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Gandham A, Gregori G, Johansson L, Larsson BAM, Johansson H, Harvey NC, Vandenput L, McCloskey E, Kanis JA, Litsne H, Axelsson K, Lorentzon M. Sarcopenia definitions and their association with injurious falls in older Swedish women from the Sahlgrenska University Hospital Prospective Evaluation of Risk of Bone fractures (SUPERB) study. Osteoporos Int 2024:10.1007/s00198-024-07196-0. [PMID: 39105786 DOI: 10.1007/s00198-024-07196-0] [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: 03/01/2024] [Accepted: 07/15/2024] [Indexed: 08/07/2024]
Abstract
Associations between different sarcopenia definitions and the risk of injurious falls were investigated in 75-80-year-old women in the Swedish SUPERB cohort. Only sarcopenia according to the Sarcopenia Definitions and Outcomes Consortium (SDOC) definition was associated with incident injurious falls with and without fractures in older women. PURPOSE To investigate the association between three commonly used sarcopenia definitions and the risk of injurious falls in a population of older Swedish women. METHODS A total of 2,883 75-80-year-old women with complete data on relevant sarcopenia definitions from the Swedish SUPERB cohort were studied. Sarcopenia was defined based on the Sarcopenia Definitions and Outcomes Consortium (SDOC: low handgrip strength and gait speed), revised European Working Group on Sarcopenia in Older People (EWGSOP2: low appendicular lean mass index (ALMI, dual-energy X-ray absorptiometry (DXA)-derived), appendicular lean mass (kg)/height (m2), hand grip strength (kg), or low chair stand time (s)), and Asian Working Group for Sarcopenia (AWGS: low ALMI and hand grip strength (kg) or low gait speed (m/s)). Questionnaires captured the occurrence of falls in the past 12 months. Incident injurious falls were identified using national registers. Cox regression (hazard ratios (HR) and 95% confidence intervals (CI)) analyses were performed without adjustment and after adjustment for age, body mass index, previous falls, and the Charlson comorbidity index. RESULTS During a median (IQR) follow-up time of 7.06 (6.2-7.9) years, there were 491 injurious falls without fracture and 962 injurious falls when also including falls resulting in a fracture. Sarcopenia according to EWGSOP2 and AWGS was not associated with an increased risk of injurious falls. Individuals with sarcopenia defined by SDOC had a higher risk of injurious falls with and without fracture (HR 2.11; 95% CI, 1.63-2.73 and HR, 2.16; 95% CI, 1.55-3.02, respectively). CONCLUSION Sarcopenia definitions confined to muscle function and strength such as SDOC, rather than including DXA-determined ALMI (EWGSOP2 and AWGS), are associated with incident injurious falls with and without fractures in older women.
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Affiliation(s)
- Anoohya Gandham
- Mary MacKillop Institute for Health Research, Australian Catholic University, Victoria, 3000, Australia.
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia.
| | - Giulia Gregori
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Lisa Johansson
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Berit A M Larsson
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Sisjön Health Centre, Sisjön, Sweden
| | - Helena Johansson
- Mary MacKillop Institute for Health Research, Australian Catholic University, Victoria, 3000, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Liesbeth Vandenput
- Mary MacKillop Institute for Health Research, Australian Catholic University, Victoria, 3000, Australia
| | - Eugene McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - John A Kanis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Victoria, 3000, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - Henrik Litsne
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Kristian Axelsson
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- n Västra Götaland, Geriatric Medicine, Institute of, Regio, Medicine, Sahlgrenska University Hospital, Building K, 6Th Floor, 431 80, Mölndal, Sweden
| | - Mattias Lorentzon
- Mary MacKillop Institute for Health Research, Australian Catholic University, Victoria, 3000, Australia.
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
- Region Västra Götaland, Geriatric Medicine, Institute of Medicine, Sahlgrenska University Hospital, Building K, 6Th Floor, 431 80, Mölndal, Sweden.
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Westbury LD, Harvey NC, Beaudart C, Bruyère O, Cauley JA, Cawthon P, Cruz-Jentoft AJ, Curtis EM, Ensrud K, Fielding RA, Johansson H, Kanis JA, Karlsson MK, Lane NE, Lengelé L, Lorentzon M, McCloskey E, Mellström D, Newman AB, Ohlsson C, Orwoll E, Reginster JY, Ribom E, Rosengren BE, Schousboe JT, Dennison EM, Cooper C. Predictive value of sarcopenia components for all-cause mortality: findings from population-based cohorts. Aging Clin Exp Res 2024; 36:126. [PMID: 38842791 PMCID: PMC11156728 DOI: 10.1007/s40520-024-02783-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/21/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Low grip strength and gait speed are associated with mortality. However, investigation of the additional mortality risk explained by these measures, over and above other factors, is limited. AIM We examined whether grip strength and gait speed improve discriminative capacity for mortality over and above more readily obtainable clinical risk factors. METHODS Participants from the Health, Aging and Body Composition Study, Osteoporotic Fractures in Men Study, and the Hertfordshire Cohort Study were analysed. Appendicular lean mass (ALM) was ascertained using DXA; muscle strength by grip dynamometry; and usual gait speed over 2.4-6 m. Verified deaths were recorded. Associations between sarcopenia components and mortality were examined using Cox regression with cohort as a random effect; discriminative capacity was assessed using Harrell's Concordance Index (C-index). RESULTS Mean (SD) age of participants (n = 8362) was 73.8(5.1) years; 5231(62.6%) died during a median follow-up time of 13.3 years. Grip strength (hazard ratio (95% CI) per SD decrease: 1.14 (1.10,1.19)) and gait speed (1.21 (1.17,1.26)), but not ALM index (1.01 (0.95,1.06)), were associated with mortality in mutually-adjusted models after accounting for age, sex, BMI, smoking status, alcohol consumption, physical activity, ethnicity, education, history of fractures and falls, femoral neck bone mineral density (BMD), self-rated health, cognitive function and number of comorbidities. However, a model containing only age and sex as exposures gave a C-index (95% CI) of 0.65(0.64,0.66), which only increased to 0.67(0.67,0.68) after inclusion of grip strength and gait speed. CONCLUSIONS Grip strength and gait speed may generate only modest adjunctive risk information for mortality compared with other more readily obtainable risk factors.
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Affiliation(s)
- Leo D Westbury
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Charlotte Beaudart
- Department of Biomedical Sciences, Clinical Pharmacology and Toxicology Research Unit, Namur Research Institute for Life Sciences (NARILIS), Faculty of Medicine, University of Namur, 5000, Namur, Belgium
| | - Olivier Bruyère
- Division of Epidemiology, Public Health and Health Economics, Department of Public Health, University of Liège, Liège, Belgium
| | - Jane A Cauley
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peggy Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | | | - Elizabeth M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Kristine Ensrud
- Medicine and Epidemiology & Community Health, University of Minnesota, Minnesota, USA
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center On Aging, Tufts University, Boston, USA
| | - Helena Johansson
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - John A Kanis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmo, Lund University and Department of Orthopedics, Skane University Hospital, Malmo, Sweden
| | - Nancy E Lane
- Division of Rheumatology, Department of Internal Medicine, UC Davis Health, 4625 Second Avenue, Sacramento, CA, 95917, USA
| | - Laetitia Lengelé
- Metabolism and Nutrition Research Group, Louvain Drug Research Institute, UCLouvain, Université catholique de Louvain, 1200 Sint-Lambrechts-Woluwe, Belgium
| | - Mattias Lorentzon
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Center for Osteoporosis Research, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Eugene McCloskey
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - Dan Mellström
- Centre for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anne B Newman
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Claes Ohlsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Drug Treatment, Gothenburg, Sweden
| | - Eric Orwoll
- Oregon Health & Science University, Portland, Oregon, USA
| | - Jean-Yves Reginster
- Protein Research Chair, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Eva Ribom
- Department of Surgical Sciences, University of Uppsala, Uppsala, Sweden
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmo, Lund University and Department of Orthopedics, Skane University Hospital, Malmo, Sweden
| | - John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, Bloomington, Minnesota, USA
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Victoria University of Wellington, Wellington, New Zealand
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
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Buitrago-Restrepo CM, Patiño-Villada FA, Arango-Paternina CM. Effects of Aquatic Exercise on Physical Performance in Older Adults: A Systematic Review and Meta-Analysis. J Aging Phys Act 2024:1-17. [PMID: 38710486 DOI: 10.1123/japa.2023-0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 01/15/2024] [Accepted: 03/05/2024] [Indexed: 05/08/2024]
Abstract
This systematic review aimed to evaluate the effects of aquatic exercise on physical performance in older adults. Databases were searched up to July 2021. Randomized controlled trials were screened by two reviewers, who extracted data and assessed study quality. Ten randomized controlled trials (603 participants) were included. Compared with nonexercising controls, aquatic exercise probably improved lower limb muscle power (30-s Chair Stand Test; mean difference 4.75 repetitions; 95% confidence interval [0.07, 9.42]; I2 = 99%; 251 participants; very low-quality evidence). When comparing aquatic exercise with land exercise, there is probably no superiority in favor of either intervention on dynamic balance (Timed Up and Go Test; mean difference -0.12 s; 95% confidence interval [-0.37, 0.12]; I2 = 3%; 244 participants; very low-quality evidence).
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Affiliation(s)
- Carlos Mario Buitrago-Restrepo
- Research Group on Physical Activity for Health (AFIS, in Spanish), University Institute of Physical Education and Sports, University of Antioquia, Medellín, Colombia
| | - Fredy Alonso Patiño-Villada
- Research Group on Physical Activity for Health (AFIS, in Spanish), University Institute of Physical Education and Sports, University of Antioquia, Medellín, Colombia
| | - Carlos Mario Arango-Paternina
- Research Group on Physical Activity for Health (AFIS, in Spanish), University Institute of Physical Education and Sports, University of Antioquia, Medellín, Colombia
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Gandham A, Gregori G, Johansson L, Johansson H, Harvey NC, Vandenput L, McCloskey E, Kanis JA, Litsne H, Axelsson K, Lorentzon M. Sarcopenia definitions and their association with fracture risk in older Swedish women. J Bone Miner Res 2024; 39:453-461. [PMID: 38477811 PMCID: PMC11262149 DOI: 10.1093/jbmr/zjae026] [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: 02/24/2023] [Revised: 01/18/2024] [Accepted: 01/25/2024] [Indexed: 03/14/2024]
Abstract
The purpose of this study was to investigate the prevalence of three sarcopenia definitions and their associations with fracture risk in older Swedish women when adjusted for fracture risk assessment (FRAX)-based risk factors; 2,883 women with a mean age of 77.8 years were included. Sarcopenia was defined based on the Sarcopenia Definitions and Outcomes Consortium (SDOC; low handgrip strength [kg] and gait speed (m/s)), revised European Working Group on Sarcopenia in Older People (EWGSOP2; low appendicular lean mass index, appendicular lean mass [ALM]/height; kg/m2], and hand grip strength [kg]), and Asian Working Group for Sarcopenia (AWGS; low ALM (kg), and hand grip strength [kg]) definitions. Femoral neck T-score was obtained from dual-energy X-ray absorptiometry. All fractures, confirmed by X-ray or medical record review, were subsequently categorized as major osteoporotic fractures (MOFs) and hip fractures. Deaths were verified through regional registers. The total follow-up time was 6.4 ± 1.3 (mean ± SD) yr. Cox regression (hazard ratios [HR] and 95% CIs) analyses were performed with adjustment for age, FRAX variables, and femoral neck T-score. Sarcopenia prevalence was 4.5% (n = 129) according to SDOC, 12.5% (n = 360) for EWGSOP2, and 10.3% (n = 296) defined by AWGS. Individuals with sarcopenia defined by SDOC had a higher mortality risk than individuals without sarcopenia (HR: 3.41; 95% CI: 2.51, 4.62) after adjusting for age and FRAX variables. Sarcopenia according to EWGSOP2 and AWGS was not associated with an increased fracture risk after adjusting for age and FRAX variables. Individuals with sarcopenia defined by SDOC had a higher risk for any fractures (HR: 1.48; 95% CI: 1.10, 1.99) and MOF (HR: 1.42; 95% CI: 1.03, 1.98) compared with individuals without sarcopenia after adjusting for clinical risk factors used in FRAX. In conclusion, sarcopenia defined by SDOC, incorporating muscle function/strength, was the only sarcopenia definition associated with fracture risk in older women.
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Affiliation(s)
- Anoohya Gandham
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria 3000, Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria 3168, Australia
| | - Giulia Gregori
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Goteborg 41345, Sweden
| | - Lisa Johansson
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Goteborg 41345, Sweden
- Region Västra Götaland, Department of Orthopedics, Sahlgrenska University Hospital, Mölndal 43180, Sweden
| | - Helena Johansson
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria 3000, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Goteborg 41345, Sweden
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, SO166YD, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO166YD, United Kingdom
| | - Liesbeth Vandenput
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria 3000, Australia
| | - Eugene McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, S10 2RX, UK
- MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, S10 2RX, UK
| | - John A Kanis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria 3000, Australia
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, SO166YD, United Kingdom
| | - Henrik Litsne
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Goteborg 41345, Sweden
| | - Kristian Axelsson
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Goteborg 41345, Sweden
- Region Västra Götaland, Närhälsan Norrmalm, Health Centre, Skövde 54940, Sweden
| | - Mattias Lorentzon
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Victoria 3000, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Goteborg 41345, Sweden
- Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, Mölndal 43180, Sweden
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Fan W, Zhong X, Wu Q, Zhang L, Yang Z, Gu Y, Guo Q, Chen X, Yu C, Zhang K, Ding W, Qi H, Zhao J, Zhang L, Zhang S, Niu J. Association between hearing loss and physical performance in patients on maintenance hemodialysis. Kidney Res Clin Pract 2024; 43:358-368. [PMID: 38148523 PMCID: PMC11181039 DOI: 10.23876/j.krcp.22.231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 05/18/2023] [Accepted: 06/20/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND The correlation between hearing loss (HL) and physical performance in patients receiving maintenance hemodialysis (MHD) remains poorly investigated. This study explored the association between HL and physical performance in patients on MHD. METHODS This multicenter cross-sectional study was conducted between July 2020 and April 2021 in seven hemodialysis centers in Shanghai and Suzhou, China. The hearing assessment was performed using pure-tone average (PTA). Physical performance was assessed using the Timed Up and Go Test (TUGT), handgrip strength, and gait speed. RESULTS Finally, 838 adult patients (male, 516 [61.6%]; 61.2 ± 2.6 years) were enrolled. Among them, 423 (50.5%) had mild to profound HL (male, 48.6% and female, 53.4%). Patients with HL had poorer physical performance than patients without HL (p < 0.001). TUGT was positively correlated with PTA (r = 0.265, p < 0.001), while handgrip strength and gait speed were negatively correlated with PTA (r = -0.356, p < 0.001 and r = -0.342, p < 0.001, respectively). Physical performance in patients aged <60 years showed significant dose-response relationships with HL. After adjusting for confounders, the odds ratios (95% confidence intervals) for HL across the TUGT quartiles (lowest to highest) were 1.00 (reference), 1.15 (0.73-1.81), 1.69 (1.07-2.70), and 2.87 (1.69-4.88) (p for trend = 0.005). CONCLUSION Lower prevalence of HL was associated with a faster TUGT and a stronger handgrip strength in patients on MHD.
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Affiliation(s)
- Weifeng Fan
- Department of Nephrology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Xiaojing Zhong
- Department of Nephrology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Qing Wu
- Department of Nephrology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Lihong Zhang
- Department of Nephrology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Zhenhao Yang
- Department of Nephrology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
| | - Yong Gu
- Department of Nephrology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
- Department of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qi Guo
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Xiaoyu Chen
- Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Chen Yu
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Kun Zhang
- Department of Nephrology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Ding
- Department of Nephrology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hualin Qi
- Department of Nephrology, Shanghai Pudong New Area People’s Hospital, Shanghai, China
| | - Junli Zhao
- Department of Nephrology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Liming Zhang
- Department of Nephrology, Shanghai Jing'an District Zhabei Central Hospital, Shanghai, China
| | - Suhua Zhang
- Department of Nephrology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Jiangsu, China
| | - Jianying Niu
- Department of Nephrology, Shanghai Fifth People’s Hospital, Fudan University, Shanghai, China
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Hassanabadi N, Berger C, Papaioannou A, Cheung AM, Rahme E, Leslie WD, Goltzman D, Morin SN. Geographic variation in bone mineral density and prevalent fractures in the Canadian longitudinal study on aging. Osteoporos Int 2024; 35:599-611. [PMID: 38040857 DOI: 10.1007/s00198-023-06975-5] [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: 04/25/2023] [Accepted: 11/08/2023] [Indexed: 12/03/2023]
Abstract
Awareness of the prevalence of osteoporosis and fractures across jurisdictions can guide the development of local preventive programs and healthcare policies. We observed geographical variations in total hip bone mineral density and in the prevalence of major osteoporotic fractures across Canadian provinces, which persisted after adjusting for important covariates. PURPOSE We aimed to describe sex-specific total hip bone mineral density (aBMD) and prevalent major osteoporotic fractures (MOF) variation between Canadian provinces. METHODS We used baseline data from 21,227 Canadians (10,716 women, 10,511 men) aged 50-85 years in the Canadian Longitudinal Study on Aging (CLSA; baseline: 2012-2015). Linear and logistic regression models were used to examine associations between province of residence and total hip aBMD and self-reported MOF, stratified by sex. CLSA sampling weights were used to generate the prevalence and regression estimates. RESULTS The mean (SD) age of participants was 63.9 (9.1) years. The mean body mass index (kg/m2) was lowest in British Columbia (27.4 [5.0]) and highest in Newfoundland and Labrador (28.8 [5.3]). Women and men from British Columbia had the lowest mean total hip aBMD and the lowest prevalence of MOF. Alberta had the highest proportion of participants reporting recent falls (12.0%), and Manitoba (8.4%) the fewest (p-value=0.002). Linear regression analyses demonstrated significant differences in total hip aBMD: women and men from British Columbia and Alberta, and women from Manitoba and Nova Scotia had lower adjusted total hip aBMD than Ontario (p-values<0.02). Adjusted odds ratios (95% confidence intervals, CI) for prevalent MOF were significantly lower in women from British Columbia (0.47 [95% CI: 0.32; 0.69]) and Quebec (0.68 [95% CI: 0.48; 0.97]) and in men from British Columbia (0.40 [95% CI:0.22; 0.71]) compared to Ontario (p-values<0.03). Results were similar when adjusting for physical performance measures and when restricting the analyses to participants who reported White race/ethnicity. CONCLUSION Geographical variations in total hip aBMD and in the prevalence of MOF between provinces persisted after adjusting for important covariates which suggests an association with unmeasured individual and environmental factors.
