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Koltun KJ, Strock NCA, Weaver C, Lee H, Williams NI, Rogers CJ, Damani J, Ferruzzi MG, Nakatsu CH, De Souza MJ. Prunes preserve cortical density and estimated strength of the tibia in a 12-month randomized controlled trial in postmenopausal women: The Prune Study. Osteoporos Int 2024; 35:863-875. [PMID: 38349471 DOI: 10.1007/s00198-024-07031-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/19/2024] [Indexed: 04/20/2024]
Abstract
Non-pharmacological therapies, such as whole-food interventions, are gaining interest as potential approaches to prevent and/or treat low bone mineral density (BMD) in postmenopausal women. Previously, prune consumption preserved two-dimensional BMD at the total hip. Here we demonstrate that prune consumption preserved three-dimensional BMD and estimated strength at the tibia. PURPOSE Dietary consumption of prunes has favorable impacts on areal bone mineral density (aBMD); however, more research is necessary to understand the influence on volumetric BMD (vBMD), bone geometry, and estimated bone strength. METHODS This investigation was a single center, parallel arm 12-month randomized controlled trial (RCT; NCT02822378) to evaluate the effects of 50 g and 100 g of prunes vs. a Control group on vBMD, bone geometry, and estimated strength of the radius and tibia via peripheral quantitative computed tomography (pQCT) in postmenopausal women. Women (age 62.1 ± 5.0yrs) were randomized into Control (n = 78), 50 g Prune (n = 79), or 100 g Prune (n = 78) groups. General linear mixed effects (LME) modeling was used to assess changes over time and percent change from baseline was compared between groups. RESULTS The most notable effects were observed at the 14% diaphyseal tibia in the Pooled (50 g + 100 g) Prune group, in which group × time interactions were observed for cortical vBMD (p = 0.012) and estimated bone strength (SSI; p = 0.024); all of which decreased in the Control vs. no change in the Pooled Prune group from baseline to 12 months/post. CONCLUSION Prune consumption for 12 months preserved cortical bone structure and estimated bone strength at the weight-bearing tibia in postmenopausal women.
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Affiliation(s)
- Kristen J Koltun
- Department of Kinesiology, Pennsylvania State University, 104 Noll Laboratory, University Park, PA, 16802, USA
| | - Nicole C A Strock
- Department of Kinesiology, Pennsylvania State University, 104 Noll Laboratory, University Park, PA, 16802, USA
| | - Connie Weaver
- School of Exercise and Nutritional Sciences, San Diego State University, San Diego, USA
| | - Hang Lee
- Biostatistics Center, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Nancy I Williams
- Department of Kinesiology, Pennsylvania State University, 104 Noll Laboratory, University Park, PA, 16802, USA
| | - Connie J Rogers
- Intercollege Graduate Degree Program in Integrative and Biomedical Physiology, Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, USA
| | - Janhavi Damani
- Intercollege Graduate Degree Program in Integrative and Biomedical Physiology, Huck Institutes of the Life Sciences, Pennsylvania State University, University Park, USA
| | - Mario G Ferruzzi
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Cindy H Nakatsu
- Department of Agronomy, Purdue University, West Lafayette, USA
| | - Mary Jane De Souza
- Department of Kinesiology, Pennsylvania State University, 104 Noll Laboratory, University Park, PA, 16802, USA.
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Chen A, Feng S, Lai L, Yan C. A meta-analysis of the value of MRI-based VBQ scores for evaluating osteoporosis. Bone Rep 2023; 19:101711. [PMID: 37681002 PMCID: PMC10480551 DOI: 10.1016/j.bonr.2023.101711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023] Open
Abstract
Objective Osteoporosis is the most common skeletal disease in humans. Early onset of osteoporosis is usually asymptomatic, so early diagnosis is critical. The purpose of this study was to analyze the value of MRI-based VBQ scores for evaluating osteoporosis. Methods We searched PubMed, Embase, the Cochrane Library databases, Web of Science, and some Chinese electronic databases for published articles and the ClinicalTrials.gov site for completed but unpublished studies on evaluating the value of MRI-based VBQ scores for evaluating osteoporosis. We calculated the summarized sensitivity, specificity, the ROC curve (AUC) values and their 95% confidence intervals (CIs) using MetaDiSc 1.4 software and STATA. Results Our study included 8 studies involving 999 patients of which 660 patients were diagnosed with osteopenia/osteoporosis, and 339 patients were identified as having normal BMD. The pooled sensitivity was 0.809 (95% CI, 0.777-0.838, I 2 = 78.8%), the pooled specificity was 0.640 (95% CI, 0.587-0.691, I 2 = 85.9%), and the pooled AUC was 0.8375. Conclusion MRI-based VBQ scores provided high sensitivity and moderate specificity in detecting osteoporosis. Opportunistic use of VBQ scores could be considered, e.g. before lumbar spine surgery. Prospero registration number CRD42022377024.
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Affiliation(s)
- Ang Chen
- Department of Endocrinology, Northern Jiangsu People's Hospital, The First Clinical College of Dalian Medical University, Yangzhou 225001, Jiangsu, China
| | - Shangyong Feng
- Department of Endocrinology, Northern Jiangsu People's Hospital, The First Clinical College of Dalian Medical University, Yangzhou 225001, Jiangsu, China
| | - Lijuan Lai
- Department of Endocrinology, Northern Jiangsu People's Hospital, The First Clinical College of Dalian Medical University, Yangzhou 225001, Jiangsu, China
| | - Caifeng Yan
- Department of Endocrinology, Northern Jiangsu People's Hospital, The First Clinical College of Dalian Medical University, Yangzhou 225001, Jiangsu, China
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Maïmoun L, Gelis A, Serrand C, Mura T, Humbert L, Boudousq V, de Santa-Barbara P, Laux D, Fattal C, Mariano-Goulart D. Alteration of Volumetric Bone Mineral Density Parameters in Men with Spinal Cord Injury. Calcif Tissue Int 2023; 113:304-316. [PMID: 37353625 DOI: 10.1007/s00223-023-01110-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/15/2023] [Indexed: 06/25/2023]
Abstract
Spinal cord injury (SCI) induces severe losses of trabecular and cortical volumetric bone mineral density (vBMD), which cannot be discriminated with conventional dual-energy X-ray absorptiometry (DXA) analysis. The objectives were to: (i) determine the effects of SCI on areal BMD (aBMD) and vBMD determined by advanced 3D-DXA-based methods at various femoral regions and (ii) model the profiles of 3D-DXA-derived parameters with the time since injury. Eighty adult males with SCI and 25 age-matched able-bodied (AB) controls were enrolled in this study. Trabecular and cortical vBMD, cortical thickness and derived strength parameters were assessed by 3D-SHAPER® software at various femoral subregions. Individuals with SCI had significantly lower integral vBMD, trabecular vBMD, cortical vBMD, cortical thickness and derived bone strength parameters (p < 0.001 for all) in total proximal femur compared with AB controls. These alterations were approximately to the same degree for all three femoral subregions, and the difference between the two groups tended to be greater for cortical vBMD than trabecular vBMD. There were minor differences according to the lesion level (paraplegics vs tetraplegics) for all 3D-DXA-derived parameters. For total proximal femur, the decreasing bone parameters tended to reach a new steady state after 5.1 years for integral vBMD, 7.4 years for trabecular vBMD and 9.2 years for cortical vBMD following SCI. At proximal femur, lower vBMD (integral, cortical and trabecular) and cortical thickness resulted in low estimated bone strength in individuals with SCI. It remains to be demonstrated whether these new parameters are more closely associated with fragility fracture than aBMD.
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Affiliation(s)
- Laurent Maïmoun
- Département de Médecine Nucléaire, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France.
- Département de Biophysique, Service de Médecine Nucléaire, PhyMedExp, INSERM, CNRS, Université de Montpellier, Hôpital Lapeyronie, 371, Avenue du Doyen Gaston Giraud, 34295, cedex 5, Montpellier, France.
| | | | - Chris Serrand
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, Nimes University Hospital, University of Montpellier, Nîmes, France
| | - Thibault Mura
- Department of Biostatistics, Clinical Epidemiology, Public Health, and Innovation in Methodology, Nimes University Hospital, University of Montpellier, Nîmes, France
| | | | - Vincent Boudousq
- Département de Médecine Nucléaire, Hôpital Carémeau, CHRU Nîmes, Nîmes, France
| | - Pascal de Santa-Barbara
- Département de Biophysique, Service de Médecine Nucléaire, PhyMedExp, INSERM, CNRS, Université de Montpellier, Hôpital Lapeyronie, 371, Avenue du Doyen Gaston Giraud, 34295, cedex 5, Montpellier, France
| | - Didier Laux
- Institut d'Electronique Et Des Système, UMR CNRS 5214, Université de Montpellier, Montpellier, France
| | | | - Denis Mariano-Goulart
- Département de Médecine Nucléaire, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France
- Département de Biophysique, Service de Médecine Nucléaire, PhyMedExp, INSERM, CNRS, Université de Montpellier, Hôpital Lapeyronie, 371, Avenue du Doyen Gaston Giraud, 34295, cedex 5, Montpellier, France
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Coussens M, Banica T, Lapauw B, De Wandele I, Rombaut L, Malfait F, Calders P. Bone parameters in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorder: A comparative cross-sectional study. Bone 2023; 166:116583. [PMID: 36243401 DOI: 10.1016/j.bone.2022.116583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/08/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To compare bone parameters between individuals with hypermobile Ehlers-Danlos syndrome (hEDS) and generalized joint hypermobility spectrum disorder (G-HSD), both diagnosed according to the most recent diagnostic criteria, and with controls. METHODS Twenty female adults with hEDS (mean age 43.8 years), 20 with G-HSD (mean age 41.8 years), and 37 healthy controls (mean age 40.8 years) participated. Body composition and bone parameters at whole body and lumbar spine were assessed by dual-energy X-ray absorptiometry. Peripheral quantitative computed tomography at the lower leg evaluated body composition (66 % site), and trabecular (4 % site) and cortical (66 % site) bone parameters at the tibia. RESULTS No significantly different body composition and bone parameters were observed between hEDS and G-HSD. Compared to controls, individuals with hEDS and G-HSD had lower muscle mass (p = 0.004 and p < 0.001, respectively) and cross-sectional area (p = 0.025 and p < 0.001, respectively), cortical bone mineral content (BMC; p = 0.024 and p = 0.027, respectively) and area (p = 0.019 and p = 0.010, respectively). Additionally, individuals with hEDS had lower muscle density (p = 0.009), trabecular BMC (p = 0.027) and bone mineral density (p = 0.022), and individuals with G-HSD lower stress-strain index (p = 0.019), and periosteal and endosteal circumference (p = 0.002 and 0.025, respectively), compared to controls. CONCLUSION Results indicated lower cortical bone mineral content and smaller cortices in hEDS and G-HSD compared to controls. Individuals with hEDS and G-HSD had no different bone parameters, suggesting that these impairments might not be reflected by the different diagnostic classification. Therefore, we recommend regular physical activity, and training to reduce the risk of falling in both hEDS or G-HSD.
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Affiliation(s)
- Marie Coussens
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium.
| | - Thiberiu Banica
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Bruno Lapauw
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium; Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium; Reference Centre for Rare Bone, Calcium and Phosphate Disorders, Ghent University Hospital, Ghent, Belgium
| | - Inge De Wandele
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Lies Rombaut
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Fransiska Malfait
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Holloway-Kew KL, Anderson KB, Tembo MC, Sui SX, Harland JW, Hyde NK, Kotowicz MA, Pasco JA. Peripheral quantitative computed tomography-derived bone parameters in men with impaired fasting glucose and diabetes. J Bone Miner Metab 2023; 41:131-142. [PMID: 36550385 DOI: 10.1007/s00774-022-01389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Individuals with type 2 diabetes mellitus (T2DM) are at higher risk of fracture, but paradoxically do not have reduced bone mineral density. We investigated associations between peripheral quantitative computed tomography (pQCT) and glycaemia status. MATERIALS AND METHODS Participants were men (n = 354, age 33-92 year) from the Geelong Osteoporosis Study. Diabetes was defined by fasting plasma glucose (FPG) ≥ 7.0 mmol/L, self-report of diabetes and/or antihyperglycaemic medication use and impaired fasting glucose (IFG) as FPG 5.6-6.9 mmol/L. Bone measures were derived using pQCT (XCT2000) at 4% and 66% radial and tibial sites. Linear regression was used, adjusting for age, body mass index and socio-economic status. RESULTS At the 4% site, men with T2DM had lower adjusted bone total area, trabecular area and cortical area at the radius (all - 6.2%) and tibia (all - 6.4%) compared to normoglycaemia. Cortical density was higher for T2DM at the radius (+ 5.8%) and tibia (+ 8.0%), as well as adjusted total bone density at the tibial site (+ 6.1%). At the 66% site, adjusted total bone area and polar stress strain index were lower for T2DM at the radius (- 4.3% and - 8.0%). Total density was also higher for T2DM (+ 1.2%). Only cortical density at the 4% tibial site was different between IFG and normoglycaemia in adjusted analyses (+ 4.5%). CONCLUSION Men with T2DM had lower total bone area, trabecular area, cortical area and polar stress strain index than the other two groups; however, total density and cortical density were higher. Only one difference was observed between IFG and normoglycaemia; increased tibial cortical density.
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Affiliation(s)
- Kara L Holloway-Kew
- IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, , VIC, 3220, Australia.
