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Wáng YXJ, Blake GM, Xiao BH, Guglielmi G, Su Y, Jiang Y, Guermazi A, Kwok TCY, Griffith JF. East Asians' T-scores for the diagnosis of osteoporosis should be calculated using ethnicity- and gender-specific BMD reference ranges: justifications. Skeletal Radiol 2024; 53:409-417. [PMID: 37566149 DOI: 10.1007/s00256-023-04423-3] [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: 06/19/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
The 2013 ISCD consensus recommended a Caucasian female reference database for T-score calculation in men, which says "A uniform Caucasian (non-race adjusted) female reference database should be used to calculate T-scores for men of all ethnic groups." However, this statement was recommended for the US population, and no position was taken with respect to BMD reference data or ethnicity matching outside of the USA. In East Asia, currently, a Japanese BMD reference database is universally adopted in Japan for clinical DXA diagnosis, while both local BMD and Caucasian BMD reference databases are in use in Mainland China, South Korea, Taiwan, and Singapore. In this article, we argue that an ethnicity- and gender-specific BMD database should be used for T-score calculations for East Asians, and we list the justifications why we advocate so. Use of a Caucasian BMD reference database leads to systematically lower T-scores for East Asians and an overestimation of the prevalence of osteoporosis. Using a female BMD reference database to calculate T-scores for male patients leads to higher T-score values and an underestimation of the prevalence of osteoporosis. Epidemiological evidence does not support using a female BMD reference database to calculate T-scores for men. We also note that BMD reference databases collected in Asia should be critically evaluated for their quality.
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Affiliation(s)
- Yi Xiang J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China.
| | - Glen M Blake
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, London, UK
| | - Ben-Heng Xiao
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Giuseppe Guglielmi
- Radiology Unit, Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
- Department of Radiology, Scientific Institute "Casa Sollievo della Sofferenza" Hospital, San Giovanni Rotondo, Italy
| | - Yi Su
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, Hunan, China
| | - Yebin Jiang
- VA Healthcare System, University of Michigan, Ann Arbor, MI, USA
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Timothy C Y Kwok
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
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Xing W, Liang L, Dong N, Chen L, Liu Z. Abnormal changes of bone metabolism markers with age in children with cerebral palsy. Front Pediatr 2023; 11:1214608. [PMID: 37593441 PMCID: PMC10427878 DOI: 10.3389/fped.2023.1214608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Cerebral palsy (CP) is a broad range of diseases with permanent and nonprogressive motor impairments, carrying a high cost for both the individual and the society. The characteristics of low bone mineral density and high risk of fractures suggest that bone metabolism disorders are present in CP. This study aims to investigate the association between indicators of bone metabolism and children with CP. A total of 139 children (75 children with CP and 64 healthy controls) were included in this cross-sectional study. Participants were divided into three age groups (0-2 years, 2.1-4 years, and 4.1-7 years). All children with CP were diagnosed according to clinical criteria and furtherly divided into clinical subtypes. The levels of total procollagen type I N-terminal propeptide (TPINP), N-MID osteocalcin (OC), beta-crosslaps (β-CTX), 25-hydroxyvitamin D (25-OHD) and parathyroid hormone (PTH) in the serum were measured with corresponding detection kits according to the manufacturer's instructions. Serum levels of TPINP and 25-OHD were lower with older age, whereas β-CTX and PTH were higher with older age. In the CP group, TPINP (age 0-2 years and 2.1-4 years) and OC (age 2.1-4 years) levels were higher, while β-CTX (age 2.1-4 years and 4.1-7 years) and PTH (age 2.1-4 years) values were lower than the control group. In addition, there were no statistically significant differences in the levels of these indicators among the CP subgroups with different clinical characteristics. Our study shows that bone turnover markers, indicators of bone metabolism, in children with CP differ significantly from healthy controls. The indicators we studied changed with age, and they did not correlate with disease severity.
