Smoking and bone loss among postmenopausal women

Ambient PM2.5 Components Are Associated With Bone Strength: Evidence From a China Multi-Ethnic Study

CONTEXT

The relationship between the components of particulate matter with an aerodynamic diameter of 2.5 or less (PM2.5) and bone strength remains unclear.

OBJECTIVE

Based on a large-scale epidemiologic survey, we investigated the individual and combined associations of PM2.5 and its components with bone strength.

METHODS

A total of 65 906 individuals aged 30 to 79 years were derived from the China Multi-Ethnic Cohort Annual average concentrations of PM2.5 and its components were estimated using satellite remote sensing and chemical transport models. Bone strength was expressed by the calcaneus quantitative ultrasound index (QUI) measured by quantitative ultrasound. The logistic regression model and weighted quantile sum method were used to estimate the associations of single and joint exposure to PM2.5 and its components with QUI, respectively.

RESULTS

Our analysis shows that per-SD increase (μg/m3) in 3-year average concentrations of PM2.5 (mean difference [MD] -7.38; 95% CI, -8.35 to -6.41), black carbon (-7.91; -8.90 to -6.92), ammonium (-8.35; -9.37 to -7.34), nitrate (-8.73; -9.80 to -7.66), organic matter (-4.70; -5.77 to -3.64), and soil particles (-5.12; -6.10 to -4.15) were negatively associated with QUI. In addition, these associations were more pronounced in men, and people older than 65 years with a history of smoking and chronic alcohol consumption.

CONCLUSION

We found that long-term exposure to PM2.5 and its components may lead to reduced bone strength, suggesting that PM2.5 and its components may potentially increase the risk of osteoporosis and even fracture. Nitrate may be responsible for increasing its risk to a greater extent.

Retrospective analysis of dental implants immediately placed in extraction sockets with periapical pathology: immediate implant placement in infected areas

BACKGROUND

The aim of this study is to examine the survival rates of immediate implants placed in extraction sockets with chronic periapical pathology.

METHODS

69 patients and 124 immediate implants were included in the study. The patients included in the study were examined in 3 groups. Group 1: Patients who underwent tooth extraction with periapical pathology and immediate implant placement. Group 2: patients who underwent tooth extraction with periapical pathology, immediate implant placement and guided bone regeneration. Group 3: Patients who underwent tooth extraction with periapical pathology, sinus lift procedure and immediate implant placement. In statistical analysis, t-test and Anova analysis were used in the evaluation of quantitative data, cross-tables and chi-square (χ2) test were used in the evaluation of classified qualitative data. Statistical significance was determined as p < 0.05.

RESULTS

It was observed that 116 (95.55%) of 124 implants were successful and 8 (4.45%) failed. The success rate was 97.2% in Group 1, 93.5% in Group 2 and 81.8% in Group 3. A significant correlation was found between the study groups and implant success in terms of χ2 test (p = 0.037). A significant relationship was found between smoking and success in terms of the χ2 test (p = 0.015).

CONCLUSIONS

High survival rates are observed for immediate implant placement in sockets with periapical pathology. The success rates observed in guided bone regenerations simultaneously with immediate implant placement are at satisfactory levels. In cases where simultaneous sinus lifting procedures are required, the success rates were observed to be significantly lower. In case of adequate curettage and debridement in sockets with periapical pathology, high implant survival rates are observed. As the complexity of the surgical procedure increases, treatment protocols may progress in safer ways.

Long-term exposure to air pollution might decrease bone mineral density T-score and increase the prevalence of osteoporosis in Hubei province: evidence from China Osteoporosis Prevalence Study

We hypothesized that air pollution could cause oxidative damage and inflammation in the human body, which was linked to bone loss. Our result showed that long-term exposure to air pollution might decrease bone mineral density (BMD) T-score and increase the prevalence of osteoporosis in Hubei province.

INTRODUCTION

Osteoporosis is becoming an increasingly serious public health problem with the advent of global aging. Long-term exposure to air pollution has been linked to multitudinous adverse health outcomes, but evidence is still relatively limited and inconsistent for BMD T-score and osteoporosis. This study aimed at exploring the associations between long-term exposure to air pollution and BMD T-score and osteoporosis.

