk-factor questionnaires at 5-year intervals. During the 25-year follow-up, the baseline cohort decreased to 686 women. The women were divided into quartiles based on their baseline BMD. Self-reported hormone replacement therapy (HRT) and corticosteroid use were divided into ever users and never users. Morbidity was assessed as the total number of self-reported diseases and BMD-affecting diseases. The mean 25-year BMD change was found to be -10.1%, p < 0.001. Higher baseline BMD was associated with higher bone loss rate; the reduction in the highest quartile BMD was 11.1% and in the lowest quartile 7.4% (p = 0.0031). Lower baseline body mass index (BMI) and a greater increase in BMI were found to protect against postmenopausal bone loss (p < 0.001). The lowest bone loss quartile included 15.2% more HRT users than the highest bone loss quartile (p = 0.004). The number of diseases/bone-affecting diseases, use of vitamin D/calcium supplementation, use of corticosteroids, smoking or alcohol use had no statistical significance for annual bone loss rate. This study presents hitherto the longest (25-year) BMD follow-up in postmenopausal women. The linear femoral neck bone loss of 10% was less than previously assumed. A 5-year BMD change appeared to predict long-term bone loss in postmenopausal women. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Anna Moilanen
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Juho Kopra
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland.,Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Reijo Sund
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Toni Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland
| | - Joonas Sirola
- Kuopio Musculoskeletal Research Unit (KMRU), Institute of Clinical Medicine, School of Medicine, University of Eastern Finland (UEF), Kuopio, Finland.,Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
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Mikkilä S, Johansson J, Nordström A, Nordström P, Emaus N, Handegård BH, Morseth B, Welde B. A 15-year follow-up study of hip bone mineral density and associations with leisure time physical activity. The Tromsø Study 2001–2016. PLoS One 2022; 17:e0262228. [PMID: 35081131 PMCID: PMC8791505 DOI: 10.1371/journal.pone.0262228] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/19/2021] [Indexed: 11/18/2022] Open
Abstract
Aims
The aim was to investigate the long-term association between leisure time physical activity and hip areal bone mineral density (aBMD), in addition to change in hip aBMD over time, in 32–86 years old women and men.
Methods
Data were retrieved from the 2001, 2007–2008, and 2015–2016 surveys of the Tromsø Study, a longitudinal population study in Norway. Leisure time physical activity was assessed by the four-level Saltin-Grimby Physical Activity Level Scale which refers to physical exertion in the past twelve months. Hip aBMD was assessed by Dual-Energy X-ray Absorptiometry. Linear Mixed Model analysis was used to examine long-term associations between physical activity and hip aBMD (n = 6324). In addition, the annual change in hip aBMD was analyzed in a subsample of 3199 participants.
Results
Physical activity was significantly and positively associated with total hip aBMD in the overall cohort (p<0.005). Participants who reported vigorous activity had 28.20 mg/cm2 higher aBMD than those who were inactive (95% CI 14.71; 41.69, controlled for confounders), and even light physical activity was associated with higher aBMD than inactivity (8.32 mg/cm2, 95% CI 4.89; 11.76). Associations between physical activity and femoral neck aBMD yielded similar results. Hip aBMD decreased with age in both sexes, although more prominently in women. From 2001 to 2007–2008, aBMD changed by –5.76 mg/cm2 per year (95% CI –6.08; –5.44) in women, and –2.31 mg/cm2 (95% CI –2.69; –1.93), in men. From 2007–2008 to 2015–2016, the change was –4.45 mg/cm2 per year (95% CI –4.84; –4.06) in women, and –1.45 mg/cm2 (95% CI –1.92; –0.98) in men.
Conclusions
In this cohort of adult men and women, physical activity levels were positively associated with hip aBMD in a dose-response relationship. Hip aBMD decreased with age, although more pronounced in women than men.
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Affiliation(s)
- Saija Mikkilä
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- * E-mail:
| | - Jonas Johansson
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anna Nordström
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Public Health and Clinical Medicine, Section for Sustainable Health, Umeå University, Umeå, Sweden
| | - Peter Nordström
- Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
| | - Nina Emaus
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bjørn Helge Handegård
- The Regional Centre for Child and Adolescent Mental Health–North, UiT The Arctic University of Norway, Tromsø, Norway
| | - Bente Morseth
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Boye Welde
- School of Sport Sciences, UiT The Arctic University of Norway, Tromsø, Norway
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Stattin K, Höijer J, Hållmarker U, Baron JA, Larsson SC, Wolk A, Michaëlsson K, Byberg L. Fracture risk across a wide range of physical activity levels, from sedentary individuals to elite athletes. Bone 2021; 153:116128. [PMID: 34302997 DOI: 10.1016/j.bone.2021.116128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/21/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To examine how physical activity is associated with risk of different fracture outcomes across the full range of physical activity. METHODS By combining information from three cohort studies and using generalized structural equation modelling, we estimated a continuous unitless latent variable reflecting physical activity that ranged from sedentary through elite athlete levels. Associations between physical activity and fracture outcomes were assessed with proportional hazards regression using restricted cubic splines with the mean physical activity (corresponding to 20-40 min walking or bicycling/day or 2-3 h exercise/week) as reference. RESULTS Among 63,980 men and women (49-68 years) and during 13 years of follow-up, 8506 fractures occurred, including 2164 distal forearm, 779 proximal humerus, 346 clinical spine, and 908 hip fractures. Both lower and higher physical activity was associated with higher risk of any fracture compared to the mean. Physical activity at 1 standard deviation (SD) below the mean, corresponding to walking/bicycling <20 min/day or exercising <1-1 h/week, was associated with a lower risk of distal forearm fracture (hazard ratio [HR]: 0.92, 95% confidence interval [CI]: 0.85-0.99) and higher risk of hip fracture (HR: 1.24, 95% CI: 1.13-1.37), but no associations were seen above the mean physical activity level for these fractures. Physical activity was not associated with proximal humerus fracture but had a possible U-shaped association with clinical spine fracture. CONCLUSION Physical activity was non-linearly associated with fracture risk and the association differed across fracture sites. Up to 2-3 h weekly exercise is beneficial for the prevention of hip fracture but may increase the risk of distal forearm fracture.
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Affiliation(s)
- Karl Stattin
- Department of Surgical Sciences, Medical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Jonas Höijer
- Department of Surgical Sciences, Medical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Ulf Hållmarker
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden; Department of Internal Medicine, Mora Lasarett, Mora, Sweden
| | - John A Baron
- Department of Surgical Sciences, Medical Epidemiology, Uppsala University, Uppsala, Sweden; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Susanna C Larsson
- Department of Surgical Sciences, Medical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Alicja Wolk
- Department of Surgical Sciences, Medical Epidemiology, Uppsala University, Uppsala, Sweden; Unit of Cardiovascular and Nutritional Epidemiology, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Medical Epidemiology, Uppsala University, Uppsala, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Medical Epidemiology, Uppsala University, Uppsala, Sweden.
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Nissinen T, Suoranta S, Saavalainen T, Sund R, Hurskainen O, Rikkonen T, Kröger H, Lähivaara T, Väänänen SP. Detecting pathological features and predicting fracture risk from dual-energy X-ray absorptiometry images using deep learning. Bone Rep 2021; 14:101070. [PMID: 33997147 PMCID: PMC8102403 DOI: 10.1016/j.bonr.2021.101070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 04/14/2021] [Indexed: 11/08/2022] Open
Abstract
Dual-energy X-ray absorptiometry (DXA) is the gold standard imaging method for diagnosing osteoporosis in clinical practice. The DXA images are commonly used to estimate a numerical value for bone mineral density (BMD), which decreases in osteoporosis. Low BMD is a known risk factor for osteoporotic fractures. In this study, we used deep learning to identify lumbar scoliosis and structural abnormalities that potentially affect BMD but are often neglected in lumbar spine DXA analysis. In addition, we tested the approach's ability to predict fractures using only DXA images. A dataset of 2949 images gathered by Kuopio Osteoporosis Risk Factor and Prevention Study was used to train a convolutional neural network (CNN) for classification. The model was able to classify scoliosis with an AUC of 0.96 and structural abnormalities causing unreliable BMD measurement with an AUC of 0.91. It predicted fractures occurring within 5 years from the lumbar spine DXA scan with an AUC of 0.63, meeting the predictive performance of combined BMD measurements from the lumbar spine and hip. In an independent test set of 574 clinical patients, AUC for lumbar scoliosis was 0.93 and AUC for unreliable BMD measurements was 0.94. In each classification task, neural network visualizations indicated the model's predictive strategy. We conclude that deep learning could complement the well established DXA method for osteoporosis diagnostics by analyzing incidental findings and image reliability, and improve its predictive ability in the future.
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Affiliation(s)
- Tomi Nissinen
- Department of Applied Physics, University of Eastern Finland, POB1627, 70211 Kuopio, Finland
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, POB1777, 70211 Kuopio, Finland
| | - Sanna Suoranta
- Department of Clinical Radiology, Kuopio University Hospital, POB1777, 70211 Kuopio, Finland
| | - Taavi Saavalainen
- Department of Clinical Radiology, Kuopio University Hospital, POB1777, 70211 Kuopio, Finland
| | - Reijo Sund
- Institute of Clinical Medicine, University of Eastern Finland, POB1627, 70211 Kuopio, Finland
| | - Ossi Hurskainen
- Department of Clinical Radiology, Kuopio University Hospital, POB1777, 70211 Kuopio, Finland
| | - Toni Rikkonen
- Institute of Clinical Medicine, University of Eastern Finland, POB1627, 70211 Kuopio, Finland
| | - Heikki Kröger
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, POB1777, 70211 Kuopio, Finland
| | - Timo Lähivaara
- Department of Applied Physics, University of Eastern Finland, POB1627, 70211 Kuopio, Finland
| | - Sami P. Väänänen
- Department of Applied Physics, University of Eastern Finland, POB1627, 70211 Kuopio, Finland
- Department of Clinical Radiology, Kuopio University Hospital, POB1777, 70211 Kuopio, Finland
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Rikkonen T, Sund R, Sirola J, Honkanen R, Poole KES, Kröger H. Obesity is associated with early hip fracture risk in postmenopausal women: a 25-year follow-up. Osteoporos Int 2021; 32:769-777. [PMID: 33095419 PMCID: PMC8026440 DOI: 10.1007/s00198-020-05665-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/01/2020] [Indexed: 12/15/2022]
Abstract
UNLABELLED Association of body mass index and hip fracture has been controversial. In this study, women with lowest and highest body weight had the highest fracture incidence. A 25-year follow-up indicated that obesity associates with early hip fracture risk and suggested increasing trend in normal-weight women at a later stage. INTRODUCTION Obesity is a pandemic health issue. Its association with hip fracture risk remains controversial. We studied the long-term relationship of body mass index and hip fracture incidence in postmenopausal women. METHODS The cohort of 12,715 Finnish women born in 1932-1941 was followed for 25 years, covering ages from 58 up to 83. Fractures and deaths were obtained from national registries. Women were investigated in deciles of BMI as well as in WHO weight categories (normal, overweight, or obese). The follow-up analysis was carried out in two age strata as "early" (58-70 years) and "late" (> 70 years). Body weight information was updated accordingly. Femoral neck BMD was recorded for a subsample (n = 3163). Altogether, 427 hip fractures were observed. RESULTS A higher risk of early hip fracture was observed in obese and normal-weight compared with overweight women with hazard ratios (HRs) of 2.3 ((95% CI) 1.4-3.7) and 2.0 (1.3-3.1) while no difference was observed in late hip fracture risk between the three WHO categories (log rank p = 0.14). All-cause mortality during the follow-up was 19.3%. Compared with normal weight women, the obese women had a higher risk of death with an HR of 1.6 (1.4-1.8) and higher baseline BMD (p < 0.001). Faster bone loss was observed in the obese compared with other women (p < 0.001). CONCLUSION Obesity associates with earlier hip fracture and higher postfracture mortality. The obese women with low BMD have clearly the highest risk of hip fracture. This combination increases hip fracture risk more than either of the factors alone. After 75 years of age, risk appears to increase more in normal weight women, but this trend is in need of further confirmation.
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Affiliation(s)
- T Rikkonen
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland.
| | - R Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - J Sirola
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
- Orthopaedics and Traumatology, Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - R Honkanen
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, University of Oulu, Oulu, Finland
| | - K E S Poole
- University of Cambridge, Addenbrookes Hospital, Cambridge, UK
| | - H Kröger
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
- Orthopaedics and Traumatology, Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
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Pinheiro MB, Oliveira J, Bauman A, Fairhall N, Kwok W, Sherrington C. Evidence on physical activity and osteoporosis prevention for people aged 65+ years: a systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. Int J Behav Nutr Phys Act 2020; 17:150. [PMID: 33239014 PMCID: PMC7690138 DOI: 10.1186/s12966-020-01040-4] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Various physical activity interventions for prevention and treatment of osteoporosis have been designed and evaluated, but the effect of such interventions on the prevention of osteoporosis in older people is unclear. The aim of this review was to investigate the association between physical activity and osteoporosis prevention in people aged 65 years and above. METHODS A systematic review was conducted and searches for individual studies were conducted in PubMed (January 2010 to March 2020) and for systematic reviews were conducted in PubMed, Embase, CINAHL and SPORTDiscus (January 2008 to July 2020). Records were screened according to the following eligibility criteria: i) population: adults aged 65 years and older; ii) exposure: greater volume, duration, frequency, or intensity of physical activity; iii) comparison: no physical activity or lesser volume, duration, frequency, or intensity of physical activity; iv) outcome: osteoporosis related measures (e.g., bone mineral density). The methodological quality of included studies was assessed and meta-analysis summarised study effects. The GRADE approach was used to rate certainty of evidence. RESULTS We included a total of 59 studies, including 12 observational studies and 47 trials. Within the included trials, 40 compared physical activity with no intervention controls, 11 compared two physical activity programs, and six investigated different doses of physical activity. Included studies suggest that physical activity interventions probably improve bone health among older adults and thus prevent osteoporosis (standardised effect size 0.15, 95% CI 0.05 to 0.25, 20 trials, moderate-certainty evidence, main or most relevant outcome selected for each of the included studies). Physical activity interventions probably improve lumbar spine bone mineral density (standardised effect size 0.17, 95% CI 0.04 to 0.30, 11 trials, moderate-certainty evidence) and may improve hip (femoral neck) bone mineral density (standardised effect size 0.09, 95% CI - 0.03 to 0.21, 14 trials, low-certainty evidence). Higher doses of physical activity and programs involving multiple exercise types or resistance exercise appear to be most effective. Typical programs for which significant intervention impacts were detected in trials were undertaken for 60+ mins, 2-3 times/week for 7+ months. Observational studies suggested a positive association between long-term total and planned physical activity on bone health. CONCLUSIONS Physical activity probably plays a role in the prevention of osteoporosis. The level of evidence is higher for effects of physical activity on lumbar spine bone mineral density than for hip. Higher dose programs and those involving multiple exercises and resistance exercises appear to be more effective.