| | - Kara B Anderson
- IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, , VIC, 3220, Australia
| | - Monica C Tembo
- IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, , VIC, 3220, Australia
| | - Sophia X Sui
- IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, , VIC, 3220, Australia
| | - Jacob W Harland
- IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, , VIC, 3220, Australia
| | - Natalie K Hyde
- IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, , VIC, 3220, Australia
| | - Mark A Kotowicz
- IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, , VIC, 3220, Australia
- Barwon Health, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia
| | - Julie A Pasco
- IMPACT-the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Level 3 (Barwon Health), PO Box 281, Geelong, , VIC, 3220, Australia
- Barwon Health, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Australia
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Coussens M, Lapauw B, Verroken C, Goemaere S, De Wandele I, Malfait F, Banica T, Calders P. Bone Mass, Density, Geometry, and Stress-Strain Index in Adults With Osteogenesis Imperfecta Type I and Their Associations With Physical Activity and Muscle Function Parameters. J Bone Miner Res 2022; 37:2456-2465. [PMID: 36239015 DOI: 10.1002/jbmr.4722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/28/2022] [Accepted: 10/08/2022] [Indexed: 11/09/2022]
Abstract
Osteogenesis imperfecta (OI) is a clinically and genetically heterogeneous heritable connective tissue disorder mainly characterized by bone fragility and increased fracture risk. This study investigated bone parameters in adults with OI type I and their relationship with physical activity and muscle function parameters in comparison with controls. A total of 27 (15 women, 12 men) adults with OI type I and 27 healthy age- and sex-matched controls, with mean age 45 years (range 18-72 years), were included. Peripheral quantitative computed tomography was performed at the lower leg and forearm to assess muscle density, muscle and fat cross-sectional area (CSA) (66% site), and trabecular (4% site) and cortical bone parameters (66% site) at radius and tibia. Physical activity (step count and moderate-to-vigorous physical activity [MVPA]) was assessed by accelerometry, muscle function parameters by Leonardo mechanography (single two-legged jump - peak power), and hand grip dynamometry (maximal hand grip strength). Overall, the OI type I group had significantly lower muscle CSA at the lower leg and forearm, lower trabecular and cortical bone mineral content, lower polar stress-strain index (SSIp), and smaller cortices but higher cortical bone mineral density and lower step count and MVPA in comparison with controls. Maximal hand grip strength was positively associated with SSIp at radius (p = 0.012) in the control group but not in the OI type I group (p = 0.338) (difference in associations: p = 0.012). No other significantly different associations between bone and muscle function parameters or physical activity (step count or MVPA) were found in the OI type I versus control group. We conclude that adults with OI type I have smaller bones, lower trabecular bone mass, lower estimates of bone strength, and higher cortical density in comparison with controls and that there are some indications of a disturbed biomechanical muscle-bone relationship in adults with OI type I. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Marie Coussens
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Bruno Lapauw
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.,Reference Centre for Rare Bone, Calcium and Phosphate Disorders, Ghent University Hospital, Ghent, Belgium
| | - Charlotte Verroken
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium.,Reference Centre for Rare Bone, Calcium and Phosphate Disorders, Ghent University Hospital, Ghent, Belgium
| | - Stefan Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium.,Reference Centre for Rare Bone, Calcium and Phosphate Disorders, Ghent University Hospital, Ghent, Belgium
| | - Inge De Wandele
- Centre for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Fransiska Malfait
- Reference Centre for Rare Bone, Calcium and Phosphate Disorders, Ghent University Hospital, Ghent, Belgium.,Centre for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Thiberiu Banica
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium
| | - Patrick Calders
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Harvey NC, Orwoll E, Cauley JA, Kwok T, Karlsson MK, Rosengren BE, Ribom E, Cawthon PM, Ensrud K, Liu E, Laskou F, Ward KA, Dennison EM, Cooper C, Kanis JA, Vandenput L, Lorentzon M, Ohlsson C, Mellström D, Johansson H, McCloskey E. Greater pQCT Calf Muscle Density Is Associated with Lower Fracture Risk, Independent of FRAX, Falls and BMD: A Meta-Analysis in the Osteoporotic Fractures in Men (MrOS) Study. JBMR Plus 2022; 6:e10696. [PMID: 36530188 PMCID: PMC9751652 DOI: 10.1002/jbm4.10696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
We investigated the predictive performance of peripheral quantitative computed tomography (pQCT) measures of both calf muscle density (an established surrogate for muscle adiposity, with higher values indicating lower muscle adiposity and higher muscle quality) and size (cross-sectional area [CSA]) for incident fracture. pQCT (Stratec XCT2000/3000) measurements at the tibia were undertaken in Osteoporotic Fractures in Men (MrOS) United States (US), Hong Kong (HK), and Swedish (SW) cohorts. Analyses were by cohort and synthesized by meta-analysis. The predictive value for incident fracture outcomes, illustrated here for hip fracture (HF), using an extension of Poisson regression adjusted for age and follow-up time, was expressed as hazard ratio (HR) per standard deviation (SD) increase in exposure (HR/SD). Further analyses adjusted for femoral neck (fn) bone mineral density (BMD) T-score, Fracture Risk Assessment Tool (FRAX) 10-year fracture probability (major osteoporotic fracture) and prior falls. We studied 991 (US), 1662 (HK), and 1521 (SW) men, mean ± SD age 77.0 ± 5.1, 73.9 ± 4.9, 80 ± 3.4 years, followed for a mean ± SD 7.8 ± 2.2, 8.1 ± 2.3, 5.3 ± 2.0 years, with 31, 47, and 78 incident HFs, respectively. Both greater muscle CSA and greater muscle density were associated with a lower risk of incident HF [HR/SD: 0.84; 95% confidence interval [CI], 0.72-1.0 and 0.78; 95% CI, 0.66-0.91, respectively]. The pattern of associations was not materially changed by adjustment for prior falls or FRAX probability. In contrast, after inclusion of fn BMD T-score, the association for muscle CSA was no longer apparent (1.04; 95% CI, 0.88-1.24), whereas that for muscle density was not materially changed (0.69; 95% CI, 0.59-0.82). Findings were similar for osteoporotic fractures. pQCT measures of greater calf muscle density and CSA were both associated with lower incidence of fractures in older men, but only muscle density remained an independent risk factor for fracture after accounting for fn BMD. These findings demonstrate a complex interplay between measures of bone, muscle size, and quality, in determining fracture risk. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Nicholas C. Harvey
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Eric Orwoll
- Division of Endocrinology, Diabetes and Clinical Nutrition, School of MedicineOregon Health & Science UniversityPortlandORUSA
| | - Jane A. Cauley
- Department of Epidemiology, Graduate School of Public HealthUniversity of PittsburghPittsburghPAUSA
| | - Timothy Kwok
- Department of Medicine & Therapeutics and School of Public HealthThe Chinese University of Hong KongShatinChina
| | - Magnus K. Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences MalmoLund University and Department of Orthopedics, Skane University HospitalMalmoSweden
| | - Björn E. Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences MalmoLund University and Department of Orthopedics, Skane University HospitalMalmoSweden
| | - Eva Ribom
- Department of Surgical SciencesUniversity of UppsalaUppsalaSweden
| | - Peggy M. Cawthon
- Research InstituteCalifornia Pacific Medical CenterSan FranciscoCAUSA
- Department of Epidemiology and BiostatisticsUniversity of CaliforniaSan FranciscoCAUSA
| | - Kristine Ensrud
- Medicine and Epidemiology & Community HealthUniversity of MinnesotaMinneapolisMNUSA
- Center for Care Delivery and Outcomes ResearchMinneapolis VA Health Care SystemMinneapolisMNUSA
| | - Enwu Liu
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
| | - Faidra Laskou
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Kate A. Ward
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Elaine M. Dennison
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
- NIHR Oxford Biomedical Research CentreUniversity of OxfordOxfordUK
| | - John A. Kanis
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
| | - Liesbeth Vandenput
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Sahlgrenska Osteoporosis Centre, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Mattias Lorentzon
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Sahlgrenska Osteoporosis Centre, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Claes Ohlsson
- Sahlgrenska Osteoporosis Centre, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Dan Mellström
- Sahlgrenska Osteoporosis Centre, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Helena Johansson
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Sahlgrenska Osteoporosis Centre, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Eugene McCloskey
- Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
- Centre for Integrated Research into Musculoskeletal Ageing (CIMA), Mellanby Centre for Musculoskeletal ResearchUniversity of SheffieldSheffieldUK
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8
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Dalla Via J, Sim M, Schousboe JT, Kiel DP, Zhu K, Hodgson JM, Gebre AK, Daly RM, Prince RL, Lewis JR. Association of Abdominal Aortic Calcification with Peripheral Quantitative Computed Tomography Bone Measures in Older Women: The Perth Longitudinal Study of Ageing Women. Calcif Tissue Int 2022; 111:485-494. [PMID: 35962793 PMCID: PMC9560937 DOI: 10.1007/s00223-022-01016-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/21/2022] [Indexed: 11/18/2022]
Abstract
We have previously shown that abdominal aortic calcification (AAC), a marker of advanced atherosclerotic disease, is weakly associated with reduced hip areal bone mineral density (aBMD). To better understand the vascular-bone health relationship, we explored this association with other key determinants of whole-bone strength and fracture risk at peripheral skeletal sites. This study examined associations of AAC with peripheral quantitative computed tomography (pQCT)-assessed total, cortical and trabecular volumetric BMD (vBMD), bone structure and strength of the radius and tibia among 648 community-dwelling older women (mean ± SD age 79.7 ± 2.5 years). We assessed associations between cross-sectional (2003) and longitudinal (progression from 1998/1999-2003) AAC assessed on lateral dual-energy X-ray absorptiometry (DXA) images with cross-sectional (2003) and longitudinal (change from 2003 to 2005) pQCT bone measures at the 4% radius and tibia, and 15% radius. Partial Spearman correlations (adjusted for age, BMI, calcium treatment) revealed no cross-sectional associations between AAC and any pQCT bone measures. AAC progression was not associated with any bone measure after adjusting for multiple comparisons, despite trends for inverse correlations with total bone area at the 4% radius (rs = - 0.088, p = 0.044), 4% tibia (rs = - 0.085, p = 0.052) and 15% radius (rs = - 0.101, p = 0.059). Neither AAC in 2003 nor AAC progression were associated with subsequent 2-year pQCT bone changes. ANCOVA showed no differences in bone measures between women with and without AAC or AAC progression, nor across categories of AAC extent. Collectively, these finding suggest that peripheral bone density and structure, or its changes with age, are not associated with central vascular calcification in older women.
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Affiliation(s)
- Jack Dalla Via
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia.
| | - Marc Sim
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - John T Schousboe
- Park Nicollet Osteoporosis Center and Health Partners Institute, Minneapolis, MN, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Douglas P Kiel
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Kun Zhu
- Medical School, The University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Jonathan M Hodgson
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - Abadi K Gebre
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Richard L Prince
- Medical School, The University of Western Australia, Perth, WA, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Joshua R Lewis
- Nutrition and Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
- Medical School, The University of Western Australia, Perth, WA, Australia
- Centre for Kidney Research, Children's Hospital at Westmead School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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9
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Tuck SP, Hanusch B, Prediger M, Walker JA, McNally R, Datta HK. Reduced trabecular bone mineral density and thinner cortices in men with distal forearm fractures. Bone 2022; 164:116513. [PMID: 35944891 DOI: 10.1016/j.bone.2022.116513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 06/29/2022] [Accepted: 08/02/2022] [Indexed: 11/02/2022]
Abstract
Men with distal forearm fractures have reduced bone density, an increased risk of osteoporosis and of further fractures. The aim of the study was to investigate the structural determinants of these observations using quantitative CT (qCT). Ninety six men with low-trauma distal forearm fracture and 101 age-matched healthy control subjects were recruited. All subjects underwent a quantitative CT on a standard 64-slice whole body CT scanner. These were analysed on Mindways QCT PRO™ Software to generate volumetric and geometric data at the lumbar spine, femoral neck and total hip, ultra-distal and distal 33 % radius. Biochemical investigations, health questionnaires and measurements of bone turnover were made. Men with fracture had significantly lower total and trabecular vBMD at all sites. The greatest percentage reduction was at the ultra-distal radius (13.5 % total and 11.7 % trabecular vBMD). In the fracture group cortical vBMD was significantly higher in the femoral neck (p < 0.001) and maintained at the ultra-distal radius compared with control subjects. However, cortical cross-sectional area (CSA) and thickness were significantly reduced at the femoral neck (p < 0.001 and p = 0.002 respectively) and forearm sites (CSA ultradistal radius p = 0.001, cortical thickness p = 0.002, CSA distal one third radius p = 0.045 and cortical thickness p = 0.005). Cross sectional moment of inertia (CSMI) and section moduli were significantly reduced at the femoral neck (CSMI1 p = 0.002, CSMI2 p = 0.012 and section moduli Z1 p < 0.001, Z2 p = 0.004) and the ultra-distal radius (CSMI1 p = 0.008 and section moduli Z1 p = 0.018, Z2 p = 0.007). In stepwise logistic regression analysis distal forearm fracture showed the strongest association with a model comprising ultra-distal forearm trabecular vBMD (negative), procollagen type I N-terminal propeptide (PINP, positive) and sex hormone binding globulin (SHBG, negative). In conclusion, these observations explain the structural reasons for the increased fracture risk in men with distal forearm fractures.
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Affiliation(s)
- Stephen P Tuck
- Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; James Cook University Hospital, Middlesbrough, UK.
| | - Birgit Hanusch
- Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; James Cook University Hospital, Middlesbrough, UK
| | - Michael Prediger
- Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; Blood Sciences, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | - Richard McNally
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Harish K Datta
- Translation and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK; James Cook University Hospital, Middlesbrough, UK
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10
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McCaskie CJ, Sim M, Newton RU, Heasman J, Rogalski B, Hart NH. Characterising lower-body musculoskeletal morphology and whole-body composition of elite female and male Australian Football players. BMC Sports Sci Med Rehabil 2022; 14:168. [PMID: 36068592 PMCID: PMC9450395 DOI: 10.1186/s13102-022-00561-8] [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] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 09/01/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Physical demands and injury rates differ between elite female and male Australian Football (AF) players. To improve understanding of contributing physical factors to these differences, the purpose of this study was to investigate lower-body morphology and whole-body composition of elite footballers competing in the Australian Football League (AFL) and Australian Football League Women's (AFLW). METHODS Lower-body morphology and whole-body composition of 23 AFL players and 23 AFLW players were assessed using peripheral Quantitative Computed Tomography and Dual-energy X-ray Absorptiometry at the beginning of pre-season. Differences between cohorts, with sub-analyses of kicking vs. support limbs, and experienced vs. inexperienced player status were assessed using two-sample independent t-tests. Magnitude of differences were assessed using Cohen's d effect sizes. RESULTS AFL players had greater absolute (p < 0.001; ES = 3.28) and relative (p < 0.001; ES = 2.29) whole body lean soft-tissue mass, with less absolute (p = 0.004; ES = 0.91) and relative (p < 0.001; ES = 2.29) fat mass than AFLW players. For AFLW players, no significant differences existed between kicking and support limbs with few differences observed between experienced and inexperienced players. CONCLUSIONS Greater emphasis on physical development in AFLW players may be required to enable increases in muscle mass and skeletal robustness, to ensure they can tolerate the loads of elite competition.
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Affiliation(s)
- Callum J McCaskie
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia.
- West Coast Eagles Football Club, Perth, WA, Australia.
| | - Marc Sim
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia
- Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Robert U Newton
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
| | | | | | - Nicolas H Hart
- School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, WA, 6027, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, WA, Australia
- Caring Futures Institute, College of Nursing and Health Science, Flinders University Adelaide, Adelaide, SA, Australia
- Institute for Health Research, University of Notre Dame Australia, Perth, WA, Australia
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
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11
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Olali AZ, Carpenter KA, Myers M, Sharma A, Yin MT, Al-Harthi L, Ross RD. Bone Quality in Relation to HIV and Antiretroviral Drugs. Curr HIV/AIDS Rep 2022; 19:312-327. [PMID: 35726043 DOI: 10.1007/s11904-022-00613-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW People living with HIV (PLWH) are at an increased risk for osteoporosis, a disease defined by the loss of bone mineral density (BMD) and deterioration of bone quality, both of which independently contribute to an increased risk of skeletal fractures. While there is an emerging body of literature focusing on the factors that contribute to BMD loss in PLWH, the contribution of these factors to bone quality changes are less understood. The current review summarizes and critically reviews the data describing the effects of HIV, HIV disease-related factors, and antiretroviral drugs (ARVs) on bone quality. RECENT FINDINGS The increased availability of high-resolution peripheral quantitative computed tomography has confirmed that both HIV infection and ARVs negatively affect bone architecture. There is considerably less data on their effects on bone remodeling or the composition of bone matrix. Whether changes in bone quality independently predict fracture risk, as seen in HIV-uninfected populations, is largely unknown. The available data suggests that bone quality deterioration occurs in PLWH. Future studies are needed to define which factors, viral or ARVs, contribute to loss of bone quality and which bone quality factors are most associated with increased fracture risk.
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Affiliation(s)
- Arnold Z Olali
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL, USA.,Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL, USA
| | - Kelsey A Carpenter
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL, USA
| | - Maria Myers
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL, USA
| | | | - Michael T Yin
- Columbia University Medical Center, New York, NY, USA
| | - Lena Al-Harthi
- Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL, USA
| | - Ryan D Ross
- Department of Anatomy & Cell Biology, Rush University Medical Center, Chicago, IL, USA. .,Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, IL, USA.
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12
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De Souza MJ, Strock NC, Rogers CJ, Williams NI, Ferruzzi MG, Nakatsu CH, Simpson AM, Weaver C. Rational and study design of Randomized Controlled Trial of Dietary Supplementation with prune (dried plums) on bone density, geometry, and estimated bone strength in postmenopausal women: The Prune study. Contemp Clin Trials Commun 2022; 28:100941. [PMID: 35669487 PMCID: PMC9163423 DOI: 10.1016/j.conctc.2022.100941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 04/24/2022] [Accepted: 05/25/2022] [Indexed: 11/24/2022] Open
Abstract
The use of non-pharmacological alternatives to pharmacological interventions, e.g., nutritional therapy, to improve or maintain bone mineral density (BMD) in postmenopausal women has gained traction over the past decade, but limited data exist regarding its efficacy. This paper describes the design of the Prune Study, a randomized controlled trial (RCT) that explored the effectiveness of a 12-month intervention of daily prune consumption on bone density, bone structure and strength estimates, bone turnover, various biomarkers of immune function, inflammation, and cardiovascular health, as well as phenolic and gut microbiota analyses. Postmenopausal women between the ages of 55–75 years were randomized into either control group (no prune consumption; n = 78), 50g prune (50g prune/day; n = 79), or 100g prune (100g prune/day; n = 78). All participants received 1200 mg calcium +800 IU vitamin D3 daily as standard of care. The Prune Study is the largest and most comprehensive investigation of a dose response of prune consumption on bone health, biomarkers of immune function, inflammation, and cardiovascular health, as well as detailed phenolic and gut microbiota analyses in postmenopausal women. 235 women were randomized and 183 women completed the entire study. The findings of this study will help expand our current understanding of clinical implications and mechanisms underlying the resultant health effects of prune as a functional food therapy.