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Affiliation(s)
- N Hassanabadi
- Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - C Berger
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - A Papaioannou
- Department of Medicine, McMaster University, Hamilton, Canada
| | - A M Cheung
- Department of Medicine, University of Toronto, Toronto, Canada
| | - E Rahme
- Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - W D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - D Goltzman
- Department of Medicine, McGill University, Montreal, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada
| | - S N Morin
- Department of Medicine, McGill University, Montreal, Canada.
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve O; Room 3E.11, Montreal, Quebec, H4A 3S5, Canada.
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Vendrami C, Shevroja E, Gonzalez Rodriguez E, Gatineau G, Elmers J, Reginster J, Harvey NC, Lamy O, Hans D. Muscle parameters in fragility fracture risk prediction in older adults: A scoping review. J Cachexia Sarcopenia Muscle 2024; 15:477-500. [PMID: 38284511 PMCID: PMC10995267 DOI: 10.1002/jcsm.13418] [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: 09/05/2023] [Revised: 11/01/2023] [Accepted: 11/28/2023] [Indexed: 01/30/2024] Open
Abstract
Half of osteoporotic fractures occur in patients with normal/osteopenic bone density or at intermediate or low estimated risk. Muscle measures have been shown to contribute to fracture risk independently of bone mineral density. The objectives were to review the measurements of muscle health (muscle mass/quantity/quality, strength and function) and their association with incident fragility fractures and to summarize their use in clinical practice. This scoping review follows the PRISMA-ScR guidelines for reporting. Our search strategy covered the three overreaching concepts of 'fragility fractures', 'muscle health assessment' and 'risk'. We retrieved 14 745 references from Medline Ovid SP, EMBASE, Web of Science Core Collection and Google Scholar. We included original and prospective studies on community-dwelling adults aged over 50 years that analysed an association between at least one muscle parameter and incident fragility fractures. We systematically extracted 17 items from each study, including methodology, general characteristics and results. Data were summarized in tables and graphically presented in adjusted forest plots. Sixty-seven articles fulfilled the inclusion criteria. In total, we studied 60 muscle parameters or indexes and 322 fracture risk ratios over 2.8 million person-years (MPY). The median (interquartile range) sample size was 1642 (921-5756), age 69.2 (63.5-73.6) years, follow-up 10.0 (4.4-12.0) years and number of incident fragility fractures 166 (88-277). A lower muscle mass was positively/not/negatively associated with incident fragility fracture in 28 (2.0), 64 (2.5) and 10 (0.2 MPY) analyses. A lower muscle strength was positively/not/negatively associated with fractures in 53 (1.3), 57 (1.7 MPY) and 0 analyses. A lower muscle function was positively/not/negatively associated in 63 (1.9), 45 (1.0 MPY) and 0 analyses. An in-depth analysis shows how each single muscle parameter was associated with each fragility fractures subtype. This review summarizes markers of muscle health and their association with fragility fractures. Measures of muscle strength and function appeared to perform better for fracture risk prediction. Of these, hand grip strength and gait speed are likely to be the most practical measures for inclusion in clinical practice, as in the evaluation of sarcopenia or in further fracture risk assessment scores. Measures of muscle mass did not appear to predict fragility fractures and might benefit from further research, on D3-creatine dilution test, lean mass indexes and artificial intelligence methods.
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Affiliation(s)
- Colin Vendrami
- Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and JointLausanne University Hospital and University of LausanneLausanneSwitzerland
- Internal Medicine Unit, Department of Internal MedicineLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Enisa Shevroja
- Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and JointLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Elena Gonzalez Rodriguez
- Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and JointLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Guillaume Gatineau
- Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and JointLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Jolanda Elmers
- University Library of Medicine, Faculty of Biology and MedicineLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Jean‐Yves Reginster
- WHO Collaborating Center for Public Health Aspects of Musculo‐Skeletal Health and Ageing, Division of Public Health, Epidemiology and Health EconomicsUniversity of LiègeLiègeBelgium
| | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Olivier Lamy
- Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and JointLausanne University Hospital and University of LausanneLausanneSwitzerland
- Internal Medicine Unit, Department of Internal MedicineLausanne University Hospital and University of LausanneLausanneSwitzerland
| | - Didier Hans
- Interdisciplinary Center of Bone Diseases, Rheumatology Unit, Department of Bone and JointLausanne University Hospital and University of LausanneLausanneSwitzerland
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Schene MR, Wyers CE, Driessen JHM, Vranken L, Meijer K, van den Bergh JP, Willems HC. The "Can Do, Do Do" Framework Applied to Assess the Association between Physical Capacity, Physical Activity and Prospective Falls, Subsequent Fractures, and Mortality in Patients Visiting the Fracture Liaison Service. J Pers Med 2024; 14:337. [PMID: 38672964 PMCID: PMC11050804 DOI: 10.3390/jpm14040337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 04/28/2024] Open
Abstract
The "can do, do do" framework combines measures of poor and normal physical capacity (PC, measured by a 6 min walking test, can do/can't do) and physical activity (PA, measured by accelerometer, do do/don't do) into four domains and is able to categorize patient subgroups with distinct clinical characteristics, including fall and fracture risk factors. This study aims to explore the association between domain categorization and prospective fall, fracture, and mortality outcomes. This 6-year prospective study included patients visiting a Fracture Liaison Service with a recent fracture. Outcomes were first fall (at 3 years of follow-up, measured by fall diaries), first subsequent fracture, and mortality (at 6 years). Cumulative incidences of all three outcomes were calculated. The association between domain categorization and time to the three outcomes was assessed by uni- and multivariate Cox proportional hazard analysis with the "can do, do do" group as reference. The physical performance of 400 patients with a recent fracture was assessed (mean age: 64 years; 70.8% female), of whom 61.5%, 20.3%, and 4.9% sustained a first fall, sustained a subsequent fracture, or had died. Domain categorization using the "can do, do do" framework was not associated with time to first fall, subsequent fracture, or mortality in the multivariate Cox regression analysis for all groups. "Can't do, don't do" group: hazard ratio [HR] for first fall: 0.75 (95% confidence interval [CI]: 0.45-1.23), first fracture HR: 0.58 (95% CI: 0.24-1.41), and mortality HR: 1.19 (95% CI: 0.54-6.95). Categorizing patients into a two-dimensional framework seems inadequate to study complex, multifactorial outcomes. A personalized approach based on known fall and fracture risk factors might be preferable.
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Affiliation(s)
- Merle R. Schene
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- Internal Medicine and Geriatrics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Caroline E. Wyers
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Johanna H. M. Driessen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands
- Department of Clinical Pharmacy, CARIM School for Cardiovascular Research Institute Maastricht, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Lisanne Vranken
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
| | - Kenneth Meijer
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Nutrition and Movement Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Joop P. van den Bergh
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Center, P.O. Box 1926, 5900 BX Venlo, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Center+, P.O. Box 616, 6200 MD Maastricht, The Netherlands
| | - Hanna C. Willems
- Internal Medicine and Geriatrics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Bone Center, Amsterdam Movement Sciences, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
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9
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Ni Lochlainn M, Bowyer RCE, Moll JM, García MP, Wadge S, Baleanu AF, Nessa A, Sheedy A, Akdag G, Hart D, Raffaele G, Seed PT, Murphy C, Harridge SDR, Welch AA, Greig C, Whelan K, Steves CJ. Effect of gut microbiome modulation on muscle function and cognition: the PROMOTe randomised controlled trial. Nat Commun 2024; 15:1859. [PMID: 38424099 PMCID: PMC10904794 DOI: 10.1038/s41467-024-46116-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
Studies suggest that inducing gut microbiota changes may alter both muscle physiology and cognitive behaviour. Gut microbiota may play a role in both anabolic resistance of older muscle, and cognition. In this placebo controlled double blinded randomised controlled trial of 36 twin pairs (72 individuals), aged ≥60, each twin pair are block randomised to receive either placebo or prebiotic daily for 12 weeks. Resistance exercise and branched chain amino acid (BCAA) supplementation is prescribed to all participants. Outcomes are physical function and cognition. The trial is carried out remotely using video visits, online questionnaires and cognitive testing, and posting of equipment and biological samples. The prebiotic supplement is well tolerated and results in a changed gut microbiome [e.g., increased relative Bifidobacterium abundance]. There is no significant difference between prebiotic and placebo for the primary outcome of chair rise time (β = 0.579; 95% CI -1.080-2.239 p = 0.494). The prebiotic improves cognition (factor score versus placebo (β = -0.482; 95% CI,-0.813, -0.141; p = 0.014)). Our results demonstrate that cheap and readily available gut microbiome interventions may improve cognition in our ageing population. We illustrate the feasibility of remotely delivered trials for older people, which could reduce under-representation of older people in clinical trials. ClinicalTrials.gov registration: NCT04309292.
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Affiliation(s)
- Mary Ni Lochlainn
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK.
| | - Ruth C E Bowyer
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK
- The Alan Turing Institute, London, NW1 2DB, UK
| | | | - María Paz García
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK
| | - Samuel Wadge
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK
| | - Andrei-Florin Baleanu
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK
| | - Ayrun Nessa
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK
| | - Alyce Sheedy
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK
| | - Gulsah Akdag
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK
| | - Deborah Hart
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK
| | - Giulia Raffaele
- GKT School of Medical Education, King's College London, London, UK
| | - Paul T Seed
- Unit for Medical Statistics/Department for Women and Children's Health, School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Caroline Murphy
- King's Clinical Trials Unit, Research Management and Innovation Directorate, King's College London, London, UK
| | - Stephen D R Harridge
- Centre for Human & Applied Physiological Sciences, King's College London, London, UK
| | - Ailsa A Welch
- Department of Epidemiology and Public Health, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Carolyn Greig
- School of Sport, Exercise, and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Kevin Whelan
- King's College London, Department of Nutritional Sciences, Franklin Wilkins Building, SE1 9NH, London, UK
| | - Claire J Steves
- King's College London, Department of Twin Research and Genetic Epidemiology, London, SE1 7EH, UK.
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10
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Hämäläinen O, Tirkkonen A, Savikangas T, Alén M, Sipilä S, Hautala A. Low physical activity is a risk factor for sarcopenia: a cross-sectional analysis of two exercise trials on community-dwelling older adults. BMC Geriatr 2024; 24:212. [PMID: 38424514 PMCID: PMC10905947 DOI: 10.1186/s12877-024-04764-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Physical inactivity is an important factor in the development of sarcopenia. This cross-sectional study explores the prevalence of sarcopenia and associations of physical activity (PA) with sarcopenia in two exercise trial populations. These study groups are clinically meaningful community-dwelling populations at increased risk for sarcopenia: older adults not meeting the PA guidelines and those with a recent hip fracture (HF). METHODS Data from 313 older adults who did not meet the PA guidelines (60% women; age 74.5 ± 3.8, body mass index 27.9 ± 4.7) and 77 individuals with HF diagnosed on average 70 ± 28 days earlier (75% women; age 79.3 ± 7.1, body mass index 25.3 ± 3.6) were included in this study. Grip strength and muscle mass (Dual-energy X-ray absorptiometry [DXA] in older adults not meeting the PA guidelines and bioimpedance analysis in participants with HF) were used to assess sarcopenia according to the European Working Group in Older People 2019 (EWGSOP2) criteria. The current level of PA was self-reported using a question with seven response options in both study groups and was measured with a hip-worn accelerometer for seven consecutive days in older adults not meeting the PA guidelines. RESULTS The prevalence of sarcopenia and probable sarcopenia was 3% (n = 8) and 13% (n = 41) in the older adults not meeting the PA guidelines and 3% (n = 2) and 40% (n = 31) in the HF group, respectively. In the age- and sex-adjusted logistic regression model, the lowest levels of self-reported PA were associated with increased probable sarcopenia and sarcopenia risk in older adults not meeting the PA guidelines (OR 2.8, 95% CI, 1.3-6.1, p = 0.009) and in the HF group (OR 3.9, 95% CI, 1.4-11.3, p = 0.012). No significant associations between accelerometer-measured PA and probable sarcopenia or sarcopenia were found. CONCLUSIONS Probable sarcopenia is common among community-dwelling older adults not meeting the PA guidelines and very common among individuals recovering from HF who are able to be involved in exercise interventions. In addition, since low PA is associated with higher probable sarcopenia and sarcopenia risk, it is recommended to screen for sarcopenia and promote regular physical activity to prevent sarcopenia in these populations.
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Affiliation(s)
- Onni Hämäläinen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
- Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland.
| | - Anna Tirkkonen
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Tiina Savikangas
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Markku Alén
- Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland
| | - Sarianna Sipilä
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Gerontology Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Arto Hautala
- Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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11
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Su Y, Zhou B, Kwok T. Fracture risk prediction in old Chinese people-a narrative review. Arch Osteoporos 2023; 19:3. [PMID: 38110842 DOI: 10.1007/s11657-023-01360-5] [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: 07/31/2023] [Accepted: 12/01/2023] [Indexed: 12/20/2023]
Abstract
With aging, the burden of osteoporotic fracture (OF) increases substantially, while China is expected to carry the greatest part in the future. The risk of fracture varies greatly across racial groups and geographic regions, and systematically organized evidence on the potential predictors for fracture risk is needed for Chinese. This review briefly introduces the epidemiology of OF and expands on the predictors and predictive tools for the risk of OF, as well as the challenges for their potential translation in the old Chinese population. There are regional differences of fracture incidence among China. The fracture incidences in Hong Kong and Taiwan have decreased in recent years, while it is still increasing in mainland China. Although the application of dual-energy X-ray absorptiometry (DXA) is limited among old Chinese in the mainland, bone mineral density (BMD) by DXA has a predictive value similar to that worldwide. Other non-DXA modalities, especially heel QUS, are helpful in assessing bone health. The fracture risk assessment tool (FRAX) has a good discrimination ability for OFs, especially the FRAX with BMD. And some clinical factors have added value to FRAX, which has been verified in old Chinese. In addition, although the application of the osteoporosis self-assessment tool for Asians (OSTA) in Chinese needs further validation, it may help identify high-risk populations in areas with limited resources. Moreover, the translation use of the muscle quality and genetic or serum biomarkers in fracture prediction needs further works. More applicable and targeted fracture risk predictors and tools are still needed for the old Chinese population.
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Affiliation(s)
- Yi Su
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China
| | - Bei Zhou
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, 410013, Hunan, China
| | - Timothy Kwok
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China.
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, SAR, China.
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12
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Jia H, Qu W, Cai X, Li M, Qian Y, Jiang Z, Zhang Z. Assessment for bone health in patients with differentiated thyroid carcinoma after postoperative thyroid-stimulating hormone suppression therapy: a new fracture risk assessment algorithm. Front Endocrinol (Lausanne) 2023; 14:1286947. [PMID: 38075039 PMCID: PMC10698692 DOI: 10.3389/fendo.2023.1286947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
Purpose The fracture risk assessment tool (FRAX) is used to assess the 10-year risk of major site and hip fractures; however, whether this tool can be applied to patients receiving levothyroxine-based thyroid-stimulating hormone (TSH) suppressive therapy for postoperative differentiated thyroid cancer (DTC) patients is yet to be clarified. Methods and design A total of 64 patients with DTC following thyroidectomy and oral levothyroxine for TSH suppression therapy and 30 gender- and age-matched controls were collected. The fracture risk was compared between the affected groups with different TSH levels. FRAX was used to calculate the fracture risk with and without bone mineral density (BMD). The TSH level was converted to an age-weighted score to estimate the fracture risk of postoperatively differentiated thyroid cancer patients. The sensitivity, specificity, and area under the AUC curve of the traditional FRAX and the new algorithm for osteoporosis diagnosis were compared. The dual-energy X-ray bone mineral density measurement T score was used as the gold standard to diagnose osteoporosis. Results There were 24 patients in the T ≥ -1-2.5 group, 23 in the -2.5 < T < -1 group, and 17 in the T ≤ -2.5 group. The T score of BMD in the disease group was significantly lower than that in the control group (p < 0.05). The risk of MOF and hip fracture without a T score were significantly different under various TSH levels (p < 0.05). The area under the curve (AUC) of FRAX without BMD for predicting major osteoporotic fractures (PMOF) and major hip fractures (PHF) was 0.694 and 0.683, respectively. The cutoff values were 2.15% and 0.25%, respectively. The AUC of FRAX with BMD for PMOF and PHF was 0.976 and 0.989, respectively, and the cutoff values were 4.15% and 1.1%, respectively. The AUC of FRAX without BMD for PMOF and PHF was 0.708 and 0.72, respectively, and the cutoff values were 5.5% and 1.55%, respectively. Conclusions FRAX is suitable for postoperative DTC patients after TSH suppressive therapy. In the absence of BMD, TSH weighted by age can improve the specificity of FRAX in the diagnosis of osteoporosis in this population.