METHODS

The Hubei part of the China Osteoporosis Prevalence Study was extracted. Data on air pollutants were collected by the national air quality real-time release platform of China Environmental Monitoring Station. Linear mixed models and multilevel logistic regression analyses were performed to assess the associations between air pollution and BMD T-score and osteoporosis, respectively. Subgroup analyses were conducted to identify vulnerable populations.

RESULTS

A total of 1845 participants were included in this cross-section study. Per 10 ug/m³ increase in PM_2.5 and SO₂ were associated with 0.20 (95% CI: 0.04, 0.36) and 0.31 (95% CI: 0.11, 0.51) decrease in BMD T-score of the neck of femur, respectively. Per 10 ug/m³ increase in CO was linked with 0.03 (95% CI: 0.02, 0.05) decrease in BMD T-score of the total hip. Per 1 ug/m³ increase in PM_2.5 was associated with 5% increase in the prevalence of osteoporosis in all participants. In general, the higher concentrations of PM_2.5 with the more adverse effect on osteoporosis (P for trend = 0.01). The impact of PM_2.5 on osteoporosis in males was higher than that in females [1.29, 95% CI (1.11, 1.50) vs 1.01, 95% CI (0.95, 1.07)]. Per 1 ug/m³ increase in PM₁₀ corresponded with 4% elevation in the risks of osteoporosis in rural population. The ORs (95% CI) for the association of osteoporosis and NO₂ in ever/current smoking and drinking population were 1.07 (1.01, 1.13) and 1.05 (1.00, 1.09), respectively. SO₂ had a statistically significant positive effect on people with comorbidity [OR = 1.10, (95% CI: 1.00 to 1.21)], while none in people without comorbidity [OR = 0.96, (95% CI: 0.88 to 1.05)].

CONCLUSION

Our study provided evidence that long-term exposure to PM_2.5 was linked with the decreased BMD T-score and increased risk of osteoporosis among all participants. The adverse impacts of PM_2.5, PM₁₀, and NO₂ were larger in males than in females. People having comorbidity, living in rural areas, and current/ever smoking or drinking were more vulnerable to air pollution. Public health departments should consider air pollution to formulate better preventive measures for osteoporosis.

Vitamin D status in Psoriasis: impact and clinical correlations

Psoriasis is a continuing, periodic, immune‑mediated, fiery skin disease branded by hyper proliferation of epidermal keratinocytes and accompanying with inflammatory cellular infiltrate in both dermis and epidermis. Immunomodulation could be an important effect of vitamin D in Psoriasis. This case-control study was designed to measure serum 25-hydroxy vitamin D levels in patients with psoriasis and healthy controls and to find out clinical correlation, if any. Six hundred two (n = 602) subjects (285 cases and 317 controls) were taken for the study. Cases and controls were frequency matched with respect to age and gender. Various demographic and clinical details were taken using a questionnaire. Chemiluminescence Micro Particle Immunoassay was used to estimate serum 25-hydroxy vitamin D levels. The vitamin D deficiency in psoriasis patients was 60.0% vs. 17.5% in controls (P < 0.001) with mean vitamin D levels of 28.3 ± 13.9 ng/ml in psoriasis patient’s vs. 37.9 ± 9.7 ng/ml in controls. Vitamin D deficiency was found to be associated with psoriasis independently of gender, age, smoking status, family history, hypertension, chronic medication, nail changes, duration of symptoms and severity of disease. Vitamin D levels were seven times lower in patients with Psoriasis as compared to controls. Reduced vitamin D levels are related to duration and clinical severity of the disease. Early detection of vitamin D deficiency and timely intervention could lead to better clinical outcome and improved quality of life in psoriasis patients.