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13
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Banica T, Verroken C, T'Sjoen G, Goemaere S, Zmierczak HG, Fiers T, Kaufman JM, Lapauw B. Modest Changes in Sex Hormones During Early and Middle Adulthood Affect Bone Mass and Size in Healthy Men: A Prospective Cohort Study. J Bone Miner Res 2022; 37:865-875. [PMID: 35279881 DOI: 10.1002/jbmr.4543] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 03/01/2022] [Accepted: 03/09/2022] [Indexed: 11/08/2022]
Abstract
Bone metabolism in men is in part determined by sex steroid exposure. This is especially clear during puberty and senescence but it remains to be established whether declines in sex steroid levels during young and middle adulthood are associated with changes in bone mass and size. This study investigated changes in bone mineral content (BMC), areal bone mineral density (aBMD), volumetric BMD (vBMD), and bone size in relation to sex steroid levels in 999 young adult men (age 24-46 years) of whom 676 were re-evaluated after a mean period of 12 years. Sex hormone-binding globulin (SHBG) levels were measured using immunoassay, testosterone (T) and estradiol (E2) using liquid chromatography-tandem mass spectrometry (LC-MS/MS), and free fractions were calculated (cFT and cFE2, respectively). Areal bone parameters and BMC were measured at the hip and lumbar spine using dual-energy X-ray absorptiometry (DXA). Radial and tibial vBMD and bone size were determined using peripheral quantitative computed tomography (pQCT). Linear mixed models were used for statistical analyses. With aging, we observed decreases in almost all bone mass and density indices, whereas changes in bone geometry resulted in larger bones with thinner cortices. These changes in bone mass and size appeared related to sex steroid levels. Specifically, decreases in cFT (but not total T) levels were associated with larger decreases in lumbar spine BMC and especially with geometric changes in cortical bone at the tibia. Similarly, decreases in total E2 and cFE2 were associated with larger decreases in bone mass (all sites) and also with some geometric changes. Also increases in SHBG were independently associated with aging-related changes in bone mass and size in these men. In summary, even small changes in T, E2, and SHBG levels during young and middle adulthood in healthy men are associated with changes in bone mass and size. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Thiberiu Banica
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine & Pediatrics, Ghent University, Ghent, Belgium
| | - Charlotte Verroken
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium.,Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Guy T'Sjoen
- Department of Internal Medicine & Pediatrics, Ghent University, Ghent, Belgium.,Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Stefan Goemaere
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine & Pediatrics, Ghent University, Ghent, Belgium
| | - Hans-Georg Zmierczak
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium
| | - Tom Fiers
- Department of Clinical Chemistry, Ghent University Hospital, Ghent, Belgium
| | - Jean-Marc Kaufman
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine & Pediatrics, Ghent University, Ghent, Belgium.,Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Bruno Lapauw
- Unit for Osteoporosis and Metabolic Bone Diseases, Ghent University Hospital, Ghent, Belgium.,Department of Internal Medicine & Pediatrics, Ghent University, Ghent, Belgium.,Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
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14
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Holloway-Kew KL, Rufus-Membere P, Anderson KB, Tembo MC, Sui SX, Hyde NK, Diez-Perez A, Kotowicz MA, Pasco JA. Associations between parameters of peripheral quantitative computed tomography and bone material strength index. Bone 2022; 155:116268. [PMID: 34856422 DOI: 10.1016/j.bone.2021.116268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/12/2021] [Accepted: 11/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bone material strength index (BMSi) is measured in vivo using impact microindentation (IMI). However, the associations between BMSi and other bone measures are not clear. This study investigated whether bone parameters derived by peripheral quantitative computed tomography (pQCT) are associated with BMSi. METHODS Participants were men (n = 373, ages 34-96 yr) from the Geelong Osteoporosis Study. BMSi was measured using an OsteoProbe (Active Life Scientific, USA). Bone measures were obtained at both the radius (n = 348) and tibia (n = 342) using pQCT (XCT 2000 Stratec Medizintechnik, Germany). Images were obtained at 4% and 66% of radial and tibial length. Associations between pQCT parameters and BMSi were tested using Spearman's correlation and multivariable regression used to determine independent associations after adjustment for potential confounders. Models were checked for interaction terms. RESULTS Weak associations were observed between total bone density (radius 4%; r = +0.108, p = 0.046, tibia 4%; r = +0.115, p = 0.035), cortical density (tibia 4%; r = +0.123, p = 0.023) and BMSi. The associations were independent of weight, height, and glucocorticoid use (total bone density: radius 4%; β = 0.020, p = 0.006, tibia 4%; β = 0.020, p = 0.027 and cortical density: radius 4%; β = 4.160, p = 0.006, tibia 4%; β = 0.038, p = 0.010). Associations with bone mass were also observed at the 66% radial and tibial site, independent of age, weight, and glucocorticoid use (β = 4.160, p = 0.053, β = 1.458, p = 0.027 respectively). Total area at the 66% tibial site was also associated with BMSi (β = 0.010, p = 0.012), independent of weight and glucocorticoid use. No interaction terms were identified. CONCLUSION There were weak associations detected between some pQCT-derived bone parameters and BMSi.
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Affiliation(s)
- Kara L Holloway-Kew
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia.
| | - Pamela Rufus-Membere
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia
| | - Kara B Anderson
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia
| | - Monica C Tembo
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia
| | - Sophia X Sui
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia
| | - Natalie K Hyde
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia
| | - Adolfo Diez-Perez
- Department of Internal Medicine, Hospital del Mar-IMIM, Autonomous University of Barcelona and CIBERFES, Instituto Carlos III, Spain
| | - Mark A Kotowicz
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia; Barwon Health, Geelong, Australia; Department of Medicine, The University of Melbourne - Western Health, St Albans, Australia
| | - Julie A Pasco
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia; Barwon Health, Geelong, Australia; Department of Medicine, The University of Melbourne - Western Health, St Albans, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Australia
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15
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Murray AA, Erlandson MC. Tibial cortical and trabecular variables together can pinpoint the timing of impact loading relative to menarche in premenopausal females. Am J Hum Biol 2021; 34:e23711. [PMID: 34878660 DOI: 10.1002/ajhb.23711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/29/2021] [Accepted: 11/26/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Though relationships between limb bone structure and mechanical loading have provided fantastic opportunities for understanding the lives of prehistoric adults, the lives of children remain poorly understood. Our aim was to determine whether or not adult tibial skeletal variables retain information about childhood/adolescent loading, through assessing relationships between cortical and trabecular bone variables and the timing of impact loading relative to menarche in premenopausal adult females. METHODS Peripheral quantitative computed tomography was used to quantify geometric and densitometric variables from the proximal tibial diaphysis (66% location) and distal epiphysis (4% location) among 81 nulliparous young adult female controls and athletes aged 19-33 years grouped according to intensity of impact loading both pre- and post-menarche: (1) Low:Low (Controls); (2) High:Low; (3) High:High; (4) Moderate:Moderate; (5) Low:Moderate. ANCOVA was used to compare properties among the groups adjusted for age, stature, and body mass. RESULTS Significant increases in diaphyseal total cross-sectional area and strength-strain index were documented among groups with any pre-menarcheal impact loading relative to groups with none, regardless of post-menarcheal loading history (p < .01). In contrast, significantly elevated distal trabecular volumetric bone mineral density was only documented among groups with recent post-menarcheal loading relative to groups with none, regardless of pre-menarcheal impact loading history (p < .01). CONCLUSIONS The consideration of diaphyseal cortical bone geometric and epiphyseal trabecular bone densitometric variables together within the tibia can identify variation in pre-menarcheal and post-menarcheal impact loading histories among premenopausal adult females.
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Affiliation(s)
- Alison A Murray
- Department of Anthropology, University of Victoria, Victoria, Canada
| | - Marta C Erlandson
- College of Kinesiology, University of Saskatchewan, Saskatoon, Canada
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16
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Bibliometric and visualized analysis of current research trends in the finite element analysis of lumbar spine. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Abstract
As survival of infants born extremely preterm increases, more are now reaching adulthood. It is well documented that survivors born extremely preterm experience more developmental delay and disability in multiple domains compared with term-born controls in early childhood and school age. However, with increasing age, health problems involving physical and mental health become more evident. Despite these challenges, it is reassuring that self-reported quality of life remains good. Future directions of research include development of age-appropriate interventions to optimise health and development of individuals born extremely preterm beyond school age.
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18
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Anderson KB, Tembo MC, Sui SX, Hyde NK, Pasco JA, Kotowicz MA, Holloway-Kew KL. Peripheral quantitative computed tomography (pQCT) measures are associated with prior low trauma fracture in men. Arch Osteoporos 2021; 16:178. [PMID: 34825263 DOI: 10.1007/s11657-021-00996-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/16/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Peripheral quantitative computed tomography (pQCT) assesses bone quantity and quality, complementary to current standard practice, and has potential to improve prediction of fracture risk. This study explored whether pQCT parameters were associated with prior fracture in men and found a number of parameters to be associated, particularly at the radius. PURPOSE Peripheral quantitative computed tomography (pQCT) provides information about bone structure and density complementary to dual x-ray absorptiometry. This study aimed to determine which pQCT parameters are associated with prior fracture. METHODS Participants were men (n = 508, age 33-96 years) from the Geelong Osteoporosis Study. Parameters at 4% (n = 469) and 66% (n = 436) of radial length, and 4% (n = 449) and 66% (n = 437) of tibial length were acquired (pQCT XCT 2000, Stratec Medizintechnik, Pforzheim, Germany), and mean standardised. Low trauma prior fractures in adulthood (≥ age 20 years) were radiologically confirmed when possible. Cross-sectional associations between pQCT and fracture were tested using logistic regression adjusting for confounders. RESULTS Prior low trauma fractures were identified for 106 participants. Fracture was negatively associated with parameters at the 4% radius site: bone mass (adjusted OR = 0.67; 95%CI = 0.52-0.86), total density (OR = 0.61; 95%CI = 0.47-0.78), trabecular density (OR = 0.62; 95%CI = 0.48-0.79) and cortical subdensity (OR = 0.61; 95%CI = 0.47-0.77). At the 66% radius site, fracture was associated with total density (OR = 0.69; 95%CI = 0.55-0.87) and cortical thickness (OR = 0.68; 95%CI = 0.54-0.86). Fracture was associated with the ratio of the cortical area at the 66% site to the total area at the 4% site (OR = 0.74; 95%CI = 0.58-0.94). Prior fracture was negatively associated with parameters at the 4% tibial site: total density (OR = 0.67; 95%CI = 0.52-0.86), trabecular density (OR = 0.64; 95%CI = 0.50-0.82) and cortical subdensity (OR = 0.72; 95%CI = 0.56-0.92). Fracture was negatively associated with cortical density at the 66% site (OR = 0.74; 95%CI = 0.58-0.94), and the ratio of the cortical area at the 66% site to the total area at the 4% site (OR = 0.65; 95%CI = 0.46-0.91), but were attenuated in adjusted models. No other associations were identified. CONCLUSION Prior fracture was associated with parameters at both the radius and tibia. This study highlights key pQCT parameters that may aid in the prediction of fracture risk.
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Affiliation(s)
- Kara B Anderson
- Epi-Centre for Healthy Ageing (ECHA), IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, PO Box 281, Barwon Health, Geelong, VIC, 3220, Australia.
| | - Monica C Tembo
- Epi-Centre for Healthy Ageing (ECHA), IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, PO Box 281, Barwon Health, Geelong, VIC, 3220, Australia
| | - Sophia X Sui
- Epi-Centre for Healthy Ageing (ECHA), IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, PO Box 281, Barwon Health, Geelong, VIC, 3220, Australia
| | - Natalie K Hyde
- Epi-Centre for Healthy Ageing (ECHA), IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, PO Box 281, Barwon Health, Geelong, VIC, 3220, Australia
| | - Julie A Pasco
- Epi-Centre for Healthy Ageing (ECHA), IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, PO Box 281, Barwon Health, Geelong, VIC, 3220, Australia
- Barwon Health, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark A Kotowicz
- Epi-Centre for Healthy Ageing (ECHA), IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, PO Box 281, Barwon Health, Geelong, VIC, 3220, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kara L Holloway-Kew
- Epi-Centre for Healthy Ageing (ECHA), IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, PO Box 281, Barwon Health, Geelong, VIC, 3220, Australia
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Candow DG, Chilibeck PD, Gordon JJ, Kontulainen S. Efficacy of Creatine Supplementation and Resistance Training on Area and Density of Bone and Muscle in Older Adults. Med Sci Sports Exerc 2021; 53:2388-2395. [PMID: 34107512 DOI: 10.1249/mss.0000000000002722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To examine the efficacy of creatine (Cr) supplementation and any sex differences during supervised whole-body resistance training (RT) on properties of bone and muscle in older adults. METHODS Seventy participants (39 men, 31 women; mean age ± standard deviation: 58 ± 6 yr) were randomized to supplement with Cr (0.1 g·kg-1·d-1) or placebo (Pl) during RT (3 d·wk-1 for 1 yr). Bone geometry (radius and tibia) and muscle area and density (forearm and lower leg) were assessed using peripheral quantitative computed tomography. RESULTS Compared with Pl, Cr increased or maintained total bone area in the distal tibia (Cr, Δ +17 ± 27 mm2; Pl, Δ -1 ± 22 mm2; P = 0.031) and tibial shaft (Cr, Δ 0 ± 9 mm2; Pl, Δ -5 ± 7 mm2; P = 0.032). Men on Cr increased trabecular (Δ +28 ± 31 mm2; P < 0.001) and cortical bone areas in the tibia (Δ +4 ± 4 mm2; P < 0.05), whereas men on Pl increased trabecular bone density (Δ +2 ± 2 mg·cm-3; P < 0.01). There were no bone changes in the radius (P > 0.05). Cr increased lower leg muscle density (Δ +0.83 ± 1.15 mg·cm-3; P = 0.016) compared with Pl (Δ -0.16 ± 1.56 mg·cm-3), with no changes in the forearm muscle. CONCLUSIONS One year of Cr supplementation and RT had some favorable effects on measures of bone area and muscle density in older adults.
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Affiliation(s)
- Darren G Candow
- Faculty of Kinesiology, University of Regina, Regina, SK, CANADA
| | - Philip D Chilibeck
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, CANADA
| | - Julianne J Gordon
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, CANADA
| | - Saija Kontulainen
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, CANADA
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20
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McCaskie CJ, Sim M, Newton RU, Hart NH. Lower-limb injury in elite Australian football: A narrative review of kinanthropometric and physical risk factors. Phys Ther Sport 2021; 52:69-80. [PMID: 34418589 DOI: 10.1016/j.ptsp.2021.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This review aims to provide a succinct and critical analysis of the current physical and mechanical demands of elite Australian football while examining lower-limb injury and the associated physical and kinanthropometric risk factors. METHODS MEDLINE, PubMed, Web of Science and SPORTSDiscus electronic databases were searched for studies that investigated the playing demands, injury trends, and physical and kinanthropometric injury risk factors of elite Australian football. Articles from similar team sports including soccer and rugby (union and league) were also included. RESULTS While the physical demands of elite AF have steadied over the past decade, injury rates continue to rise with more than two-thirds of all injuries affecting the lower-limbs. Body composition and musculoskeletal morphological assessments are regularly adopted in many sporting settings with current research suggesting high and low body mass are both associated with heightened injury risk. However, more extensive investigations are required to determine whether the proportions of muscle and fat are linked. Repeated assessment of musculoskeletal morphology may also provide further insight into stress fracture rates. CONCLUSIONS While kinanthropometric and physical attributes are highly valued within elite sporting environments, establishing a deeper connection with injury may provide practitioners with more insight into current injury trends.