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Affiliation(s)
- Huiran Jia
- Endocrinology Department, Postgraduate Training Base of Jinzhou Medical University, Jinzhou, Liaoning, China
- Endocrinology Department, The 960th Hospital of the People’s Liberation Army Joint Logistics Support Force, Jinan, China
| | - Wei Qu
- Endocrinology Department, The 960th Hospital of the People’s Liberation Army Joint Logistics Support Force, Jinan, China
| | - Xiaoting Cai
- Endocrinology Department, Postgraduate Training Base of Jinzhou Medical University, Jinzhou, Liaoning, China
- Endocrinology Department, The 960th Hospital of the People’s Liberation Army Joint Logistics Support Force, Jinan, China
| | - Meiye Li
- Endocrinology Department, The 960th Hospital of the People’s Liberation Army Joint Logistics Support Force, Jinan, China
| | - Ying Qian
- Endocrinology Department, The 960th Hospital of the People’s Liberation Army Joint Logistics Support Force, Jinan, China
| | - Zhaoshun Jiang
- Endocrinology Department, The 960th Hospital of the People’s Liberation Army Joint Logistics Support Force, Jinan, China
| | - Zongjing Zhang
- Endocrinology Department, The 960th Hospital of the People’s Liberation Army Joint Logistics Support Force, Jinan, China
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13
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Jaiswal R, Johansson H, Axelsson KF, Magnusson P, Harvey NC, Vandenput L, McCloskey E, Kanis JA, Litsne H, Johansson L, Lorentzon M. Hemoglobin Levels Improve Fracture Risk Prediction in Addition to FRAX Clinical Risk Factors and Bone Mineral Density. J Clin Endocrinol Metab 2023; 108:e1479-e1488. [PMID: 37406247 PMCID: PMC10655535 DOI: 10.1210/clinem/dgad399] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 07/07/2023]
Abstract
CONTEXT Anemia and decreasing levels of hemoglobin (Hb) have previously been linked to increased fracture risk, but the added value to FRAX, the most utilized fracture prediction tool worldwide, is unknown. OBJECTIVE To investigate the association between anemia, Hb levels, bone microstructure, and risk of incident fracture and to evaluate whether Hb levels improve fracture risk prediction in addition to FRAX clinical risk factors (CRFs). METHODS A total of 2778 community-dwelling women, aged 75-80 years, and part of a prospective population-based cohort study in Sweden were included. At baseline, information on anthropometrics, CRFs, and falls was gathered, blood samples were collected, and skeletal characteristics were investigated using dual-energy x-ray absorptiometry and high-resolution peripheral quantitative computed tomography. At the end of follow-up, incident fractures were retrieved from a regional x-ray archive. RESULTS The median follow-up time was 6.4 years. Low Hb was associated with worse total hip and femoral neck bone mineral density (BMD), and lower tibia cortical and total volumetric BMD, and anemia was associated with increased risk of major osteoporotic fracture (MOF; hazard ratio 2.04; 95% CI 1.58-2.64). Similar results were obtained for hip fracture and any fracture, also when adjusting for CRFs. The ratio between 10-year fracture probabilities of MOF assessed in models with Hb levels included and not included ranged from 1.2 to 0.7 at the 10th and 90th percentile of Hb, respectively. CONCLUSION Anemia and decreasing levels of Hb are associated with lower cortical BMD and incident fracture in older women. Considering Hb levels may improve the clinical evaluation of patients with osteoporosis and the assessment of fracture risk.
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Affiliation(s)
- Raju Jaiswal
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Helena Johansson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, 3000, Australia
| | - Kristian F Axelsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Norrmalm, Health Centre, 549 40 Skövde, Sweden
| | - Per Magnusson
- Department of Clinical Chemistry, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Liesbeth Vandenput
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, 3000, Australia
| | - Eugene McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- MRC Versus Arthritis Centre for Integrated research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - John A Kanis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, 3000, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - Henrik Litsne
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
| | - Lisa Johansson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
- Region Västra Götaland, Department of Orthopedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Mattias Lorentzon
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, University of Gothenburg, 413 45 Gothenburg, Sweden
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, 3000, Australia
- Region Västra Götaland, Department of Geriatric Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
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Uragami M, Matsushita K, Shibata Y, Takata S, Karasugi T, Sueyoshi T, Masuda T, Nakamura T, Tokunaga T, Hisanaga S, Yugami M, Sugimoto K, Yonemitsu R, Ideo K, Fukuma Y, Takata K, Arima T, Kawakami J, Maeda K, Yoshimura N, Matsunaga H, Kai Y, Tanimura S, Shimada M, Tateyama M, Miyamoto K, Kubo R, Tajiri R, Tian X, Homma F, Morinaga J, Yamanouchi Y, Takebayashi M, Kajitani N, Uehara Y, Miyamoto T. A machine learning-based scoring system and ten factors associated with hip fracture occurrence in the elderly. Bone 2023; 176:116865. [PMID: 37562661 DOI: 10.1016/j.bone.2023.116865] [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: 07/04/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
Hip fractures are fragility fractures frequently seen in persons over 80-years-old. Although various factors, including decreased bone mineral density and a history of falls, are reported as hip fracture risks, few large-scale studies have confirmed their relevance to individuals older than 80, and tools to assess contributions of various risks to fracture development and the degree of risk are lacking. We recruited 1395 fresh hip fracture patients and 1075 controls without hip fractures and comprehensively evaluated various reported risk factors and their association with hip fracture development. We initially constructed a predictive model using Extreme Gradient Boosting (XGBoost), a machine learning algorithm, incorporating all 40 variables and evaluated the model's performance using the area under the receiver operating characteristic curve (AUC), yielding a value of 0.87. We also employed SHapley Additive exPlanation (SHAP) values to evaluate each feature importance and ranked the top 20. We then used a stepwise selection method to determine key factors sequentially until the AUC reached a plateau nearly equal to that of all variables and identified the top 10 sufficient to evaluate hip fracture risk. For each, we determined the cutoff value for hip fracture occurrence and calculated scores of each variable based on the respective feature importance. Individual scores were: serum 25(OH)D levels (<10 ng/ml, score 7), femoral neck T-score (<-3, score 5), Barthel index score (<100, score 3), maximal handgrip strength (<18 kg, score 3), GLFS-25 score (≥24, score 2), number of falls in previous 12 months (≥3, score 2), serum IGF-1 levels (<50 ng/ml, score 2), cups of tea/day (≥5, score -2), use of anti-osteoporosis drugs (yes, score -2), and BMI (<18.5 kg/m2, score 1). Using these scores, we performed receiver operating characteristic (ROC) analysis and the resultant optimal cutoff value was 7, with a specificity of 0.78, sensitivity of 0.75, and AUC of 0.85. These ten factors and the scoring system may represent tools useful to predict hip fracture.
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Affiliation(s)
- Masaru Uragami
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kozo Matsushita
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yuto Shibata
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Shu Takata
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Tatsuki Karasugi
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Takanao Sueyoshi
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Tetsuro Masuda
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Takayuki Nakamura
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Takuya Tokunaga
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Satoshi Hisanaga
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Masaki Yugami
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kazuki Sugimoto
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Ryuji Yonemitsu
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Katsumasa Ideo
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yuko Fukuma
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kosei Takata
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Takahiro Arima
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Jyunki Kawakami
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kazuya Maeda
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Naoto Yoshimura
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Hideto Matsunaga
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yuki Kai
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Shuntaro Tanimura
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Masaki Shimada
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Makoto Tateyama
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Kana Miyamoto
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Ryuta Kubo
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Rui Tajiri
- Department of Oral and Maxillofacial Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Xiao Tian
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Fuka Homma
- Department of Clinical Investigation, Kumamoto University Hospital, 1-1-1 Honjo, Chuo-ku, Kumamoto, Kumamoto 860-8556, Japan
| | - Jun Morinaga
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yoshinori Yamanouchi
- Department of Dentistry and Oral Surgery, Keio University School of Medicine, 35 Shinano-machi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Minoru Takebayashi
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Naoto Kajitani
- Department of Neuropsychiatry, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan; Center for Metabolic Regulation of Healthy Aging, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yusuke Uehara
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
| | - Takeshi Miyamoto
- Department of Orthopedic Surgery, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan.
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Kirk B, Harrison SL, Zanker J, Burghardt AJ, Orwoll E, Duque G, Cawthon PM. Interactions Between HR-pQCT Bone Density and D 3 Cr Muscle Mass (or HR-pQCT Bone Structure and HR-pQCT Muscle Density) in Predicting Fractures: The Osteoporotic Fractures in Men Study. J Bone Miner Res 2023; 38:1245-1257. [PMID: 37351915 PMCID: PMC10528106 DOI: 10.1002/jbmr.4874] [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: 02/21/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 06/24/2023]
Abstract
We examined if an interaction exists between bone and muscle in predicting fractures in older men. Prospective data from the Osteoporotic Fractures in Men study was used to build Cox proportional hazards models. Predictors included HR-pQCT total volumetric BMD (Tt.BMD), trabecular BMD (Tb.BMD), cortical BMD (Ct.BMD) and cortical area (Ct.Ar) at distal radius/tibia, HR-pQCT muscle volume and density (diaphyseal tibia), D3 -creatine dilution (D3 Cr) muscle mass, and grip strength and leg force, analyzed as continuous variables and as quartiles. Incident fractures were self-reported every 4 months via questionnaires and centrally adjudicated by physician review of radiology reports. Potential confounders (demographics, comorbidities, lifestyle factors, etc.) were considered. A total of 1353 men (mean age 84.2 ± 4.0 years, 92.7% white) were followed for 6.03 ± 2.11 years. In the unadjusted (continuous) model, there were no interactions (p > 0.05) between any muscle variable (D3 Cr muscle mass, muscle volume, muscle density, grip strength or leg force) and Tt.BMD at distal radius/tibia for fractures (all: n = 182-302; nonvertebral: n = 149-254; vertebral: n = 27-45). No consistent interactions were observed when interchanging Tt.BMD for Tb.BMD/Ct.BMD or for Ct.Ar (bone structure) at the distal radius/tibia in the unadjusted (continuous) models. Compared with men in quartiles (Q) 2-4 of D3 Cr muscle mass and Q2-4 of distal tibia Tt.BMD, men in Q1 of both had increased risk for all fractures (hazard ratio (HR) = 2.00; 95% confidence interval [CI] 1.24-3.23, p = 0.005) and nonvertebral fractures (HR = 2.10; 95% CI 1.25-3.52, p < 0.001) in the multivariable-adjusted model. Confidence intervals overlapped (p > 0.05) when visually inspecting other quartile groups in the multivariable-adjusted model. In this prospective cohort study of older men, there was no consistent interactions between bone and muscle variables on fracture risk. Larger sample sizes and longer follow-up may be needed to clarify if there is an interaction between bone and muscle on fracture risk in men. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Ben Kirk
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | | | - Jesse Zanker
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Andrew J. Burghardt
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Eric Orwoll
- Division of Endocrinology, Diabetes and Clinical Nutrition, School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Gustavo Duque
- Department of Medicine, Western Health, Melbourne Medical School, The University of Melbourne, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Dr. Joseph Kaufmann Chair in Geriatric Medicine, McGill University, Montreal, QC, Canada
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
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16
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Asahi R, Nakamura Y, Koike Y, Kanai M, Watanabe K, Yuguchi S, Kamo T, Azami M, Ogihara H, Asano S. Does locomotive syndrome severity predict future fragility fractures in community-dwelling women with osteoporosis? Mod Rheumatol 2023; 33:1036-1043. [PMID: 36029035 DOI: 10.1093/mr/roac101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/28/2022] [Accepted: 08/26/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVES We investigated whether the locomotive syndrome (LS) severity affects future fragility fractures in osteoporosis patients. METHODS In this retrospective cohort study, 315 women with osteoporosis (mean follow-up period, 2.8 years) were reviewed, of whom 244 were included in the analysis. At baseline, we obtained medical information, bone mineral density of the lumbar spine and femoral neck, and sagittal vertical axis. Additionally, LS risk was assessed using the two-step test, stand-up test, and 25-question geriatric locomotive function scale scores. The LS risk test results were used to classify LS severity, which was rated on a 4-point scale from stage 0 (robust) to 3 (worsening). Cox proportional hazards regression analysis was used to determine the association of the severity with future fragility fracture. RESULTS Fragility fractures occurred in 37 of 315 participants (11.8%). This study showed that sagittal vertical axis (hazard ratio = 1.014; 95% confidence interval, 1.005-1.023; p value = 0.003) and LS severity (hazard ratio =1.748; 95% confidence interval, 1.133-2.699; p = 0.012) were independent risk factors for incidence of fragility fracture. CONCLUSIONS This study revealed the LS severity to predicted fragility fractures. We suggested that the progression of LS associated with osteoporosis increases the fracture risk.
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Affiliation(s)
- Ryoma Asahi
- School of Health Sciences, Japan University of Health Sciences, Saitama, Japan
| | - Yutaka Nakamura
- Saitama Spine Center, Higashi Saitama General Hospital, Saitama, Japan
| | - Yoshinao Koike
- Saitama Spine Center, Higashi Saitama General Hospital, Saitama, Japan
| | - Masayoshi Kanai
- Saitama Spine Center, Higashi Saitama General Hospital, Saitama, Japan
| | - Kento Watanabe
- Department of Rehabilitation, Kawaguchi Sakura Hospital, Saitama, Japan
| | - Satoshi Yuguchi
- School of Health Sciences, Japan University of Health Sciences, Saitama, Japan
| | - Tomohiko Kamo
- Department of Rehabilitation, Gunma Paz University, Gunma, Japan
| | - Masato Azami
- School of Health Sciences, Japan University of Health Sciences, Saitama, Japan
| | - Hirofumi Ogihara
- Division of Physical Therapy, Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, Nagano, Japan
| | - Satoshi Asano
- Saitama Spine Center, Higashi Saitama General Hospital, Saitama, Japan
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17
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Perrott SL, Martin K, Keevil VL, Wareham NJ, Khaw KT, Myint PK. Calcaneal broadband ultrasound attenuation predicts physical capability: EPIC-Norfolk prospective population-based study. Maturitas 2023; 173:7-15. [PMID: 37146366 DOI: 10.1016/j.maturitas.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 03/02/2023] [Accepted: 04/15/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Calcaneal ultrasound (broadband ultrasound attenuation - BUA), a marker of bone strength, may predict future physical capability and thus provide a strategy to identify individuals at risk of age-related deterioration of health. This study aims to determine if BUA can predict future physical capability among middle-aged and older adults. METHODS Summary performance scores (SPS), an objective quantification of physical capability, were devised using participants' measures of standing balance, gait speed and timed chair rises. Associations between BUA and SPS, measured at least six years apart, were investigated using univariable and multivariate sex-specific linear and logistic regression, adjusting for confounders. RESULTS 5893 participants were included. In men and women, for every five points lower BUA, there was a 0.2-point decrease in SPS. In women, BUA less than one standard deviation below the mean was associated with low physical capability (defined as SPS 3-6); fully adjusted odds ratio (OR) (95 % confidence interval (CI)) 1.35 (1.01-1.84). No association existed among men; OR (95 % CI) 0.84 (0.59-1.19). Significant risk factors for low physical capability in men with baseline low BUA were: older age [OR 5.77]; high BMI [OR 2.85]; lower social class [OR 1.59]; low physical activity [OR 1.64]. Risk factors among women were: older age [OR 5.54]; high BMI [OR 2.08]; lower education [OR 1.42], low physical activity [OR 1.27]; steroid use [OR 2.05]; and stroke [OR 2.74]. CONCLUSION BUA may predict future physical capability in older adults. With further validation, BUA could stratify individuals at risk of deterioration in physical health.
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Affiliation(s)
- Sarah L Perrott
- Ageing Clinical & Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
| | - Kathryn Martin
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; The Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | | | | | - Kay-Tee Khaw
- Department of Medicine, University of Cambridge, UK
| | - Phyo Kyaw Myint
- Ageing Clinical & Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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18
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Gielen E, Dupont J, Dejaeger M, Laurent MR. Sarcopenia, osteoporosis and frailty. Metabolism 2023; 145:155638. [PMID: 37348597 DOI: 10.1016/j.metabol.2023.155638] [Citation(s) in RCA: 35] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/21/2023] [Accepted: 06/17/2023] [Indexed: 06/24/2023]
Abstract
Muscles and bones are intricately connected tissues displaying marked co-variation during development, growth, aging, and in many diseases. While the diagnosis and treatment of osteoporosis are well established in clinical practice, sarcopenia has only been classified internationally as a disease in 2016. Both conditions are associated with an increased risk of adverse health outcomes such as fractures, dysmobility and mortality. Rather than focusing on one dimension of bone or muscle mass or weakness, the concept of musculoskeletal frailty captures the overall loss of physiological reserves in the locomotor system with age. The term osteosarcopenia in particular refers to the double jeopardy of osteoporosis and sarcopenia. Muscle-bone interactions at the biomechanical, cellular, paracrine, endocrine, neuronal or nutritional level may contribute to the pathophysiology of osteosarcopenia. The paradigm wherein muscle force controls bone strength is increasingly facing competition from a model centering on the exchange of myokines, osteokines and adipokines. The most promising results have been obtained in preclinical models where common drug targets have been identified to treat these conditions simultaneously. In this narrative review, we critically summarize the current understanding of the definitions, epidemiology, pathophysiology, and treatment of osteosarcopenia as part of an integrative approach to musculoskeletal frailty.
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Affiliation(s)
- Evelien Gielen
- Gerontology and Geriatrics Unit, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium; Centre for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Jolan Dupont
- Gerontology and Geriatrics Unit, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium
| | - Marian Dejaeger
- Gerontology and Geriatrics Unit, Department of Public Health and Primary Care, University of Leuven, Leuven, Belgium; Centre for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Michaël R Laurent
- Centre for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium; Geriatrics Department, Imelda Hospital, Bonheiden, Belgium.
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Kirk B, Zhang S, Vogrin S, Harijanto C, Sales M, Duque G. Comparing the Fracture Profile of Osteosarcopenic Older Adults with Osteopenia/Osteoporosis Alone. Calcif Tissue Int 2023; 112:297-307. [PMID: 36436030 DOI: 10.1007/s00223-022-01044-1] [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: 07/05/2022] [Accepted: 11/13/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine whether osteosarcopenia is associated with a greater likelihood of recurrent fractures, as well as type of fracture, than osteopenia/osteoporosis or sarcopenia alone. METHODS Anthropometry (height/weight; scales and stadiometer), body composition (bone mineral density [BMD] and appendicular lean mass; dual-energy x-ray absorptiometry), grip strength (hydraulic dynamometer), and gait speed (4 m) were measured in an outpatient clinic. WHO definition for osteopenia/osteoporosis (BMD T-score below -1 SDs) while sarcopenia was defined by SDOC or EWGSOP2. Number and location of fractures within the past 5 years were self-reported and verified by medical records (unverified fractures excluded). Univariable and multivariable regressions were used to examine the association between the exposure and outcome while adjusting for confounders. RESULTS 481 community-dwelling older adults (median age: 78, IQR: 72, 83; 75.9% women) were included. Prevalence of osteosarcopenia depended on the definition (SDOC: 179 (37.2%); EWGSOP2: 123 (25.6%)). In multivariable analysis adjusting for age, sex, alcohol, smoking, BMI, lowest BMD T-score, physical activity, and comorbidities, the likelihood of recurrent fractures (≥ 2 vs 0-1) was significantly higher in those with osteosarcopenia versus osteopenia/osteoporosis irrespective of the definition (SDOC: odds ratio [OR]: 1.63, 95% CI: 1.03, 2.59, p = 0.037; EWGSOP2: OR: 1.83, 95% CI: 1.12, 3.01, p = 0.016]. Associations with sarcopenia alone (SDOC: 10; EWGSOP2: 7) were not possible due to the extremely low prevalence of this condition in those with normal BMD. CONCLUSION Our data suggest osteosarcopenia is associated with a greater likelihood of recurrent fractures versus osteopenia/osteoporosis alone. Further studies are needed to evaluate the relationship with sarcopenia alone.