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Affiliation(s)
- Marina B Pinheiro
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia.
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Juliana Oliveira
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Adrian Bauman
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Nicola Fairhall
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Wing Kwok
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Association of Baltic Sea and Mediterranean diets with frailty phenotype in older women, Kuopio OSTPRE-FPS study. Eur J Nutr 2020; 60:821-831. [PMID: 32462318 PMCID: PMC7900336 DOI: 10.1007/s00394-020-02290-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/18/2020] [Indexed: 02/07/2023]
Abstract
Purpose To evaluate the association between Baltic Sea diet (BSD) and Mediterranean diet (MED) with frailty. Methods This was a secondary analysis on the osteoporosis risk factor and prevention–fracture prevention study on 440 women aged 65–72 years. Frailty was ascertained with the presence of 3–5 and prefrailty 1–2 of the following criteria: weight loss ≥ 5%, low life satisfaction score, walking speed ≤ 0.51 m/s, handgrip strength divided by body mass index ≤ 0.67 kg/m2 and physical activity ≤ 2 h/week. Women answered to questionnaires on lifestyle factors and 3-day food record. BSD score was ascertained using intake of nine and MED score of eight foods or nutrients components from food record. Multinomial logistic regression models adjusted for age, energy intake, smoking, living status, marital status and intervention group evaluated associations between MED and BSD with frailty phenotype status. Results At 3-year follow-up, 206 women (46.8%) were prefrail and 36 (8.2%) were frail. After adjusting for confounders, a tendency was found between BSD per standard deviation (SD)-unit increase and lower likelihood of frailty (β = 0.62, 95% CI = 0.38–1.01, P = 0.057). Further, MED per SD-unit increase was associated with lower likelihood of prefrailty (β = 0.74, 95% CI = 0.6–0.9, P = 0.009). Consumption of vegetables was lower in frail (31.5 ± 36.0 g/day) and prefrail women (37.1 ± 42.0 g/day) than in non-frail women (48.6 ± 40.7 g/day) (P for trend = 0.041). Conclusions Positive behavioral characteristics such as following MED and BSD may be associated with lower likelihood of prefrailty and frailty in older women. However, further longitudinal analyses are warranted. Electronic supplementary material The online version of this article (10.1007/s00394-020-02290-5) contains supplementary material, which is available to authorized users.
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10
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Uusi-Rasi K, Karinkanta S, Kannus P, Tokola K, Sievänen H. Does long-term recreational gymnastics prevent injurious falls in older women? A prospective 20-year follow-up. BMC Geriatr 2020; 20:37. [PMID: 32007107 PMCID: PMC6995047 DOI: 10.1186/s12877-020-1428-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 01/14/2020] [Indexed: 02/06/2023] Open
Abstract
Background Exercise interventions focusing on balance and strength training have been shown to be effective for falls prevention. The aim of this 20-year register-based follow-up was to examine whether long-term participation in recreational female gymnastics is associated with a lower risk of medically-attended injurious falls. Methods Health care register data of 187 women (103 recreational gymnasts and 84 sedentary controls) from the original cohort of 243 women were assessed. The mean age (sd) at baseline was 62.8 (5.4) years and the mean follow-up time was 19.4 (2.7) years (range from 5.6 to 21.0 years). Injurious falls were scrutinized from medical records. An injurious fall was defined as an event in which falling was mentioned as a reason for making contact with health-care professionals. Negative binomial regression was used to estimate incidence rate ratios (IRR) for injurious falls, and Cox-regression models for calculating hazard ratios (HR) for injured fallers with the control group as reference. Results Recreational gymnasts had about 30% less injurious falls compared to controls, the mean IRR (95% CI) being 0.71 (0.51 to 0.96). The HR for injured fallers was 0.73 (0.52 to 1.02) favoring the recreational gymnasts. There were no statistically significant between-group differences for fractures. Conclusions Long-term recreational gymnastics appears to reduce the risk of injurious falls in old age.
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Affiliation(s)
- Kirsti Uusi-Rasi
- UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, FI-33500, Tampere, Finland.
| | - Saija Karinkanta
- UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, FI-33500, Tampere, Finland
| | - Pekka Kannus
- UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, FI-33500, Tampere, Finland.,Medical School, University of Tampere, Tampere, Finland.,Department of Orthopedics and Trauma Surgery, Tampere University Hospital, Tampere, Finland
| | - Kari Tokola
- UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, FI-33500, Tampere, Finland
| | - Harri Sievänen
- UKK Institute for Health Promotion Research, Kaupinpuistonkatu 1, FI-33500, Tampere, Finland
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11
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Cauley JA, Giangregorio L. Physical activity and skeletal health in adults. Lancet Diabetes Endocrinol 2020; 8:150-162. [PMID: 31759956 DOI: 10.1016/s2213-8587(19)30351-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/07/2019] [Accepted: 10/08/2019] [Indexed: 12/15/2022]
Abstract
The purpose of this Review is to examine the associations between physical activity and skeletal health, with an emphasis on observational studies with fracture outcomes and randomised controlled trials (RCTs) of physical activity interventions in adults older than 40 years. In general, increased physical activity-primarily leisure time activity or moderate or vigorous physical activity-is associated with a 1-40% lower risk of hip and all fractures. The primary limitation of these studies relates to health status; healthy people are more likely to exercise and less likely to fracture. Although there is no sufficiently powered RCT of exercise with a fracture outcome, there is evidence that some types of exercise prevent falls and bone loss, and meta-analyses support the anti-fracture effectiveness of exercise. RCTs and meta-analyses suggest that programmes combining impact exercise with moderate or high-intensity progressive resistance exercise might maintain or improve bone mass and prevent fractures, and that functional strength and balance training prevents falls.
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Affiliation(s)
- Jane A Cauley
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Lora Giangregorio
- BC Matthews Hall and Lyle S Hallman Institute, Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
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12
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LaMonte MJ, Wactawski-Wende J, Larson JC, Mai X, Robbins JA, LeBoff MS, Chen Z, Jackson RD, LaCroix AZ, Ockene JK, Hovey KM, Cauley JA. Association of Physical Activity and Fracture Risk Among Postmenopausal Women. JAMA Netw Open 2019; 2:e1914084. [PMID: 31651972 PMCID: PMC6822158 DOI: 10.1001/jamanetworkopen.2019.14084] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/04/2019] [Indexed: 01/11/2023] Open
Abstract
Importance Physical activity is inversely associated with hip fracture risk in older women. However, the association of physical activity with fracture at other sites and the role of sedentary behavior remain unclear. Objective To assess the associations of physical activity and sedentary behavior with fracture incidence among postmenopausal women. Design, Setting, and Participants The Women's Health Initiative prospective cohort study enrolled 77 206 postmenopausal women aged 50 to 79 years between October 1993 and December 1998 at 40 US clinical centers. Participants were observed for outcomes through September 2015, with data analysis conducted from June 2017 to August 2019. Exposures Self-reported physical activity and sedentary time. Main Outcomes and Measures Hazard ratios (HRs) and 95% CIs for total and site-specific fracture incidence. Results During a mean (SD) follow-up period of 14.0 (5.2) years among 77 206 women (mean [SD] age, 63.4 [7.3] years; 66 072 [85.6%] white), 25 516 (33.1%) reported a first incident fracture. Total physical activity was inversely associated with the multivariable-adjusted risk of hip fracture (>17.7 metabolic equivalent [MET] h/wk vs none: HR, 0.82; 95% CI, 0.72-0.95; P for trend < .001). Inverse associations with hip fracture were also observed for walking (>7.5 MET h/wk vs none: HR, 0.88; 95% CI, 0.78-0.98; P for trend = .01), mild activity (HR, 0.82; 95% CI, 0.73-0.93; P for trend = .003), moderate to vigorous activity (HR, 0.88; 95% CI, 0.81-0.96; P for trend = .002), and yard work (HR, 0.90; 95% CI, 0.82-0.99; P for trend = .04). Total activity was positively associated with knee fracture (>17.7 MET h/wk vs none: HR, 1.26; 95% CI, 1.05-1.50; P for trend = .08). Mild activity was associated with lower risks of clinical vertebral fracture (HR, 0.87; 95% CI, 0.78-0.96; P for trend = .006) and total fractures (HR, 0.91; 95% CI, 0.87-0.94; P for trend < .001). Moderate to vigorous activity was positively associated with wrist or forearm fracture (HR, 1.09; 95% CI, 1.03-1.15; P for trend = .004). After controlling for covariates and total physical activity, sedentary time was positively associated with total fracture risk (>9.5 h/d vs <6.5 h/d: HR, 1.04; 95% CI, 1.01-1.07; P for trend = .01). When analyzed jointly, higher total activity mitigated some of the total fracture risk associated with sedentary behavior. Analysis of time-varying exposures resulted in somewhat stronger associations for total physical activity, whereas those for sedentary time were materially unchanged. Conclusions and Relevance In older ambulatory women, higher total physical activity was associated with lower total and hip fracture risk but higher knee fracture risk. Mild activity and walking were associated with lower hip fracture risk, a finding with important public health implications because these activities are common in older adults. The positive association between sedentary time and total fracture risk requires further investigation.
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Affiliation(s)
- Michael J. LaMonte
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo
| | - Joseph C. Larson
- Data Coordinating Center, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Xiaodan Mai
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo
| | - John A. Robbins
- Department of Medicine, University of California, Davis, Sacramento
| | - Meryl S. LeBoff
- Division of Endocrine, Diabetes, and Hypertension, Brigham and Woman’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Zhao Chen
- Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson
| | - Rebecca D. Jackson
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, The Ohio State University, Columbus
| | - Andrea Z. LaCroix
- Division of Epidemiology, Department of Family Medicine and Public Health, University of California, San Diego
| | - Judith K. Ockene
- Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester
| | - Kathleen M. Hovey
- Department of Epidemiology and Environmental Health, University at Buffalo, The State University of New York, Buffalo
| | - Jane A. Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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13
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Bone Mass and Strength and Fall-Related Fractures in Older Age. J Osteoporos 2019; 2019:5134690. [PMID: 31583071 PMCID: PMC6754934 DOI: 10.1155/2019/5134690] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/14/2019] [Accepted: 08/22/2019] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Low bone mineral density is a risk factor for fractures. The aim of this follow-up study was to assess the association of various bone properties with fall-related fractures. MATERIALS AND METHODS 187 healthy women aged 55 to 83 years at baseline who were either physically active or inactive were followed for 20 years. They were divided into two groups by whether or not they sustained fall-related fractures: fracture group (F) and nonfracture group (NF). At baseline, several bone properties were measured with DXA and pQCT, and their physical performance was also assessed. RESULTS During the follow-up, 120 women had no fall-related fractures, while 67 (38%) sustained at least one fall with fracture. NF group had about 4 to 11% greater BMD at the femoral neck and distal radius; the mean differences (95% CI) were 4.5 (0.3 to 8.6) % and 11.1 (6.3 to 16.1) %, respectively. NF group also had stronger bone structure at the tibia, the mean difference in BMC at the distal tibia was 6.0 (2.2 to 9.7) %, and at the tibial shaft 3.6 (0.4 to 6.8) %. However, there was no mean difference in physical performance. CONCLUSIONS Low bone properties contribute to the risk of fracture if a person falls. Therefore, in the prevention of fragility fractures, it is essential to focus on improving bone mass, density, and strength during the lifetime. Reduction of falls by improving physical performance, balance, mobility, and muscle power is equally important.
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14
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Vilpunaho T, Kröger H, Honkanen R, Koivumaa-Honkanen H, Sirola J, Kuvaja-Köllner V, Sund R, Rikkonen T. Randomised controlled trial (RCT) study design for a large-scale municipal fall prevention exercise programme in community-living older women: study protocol for the Kuopio Fall Prevention Study (KFPS). BMJ Open 2019; 9:e028716. [PMID: 31230026 PMCID: PMC6596943 DOI: 10.1136/bmjopen-2018-028716] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Falls are a substantial health problem in seniors, causing fractures and being the leading cause of fatal injuries. The benefits of physical activity in fall prevention have been shown in randomised controlled trials (RCTs) in small cohorts (eg, ≤200 persons), but there is a gap between the known health effects of exercise and the large-scale implementation of effective activity in communities. Mental health and subjective well-being (SWB) should also be studied since they are strongly related to healthy ageing. Thus far, the proven efficacy of communal strategies to reduce falls and improve healthy ageing is sparse. METHODS AND ANALYSIS In 2016, a 2-year RCT was launched in Kuopio, Finland to estimate the efficacy of a large, population-based, fall prevention exercise programme in community-living older women (born 1932-1945). Both the intervention and control group (n=457+457) receive health education. The intervention group is also offered free 6-month supervised training courses (weekly gym training and Taiji sessions), followed by a free 6-month unsupervised use of exercise facilities, as well as unsupervised low-cost exercise is also offered for another 12 months. During the whole 24-month follow-up, controls are free to pursue all their normal physical activities. Both study groups undergo the study measurements three times. Outcome measures include recording of falls, injuries, bone mineral density, changes in health and functional status and cognitive performance, deaths and SWB. Finally, the cost-effectiveness and cost-utility analysis will be conducted from the societal view. The main analyses comparing outcomes between study groups will be conducted using the intention to treat principle. ETHICS AND DISSEMINATION The study has been reviewed and approved by the Research Ethics Committee of the Hospital District of North Savo. All regulations and measures of ethics and confidentiality are handled in accordance with the Declaration of Helsinki. TRIAL REGISTRATION NUMBER NCT02665169; Pre-results.