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Affiliation(s)
- Callum J McCaskie
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, 270 Joondalup Drive, Joondalup, WA, 6027, Australia.
| | - Marc Sim
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, 270 Joondalup Drive, Joondalup, WA, 6027, Australia; Institute of Nutrition Research, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, 6027, Perth, Australia.
| | - Robert U Newton
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, 270 Joondalup Drive, Joondalup, WA, 6027, Australia; Exercise Medicine Research Institute, Edith Cowan University, Building 21, 270 Joondalup Drive, Joondalup, WA, 6027, Perth, Australia.
| | - Nicolas H Hart
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, 270 Joondalup Drive, Joondalup, WA, 6027, Australia; Exercise Medicine Research Institute, Edith Cowan University, Building 21, 270 Joondalup Drive, Joondalup, WA, 6027, Perth, Australia.
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21
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Anderson KB, Tembo MC, Sui SX, Hyde NK, Rufus PG, Pasco JA, Kotowicz MA, Holloway-Kew KL. Normative data for peripheral quantitative computed tomography (pQCT) bone parameters in Australian men. Bone Rep 2021; 15:101107. [PMID: 34355046 PMCID: PMC8322301 DOI: 10.1016/j.bonr.2021.101107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/06/2021] [Indexed: 10/29/2022] Open
Abstract
Background Peripheral quantitative computed tomography (pQCT) can provide information complementary to dual x-ray absorptiometry (DXA), however, there is sparse normative data to enable meaningful clinical interpretation and comparison. This study aimed to develop age-stratified normative data for pQCT-derived bone parameters in Australian men. Methods Participants were men (n = 508, age 33-96 yr) from the Geelong Osteoporosis Study. Bone parameters at 4% (n = 469) and 66% (n = 436) of radial length, and 4% (n = 449) and 66% (n = 438) of tibial length were acquired using pQCT (XCT 2000, Stratec Medizintechnik, Pforzheim, Germany). Best models of age, height and weight for each parameter were developed and where parameters exhibited variation with age, age decade mean (±SD) values were determined. Scatterplots were used to visualise the relationships between each of the parameters and age, height and weight. Results Thirteen parameters at tibial and radial sites were correlated with age, height and weight, allowing for their inclusion in multiple linear regression models. A positive association with age was found for total area of the tibia or radius (as appropriate) (mm2) at all sites, trabecular bone area (mm2) at 4% sites, and total bone area (both long bones) (mm2) at 66% sites. A negative association with age was found for cortical density (mg/cm3) and cortical thickness (mm) at both radial and tibial 66% sites, but total density (mg/cm3) at the 66% radial site and total cortical density of both long bones (mg/cm3) at the 66% tibial site only. Conclusion This study presents normative data for pQCT-derived bone parameters and describes age related associations in a number of these variables. Broadly, parameters of bone area were positively associated with age, whereas parameters associated with bone density and structure were negatively associated with age. These data have the potential to be used in clinical settings when assessing age-related decline in bone health. Mini abstract Normative data for pQCT parameters in Australian men are presented, adjusted for age, height and weight.
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Affiliation(s)
- Kara B Anderson
- Deakin University, IMPACT (Institute for Mental and Physical Health and Clinical Translation), Geelong, VIC, Australia
| | - Monica C Tembo
- Deakin University, IMPACT (Institute for Mental and Physical Health and Clinical Translation), Geelong, VIC, Australia
| | - Sophia X Sui
- Deakin University, IMPACT (Institute for Mental and Physical Health and Clinical Translation), Geelong, VIC, Australia
| | - Natalie K Hyde
- Deakin University, IMPACT (Institute for Mental and Physical Health and Clinical Translation), Geelong, VIC, Australia
| | - Pamela G Rufus
- Deakin University, IMPACT (Institute for Mental and Physical Health and Clinical Translation), Geelong, VIC, Australia
| | - Julie A Pasco
- Deakin University, IMPACT (Institute for Mental and Physical Health and Clinical Translation), Geelong, VIC, Australia.,Barwon Health, Geelong, VIC, Australia.,Department of Medicine - Western Health, The University of Melbourne, St Albans, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Prahran, VIC, Australia
| | - Mark A Kotowicz
- Deakin University, IMPACT (Institute for Mental and Physical Health and Clinical Translation), Geelong, VIC, Australia.,Barwon Health, Geelong, VIC, Australia.,Department of Medicine - Western Health, The University of Melbourne, St Albans, VIC, Australia
| | - Kara L Holloway-Kew
- Deakin University, IMPACT (Institute for Mental and Physical Health and Clinical Translation), Geelong, VIC, Australia
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22
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Qiu J, Li C, Dong Z, Wang J. Is diabetes mellitus a risk factor for low bone density: a systematic review and meta-analysis. BMC Endocr Disord 2021; 21:65. [PMID: 33849514 PMCID: PMC8045181 DOI: 10.1186/s12902-021-00728-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 03/30/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This systematic review aimed to investigate whether diabetes mellitus is a risk factor for low bone density, as this might be important and necessary for doctors specialized in treating patients with low bone density. METHODS PubMed, Embase, CINAHL, and SciELO were searched for cohort, case-control, and cross-sectional studies that investigated the effects of diabetes mellitus on bone mineral density till January 2020. Data screening and extraction are done independently, whereas the methodological quality of the studies was assessed according to the Newcastle-Ottawa Scale (NOS). RESULTS A total of 14 studies that met the eligibility criteria including 24,340 participants were enrolled. The overall quality of the studies had a scale of over 6 points. The overall odds ratio (OR) regarding the risk of diabetes mellitus in low bone density patients was 1.20 [95% confidence interval (CI)0.80-1.79, P = 0.30], and type 2 diabetes mellitus (T2DM) (OR = 0.69 [0.11, 4.55], P = 0.70). Subgroup analysis revealed that whether females or males, developed or developing countries, T2DM, studies after 2015, and quality over 7 points (all P values > 0.05) showed no significant differences with the risk of low bone density, except type 1 diabetes mellitus (T1DM) (OR = 3.83 [1.64, 8.96], P = 0.002), and studies before 2015 (OR = 1.76 [1.06, 2.92], P = 0.03), and quality below 7 points (OR = 2.27 [1.50, 3.43], P = 0.0001). Funnel plot showed no significant asymmetry. CONCLUSIONS These findings revealed no relationship between T2DM and low bone density, and also, the evidence between T1DM and low bone density is inadequate, requiring further analysis of well-designed cohort studies.
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Affiliation(s)
- Jingying Qiu
- Department of Endocrinology, Shengzhou People’s Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch, Zhejiang, China), No. 666, Dangui Road, Shengzhou, 312400 Zhejiang China
| | - Chengjiang Li
- Department of Endocrinology, The First Affiliated Hospital Zhejiang University, Hangzhou, Zhejiang China
| | - Zhichun Dong
- Department of Endocrinology, Shengzhou People’s Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch, Zhejiang, China), No. 666, Dangui Road, Shengzhou, 312400 Zhejiang China
| | - Jing Wang
- Department of Endocrinology, Shengzhou People’s Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch, Zhejiang, China), No. 666, Dangui Road, Shengzhou, 312400 Zhejiang China
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23
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Haikerwal A, Doyle LW, Patton G, Garland SM, Cheung MM, Wark JD, Cheong JLY. Bone health in young adult survivors born extremely preterm or extremely low birthweight in the post surfactant era. Bone 2021; 143:115648. [PMID: 32950698 DOI: 10.1016/j.bone.2020.115648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/18/2020] [Accepted: 09/12/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Most infants born extremely preterm (EP; <28 weeks' gestation) or extremely low birthweight (ELBW; <1000 g birthweight) in the post surfactant era (early 1990s) are now surviving into adulthood. Preterm birth/low birthweight are risk factors for reduced bone growth and mineralisation in infants and children. However, little is known about their bone health around peak bone mass and through adult life. OBJECTIVE To compare bone health (bone mineral measures, bone structure and strength) in young adults born EP/ELBW with controls (>2499 g birthweight), and within the EP/ELBW group examine perinatal and later variables associated with long term bone health. METHODS A geographic cohort comprising all 297 survivors born EP/ELBW in 1991-92 in the state of Victoria, Australia, and 260 contemporaneous controls (>2499 g birthweight) were recruited into a longitudinal study from birth. At age 25 years, investigations included dual energy X ray absorptiometry and peripheral quantitative computed tomography to measure bone, muscle and soft tissue variables, and fasting blood samples to measure serum 25 hydroxyvitamin D (25(OH)D) and bone turnover markers (BTM). Linear regression analysis, with models fitted using generalised estimating equations, was used to compare outcomes between groups, adjusting for height and weight. RESULTS Compared with controls (n = 129), young adults born EP/ELBW (n = 162) had lower areal bone mineral density (g/cm2) (mean difference [MD] -0.044; 95% confidence interval [CI] -0.076,-0.013) and Z-scores (MD -0.53; 95% CI -0.75, -0.30) in the femoral neck, and lower total hip Z-score (MD -0.35; 95% CI -0.54, -0.15) after adjusting for height and weight. EP/ELBW males generally displayed more bone and soft tissue deficits than females, compared with their respective controls. Within the EP/ELBW group, early growth, male sex, height and lean mass, muscle measures, 25(OH)D levels, and BTM were independently associated with bone mineral measures, structure or strength. CONCLUSIONS Young adults born EP/ELBW had evidence of impaired bone health around the age of peak bone mass compared with controls. Further follow-up of the EP/ELBW groups will determine if they have a heightened low-trauma fracture risk in later life.
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Affiliation(s)
- Anjali Haikerwal
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.
| | - Lex W Doyle
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Obstetrics and Gynecology, The Royal Women's Hospital, The University of Melbourne, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - George Patton
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
| | - Suzanne M Garland
- Department of Obstetrics and Gynecology, The Royal Women's Hospital, The University of Melbourne, Melbourne, Australia; Centre for Women's Infectious Diseases Research, The Royal Women's Hospital, Parkville, Australia; Infection & Immunity Theme, Murdoch Children's Research Institute, Parkville, Australia
| | - Michael M Cheung
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Heart Research, Murdoch Children's Research Institute, Melbourne, Australia; Department of Cardiology, Royal Children's Hospital, Melbourne, Australia
| | - John D Wark
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Bone and Mineral Medicine, The Royal Melbourne Hospital, Melbourne, Australia
| | - Jeanie L Y Cheong
- Newborn Services, The Royal Women's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Obstetrics and Gynecology, The Royal Women's Hospital, The University of Melbourne, Melbourne, Australia
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24
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Shah N, Khadilkar A, Ekbote V, Mughal Z, Gondhalekar K, Khadilkar S, Ramanan V, Khadilkar V, Padidela R. DXA and pQCT derived parameters in Indian children with beta thalassemia major - A case controlled study. Bone 2021; 143:115730. [PMID: 33137537 DOI: 10.1016/j.bone.2020.115730] [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: 08/21/2020] [Revised: 09/26/2020] [Accepted: 10/20/2020] [Indexed: 01/19/2023]
Abstract
Children with beta thalassemia major (BTM) are known to have reduced bone mass which increases incidence of non-traumatic fractures. Few studies have assessed prevalence of fractures and bone health in underprivileged children with BTM. Our objectives were to 1) determine prevalence of fractures in underprivileged Indian children with BTM, 2) assess size corrected bone density and bone geometry using Dual x-ray absorptiometry (DXA) and peripheral quantitative computerized tomography (pQCT) in these children and healthy controls 3) determine predictors of fractures in children with BTM 4) compare differences in bone density between children with BMT with and without fractures. Bone mineral content and areal bone mineral density (aBMD) of lumbar spine and whole body and vertebral fracture assessment (VFA) was performed by DXA in 334 children (3-18 years, 167 BTM + 167 controls). Volumetric BMD (vBMD) and bone geometry were assessed by pQCT (subset, 70 BTM, 70 healthy) at distal radius. Children with BTM had higher prevalence of vertebral and long bone fractures (p < 0.05). DXA aBMD was lower in children with BTM (p < 0.05), whereas, lumbar spine bone mineral apparent density (LSBMAD) was higher (p > 0.05). Children with BTM had lower total distal radial vBMD, cortical vBMD and strength strain index (SSI) at 66% site whereas, distal radial trabecular vBMD at 4% was higher (p < 0.05). On height adjustment, children with BTM had lower muscle area and cortical thickness and higher marrow area (p < 0.05) at 66% site. Age, body size, total body less head (TBLH) aBMD and strength strain index (SSI) were important predictors of fractures in children with BTM. Thus, children with BTM had higher prevalence of non-traumatic fractures. Despite lower areal and volumetric densities, they had higher LSBMAD and trabecular densities which may be attributed to erythroid hyperplasia and iron deposition due to inadequate transfusion and chelation. As LSBMAD is raised in these children, it is unlikely to identify BTM subjects at risk of fracture; VFA thus maybe useful in identifying asymptomatic vertebral fractures.
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Affiliation(s)
- Nikhil Shah
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Anuradha Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India.
| | - Veena Ekbote
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Zulf Mughal
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University, NHS Foundation Trust, Manchester, UK
| | - Ketan Gondhalekar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Shachi Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Vijay Ramanan
- Clinical Hematology and Transplant, Yashoda Hematology Clinic, Pune, Maharashtra, India
| | - Vaman Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India
| | - Raja Padidela
- Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester University, NHS Foundation Trust, Manchester, UK
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Dumuid D, Simm P, Wake M, Burgner D, Juonala M, Wu F, Magnussen CG, Olds T. The "Goldilocks Day" for Children's Skeletal Health: Compositional Data Analysis of 24-Hour Activity Behaviors. J Bone Miner Res 2020; 35:2393-2403. [PMID: 32730680 DOI: 10.1002/jbmr.4143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 07/16/2020] [Accepted: 07/23/2020] [Indexed: 12/13/2022]
Abstract
Optimization of children's activity behaviors for skeletal health is a key public health priority, yet it is unknown how many hours of moderate to vigorous physical activity (MVPA), light physical activity (LPA), sedentary behavior, or sleep constitute the best day-the "Goldilocks Day"-for children's bone structure and function. To describe the best day for children's skeletal health, we used data from the cross-sectional Child Health CheckPoint. Included participants (n = 804, aged 10.7 to 12.9 years, 50% male) underwent tibial peripheral quantitative CT to assesses cross-sectional area, trabecular and cortical density, periosteal and endosteal circumference, polar moment of inertia, and polar stress-strain index. Average daily time-use composition (MVPA, LPA, sedentary time, and sleep) was assessed through 8-day, 24-hour accelerometry. Skeletal outcomes were regressed against time-use compositions expressed as isometric log-ratios (with quadratic terms where indicated), adjusted for sex, age, pubertal status, and socioeconomic position. The models were used to estimate optimal time-use compositions (associated with best 5% of each skeletal outcome), which were plotted in three-dimensional quaternary figures. The center of the overlapping area was considered the Goldilocks Day for skeletal health. Children's time-use composition was associated with all skeletal measures (all p ≤ 0.001) except cross-sectional area (p = 0.72). Days with more sleep and MVPA, less sedentary time, and moderate LPA were beneficially associated with skeletal measures, except cortical density, which was adversely associated. The Goldilocks daily time-use composition for overall skeletal health was center (range): 10.9 (10.5 to 11.5) hours sleep; 8.2 (7.8 to 8.8) hours sedentary time; 3.4 (2.8 to 4.2) hours LPA, and 1.5 (1.3 to 1.5) hours MVPA. Estimated optimal sleep duration is consistent with current international guidelines (9 to 11 hours), while estimated optimal MVPA exceeds recommendations of at least 60 min/d. This first study to describe optimal durations of daily activities for children's skeletal health provides evidence to underpin guidelines. © 2020 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Dorothea Dumuid
- Allied Health & Human Performance, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia
| | - Peter Simm
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Australia
| | - Melissa Wake
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Liggins Institute, University of Auckland, Grafton, New Zealand
| | - David Burgner
- Murdoch Children's Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
- Division of Medicine, Turku University Hospital, Turku, Finland
| | - Feitong Wu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Costan G Magnussen
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Timothy Olds
- Allied Health & Human Performance, Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia
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26
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Drey M, Henkel M, Petermeise S, Weiß S, Ferrari U, Rottenkolber M, Schmidmaier R. Assessment of Bone and Muscle Measurements by Peripheral Quantitative Computed Tomography in Geriatric Patients. J Clin Densitom 2020; 23:604-610. [PMID: 30425007 DOI: 10.1016/j.jocd.2018.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 01/19/2023]
Abstract
The loss of bone and muscle mass increases the risk of osteoporotic fractures. Dual energy X-ray absorptiometry (DXA) loses sensitivity in older age. The purpose of this study was to evaluate bone and muscle measurements of peripheral quantitative computed tomography (pQCT) in a geriatric cohort with osteoporosis. Bone mineral density and muscle area of 168 patients aged 65 years and older (76.3 ± 6.5) were measured with pQCT at distal forearm additionally to an osteoporosis assessment consisting of anamnesis, blood test and DXA of lumbar spine and hip. Prior fractures were categorized in minor and major osteoporotic fractures. Logistic regression was used to show the association of bone mineral density and muscle area with major fractures. 54.8% of the participants had at least one major fracture. Bone mineral density measured with pQCT and muscle area were significantly associated with these fractures (total and trabecular bone mineral density OR 2.243 and 2.195, p < 0.01; muscle area OR 2.378, p < 0.05), whereas DXA bone mineral density showed no significant association. These associations remained after adjustment for age, sex, BMI, physical activity and other factors. In all models for patients >75 years only muscle area was significantly associated (OR 5.354, p < 0.05) with major fractures. Measurement of bone mineral density and muscle area with pQCT seems to have advantage over DXA in fracture association in geriatric patients. Measuring muscle area also adds useful information to estimate the presence of osteosarcopenia.