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Affiliation(s)
- Ben Kirk
- Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Simon Zhang
- Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Sara Vogrin
- Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Christel Harijanto
- Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Myrla Sales
- Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health, St Albans, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia
| | - Gustavo Duque
- Department of Medicine, Melbourne Medical School, University of Melbourne, Western Health, St Albans, Melbourne, VIC, Australia.
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St Albans, Melbourne, VIC, Australia.
- Department of Medicine and Research Institute, McGill University Health Centre, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada.
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20
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Westbury LD, Beaudart C, Bruyère O, Cauley JA, Cawthon P, Cruz‐Jentoft AJ, Curtis EM, Ensrud K, Fielding RA, Johansson H, Kanis JA, Karlsson MK, Lane NE, Lengelé L, Lorentzon M, McCloskey E, Mellström D, Newman AB, Ohlsson C, Orwoll E, Reginster J, Ribom E, Rosengren BE, Schousboe JT, Shiroma EJ, Harvey NC, Dennison EM, Cooper C. Recent sarcopenia definitions-prevalence, agreement and mortality associations among men: Findings from population-based cohorts. J Cachexia Sarcopenia Muscle 2023; 14:565-575. [PMID: 36604970 PMCID: PMC9891989 DOI: 10.1002/jcsm.13160] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/25/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The 2019 European Working Group on Sarcopenia in Older People (EWGSOP2) and the Sarcopenia Definitions and Outcomes Consortium (SDOC) have recently proposed sarcopenia definitions. However, comparisons of the performance of these approaches in terms of thresholds employed, concordance in individuals and prediction of important health-related outcomes such as death are limited. We addressed this in a large multinational assembly of cohort studies that included information on lean mass, muscle strength, physical performance and health outcomes. METHODS White men from the Health Aging and Body Composition (Health ABC) Study, Osteoporotic Fractures in Men (MrOS) Study cohorts (Sweden, USA), the Hertfordshire Cohort Study (HCS) and the Sarcopenia and Physical impairment with advancing Age (SarcoPhAge) Study were analysed. Appendicular lean mass (ALM) was ascertained using DXA; muscle strength by grip dynamometry; and usual gait speed over courses of 2.4-6 m. Deaths were recorded and verified. Definitions of sarcopenia were as follows: EWGSOP2 (grip strength <27 kg and ALM index <7.0 kg/m2 ), SDOC (grip strength <35.5 kg and gait speed <0.8 m/s) and Modified SDOC (grip strength <35.5 kg and gait speed <1.0 m/s). Cohen's kappa statistic was used to assess agreement between original definitions (EWGSOP2 and SDOC). Presence versus absence of sarcopenia according to each definition in relation to mortality risk was examined using Cox regression with adjustment for age and weight; estimates were combined across cohorts using random-effects meta-analysis. RESULTS Mean (SD) age of participants (n = 9170) was 74.3 (4.9) years; 5929 participants died during a mean (SD) follow-up of 12.1 (5.5) years. The proportion with sarcopenia according to each definition was EWGSOP2 (1.1%), SDOC (1.7%) and Modified SDOC (5.3%). Agreement was weak between EWGSOP2 and SDOC (κ = 0.17). Pooled hazard ratios (95% CI) for mortality for presence versus absence of each definition were EWGSOP2 [1.76 (1.42, 2.18), I2 : 0.0%]; SDOC [2.75 (2.28, 3.31), I2 : 0.0%]; and Modified SDOC [1.93 (1.54, 2.41), I2 : 58.3%]. CONCLUSIONS There was low prevalence and poor agreement among recent sarcopenia definitions in community-dwelling cohorts of older white men. All indices of sarcopenia were associated with mortality. The strong relationship between sarcopenia and mortality, regardless of the definition, illustrates that identification of appropriate management and lifecourse intervention strategies for this condition is of paramount importance.
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Affiliation(s)
- Leo D. Westbury
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Charlotte Beaudart
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health EconomicsUniversity of LiègeLiègeBelgium
| | - Olivier Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health EconomicsUniversity of LiègeLiègeBelgium
| | - Jane A. Cauley
- Department of Epidemiology, School of Public HealthUniversity of PittsburghPittsburghPAUSA
| | - Peggy 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 Research, Minneapolis VA Health Care SystemMinneapolisMNUSA
| | - Roger A. Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on AgingTufts UniversityBostonMAUSA
| | - Helena Johansson
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Sahlgrenska Osteoporosis Centre, Institute of MedicineUniversity of GothenburgGothenburgSweden
| | - John A. Kanis
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
| | - Magnus K. Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmo, Lund University and Department of OrthopedicsSkane University HospitalMalmoSweden
| | - Nancy E. Lane
- Division of Rheumatology, Department of Internal MedicineUC Davis HealthSacramentoCAUSA
| | - Laetitia Lengelé
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health EconomicsUniversity of LiègeLiègeBelgium
| | - Mattias Lorentzon
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Geriatric Medicine, Institute of Medicine, Sahlgrenska AcademySahlgrenska University HospitalMölndalSweden
| | - Eugene McCloskey
- Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Centre for Integrated Research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone ResearchUniversity of SheffieldSheffieldUK
| | - Dan Mellström
- Centre for Bone and Arthritis Research (CBAR), Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Anne B. Newman
- Department of Epidemiology, School of Public HealthUniversity of PittsburghPittsburghPAUSA
| | - Claes Ohlsson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research at the Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Region Västra GötalandSahlgrenska University Hospital, Department of Drug TreatmentGothenburgSweden
| | - Eric Orwoll
- Oregon Health & Science UniversityPortlandORUSA
| | - Jean‐Yves Reginster
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health EconomicsUniversity of LiègeLiègeBelgium
| | - Eva Ribom
- Department of Surgical SciencesUniversity of UppsalaUppsalaSweden
| | - Björn E. Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmo, Lund University and Department of OrthopedicsSkane University HospitalMalmoSweden
| | - John T. Schousboe
- Park Nicollet Clinic and HealthPartners InstituteBloomingtonMNUSA
- University of MinnesotaMinneapolisMNUSA
| | - Eric J. Shiroma
- Laboratory of Epidemiology and Population Sciences, Intramural Research ProgramNational Institute on AgingBaltimoreMDUSA
| | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - Elaine M. Dennison
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
- Victoria University of WellingtonWellingtonNew Zealand
| | - 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
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21
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Labata-Lezaun N, González-Rueda V, Llurda-Almuzara L, López-de-Celis C, Rodríguez-Sanz J, Bosch J, Vicente-Rodríguez G, Gorczakowska D, Araluze-Arizti P, Pérez-Bellmunt A. Effectiveness of multicomponent training on physical performance in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2023; 104:104838. [PMID: 36272227 DOI: 10.1016/j.archger.2022.104838] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022]
Abstract
Multicomponent training (MCT) is characterized by the combination of at least 3 types of training. The purpose of this meta-analysis was to assess the effectiveness of MCT programs for improving physical performance in healthy older adults. A systematic review and meta-analysis of randomized control trials (RCTs) was conducted. The systematic search was performed in the Web of Sciences, PubMed (MEDLINE), and Cochrane Library databases. Articles were included if participants were healthy and 65 years or older, and the control group did not perform any type of training. Studies were excluded if the interventions lasted less than 8 weeks. PEDro scale and Risk of Bias tool (RoB) were used in order to assess the quality of the articles. The search strategy found a total of 388 studies. After inclusion and exclusion criteria, 19 studies were included for the qualitative analysis. Finally, 13 articles were included in the meta-analysis, with a total of 808 healthy older adults analyzed. The main results of the meta-analysis showed that MCT improves physical performance significantly more than no training (SMD: 0.78; 95% CI: 0.55, 1.00; Z = 6.84, p < 0.01; I2 = 54%). In addition, the MCT also seems to significantly increase in upper and lower limb strength, walking speed and aerobic capacity. MCT improves general functionality, strength in upper and lower extremities, walking speed and aerobic capacity. Implementation of MCT programs should be encouraged as an effective strategy in the prevention of adverse conditions in the older adult.
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Affiliation(s)
- Noé Labata-Lezaun
- Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona 08195, Spain; ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona 08195, Spain
| | - Vanessa González-Rueda
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona 08195, Spain; Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona 08195, Spain; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona 08007, Spain
| | - Luis Llurda-Almuzara
- Physiotherapy Department, Faculty of Health Sciences, European University of Gasteiz - EUNEIZ, La Biosfera Ibilbidea, 6, Vitoria-Gasteiz 01013, Spain
| | - Carlos López-de-Celis
- ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona 08195, Spain; Physiotherapy Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona 08195, Spain; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona 08007, Spain
| | - Jacobo Rodríguez-Sanz
- Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona 08195, Spain; ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona 08195, Spain
| | - Joan Bosch
- Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona 08195, Spain
| | - Germán Vicente-Rodríguez
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, Universidad de Zaragoza, Zaragoza 50009, Spain
| | - Dorota Gorczakowska
- Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona 08195, Spain
| | - Paola Araluze-Arizti
- Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona 08195, Spain
| | - Albert Pérez-Bellmunt
- Anatomy Unit, Basic Sciences Department, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona 08195, Spain; ACTIUM Functional Anatomy Group, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona 08195, Spain.
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22
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Llurda-Almuzara L, Rodríguez-Sanz J, López-de-Celis C, Aiguadé-Aiguadé R, Arán-Jové R, Labata-Lezaun N, Fernández-de-las-Peñas C, Bosch J, Pérez-Bellmunt A. Effects of Adding an Online Exercise Program on Physical Function in Individuals Hospitalized by COVID-19: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16619. [PMID: 36554510 PMCID: PMC9778879 DOI: 10.3390/ijerph192416619] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
The worldwide pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has impacted all healthcare systems. One potential sequela experienced by hospitalized coronavirus disease 2019 (COVID-19) survivors includes muscle weakness with a reduction in strength and, consequently, a possible increase in frailty. The aim of this clinical trial was to evaluate the efficacy of adding an online therapeutic exercise program for 8 weeks to the medical prescriptions on functional variables in patients hospitalized due to COVID-19. A randomized controlled trial including 70 previously hospitalized COVID-19 survivors was conducted. Patients were randomly allocated to an experimental (n = 35) or control (n = 35) group. Both groups received regular prescriptions provided by their medical doctors. The experimental group also received a live online therapeutic exercise program for 8 weeks (3 sessions/week). Handgrip strength, gait speed, lower-extremity strength, balance, and frailty were assessed at baseline, at the end of the program, and one month after the end of the intervention. The repeated measures analysis of variance revealed significant Group*Time interactions for all the outcomes: (handgrip dominant: F = 17.395, p < 0.001, η2 = 0.24; handgrip non-dominant: F = 33.197, p < 0.001, η2 = 0.33; 4 m walk test (4WT): F = 13.039, p = 0.001, η2 = 0.16; short physical performance battery (SPPB): F = 26.421, p < 0.001, η2 = 0.28; the five chair-raise test (5CRT): F = 5.628, p = 0.004, η2 = 0.08; FRAIL scale: F = 11.249, p = 0.001, η2 = 0.14): patients in the experimental group experienced greater improvements in all outcomes than those assigned to the control group. This study revealed that the addition of an online exercise program for 8 weeks obtained greater improvements in handgrip strength, gait speed, lower-extremity strength, balance, and frailty in a sample of previously hospitalized COVID-19 survivors than application of just usual medical prescription.
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Affiliation(s)
- Luis Llurda-Almuzara
- Physiotherapy Department, Faculty of Health Sciences, European University of Gasteiz—EUNEIZ, La Biosfera Ibilbidea, 6, 01013 Vitoria-Gasteiz, Spain
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC-Barcelona), C/Josep Trueta s/n, 08017 Sant Cugat del Vallès, Spain
| | - Jacobo Rodríguez-Sanz
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC-Barcelona), C/Josep Trueta s/n, 08017 Sant Cugat del Vallès, Spain
- ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain
| | - Carlos López-de-Celis
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC-Barcelona), C/Josep Trueta s/n, 08017 Sant Cugat del Vallès, Spain
- ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain
- Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina, 08007 Barcelona, Spain
| | | | - Raúl Arán-Jové
- Oxigena Fisioterapia, Calle N, 51, 50170 Mequinenza, Spain
- Hospital Universitari Santa Maria, Av. Alcalde Rovira Roure, 44, 25198 Lleida, Spain
| | - Noé Labata-Lezaun
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC-Barcelona), C/Josep Trueta s/n, 08017 Sant Cugat del Vallès, Spain
- ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain
| | - César Fernández-de-las-Peñas
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Universidad Rey Juan Carlos (URJC), 28922 Alcorcon, Spain
| | - Joan Bosch
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC-Barcelona), C/Josep Trueta s/n, 08017 Sant Cugat del Vallès, Spain
| | - Albert Pérez-Bellmunt
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC-Barcelona), C/Josep Trueta s/n, 08017 Sant Cugat del Vallès, Spain
- ACTIUM Functional Anatomy Group, 08017 Barcelona, Spain
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23
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van Oostwaard MM, van den Bergh JP, van de Wouw Y, Janssen-Heijnen M, de Jong M, Wyers CE. High prevalence of vertebral fractures at initiation of androgen deprivation therapy for prostate cancer. J Bone Oncol 2022; 38:100465. [PMID: 36591574 PMCID: PMC9798166 DOI: 10.1016/j.jbo.2022.100465] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/12/2022] Open
Abstract
Purpose Treatment of Prostate Cancer (PCa) with Androgen Deprivation Therapy (ADT) involves long-term consequences including bone loss and fractures. Our aim was to evaluate the calculated fracture risk and the prevalence of osteoporosis, vertebral fractures (VF) and sarcopenia in men with PCa at initiation of ADT, as ADT will increase fracture risk from that moment onward. Methods In this cross-sectional real-world study in men at ADT initiation, fracture risk factors including comorbidities, medication, and 10-year fracture risk (FRAX®) were assessed. Laboratory tests, dual-energy X-ray absorptiometry, and spinal X-rays were performed. Sarcopenia was defined according to EWGSOP2. Results In 115 men at ADT initiation, aged 73.3 (±7.6) years, osteoporosis was diagnosed in 4.3 % and osteopenia in 35.7 %. The mean 10-year fracture risk of major osteoporotic fracture was 4.4 % and of hip fracture 1.7 %, respectively. At least one VF was present in 32.2 % and 33.9 % of men had osteoporosis and/or a VF assessed on spinal X-rays. In 10.4 % at least one new fracture-risk-associated metabolic bone disorder was diagnosed with laboratory testing. Sarcopenia was diagnosed in only one patient. Conclusions Although the prevalence of osteoporosis, sarcopenia and 10-years fracture risk is low, there is a high prevalence of vertebral fractures in a third of the men with PCa at the time of ADT initiation. Besides a BMD measurement and fracture risk calculation using FRAX, a systematic vertebral fracture assessment should be considered in all men with PCa at initiation of ADT to provide a reliable baseline classification of VFs to improve identification of true incident VFs during ADT.
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Affiliation(s)
- Marsha M. van Oostwaard
- Department of Internal Medicine, VieCuri Medical Centre, P.O. Box 1926, 5900 BX Venlo, the Netherlands,Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (Maastricht UMC+), P.O. Box 616, 6200 MD Maastricht, the Netherlands,Corresponding author at: Department of Internal Medicine, VieCuri Medical Centre, P.O. Box 1926, 5900 BX Venlo, the Netherlands.
| | - Joop P. van den Bergh
- Department of Internal Medicine, VieCuri Medical Centre, P.O. Box 1926, 5900 BX Venlo, the Netherlands,Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (Maastricht UMC+), P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Yes van de Wouw
- Department of Internal Medicine, VieCuri Medical Centre, P.O. Box 1926, 5900 BX Venlo, the Netherlands
| | - Maryska Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Center, Venlo, the Netherlands,Department of Epidemiology, GROW School for Oncology and Reproduction, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Marc de Jong
- Department of Urology, VieCuri Medical Centre, P.O. Box 1926, 5900 BX Venlo, the Netherlands
| | - Caroline E. Wyers
- Department of Internal Medicine, VieCuri Medical Centre, P.O. Box 1926, 5900 BX Venlo, the Netherlands
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24
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David K, Narinx N, Antonio L, Evenepoel P, Claessens F, Decallonne B, Vanderschueren D. Bone health in ageing men. Rev Endocr Metab Disord 2022; 23:1173-1208. [PMID: 35841491 DOI: 10.1007/s11154-022-09738-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 01/11/2023]
Abstract
Osteoporosis does not only affect postmenopausal women, but also ageing men. The burden of disease is projected to increase with higher life expectancy both in females and males. Importantly, osteoporotic men remain more often undiagnosed and untreated compared to women. Sex steroid deficiency is associated with bone loss and increased fracture risk, and circulating sex steroid levels have been shown to be associated both with bone mineral density and fracture risk in elderly men. However, in contrast to postmenopausal osteoporosis, the contribution of relatively small decrease of circulating sex steroid concentrations in the ageing male to the development of osteoporosis and related fractures, is probably only minor. In this review we provide several clinical and preclinical arguments in favor of a 'bone threshold' for occurrence of hypogonadal osteoporosis, corresponding to a grade of sex steroid deficiency that in general will not occur in many elderly men. Testosterone replacement therapy has been shown to increase bone mineral density in men, however data in osteoporotic ageing males are scarce, and evidence on fracture risk reduction is lacking. We conclude that testosterone replacement therapy should not be used as a sole bone-specific treatment in osteoporotic elderly men.