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Affiliation(s)
- Tommi Vilpunaho
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland - Kuopio Campus, Finland
| | - Heikki Kröger
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland - Kuopio Campus, Finland
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Finland
| | - Risto Honkanen
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland - Kuopio Campus, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine (Psychiatry), University of Eastern Finland - Kuopio Campus, Finland
- Department of Psychiatry, Kuopio University Hospital, Finland
| | - Joonas Sirola
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland - Kuopio Campus, Finland
- Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, Finland
| | - Virpi Kuvaja-Köllner
- Department of Health and Social Management, University of Eastern Finland - Kuopio Campus, Finland
| | - Reijo Sund
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland - Kuopio Campus, Finland
| | - Toni Rikkonen
- Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland - Kuopio Campus, Finland
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15
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Cervo MM, Shivappa N, Hebert JR, Oddy WH, Winzenberg T, Balogun S, Wu F, Ebeling P, Aitken D, Jones G, Scott D. Longitudinal associations between dietary inflammatory index and musculoskeletal health in community-dwelling older adults. Clin Nutr 2019; 39:516-523. [PMID: 30852031 DOI: 10.1016/j.clnu.2019.02.031] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 02/06/2019] [Accepted: 02/17/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND & AIMS Aging is characterized by progressive decline in physiologic reserves and functions as well as prolonged inflammation, increasing susceptibility to disease. Diet plays an important role in maintaining health, and reducing morbidity and mortality, especially in older populations. This study was designed to determine prospective associations between dietary inflammatory index (DII®) scores and bone health, sarcopenia-related outcomes, falls risk and incident fractures in community-dwelling Australian older adults. METHODS A total of 1098 [51% male; age (mean ± SD) 63.0 ± 7.5 years] non-institutionalized older adults who participated in the Tasmanian Older Adult Cohort Study (TASOAC) at baseline, 768 at 5 years, and 566 at 10 years follow-up were included in this analysis. Baseline energy-adjusted DII (E-DII) scores were calculated using a validated Food Frequency Questionnaire. Changes in bone mineral density (BMD) and appendicular lean mass (ALM) were measured over ten years using dual-energy x-ray absorptiometry. Ten-year changes in hand grip, knee extensor and whole lower-limb muscle strength and quality were assessed by dynamometers and change in falls risk score using the Physical Profile Assessment (PPA). Incident fractures at any site and non-vertebral fractures over 10 years were self-reported. RESULTS The E-DII range was -3.48 to +3.23 in men and -3.80 to +2.74 in women. Higher E-DII score (indicating a more pro-inflammatory diet) was associated with lower total hip (B: -0.009; 95% CI: -0.017, 0.000) and lumbar spine BMD (B: -0.013; 95% CI: -0.024, -0.002), and higher falls risk score (B: 0.040; 95% CI: 0.002, 0.078) over 10 years in men. Women with higher E-DII scores had higher whole lower-limb muscle quality over 10 years (B: 0.109; 95% CI: 0.002, 0.215). For every unit increase in E-DII score, incident fracture rates increased by 9.0% in men (IRR: 1.090; 95% CI: 1.011, 1.175) and decreased by 12.2% in women (IRR: 0.878; 95% CI: 0.800, 0.964) in a fully adjusted model. CONCLUSION Higher E-DII scores were associated with lower bone density, higher falls risk, and increased incidence of fractures in community-dwelling older men, but decreased fracture incidence in women, over 10 years. This suggests pro-inflammatory diets may be more detrimental to musculoskeletal health in older men than in women. Additional studies are warranted to elucidate these sex differences.
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Affiliation(s)
- Mavil May Cervo
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
| | - Nitin Shivappa
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - James R Hebert
- Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Wendy H Oddy
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Tania Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Saliu Balogun
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Feitong Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Peter Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Australian Institute for Musculoskeletal Science, Department of Medicine - Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Australian Institute for Musculoskeletal Science, Department of Medicine - Western Health, The University of Melbourne, St Albans, Victoria, Australia
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16
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Muthuri SG, Ward KA, Kuh D, Elhakeem A, Adams JE, Cooper R. Physical Activity Across Adulthood and Bone Health in Later Life: The 1946 British Birth Cohort. J Bone Miner Res 2019; 34:252-261. [PMID: 30347128 PMCID: PMC6392181 DOI: 10.1002/jbmr.3607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/11/2018] [Accepted: 10/09/2018] [Indexed: 12/29/2022]
Abstract
Leisure-time physical activity (LTPA) is widely recommended for the prevention of osteoporosis and fractures in older populations. However, whether the beneficial effects of LTPA on bone accumulate across life and are maintained even after reduction or cessation of regular PA in later life is unknown. We examined whether LTPA across adulthood was cumulatively associated with volumetric and areal bone mineral density (vBMD, aBMD) at ages 60 to 64 and whether associations were mediated by lean mass. Up to 1498 participants from the Medical Research Council National Survey of Health and Development were included in analyses. LTPA was self-reported at ages 36, 43, 53, and 60 to 64, and responses summed to generate a cumulative score (range 0 = inactive at all four ages to 8 = most active at all four ages). Total and trabecular vBMD were measured at the distal radius using pQCT and aBMD at the total hip and lumbar spine (L1 to L4) using DXA. Linear regression was used to test associations of the cumulative LTPA score with each bone outcome. After adjustment for height and weight, a 1-unit increase in LTPA score (95% CI) in men was associated with differences of 1.55% (0.78% to 2.31%) in radial trabecular vBMD, 0.83% (0.41% to 1.25%) in total hip aBMD, and 0.97% (0.44% to 1.49%) in spine aBMD. Among women, positive associations were seen for radial trabecular vBMD and total hip aBMD, but only among those of greater weight (LTPA × weight interaction p ≤ 0.01). In men, there was evidence to suggest that lean mass index may partly mediate these associations. These findings suggest that there are cumulative benefits of LTPA across adulthood on BMD in early old age, especially among men. The finding of weaker associations among women suggests that promotion of specifıc types of LTPA may be needed to benefit bone health in women. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals, Inc.
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Affiliation(s)
| | - Kate A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,MRC Nutrition and Bone Health Research Group, Cambridge, UK
| | - Diana Kuh
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
| | - Ahmed Elhakeem
- MRC Integrative Epidemiology Unit at University of Bristol, Bristol, UK
| | - Judith E Adams
- Manchester Academic Health Science Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK
| | - Rachel Cooper
- MRC Unit for Lifelong Health and Ageing at UCL, London, UK
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Effects of ethinyl estradiol-containing oral contraception and other factors on body composition and muscle strength among young healthy females in Finland—A cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2019; 232:75-81. [DOI: 10.1016/j.ejogrb.2018.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 05/16/2018] [Accepted: 11/12/2018] [Indexed: 01/06/2023]
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18
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Stattin K, Hållmarker U, Ärnlöv J, James S, Michaëlsson K, Byberg L. Decreased Hip, Lower Leg, and Humeral Fractures but Increased Forearm Fractures in Highly Active Individuals. J Bone Miner Res 2018; 33:1842-1850. [PMID: 29933501 DOI: 10.1002/jbmr.3476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/27/2018] [Accepted: 05/20/2018] [Indexed: 01/01/2023]
Abstract
It is not known how physical exercise affects the risk of different types of fractures, especially in highly active individuals. To investigate this association, we studied a cohort of 118,204 men and 71,757 women who from 1991 to 2009 participated in Vasaloppet, a long-distance cross-country skiing race in Sweden, and 505,194 nonparticipants frequency-matched on sex, age, and county of residence from the Swedish population. Participants ranged from recreational exercisers to world-class skiers. Race participation, distance of race run, number of races participated in, and finishing time were used as proxies for physical exercise. Incident fractures from 1991 to 2010 were obtained from national Swedish registers. Over a median follow-up of 8.9 years, 53,175 fractures of any type, 2929 hip, 3107 proximal humerus, 11,875 lower leg, 11,733 forearm, and 2391 vertebral fractures occurred. In a Cox proportional hazard regression analysis using time-updated exposure and covariate information, participation in the race was associated with an increased risk of any type of fracture (hazard ratio [HR], 1.02; 95% CI, 1.00 to 1.05); forearm fractures had an HR, 1.11 with a 95% CI, 1.06 to 1.15. There was a lower risk of hip (HR, 0.75; 95% CI, 0.67 to 0.83), proximal humerus (HR, 0.90; 95% CI, 0.82 to 0.98), and lower leg fractures (HR, 0.93; 95% CI, 0.89 to 0.97), whereas the HR of vertebral fracture was 0.97 with a 95% CI, 0.88 to 1.07. Among participants, the risk of fracture was similar irrespective of race distance and number of races run. Participants close to the median finishing time had a lower risk of fracture compared with faster and slower participants. In summary, high levels of physical exercise were associated with a slightly higher risk of fractures of any type, including forearm fractures, but a lower risk of hip, proximal humerus, and lower leg fractures. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Karl Stattin
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | - Ulf Hållmarker
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Department of Internal Medicine, Mora Lasarett, Mora, Sweden
| | - Johan Ärnlöv
- Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden.,School of Health and Social Studies, Dalarna University, Falun, Dalarna, Sweden
| | - Stefan James
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden.,Uppsala Clinical Research Center, Uppsala, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
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Rikkonen T, Poole K, Sirola J, Sund R, Honkanen R, Kröger H. Long-term effects of functional impairment on fracture risk and mortality in postmenopausal women. Osteoporos Int 2018; 29:2111-2120. [PMID: 29860666 DOI: 10.1007/s00198-018-4588-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/24/2018] [Indexed: 12/19/2022]
Abstract
UNLABELLED Our findings imply that simple functional tests can predict both hip fracture risk and excess mortality in postmenopausal women. Since the tests characterize general functional capacity (one-legged stance, squatting down, and grip strength), these simple measures should have clinical utility in the assessment of women at risk of falls and fragility fracture. INTRODUCTION Functional impairment is associated with the risk of fall, which is the leading cause of hip fracture. We aimed to determine how clinical assessments of functional impairment predict long-term hip fracture and mortality. METHODS A population-based prospective cohort involved 2815 Caucasian women with the average baseline age of 59.1 years. The mean follow-up time in 1994-2014 was 18.3 years. Three functional tests and their combinations assessed at baseline were treated as dichotomous risk factors: (1) inability to squat down and touch the floor (SQ), (2) inability to stand on one leg for 10 s (SOL), and (3) having grip strength (GS) within the lowest quartile (≤ 58 kPa, mean 45.6 kPa). Bone mineral density (BMD) at the proximal femur was measured by DXA. Fractures and deaths were verified from registries. Hazard ratios were determined by using Cox proportional models. Age, body mass index (BMI), and BMD were included as covariates for fracture risk estimates. Age, BMI, and smoking were used for mortality. RESULTS Altogether, 650 (23.1%) women had 718 follow-up fractures, including 86 hip fractures. The mortality during the follow-up was 16.8% (n = 473). Half of the women (56.8%, n = 1600) had none of the impairments and were regarded as the referent group. Overall, women with any of the three impairments (43.2%, n = 1215) had higher risks of any fracture, hip fracture, and death, with hazard ratios (HR) of 1.3 ((95% CI) 1.0-1.5, p < 0.01), 2.4 (1.5-3.4, p < 0.001), and 1.5 (1.3-1.8, p < 0.001), respectively. The strongest single predictor for hip fracture was failing to achieve a one-leg stand for 10 s (prevalence 7.1%, n = 200), followed by inability to squat down (27.0%, n = 759) and weak grip strength (24.4%, n = 688), with their respective HRs of 4.3 (2.3-8.0, p < 0.001), 3.1 (2.0-5.0, p < 0.001), and 2.0 (1.2-3.4, p < 0.001). In addition, age, lower BMD, BMI, and smoking were significant covariates. CONCLUSIONS These findings suggest that functional tests provide long-term prediction of fracture and death in postmenopausal women. Whether reversal of these impairments is associated with a reduction in adverse outcomes is an area for future trials.