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Affiliation(s)
- M Drey
- Medizinische Klinik und Poliklinik IV, Schwerpunkt Akutgeriatrie, Klinikum der Universität München (LMU), München, Bavaria,Germany.
| | - M Henkel
- Medizinische Klinik und Poliklinik IV, Schwerpunkt Akutgeriatrie, Klinikum der Universität München (LMU), München, Bavaria,Germany
| | - S Petermeise
- Medizinische Klinik und Poliklinik IV, Schwerpunkt Akutgeriatrie, Klinikum der Universität München (LMU), München, Bavaria,Germany
| | - S Weiß
- Medizinische Klinik und Poliklinik IV, Schwerpunkt Akutgeriatrie, Klinikum der Universität München (LMU), München, Bavaria,Germany
| | - U Ferrari
- Medizinische Klinik und Poliklinik IV, Schwerpunkt Akutgeriatrie, Klinikum der Universität München (LMU), München, Bavaria,Germany
| | - M Rottenkolber
- Medizinische Klinik und Poliklinik IV, Schwerpunkt Akutgeriatrie, Klinikum der Universität München (LMU), München, Bavaria,Germany
| | - R Schmidmaier
- Medizinische Klinik und Poliklinik IV, Schwerpunkt Akutgeriatrie, Klinikum der Universität München (LMU), München, Bavaria,Germany; Medizinische Klinik und Poliklinik IV, Schwerpunkt Endokrinologie, Klinikum derUniversität München (LMU), München, Bavaria, Germany
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Hart NH, Newton RU, Tan J, Rantalainen T, Chivers P, Siafarikas A, Nimphius S. Biological basis of bone strength: anatomy, physiology and measurement. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2020; 20:347-371. [PMID: 32877972 PMCID: PMC7493450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/24/2020] [Indexed: 11/26/2022]
Abstract
Understanding how bones are innately designed, robustly developed and delicately maintained through intricate anatomical features and physiological processes across the lifespan is vital to inform our assessment of normal bone health, and essential to aid our interpretation of adverse clinical outcomes affecting bone through primary or secondary causes. Accordingly this review serves to introduce new researchers and clinicians engaging with bone and mineral metabolism, and provide a contemporary update for established researchers or clinicians. Specifically, we describe the mechanical and non-mechanical functions of the skeleton; its multidimensional and hierarchical anatomy (macroscopic, microscopic, organic, inorganic, woven and lamellar features); its cellular and hormonal physiology (deterministic and homeostatic processes that govern and regulate bone); and processes of mechanotransduction, modelling, remodelling and degradation that underpin bone adaptation or maladaptation. In addition, we also explore commonly used methods for measuring bone metabolic activity or material features (imaging or biochemical markers) together with their limitations.
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Affiliation(s)
- Nicolas H Hart
- Exercise Medicine Research Institute, Edith Cowan University, Perth, W.A., Australia
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, W.A., Australia
- Western Australian Bone Research Collaboration, Perth, W.A., Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, W.A., Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, W.A., Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, W.A., Australia
| | - Jocelyn Tan
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, W.A., Australia
- Western Australian Bone Research Collaboration, Perth, W.A., Australia
- School of Health Sciences, The University of Notre Dame Australia, Perth, W.A., Australia
| | - Timo Rantalainen
- Exercise Medicine Research Institute, Edith Cowan University, Perth, W.A., Australia
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, W.A., Australia
- Western Australian Bone Research Collaboration, Perth, W.A., Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, W.A., Australia
- Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Paola Chivers
- Exercise Medicine Research Institute, Edith Cowan University, Perth, W.A., Australia
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, W.A., Australia
- Western Australian Bone Research Collaboration, Perth, W.A., Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, W.A., Australia
| | - Aris Siafarikas
- Exercise Medicine Research Institute, Edith Cowan University, Perth, W.A., Australia
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, W.A., Australia
- Western Australian Bone Research Collaboration, Perth, W.A., Australia
- Department of Endocrinology and Diabetes, Perth Childrens Hospital, Perth, W.A., Australia
- School of Paediatrics and Child Health, University of Western Australia, Perth, W.A., Australia
| | - Sophia Nimphius
- Western Australian Bone Research Collaboration, Perth, W.A., Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, W.A., Australia
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Macdonald HM, Maan EJ, Berger C, Dunn RA, Côté HCF, Murray MCM, Pick N, Prior JC. Deficits in bone strength, density and microarchitecture in women living with HIV: A cross-sectional HR-pQCT study. Bone 2020; 138:115509. [PMID: 32599222 DOI: 10.1016/j.bone.2020.115509] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE With the advent of combined antiretroviral therapy (cART), life expectancy has increased among persons living with HIV, but so too has risk for comorbidities including osteoporosis and fragility fracture. To explore whether HIV status and cART influence three-dimensional measures of BMD, bone microarchitecture and strength we aimed to compare these outcomes between women living with HIV (WLWH; n = 50; 50.4 ± 1.2 years, 44% postmenopausal) and without HIV (controls; n = 50; 51.8 ± 1.2 years, 52% postmenopausal). METHODS Outcomes were lumbar spine, total hip and femoral neck areal BMD by DXA; distal radius and tibia trabecular BMD, thickness and number, and cortical BMD and area by HR-pQCT; and finite element analysis-derived bone strength (failure load). Multivariable regression analysis compared bone outcomes between groups adjusting for known osteoporosis risk factors. Within WLWH, we examined associations between bone outcomes and HIV-related factors including disease severity and cART duration. RESULTS WLWH were diagnosed 20 ± 4 years ago, were on cART for 123 ± 37 months and 80% had HIV plasma viral load <40 copies/mL. For women ≥50 years (n = 61), total hip aBMD T-Score was lower among WLWH than controls. Adjusted distal radius trabecular BMD and thickness and distal tibia trabecular BMD and failure load were 8-19% lower in WLWH than controls (p < 0.05). Cortical BMD and area did not differ between groups at either site. Lifetime cART duration and current plasma viral load were not associated with bone outcomes in WLWH; however, previous treatment with tenofovir was negatively associated with distal radius trabecular BMD and trabecular number and LS aBMD T-score. CONCLUSIONS WLWH have compromised BMD, bone microarchitecture and strength vs. controls of similar age and reproductive status. Treatment with tenofovir may contribute to bone deficits in WLWH.
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Affiliation(s)
- Heather M Macdonald
- Department of Family Practice, Faculty of Medicine, University of British Columbia, 5950 University Blvd, Vancouver, British Columbia V6T 1Z3, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, 2735 Laurel St, Vancouver, British Columbia V5Z 1M9, Canada.
| | - Evelyn J Maan
- Oak Tree Clinic, BC Women's Hospital and Health Centre, 4500 Oak St, Vancouver, British Columbia V5Z 0A7, Canada; Women's Health Research Institute, H214-4500 Oak St, Vancouver, British Columbia V6H 3N1, Canada.
| | - Claudie Berger
- Research Institute of the McGill University Health Centre, 2155 Guy Street, Suite 500, Montreal, Quebec H3H 2R9, Canada.
| | - Rachel A Dunn
- Department of Pathology & Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5, Canada; Centre for Blood Research, University of British Columbia, 4302-2350 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Hélène C F Côté
- Women's Health Research Institute, H214-4500 Oak St, Vancouver, British Columbia V6H 3N1, Canada; Department of Pathology & Laboratory Medicine, University of British Columbia, Rm. G227 - 2211 Wesbrook Mall, Vancouver, British Columbia V6T 2B5, Canada; Centre for Blood Research, University of British Columbia, 4302-2350 Health Sciences Mall, Vancouver, British Columbia V6T 1Z3, Canada.
| | - Melanie C M Murray
- Oak Tree Clinic, BC Women's Hospital and Health Centre, 4500 Oak St, Vancouver, British Columbia V5Z 0A7, Canada; Women's Health Research Institute, H214-4500 Oak St, Vancouver, British Columbia V6H 3N1, Canada; Department of Medicine, Division of Infectious Diseases, University of British Columbia, 328C, Heather Pavilion East, VGH, 2733 Heather Street, Vancouver, British Columbia V5Z 3J5, Canada.
| | - Neora Pick
- Oak Tree Clinic, BC Women's Hospital and Health Centre, 4500 Oak St, Vancouver, British Columbia V5Z 0A7, Canada; Women's Health Research Institute, H214-4500 Oak St, Vancouver, British Columbia V6H 3N1, Canada; Department of Medicine, Division of Infectious Diseases, University of British Columbia, 328C, Heather Pavilion East, VGH, 2733 Heather Street, Vancouver, British Columbia V5Z 3J5, Canada.
| | - Jerilynn C Prior
- Women's Health Research Institute, H214-4500 Oak St, Vancouver, British Columbia V6H 3N1, Canada; Department of Medicine, Division of Endocrinology, University of British Columbia, Gordon and Leslie Diamond Centre, 2775 Laurel Street, 4th Floor, Vancouver, British Columbia V5Z 1M9, Canada; Centre for Menstrual Cycle and Ovulation Research, The Gordon and Leslie Diamond Health Care Centre, Room 4111 - 4th Floor, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada.
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Hamza S, Fathy S, El-Azab S. Effect of diode laser biostimulation compared to Teriparatide on induced osteoporosis in rats: an animal study from Egypt. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2020; 13:1970-1985. [PMID: 32922592 PMCID: PMC7476941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/29/2020] [Indexed: 06/11/2023]
Abstract
Our aim in this study was to evaluate the effect of low-level laser therapy (LLLT) by means of diode laser bio-stimulation compared to Teriparatide in induced osteoporosis in rats. A total of 45 adult female Egyptian albino rats were used. Rats were divided into five groups: normal control, osteoporotic control, Teriparatide (TPTD) group (T), laser group (L), and laser and teriparatide (T+L) combination group. Osteoporosis was induced by performing double ovariectomy in rats. Lower jaws and left femurs were dissected. The specimens were tested using a Computed tomography unit, scanning EM (SEM) equipped with Energy Dispersive X-Ray Analyzer, and Rat PINP ELISA Kit. The histopathologic examination of experimental rat jaws and femurs revealed changes in bone architecture among the various groups throughout the experiment. CT examination showed a noticeable difference in radiodensity between jaw and femur bones. By SEM, bones of the Normal Control (NC) group showed normal bone porosity. However, bones of the Osteoporotic Control (OC) group showed a great difference as bone pores were large and numerous with irregular outlines. The ELISA test for PINP concentration showed a steady rise in the PINP concentrations in OC, T, L and T+L groups. We concluded that TPTD has osteogenic potential and is capable to enhance bone architecture by inducing the formation of new well-organized bone with narrower bone pore diameter. LLLT can be used as a good alternative local treatment strategy with minimal side effects and superior outcomes.
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Affiliation(s)
- Shymaa Hamza
- Department of Oral Pathology, Faculty of Dentistry, Cairo University Cairo, Egypt
| | - Safa Fathy
- Department of Oral Pathology, Faculty of Dentistry, Cairo University Cairo, Egypt
| | - Samia El-Azab
- Department of Oral Pathology, Faculty of Dentistry, Cairo University Cairo, Egypt
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Harding AT, Weeks BK, Lambert C, Watson SL, Weis LJ, Beck BR. Effects of supervised high-intensity resistance and impact training or machine-based isometric training on regional bone geometry and strength in middle-aged and older men with low bone mass: The LIFTMOR-M semi-randomised controlled trial. Bone 2020; 136:115362. [PMID: 32289518 DOI: 10.1016/j.bone.2020.115362] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/23/2020] [Accepted: 04/07/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Few data exist on the effects of bone-targeted exercise on geometric and biomechanical indices of bone strength in men. The Lifting Intervention For Training Muscle and Osteoporosis Rehabilitation for Men (LIFTMOR-M) trial was designed to compare the efficacy and safety of two novel, supervised, twice-weekly, high-intensity exercise programs in middle-aged and older men with osteopenia and osteoporosis on musculoskeletal health and risk factors related to falls and fractures. The current report includes secondary outcomes of the LIFTMOR-M exercise intervention trial. PURPOSE Our goal was to determine the effects of two supervised, twice-weekly, high-intensity exercise programs on bone geometry and strength of the proximal femur, and distal and proximal sites of the tibia and radius in middle-aged and older men with osteopenia and osteoporosis. METHODS Generally-healthy men (≥45 years), with low lumbar spine (LS) and/or proximal femur areal bone mineral density (aBMD), were recruited from the community. Eligible participants were randomised to either eight months of twice-weekly supervised high-intensity progressive resistance and impact training (HiRIT) or supervised machine-based isometric axial compression (IAC) exercise training. Intervention group outcomes were compared at baseline and eight months with a matched but non-randomised control group (CON) who self-selected to usual activities. DXA scans (Medix DR, Medilink, France) of the skeletally non-dominant proximal femur were analysed using 3D hip software (DMS Group, France) to derive femoral neck (FN) and total hip (TH) bone mineral content (BMC), volume, and volumetric bone mineral density (vBMD) for total, trabecular and cortical bone compartments. Total FN cortical thickness was determined as well as anterior, posterior, lateral and medial subregions. pQCT scans (XCT-3000, Stratec, Germany) of the 4 and 38% sites of the tibia, and 4 and 66% sites of the radius were conducted to determine a range of geometric and bone structural strength indices. Intervention effects were examined using univariate ANCOVA of percent change, and repeated measures ANCOVA of raw baseline and follow-up data, controlling for initial values, using intention-to-treat and per-protocol approaches. RESULTS Ninety-three men (67.1 ± 7.5 yrs, 175.2 ± 6.7 cm, 82.1 ± 11.6 kg, 26.7 ± 3.5 kg/m2) with lower than average aBMD (LS T-score -0.06 ± 1.04, FN T-score -1.58 ± 0.58, TH T-score -1.00 ± 0.58) were recruited, and designated CON (n = 26) or randomised to HiRIT (n = 34) or IAC (n = 33). Compliance to the supervised exercise programs did not differ (HiRIT 77.8 ± 16.6% versus IAC 78.5 ± 14.8%, p = 0.872). HiRIT improved medial FN cortical thickness compared with CON (5.6 ± 1.7% versus -0.1 ± 1.9%, p = 0.028) and IAC (5.6 ± 1.7% versus 0.7 ± 1.7%, p = 0.044). Distal tibia total BMC, vBMD, area and bone strength index, and trabecular BMC and bone strength index all declined for CON compared with maintenance for both HiRIT and IAC (all p < 0.05). HiRIT maintained distal tibia trabecular area compared with a loss in CON (0.2 ± 0.5% versus -1.6 ± 0.5%, p = 0.013). HiRIT and IAC maintained distal radius total BMC compared with loss in CON (-0.1 ± 0.7% versus -3.7 ± 0.8%, p = 0.001; 1.3 ± 0.7% versus -3.7 ± 0.8%, p < 0.001, respectively). HiRIT and IAC maintained distal radius total bone strength index compared with loss in CON (1.4 ± 1.4% versus -6.0 ± 1.6%, p = 0.001; 0.2 ± 1.3% versus -6.0 ± 1.6%, p = 0.004, respectively). HiRIT reduced proximal radius cortical area compared with CON (-3.1 ± 1.0% versus 1.1 ± 1.2%, p = 0.011) and IAC (-3.1 ± 1.0% versus -0.2 ± 1.0%, p = 0.042). No between-group differences were detected in any pQCT-derived bone outcome at the diaphyseal tibia 38% site. CONCLUSION Findings indicate that supervised HiRIT provides a positive stimulus to cortical bone at the medial FN compared with supervised IAC exercise, and both HiRIT and IAC preserve bone strength at the distal tibia and distal radius. These effects may translate into a reduced risk of lower and upper extremity fracture in middle-aged and older men with low bone mass.