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Affiliation(s)
- Karel David
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, ON1bis box 902, 3000 , Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Nick Narinx
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, ON1bis box 902, 3000 , Leuven, Belgium
- Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Leen Antonio
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, ON1bis box 902, 3000 , Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Pieter Evenepoel
- Nephrology and Renal Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Leuven, Belgium
| | - Frank Claessens
- Laboratory of Molecular Endocrinology, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium
| | - Brigitte Decallonne
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, ON1bis box 902, 3000 , Leuven, Belgium
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Vanderschueren
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Diseases and Metabolism, KU Leuven, Herestraat 49, ON1bis box 902, 3000 , Leuven, Belgium.
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.
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25
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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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Chen FP, Lin YJ, Chao AS, Lin YC, Sung CM, Chen JF, Wong AMK. Utilizing nomograms to predict prevalent vertebral fracture risk: An analysis of dysmobility syndrome in a community-dwelling population. Biomed J 2022; 45:931-939. [PMID: 34801764 PMCID: PMC9795362 DOI: 10.1016/j.bj.2021.11.008] [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: 04/23/2021] [Revised: 10/22/2021] [Accepted: 11/12/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND To determine a reliable method to predict prevalent vertebral fractures (VF) by assessing the association between dysmobility syndrome (DS) and VF in a community-dwelling population. METHODS This cross-sectional study enrolled 518 participants from fracture-prevention educational activities held in multiple communities in Taiwan. Assessments included questionnaires, fracture risk assessment tool (FRAX), bone mineral density (BMD) and body composition using dual-energy x-ray absorptiometry (DXA), lateral thoracolumbar spine x-rays (specifically T8-S1), grip strength (GS), walking speed, and fall history. RESULTS DS was noted in 257 participants (49.6%) and VF was identified in 196 participants (37.8%). A higher prevalence of VF was noted in those with DS. The prevalence of VF was significantly associated with age, gender, FRAX both with and without BMD, osteoporosis, low GS, and DS. In multivariate models accounting for age and sex, the c-index was greater in those with low GS plus osteoporosis as compared to DS alone. Low GS, osteoporosis, and pre-BMD FRAX all had similar c-indexes. Pre-BMD FRAX plus low GS and osteoporosis was superior in predicting VF compared to pre-BMD FRAX plus low GS or osteoporosis alone. Besides the inclusion of age and gender, the nomogram with pre-BMD FRAX major osteoporosis fracture probability (MOF) plus low GS had improved correlation between the estimated and actual VF probability than those with pre-BMD FRAX MOF plus osteoporosis. CONCLUSIONS The constructed nomogram containing pre-BMD FRAX MOF plus low GS may be considered as a first-line prevalent VF screening method. Those with high-risk scores should subsequently undergo vertebral radiography and/or BMD.
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Affiliation(s)
- Fang-Ping Chen
- Keelung Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan,Corresponding author. Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Keelung, 222 Mai-Chin Rd., Keelung 204, Taiwan.
| | - Yu-Jr Lin
- Research Service Center for Health Information, Chang Gung University, Taoyuan, Taiwan
| | - An-Shine Chao
- Keelung Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan,Department of Obstetrics and Gynecology, Keelung Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Yu-Ching Lin
- Keelung Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan,Department of Radiology, Keelung Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Chen-Ming Sung
- Department of Radiology, Keelung Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Jung-Fu Chen
- Keelung Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan,Department of Endocrinology and Metabolism, Osteoporosis Prevention and Treatment Center, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan
| | - Alice MK. Wong
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
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de Almeida Marques Bernabé R, de Souza Vieira M, Felício de Souza V, Gomes Fontana L, Albergaria BH, Marques-Rocha JL, Guandalini VR. Muscle strength is associated with fracture risk obtained by fracture risk assessment tool (FRAX) in women with breast cancer. BMC Cancer 2022; 22:1115. [PMID: 36320019 PMCID: PMC9623985 DOI: 10.1186/s12885-022-10203-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
Abstract
Background Women with breast cancer are at risk for the development of sarcopenia and occurrence of fractures. The initial and periodic screening of these conditions can prevent the risks of disability, poor quality of life, and death. The present study investigated the association between sarcopenia phenotypes and fracture risk, assessed by the Fracture Risk Assessment Tool (FRAX) in women with breast cancer. Methods Cross-sectional study. It included women aged between 40 and 80 years, diagnosed with Luminal subtype breast cancer, with time of diagnosis ≤ 12 months, who had not started endocrine therapy, did not have metastasis, had not been treated for another malignancy, and had no recurrences. Sociodemographic, habits and lifestyle, clinical, anthropometric, and body composition variables were considered. Muscle strength, skeletal muscle mass, and physical performance were investigated using handgrip strength (HGS), appendicular skeletal muscle mass index (ASMI), and Timed Up and Go test (TUGT), respectively. Fracture risk was assessed using FRAX. Multiple linear regression models were conducted to verify the association between exposure variables and sarcopenia phenotypes. A significance level of p < 0.05 was adopted for all tests using the SPPS 25.0 program. Results Sixty-two women with a mean age of 58.1 ± 10.4 years were evaluated. Of these, 66.1% self-declared to be non-white, 41.9% and 71.0% did not consume alcohol or smoke, respectively, and 61.3% were insufficiently active. A total of 45.2% had clinical stage II carcinoma and 65.5% had the invasive breast carcinoma histological subtype. There was a predominance of adequacy of HGS (88.7%), ASMI (94.5%), and TUGT (96.8%), as well as low risk of hip fractures (85.5%) and major fractures (82.3%). HGS remained associated with FRAX hip fractures (p = 0.007) and FRAX major fractures (p = 0.007) in the adjusted models, while ASMI was associated with body mass (p < 0.001). Conclusions Low muscle strength was the sarcopenia phenotype that remained associated with fracture risk in women with breast cancer, independently of sociodemographic factors, level of physical activity, and clinical factors. In addition to the assessment of probable sarcopenia, this measurement may point out the risk of fractures.
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Affiliation(s)
- Rayne de Almeida Marques Bernabé
- grid.412371.20000 0001 2167 4168Postgraduate Program in Nutrition and Health, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Vitória CEP: 29040-090 Espírito Santo, Brazil
| | - Mariana de Souza Vieira
- grid.412371.20000 0001 2167 4168Postgraduate Program in Nutrition and Health, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Vitória CEP: 29040-090 Espírito Santo, Brazil
| | - Vanusa Felício de Souza
- grid.412371.20000 0001 2167 4168Postgraduate Program in Nutrition and Health, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Vitória CEP: 29040-090 Espírito Santo, Brazil
| | - Luana Gomes Fontana
- grid.412371.20000 0001 2167 4168Department of Integrated Health Education, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Espírito Santo, Vitória CEP: 29040-090 Brazil
| | - Ben-Hur Albergaria
- grid.412371.20000 0001 2167 4168Department of Social Medicine, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 - Maruípe, Espírito Santo, Vitória CEP: 29040-090 Brazil
| | - José Luiz Marques-Rocha
- grid.412371.20000 0001 2167 4168Postgraduate Program in Nutrition and Health, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Vitória CEP: 29040-090 Espírito Santo, Brazil ,grid.412371.20000 0001 2167 4168Department of Integrated Health Education, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Espírito Santo, Vitória CEP: 29040-090 Brazil
| | - Valdete Regina Guandalini
- grid.412371.20000 0001 2167 4168Postgraduate Program in Nutrition and Health, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Vitória CEP: 29040-090 Espírito Santo, Brazil ,grid.412371.20000 0001 2167 4168Department of Integrated Health Education, Health Science Center, Federal University of Espírito Santo, Marechal Campos Avenue, 1468 – Maruípe, Espírito Santo, Vitória CEP: 29040-090 Brazil
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Yu G, Yu M, Liu S, Xue H, Sun Y. Investigation of the Clinical Effect of New Shoulder Joint Abduction Frame in Humeral Fracture Patients after Arthroscopic Shoulder Surgery. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:8764155. [PMID: 36267303 PMCID: PMC9578869 DOI: 10.1155/2022/8764155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/08/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022]
Abstract
Objective This work is organized to analyze the clinical effects of new shoulder joint abduction frame on the bone metabolic markers, shoulder joint function, and visual analogue scale (VAS) of humeral fracture patients undergoing arthroscopic surgery. Methods 118 patients with humeral fracture who planned to undergo shoulder surgery in our hospital from November 2018 to June 2021 were selected as the study objects and were divided into two groups according to the random number method, with 59 patients in each group. The patients in the two groups were subjected to arthroscopic shoulder surgery. New shoulder joint abduction frame was used for shoulder joint fixation in the abduction frame group, and sling was used for shoulder joint fixation in the sling group after surgery. The duration of fixation was 4-6 weeks. Finally, the prognostic indicators, complications, and serum bone metabolism levels in 4 and 6 weeks after surgery, shoulder joint function (Neer score), VAS score before surgery and after 3 and 6 months of surgery, and excellent or good rate of shoulder joint activity after 6 months of surgery were compared between the two groups. Results The postoperative fracture healing time and start time of shoulder joint training were shorter, and the humeral varus angle and femur height loss were smaller in the abduction frame group than in the sling group (P < 0.05). There was no significant difference in the total incidence of complications between the two groups (3.39% and 13.56%, respectively) (P > 0.05). After 4 or 6 weeks of surgery, the levels of serum osteoprotegerin (OPG) and carboxyterminal propeptide of type I procollagen (PICP) were increased but the levels of tartrate-resistant acid phosphatase-5B (TRAP-5B) were decreased in the two groups with more significant differences in the abduction frame group (P < 0.05). After 6 months of follow-up, 2 cases were lost to follow-up in the abduction frame group and 3 cases in the sling group. Neer scores were increased, while VAS scores were decreased in the two groups in the third or sixth months after surgery with significant differences in the abduction frame group (P < 0.05). The excellent or good rate of shoulder joint activity was 94.74% (54/57) in the abduction frame group, significantly higher than that in the sling group (80.36%; 45/56) (P < 0.05). Conclusion The fixation effect of new shoulder joint abduction frame is significant after arthroscopic surgery, and patients can carry out functional training as early as possible, which is helpful to promote fracture healing, relieve pain, and restore shoulder joint function with high safety.
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Affiliation(s)
- Guiyang Yu
- Second Central Hospital of Baoding, Zhuozhou 072750, China
| | - Meining Yu
- Second Central Hospital of Baoding, Zhuozhou 072750, China
| | - Shan Liu
- Second Central Hospital of Baoding, Zhuozhou 072750, China
| | - Hui Xue
- Second Central Hospital of Baoding, Zhuozhou 072750, China
| | - Yuehua Sun
- Second Central Hospital of Baoding, Zhuozhou 072750, China
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Curtis EM, Codd V, Nelson C, D'Angelo S, Wang Q, Allara E, Kaptoge S, Matthews PM, Tobias JH, Danesh J, Cooper C, Samani NJ, Harvey NC. Telomere Length and Risk of Incident Fracture and Arthroplasty: Findings From UK Biobank. J Bone Miner Res 2022; 37:1997-2004. [PMID: 35880304 PMCID: PMC9826022 DOI: 10.1002/jbmr.4664] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 07/12/2022] [Accepted: 07/20/2022] [Indexed: 01/11/2023]
Abstract
We investigated independent associations between telomere length and risk of fracture and arthroplasty in UK Biobank participants. Leukocyte telomere length (LTL) was measured in baseline samples using a validated polymerase chain reaction (PCR) method. We used, in men and women separately, Cox proportional hazards models to calculate the hazard ratio (HR) for incident fracture (any, osteoporotic) or arthroplasty (hip or knee) over 1,186,410 person-years of follow-up. Covariates included age, white cell count, ethnicity, smoking, alcohol, physical activity, and menopause (women). In further analyses we adjusted for either estimated bone mineral density (eBMD) from heel quantitative ultrasound, handgrip strength, gait speed, total fat mass (bioimpedance), or blood biomarkers, all measured at baseline (2006-2010). We studied 59,500 women and 51,895 men, mean ± standard deviation (SD) age 56.4 ± 8.0 and 57.0 ± 8.3 years, respectively. During follow-up there were 5619 fractures; 5285 hip and 4261 knee arthroplasties. In confounder-adjusted models, longer LTL was associated with reduced risk of incident knee arthroplasty in both men (HR/SD 0.93; 95% confidence interval [CI], 0.88-0.97) and women (0.92; 95% CI, 0.88-0.96), and hip arthroplasty in men (0.91; 95% CI, 0.87-0.95), but not women (0.98; 95% CI, 0.94-1.01). Longer LTL was weakly associated with reduced risk of any incident fracture in women (HR/SD 0.96; 95% CI, 0.93-1.00) with less evidence in men (0.98; 95% CI, 0.93-1.02). Associations with incident outcomes were not materially altered by adjustment for heel eBMD, grip strength, gait speed, fat mass, or blood biomarker measures. In this, the largest study to date, longer LTL was associated with lower risk of incident knee or hip arthroplasty, but only weakly associated with lower risk of fracture. The relative risks were low at a population level, but our findings suggest that common factors acting on the myeloid and musculoskeletal systems might influence later life musculoskeletal outcomes. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
| | - Veryan Codd
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- NIHR Leicester Biomedical Research CentreGlenfield HospitalLeicesterUK
| | - Christopher Nelson
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- NIHR Leicester Biomedical Research CentreGlenfield HospitalLeicesterUK
| | - Stefania D'Angelo
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
| | - Qingning Wang
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- NIHR Leicester Biomedical Research CentreGlenfield HospitalLeicesterUK
| | - Elias Allara
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and GenomicsUniversity of CambridgeCambridgeUK
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeCambridgeUK
| | - Stephen Kaptoge
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and GenomicsUniversity of CambridgeCambridgeUK
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeCambridgeUK
| | - Paul M. Matthews
- Department of Brain Sciences and UK Dementia Research Institute CentreImperial College LondonLondonUK
| | - Jonathan H. Tobias
- Musculoskeletal Research UnitUniversity of BristolBristolUK
- Medical Research Council Integrative Epidemiology UnitUniversity of BristolBristolUK
| | - John Danesh
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
- National Institute for Health Research Blood and Transplant Research Unit in Donor Health and GenomicsUniversity of CambridgeCambridgeUK
- British Heart Foundation Centre of Research ExcellenceUniversity of CambridgeCambridgeUK
- Health Data Research UK CambridgeWellcome Genome Campus and University of CambridgeCambridgeUK
- Department of Human GeneticsWellcome Sanger InstituteHinxtonUK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- National Institute for Health and Care Research (NIHR) Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
- National Institute for Health and Care Research (NIHR) Oxford Biomedical Research CentreUniversity of OxfordOxfordUK
| | - Nilesh J. Samani
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
- NIHR Leicester Biomedical Research CentreGlenfield HospitalLeicesterUK
| | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology CentreUniversity of SouthamptonSouthamptonUK
- National Institute for Health and Care Research (NIHR) Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
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Correlation between Physical Performance and Stabilometric Parameters in Older Adults. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091211. [PMID: 36143889 PMCID: PMC9506392 DOI: 10.3390/medicina58091211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Falls are a common and serious threat to the health and independence of older adults. The decrease in functional capacity during aging means an increased risk of falls. To date, it is not known whether there is a relationship between balance and functional tests. The aim of the study was to evaluate the correlation between eyes-open and eyes-closed static balance with different functional tests. Materials and Methods: A correlation study was designed with 52 healthy subjects over 65 years of age. Results: Regarding the open eyes stabilometric parameters, significant correlations observed between the surface and the functional tests were weak in all cases. The correlations observed between length and the functional tests performed were moderate, except for that of the Timed Up and Go test (TUG) which was weak. No significant correlation between TUG and surface was found. Regarding the closed eyes stabilometric parameters, statistically significant moderate correlations were found between the surface and the Short Physical Performance Battery (SPPB) and the Five Times Sit to Stand test (5XSST). In the case of the length with eyes closed, a statistically significant moderate correlation (rho = 0.40-0.69) was found with the SPPB and 5XSST variables, and weak correlations with the 4 m Walk Speed test (4WS) and TUG variables. Conclusions: There is a mild to moderate correlation between some functional tests and stabilometric parameters in adults over 65 years old.
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Laskou F, Westbury LD, Fuggle NR, Edwards MH, Cooper C, Dennison EM. Relationships Between Muscle Parameters and History of Falls and Fractures in the Hertfordshire Cohort Study: Do All Muscle Components Relate Equally to Clinical Outcomes? Calcif Tissue Int 2022; 111:242-247. [PMID: 35590077 PMCID: PMC9395432 DOI: 10.1007/s00223-022-00986-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/26/2022] [Indexed: 11/21/2022]
Abstract
In previous work, relationships between muscle and bone size and strength have been demonstrated and were stronger in females, suggesting possible sexual dimorphism. Here we examine sex-specific associations between individual muscle sarcopenia components with clinical outcomes (falls and fractures). 641 participants were recruited. Muscle mass was assessed as cross-sectional area (CSA) by peripheral quantitative computed tomography of the calf, grip strength (GpS) by Jamar dynamometry and function by gait speed (GtS). Falls and fractures were self-reported. Ordinal and logistic regression were used to examine the associations between muscle measurements and outcomes with and without adjustment for confounders. Mean (SD) age was 69.3 (2.6) years. CSA, GpS, and GtS were greater among males (p < 0.002). A higher proportion of females had fallen since age 45 (61.3% vs 40.2%, p < 0.001); in the last year (19.9% vs 14.1%, p = 0.053); and reported a previous fracture since age 45 (21.8% vs 18.5%, p = 0.302), than males. Among females, greater CSA was related to reduced risk of falling and fewer falls in the previous year in fully adjusted analysis only (p < 0.05); higher GpS was related to lower risk of falls since age 45 in unadjusted analysis (p = 0.045) and lower risk of fracture since age 45 in both unadjusted and fully adjusted analysis (p < 0.045). No statistically significant associations were observed for GtS among either sex for any relationships between muscle measurements and clinical outcomes studied. We observed relationships between muscle mass and strength but not function with falls and fractures in females only; further longitudinal studies are required to reproduce these results.