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Affiliation(s)
| | | | | | | | - Zhizhong Liu
- Department of Clinical Laboratory, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, China
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Change in vertebral strength and bone mineral density in men and women over the year post-hip fracture: a subgroup analysis. Arch Osteoporos 2021; 16:37. [PMID: 33619589 PMCID: PMC8183184 DOI: 10.1007/s11657-021-00907-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 02/05/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study examines changes in bone density and strength in the spine over the year after hip fracture to see if there are differences in the changes between men and women. Results show losses in the spine that may increase the risk of subsequent vertebral fractures, particularly for women. PURPOSE Compare changes over the first year post-hip fracture in vertebral bone mineral density (BMD) and compressive strength, measured from quantitative computed tomography (QCT) scans of the spine (T12-L1), between women and men. METHODS QCT scans were performed on 37 participants (21 men and 16 women) at 2 and 12 months post-hip fracture as part of an ancillary observational study of hip fracture recovery in older community-dwelling men and women. Vertebral BMD and compressive strength were calculated using VirtuOst® (O.N. Diagnostics, Berkeley, CA). Unpaired t-tests were used to compare men and women with respect to baseline demographics, measurements of BMD and bone strength for the whole vertebra and the cortical and trabecular compartments, and any changes in these parameters between months 2 and 12. RESULTS At 2 months post-fracture, there were no significant sex differences in any measurements of vertebral strength or BMD. Between months 2 and 12, vertebral strength decreased significantly in women (- 3.8%, p < 0.05) but not in men (- 2.3%, p < 0.20), vertebral trabecular BMD decreased similarly in both sexes (- 5.7% women; - 6.0% men), but cortical BMD did not change for either sex. CONCLUSION Despite the small sample size, these findings suggest that appreciable loss of vertebral trabecular bone can occur for both sexes in the year following hip fracture, which may increase the risk of subsequent vertebral fracture, particularly for women.
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Parker DC, Colόn-Emeric C, Huebner JL, Chou CH, Kraus VB, Pieper CF, Sloane R, Whitson HE, Orwig D, Crabtree DM, Magaziner J, Bain JR, Muehlbauer M, Ilkayeva OR, Huffman KM. Biomarkers Associated with Physical Resilience After Hip Fracture. J Gerontol A Biol Sci Med Sci 2020; 75:e166-e172. [PMID: 32386291 PMCID: PMC7518564 DOI: 10.1093/gerona/glaa119] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Clinically similar older adults demonstrate variable responses to health stressors, heterogeneity attributable to differences in physical resilience. However, molecular mechanisms underlying physical resilience are unknown. We previously derived a measure of physical resilience after hip fracture-the expected recovery differential (ERD)-that captures the difference between actual recovery and predicted recovery. Starting with biomarkers associated with physical performance, morbidity, mortality, and hip fracture, we evaluated associations with the ERD to identify biomarkers of physical resilience after hip fracture. METHODS In the Baltimore Hip Studies (N = 304) sera, we quantified biomarkers of inflammation (TNFR-I, TNFR-II, sVCAM-1, and IL-6), metabolic and mitochondrial function (non-esterified fatty acids, lactate, ketones, acylcarnitines, free amino acids, and IGF-1), and epigenetic dysregulation (circulating microRNAs). We used principal component analysis, canonical correlation, and least absolute shrinkage and selection operator regression (LASSO) to identify biomarker associations with better-than-expected recovery (greater ERD) after hip fracture. RESULTS Participants with greater ERD were more likely to be women and less disabled at baseline. The complete biomarker set explained 37% of the variance in ERD (p < .001) by canonical correlation. LASSO regression identified a biomarker subset that accounted for 27% of the total variance in the ERD and included a metabolic factor (aspartate/asparagine, C22, C5:1, lactate, glutamate/mine), TNFR-I, miR-376a-3p, and miR-16-5p. CONCLUSIONS We identified a set of biomarkers that explained 27% of the variance in ERD-a measure of physical resilience after hip fracture. These ERD-associated biomarkers may be useful in predicting physical resilience in older adults facing hip fracture and other acute health stressors.