Embryonic Exposure to Cigarette Smoke Extract Impedes Skeletal Development and Evokes Craniofacial Defects in Zebrafish

Exposure to cigarette smoke represents the largest source of preventable death and disease in the United States. This may be in part due to the nature of the delayed harmful effects as well as the lack of awareness of the scope of harm presented by these products. The presence of “light” versions further clouds the harmful effects of tobacco products. While active smoking in expectant mothers may be reduced by educational and outreach campaigns, exposure to secondhand smoke is often involuntary yet may harm the developing embryo. In this study, we show that the main component of secondhand smoke, sidestream cigarette smoke, from several brands, including harm-reduction versions, triggered unsuccessful hatching at 3 dpf and reduced overall survival at 6 dpf in developing zebrafish. At non-lethal concentrations, craniofacial defects with different severity based on the cigarette smoke extract were noted by 6 dpf. All tested products, including harm-reduction products, significantly impacted cartilage formation and/or bone mineralization in zebrafish embryos, independent of whether the bones/cartilage formed from the mesoderm or neural crest. Together, these results in a model system often used to detect embryonic malformations imply that exposure of a woman to secondhand smoke while pregnant may lead to mineralization issues in the skeleton of her newborn, ultimately adding a direct in utero association to the increased fracture risk observed in children of mothers exposed to cigarette smoke.

Fracture, nonunion and postoperative infection risk in the smoking orthopaedic patient: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to analyse negative effects of smoking in orthopaedic and trauma patients.

A PubMed search was carried out for studies published until July 2020 regarding effects of smoking on fracture risk, nonunion, infection after orthopaedic surgery, and persisting nonunion after scaphoid nonunion surgery. Random effects models calculated for outcome parameters, and relative risks (RR) with 95% confidence intervals are provided. No adjustments for covariates were made. Heterogeneity was assessed with Higgins’ I2, publication bias with Harbord’s p (Hp), sensitivity analysis performed on funnel plots and quality of studies was analysed using the Newcastle-Ottawa Scale.

Of 3362 retrieved entries, 69 were included in the final analysis. Unadjusted RR for smokers to develop vertebral (six studies, seven entries; RR: 1.61; p = 0.008; I2 = 89.4%), hip (11 studies, 15 entries; RR: 1.28; p = 0.007; I2 = 84.1%), and other fractures (eight studies, 10 entries; RR: 1.75; p = 0.019; I2 = 89.3%) was significantly higher. Postoperative infection risk was generally higher for smokers (21 studies; RR: 2.20; p < 0.001; I2 = 58.9%), and remained upon subgroup analysis for elective spinal (two studies; RR: 4.38; p < 0.001; I2 = 0.0%) and fracture surgery (19 studies; RR: 2.10; p < 0.001; I2 = 58.5%). Nonunion risk after orthopaedic (eight studies; RR: 2.15; p < 0.001; I2 = 35.9%) and fracture surgery (11 studies; RR: 1.85; p < 0.001; I2 = 39.9%) was significantly higher for smokers, as was persisting nonunion risk after surgery for scaphoid nonunion (five studies; RR: 3.52; p < 0.001; I2 = 0.0%). Sensitivity analysis for each model reduced heterogeneity whilst maintaining significance (all I2 < 20.0%).

Smoking has a deleterious impact on fracture incidence, and (subsequent) development of nonunions and postoperative infections.

Cite this article: EFORT Open Rev 2021;6:1006-1019. DOI: 10.1302/2058-5241.6.210058

Impact of Cigarette Smoking on the Risk of Osteoporosis in Inflammatory Bowel Diseases

Cigarette smoking constitutes one of the most important modifiable factors of osteoporosis, as well as contributes to an early death, tumors, and numerous chronic diseases. The group with an increased risk of a lower bone mineral density are patients suffering from inflammatory bowel diseases. In fact, tobacco smoke, which contains more than 7000 chemical compounds, affects bone mineral density (BMD) both directly and indirectly, as it has an impact on the RANK-RANKL-OPG pathway, intestinal microbiota composition, and calcium-phosphate balance. Constant cigarette use interferes with the production of protective mucus and inhibits the repair processes in the intestinal mucus. Nicotine as well as the other compounds of the cigarette smoke are important risk factors of the inflammatory bowel disease and osteoporosis. Additionally, cigarette smoking may decrease BMD in the IBD patients. Interestingly, it affects patients with Crohn's disease and ulcerative colitis in different ways-on the one hand it protects against ulcerative colitis, whereas on the other it increases the risk of Crohn's disease development. Nevertheless, all patients should be encouraged to cease smoking in order to decrease the risk of developing other disorders.