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Affiliation(s)
- Faidra Laskou
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Leo D Westbury
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Nicholas R Fuggle
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- The Alan Turing Institute, London, UK
| | | | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
- Victoria University of Wellington, Wellington, New Zealand.
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Zhang SB, Chen H, Xu HW, Yi YY, Fang XY, Wang SJ. Computed tomography-based paravertebral muscle density predicts subsequent vertebral fracture risks independently of bone mineral density in postmenopausal women following percutaneous vertebral augmentation. Aging Clin Exp Res 2022; 34:2797-2805. [PMID: 36001272 DOI: 10.1007/s40520-022-02218-5] [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] [Received: 08/10/2021] [Accepted: 07/29/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND The risk of subsequent vertebral fractures (SVF) after the primary vertebral fracture cannot be explained by lower bone mineral density (BMD) alone. Computed tomography (CT) measurements of paravertebral muscle density (PMD) are recognized radiographic markers used to predict physical function, fragile fractures. AIMS This study aims to investigate the relationship between PMD and the risk of SVF in cohorts of postmenopausal women, and to determine if combining both PMD and BMD measures derived from CT can improve the accuracy of predicting SVF. METHODS This study enrolled 305 postmenopausal women between the ages of 50 and 88 for 3 years of follow-up studies. Trabecular attenuation (Hounsfield units, HU) was measured at L1 level and muscle attenuation of paravertebral muscle at L3 level on preoperative lumbar CT scans to determine the L1 BMD and L3 PMD. Kaplan-Meier analysis was applied to evaluate SVF-free survival. The hazard ratios (HRs) of PMD for SVF events were estimated with the Cox proportional hazards model. The predictive values of L1 BMD and L3 PMD for SVF were quantified using the Receiver-Operating Characteristic (ROC) curve. RESULT During the 3 years of follow-up studies, 88 patients (28.9%) suffered an SVF. ROC curve analysis demonstrated that an L3 PMD threshold of 32 HU had a sensitivity of 89.8% and a specificity of 62% for the prediction of SVF. Kaplan-Meier analysis showed that L3 PMD ≤ 32 HU was significantly associated with lower SVF-free survival (p < 0.001; log-rank test). After adjusting for age, BMI, diabetes, postoperative osteoporosis treatment, handgrip strength, L1 BMD, multivariate analyses also indicated a persistent modest effect of L3 PMD on SVF-free survival. The area under the ROC curve of L3 PMD and L1 BMD, combined to predict the risk of SVF, was 0.790, which was significantly higher than the value for L1 BMD alone (0.735). L3 PMD and L1 BMD significantly improved the accuracy of SVF risk prediction compared with L1 BMD alone, which was confirmed by reclassification improvement measures. The inclusion of handgrip strength and postoperative osteoporosis treatment in the model further improved SVF prediction accuracy, and PMD remained significant in the model. CONCLUSION Decreased L3 PMD is an independent risk predictor of SVF. Combined CT-based L1 BMD and L3 PMD can significantly improve the accuracy of predicting the risk of SVF in postmenopausal women who have suffered prior osteoporotic vertebral fractures.
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Affiliation(s)
- Shu-Bao Zhang
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150# Jimo RD, Pudong New Area, Shanghai, 200120, China
| | - Hao Chen
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150# Jimo RD, Pudong New Area, Shanghai, 200120, China
| | - Hao-Wei Xu
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150# Jimo RD, Pudong New Area, Shanghai, 200120, China
| | - Yu-Yang Yi
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150# Jimo RD, Pudong New Area, Shanghai, 200120, China
| | - Xin-Yue Fang
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150# Jimo RD, Pudong New Area, Shanghai, 200120, China
| | - Shan-Jin Wang
- Department of Spinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150# Jimo RD, Pudong New Area, Shanghai, 200120, China. .,Department of Orthopedic, East Hospital, Ji'an Hospital, Jiangxi, 343000, China.
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Harris RJ, Parimi N, Cawthon PM, Strotmeyer ES, Boudreau RM, Brach JS, Kwoh CK, Cauley JA. Associations of components of sarcopenia with risk of fracture in the Osteoporotic Fractures in Men (MrOS) study. Osteoporos Int 2022; 33:1815-1821. [PMID: 35380213 PMCID: PMC10011872 DOI: 10.1007/s00198-022-06390-2] [Citation(s) in RCA: 5] [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: 04/29/2021] [Accepted: 03/28/2022] [Indexed: 10/18/2022]
Abstract
Our aim was to evaluate the associations between the individual components of sarcopenia and fracture types. In this cohort, the risk of experiencing any clinical, hip, or major osteoporotic fracture is greater in men with slow walking speed in comparison to normal walking speed. INTRODUCTION The association between the components of sarcopenia and fractures has not been clearly elucidated and has hindered the development of appropriate therapeutic interventions. Our aim was to evaluate the associations between the individual components of sarcopenia, specifically lean mass, strength, and physical performance and fracture (any fracture, hip fracture, major osteoporotic fracture) in the Osteoporotic Fractures in Men (MrOS) study. METHODS The Osteoporotic Fractures in Men study (MrOS) recruited 5995 men ≥ 65 years of age. We measured appendicular lean mass (ALM) by dual-energy X-ray absorptiometry (low as residual value < 20th percentile for the cohort), walking speed (fastest trial of usual pace, values < 0.8 m/s were low), and grip strength (max score of 2 trials, values < 30 kg were low). Information on fractures was assessed tri-annually over an average follow-up of 12 years and centrally adjudicated. Cox proportional hazard models estimated the hazard ratio (HR) (95% confidence intervals) for slow walking speed, low grip strength, and low lean mass. RESULTS Overall, 1413 men had a fracture during follow-up. Slow walking speed was associated with an increased risk for any HR = 1.39, 1.05-1.84; hip HR = 2.37, 1.54-3.63; and major osteoporotic, HR = 1.89, 1.34-2.67 in multi-variate-adjusted models. Low lean mass and low grip strength were not significantly associated with fracture. CONCLUSIONS In this cohort of older adult men, the risk of experiencing any, hip, or major osteoporotic fracture is greater in men with slow walking speed in comparison to men with normal walking speed, but low grip strength and low lean mass were not associated with fracture.
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Affiliation(s)
- R J Harris
- Department of Epidemiology Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA, USA.
- VA Boston Healthcare System, Boston, MA, USA.
| | - N Parimi
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - P M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - E S Strotmeyer
- Department of Epidemiology Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA, USA
| | - R M Boudreau
- Department of Epidemiology Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA, USA
| | - J S Brach
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - C K Kwoh
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - J A Cauley
- Department of Epidemiology Graduate School of Public Health University of Pittsburgh, Pittsburgh, PA, USA
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Alajlouni DA, Bliuc D, Tran TS, Blank RD, Cawthon PM, Ensrud KE, Lane NE, Orwoll ES, Cauley JA, Center JR. Muscle Strength and Physical Performance Are Associated With Risk of Postfracture Mortality But Not Subsequent Fracture in Men. J Bone Miner Res 2022; 37:1571-1579. [PMID: 35689796 PMCID: PMC9378706 DOI: 10.1002/jbmr.4619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/10/2022] [Accepted: 06/04/2022] [Indexed: 11/14/2022]
Abstract
Muscle strength and physical performance are associated with incident fractures and mortality. However, their role in the risk of subsequent fracture and postfracture mortality is not clear. We assessed the association between muscle strength (grip strength) and performance (gait speed and chair stands time) and the risk of subsequent fracture and mortality in 830 men with low-trauma index fracture, who participated in the Osteoporotic Fractures in Men (MrOS) USA Study and had their index measurements assessed within 5 years prior to the index fracture. The annual decline in muscle strength and performance following index fracture, estimated using linear mixed-effects regression, was also examined in relation to mortality. The associations were assessed using Cox proportional hazards models adjusted for age, femoral neck bone mineral density (FN BMD), prior fractures, falls, body mass index (BMI), index fracture site, lifestyle factors, and comorbidities. Over a median follow-up of 3.7 (interquartile range [IQR], 1.3-8.1) years from index fracture to subsequent fracture, 201 (24%) men had a subsequent fracture and over 5.1 (IQR, 1.8-9.6) years to death, and 536 (65%) men died. Index measurements were not associated with subsequent fracture (hazard ratios [HRs] ranging from 0.97 to 1.07). However, they were associated with postfracture mortality. HR (95% confidence interval [CI]) per 1 standard deviation (1-SD) decrement in grip strength: HR 1.12 (95% CI, 1.01-1.25) and gait speed: HR 1.14 (95% CI, 1.02-1.27), and 1-SD increment in chair stands time: HR 1.08 (95% CI, 0.97-1.21). Greater annual declines in these measurements were associated with higher mortality risk, independent of the index values and other covariates. HR (95% CI) per 1-SD annual decrement in change in grip strength: HR 1.15 (95% CI, 1.01-1.33) and in gait speed: HR 1.38 (95% CI, 1.13-1.68), and 1-SD annual increment in chair stands time: HR 1.28 (95% CI, 1.07-1.54). Men who were unable to complete one or multiple tests had greater risk of postfracture mortality (24%-109%) compared to those performed all tests. It remains to be seen whether improvement in these modifiable factors can reduce postfracture mortality. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Dima A. Alajlouni
- Bone BiologyGarvan Institute of Medical ResearchSydneyAustralia
- Faculty of MedicineUNSW SydneySydneyAustralia
| | - Dana Bliuc
- Bone BiologyGarvan Institute of Medical ResearchSydneyAustralia
- Faculty of MedicineUNSW SydneySydneyAustralia
| | - Thach S. Tran
- Bone BiologyGarvan Institute of Medical ResearchSydneyAustralia
- Faculty of MedicineUNSW SydneySydneyAustralia
| | - Robert D. Blank
- Bone BiologyGarvan Institute of Medical ResearchSydneyAustralia
| | - Peggy M. Cawthon
- Research InstituteCalifornia Pacific Medical CenterSan FranciscoCAUSA
- Department of Epidemiology and BiostatisticsUniversity of California, San Francisco Coordinating CenterSan FranciscoCAUSA
| | - Kristine E. Ensrud
- Center for Care Delivery and Outcomes ResearchMinneapolis VA Healthcare SystemMinneapolisMNUSA
- Division of Epidemiology and Community HealthUniversity of MinnesotaMinneapolisMNUSA
| | - Nancy E. Lane
- Department of MedicineUniversity of California at Davis, School of MedicineSacramentoCAUSA
| | - Eric S. Orwoll
- Department of MedicineOregon Health and Science UniversityPortlandORUSA
| | - Jane A. Cauley
- Department of Epidemiology, Graduate School of Public HealthUniversity of PittsburghPittsburghPAUSA
| | - Jacqueline R. Center
- Bone BiologyGarvan Institute of Medical ResearchSydneyAustralia
- Faculty of MedicineUNSW SydneySydneyAustralia
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35
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Lee S, Song DW, Shin S, Hong N, Rhee Y. Elevated serum gamma-glutamyl transferase is associated with low muscle function in adults independent of muscle mass. Nutrition 2022; 103-104:111813. [DOI: 10.1016/j.nut.2022.111813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 07/18/2022] [Accepted: 08/02/2022] [Indexed: 10/31/2022]
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36
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Cawthon PM, Peters KE, Cummings SR, Orwoll ES, Hoffman AR, Ensrud KE, Cauley JA, Evans WJ. Association Between Muscle Mass Determined by D 3 -Creatine Dilution and Incident Fractures in a Prospective Cohort Study of Older Men. J Bone Miner Res 2022; 37:1213-1220. [PMID: 35253257 PMCID: PMC9283198 DOI: 10.1002/jbmr.4505] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 12/10/2021] [Accepted: 01/12/2022] [Indexed: 11/05/2022]
Abstract
The relation between a novel measure of total skeletal muscle mass (assessed by D3 -creatine dilution [D3 Cr]) and incident fracture is unknown. In 1363 men (mean age 84.2 years), we determined D3 Cr muscle mass; Fracture Risk Assessment Tool (FRAX) 10-year probability of hip and major osteoporotic (hip, humerus, vertebral, forearm) fracture; and femoral neck bone mineral density (BMD) (by dual-energy X-ray absorptiometry [DXA]). Incident fractures were centrally adjudicated by review of radiology reports over 4.6 years. Correlations adjusted for weight and height were calculated between femoral neck BMD and D3 Cr muscle mass. Across quartiles of D3 Cr muscle mass/weight, proportional hazards models calculated hazard ratios (HRs) for any (n = 180); nonspine (n = 153); major osteoporotic fracture (n = 85); and hip fracture (n = 40) after adjustment for age, femoral neck BMD, recurrent fall history, and FRAX probability. Models were then adjusted to evaluate the mediating influence of physical performance (walking speed, chair stands, and grip strength). D3 Cr muscle mass was weakly correlated with femoral BMD (r = 0.10, p < 0.001). Compared to men in the highest quartile, those in the lowest quartile of D3 Cr muscle mass/weight had an increased risk of any clinical fracture (HR 1.8; 95% confidence interval [CI], 1.1-2.8); nonspine fracture (HR 1.8; 95% CI, 1.1-3.0), major osteoporotic fracture (HR 2.3; 95% CI, 1.2-4.6), and hip fracture (HR 5.9; 95% CI, 1.6-21.1). Results were attenuated after adjustment for physical performance, but associations remained borderline significant for hip and major osteoporotic fractures (p ≥ 0.05 to 0.10). Low D3 Cr muscle mass/weight is associated with a markedly high risk of hip and potentially other fractures in older men; this association is partially mediated by physical performance. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Katherine E Peters
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
| | - Steven R Cummings
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Eric S Orwoll
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | | | - Kristine E Ensrud
- Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA.,Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.,Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jane A Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - William J Evans
- Nutritional Sciences & Toxicology, University of California, Berkeley, CA, USA.,Department of Medicine, Duke University, Durham, NC, USA
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37
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Kirk B, Duque G. Muscle and Bone: An Indissoluble Union. J Bone Miner Res 2022; 37:1211-1212. [PMID: 35764095 DOI: 10.1002/jbmr.4626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/10/2022] [Accepted: 06/04/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Ben Kirk
- Australian Institute for Musculoskeletal Science (AIMSS), Geroscience & Osteosarcopenia Research Program, The University of Melbourne and Western Health, St. Albans, VIC, Australia.,Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), Geroscience & Osteosarcopenia Research Program, The University of Melbourne and Western Health, St. Albans, VIC, Australia.,Department of Medicine-Western Health, The University of Melbourne, St. Albans, VIC, Australia
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38
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Asahi R, Nakamura Y, Kanai M, Watanabe K, Yuguchi S, Kamo T, Azami M, Ogihara H, Asano S. Association with sagittal alignment and osteoporosis-related fractures in outpatient women with osteoporosis. Osteoporos Int 2022; 33:1275-1284. [PMID: 35091788 DOI: 10.1007/s00198-021-06282-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
Abstract
UNLABELLED The baseline sagittal vertical axis (SVA) and pelvic tilt (PT) are independent risk factors of osteoporosis-related fractures in women with osteoporosis. We clarified the SVA and PT to predict the incidence of osteoporosis-related fractures. PURPOSE Sagittal alignment with osteoporosis women deteriorates with advancing age and sagittal alignment may indicate osteoporosis-related fractures in the future. However, whether the sagittal alignment predicts future osteoporosis-related fracture in patients with osteoporosis has not been clarified. We aimed to investigate the association between sagittal alignment and future osteoporosis-related fractures. METHODS This was a retrospective cohort study. Of the 313 participants (mean follow-up period, 2.9 years), 236 were included in the analysis. At baseline, we measured bone mineral density (BMD) of the lumbar spine and the femoral neck, sagittal vertical axis (SVA), thoracic kyphosis, pelvic incidence minus lumbar lordosis, sacral slope, pelvic tilt (PT), geriatric locomotive function scale (GLFS), two-step value, and stand-up test. The information on medications and the duration of treatment were reviewed from the medical records. Additionally, participants reported their history of falls at baseline. Multiple logistic regression analysis was used to determine the association of future osteoporosis-related fracture, and adjusted Odds ratios (OR) and 95% confidence interval (CI) were calculated with all predictors as covariates. All continuous variables were calculated using standardized OR (sOR). RESULTS Osteoporosis-related fractures occurred in 33 of 313 participants (10.5%). Multiple logistic regression analysis showed that a history of falls (OR =4.092, 95% CI: 1.029-16.265, p =0.045), SVA (sOR =4.228, 95% CI: 2.118-8.439, p <0.001), and PT (sOR =2.497, 95% CI: 1.087-5.733, p =0.031) were independent risk factors for future osteoporosis-related fractures. CONCLUSIONS This study revealed the SVA and PT to predict osteoporosis-related fractures. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION UMIN000036516 (April 1, 2019).