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Affiliation(s)
- T Rikkonen
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Yliopistonranta 1b, PL 1627,, 70211, Kuopio, Finland.
| | - K Poole
- Addenbrookes' Hospital, Box 157, Hills Road, Cambridge, CB2 0QQ, UK
| | - J Sirola
- Department of Orthopaedics, Traumatology and Handsurgery, Kuopio University Hospital, Puijonlaaksontie 2, PL 100, 700029, Kuopio, Finland
| | - R Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Yliopistonranta 1b, PL 1627,, 70211, Kuopio, Finland
| | - R Honkanen
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Yliopistonranta 1b, PL 1627,, 70211, Kuopio, Finland
| | - H Kröger
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Yliopistonranta 1b, PL 1627,, 70211, Kuopio, Finland
- Department of Orthopaedics, Traumatology and Handsurgery, Kuopio University Hospital, Puijonlaaksontie 2, PL 100, 700029, Kuopio, Finland
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Ochi K. Distal Radial Fracture Malunion in Sweden: Is It the Same in Your Region?: Commentary on an article by Muhanned Ali, MD, et al.: "Association Between Distal Radial Fracture Malunion and Patient-Reported Activity Limitations. A Long-Term Follow-up". J Bone Joint Surg Am 2018; 100:e52. [PMID: 29664861 DOI: 10.2106/jbjs.17.01559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Stattin K, Michaëlsson K, Larsson SC, Wolk A, Byberg L. Leisure-Time Physical Activity and Risk of Fracture: A Cohort Study of 66,940 Men and Women. J Bone Miner Res 2017; 32:1599-1606. [PMID: 28460152 DOI: 10.1002/jbmr.3161] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/12/2017] [Accepted: 04/26/2017] [Indexed: 01/29/2023]
Abstract
Physical activity has been associated with reduced risk of fracture, but it is not known how the intensity or frequency of physical activity influences this risk reduction. We aim to compare the risk of hip fracture and fracture of any locale between men and women with different levels of leisure-time walking/bicycling and exercise. A total of 37,238 women (born 1914-1948) from the Swedish Mammography Cohort and 45,906 men (born 1918-1952) from the Cohort of Swedish Men were followed for a maximum of 17 years. Exposure and covariate information was collected through a self-administered questionnaire in 1997. Incident fractures (5153 individuals with hip fracture and 15,043 with any type of fracture) and comorbidities were gathered from national and local patient registries. Hazard ratios (HRs) were calculated using Cox proportional hazards regression. Individuals who walked/bicycled less than 20 minutes per day had a lower rate of hip fracture (multivariable adjusted HR = 0.77; 95% confidence interval [CI] 0.70 to 0.85) and any fracture (HR = 0.87; 95% CI 0.82 to 0.92) compared with those who hardly ever walked/bicycled. These reduced rates were also evident in both sexes, in different age categories, for vertebral fractures and for non-hip, non-vertebral fractures. Those who reported exercise 1 hour per week had a lower rate of hip fracture (HR = 0.87; 95% CI 0.80 to 0.96) and any fracture (HR = 0.94; 95% CI 0.89 to 0.99) compared with those who exercised less than 1 hour per week. Only minor differences in HRs were observed in individuals with moderate compared with higher levels of walking/bicycling or exercise. Walking/bicycling and exercise showed almost equal reductions in rate of fracture when compared with those in a joint category with lowest activity. In conclusion, both moderate and high self-reported frequency of physical activity is associated with reduced future risk of fracture. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Karl Stattin
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | - Karl Michaëlsson
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
| | - Susanna C Larsson
- Unit of Nutritional Epidemiology, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alicja Wolk
- Unit of Nutritional Epidemiology, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Liisa Byberg
- Department of Surgical Sciences, Orthopedics, Uppsala University, Uppsala, Sweden
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22
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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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Orchard T, Yildiz V, Steck SE, Hébert JR, Ma Y, Cauley JA, Li W, Mossavar-Rahmani Y, Johnson KC, Sattari M, LeBoff M, Wactawski-Wende J, Jackson RD. Dietary Inflammatory Index, Bone Mineral Density, and Risk of Fracture in Postmenopausal Women: Results From the Women's Health Initiative. J Bone Miner Res 2017; 32:1136-1146. [PMID: 28019686 PMCID: PMC5413384 DOI: 10.1002/jbmr.3070] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 12/20/2016] [Accepted: 12/21/2016] [Indexed: 12/18/2022]
Abstract
Previous studies suggest that bone loss and fracture risk are associated with higher inflammatory milieu, potentially modifiable by diet. The primary objective of this analysis was to evaluate the association of the dietary inflammatory index (DII), a measure of the inflammatory potential of diet, with risk of hip, lower-arm, and total fracture using longitudinal data from the Women's Health Initiative Observational Study and Clinical Trials. Secondarily, we evaluated changes in bone mineral density (BMD) and DII scores. DII scores were calculated from baseline food frequency questionnaires (FFQs) completed by 160,191 participants (mean age 63 years) without history of hip fracture at enrollment. Year 3 FFQs were used to calculate a DII change score. Fractures were reported at least annually; hip fractures were confirmed by medical records. Hazard ratios for fractures were computed using multivariable-adjusted Cox proportional hazard models, further stratified by age and race/ethnicity. Pairwise comparisons of changes in hip BMD, measured by dual-energy X-ray absorptiometry from baseline, year 3, and year 6 were analyzed by quartile (Q1 = least inflammatory diet) of baseline DII scores in a subgroup of women (n = 10,290). Mean DII score improved significantly over 3 years (p < 0.01), but change was not associated with fracture risk. Baseline DII score was only associated with hip fracture risk in younger white women (HR Q4,1.48; 95% CI, 1.09 to 2.01; p = 0.01). There were no significant associations among white women older than 63 years or other races/ethnicities. Women with the least inflammatory DII scores had less loss of hip BMD (p = 0.01) by year 6, despite lower baseline hip BMD, versus women with the most inflammatory DII scores. In conclusion, a less inflammatory dietary pattern was associated with less BMD loss in postmenopausal women. A more inflammatory diet was associated with increased hip fracture risk only in white women younger than 63 years. © 2016 American Society for Bone and Mineral Research.
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Affiliation(s)
- Tonya Orchard
- Department of Human Sciences, Human Nutrition Program, The Ohio State University, Columbus, OH, USA
| | - Vedat Yildiz
- Women's Health Initiative Midwest Regional Center for Biostatistics, The Ohio State University, Columbus, OH, USA
| | - Susan E Steck
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - James R Hébert
- Cancer Prevention and Control Program and Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Yunsheng Ma
- Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jane A Cauley
- Graduate School of Public Health, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Wenjun Li
- Health Statistics and Geography Lab, Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Karen C Johnson
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Maryam Sattari
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Meryl LeBoff
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Jean Wactawski-Wende
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Rebecca D Jackson
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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24
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Giangregorio L, El-Kotob R. Exercise, muscle, and the applied load-bone strength balance. Osteoporos Int 2017; 28:21-33. [PMID: 27738713 DOI: 10.1007/s00198-016-3780-7] [Citation(s) in RCA: 17] [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: 04/20/2016] [Accepted: 09/14/2016] [Indexed: 12/01/2022]
Abstract
A fracture occurs when the applied load is greater than the bone can withstand. Clinical practice guidelines for the management of osteoporosis include recommendations for exercise; one of the few therapies where the proposed anti-fracture mechanisms that include effects on both bone strength and applied loads, where applied loads can come in the form of a fall, externally applied loads, body weight, or muscle forces. The aim of this review is to provide an overview of the clinical evidence pertaining to the potential efficacy of exercise for preventing fractures in older adults, including its direct effects on outcomes along the causal pathway to fractures (e.g., falls, posture, bone strength) and the indirect effects on muscle or the muscle-bone relationship. The evidence is examined as it pertains to application in clinical practice. Considerations for future research are discussed, such as the need for trials in individuals with low bone mass or students that evaluate whether changes in muscle mediate changes in bone. Future trials should also consider adequacy of calorie or protein intake, the confounding effect of exercise-induced weight loss, or the most appropriate therapeutic goal (e.g., strength, weight bearing, or hypertrophy) and outcome measures (e.g., fracture, disability, cost-effectiveness).
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Affiliation(s)
- L Giangregorio
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada.
| | - R El-Kotob
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
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25
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Afrin N, Honkanen R, Koivumaa-Honkanen H, Lukkala P, Rikkonen T, Sirola J, Williams LJ, Kröger H. Multimorbidity predicts falls differentially according to the type of fall in postmenopausal women. Maturitas 2016; 91:19-24. [DOI: 10.1016/j.maturitas.2016.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/11/2016] [Accepted: 05/06/2016] [Indexed: 10/21/2022]
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Lacombe J, Cairns BJ, Green J, Reeves GK, Beral V, Armstrong MEG. The Effects of Age, Adiposity, and Physical Activity on the Risk of Seven Site-Specific Fractures in Postmenopausal Women. J Bone Miner Res 2016; 31:1559-68. [PMID: 26950269 PMCID: PMC4973709 DOI: 10.1002/jbmr.2826] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 02/12/2016] [Accepted: 03/03/2016] [Indexed: 11/26/2022]
Abstract
Risk factors for fracture of the neck of the femur are relatively well established, but those for fracture at other sites are little studied. In this large population study we explore the role of age, body mass index (BMI), and physical activity on the risk of fracture at seven sites in postmenopausal women. As part of the Million Women Study, 1,154,821 postmenopausal UK women with a mean age of 56.0 (SD 4.8) years provided health and lifestyle data at recruitment in 1996 to 2001. All participants were linked to National Health Service (NHS) hospital records for day-case or overnight admissions with a mean follow-up of 11 years per woman. Adjusted absolute and relative risks for seven site-specific incident fractures were calculated using Cox regression models. During follow-up, 4931 women had a fracture of the humerus; 2926 of the forearm; 15,883 of the wrist; 9887 of the neck of the femur; 1166 of the femur (not neck); 3199 a lower leg fracture; and 10,092 an ankle fracture. Age-specific incidence rates increased gradually with age for fractures of forearm, lower leg, ankle, and femur (not neck), and steeply with age for fractures of neck of femur, wrist, and humerus. When compared to women with desirable BMI (20.0 to 24.9 kg/m(2) ), higher BMI was associated with a reduced risk of fracture of the neck of femur, forearm, and wrist, but an increased risk of humerus, femur (not neck), lower leg, and ankle fractures (p < 0.001 for all). Strenuous activity was significantly associated with a decreased risk of fracture of the humerus and femur (both neck and remainder of femur) (p < 0.001), but was not significantly associated with lower leg, ankle, wrist, and forearm fractures. Postmenopausal women are at a high lifetime risk of fracture. BMI and physical activity are modifiable risk factors for fracture, but their associations with fracture risk differ substantially across fracture sites. © 2016 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Jason Lacombe
- Faculty of Kinesiology & Physical EducationUniversity of TorontoTorontoCanada
| | | | - Jane Green
- Cancer Epidemiology UnitUniversity of OxfordOxfordUnited Kingdom
| | - Gillian K Reeves
- Cancer Epidemiology UnitUniversity of OxfordOxfordUnited Kingdom
| | - Valerie Beral
- Cancer Epidemiology UnitUniversity of OxfordOxfordUnited Kingdom
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Lee I, Ha C, Kang H. Association of sarcopenia and physical activity with femur bone mineral density in elderly women. J Exerc Nutrition Biochem 2016; 20:23-8. [PMID: 27298809 PMCID: PMC4899897 DOI: 10.20463/jenb.2016.03.20.1.8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 03/17/2016] [Accepted: 03/17/2016] [Indexed: 12/01/2022] Open
Abstract
[Purpose] This study examined the association of femur bone mineral density (BMD) with body composition and physical activity in elderly women. [Methods] This was a cross sectional study involving 119 women with mean age of 73.1±5.5 years. Body composition parameters including body mass index (BMI), percent of body fat (%BF), appendicular skeletal muscle mass (ASM) index and femur BMD was measured by dual-energy X-ray absorptiometry (DXA). Physical activity was assessed by the uniaxial accelerometer for 7 consecutive days including weekends. Based on femur BMD T-scores, subjects were classified as optimal group, osteopenia group, and osteoporosis group. Based on ASM index, subjects were classified as normal group and sarcopenia group. According to WHO recommendations of physical activity for elderly, the subjects were classified as active group or inactive group. Logistic regression analyses were used to determine the odds ratio (OR) for osteopenia and osteoporosis. [Results] There were linear decreases for body composition parameters including weight (P=.023), BMI (P=.039), lean mass (P=.032), ASM index (P=.007) and physical activity parameters including daily of step (P<.001), low intensity physical activity (P<.001), moderate intensity physical activity (P=.001) across femur BMD levels. Compared to the normal group (OR=1), the sarcopenia group had a significantly higher OR (OR=4.823; P=.042), and the inactive group had a significantly higher OR (OR=5.478; P=.005) having osteopenia and osteoporosis when compared to the active group (OR=1). [Conclusion] The findings of this study suggested that physical activity along with a healthy nutrition should be promoted as a preventive strategy against osteopenia and osteoporosis in elderly women.
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Affiliation(s)
- Inhwan Lee
- College of Sport Science, Sungkyunkwan University, Suwon Korea
| | - Changduk Ha
- College of Sport Science, Sungkyunkwan University, Suwon Korea
| | - Hyunsik Kang
- College of Sport Science, Sungkyunkwan University, Suwon Korea
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28
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Lloyd JT, Alley DE, Hochberg MC, Waldstein SR, Harris TB, Kritchevsky SB, Schwartz AV, Strotmeyer ES, Womack C, Orwig DL. Changes in bone mineral density over time by body mass index in the health ABC study. Osteoporos Int 2016; 27:2109-16. [PMID: 26856584 PMCID: PMC5892439 DOI: 10.1007/s00198-016-3506-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 01/26/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED Obesity appears protective against osteoporosis in cross-sectional studies. However, results from this longitudinal study found that obesity was associated with bone loss over time. Findings underscore the importance of looking at the longitudinal relationship, particularly given the increasing prevalence and duration of obesity among older adults. INTRODUCTION Cross-sectional studies have found a positive association between body mass index (BMI) and bone mineral density (BMD), but little is known about the longitudinal relationship in US older adults. METHODS We examined average annual rate of change in BMD by baseline BMI in the Health, Aging, and Body Composition Study. Repeated measurement of BMD was performed with dual-energy X-ray absorptiometry (DXA) at baseline and years 3, 5, 6, 8, and 10. Multivariate generalized estimating equations were used to predict mean BMD (femoral neck, total hip, and whole body) by baseline BMI (excluding underweight), adjusting for covariates. RESULTS In the sample (n = 2570), 43 % were overweight and 24 % were obese with a mean baseline femoral neck BMD of 0.743 g/cm(2), hip BMD of 0.888 g/cm(2), and whole-body BMD of 1.09 g/cm(2). Change in total hip or whole-body BMD over time did not vary by BMI groups. However, obese older adults lost 0.003 g/cm(2) of femoral neck BMD per year more compared with normal weight older adults (p < 0.001). Femoral neck BMD change over time did not differ between the overweight and normal weight BMI groups (p = 0.74). In year 10, adjusted femoral neck BMD ranged from 0.696 g/cm(2) among obese, 0.709 g/cm(2) among normal weight, and 0.719 g/cm(2) among overweight older adults. CONCLUSIONS Findings underscore the importance of looking at the longitudinal relationship between body composition and bone mineral density among older adults, indicating that high body mass may not be protective for bone loss over time.