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Affiliation(s)
- Amy T Harding
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Benjamin K Weeks
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Conor Lambert
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Steven L Watson
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Lisa J Weis
- The Bone Clinic, Brisbane, Queensland, Australia
| | - Belinda R Beck
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia; School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia; The Bone Clinic, Brisbane, Queensland, Australia.
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McGuire A, Warrington G, Doyle L. Low energy availability in male athletes: A systematic review of incidence, associations, and effects. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Amy McGuire
- Department of Sport and Exercise Science Waterford Institute of Technology Waterford Ireland
| | - Giles Warrington
- Department of Physical Education and Social Sciences University of Limerick Limerick Ireland
- Sport and Human Performance Research Centre Health Research Institute University of Limerick Limerick Ireland
| | - Lorna Doyle
- Department of Sport and Exercise Science Waterford Institute of Technology Waterford Ireland
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Jiang H, Robinson DL, Yates CJ, Lee PVS, Wark JD. Peripheral quantitative computed tomography (pQCT)-based finite element analysis provides enhanced diagnostic performance in identifying non-vertebral fracture patients compared with dual-energy X-ray absorptiometry. Osteoporos Int 2020; 31:141-151. [PMID: 31720708 DOI: 10.1007/s00198-019-05213-1] [Citation(s) in RCA: 5] [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: 05/05/2019] [Accepted: 10/28/2019] [Indexed: 12/24/2022]
Abstract
UNLABELLED Due to limitations of the predominant clinical method for diagnosing osteoporosis, an engineering model based on a dedicated CT scanner for bone density and structure was applied in fracture patients and controls. Improved diagnostic performance was observed, which supports its potential use in future research and clinical practice. INTRODUCTION Dual-energy X-ray absorptiometry (DXA), the predominant clinical method for diagnosing osteoporosis, has limitations in identifying individuals with increased fracture risk. Peripheral quantitative computed tomography (pQCT) provides additional information and can be used to generate finite element (FE) models from which bone strength properties can be estimated. We investigated the ability of pQCT-FE properties to distinguish peripheral low-trauma fracture patients from healthy controls, by comparison with DXA and standard pQCT. METHODS One hundred and eight fracture patients (77 females aged 67.7 ± 7.9 years, 31 males aged 69.7 ± 8.9 years) were recruited from a hospital fracture liaison service. One hundred and twenty healthy community controls (85 females aged 69.8 ± 8.5 years, 35 males aged 68.9 ± 7.2 years) were recruited. RESULTS Significant differences between groups were observed in pQCT-FE properties, especially at the 4% tibia site. Fracture odds increased most per standard deviation decrease in pQCT-FE at this location [shear stiffness estimate, kshear, in females, OR = 10.34, 95% CI (1.91, 43.98); bending stiffness estimate, kbend, in males, OR = 8.32, 95% CI (4.15, 33.84)]. Area under the receiver operating characteristics curve (AUROC) was observed to be highest with pQCT-FE properties at 4% the tibia site. In females, this was 0.83 for the pQCT-FE variable kshear, compared with 0.72 for DXA total hip bone density (TH aBMD) and 0.76 for pQCT tibia trabecular density (Trb vBMD); in males, this was 0.81 for the pQCT-FE variable kbend at the 4% tibia site, compared with 0.62 for TH aBMD and 0.71 for Trb vBMD. There were significant differences in AUROC between DXA and pQCT-FE variables in both females (p = 0.02) and males (p = 0.03), while no difference was observed in AUROC between primary pQCT and pQCT-FE variables. CONCLUSIONS pQCT-FE modeling can provide enhanced diagnostic performance compared with DXA and, given its moderate cost, may be useful in clinical settings.
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Affiliation(s)
- H Jiang
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, 3052, Australia
| | - D L Robinson
- Department of Biomedical Engineering, University of Melbourne, Melbourne, 3052, Victoria, Australia
| | - C J Yates
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, 3052, Australia
- Bone and Mineral Medicine, Royal Melbourne Hospital, Melbourne, 3052, Victoria, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, 3052, Victoria, Australia
| | - P V S Lee
- Department of Biomedical Engineering, University of Melbourne, Melbourne, 3052, Victoria, Australia
| | - J D Wark
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, 3052, Australia.
- Bone and Mineral Medicine, Royal Melbourne Hospital, Melbourne, 3052, Victoria, Australia.
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, 3052, Victoria, Australia.
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Mesinovic J, McMillan LB, Shore-Lorenti C, Zengin A, De Courten B, Ebeling PR, Scott D. Sex-specific associations between insulin resistance and bone parameters in overweight and obese older adults. Clin Endocrinol (Oxf) 2019; 90:680-689. [PMID: 30724369 DOI: 10.1111/cen.13947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To determine sex-specific associations between insulin resistance and bone parameters measured by peripheral quantitative computed tomography in overweight and obese community-dwelling older adults. STUDY DESIGN Cross-sectional study of 79 community-dwelling overweight and obese adults (mean ± SD age 62.8 ± 7.9 years; body mass index 32.3 ± 6.1 kg/m2 ; 58% women). MAIN OUTCOME MEASURES Peripheral quantitative computed tomography assessed distal radius and tibia trabecular volumetric bone mineral density (vBMD) and proximal radius and tibia cortical vBMD, periosteal circumference, endosteal circumference and stress-strain index. The Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) score was calculated from fasting glucose and insulin values. Lean mass was assessed using dual-energy X-ray absorptiometry. Total minutes of moderate and vigorous physical activity (MVPA) were calculated using the Active Australia Survey. RESULTS Men and women in this cohort had no significant differences in fasting glucose and insulin concentrations, HOMA-IR values and diabetes prevalence (all P > 0.05). In women, HOMA-IR was positively correlated with proximal radius periosteal and endosteal circumference (r = 0.331; P = 0.034 and r = 0.325; P = 0.038, respectively). These associations became nonsignificant in multivariable regression analyses; however, HOMA-IR was negatively associated with proximal radius cortical vBMD (B = -4.79; 95% CI -8.66, -0.92) after adjusting for age, lean mass and MVPA. All associations between HOMA-IR and bone parameters became nonsignificant in a sensitivity analysis excluding individuals with diabetes, or self-reported use of glucose-lowering medications. There were no associations between HOMA-IR and bone parameters in men. CONCLUSIONS Homeostatic Model Assessment of Insulin Resistance was negatively associated with radial cortical vBMD in overweight and obese older women, but not in men. Further studies are needed to clarify sex-specific associations between insulin resistance and bone health in overweight and obese older adults.
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Affiliation(s)
- Jakub Mesinovic
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Lachlan B McMillan
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Catherine Shore-Lorenti
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Ayse Zengin
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Barbora De Courten
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Peter R Ebeling
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, St. Albans, Victoria, Australia
| | - David Scott
- Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, St. Albans, Victoria, Australia
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Activity Behaviors and Physiological Characteristics of Women With Advanced-Stage Ovarian Cancer: A Preliminary Cross-sectional Investigation. Int J Gynecol Cancer 2019; 28:604-613. [PMID: 29369120 DOI: 10.1097/igc.0000000000001197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES Ovarian cancer (OC) survivors experience many disease and treatment adverse effects. However, the impact of OC and its treatment on objective activity behaviors and physiological status have not been examined. The purpose of this study was to compare objectively measured activity behaviors and physiological characteristics of advanced-stage OC survivors to age-matched controls. METHODS Twenty stage III-IV OC survivors and 20 controls completed assessments of activity behaviors (7-day accelerometry), physical function (400-meter walk as indicator of cardiorespiratory fitness, repeated chair rise, 6-meter walking tests), muscle strength (1-repetition maximum and handgrip), body composition (dual-energy x-ray absorptiometry), and musculoskeletal morphology (peripheral quantitative computed tomography). RESULTS Compared with controls, OC survivors spent more time/day in prolonged sedentary bouts (P = 0.039, r = 0.32), had lower cardiorespiratory fitness (P = 0.041, r = 0.33) and upper body strength (P = 0.023, r = 0.37), had higher areal bone mineral content (P = 0.047, r = 0.33) and volumetric trabecular density (P = 0.048, r = 0.31), but were not different in other measures of body composition nor in muscle morphology (P > 0.050). Only 20% (n = 4) of OC survivors accrued 150 minutes/week or greater moderate and vigorous physical activity (MVPA) time in 10-minute bouts or greater. Moderate and vigorous physical activity time/day in 10-minute bouts or greater was strongly associated with cardiorespiratory fitness (P = 0.001, ρ = -0.702) and lower extremity function (P = 0.019, ρ = -0.519) and moderately associated with muscle cross-sectional area (P = 0.035, ρ = 0.473). CONCLUSIONS Posttreatment OC survivors spent more time in prolonged sedentary bouts and had lower cardiorespiratory fitness and upper body strength compared with controls. Moderate and vigorous physical activity was associated with physical function and muscle cross-sectional area. Future studies should test the efficacy of exercise interventions to increase MVPA, reduce sedentary behavior, and increase cardiorespiratory fitness and muscle strength in OC survivors.
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Affiliation(s)
- Fuxingzi Li
- Department of Endocrinology and Metabolism, the Second XiangYa Hospital, Central South University, Changsha, Hunan, China
| | - Xiao Lin
- Department of Endocrinology and Metabolism, the Second XiangYa Hospital, Central South University, Changsha, Hunan, China
| | - Ling-Qing Yuan
- Department of Endocrinology and Metabolism, the Second XiangYa Hospital, Central South University, Changsha, Hunan, China
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Zhang P, Xi H, Yan R. Effects of thyrotropin suppression on lumbar bone mineral density in postmenopausal women with differentiated thyroid carcinoma. Onco Targets Ther 2018; 11:6687-6692. [PMID: 30349302 PMCID: PMC6186301 DOI: 10.2147/ott.s171282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose The aim of this study was to evaluate the effect of postoperative thyroid-stimulating hormone suppression (TSHS) on bone mineral density (BMD) in Chinese postmenopausal women with differentiated thyroid carcinoma (DTC). Patients and methods A total of 225 postmenopausal women with DTC who had received TSHS were included in the study. Postmenopausal women with postoperative DTC undergoing thyroid residual ablation or metastasis treatment between 2009 and 2015 were enrolled and followed up for 2 years. They were divided into two groups: TSHS group (median thyroid-stimulating hormone [TSH] <0.3 μIU/mL) and postmenopausal control group (median TSH >0.3 μIU/mL). Lumbar 1–4 BMD levels were measured by a dual-energy X-ray absorptiometry (DXA) at baseline and 6, 12 and 24 months. All patients had calcium and vitamin D supplementation. The diagnosis of osteopenia (−1 SD > T >−2.5 SD) and osteoporosis (T <−2.5 SD) was made according to WHO guidelines. Results Thyroid cancers included 211 papillary carcinomas and 14 follicular carcinomas. One hundred and fifty-four patients were in the TSHS group, and 71 patients were in the non-suppressed TSH group (postmenopausal controls). No significant differences were found in the BMD of the lumbar spine between baseline and after 6, 12 and 24 months, pre and post treatment in TSHS and non-suppressed TSH patients. Compared with pre-TSHS, there was a reduction in the BMD of 1.9% in the lumbar spine at the 2-year follow-up. Significant difference in the number of osteopenia and osteoporosis patients at 24 months (χ2=2.88, P=0.004) was found between the TSHS (103/152) and postmenopausal control (32/68) groups. TSHS is not a significant risk of bone loss, but it is the incidence of osteopenia in postmenopausal women with DTC. Conclusion Our 2-year follow-up data indicated that TSHS had little effect on BMD in postmenopausal women with DTC. Large population with at least 5-year follow-up should be further investigated. BMD in postmenopausal women with DTC should be followed up regularly.
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Affiliation(s)
- Pei Zhang
- Department of Endocrinology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Hui Xi
- Department of Oncology, Liaocheng People's Hospital, Liaocheng, Shandong, China,
| | - Ruihong Yan
- Department of Nuclear Medicine, Liaocheng People's Hospital, Liaocheng, Shandong, China
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Ho-Pham LT, Chau PMN, Do AT, Nguyen HC, Nguyen TV. Type 2 diabetes is associated with higher trabecular bone density but lower cortical bone density: the Vietnam Osteoporosis Study. Osteoporos Int 2018; 29:2059-2067. [PMID: 29967929 DOI: 10.1007/s00198-018-4579-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/15/2018] [Indexed: 01/19/2023]
Abstract
UNLABELLED It is not clear why type 2 diabetes (T2D) has an increased risk of fracture despite higher areal bone mineral density. This study showed that compared with controls, T2D patients had higher trabecular bone density but lower cortical bone density, resulting in a lower bone strength. INTRODUCTION To define the association between type 2 diabetes and bone architecture and measures of bone strength. METHODS The study was part of the Vietnam Osteoporosis Study, in which 1115 women and 614 men aged ≥ 30 were randomly recruited from Ho Chi Minh City. HbA1c levels were measured with analyzers ADAMS™ A1c HA-8160 (Arkray, Kyoto, Japan). The diagnosis of T2D was made if HbA1c was ≥ 6.5%. Trabecular and cortical volumetric bone density (vBMD) was measured in the forearm and leg by a pQCT XCT2000 (Stratec, Germany). Polar stress strain index (pSSI) was derived from the pQCT measurements. Difference in bone parameters between T2D and non-diabetic individuals was assessed by the number of standard deviations (effect size [ES]) by the propensity score analysis. RESULTS The prevalence of T2D was ~ 8%. The results of propensity score matching for age, sex, and body mass index in 137 pairs of diabetic and non-diabetic individuals showed that T2D patients had significantly higher distal radius trabecular vBMD (ES 0.26; 95% CI, 0.02 to 0.50), but lower cortical vBMD (ES - 0.22; - 0.46 to 0.00) and reduced pSSI (ES - 0.23; - 0.47 to - 0.02) compared with non-diabetic individuals. Multiple linear regression analysis based on the entire sample confirmed the results of the propensity score analysis. CONCLUSION Compared with non-diabetic individuals, patients with T2D have greater trabecular but lower cortical vBMD which leads to lower bone strength.