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Affiliation(s)
- R Asahi
- School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte City, Saitama, 340-0145, Japan.
| | - Y Nakamura
- Saitama Spine Center, Higashi Saitama General Hospital, 517-5, Yoshino, Satte City, Saitama, 340-0153, Japan
| | - M Kanai
- Saitama Spine Center, Higashi Saitama General Hospital, 517-5, Yoshino, Satte City, Saitama, 340-0153, Japan
| | - K Watanabe
- Department of Rehabilitation, Higashi Saitama General Hospital, 517-5, Yoshino, Satte City, Saitama, 340-0153, Japan
| | - S Yuguchi
- School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte City, Saitama, 340-0145, Japan
| | - T Kamo
- School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte City, Saitama, 340-0145, Japan
| | - M Azami
- School of Health Sciences, Japan University of Health Sciences, 2-555, Hirasuka, Satte City, Saitama, 340-0145, Japan
| | - H Ogihara
- Division of Physical Therapy, Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, 11-1, Imaihara, Kawanakajima-machi, Nagano City, Nagano, 381-2227, Japan
| | - S Asano
- Saitama Spine Center, Higashi Saitama General Hospital, 517-5, Yoshino, Satte City, Saitama, 340-0153, Japan
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39
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Cailleaux PE, Cohen-Solal M. Managing Musculoskeletal and Kidney Aging: A Call for Holistic Insights. Clin Interv Aging 2022; 17:717-732. [PMID: 35548383 PMCID: PMC9081621 DOI: 10.2147/cia.s357501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/20/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Martine Cohen-Solal
- Inserm UMR-S 1132 Bioscar, Université Paris Cité - Hôpital Lariboisiere, Paris, F-75010, France
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40
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Alajlouni D, Tran T, Bliuc D, Blank RD, Cawthon PM, Orwoll ES, Center JR. Muscle Strength and Physical Performance Improve Fracture Risk Prediction Beyond Garvan and FRAX: The Osteoporotic Fractures in Men (MrOS) Study. J Bone Miner Res 2022; 37:411-419. [PMID: 34842309 PMCID: PMC8940659 DOI: 10.1002/jbmr.4483] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/01/2021] [Accepted: 11/20/2021] [Indexed: 12/14/2022]
Abstract
Muscle strength and physical performance are associated with fracture risk in men. However, it is not known whether these measurements enhance fracture prediction beyond Garvan and FRAX tools. A total of 5665 community-dwelling men, aged ≥65 years, from the Osteoporotic Fractures in Men (MrOS) Study, who had data on muscle strength (grip strength) and physical performance (gait speed and chair stand tests), were followed from 2000 to 2019 for any fracture, major osteoporotic fracture (MOF), initial hip, and any hip fracture. The contributions to different fracture outcomes were assessed using Cox's proportional hazard models. Tool-specific analysis approaches and outcome definitions were used. The added predictive values of muscle strength and physical performance beyond Garvan and FRAX were assessed using categorical net reclassification improvement (NRI) and relative importance analyses. During a median follow-up of 13 (interquartile range 7-17) years, there were 1014 fractures, 536 MOFs, 215 initial hip, and 274 any hip fractures. Grip strength and chair stand improved prediction of any fracture (NRI for grip strength 3.9% and for chair stand 3.2%) and MOF (5.2% and 6.1%). Gait speed improved prediction of initial hip (5.7%) and any hip (7.0%) fracture. Combining grip strength and the relevant performance test further improved the models (5.7%, 8.9%, 9.4%, and 7.0% for any, MOF, initial, and any hip fractures, respectively). The improvements were predominantly driven by reclassification of those with fracture to higher risk categories. Apart from age and femoral neck bone mineral density, muscle strength and performance were ranked equal to or better than the other risk factors included in fracture models, including prior fractures, falls, smoking, alcohol, and glucocorticoid use. Muscle strength and performance measurements improved fracture risk prediction in men beyond Garvan and FRAX. They were as or more important than other established risk factors. These measures should be considered for inclusion in fracture risk assessment tools. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Dima Alajlouni
- Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.,Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Thach Tran
- Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.,Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Dana Bliuc
- Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.,Faculty of Medicine, UNSW Sydney, Sydney, Australia
| | - Robert D Blank
- Bone Biology, Garvan Institute of Medical Research, Sydney, Australia
| | - Peggy M Cawthon
- California Pacific Medical Center, Research Institute, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco Coordinating Center, San Francisco, CA, USA
| | - Eric S Orwoll
- Bone and Mineral Unit, Oregon Health & Science University, Portland, OR, USA
| | - Jacqueline R Center
- Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.,Faculty of Medicine, UNSW Sydney, Sydney, Australia
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41
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Perrott S, Martin K, Keevil VL, Wareham NJ, Khaw KT, Myint PK. Self-reported physical functional health predicts future bone mineral density in EPIC-Norfolk cohort. Arch Osteoporos 2022; 17:25. [PMID: 35089428 PMCID: PMC8796741 DOI: 10.1007/s11657-021-01043-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/17/2021] [Indexed: 02/03/2023]
Abstract
Using a large population sample from the UK, we found that self-reported physical functional health may be used to predict future bone mineral density especially in women. It may be a useful and inexpensive way to identify individuals before further decline in bone mineral density and the risk of fracture. PURPOSE Self-reported physical functional health may predict bone mineral density (BMD) and thus provide a method to identify people at risk of low BMD. In this study, the association between the 36-item short-form questionnaire (SF-36) physical component summary (PCS) score and future BMD in participants aged 40-79 years enrolled in the European Prospective Investigation of Cancer-Norfolk study was investigated. METHODS Associations between a participant's SF-36 PCS score, measured 18 months after baseline health check, and broadband ultrasound attenuation (BUA-a measure of BMD), measured 2-5 years after baseline, were examined using sex-specific linear and logistic regression analyses adjusting for age, BMI, medical co-morbidities, lifestyle and socioeconomic factors. RESULTS Data from 10,203 participants, mean (standard deviation (SD)) age 61.5 (8.9) years (57.4% women), were analysed from 1993 to 2000. For every five points lower PCS score in men and women, there was approximately a 0.5 dB/MHz lower mean BUA. In women, a PCS score of less than one standard deviation (1SD) below the sex-specific mean was associated with having a low BUA (< 1SD below sex-specific mean) and very low BUA (< 2.5SD below the sex specific mean); odds ratio (OR) (95% confidence interval) 1.53 (1.24, 1.88) and 8.28 (2.67, 25.69), respectively. The relationship was lesser so in men; corresponding OR (95% CI) were 1.34 (0.91, 1.98) and 2.57 (0.72, 9.20), respectively. CONCLUSIONS Self-reported physical functioning predicts BMD in an apparently healthy population, particularly in women. This could potentially provide an inexpensive, simple screening tool to identify individuals at risk of osteoporosis.
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Affiliation(s)
- Sarah Perrott
- Ageing Clinical & Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Polwarth Building, Room 4:013, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Kathryn Martin
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- The Aberdeen Centre for Arthritis and Musculoskeletal Health, Aberdeen, UK
| | | | | | - Kay-Tee Khaw
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Phyo Kyaw Myint
- Ageing Clinical & Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Polwarth Building, Room 4:013, Foresterhill, Aberdeen, AB25 2ZD, UK.
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42
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Fujita Y, Iki M, Yura A, Harano A, Kouda K, Tamaki J, Sato Y, Tachiki T, Kajita E, Ishizuka R, Moon JS, Okamoto N, Kurumatani N. Combined results of three physical performance tests predict incident fracture independently of aBMD in community-dwelling elderly Japanese men: Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) Cohort Study. Bone 2022; 154:116240. [PMID: 34678493 DOI: 10.1016/j.bone.2021.116240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/07/2021] [Accepted: 10/18/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Several studies have examined the association between physical performance and fracture in women, but few such studies have targeted elderly men. This study aimed to determine whether the combined results of several physical performance tests can predict the subsequent incidence of fractures in elderly men after adjusting for confounding factors. METHODS Of the 2174 elderly men who participated in this study, 2012 completed the baseline study visit, including physical performance tests (walking speed, hand grip strength, and one-leg standing) and measurement of bone mineral density by dual-energy X-ray absorptiometry. Follow-up study visits were conducted five and ten years later, during which incident fractures were identified by detailed interviews. We excluded 140 men with diseases or who took medications known to affect bone metabolism at baseline, 185 with missing values for predictors and potential confounding factors, and one who did not participate in any of the follow-up study visits. The remaining 1686 men were analyzed. Each physical performance test was analyzed by quartiles. Poor performance was defined as belonging to the worst quartile of performance. The association between physical performance and fracture was assessed using Cox proportional hazards models. RESULTS We identified 175 clinical fractures (osteoporotic fracture: 77, major osteoporotic fracture: 48) in 1686 men during a mean follow-up period of 8.4 years. After adjusting for potential confounding factors including bone mineral density, men who performed poorly on all three physical performance tests had a 3.7-fold higher risk of osteoporotic fracture and a 6.6-fold higher risk of major osteoporotic fracture than men who did not perform poorly on any of the tests. CONCLUSIONS Japanese elderly men who performed poorly on all three physical performance tests had a significantly higher risk of incident osteoporotic fracture independently of bone mineral density. The combined results of several physical performance tests may be useful for predicting incident fractures in elderly men.
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Affiliation(s)
- Yuki Fujita
- Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Masayuki Iki
- Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka 589-8511, Japan.
| | - Akiko Yura
- Department of Public Health, Kindai University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Akihiro Harano
- Department of Orthopedics, Yamato Takada Municipal Hospital, 1-1 Isonokitamachi, Yamato-Takada, Nara 635-8501, Japan
| | - Katsuyasu Kouda
- Department of Hygiene and Public Health, Kansai Medical University, 2-5-1 Shin-machi, Hirakata, Osaka 573-1010, Japan
| | - Junko Tamaki
- Department of Hygiene and Public Health, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan
| | - Yuho Sato
- Department of Human Life, Jin-ai University, 3-1-1 Ohdecho, Echizen, Fukui 915-8586, Japan
| | - Takahiro Tachiki
- Chukyo Gakuin University Faculty of Nursing, 2216 Tokicho, Mizunami, Gifu 509-6192, Japan
| | - Etsuko Kajita
- Chukyo Gakuin University Faculty of Nursing, 2216 Tokicho, Mizunami, Gifu 509-6192, Japan
| | - Rika Ishizuka
- Nara Medical University School of Medicine, 840 Shijocho, Kashihara, Nara 634-8521, Japan
| | - Jong-Seong Moon
- Department of Nursing, Kio University, 4-2-2 Umami-naka, Koryo-cho, Nara 635-0832, Japan
| | - Nozomi Okamoto
- Graduate School of Education, Hyogo University of Teacher Education, 942-1 Shimokume, Kato-City, Hyogo 673-1494, Japan
| | - Norio Kurumatani
- Nara Medical University School of Medicine, 840 Shijocho, Kashihara, Nara 634-8521, Japan
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43
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Vescini F, Chiodini I, Falchetti A, Palermo A, Salcuni AS, Bonadonna S, De Geronimo V, Cesareo R, Giovanelli L, Brigo M, Bertoldo F, Scillitani A, Gennari L. Management of Osteoporosis in Men: A Narrative Review. Int J Mol Sci 2021; 22:ijms222413640. [PMID: 34948434 PMCID: PMC8705761 DOI: 10.3390/ijms222413640] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 12/12/2022] Open
Abstract
Male osteoporosis is a still largely underdiagnosed pathological condition. As a consequence, bone fragility in men remains undertreated mainly due to the low screening frequency and to controversies in the bone mineral density (BMD) testing standards. Up to the 40% of overall osteoporotic fractures affect men, in spite of the fact that women have a significant higher prevalence of osteoporosis. In addition, in males, hip fractures are associated with increased morbidity and mortality as compared to women. Importantly, male fractures occur about 10 years later in life than women, and, therefore, due to the advanced age, men may have more comorbidities and, consequently, their mortality is about twice the rate in women. Gender differences, which begin during puberty, lead to wider bones in males as compared with females. In men, follicle-stimulating hormones, testosterone, estrogens, and sex hormone-binding levels, together with genetic factors, interact in determining the peak of bone mass, BMD maintenance, and lifetime decrease. As compared with women, men are more frequently affected by secondary osteoporosis. Therefore, in all osteoporotic men, a complete clinical history should be collected and a careful physical examination should be done, in order to find clues of a possible underlying diseases and, ultimately, to guide laboratory testing. Currently, the pharmacological therapy of male osteoporosis includes aminobisphosphonates, denosumab, and teriparatide. Hypogonadal patients may be treated with testosterone replacement therapy. Given that the fractures related to mortality are higher in men than in women, treating male subjects with osteoporosis is of the utmost importance in clinical practice, as it may impact on mortality even more than in women.
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Affiliation(s)
- Fabio Vescini
- Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia, 33100 Udine, Italy; (F.V.); (A.S.S.)
| | - Iacopo Chiodini
- Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy; (A.F.); (S.B.)
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122 Milan, Italy;
- Correspondence:
| | - Alberto Falchetti
- Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy; (A.F.); (S.B.)
| | - Andrea Palermo
- Unit of Endocrinology and Diabetes, Campus Bio-Medico University, 00128 Rome, Italy;
| | - Antonio Stefano Salcuni
- Endocrinology and Metabolism Unit, University-Hospital S. Maria della Misericordia, 33100 Udine, Italy; (F.V.); (A.S.S.)
| | - Stefania Bonadonna
- Istituto Auxologico Italiano, IRCCS, 20149 Milan, Italy; (A.F.); (S.B.)
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122 Milan, Italy;
| | | | - Roberto Cesareo
- Center of Metabolic Disease, S.M. Goretti Hospital, 04100 Latina, Italy;
| | - Luca Giovanelli
- Department of Medical Biotechnology and Translational Medicine, University of Milan, 20122 Milan, Italy;
| | - Martina Brigo
- Department of Medicine, University of Verona, 37129 Verona, Italy; (M.B.); (F.B.)
| | - Francesco Bertoldo
- Department of Medicine, University of Verona, 37129 Verona, Italy; (M.B.); (F.B.)
| | - Alfredo Scillitani
- Unit of Endocrinology, Ospedale “Casa Sollievo della Sofferenza”, IRCCS, San Giovanni Rotondo, 71013 Foggia, Italy;
| | - Luigi Gennari
- Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy;
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Jafari M, Anwar S, Kour K, Sanjoy S, Goyal K, Prasad B. T Scores, FRAX, Frailty Phenotype, Falls, and Its Relationship to Fractures in Patients on Maintenance Hemodialysis. Can J Kidney Health Dis 2021; 8:20543581211041184. [PMID: 34457317 PMCID: PMC8392815 DOI: 10.1177/20543581211041184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/18/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite the magnitude of fracture and the consequences in patients receiving hemodialysis, optimal risk assessment tools in this population are not well explored. Frailty and falls-known risk factors for fracture in chronic kidney disease (CKD) and non-CKD populations-are common in patients receiving hemodialysis (HD) therapy. While the relationship between T scores in relation to fractures in patients receiving HD is recognized, there is a paucity of data to the additional contributions of fracture assessment tool (FRAX), frailty status, and falls in its relationship with fracture. OBJECTIVES To evaluate the clinical utility of adding FRAX, frailty status, and falls to T scores at the femoral neck to determine whether it enhances fracture discrimination in patients on maintenance HD. DESIGN A cross-sectional observational study. SETTING Two main dialysis units in Regina, Saskatchewan, Canada. PATIENTS A total of 109 patients on maintenance HD at two dialysis units from January 1, 2017, to December 31, 2018, were included in the study. MEASUREMENTS Fracture (the main outcome) was documented based on the review of medical charts, self-recall, and additionally vertebral fractures were identified by an x-ray. Areal bone mineral density (BMD) was measured by dual-energy x-ray absorptiometry (DXA). FRAX score was calculated using an online algorithm based on 11 clinical risk factors. We calculated the FRAX score for hip fracture and major osteoprotoic fracture with and without the inclusion of BMD. Frailty was assessed using the Fried criteria, which included assessments of unintentional weight loss, weakness (handgrip strength), slowness (walking speed), and questionnaires for physical activity and self-perceived exhaustion. Patients were enquired about the history and frequency of falls. METHODS A total of 131 patients underwent frailty assessments at the two dialysis units during the dialysis treatment. Following frailty assessments, they were referred for DXA scans and upon receipt of the results undertook FRAX questionnaires. They were additionally sent for lumbar x-rays and contacted for a history of falls. Association between the BMD-T score, FRAX, frailty status, falls, with fracture were examined with sequential multivariable logistic regression models. Differences were considered statistically significant at P values <.05. RESULTS A total of 109 patients were included in the data analysis. The composite of fracture occurred in 37.6% of patients. About 59.3% were identified as frail, and 29% of the participants had at least one fall in the last year. On multivariate regression analysis, each lower standard deviation (SD) in femoral neck T score was associated with 48% higher odds of fracture (odds ratio [OR] = 1.48; 95% confidence interval [CI] 1.20-1.68, P = .005). With the inclusion for FRAX scores (hip), the OR for fracture remained significant at 1.38 (OR = 1.38, 95% CI 1.04-1.63, P = .043). The addition of frailty status and history of falls did not further improve the model. Low T score and FRAX were both independent risk factors in patients on HD therapy. LIMITATIONS This is a single-center study with a small sample size which limits the generalizability of the findings. Due to the cross-sectional study, associations identified may be difficult to interpret. CONCLUSIONS Both BMD measurements by DXA and FRAX are useful tools to assess fracture in patients receiving HD. The addition of frailty status and history of falls is not associated with fractures in this population. Larger prospective studies are needed to determine whether the inclusion of frailty and falls to the conventional models will improve fracture assessment in the population receiving HD. TRIAL REGISTRATION The study was not registered on a publicly accessible registry as it did not involve health care intervention on human participants.
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Affiliation(s)
- Maryam Jafari
- Dr. T. Bhanu Prasad Medical Professional Corporation, Regina, SK, Canada
| | - Salman Anwar
- College of Medicine, University of Saskatchewan, Regina, Canada
| | - Kaval Kour
- Dr. T. Bhanu Prasad Medical Professional Corporation, Regina, SK, Canada
| | - Shubrandu Sanjoy
- Research Department, Saskatchewan Health Authority, Regina, Canada
| | - Kunal Goyal
- Department of Radiology, Regina General Hospital, Regina, SK, Canada
| | - Bhanu Prasad
- Section of Nephrology, Department of Medicine, Regina General Hospital, Regina, SK, Canada
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Abstract
➤ Our ability to accurately identify high fracture risk in individuals has improved as the volume of clinical data has expanded and fracture risk assessment tools have been developed. ➤ Given its accessibility, affordability, and low radiation exposure, dual x-ray absorptiometry (DXA) remains the standard for osteoporosis screening and monitoring response to treatment. ➤ The trabecular bone score (TBS) is a DXA software add-on that uses lumbar spine DXA imaging to produce an output that correlates with bone microarchitecture. It has been identified as an independent fracture risk factor and may prove useful in further stratifying fracture risk among those with a bone mineral density (BMD) in the osteopenic range (-1.0 to -2.4 standard deviations), in those with low-energy fractures but normal or only mildly low BMD, or in those with conditions known to impair bone microarchitecture. ➤ Fracture risk assessment tools, including the Fracture Risk Assessment Tool (FRAX), Garvan fracture risk calculator, and QFracture, evaluate the impact of multiple clinical factors on fracture risk, even in the absence of BMD data. Each produces an absolute fracture risk output over a defined interval of time. When used appropriately, these enhance our ability to identify high-risk patients and allow us to differentiate fracture risk among patients who present with similar BMDs. ➤ For challenging clinical cases, a combined approach is likely to improve accuracy in the identification of high-risk patients who would benefit from the available osteoporosis therapies.