Smoking and the patient with a complex lower limb injury

Smoking is known to increase the risk of peri-operative complications in Orthoplastic surgery by impairing bone and wound healing. The effects of nicotine replacement therapies (NRTs) and electronic cigarettes (e-cigarettes) has been less well established. Previous reviews have examined the relationship between smoking and bone and wound healing separately. This review provides surgeons with a comprehensive and contemporaneous account of how smoking in all forms interacts with all aspects of complex lower limb trauma. We provide a guide for surgeons to refer to during the consent process to enable them to tailor information towards smokers in such a way that the patient may understand the risks involved with their surgical treatment. We update the literature with recently discovered methods of monitoring and treating the troublesome complications that occur more commonly in smokers effected by trauma.

Efficacy of Biocage in treating single-segment lumbar degenerative disease in patients with high risk of non-fusion: a prospective controlled study with at least 2 years' follow-up

OBJECTIVE

To evaluate the clinical efficacy of an allogeneic bone cage (Biocage; Beijing Datsing Bio-Tech Co., Ltd., Beijing, China) for treatment of single-segment lumbar degenerative disease in patients with a high risk of non-fusion.

METHODS

From January 2013 to December 2016, 67 patients who underwent lumbar fusion were divided into the Biocage group (n = 33) and polyether ether ketone (PEEK) group (n = 34). The patients were followed up for 24 to 48 months. The mean intervertebral height of the fusion level, fusion rate, height of the intervertebral foramen, visual analog scale score, and Oswestry disability index were compared.

RESULTS

The PEEK group had a lower fusion rate than the Biocage group (88.24% vs. 90.91%), although the difference was not statistically significant. During follow-up, the height of the intervertebral space was similar between the Biocage and PEEK groups (12.88 ± 0.45 and 12.84 ± 1.01 mm, respectively). The height of the intervertebral foramen was larger in the Biocage than PEEK group (20.67 ± 1.34 vs. 20.00 ± 2.05 mm). Good clinical efficacy was achieved in both groups.

CONCLUSION

The Biocage is efficient and safe for treatment of single-segment lumbar degenerative disease in patients with a high risk of non-fusion.

The Impact of Smoking on Bone Metabolism, Bone Mineral Density and Vertebral Fractures in Postmenopausal Women

BACKGROUND

Smoking is recognized among the risk factors for osteoporosis, but only few studies have comprehensively explored its influence on bone metabolism and strength. We aimed to evaluate smoking effects on calcium-phosphate metabolism, bone mineral density (BMD) and fracture risk in postmenopausal women.

METHODS

Our sample included 1067 postmenopausal women who arrived to our osteoporosis outpatient clinic. Anamnestic data, smoking habits (categorized as never, former, and current; and by smoking intensity and duration), biochemical parameters, lumbar/femoral BMD, and presence of vertebral fractures were recorded. In a subsample of 357 women, the changes in BMD after a 2-yr follow-up period were also assessed.

RESULTS

Current smokers had shorter reproductive age, lower body mass index, and higher prevalence of heavy alcohol consumption than former/never smokers. They also had lower PTH values and weaker linear association between serum vitamin D and parathyroid hormone (current β = -0.11[SE = 0.004]; former β = -0.14[SE = 0.01]; never β = -0.20[SE = 0.003]; p < 0.01 for all). Baseline BMD did not reflect differences based on smoking habits, duration or intensity. However, after 2 years, only current smokers significantly worsened in femural BMD. After adjustment for confounders, the chance of having sustained vertebral fractures at the first evaluation increased by 74% (95% confidence interval:1.07-2.83) in current compared with never smokers, especially among heavy smokers.

CONCLUSIONS

Smoking may negatively affect bone by inhibiting vitamin D-parathyroid hormone axis, reducing estrogen exposure, promoting risky health behaviors, and accelerating bone loss, especially at the femur. No significant differences were observed in these outcomes among former smokers, suggesting that quitting smoking has beneficial effects on bone health.