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Affiliation(s)
- J T Lloyd
- Centers for Medicare and Medicaid Services, 7500 Security Blvd, WB-06-05, Baltimore, MD, 21244, USA.
| | - D E Alley
- Centers for Medicare and Medicaid Services, 7500 Security Blvd, WB-06-05, Baltimore, MD, 21244, USA
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - M C Hochberg
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - S R Waldstein
- Doctoral Program in Gerontology, University of Maryland, Baltimore and Baltimore County, Baltimore, MD, USA
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - T B Harris
- Laboratory of Epidemiology and Population Sciences, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA
| | - S B Kritchevsky
- Sticht Center on Aging, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - A V Schwartz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - E S Strotmeyer
- Department of Epidemiology, Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA, USA
| | - C Womack
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - D L Orwig
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
- Doctoral Program in Gerontology, University of Maryland, Baltimore and Baltimore County, Baltimore, MD, USA
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Rong K, Liu XY, Wu XH, Li XL, Xia QQ, Chen J, Yin XF. Increasing Level of Leisure Physical Activity Could Reduce the Risk of Hip Fracture in Older Women: A Dose-Response Meta-analysis of Prospective Cohort Studies. Medicine (Baltimore) 2016; 95:e2984. [PMID: 26986111 PMCID: PMC4839892 DOI: 10.1097/md.0000000000002984] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 01/30/2016] [Accepted: 02/10/2016] [Indexed: 12/27/2022] Open
Abstract
We carried out the study to investigate and quantitatively assess the potential association between current level of physical activity and the risk of osteoporosis hip fracture in older women. Relevant publications before October 2015 were identified using the PubMed and Ovid searching tools. A dose-response meta-analysis was carried out to combine and analysis results. Fourteen prospective studies were included in the meta-analysis. A general analysis of 9 studies showed a significant inverse relationship between increasing level of physical activity and risk of hip fracture in older women [relative risk (RR) = 0.93, 95% confidence interval (95% CI): 0.91-0.96]. The result of a sensitivity analysis was consistent with the general analysis (RR = 0.94, 95% CI: 0.93-0.96). The association between increasing level of physical activity and risk of wrist fracture was not statistically significant in a general analysis of three studies (RR = 1.004, 95% CI: 0.98-1.03). A potential direct association between increasing level of physical activity and risk of wrist fracture was observed after removing 1 study with the greatest weight (RR = 1.01, 95% CI: 1.00-1.03). No significant publication bias was observed in our analysis. Our results show that increasing level of physical activity within an appropriate range may reduce the risk of hip fracture but not the risk of wrist fracture in older women.
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Affiliation(s)
- Ke Rong
- From the Department of Orthopedics (KR, XHW, QX, JC, XFY), Minhang Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging (XYL), Shanghai, China; Department of Interventional Radiology (XYL), Zhongshan Hospital, Fudan University, Shanghai, China; Department of Epidemiology (XYL), School of Public Health, Fudan University, Shanghai, China; and Department of Rehabilitation Medicine (XL), Minhang Hospital, Fudan University, Shanghai, China
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Mehta SP, MacDermid JC, Richardson J, MacIntyre NJ, Grewal R. Reliability and validity of selected measures associated with increased fall risk in females over the age of 45 years with distal radius fracture - A pilot study. J Hand Ther 2016; 28:2-9; quiz 10. [PMID: 25459279 DOI: 10.1016/j.jht.2014.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 09/17/2014] [Accepted: 09/30/2014] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN Clinical measurement. PURPOSE This study examined test-retest reliability and convergent/divergent construct validity of selected tests and measures that assess balance impairment, fear of falling (FOF), impaired physical activity (PA), and lower extremity muscle strength (LEMS) in females >45 years of age after the distal radius fracture (DRF) population. METHODS Twenty one female participants with DRF were assessed on two occasions. Timed Up and Go, Functional Reach, and One Leg Standing tests assessed balance impairment. Shortened Falls Efficacy Scale, Activity-specific Balance Confidence scale, and Fall Risk Perception Questionnaire assessed FOF. International Physical Activity Questionnaire and Rapid Assessment of Physical Activity were administered to assess PA level. Chair stand test and isometric muscle strength testing for hip and knee assessed LEMS. Intraclass correlation coefficients (ICC) examined the test-retest reliability of the measures. Pearson correlation coefficients (r) examined concurrent relationships between the measures. RESULTS The results demonstrated fair to excellent test-retest reliability (ICC between 0.50 and 0.96) and low to moderate concordance between the measures (low if r ≤ 0.4; moderate if r = 0.4-0.7). DISCUSSION The results provide preliminary estimates of test-retest reliability and convergent/divergent construct validity of selected measures associated with increased risk for falling in the females >45 years of age after DRF. Further research directions to advance knowledge regarding fall risk assessment in DRF population have been identified.
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Affiliation(s)
- Saurabh P Mehta
- School of Physical Therapy, Marshall University, Huntington, WV 25702, USA; Department of Orthopedic Surgery, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV 25701, USA.
| | - Joy C MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Hand and Upper Limb Centre Clinical Research Laboratory, St. Joseph's Health Centre, 268 Grosvenor St., London, Ontario, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Norma J MacIntyre
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Ruby Grewal
- Hand and Upper Limb Centre Clinical Research Laboratory, St. Joseph's Health Centre, 268 Grosvenor St., London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
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Suuronen J, Sjöblom S, Honkanen R, Koivumaa-Honkanen H, Kröger H, Sirola J, Rikkonen T. The relationship of severe health disorders with bone loss, grip strength, and mobility in postmenopausal women - a 15-year follow-up study. Disabil Rehabil 2015; 38:1407-14. [PMID: 26693679 DOI: 10.3109/09638288.2015.1103789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To investigate the relationships of severe health disorders (SHD) with bone loss, grip strength (GS) and mobility in postmenopausal women. METHOD The study sample consisted of 2227 Finnish women (mean age 53.2) from the Kuopio Osteoporosis Risk Factor and Prevention (OSTPRE) cohort. Postal inquiries and clinical measurements were completed during the 15-year follow-up at 5-year intervals between 1989 and 2004. Femoral neck bone mineral density (BMD) and GS were measured. Life-style factors and mobility were obtained via postal inquiries. Work disability pension according to the ICD-9 was an indicator of a SHD. RESULTS At the baseline 242 women had SHD, 506 got late SHD during 1989-1995, whereas 1479 women had none until 1996. The women with baseline SHD had higher annual bone loss (0.44%) than those without SHD (0.34%) (p < 0.05), those with late SHD (0.39%) no difference was seen. Bone loss was highest with respiratory diseases, but BMD was lowest throughout the follow-up in nervous and sense organ diseases. Lower GS and mobility was also associated with SHD. CONCLUSION Effects of SHDs on BMD, GS, and mobility are disease-specific. Thus, rehabilitation should be encouraged in postmenopausal women with SHD, especially in case of diseases of respiratory and nervous system. Implications for Rehabilitation Osteoporosis, muscle strength and co-morbidity Women with severe health disorders (SHD) leading to work disability have impaired musculoskeletal health. Active monitoring of the musculoskeletal health is advised for those with SHD. Women with SHD may benefit from rehabilitative treatment in order to avoid complications of musculoskeletal impairments.
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Affiliation(s)
- Juha Suuronen
- a Kuopio Musculoskeletal Research Unit (KMRU) , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland
| | - Samu Sjöblom
- a Kuopio Musculoskeletal Research Unit (KMRU) , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland
| | - Risto Honkanen
- a Kuopio Musculoskeletal Research Unit (KMRU) , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland
| | - Heli Koivumaa-Honkanen
- b Department of Psychiatry, Institute of Clinical Psychiatry , University of Eastern Finland , Kuopio , Finland.,c Kuopio University Hospital, South-Savonia Hospital District , Mikkeli , Finland.,d North Karelia Central Hospital , Joensuu , Finland.,e SOSTERI , Savonlinna , Finland.,f SOTE , Iisalmi , Finland.,g Lapland Hospital District , Rovaniemi , Finland.,h Clinic of Child Psychiatry , Oulu University Hospital , Oulu , Finland
| | - Heikki Kröger
- a Kuopio Musculoskeletal Research Unit (KMRU) , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland.,i Department of Orthopaedics, Traumatology and Hand Surgery , Kuopio University Hospital , Kuopio , Finland
| | - Joonas Sirola
- a Kuopio Musculoskeletal Research Unit (KMRU) , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland.,i Department of Orthopaedics, Traumatology and Hand Surgery , Kuopio University Hospital , Kuopio , Finland
| | - Toni Rikkonen
- a Kuopio Musculoskeletal Research Unit (KMRU) , Institute of Clinical Medicine, University of Eastern Finland , Kuopio , Finland
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Crandall CJ, Hovey KM, Andrews CA, Cauley JA, Manson JE, Wactawski-Wende J, Wright NC, Li W, Beavers K, Curtis JR, LeBoff MS. Bone Mineral Density as a Predictor of Subsequent Wrist Fractures: Findings From the Women's Health Initiative Study. J Clin Endocrinol Metab 2015; 100:4315-24. [PMID: 26367200 PMCID: PMC4702460 DOI: 10.1210/jc.2015-2568] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
CONTEXT Wrist fractures are common among postmenopausal women. Associations of bone mineral density (BMD) and 10-year predicted risk of major osteoporotic fracture (MOF) with wrist fractures are poorly characterized. OBJECTIVE The objective was to examine associations between the Fracture Risk Assessment Tool (FRAX)-predicted risk of MOF, BMD, BMD change, and wrist fracture. DESIGN This was a prospective observational study with a mean follow-up of 8.5 years. SETTING This study included 40 US centers. PARTICIPANTS A total of 11 392 participants from the Women's Health Initiative BMD Cohort aged 50-79 years at baseline were included in this study. INTERVENTIONS None. MAIN OUTCOME The goal was to measure incident wrist fracture. RESULTS A FRAX-predicted MOF risk ≥9.3% identified 17% of the women aged <65 years who subsequently experienced wrist fracture. Each one standard deviation lower BMD was associated with higher wrist fracture risk, with adjusted hazard ratio (95% confidence interval) of 1.66 (1.42-1.93) for femoral neck (FN) BMD and 1.45 (1.28-1.64) for lumbar spine BMD. Compared with FN BMD T score ≥ -1.0, wrist fracture adjusted hazard ratios (95% confidence interval) were: 1.51 (1.06-2.16) for a T score between -1.01 and -1.49; 1.93 (1.36-2.72) for T score between -1.50 and -1.99; 2.52 (1.77-3.60) for a T score between -2.00 and -2.49; and 2.65 (1.78-3.95) for a T score ≤ -2.5. Decrease in FN BMD between baseline and year 3 was associated with increased risk of subsequent wrist fracture; however, change in lumbar spine BMD was not. CONCLUSIONS Lumbar spine and femoral neck BMDs were associated with incident wrist fracture, but the FRAX threshold recommended to identify screening candidates did not identify the majority of women who subsequently experienced wrist fracture. Improved understanding of determinants of wrist fractures is warranted.