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Affiliation(s)
- Daniel C Parker
- Division of Geriatrics, Duke University School of Medicine, Durham, North Carolina,Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
| | - Cathleen Colόn-Emeric
- Division of Geriatrics, Duke University School of Medicine, Durham, North Carolina,Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina,Address correspondence to: Cathleen Colón-Emeric, MD, MHS, Box 3003 DUMC, Durham, NC 27710. E-mail
| | - Janet L Huebner
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Ching-Heng Chou
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Virginia Byers Kraus
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina,Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina,Department of Biostatistics, Duke University School of Medicine, Durham, North Carolina
| | - Carl F Pieper
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Richard Sloane
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
| | - Heather E Whitson
- Division of Geriatrics, Duke University School of Medicine, Durham, North Carolina,Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina,Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Denise Orwig
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Donna M Crabtree
- Duke Office of Clinical Research, Duke University Medical Center, Durham, North Carolina
| | - Jay Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - James R Bain
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Michael Muehlbauer
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Olga R Ilkayeva
- Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina
| | - Kim M Huffman
- Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina,Duke University School of Medicine, Duke Molecular Physiology Institute, Durham, North Carolina,Division of Rheumatology, Duke University School of Medicine, Durham, North Carolina
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Saribal D, Hocaoglu-Emre FS, Erdogan S, Bahtiyar N, Caglar Okur S, Mert M. Inflammatory cytokines IL-6 and TNF-α in patients with hip fracture. Osteoporos Int 2019; 30:1025-1031. [PMID: 30701344 DOI: 10.1007/s00198-019-04874-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/22/2019] [Indexed: 12/24/2022]
Abstract
UNLABELLED Mortality and remaining bedridden following the hip fracture surgery are not rare. We tried to measure the levels of inflammatory markers tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) following the hip fracture surgery and compare their levels with controls. We aimed to show a relationship between the levels of these markers and post-operative mortality and walking capability. INTRODUCTION Osteoporosis is a condition, causing the hip fractures in the elderly. Hip fractures have a high rate of overall mortality up to 30% following the incident. Cytokines such as IL-6 and TNF-α are suggested to play a role in bone resorption and, thus, in the etiology of osteoporosis. METHODS Plasma levels of IL-6 and TNF-α were measured pre-operatively and on the first and second days after the surgery in 40 Turkish hip fracture patients. The levels of these cytokines were compared with 40 Turkish age-matched healthy controls. The levels of these cytokines were compared between the deceased and surviving patients, as well as the existence of walking capability following the surgery. RESULTS Significantly higher IL-6 levels were shown on the first and second days after the surgery (p = 0.005; p = 0.01, respectively). The overall death rate of our study group within the 2-year follow-up time was found to be 35%. No statistical significance was found in the means of 2-year follow-up mortality between the patients. Presence of walking capability did not differ between the patients, as well. CONCLUSION We demonstrated an association between IL-6 levels and hip fracture in our study group following the surgery. We also suggest that TNF-α and IL-6 levels are not related to the occurrence of death and walking capability after the surgery. However, these findings need further functional and clinical confirmation.
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Affiliation(s)
- D Saribal
- Department of Biophysics, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - F S Hocaoglu-Emre
- Department of Nutrition and Dietetics, Beykent University, Istanbul, Turkey.
| | - S Erdogan
- Department of Orthopedic Surgery, Istanbul Metin Sabanci Baltalimanı Training and Research Hospital for Bone Diseases, Istanbul, Turkey
| | - N Bahtiyar
- Department of Biophysics, Istanbul University Cerrahpaşa Medical Faculty, Istanbul, Turkey
| | - S Caglar Okur
- Department of Physical Treatment and Rehabilitation, Bakirkoy Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - M Mert
- Department of Orthopedic Surgery, Yeniyuzyil University Medical School, Istanbul, Turkey
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