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Affiliation(s)
| | - Lisa K Schroder
- University of Minnesota, Minneapolis, Minnesota.,Park Nicollet Methodist Hospital, St. Louis Park, Minnesota
| | - Julie A Switzer
- University of Minnesota, Minneapolis, Minnesota.,Park Nicollet Methodist Hospital, St. Louis Park, Minnesota
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Ni Lochlainn M, Nessa A, Sheedy A, Horsfall R, García MP, Hart D, Akdag G, Yarand D, Wadge S, Baleanu AF, Whelan K, Steves C. The PROMOTe study: targeting the gut microbiome with prebiotics to overcome age-related anabolic resistance: protocol for a double-blinded, randomised, placebo-controlled trial. BMC Geriatr 2021; 21:407. [PMID: 34210274 PMCID: PMC8248289 DOI: 10.1186/s12877-021-02301-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/26/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Loss of skeletal muscle mass and strength occurs with increasing age and is associated with loss of function, disability, and the development of sarcopenia and frailty. Dietary protein is essential for skeletal muscle function, but older adults do not anabolise muscle in response to protein supplementation as well as younger people, so called 'anabolic resistance'. The aetiology and molecular mechanisms for this are not understood, however the gut microbiome is known to play a key role in several of the proposed mechanisms. Thus, we hypothesise that the gut microbiome may mediate anabolic resistance and therefore represent an exciting new target for ameliorating muscle loss in older adults. This study aims to test whether modulation of the gut microbiome using a prebiotic, in addition to protein supplementation, can improve muscle strength (as measured by chair-rise time) versus protein supplementation alone. METHODS The study is a randomised, double-blinded, placebo-controlled trial, with two parallel arms; one will receive prebiotic and protein supplementation, and the other will receive placebo (maltodextrin) and protein supplementation. Participants will be randomised as twin pairs, with one twin from each pair in each arm. Participants will be asked to take supplementation once daily for 12 weeks in addition to resistance exercises. Every participant will receive a postal box, containing their supplements, and the necessary equipment to return faecal, urine, saliva and capillary blood samples, via post. A virtual visit will be performed using online platform at the beginning and end of the study, with measures taken over video. Questionnaires, food diary and cognitive testing will be sent out via email at the beginning and end of the study. DISCUSSION This study aims to provide evidence for the role of the gut microbiome in anabolic resistance to dietary protein. If those who take the prebiotic and protein supplementation have a greater improvement in muscle strength compared with those who take protein supplementation alone, this would suggest that strategies to modify the gut microbiome may reduce anabolic resistance, and therefore potentially mitigate sarcopenia and frailty in older adults. TRIAL REGISTRATION Clinicaltrials.gov: NCT04309292 . Registered on the 2nd May 2020.
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Affiliation(s)
- Mary Ni Lochlainn
- Department of Twin Research & Genetic Epidemiology, King's College London, 3rd Floor South Wing, St Thomas' Hospital, SE1 7EH, London, UK.
| | - Ayrun Nessa
- Department of Twin Research & Genetic Epidemiology, King's College London, 3rd Floor South Wing, St Thomas' Hospital, SE1 7EH, London, UK
| | - Alyce Sheedy
- Department of Twin Research & Genetic Epidemiology, King's College London, 3rd Floor South Wing, St Thomas' Hospital, SE1 7EH, London, UK
| | - Rachel Horsfall
- Department of Twin Research & Genetic Epidemiology, King's College London, 3rd Floor South Wing, St Thomas' Hospital, SE1 7EH, London, UK
| | - María Paz García
- Department of Twin Research & Genetic Epidemiology, King's College London, 3rd Floor South Wing, St Thomas' Hospital, SE1 7EH, London, UK
| | - Deborah Hart
- Department of Twin Research & Genetic Epidemiology, King's College London, 3rd Floor South Wing, St Thomas' Hospital, SE1 7EH, London, UK
| | - Gulsah Akdag
- Department of Twin Research & Genetic Epidemiology, King's College London, 3rd Floor South Wing, St Thomas' Hospital, SE1 7EH, London, UK
| | - Darioush Yarand
- Department of Twin Research & Genetic Epidemiology, King's College London, 3rd Floor South Wing, St Thomas' Hospital, SE1 7EH, London, UK
| | - Samuel Wadge
- Department of Twin Research & Genetic Epidemiology, King's College London, 3rd Floor South Wing, St Thomas' Hospital, SE1 7EH, London, UK
| | - Andrei-Florin Baleanu
- Department of Twin Research & Genetic Epidemiology, King's College London, 3rd Floor South Wing, St Thomas' Hospital, SE1 7EH, London, UK
| | - Kevin Whelan
- Department of Nutritional Sciences, King's College London, London, UK
| | - Claire Steves
- Department of Twin Research & Genetic Epidemiology, King's College London, 3rd Floor South Wing, St Thomas' Hospital, SE1 7EH, London, UK
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Harvey NC, Orwoll E, Kwok T, Karlsson MK, Rosengren BE, Ribom E, Cauley JA, Cawthon PM, Ensrud K, Liu E, Cruz-Jentoft AJ, Fielding RA, Cooper C, Kanis JA, Lorentzon M, Ohlsson C, Mellström D, Johansson H, McCloskey E. Sarcopenia Definitions as Predictors of Fracture Risk Independent of FRAX ® , Falls, and BMD in the Osteoporotic Fractures in Men (MrOS) Study: A Meta-Analysis. J Bone Miner Res 2021; 36:1235-1244. [PMID: 33831257 PMCID: PMC7611727 DOI: 10.1002/jbmr.4293] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/01/2021] [Accepted: 03/16/2021] [Indexed: 12/11/2022]
Abstract
Dual-energy X-ray absorptiometry (DXA)-derived appendicular lean mass/height2 (ALM/ht2 ) is the most commonly used estimate of muscle mass in the assessment of sarcopenia, but its predictive value for fracture is substantially attenuated by femoral neck (fn) bone mineral density (BMD). We investigated predictive value of 11 sarcopenia definitions for incident fracture, independent of fnBMD, fracture risk assessment tool (FRAX® ) probability, and prior falls, using an extension of Poisson regression in US, Sweden, and Hong Kong Osteoporois Fractures in Men Study (MrOS) cohorts. Definitions tested were those of Baumgartner and Delmonico (ALM/ht2 only), Morley, the International Working Group on Sarcopenia, European Working Group on Sarcopenia in Older People (EWGSOP1 and 2), Asian Working Group on Sarcopenia, Foundation for the National Institutes of Health (FNIH) 1 and 2 (using ALM/body mass index [BMI], incorporating muscle strength and/or physical performance measures plus ALM/ht2 ), and Sarcopenia Definitions and Outcomes Consortium (gait speed and grip strength). Associations were adjusted for age and time since baseline and reported as hazard ratio (HR) for first incident fracture, here major osteoporotic fracture (MOF; clinical vertebral, hip, distal forearm, proximal humerus). Further analyses adjusted additionally for FRAX-MOF probability (n = 7531; calculated ± fnBMD), prior falls (y/n), or fnBMD T-score. Results were synthesized by meta-analysis. In 5660 men in USA, 2764 Sweden and 1987 Hong Kong (mean ages 73.5, 75.4, and 72.4 years, respectively), sarcopenia prevalence ranged from 0.5% to 35%. Sarcopenia status, by all definitions except those of FNIH, was associated with incident MOF (HR = 1.39 to 2.07). Associations were robust to adjustment for prior falls or FRAX probability (without fnBMD); adjustment for fnBMD T-score attenuated associations. EWGSOP2 severe sarcopenia (incorporating chair stand time, gait speed, and grip strength plus ALM) was most predictive, albeit at low prevalence, and appeared only modestly influenced by inclusion of fnBMD. In conclusion, the predictive value for fracture of sarcopenia definitions based on ALM is reduced by adjustment for fnBMD but strengthened by additional inclusion of physical performance measures. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Eric Orwoll
- Oregon Health & Science University, Portland, OR, USA
| | - Timothy Kwok
- Department of Medicine and Therapeutics and School of Public Health, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmo, Lund University and Department of Orthopedics, Skane University Hospital, Malmo, Sweden
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences Malmo, Lund University and Department of Orthopedics, Skane University Hospital, Malmo, Sweden
| | - Eva Ribom
- Department of Surgical Sciences, University of Uppsala, Uppsala, Sweden
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kristine Ensrud
- Medicine and Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Enwu Liu
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | | | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - John A Kanis
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Mattias Lorentzon
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Claes Ohlsson
- Department of Internal Medicine and Clinical Nutrition, Center for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Drug Treatment, Gothenburg, Sweden
| | - Dan Mellström
- Department of Internal Medicine and Clinical Nutrition, Center for Bone and Arthritis Research, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Helena Johansson
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - Eugene McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- Centre for Integrated research in Musculoskeletal Ageing (CIMA), Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
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48
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Sarcopenia and Malnutrition Screening in Female Osteoporosis Patients-A Cross-Sectional Study. J Clin Med 2021; 10:jcm10112344. [PMID: 34071858 PMCID: PMC8198508 DOI: 10.3390/jcm10112344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 11/17/2022] Open
Abstract
Sarcopenia and malnutrition are important determinants of increased fracture risk in osteoporosis. SARC-F and MNA-SF are well-established questionnaires for identifying patients at risk for these conditions. We sought to evaluate the feasibility and potential added benefit of such assessments as well as the actual prevalence of these conditions in osteoporosis patients. We conducted a cross-sectional, single-center study in female osteoporosis patients ≥ 65 years (SaNSiBaR-study). Results of the sarcopenia (SARC-F) and malnutrition (MNA-SF) screening questionnaires were matched with a functional assessment for sarcopenia and data from patients’ medical records. Out of 107 patients included in the analysis, a risk for sarcopenia (SARC-F ≥ 4 points) and a risk for malnutrition (MNA-SF ≤ 11 points) was found in 33 (30.8%) and 38 (35.5%) patients, respectively. Diagnostic overlap with coincident indicative findings in both questionnaires was observed in 17 patients (16%). As compared to the respective not-at-risk groups, the mean short physical performance battery (SPPB) score was significantly reduced in both patients at risk for sarcopenia (7.0 vs. 10.9 points, p < 0.001) and patients at risk for malnutrition (8.7 vs. 10.5 points, p = 0.005). Still, confirmed sarcopenia according to EWGSOP2 criteria was present in only 6 (6%) of all 107 patients, with only 3 of them having an indicative SARC-F score. Bone mineral density was not significantly different in any of the at-risk groups at any site. In summary, applying SARC-F and MNA-SF in osteoporosis patients appears to be a complementary approach to identify individuals with functional deficits.
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Che J, Xu C, Wu Y, Jia P, Han Q, Ma Y, Wang X, Du Y, Zheng Y. Early-senescent bone marrow mesenchymal stem cells promote C2C12 cell myogenic differentiation by preventing the nuclear translocation of FOXO3. Life Sci 2021; 277:119520. [PMID: 33887345 DOI: 10.1016/j.lfs.2021.119520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 10/21/2022]
Abstract
AIMS Mouse bone marrow mesenchymal stem cells (BMSCs) are pluripotent cells with self-renewal and differentiation abilities. Since the effects of senescent BMSCs on C2C12 cells are not fully clear, the present study aimed to elucidate these effects. MAIN METHODS Senescence-associated β-galactosidase staining and western blotting were performed to confirm the senescence of BMSCs. Immunofluorescence and western blotting were used to assess myoblast differentiation in each group. The role of the AKT/P70 signaling pathway and forkhead box O3 (FOXO3) nuclear translocation was explored by western blotting. BMSC-derived exosomes were injected into the tibialis anterior of mice, and RT-qPCR was used to assess the role of exosomes in promoting muscle differentiation. KEY FINDINGS Conditioned medium (CM) from early-senescent BMSCs promoted myogenic differentiation in vitro, which was detected as enhanced expression of myosin heavy chain (MHC), myogenin (MYOG), and myogenic differentiation 1 (MyoD). The AKT signaling pathway was found to be regulated by CM, which inhibited FOXO3 nuclear translocation. RT-qPCR analysis results showed that MHC, MyoD, and MYOG mRNA expression increased in the tibialis anterior of mice after exosome injection. SIGNIFICANCE The present study demonstrated that early-senescent BMSCs accelerated C2C12 cell myogenic differentiation, and the transcription factor, FOXO3, was the target of senescent cells. Collectively, our results suggest that the AKT/P70 signaling pathway mediates the effect of BMSCs on neighboring cells.
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Affiliation(s)
- Ji Che
- Department of Pain, Huadong Hospital, Shanghai Key Laboratory of Clinical Geriatric Medicine, Fudan University, Shanghai, China
| | - Cuidi Xu
- Department of Osteoporosis and Bone Disease, Huadong Hospital, Research Section of Geriatric Metabolic Bone Disease, Shanghai Geriatric Institute, Shanghai, China
| | - Yuanyuan Wu
- Department of Pain, Huadong Hospital, Shanghai Key Laboratory of Clinical Geriatric Medicine, Fudan University, Shanghai, China
| | - Peiyu Jia
- Department of Pain, Huadong Hospital, Shanghai Key Laboratory of Clinical Geriatric Medicine, Fudan University, Shanghai, China
| | - Qi Han
- Department of Pain, Huadong Hospital, Shanghai Key Laboratory of Clinical Geriatric Medicine, Fudan University, Shanghai, China
| | - Yantao Ma
- Department of Pain, Huadong Hospital, Shanghai Key Laboratory of Clinical Geriatric Medicine, Fudan University, Shanghai, China
| | - Xiaolei Wang
- Department of Pain, Huadong Hospital, Shanghai Key Laboratory of Clinical Geriatric Medicine, Fudan University, Shanghai, China
| | - Yijie Du
- Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai, China; Institutes of Integrative Medicine, Fudan University, Shanghai, China; Qingpu Traditional Chinese Medicine Hospital, Shanghai, China.
| | - Yongjun Zheng
- Department of Pain, Huadong Hospital, Shanghai Key Laboratory of Clinical Geriatric Medicine, Fudan University, Shanghai, China.
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50
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Harvey NC, Kanis JA, Liu E, Cooper C, Lorentzon M, Bea JW, Carbone L, Cespedes Feliciano EM, Laddu DR, Schnatz PF, Shadyab AH, Stefanick ML, Wactawski‐Wende J, Crandall CJ, Johansson H, McCloskey E. Predictive Value of DXA Appendicular Lean Mass for Incident Fractures, Falls, and Mortality, Independent of Prior Falls, FRAX, and BMD: Findings from the Women's Health Initiative (WHI). J Bone Miner Res 2021; 36:654-661. [PMID: 33450071 PMCID: PMC7610603 DOI: 10.1002/jbmr.4239] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 12/14/2020] [Accepted: 12/23/2020] [Indexed: 12/26/2022]
Abstract
In the Women's Health Initiative (WHI), we investigated associations between baseline dual-energy X-ray absorptiometry (DXA) appendicular lean mass (ALM) and risk of incident fractures, falls, and mortality (separately for each outcome) among older postmenopausal women, accounting for bone mineral density (BMD), prior falls, and Fracture Risk Assessment Tool (FRAX® ) probability. The WHI is a prospective study of postmenopausal women undertaken at 40 US sites. We used an extension of Poisson regression to investigate the relationship between baseline ALM (corrected for height2 ) and incident fracture outcomes, presented here for major osteoporotic fracture (MOF: hip, clinical vertebral, forearm, or proximal humerus), falls, and death. Associations were adjusted for age, time since baseline and randomization group, or additionally for femoral neck (FN) BMD, prior falls, or FRAX probability (MOF without BMD) and are reported as gradient of risk (GR: hazard ratio for first incident fracture per SD increment) in ALM/height2 (GR). Data were available for 11,187 women (mean [SD] age 63.3 [7.4] years). In the base models (adjusted for age, follow-up time, and randomization group), greater ALM/height2 was associated with lower risk of incident MOF (GR = 0.88; 95% confidence interval [CI] 0.83-0.94). The association was independent of prior falls but was attenuated by FRAX probability. Adjustment for FN BMD T-score led to attenuation and inversion of the risk relationship (GR = 1.06; 95% CI 0.98-1.14). There were no associations between ALM/height2 and incident falls. However, there was a 7% to 15% increase in risk of death during follow-up for each SD greater ALM/height2 , depending on specific adjustment. In WHI, and consistent with our findings in older men (Osteoporotic Fractures in Men [MrOS] study cohorts), the predictive value of DXA-ALM for future clinical fracture is attenuated (and potentially inverted) after adjustment for femoral neck BMD T-score. However, intriguing positive, but modest, associations between ALM/height2 and mortality remain robust. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Nicholas C Harvey
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
| | - John A Kanis
- Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
- Mary McKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
| | - Enwu Liu
- Mary McKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology UnitUniversity of SouthamptonSouthamptonUK
- NIHR Southampton Biomedical Research CentreUniversity of Southampton and University Hospital Southampton NHS Foundation TrustSouthamptonUK
- NIHR Biomedical Research CentreUniversity of OxfordOxfordUK
| | - Mattias Lorentzon
- Mary McKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
- Geriatric Medicine, Department of Internal Medicine and Clinical NutritionInstitute of Medicine, University of GothenburgGothenburgSweden
- Geriatric MedicineSahlgrenska University HospitalMölndalSweden
| | | | - Laura Carbone
- Department of Medicine, Division of Rheumatology, J Harold Harrison, MD, Distinguished University Chair in RheumatologyMedical College of Georgia at Augusta UniversityAugustaGAUSA
| | | | - Deepika R Laddu
- Department of Physical TherapyCollege of Applied Health Sciences, University of Illinois at ChicagoChicagoILUSA
| | | | | | - Marcia L Stefanick
- Department of Medicine (Stanford Prevention Research Center)Stanford School of Medicine, Stanford UniversityStanfordCAUSA
| | | | - Carolyn J Crandall
- David Geffen School of Medicine at the University of CaliforniaLos AngelesCAUSA
| | - Helena Johansson
- Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
- Mary McKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
| | - Eugene McCloskey
- Centre for Metabolic Bone DiseasesUniversity of SheffieldSheffieldUK
- Centre for Integrated Research in Musculoskeletal Ageing (CIMA)Mellanby Centre for Bone Research, University of SheffieldSheffieldUK
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