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Affiliation(s)
- Carolyn J Crandall
- Department of Medicine (C.J.C.), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90024; Department of Epidemiology and Environmental Health (K.M.H., J.W.-W.), State University of New York at Buffalo, Buffalo, New York 14260; Department of Ophthalmology and Visual Sciences (C.A.A.), University of Michigan, Ann Arbor, Michigan 48109; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; Division of Preventive Medicine (J.E.M.) and Department of Medicine, Endocrine, Diabetes and Hypertension Division (M.S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02467; Department of Epidemiology (N.C.W.) and Division of Clinical Immunology and Rheumatology (J.R.C.), University of Alabama at Birmingham, Birmingham, Alabama 35294; Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655; and Department of Health and Exercise Science (K.B.), Wake Forest University, Winston-Salem, North Carolina 27106
| | - Kathleen M Hovey
- Department of Medicine (C.J.C.), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90024; Department of Epidemiology and Environmental Health (K.M.H., J.W.-W.), State University of New York at Buffalo, Buffalo, New York 14260; Department of Ophthalmology and Visual Sciences (C.A.A.), University of Michigan, Ann Arbor, Michigan 48109; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; Division of Preventive Medicine (J.E.M.) and Department of Medicine, Endocrine, Diabetes and Hypertension Division (M.S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02467; Department of Epidemiology (N.C.W.) and Division of Clinical Immunology and Rheumatology (J.R.C.), University of Alabama at Birmingham, Birmingham, Alabama 35294; Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655; and Department of Health and Exercise Science (K.B.), Wake Forest University, Winston-Salem, North Carolina 27106
| | - Christopher A Andrews
- Department of Medicine (C.J.C.), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90024; Department of Epidemiology and Environmental Health (K.M.H., J.W.-W.), State University of New York at Buffalo, Buffalo, New York 14260; Department of Ophthalmology and Visual Sciences (C.A.A.), University of Michigan, Ann Arbor, Michigan 48109; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; Division of Preventive Medicine (J.E.M.) and Department of Medicine, Endocrine, Diabetes and Hypertension Division (M.S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02467; Department of Epidemiology (N.C.W.) and Division of Clinical Immunology and Rheumatology (J.R.C.), University of Alabama at Birmingham, Birmingham, Alabama 35294; Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655; and Department of Health and Exercise Science (K.B.), Wake Forest University, Winston-Salem, North Carolina 27106
| | - Jane A Cauley
- Department of Medicine (C.J.C.), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90024; Department of Epidemiology and Environmental Health (K.M.H., J.W.-W.), State University of New York at Buffalo, Buffalo, New York 14260; Department of Ophthalmology and Visual Sciences (C.A.A.), University of Michigan, Ann Arbor, Michigan 48109; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; Division of Preventive Medicine (J.E.M.) and Department of Medicine, Endocrine, Diabetes and Hypertension Division (M.S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02467; Department of Epidemiology (N.C.W.) and Division of Clinical Immunology and Rheumatology (J.R.C.), University of Alabama at Birmingham, Birmingham, Alabama 35294; Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655; and Department of Health and Exercise Science (K.B.), Wake Forest University, Winston-Salem, North Carolina 27106
| | - JoAnn E Manson
- Department of Medicine (C.J.C.), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90024; Department of Epidemiology and Environmental Health (K.M.H., J.W.-W.), State University of New York at Buffalo, Buffalo, New York 14260; Department of Ophthalmology and Visual Sciences (C.A.A.), University of Michigan, Ann Arbor, Michigan 48109; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; Division of Preventive Medicine (J.E.M.) and Department of Medicine, Endocrine, Diabetes and Hypertension Division (M.S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02467; Department of Epidemiology (N.C.W.) and Division of Clinical Immunology and Rheumatology (J.R.C.), University of Alabama at Birmingham, Birmingham, Alabama 35294; Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655; and Department of Health and Exercise Science (K.B.), Wake Forest University, Winston-Salem, North Carolina 27106
| | - Jean Wactawski-Wende
- Department of Medicine (C.J.C.), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90024; Department of Epidemiology and Environmental Health (K.M.H., J.W.-W.), State University of New York at Buffalo, Buffalo, New York 14260; Department of Ophthalmology and Visual Sciences (C.A.A.), University of Michigan, Ann Arbor, Michigan 48109; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; Division of Preventive Medicine (J.E.M.) and Department of Medicine, Endocrine, Diabetes and Hypertension Division (M.S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02467; Department of Epidemiology (N.C.W.) and Division of Clinical Immunology and Rheumatology (J.R.C.), University of Alabama at Birmingham, Birmingham, Alabama 35294; Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655; and Department of Health and Exercise Science (K.B.), Wake Forest University, Winston-Salem, North Carolina 27106
| | - Nicole C Wright
- Department of Medicine (C.J.C.), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90024; Department of Epidemiology and Environmental Health (K.M.H., J.W.-W.), State University of New York at Buffalo, Buffalo, New York 14260; Department of Ophthalmology and Visual Sciences (C.A.A.), University of Michigan, Ann Arbor, Michigan 48109; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; Division of Preventive Medicine (J.E.M.) and Department of Medicine, Endocrine, Diabetes and Hypertension Division (M.S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02467; Department of Epidemiology (N.C.W.) and Division of Clinical Immunology and Rheumatology (J.R.C.), University of Alabama at Birmingham, Birmingham, Alabama 35294; Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655; and Department of Health and Exercise Science (K.B.), Wake Forest University, Winston-Salem, North Carolina 27106
| | - Wenjun Li
- Department of Medicine (C.J.C.), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90024; Department of Epidemiology and Environmental Health (K.M.H., J.W.-W.), State University of New York at Buffalo, Buffalo, New York 14260; Department of Ophthalmology and Visual Sciences (C.A.A.), University of Michigan, Ann Arbor, Michigan 48109; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; Division of Preventive Medicine (J.E.M.) and Department of Medicine, Endocrine, Diabetes and Hypertension Division (M.S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02467; Department of Epidemiology (N.C.W.) and Division of Clinical Immunology and Rheumatology (J.R.C.), University of Alabama at Birmingham, Birmingham, Alabama 35294; Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655; and Department of Health and Exercise Science (K.B.), Wake Forest University, Winston-Salem, North Carolina 27106
| | - Kristen Beavers
- Department of Medicine (C.J.C.), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90024; Department of Epidemiology and Environmental Health (K.M.H., J.W.-W.), State University of New York at Buffalo, Buffalo, New York 14260; Department of Ophthalmology and Visual Sciences (C.A.A.), University of Michigan, Ann Arbor, Michigan 48109; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; Division of Preventive Medicine (J.E.M.) and Department of Medicine, Endocrine, Diabetes and Hypertension Division (M.S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02467; Department of Epidemiology (N.C.W.) and Division of Clinical Immunology and Rheumatology (J.R.C.), University of Alabama at Birmingham, Birmingham, Alabama 35294; Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655; and Department of Health and Exercise Science (K.B.), Wake Forest University, Winston-Salem, North Carolina 27106
| | - Jeffrey R Curtis
- Department of Medicine (C.J.C.), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90024; Department of Epidemiology and Environmental Health (K.M.H., J.W.-W.), State University of New York at Buffalo, Buffalo, New York 14260; Department of Ophthalmology and Visual Sciences (C.A.A.), University of Michigan, Ann Arbor, Michigan 48109; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; Division of Preventive Medicine (J.E.M.) and Department of Medicine, Endocrine, Diabetes and Hypertension Division (M.S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02467; Department of Epidemiology (N.C.W.) and Division of Clinical Immunology and Rheumatology (J.R.C.), University of Alabama at Birmingham, Birmingham, Alabama 35294; Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655; and Department of Health and Exercise Science (K.B.), Wake Forest University, Winston-Salem, North Carolina 27106
| | - Meryl S LeBoff
- Department of Medicine (C.J.C.), David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California 90024; Department of Epidemiology and Environmental Health (K.M.H., J.W.-W.), State University of New York at Buffalo, Buffalo, New York 14260; Department of Ophthalmology and Visual Sciences (C.A.A.), University of Michigan, Ann Arbor, Michigan 48109; Department of Epidemiology (J.A.C.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania 15261; Division of Preventive Medicine (J.E.M.) and Department of Medicine, Endocrine, Diabetes and Hypertension Division (M.S.L.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02467; Department of Epidemiology (N.C.W.) and Division of Clinical Immunology and Rheumatology (J.R.C.), University of Alabama at Birmingham, Birmingham, Alabama 35294; Division of Preventive and Behavioral Medicine (W.L.), University of Massachusetts Medical School, Worcester, Massachusetts 01655; and Department of Health and Exercise Science (K.B.), Wake Forest University, Winston-Salem, North Carolina 27106
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Ochi K, Furuya T, Ishibashi M, Watanabe M, Ikari K, Taniguchi A, Yamanaka H, Momohara S. Risk factors associated with the occurrence of proximal humerus fractures in patients with rheumatoid arthritis: a custom strategy for preventing proximal humerus fractures. Rheumatol Int 2015; 36:213-9. [DOI: 10.1007/s00296-015-3371-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 09/22/2015] [Indexed: 01/23/2023]
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Karinkanta S, Kannus P, Uusi-Rasi K, Heinonen A, Sievänen H. Combined resistance and balance-jumping exercise reduces older women's injurious falls and fractures: 5-year follow-up study. Age Ageing 2015; 44:784-9. [PMID: 25990940 DOI: 10.1093/ageing/afv064] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 03/04/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVE previously, a randomised controlled exercise intervention study (RCT) showed that combined resistance and balance-jumping training (COMB) improved physical functioning and bone strength. The purpose of this follow-up study was to assess whether this exercise intervention had long-lasting effects in reducing injurious falls and fractures. DESIGN five-year health-care register-based follow-up study after a 1-year, four-arm RCT. SETTING community-dwelling older women in Finland. SUBJECTS one hundred and forty-five of the original 149 RCT participants; women aged 70-78 years at the beginning. METHODS participants' health-care visits were collected from computerised patient register. An injurious fall was defined as an event in which the subject contacted the health-care professionals or was taken to a hospital, due to a fall. The rate of injured fallers was assessed by Cox proportional hazards model (hazard ratio, HR), and the rate of injurious falls and fractures by Poisson regression (risk ratio, RR). RESULTS eighty-one injurious falls including 26 fractures occurred during the follow-up. The rate of injured fallers was 62% lower in COMB group compared with the controls (HR 0.38, 95% CI 0.17 to 0.85). In addition, COMB group had 51% less injurious falls (RR 0.49, 95% CI 0.25 to 0.98) and 74% less fractures (RR 0.26, 95% CI 0.07 to 0.97). CONCLUSIONS home-dwelling older women who participated in a 12-month intensive multi-component exercise training showed a reduced incidence for injurious falls during 5-year post-intervention period. Reduction in fractures was also evident. These long-term effects need to be confirmed in future studies.
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Affiliation(s)
- Saija Karinkanta
- The UKK Institute for Health Promotion Research, Tampere 33501, Finland
| | - Pekka Kannus
- The UKK Institute for Health Promotion Research, Tampere 33501, Finland Medical School, University of Tampere, and Department of Orthopaedics and Trauma Surgery, Tampere University Hospital, Tampere, Finland
| | - Kirsti Uusi-Rasi
- The UKK Institute for Health Promotion Research, Tampere 33501, Finland
| | - Ari Heinonen
- Department of Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland
| | - Harri Sievänen
- The UKK Institute for Health Promotion Research, Tampere 33501, Finland
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Effects of physical exercise on health-related quality of life and blood lipids in perimenopausal women: a randomized placebo-controlled trial. Menopause 2015; 21:1269-76. [PMID: 24937024 DOI: 10.1097/gme.0000000000000264] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aims to evaluate the treatment effects of physical exercise on menopausal symptoms in middle-aged female medical staff experiencing perimenopausal syndrome. METHODS A total of 157 female medical staff aged 40 to 55 years and with a Kupperman index score of 15 points or higher were randomized 1:1 into an intervention group (n = 78) or a control group (n = 79). Women in the intervention group were asked to perform aerobic physical exercise (walking with strides) three times a week or more, whereas those in the control group continued as normal. Measurements were taken at baseline and on weeks 4, 8, and 12, with total Kupperman index score, scores on individual elements of the scale, weight, and waist circumference recorded. In addition, fasting blood glucose, triglycerides, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were recorded at baseline and on week 12. The effects of physical exercise therapy on perimenopausal syndrome were evaluated by comparing changes in these parameters between the control group and the intervention group. RESULTS Fifty-four and 57 women completed all three follow-ups in the intervention and control groups, respectively. On week 12, the mean (SD) change in total Kupperman index score (-9.23 [6.23]) from baseline to week 12; the mean (SD) changes in individual scores for paresthesia (-1.08 [1.51]), insomnia (-1.00 [1.46]), irritability (-1.00 [1.34]), joint or muscle pain (-0.75 [0.74]), fatigue (-0.56 [0.75]), headache (-0.54 [0.75]), formication (-0.38 [0.66]), and sexual life (-0.62 [1.71]); and the mean (SD) changes in total cholesterol (-0.76 [0.63] mmol/L) and triglycerides (-0.20 [0.50] mmol/L) were significantly higher in the intervention group than in the control group (P < 0.05). In the intervention group, total Kupperman index score, weight, body mass index, waist circumference, triglycerides, and total cholesterol were significantly lower on week 12 compared with baseline (P < 0.05). CONCLUSIONS Physical exercise can substantially reduce menopausal symptoms and improve blood lipid status and body weight.
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Rauma PH, Koivumaa-Honkanen H, Williams LJ, Tuppurainen MT, Kröger HP, Honkanen RJ. Life satisfaction and bone mineral density among postmenopausal women: cross-sectional and longitudinal associations. Psychosom Med 2014; 76:709-15. [PMID: 25373893 DOI: 10.1097/psy.0000000000000114] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether and how global life satisfaction is associated with bone mineral density (BMD) and bone loss. METHODS A total of 2167 women from a cohort of Finnish women born in 1932 to 1941 were included in the cross-sectional and 1147 women in the 10-year longitudinal part of the present study. Participants responded to a postal enquiry and underwent femoral BMD densitometry in 1999 (baseline) and 2009 (follow-up). During the follow-up, their life satisfaction was repeatedly measured using a four-item scale. Self-reported data on health, life-style, and medication were used to adjust the multivariate linear regression models. RESULTS Mean (standard deviation) femoral BMD decreased over the 10-year follow-up from 880 (125) to 846 (122) mg/cm. In the multivariate model, life satisfaction (p = .028) and its improvement (p = .001) predicted reduced bone loss, whereas hospitalization due to depression predicted increased bone loss (B = -0.523 annual % change, standard error = 0.212, p = .014). These effects were independent of each other. CONCLUSIONS Easily assessed global life satisfaction should be taken into account when effects of aging and prevention of osteoporosis as well as health promotion in postmenopausal women are considered.