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Affiliation(s)
- L T Ho-Pham
- Bone and Muscle Research Group & Faculty of Applied Sciences, Ton Duc Thang University, 19 Nguyen Huu Tho, Tan Phong, District 7, Ho Chi Minh City, 700000, Vietnam.
| | - P M N Chau
- Bone and Muscle Research Group & Faculty of Applied Sciences, Ton Duc Thang University, 19 Nguyen Huu Tho, Tan Phong, District 7, Ho Chi Minh City, 700000, Vietnam
| | - A T Do
- Bone and Muscle Research Group & Faculty of Applied Sciences, Ton Duc Thang University, 19 Nguyen Huu Tho, Tan Phong, District 7, Ho Chi Minh City, 700000, Vietnam
| | - H C Nguyen
- Bone and Muscle Research Group & Faculty of Applied Sciences, Ton Duc Thang University, 19 Nguyen Huu Tho, Tan Phong, District 7, Ho Chi Minh City, 700000, Vietnam
| | - T V Nguyen
- Bone and Muscle Research Group & Faculty of Applied Sciences, Ton Duc Thang University, 19 Nguyen Huu Tho, Tan Phong, District 7, Ho Chi Minh City, 700000, Vietnam
- School of Biomedical Engineering, University of Technology Sydney (UTS), Sydney, Australia
- Bone Biology Division, Garvan Institute of Medical Research, Sydney, Australia
- St Vincent's Clinical School, UNSW Sydney, Sydney, Australia
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Chalhoub D, Boudreau R, Greenspan S, Newman AB, Zmuda J, Frank-Wilson AW, Nagaraj N, Hoffman AR, Lane NE, Stefanick ML, Barrett-Connor E, Dam T, Cawthon PM, Orwoll ES, Cauley JA. Associations Between Lean Mass, Muscle Strength and Power, and Skeletal Size, Density and Strength in Older Men. J Bone Miner Res 2018; 33:1612-1621. [PMID: 29701926 PMCID: PMC6266871 DOI: 10.1002/jbmr.3458] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 04/17/2018] [Accepted: 04/22/2018] [Indexed: 11/06/2022]
Abstract
Studies examining the relationship between muscle parameters and bone strength have not included multiple muscle measurements and/or both central and peripheral skeletal parameters. The purpose of this study was to explore the relationship between lean mass, muscle strength and power, and skeletal size, bone density, and bone strength. We studied the association between appendicular lean mass (ALM), grip strength, and leg power, and central quantitative computed tomography (QCT) parameters in 2857 men aged 65 years or older; peripheral QCT was available on a subset (n = 786). ALM, grip strength, and leg power were measured by dual-energy X-ray absorptiometry (DXA), Jamar dynamometer, and the Nottingham Power Rig, respectively. Multivariable models adjusting for potential confounders including age, race, study site, BMI, and muscle measurements were developed and least squares means were generated from linear regression models. For the multivariable model, percent differences of bone parameters between lowest (Q1) and highest quartiles (Q4) of ALM, grip strength, and leg power were reported. ALM was significantly associated with central and peripheral QCT parameters: percent higher values (Q4 versus Q1) ranging from 3.3% (cortical volumetric bone mineral density [vBMD] of the femoral neck) to 31% (vertebral strength index of the spine). Grip strength was only significantly associated with radial parameters: percent higher values (Q4 versus Q1) ranging from 2.5% (periosteal circumference) to 7.5% (33% axial strength index [SSIx]). Leg power was associated with vertebral strength and lower cross-sectional area with percent lower values (Q4 versus Q1) of -11.9% and -2.7%, respectively. In older men, stronger associations were observed for ALM compared to muscle strength and power. Longitudinal studies are needed to examine the relationship between independent changes in muscle measurements and skeletal size, density and strength. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Didier Chalhoub
- Intramural Research Program, Laboratory of Epidemiology, and Population Sciences, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Robert Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Susan Greenspan
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Joseph Zmuda
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew W Frank-Wilson
- Intramural Research Program, Laboratory of Epidemiology, and Population Sciences, National Institute on Aging, National Institutes of Health, Bethesda, MD, USA
| | - Nayana Nagaraj
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew R Hoffman
- Department of Endocrinology, Stanford University School of Medicine, CA, USA
| | - Nancy E Lane
- Center for Musculoskeletal Health, University of California, Davis School of Medicine, Davis, CA, USA
| | - Marcia L Stefanick
- Department of Endocrinology, Stanford University School of Medicine, CA, USA
| | - Elizabeth Barrett-Connor
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Tien Dam
- Division of Epidemiology, Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, CA, USA.,Division of Geriatrics and Aging, Columbia University, New York, NY, USA
| | - Peggy M Cawthon
- Research Institute, San Francisco Coordinating Center, California Pacific Medical Center, San Francisco, CA, USA
| | - Eric S Orwoll
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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Tack LJW, Craen M, Lapauw B, Goemaere S, Toye K, Kaufman JM, Vandewalle S, T'Sjoen G, Zmierczak HG, Cools M. Proandrogenic and Antiandrogenic Progestins in Transgender Youth: Differential Effects on Body Composition and Bone Metabolism. J Clin Endocrinol Metab 2018; 103:2147-2156. [PMID: 29672753 DOI: 10.1210/jc.2017-02316] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 04/11/2018] [Indexed: 02/13/2023]
Abstract
CONTEXT Progestins can be used to attenuate endogenous hormonal effects in late-pubertal transgender (trans) adolescents (Tanner stage B4/5 and G4/5). Currently, no data are available on the effects of progestins on the development of bone mass or body composition in trans youth. OBJECTIVE To study prospectively the evolution of body composition and bone mass in late-pubertal trans adolescents using the proandrogenic or antiandrogenic progestins lynestrenol (L) and cyproterone acetate (CA), respectively. DESIGN AND OUTCOME MEASUREMENTS Forty-four trans boys (Tanner B4/5) and 21 trans girls (Tanner G4/5) were treated with L or CA for 11.6 (4 to 40) and 10.6 (5 to 31) months, respectively. Anthropometry, grip strength, body composition, and bone mass, size, and density were determined by dual-energy X-ray absorptiometry and peripheral quantitative computed tomography before the start of progestin and before addition of cross-sex hormones. RESULTS Using L, lean mass [+3.2 kg (8.6%)] and grip strength [+3 kg (10.6%)] significantly increased, which coincided with a more masculine body shape in trans boys. Trans girls showed loss of lean mass [-2.2 kg (4.7%)], gain of fat mass [+1.5 kg (9.4%)], and decreased grip strength Z scores. CA limited normal bone expansion and impeded pubertal bone mass accrual, mostly at the lumbar spine [Z score: -0.765 to -1.145 (P = 0.002)]. L did not affect physiological bone development. CONCLUSION Proandrogenic and antiandrogenic progestins induce body composition changes in line with the desired appearance within 1 year of treatment. Bone health, especially at the lumbar spine, is of concern in trans girls, as bone mass accrual is severely affected by androgen suppressive therapy.
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Affiliation(s)
- Lloyd J W Tack
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Margarita Craen
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Bruno Lapauw
- Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Stefan Goemaere
- Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Kaatje Toye
- Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Jean-Marc Kaufman
- Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Sara Vandewalle
- Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Guy T'Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Hans-Georg Zmierczak
- Department of Endocrinology, Ghent University Hospital, Ghent University, Ghent, Belgium
- Unit for Osteoporosis and Metabolic Bone Diseases, Department of Internal Medicine, Ghent University Hospital, Ghent, Belgium
| | - Martine Cools
- Division of Pediatric Endocrinology, Department of Pediatrics, Ghent University Hospital, Ghent University, Ghent, Belgium
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Biver E, Durosier-Izart C, Chevalley T, van Rietbergen B, Rizzoli R, Ferrari S. Evaluation of Radius Microstructure and Areal Bone Mineral Density Improves Fracture Prediction in Postmenopausal Women. J Bone Miner Res 2018; 33:328-337. [PMID: 28960489 DOI: 10.1002/jbmr.3299] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/10/2022]
Abstract
A majority of low-trauma fractures occur in subjects with only moderate decrease of areal bone mineral density (aBMD), ie, osteopenia, assessed by dual-energy X-ray absorptiometry (DXA) or low fracture probability assessed by FRAX. We investigated whether peripheral bone microstructure and estimated strength improve the prediction of incident fractures beyond central DXA and FRAX. In this population-based study of 740 postmenopausal women (aged 65.0 ± 1.4 years) from the Geneva Retirees Cohort (ISRCTN registry 11865958), we assessed at baseline cortical (Ct) and trabecular (Tb) volumetric bone mineral density (vBMD) and microstructure by peripheral quantitative computed tomography (HR-pQCT); bone strength by micro-finite element analysis; aBMD and trabecular bone score (TBS) by DXA; and FRAX fracture probability. Eighty-five low-trauma fractures occurred in 68 women over a follow-up of 5.0 ± 1.8 years. Tb and Ct vBMD and microstructure predicted incident fractures, independently of each other and of femoral neck (FN) aBMD and FRAX (with BMD ± TBS). However, the associations were markedly attenuated after adjustment for ultra-distal radius aBMD (same bone site). The best discrimination between women with and without fracture was obtained at the radius with total vBMD, the combination of a Tb with a Ct parameter, or with failure load, which improved the area under the curve (AUC) for major osteoporotic fracture when added to FN aBMD (0.760 versus 0.695, p = 0.022) or to FRAX-BMD (0.759 versus 0.714, p = 0.015). The replacement of failure load by ultra-distal aBMD did not significantly decrease the AUC (0.753, p = 0.747 and 0.750, p = 0.509, respectively). In conclusion, peripheral bone microstructure and strength improve the prediction of fractures beyond central DXA and FRAX but are partially captured in aBMD measured by DXA at the radius. Because HR-pQCT is not widely available for clinical purposes, assessment of ultra-distal radius aBMD by DXA may meanwhile improve fracture risk estimation. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Emmanuel Biver
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Claire Durosier-Izart
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Thierry Chevalley
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Bert van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Serge Ferrari
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Jiang H, Yates CJ, Gorelik A, Kale A, Song Q, Wark JD. Peripheral Quantitative Computed Tomography (pQCT) Measures Contribute to the Understanding of Bone Fragility in Older Patients With Low-trauma Fracture. J Clin Densitom 2018; 21:140-147. [PMID: 28285742 DOI: 10.1016/j.jocd.2017.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/24/2017] [Accepted: 02/13/2017] [Indexed: 02/01/2023]
Abstract
Dual-energy X-ray absorptiometry (DXA) as currently used has limitations in identifying patients with osteoporosis and predicting occurrence of fracture. We aimed to express peripheral quantitative computed tomography (pQCT) variables of patients with low-trauma fracture as T-scores by using T-score scales obtained from healthy young women, and to evaluate the potential clinical utility of pQCT for the assessment of bone fragility. Fracture patients were recruited from a fracture liaison service at the Royal Melbourne Hospital. Reference pQCT data were obtained from studies on women's health conducted by our group. A study visit was arranged with fracture patients, during which DXA and pQCT were applied to measure their bone strength. A total of 59 fracture patients were recruited, and reference data were obtained from 78 healthy young females. All DXA variables and most pQCT variables were significantly different between healthy young females and fracture patients (p < 0.05), except polar stress-strain index (p = 0.34) and cortical bone density (p = 0.19). Fracture patients were divided into osteoporosis and non-osteoporosis groups according to their DXA T-scores. Significant differences were observed in most pQCT variables (p < 0.05), except trabecular area and cortical density (p > 0.9 and p = 0.5, respectively). By applying pQCT T-scores, 11 (27%) of patients who were classified as having low or medium risk of osteoporosis on DXA T-scores alone were reclassified as high risk. Results of logistic regression suggested trabecular bone density as an independent predictor of osteoporosis status. More patients can be identified with osteoporosis by applying pQCT T-score variables in older people with low-trauma fracture. Peripheral QCT T-scores contribute to the understanding of bone fragility in this population.
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Affiliation(s)
- Hongyuan Jiang
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Christopher J Yates
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Alexandra Gorelik
- Melbourne EpiCentre, University of Melbourne and Melbourne Health, Parkville, Victoria, Australia
| | - Ashwini Kale
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Qichun Song
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Department of Orthopaedics, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - John D Wark
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia; Bone and Mineral Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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Volumetric bone mineral density (vBMD), bone structure, and structural geometry among rural South Indian, US Caucasian, and Afro-Caribbean older men. Arch Osteoporos 2018; 13:60. [PMID: 29790041 PMCID: PMC5978815 DOI: 10.1007/s11657-018-0473-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 05/02/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED Peripheral quantitative computed tomography (pQCT) provides biomechanical estimates of bone strength. Rural South Indian men have reduced biomechanical indices of bone strength compared to US Caucasian and Afro-Caribbean men. This suggests an underlying higher risk of osteoporotic fractures and greater future fracture burden among the rural South Indian men. INTRODUCTION Geographical and racial comparisons of bone mineral density (BMD) have largely focused on DXA measures of areal BMD. In contrast, peripheral quantitative computed tomography (pQCT) measures volumetric BMD (vBMD), bone structural geometry and provides estimates of biomechanical strength. To further understand potential geographical and racial differences in skeletal health, we compared pQCT measures among US Caucasian, Afro-Caribbean, and rural South Indian men. METHODS We studied men aged ≥ 60 years enrolled in the Mobility and Independent Living among Elders Study (MILES) in rural south India (N = 245), Osteoporotic Fractures in Men Study (MrOS) in the US (N = 1148), and the Tobago Bone Health Study (N = 828). RESULTS The BMI (kg/m2) of rural South Indian men (21.6) was significantly lower compared to the US Caucasians (28) and Afro-Caribbean men (26.9). Adjusting for age, height, body weight, and grip strength; rural South Indian men compared to US Caucasians had significantly lower trabecular vBMD [- 1.3 to - 1.5 standard deviation (SD)], cortical thickness [- 0.8 to - 1.2 SD]; significantly higher endosteal circumference [0.5 to 0.8 SD]; but similar cortical vBMD. Afro-Caribbean men compared to US Caucasians had similar trabecular vBMD but significantly higher cortical vBMD [0.9 to 1.2 SD], SSIp [0.2 to 1.4 SD], and tibial endosteal circumference [1 SD], CONCLUSIONS: In comparison to US Caucasians, rural South Indian men have reduced bone strength (lower trabecular vBMD) and Afro-Caribbean men have greater bone strength (higher cortical vBMD). These results suggest an underlying higher risk of osteoporotic fractures and greater future fracture burden among rural South Indian men.
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Association between bone-specific physical activity scores and pQCT-derived measures of bone strength and geometry in healthy young and middle-aged premenopausal women. Arch Osteoporos 2018; 13:83. [PMID: 30056572 PMCID: PMC6096690 DOI: 10.1007/s11657-018-0495-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/14/2018] [Indexed: 02/03/2023]
Abstract
UNLABELLED The aim of this study was to determine if bone-specific physical activity questionnaire (BPAQ) scores were positively related to bone health in healthy young and middle-aged premenopausal women. The total BPAQ was a stronger predictor of bone strength and bone mineral density of hip in young women as compared to middle-aged premenopausal women. PURPOSE The purpose of this study was to determine whether the BPAQ scores were predictive indices of volumetric BMD (vBMD), bone strength, and bone geometry in young and middle-aged premenopausal women. METHODS Healthy young (n = 60) and middle-aged premenopausal women (n = 54) between the ages of 18 and 50 years were recruited for this study. Areal bone mineral density (aBMD) of lumbar spine and dual proximal femur (FN; femoral neck) was measured using DXA. We assessed vBMD of the tibia 4%, 38%, and 66% by peripheral quantitative computed tomography (pQCT). The BPAQ was used to obtain a comprehensive account of lifetime physical activity related to bone health. RESULTS Pearson's correlation tests showed positive correlations between total BPAQ and aBMD of the right FN (r = 0.313, p = 0.015) and the left FN (r = 0.307, p = 0.017) in young women while not found in middle-aged premenopausal women (p > 0.05). A positive relationship was only observed between total BPAQ and tibia 38% vBMD in middle-aged premenopausal women (r = 0.283, p = 0.038). All bone geometry variables were associated with total BPAQ (r = 0.280-0.422, p = 0.03-0.001) in young women. The Strength-Strain Index of tibia 38% (r = 0.350, p = 0.006) and 66% (r = 0.406, p = 0.001) was associated with total BPAQ in young women. In both young and middle-aged premenopausal women, when age, bone-free lean body mass (BFLBM), and total BPAQ were included in a stepwise multiple linear regression analysis, BFLBM was a significant predictor of all aBMD variables, accounting for 7-25.7% (p = 0.043-0.001). CONCLUSIONS The total BPAQ score-derived physical activity was more predictive of positive bone characteristics in young women than in middle-aged premenopausal women.