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Affiliation(s)
- Päivi H Rauma
- From the Social Pharmacy (P.H.R.), School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland; Bone and Cartilage Research Unit (P.H.R., M.T.T., H.P.K., R.J.H.), Surgery, Institute of Clinical Medicine, UEF, Kuopio, Finland; Institute of Clinical Medicine (H.K.-H.), Psychiatry, UEF, Kuopio, Finland; Clinic of Child Psychiatry (H.K.-H.), Oulu University Hospital, Oulu, Finland; Department of Psychiatry (H.K.-H.), Kuopio University Hospital (KUH), Kuopio, Finland; South-Savonia Hospital District (H.K.-H.), Mikkeli, Finland; North Karelia Central Hospital (H.K.-H.), Joensuu, Finland; SOSTERI (H.K.-H), Savonlinna, Finland; SOTE (H.K.-H), Iisalmi, Finland; Lapland Hospital District (H.K.-H.), Rovaniemi, Finland; University of Oulu (H.K.-H.), Oulu, Finland; School of Medicine (L.J.W.), Deakin University, Geelong, Australia; Department of Psychiatry (L.J.W.), The University of Melbourne, Parkville, Australia; Departments of Obstetrics and Gynaecology (M.T.T.) and Orthopaedics, Traumatology and Handsurgery (H.P.K.), KUH, Kuopio, Finland; and Institute of Public Health and Clinical Nutrition (R.J.H.), UEF, Kuopio, Finland
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Salo S, Leinonen V, Rikkonen T, Vainio P, Marttila J, Honkanen R, Tuppurainen M, Kröger H, Sirola J. Association between bone mineral density and lumbar disc degeneration. Maturitas 2014; 79:449-55. [PMID: 25266266 DOI: 10.1016/j.maturitas.2014.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 09/14/2014] [Accepted: 09/15/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Higher vertebral bone mineral density (BMD) has been found to be related with lumbar disc degeneration (LDD), while relationship between femoral neck BMD and LDD remains controversial. The aim of our research was to study the relationship between LDD and BMD of the lumbar spine and femoral neck. STUDY DESIGN The study population consisted of 168 postmenopausal women (aged 63.3-75.0 years, mean 68.6 years) from the prospective OSTPRE and OSTPRE-FPS study cohorts. The severity of LDD was graded from T2-weighted MRI images using the five-grade Pfirrmann classification. Four vertebral levels (L1-L4) were studied (total 672 discs). The association between lumbar BMD and Z-score and the severity of LDD was studied separately for each vertebral level with AN(C)OVA analysis, using potential confounders as covariates. RESULTS Higher lumbar BMD and Z-score were associated with more severe LDD at all studied levels (L1-L4): between L4-L5 disc and L4 BMD (p=0.044) and L4 Z-score (p=0.052), between L2-L3 disc and L3 BMD (p=0.001) and at all other levels (p<0.001). The mean degeneration grade of the studied discs was associated with the mean L1-L4 BMD and Z-score (p<0.001). Statistical significance of any result did not alter after controlling for confounding factors. There was no significant association between femoral neck BMD and LDD. CONCLUSIONS Higher lumbar BMD/Z-score were associated with more severe LDD. There was no significant association between femoral neck BMD and disc degeneration. Femoral neck BMD may be a more reliable measurement for diagnosing osteoporosis in postmenopausal women with degenerative changes in the lumbar spine.
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Affiliation(s)
- Sami Salo
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Ville Leinonen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Toni Rikkonen
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Pauli Vainio
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Jarkko Marttila
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Risto Honkanen
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Lapland Hospital District, Rovaniemi, Finland
| | - Marjo Tuppurainen
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Obstetrics and Gynecology, Kuopio University Hospital, Finland
| | - Heikki Kröger
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
| | - Joonas Sirola
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; Department of Orthopedics, Traumatology and Hand Surgery, Kuopio University Hospital, Kuopio, Finland
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Build better bones with exercise: protocol for a feasibility study of a multicenter randomized controlled trial of 12 months of home exercise in women with a vertebral fracture. Phys Ther 2014; 94:1337-52. [PMID: 24786946 PMCID: PMC4155040 DOI: 10.2522/ptj.20130625] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Our goal is to conduct a multicenter randomized controlled trial (RCT) to investigate whether exercise can reduce incident fractures compared with no intervention among women aged ≥65 years with a vertebral fracture. OBJECTIVES This pilot study will determine the feasibility of recruitment, retention, and adherence for the proposed trial. DESIGN The proposed RCT will be a pilot feasibility study with 1:1 randomization to exercise or attentional control groups. SETTING Five Canadian sites (1 community hospital partnered with an academic center and 4 academic hospitals or centers affiliated with an academic center) and 2 Australian centers (1 academic hospital and 1 center for community primary care, geriatric, and rehabilitation services). PARTICIPANTS One hundred sixty women aged ≥65 years with vertebral fracture at 5 Canadian and 2 Australian centers will be recruited. INTERVENTION The Build Better Bones With Exercise (B3E) intervention includes exercise and behavioral counseling, delivered by a physical therapist in 6 home visits over 8 months, and monthly calls; participants are to exercise ≥3 times weekly. Controls will receive equal attention. MEASUREMENTS Primary outcomes will include recruitment, retention, and adherence. Adherence to exercise will be assessed via calendar diary. Secondary outcomes will include physical function (lower extremity strength, mobility, and balance), posture, and falls. Additional secondary outcomes will include quality of life, pain, fall self-efficacy, behavior change variables, intervention cost, fractures, and adverse events. Analyses of feasibility objectives will be descriptive or based on estimates with 95% confidence intervals, where feasibility will be assessed relative to a priori criteria. Differences in secondary outcomes will be evaluated in intention-to-treat analyses via independent Student t tests, chi-square tests, or logistic regression. The Bonferroni method will be used to adjust the level of significance for secondary outcomes so the overall alpha level is .05. LIMITATIONS No assessment of bone mineral density will be conducted. The proposed definitive trial will require a large sample size. CONCLUSIONS The viability of a large-scale exercise trial in women with vertebral fractures will be evaluated, as well as the effects of a home exercise program on important secondary outcomes.
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Värri M, Tuomainen TP, Honkanen R, Rikkonen T, Niskanen L, Kröger H, Tuppurainen MT. Carotid intima-media thickness and calcification in relation to bone mineral density in postmenopausal women—The OSTPRE-BBA study. Maturitas 2014; 78:304-9. [DOI: 10.1016/j.maturitas.2014.05.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 05/17/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
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Giangregorio LM, MacIntyre NJ, Heinonen A, Cheung AM, Wark JD, Shipp K, McGill S, Ashe MC, Laprade J, Jain R, Keller H, Papaioannou A. Too Fit To Fracture: a consensus on future research priorities in osteoporosis and exercise. Osteoporos Int 2014; 25:1465-72. [PMID: 24610579 PMCID: PMC5094885 DOI: 10.1007/s00198-014-2652-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 02/09/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED An international consensus process identified the following research priorities in osteoporosis and exercise: study of exercise in high-risk cohorts, evaluation of multimodal interventions, research examining translation into practice and a goal to examine fracture outcomes. INTRODUCTION To identify future research priorities related to exercise for people with osteoporosis with and without osteoporotic spine fracture via international consensus. METHODS An international expert panel and representatives from Osteoporosis Canada led the process and identified opinion leaders or stakeholders to contribute. A focus group of four patient advocates identified quality of life, mobility, activities of daily living, falls, bone mineral density, and harms as outcomes important for decision-making. Seventy-five individuals were invited to participate in an online survey asking respondents to define future research priorities in the area of osteoporosis and exercise; the response rate was 57%. Fifty-five individuals from seven countries were invited to a half-day consensus meeting; 60% of invitees attended. The results of the online survey, knowledge synthesis activities, and results of the focus group were presented. Nominal group technique was used to come to consensus on research priorities. RESULTS Research priorities included the study of exercise in high-risk cohorts (e.g., ≥ 65 years, low BMD, moderate/high risk of fracture, history of osteoporotic vertebral fractures, hyperkyphotic posture, functional impairments, or sedentary), the evaluation of multimodal interventions, research examining translation into practice, and a goal to examine fracture outcomes. The standardization of outcomes or protocols that could be evolved into large multicentre trials was discussed. CONCLUSIONS The research priorities identified as part of the Too Fit To Fracture initiative can be used to inform the development of multicentre collaborations to evaluate and implement strategies for engaging individuals with osteoporosis in a safe and effective exercise.
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Affiliation(s)
- L M Giangregorio
- Department of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada,
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Orchard TS, Larson JC, Alghothani N, Bout-Tabaku S, Cauley JA, Chen Z, LaCroix AZ, Wactawski-Wende J, Jackson RD. Magnesium intake, bone mineral density, and fractures: results from the Women's Health Initiative Observational Study. Am J Clin Nutr 2014; 99:926-33. [PMID: 24500155 PMCID: PMC3953885 DOI: 10.3945/ajcn.113.067488] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Magnesium is a necessary component of bone, but its relation to osteoporotic fractures is unclear. OBJECTIVE We examined magnesium intake as a risk factor for osteoporotic fractures and altered bone mineral density (BMD). DESIGN This prospective cohort study included 73,684 postmenopausal women enrolled in the Women's Health Initiative Observational Study. Total daily magnesium intake was estimated from baseline food-frequency questionnaires plus supplements. Hip fractures were confirmed by a medical record review; other fractures were identified by self-report. A baseline BMD analysis was performed in 4778 participants. RESULTS Baseline hip BMD was 3% higher (P < 0.001), and whole-body BMD was 2% higher (P < 0.001), in women who consumed >422.5 compared with <206.5 mg Mg/d. However, the incidence and RR of hip and total fractures did not differ across quintiles of magnesium. In contrast, risk of lower-arm or wrist fractures increased with higher magnesium intake [multivariate-adjusted HRs of 1.15 (95% CI: 1.01, 1.32) and 1.23 (95% CI: 1.07, 1.42) for quintiles 4 and 5, respectively, compared with quintile 1; P-trend = 0.002]. In addition, women with the highest magnesium intakes were more physically active and at increased risk of falls [HR for quintile 4: 1.11 (95% CI: 1.06, 1.16); HR for quintile 5: 1.15 (95% CI: 1.10, 1.20); P-trend < 0.001]. CONCLUSIONS Lower magnesium intake is associated with lower BMD of the hip and whole body, but this result does not translate into increased risk of fractures. A magnesium consumption slightly greater than the Recommended Dietary Allowance is associated with increased lower-arm and wrist fractures that are possibly related to more physical activity and falls.
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Affiliation(s)
- Tonya S Orchard
- Department of Human Nutrition, College of Education and Human Ecology (TSO) and the Division of Endocrinology, Diabetes, and Metabolism, College of Medicine (NA and RDJ), The Ohio State University, Columbus, OH (TSO); the Fred Hutchinson Cancer Research Center, Seattle, WA (JCL and AZL); the Nationwide Children's Hospital, Columbus, OH (SB-T); the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA (JAC); the Epidemiology and Biostatistics Division, University of Arizona, Tucson, AZ (ZC); and the Departments of Social and Preventive Medicine and Gynecology-Obstetrics, University at Buffalo, Buffalo, NY (JW-W)
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Giangregorio LM, Papaioannou A, Macintyre NJ, Ashe MC, Heinonen A, Shipp K, Wark J, McGill S, Keller H, Jain R, Laprade J, Cheung AM. Too Fit To Fracture: exercise recommendations for individuals with osteoporosis or osteoporotic vertebral fracture. Osteoporos Int 2014; 25:821-35. [PMID: 24281053 PMCID: PMC5112023 DOI: 10.1007/s00198-013-2523-2] [Citation(s) in RCA: 128] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 09/17/2013] [Indexed: 11/25/2022]
Abstract
SUMMARY A consensus process was conducted to develop exercise recommendations for individuals with osteoporosis or vertebral fractures. A multicomponent exercise program that includes balance and resistance training is recommended. INTRODUCTION The aim was to develop consensus on exercise recommendations for older adults: (1) with osteoporosis and (2) with osteoporotic vertebral fracture(s). METHODS The Grading of Recommendations Assessment, Development, and Evaluation method was used to evaluate the quality of evidence and develop recommendations. Outcomes important for decision making were nominated by an expert panel and patient advocates. They included falls, fractures, bone mineral density (BMD), and adverse events for individuals with osteoporosis/vertebral fractures, and pain, quality of life, and function for those with vertebral fracture. Meta-analyses evaluating the effects of exercise on the outcomes were reviewed. Observational studies or clinical trials were reviewed when meta-analyses were not available. Quality ratings were generated, and informed the recommendations. RESULTS The outcome for which evidence is strongest is falls. Point estimates of the effects of exercise on falls, fractures, and BMD vary according to exercise type. There is not enough evidence to quantify the risks of exercise in those with osteoporosis or vertebral fracture. Few trials of exercise exist in those with vertebral fracture. The exercise recommendations for exercise in individuals with osteoporosis or osteoporotic vertebral fracture are conditional. The panel strongly recommends a multicomponent exercise program including resistance and balance training for individuals with osteoporosis or osteoporotic vertebral fracture. The panel recommends that older adults with osteoporosis or vertebral fracture do not engage in aerobic training to the exclusion of resistance or balance training. CONCLUSIONS The consensus of our international panel is that exercise is recommended for older adults with osteoporosis or vertebral fracture, but our recommendations are conditional.
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Affiliation(s)
- L M Giangregorio
- Department of Kinesiology, University of Waterloo, 200 University Ave, Waterloo, ON, N2L 3G1, Canada,
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Risk factors associated with the occurrence of distal radius fractures in Japanese patients with rheumatoid arthritis: a prospective observational cohort study. Clin Rheumatol 2013; 33:477-83. [DOI: 10.1007/s10067-013-2415-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/05/2013] [Accepted: 10/18/2013] [Indexed: 11/25/2022]
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Malo MKH, Rohrbach D, Isaksson H, Töyräs J, Jurvelin JS, Tamminen IS, Kröger H, Raum K. Longitudinal elastic properties and porosity of cortical bone tissue vary with age in human proximal femur. Bone 2013; 53:451-8. [PMID: 23334084 DOI: 10.1016/j.bone.2013.01.015] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 01/08/2013] [Accepted: 01/10/2013] [Indexed: 11/26/2022]
Abstract
Tissue level structural and mechanical properties are important determinants of bone strength. As an individual ages, microstructural changes occur in bone, e.g., trabeculae and cortex become thinner and porosity increases. However, it is not known how the elastic properties of bone change during aging. Bone tissue may lose its elasticity and become more brittle and prone to fractures as it ages. In the present study the age-dependent variation in the spatial distributions of microstructural and microelastic properties of the human femoral neck and shaft were evaluated by using acoustic microscopy. Although these properties may not be directly measured in vivo, there is a major interest to investigate their relationships with the linear elastic measurements obtained by diagnostic ultrasound at the most severe fracture sites, e.g., the femoral neck. However, before the validity of novel in vivo techniques can be established, it is essential to understand the age-dependent variation in tissue elastic properties and porosity at different skeletal sites. A total of 42 transverse cross-sectional bone samples were obtained from the femoral neck (Fn) and proximal femoral shaft (Ps) of 21 men (mean±SD age 47.1±17.8, range 17-82years). Samples were quantitatively imaged using a scanning acoustic microscope (SAM) equipped with a 50MHz ultrasound transducer. Distributions of the elastic coefficient (c33) of cortical (Ct) and trabecular (Tr) tissues and microstructure of cortex (cortical thickness Ct.Th and porosity Ct.Po) were determined. Variations in c33 were observed with respect to tissue type (c33Tr<c33Ct), location (c33(Ct.Ps)=37.7GPa>c33(Ct.Fn)=35.3GPa>c33(Tr.Ps)=33.8GPa>c33(Tr.Fn)=31.9GPa), and cadaver age (R(2)=0.28-0.46, p<0.05). Regional variations in porosity were found in the neck (superior 13.1%; inferior 6.1%; anterior 10.1%; posterior 8.6%) and in the shaft (medial 9.5%; lateral 7.7%; anterior 8.6%; posterior 12.0%). In conclusion, significant variations in elastic coefficients were detected between femoral neck and shaft as well as between the quadrants of the cross-sections of neck and shaft. Moreover, an age-related increase in cortical porosity and a stiffening of the bone tissue were observed. These findings may explain in part the increase in susceptibility to suffer low energy fractures during aging and highlight the potential of ultrasound in clinical osteoporosis diagnostics.
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Affiliation(s)
- M K H Malo
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland.
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Englund U, Nordström P, Nilsson J, Hallmans G, Svensson O, Bergström U, Pettersson-Kymmer U. Active commuting reduces the risk of wrist fractures in middle-aged women-the UFO study. Osteoporos Int 2013; 24:533-40. [PMID: 22525983 DOI: 10.1007/s00198-012-1988-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 03/26/2012] [Indexed: 12/01/2022]
Abstract
SUMMARY Middle-aged women with active commuting had significantly lower risk for wrist fracture than women commuting by car/bus. INTRODUCTION Our purpose was to investigate whether a physically active lifestyle in middle-aged women was associated with a reduced risk of later sustaining a low-trauma wrist fracture. METHODS The Umeå Fracture and Osteoporosis (UFO) study is a population-based nested case-control study investigating associations between lifestyle and fragility fractures. From a cohort of ~35,000 subjects, we identified 376 female wrist fracture cases who had reported data regarding their commuting habits, occupational, and leisure physical activity, before they sustained their fracture. Each fracture case was compared with at least one control drawn from the same cohort and matched for age and week of reporting data, yielding a total of 778 subjects. Mean age at baseline was 54.3 ± 5.8 years, and mean age at fracture was 60.3 ± 5.8 years. RESULTS Conditional logistic regression analysis with adjustments for height, body mass index, smoking, and menopausal status showed that subjects with active commuting (especially walking) were at significantly lower risk of sustaining a wrist fracture (OR 0.48; 95 % CI 0.27-0.88) compared with those who commuted by car or bus. Leisure time activities such as dancing and snow shoveling were also associated with a lower fracture risk, whereas occupational activity, training, and leisure walking or cycling were unrelated to fracture risk. CONCLUSION This study suggests that active commuting is associated with a lower wrist fracture risk, in middle-aged women.
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Affiliation(s)
- U Englund
- Division of Geriatric Medicine, Department of Community Medicine and Rehabilitation, Umeå University, 901 87, Umeå, Sweden.
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Abstract
PURPOSE OF REVIEW With the recent emergence of associations of bisphosphonate therapy with atypical fractures and osteonecrosis of the jaw, there is renewed interest among clinicians and patients for nonpharmacological approaches to bone health. Here, we review the new studies published in the past year or two that advance our knowledge of the effect of mechanical stimuli on bone health. RECENT FINDINGS Physical activity is associated with serum sclerostin levels; the most physically active individuals have the lowest serum sclerostin levels. Observational trials suggest that physical activity participation results in higher bone mass, but clinical trials suggest that the effects of exercise on areal bone mineral density are small, and vary with the site measured and the type of exercise. Based on current data, it may be best to combine progressive resistance training with interventions such as walking or aerobic dancing if the desire is to improve both spine and hip in postmenopausal women. Low-magnitude high-frequency whole body vibration does not improve bone mineral density and bone structure in postmenopausal women. SUMMARY Physical activity and exercise are important for the maintenance of musculoskeletal health as we age. Future studies need to investigate the effects of exercise in older populations with rheumatological diseases and those with a history of fragility fractures.
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Wilczek ML, Kälvesten J, Algulin J, Beiki O, Brismar TB. Digital X-ray radiogrammetry of hand or wrist radiographs can predict hip fracture risk--a study in 5,420 women and 2,837 men. Eur Radiol 2012; 23:1383-91. [PMID: 23229168 PMCID: PMC3622796 DOI: 10.1007/s00330-012-2706-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 09/28/2012] [Accepted: 10/15/2012] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To assess whether digital X-ray radiogrammetry (DXR) analysis of standard clinical hand or wrist radiographs obtained at emergency hospitals can predict hip fracture risk. METHODS A total of 45,538 radiographs depicting the left hand were gathered from three emergency hospitals in Stockholm, Sweden. Radiographs with insufficiently included metacarpal bone, fractures in measurement regions, foreign material or unacceptable positioning were manually excluded. A total of 18,824 radiographs from 15,072 patients were analysed with DXR, yielding a calculated BMD equivalent (DXR-BMD). Patients were matched with the national death and inpatient registers. Inclusion criteria were age ≥ 40 years, no prior hip fracture and observation time > 7 days. Hip fractures were identified via ICD-10 codes. Age-adjusted hazard ratio per standard deviation (HR/SD) was calculated using Cox regression. RESULTS 8,257 patients (65.6 % female, 34.4 % male) met the inclusion criteria. One hundred twenty-two patients suffered a hip fracture after their radiograph. The fracture group had a significantly lower DXR-BMD than the non-fracture group when adjusted for age. The HR/SD for hip fracture was 2.52 and 2.08 in women and men respectively. The area under the curve was 0.89 in women and 0.84 in men. CONCLUSIONS DXR analysis of wrist and hand radiographs obtained at emergency hospitals predicts hip fracture risk in women and men. KEY POINTS • Digital X-ray radiogrammetry of emergency hand/wrist radiographs predicts hip fracture risk. • Digital X-ray radiogrammetry (DXR) predicts hip fracture risk in both women and men. • Osteoporosis can potentially be identified in patients with suspected wrist fractures. • DXR can potentially be used for selective osteoporosis screening.
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Affiliation(s)
- M L Wilczek
- Karolinska Institutet, Department for Clinical Science, Intervention and Technology, Division of Radiology, Karolinska University Hospital, Stockholm, Sweden.
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Määttä M, Terho E, Jokinen H, Pulkkinen P, Korpelainen J, Heikkinen J, Keinänen-Kiukaanniemi S, Jämsä T, Korpelainen R. Lifestyle factors and site-specific risk of hip fracture in community dwelling older women--a 13-year prospective population-based cohort study. BMC Musculoskelet Disord 2012; 13:173. [PMID: 22978821 PMCID: PMC3522545 DOI: 10.1186/1471-2474-13-173] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Accepted: 09/13/2012] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Several risk factors are associated to hip fractures. It seems that different hip fracture types have different etiologies. In this study, we evaluated the lifestyle-related risk factors for cervical and trochanteric hip fractures in older women over a 13-year follow-up period. METHODS The study design was a prospective, population-based study consisting of 1681 women (mean age 72 years). Seventy-three percent (n = 1222) participated in the baseline measurements, including medical history, leisure-time physical activity, smoking, and nutrition, along with body anthropometrics and functional mobility. Cox regression was used to identify the independent predictors of cervical and trochanteric hip fractures. RESULTS During the follow-up, 49 cervical and 31 trochanteric fractures were recorded. The women with hip fractures were older, taller, and thinner than the women with no fractures (p < 0.05). Low functional mobility was an independent predictor of both cervical and trochanteric fractures (HR = 3.4, 95% CI 1.8-6.6, and HR = 5.3, 95% CI 2.5-11.4, respectively). Low baseline physical activity was associated with an increased risk of hip fracture, especially in the cervical region (HR = 2.5, 95% CI 1.3-4.9). A decrease in cervical fracture risk (p = 0.002) was observed with physically active individuals compared to their less active peers (categories: very low or low, moderate, and high). Moderate coffee consumption and hypertension decreased the risk of cervical fractures (HR = 0.4, 95% CI 0.2-0.8, for both), while smoking was a predisposing factor for trochanteric fractures (HR = 3.2, 95% CI 1.1-9.3). CONCLUSIONS Impaired functional mobility, physical inactivity, and low body mass may increase the risk for hip fractures with different effects at the cervical and trochanteric levels.
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Affiliation(s)
- Mikko Määttä
- Department of Medical Technology, University of Oulu, PO Box 5000, FI-90014, Oulu, Finland.
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Rikkonen T, Sirola J, Salovaara K, Tuppurainen M, Jurvelin JS, Honkanen R, Kröger H. Muscle strength and body composition are clinical indicators of osteoporosis. Calcif Tissue Int 2012; 91:131-8. [PMID: 22733383 DOI: 10.1007/s00223-012-9618-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 05/15/2012] [Indexed: 11/24/2022]
Abstract
We examined the role of muscle strength, lean tissue distribution, and overall body composition as indicators of osteoporosis (OP) in a pooled sample of 979 Finnish postmenopausal women (mean age 68.1 years) from the Kuopio Osteoporosis Risk Factor and Prevention study. Bone mineral density (BMD) at the femoral neck (FN) and total body composition were assessed by dual-energy X-ray absorptiometry scans. The women (n = 979) were divided into three groups according to WHO criteria, based on FN BMD T score: normal (n = 474), osteopenia (n = 468), and OP (n = 37). Soft tissue proportions, fat mass index (FMI, fat/height²), lean mass index (LMI, lean/height²), and appendicular skeletal muscle mass (ASM, (arms + legs)/height²) were calculated. Handgrip and knee extension strength measurements were made. OP subjects had significantly smaller LMI (p = 0.001), ASM (p = 0.001), grip strength (p < 0.0001), and knee extension strength (p < 0.05) but not FMI (p > 0.05) compared to other subjects. Grip and knee extension strength were 19 and 16 % weaker in OP women compared to others, respectively. The area under the receiver operating characteristic curve was 69 % for grip and 71 % for knee extension strength. In tissue proportions only LMI showed predictive power (63 %, p = 0.016). An overall linear association of LMI (R² = 0.007, p = 0.01) and FMI (R² = 0.028, p < 0.001) with FN BMD remained significant. In the multivariate model, after adjusting for age, grip strength, leg extension strength, FMI, LMI, number of medications, alcohol consumption, current smoking, dietary calcium intake, and hormone therapy, grip strength (adjusted OR = 0.899, 95 % CI 0.84-0.97, p < 0.01), leg extension strength (OR = 0.998, 95 % CI 0.99-1, p < 0.05), and years of hormone therapy (OR = 0.905, 95 % CI 0.82-1, p < 0.05) remained as significant determinants of OP. Muscle strength tests, especially grip strength, serve as an independent and useful tool for postmenopausal OP risk assessment. In addition, lean mass contributes to OP in this age group. Muscle strength and lean mass should be considered separately since both are independently associated with postmenopausal BMD.
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Affiliation(s)
- Toni Rikkonen
- Bone and Cartilage Research Unit, Mediteknia Building, University of Eastern Finland, Kuopio, Finland.
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Trimpou P, Lindahl A, Lindstedt G, Oleröd G, Wilhelmsen L, Landin-Wilhelmsen K. Secular trends in sex hormones and fractures in men and women. Eur J Endocrinol 2012; 166:887-95. [PMID: 22307572 DOI: 10.1530/eje-11-0808] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To study secular trends in sex hormones, anthropometry, bone measures and fractures. DESIGN A random population sample was studied twice and subjects of similar age group were compared 13 years apart. METHODS X-ray-verified fractures were retrieved from a random population sample of 2400 men and women (participants 1616=67%) aged 25-64 years from the WHO, MONICA Project in Gothenburg, Sweden, in 1995 and 2008. Fasting serum hormones and calcaneal ultrasound were measured in every fourth subject. In fertile women, measurements were performed on cycle day interval 7-9. RESULTS In 2008, men had lower serum free testosterone than men of similar age in 1995 (P<0.001). Body composition, physical activity and fracture incidence were similar. In women, hormone replacement therapy (HRT) was lower in 2008, 7 vs 28% (P<0.0001), as was serum oestradiol, although use of tranquilisers and leisure time physical activity were higher. In 2008, the fracture incidence was higher in postmenopausal women, 29 vs 17% (P<0.001), and vertebral crush had increased from 8 to 19% of all fractures (P=0.031). Serum cholesterol and triglycerides were lower in all subjects in 2008 compared with that in 1995. CONCLUSIONS Secular trends were observed with lower serum testosterone in men in 2008, but no effect was seen on the fracture incidence of these fairly young men. In postmenopausal women in 2008, there was a higher fracture incidence along with more vertebral compressions. Lower HRT use, lower serum oestradiol and higher fall risk exposure due with more tranquilisers and leisure time physical activity in 2008 may explain the results.
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Affiliation(s)
- Penelope Trimpou
- Section for Endocrinology, Department of Medicine, Sahlgrenska University Hospital at Sahlgrenska Academy, University of Gothenburg, SE-413 45 Gothenburg, Sweden.
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