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Baker JF, Long J, Mostoufi-Moab S, Denburg M, Jorgenson E, Sharma P, Zemel BS, Taratuta E, Ibrahim S, Leonard MB. Muscle Deficits in Rheumatoid Arthritis Contribute to Inferior Cortical Bone Structure and Trabecular Bone Mineral Density. J Rheumatol 2017; 44:1777-1785. [PMID: 28916544 DOI: 10.3899/jrheum.170513] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is associated with muscle loss, osteoporosis, and fracture. We examined associations between skeletal muscle mass, strength, and quality and trabecular and cortical bone deficits in patients with RA and healthy controls. METHODS Participants, ages 18-75 years, completed whole-body dual-energy x-ray absorptiometry and peripheral quantitative computed tomography (pQCT) of the tibia to quantify appendicular lean mass and fat mass indices (ALMI, FMI), muscle density at the lower leg, trabecular bone density, and cortical bone thickness. Age-, sex-, and race-specific Z scores were calculated based on distributions in controls. Associations between body composition and pQCT bone outcomes were assessed in patients with RA and controls. Linear regression analyses assessed differences in bone outcomes after considering differences in body mass index (BMI) and body composition. RESULTS The sample consisted of 112 patients with RA (55 men) and 412 controls (194 men). Compared to controls, patients with RA had greater BMI Z score (p < 0.001), lower ALMI Z score after adjustment for FMI (p = 0.02), lower muscle strength Z score (p = 0.01), and lower muscle density Z score (p < 0.001). Among RA, ALMI Z scores were positively associated with trabecular density [β: 0.29 (0.062-0.52); p = 0.01] and cortical thickness [β: 0.33 (0.13-0.53; p = 0.002]. Associations were similar in controls. Bone outcomes were inferior in patients with RA after adjusting for BMI, but similar to controls when adjusting for body composition. Radiographic damage and higher adiponectin levels were independently associated with inferior bone outcomes. CONCLUSION Patients with RA exhibit deficits in cortical bone structure and trabecular density at the tibia and a preserved functional muscle-bone unit. A loss of mechanical loading may contribute to bone deficits.
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Affiliation(s)
- Joshua F Baker
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA. .,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University.
| | - Jin Long
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA.,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University
| | - Sogol Mostoufi-Moab
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA.,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University
| | - Michele Denburg
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA.,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University
| | - Erik Jorgenson
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA.,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University
| | - Prerna Sharma
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA.,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University
| | - Babette S Zemel
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA.,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University
| | - Elena Taratuta
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA.,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University
| | - Said Ibrahim
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA.,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University
| | - Mary B Leonard
- From the Division of Rheumatology, and Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center; Department of Epidemiology, Biostatistics, and Informatics, and the Department of Radiology, University of Pennsylvania; Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, Stanford University, Palo Alto, California, USA.,J.F. Baker, MD, MSCE, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center, Division of Rheumatology, and the Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; J. Long, PhD, Department of Pediatrics, Stanford University; S. Mostoufi-Moab, MD, MSCE, Department of Pediatrics, Children's Hospital of Philadelphia; M. Denburg, MD, MSCE, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania, Department of Pediatrics, and the Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia; E. Jorgenson, MPH, Department of Epidemiology, Biostatistics, and Informatics, University of Pennsylvania; P. Sharma, BA, Division of Rheumatology, Corporal Michael J. Crescenz VA Medical Center; B.S. Zemel, PhD, Department of Pediatrics, Children's Hospital of Philadelphia; E. Taratuta, MD, Department of Radiology, University of Pennsylvania; S. Ibrahim, MD, MPH, MBA, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; M.B. Leonard, MD, MSCE, Department of Pediatrics, Stanford University
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Hart N, Nimphius S, Rantalainen T, Ireland A, Siafarikas A, Newton R. Mechanical basis of bone strength: influence of bone material, bone structure and muscle action. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2017; 17:114-139. [PMID: 28860414 PMCID: PMC5601257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/19/2017] [Indexed: 11/09/2022]
Abstract
This review summarises current understanding of how bone is sculpted through adaptive processes, designed to meet the mechanical challenges it faces in everyday life and athletic pursuits, serving as an update for clinicians, researchers and physical therapists. Bone's ability to resist fracture under the large muscle and locomotory forces it experiences during movement and in falls or collisions is dependent on its established mechanical properties, determined by bone's complex and multidimensional material and structural organisation. At all levels, bone is highly adaptive to habitual loading, regulating its structure according to components of its loading regime and mechanical environment, inclusive of strain magnitude, rate, frequency, distribution and deformation mode. Indeed, the greatest forces habitually applied to bone arise from muscular contractions, and the past two decades have seen substantial advances in our understanding of how these forces shape bone throughout life. Herein, we also highlight the limitations of in vivo methods to assess and understand bone collagen, and bone mineral at the material or tissue level. The inability to easily measure or closely regulate applied strain in humans is identified, limiting the translation of animal studies to human populations, and our exploration of how components of mechanical loading regimes influence mechanoadaptation.
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Affiliation(s)
- N.H. Hart
- Exercise Medicine Research Institute, Edith Cowan University, Perth, W.A., Australia
- Western Australian Bone Research Collaboration, Perth, W.A., Australia
| | - S. Nimphius
- Western Australian Bone Research Collaboration, Perth, W.A., Australia
- Centre for Exercise and Sport Science Research, Edith Cowan University, Perth, W.A., Australia
| | - T. Rantalainen
- Western Australian Bone Research Collaboration, Perth, W.A., Australia
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| | - A. Ireland
- School of Healthcare Science, Manchester Metropolitan University, Manchester, United Kingdom
| | - A. Siafarikas
- Western Australian Bone Research Collaboration, Perth, W.A., Australia
- Department of Endocrinology, Princess Margaret Hospital, Perth, W.A., Australia
- School of Paediatrics and Child Health, University of Western Australia, Perth, W.A., Australia
- Institute of Health Research, University of Notre Dame Australia, Perth, W.A., Australia
| | - R.U. Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, W.A., Australia
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Wong AL, Meals CG, Ruff CB. Computed tomographic analysis of the internal structure of the metacarpals and its implications for hand use, pathology, and surgical intervention. Anat Sci Int 2017; 93:231-237. [PMID: 28341969 DOI: 10.1007/s12565-017-0400-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
The variation of bone structure and biomechanics between the metacarpals is not well characterized. It was hypothesized that their structure would reflect their common patterns of use (i.e., patterns of hand grip), specifically that trabecular bone density would be greater on the volar aspect of all metacarpal bases, that this would be most pronounced in the thumb, and that the thumb diaphysis would have the greatest bending strength. Cross-sections at basal and mid-diaphyseal locations of 50 metacarpals from 10 human hands were obtained by peripheral quantitative computed tomography. The volar and dorsal trabecular densities of each base were measured and characterized using the volar/dorsal density ratio. The polar stress-strain index (SSIp), a surrogate measure of torsional/bending strength, was measured for each diaphysis and standardized for bone length and mass. Comparisons were made using mixed-model analyses of variance (ANOVAs) and post hoc tests. Volar/dorsal trabecular density ratios showed even distribution in all metacarpal bases except for the thumb, which showed greater values on the volar aspect. The thumb, second, and third metacarpals all had high bending strength (SSIp), but the thumb's SSIp relative to its length and trabecular mass was much higher than those of the other metacarpals. Trabecular density of the metacarpal bases was evenly distributed except in the thumb, which also showed higher bending strength relative to its length and mass. Understanding of how these indicators of strength differ across metacarpals may improve both fracture diagnosis and treatment and lays the groundwork for investigating changes with age, hand dominance, and occupation.
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Affiliation(s)
- Alison L Wong
- Center for Bioengineering Innovation and Design, Johns Hopkins University, 3400 N. Charles Street, Clark Hall, Suite 200, Baltimore, MD, 21218, USA. .,Division of Plastic and Reconstructive Surgery, Dalhousie University, Room 4714 Halifax Infirmary Site, 1796 Summer Street, Halifax, NS, B3H 3A7, Canada.
| | - Clifton G Meals
- The Curtis National Hand Center, MedStar Union Memorial Hospital, 3333 North Calvert Street, Baltimore, MD, 21218, USA
| | - Christopher B Ruff
- Center for Functional Anatomy and Evolution, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Room 302, Baltimore, MD, 21205, USA
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Wong AKO. A Comparison of Peripheral Imaging Technologies for Bone and Muscle Quantification: a Mixed Methods Clinical Review. Curr Osteoporos Rep 2016; 14:359-373. [PMID: 27796924 DOI: 10.1007/s11914-016-0334-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Bone and muscle peripheral imaging technologies are reviewed for their association with fractures and frailty. A narrative systematized review was conducted for bone and muscle parameters from each imaging technique. In addition, meta-analyses were performed across all bone quality parameters. RECENT FINDINGS The current body of evidence for bone quality's association with fractures is strong for (high-resolution) peripheral quantitative computed tomography (pQCT), with trabecular separation (Tb.Sp) and integral volumetric bone mineral density (vBMD) reporting consistently large associations with various fracture types across studies. Muscle has recently been linked to fractures and frailty, but the quality of evidence remains weaker from studies of small sample sizes. It is increasingly apparent that musculoskeletal tissues have a complex relationship with interrelated clinical endpoints such as fractures and frailty. Future studies must concurrently address these relationships in order to decipher the relative importance of one causal pathway from another.
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Affiliation(s)
- Andy Kin On Wong
- Joint Department of Medical Imaging, Toronto General Research Institute, University Health Network, Toronto General Hospital, 200 Elizabeth St. 7EN-238, Toronto, ON, M5G 2C4, Canada.
- McMaster University, Department of Medicine, Faculty of Health Sciences, Hamilton, ON, Canada.
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48
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Bone mineral content and areal density, but not bone area, predict an incident fracture risk: a comparative study in a UK prospective cohort. Arch Osteoporos 2016; 11:39. [PMID: 27915448 PMCID: PMC5238932 DOI: 10.1007/s11657-016-0293-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/24/2016] [Indexed: 02/03/2023]
Abstract
UNLABELLED We studied a prospective UK cohort of women aged 20 to 80 years, assessed by dual-energy X-ray absorptiometry (DXA) at baseline. Bone mineral content (BMC) and areal bone mineral density (aBMD), but not bone area (BA), at femoral neck, lumbar spine and the whole body sites were similarly predictive of incident fractures. BACKGROUND Low aBMD, measured by DXA, is a well-established risk factor for future fracture, but little is known about the performance characteristics of other DXA measures such as BA and BMC in fracture prediction. We therefore investigated the predictive value of BA, BMC and aBMD for incident fracture in a prospective cohort of UK women. METHODS In this study, 674 women aged 20-80 years, recruited from four GP practices in Southampton, underwent DXA assessment (proximal femur, lumbar spine, total body) between 1991 and 1993. All women were contacted in 1998-1999 with a validated postal questionnaire to collect information on incident fractures and potential confounding factors including medication use. Four hundred forty-three women responded, and all fractures were confirmed by the assessment of images and radiology reports by a research nurse. Cox proportional hazard models were used to explore the risk of incident fracture, and the results are expressed as hazard ratio (HR) per 1 SD decrease in the predictor and 95% CI. Associations were adjusted for age, BMI, alcohol consumption, smoking, HRT, medications and history of fracture. RESULTS Fifty-five women (12%) reported a fracture. In fully adjusted models, femoral neck BMC and aBMD were similarly predictive of incident fracture. Femoral neck BMC: HR/SD = 1.64 (95%CI: 1.19, 2.26; p = 0.002); femoral neck aBMD: HR/SD = 1.76 (95%CI: 1.19, 2.60; p = 0.005). In contrast, femoral neck BA was not associated with incident fracture, HR/SD = 1.15 (95%CI: 0.88, 1.50; p = 0.32). Similar results were found with bone indices at the lumbar spine and the whole body. CONCLUSIONS In conclusion, BMC and aBMD appear to predict incident fracture with similar HR/SD, even after adjustment for body size. In contrast, BA only weakly predicted the future fracture. These findings support the use of DXA aBMD in fracture risk assessment, but also suggest that factors which specifically influence BMC will have a relevance to the risk of the incident fracture.
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Krishnasamy R, Hawley CM, Johnson DW. An update on bone imaging and markers in chronic kidney disease. Expert Rev Endocrinol Metab 2016; 11:455-466. [PMID: 30058917 DOI: 10.1080/17446651.2016.1239527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Bone disorders in chronic kidney disease (CKD) are associated with heightened risks of fractures, vascular calcification, poor quality of life and mortality compared to the general population. However, diagnosis and management of these disorders in CKD are complex and appreciably limited by current diagnostic modalities. Areas covered: Bone histomorphometry remains the gold standard for diagnosis but is not widely utilised and lacks feasibility as a monitoring tool. In practice, non-invasive imaging and biochemical markers are preferred to guide therapeutic decisions. Expert commentary: This review aims to summarize the risk factors for, and spectrum of bone disease in CKD, as well as appraise the clinical utility of dual energy X-ray densitometry, peripheral quantitative computed tomography, high-resolution peripheral quantitative computed tomography, and bone turnover markers.
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Affiliation(s)
- Rathika Krishnasamy
- a Department of Nephrology , Nambour General Hospital , Nambour , Australia
- c School of Medicine , The University of Queensland , Brisbane , Australia
| | - Carmel M Hawley
- b Department of Nephrology , Princess Alexandra Hospital , Brisbane , Australia
- c School of Medicine , The University of Queensland , Brisbane , Australia
- d Department of Nephrology , Translation Research Institute , Brisbane , Australia
| | - David W Johnson
- b Department of Nephrology , Princess Alexandra Hospital , Brisbane , Australia
- c School of Medicine , The University of Queensland , Brisbane , Australia
- d Department of Nephrology , Translation Research Institute , Brisbane , Australia
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Cheung AM, Frame H, Ho M, Mackinnon ES, Brown JP. Bone strength and management of postmenopausal fracture risk with antiresorptive therapies: considerations for women's health practice. Int J Womens Health 2016; 8:537-547. [PMID: 27729815 PMCID: PMC5047712 DOI: 10.2147/ijwh.s112621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Bone strength – and, hence, fracture risk – reflects the structural and material properties of the skeleton, which changes with bone turnover during aging and following effective pharmacotherapy. A variety of powerful new techniques (quantitative computed tomography, as well as peripheral quantitative computed tomography and high-resolution peripheral quantitative computed tomography) provide precise images of bone structure and can be used to model the response of specific bones to different types of mechanical load. This review explores the various components of bone strength and the clinical significance of measures, such as bone mineral density, bone turnover markers, and modern imaging data, with regard to fracture risk in women with postmenopausal osteoporosis, before and after initiating antiresorptive therapy. These imaging and related techniques offer an ever-clearer picture of the changes in bone structure and bone mineral metabolism during normal aging and in osteoporosis, as well as in response to treatment. However, because the newer techniques are not yet available in routine practice, validated tools for absolute fracture risk assessment remain essential for clinical decision making. These tools, which are tailored to patient risk data in individual countries, are based on bone mineral density and other readily available clinical data. In addition, bone turnover marker measurements can be useful in assessing risk and guiding treatment decisions for women with postmenopausal osteoporosis. Such tests may be used before starting a patient on antiresorptive therapy and for ongoing monitoring of treatment effectiveness.
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Affiliation(s)
- Angela M Cheung
- Department of Medicine, University of Toronto; Centre of Excellence in Skeletal Health Assessment, Joint Department of Medical Imaging, University Health Network (UHN); Mount Sinai Hospital, University of Toronto, Toronto, ON
| | | | | | | | - Jacques P Brown
- Rheumatology Division, CHU de Québec Research Centre, Laval University, Quebec City, QC, Canada
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