An association between air pollution and daily most frequently visits of eighteen outpatient diseases in an industrial city

Toxic effects of air pollutants were individually identified in various organs of the body. However, the concurrent occurrences and the connection of diseases in multiple organs arise from air pollution has not been concurrently studied before. Here we hypothesize that there exist connected health effects arise from air pollution when diseases in various organs were considered together. We used medical data from hospital outpatient visits for various organs in the body with a disease-air pollution model that represents each of the diseases as a function of the environmental factors. Our results show that elevated air pollution risks (above 40%) concurrently occurred in diseases of spondylosis, cerebrovascular, pneumonia, accidents, chronic obstructive pulmonary disease (COPD), influenza, osteoarthritis (OA), asthma, peptic ulcer disease (PUD), cancer, heart, hypertensive, diabetes, kidney, and rheumatism. Air pollutants that were associated with elevated health risks are particular matters with diameters equal or less than 2.5 μm (PM_2.5), nitrogen dioxide (NO₂), ozone (O₃), particular matters with diameters equal or less than 10 μm (PM₁₀), carbon monoxide (CO), and nitrogen oxide (NO). Concurrent occurrences of diseases in various organs indicate that the immune system tries to connectively defend the body from persistent and rising air pollution.

Nonpharmacological interventions for osteoporosis treatment: Systematic review of clinical practice guidelines

Objectives

The aim of this study was to perform a systematic review of clinical practice guidelines to identify nonpharmacologic recommendations for osteoporosis treatment.

Methods

A systematic review of literature following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-statement methodology for clinical practice guidelines was conducted; PROSPERO CRD42019138548. Assessment of selected clinical practice guidelines with the AGREE (Appraisal of Guidelines for Research & Evaluation)-II methodological quality instrument was performed, and those graded over 60 points were selected for recommendations extraction and evidence analysis.

Results

Only 6 clinical practice guidelines fulfilled criteria, 69 nonpharmacological recommendations were extracted: 13 from American Association of Clinical Endocrinologists and American College of Endocrinology guideline, 16 from Malaysian Osteoporosis Society guideline, 15 from the Ministry of Health in Mexico guideline, 14 from Royal Australian College of General Practitioners guideline, 7 from Sociedad Española de Investigación Ósea y del Metabolismo Mineral guideline, and 7 from National Osteoporosis Guideline Group guideline. Percentage by theme showed that the highest number of recommendations were 12 (17.1%) for vitamin D, 11 (15.7%) for a combination of calcium and vitamin D, and 11 (15.7%) for exercise.

Conclusions

These recommendations address integrating interventions to modify lifestyle, mainly calcium and vitamin D intake, and exercise. Other recommendations include maintaining adequate protein intake, identification and treatment of risk factors for falls, and limiting the consumption of coffee, alcohol and tobacco. Considerations on prescription must be taken.

The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms

Recent evidence demonstrates that tobacco smoking causes an imbalance in bone turnover, leading to lower bone mass and making bone vulnerable to osteoporosis and fracture. Tobacco smoke influences bone mass indirectly through alteration of body weight, parathyroid hormone-vitamin D axis, adrenal hormones, sex hormones, and increased oxidative stress on bony tissues. Also, tobacco smoke influences bone mass through a direct effect on osteogenesis and angiogenesis of bone. A RANKL-RANK-OPG pathway is an essential regulatory pathway for bone metabolism and its importance lies in its interaction with most of the pathophysiologic mechanisms by which smoking influences bone mass. Both first- and secondhand smoke adversely affect bone mass; smoking cessation seems to reverse the effect of smoking and improve bone health. Recent advances in research on bone turnover markers could advance scientific knowledge regarding the mechanisms by which smoking may influence bone mass.

A comprehensive overview on osteoporosis and its risk factors

Osteoporosis is a bone disorder with remarkable changes in bone biologic material and consequent bone structural distraction, affecting millions of people around the world from different ethnic groups. Bone fragility is the worse outcome of the disease, which needs long term therapy and medical management, especially in the elderly. Many involved genes including environmental factors have been introduced as the disease risk factors so far, of which genes should be considered as effective early diagnosis biomarkers, especially for the individuals from high-risk families. In this review, a number of important criteria involved in osteoporosis are addressed and discussed.

Is There Causal Relationship of Smoking and Alcohol Consumption with Bone Mineral Density? A Mendelian Randomization Study

Observational studies examining associations of smoking and alcohol consumption with bone mineral density (BMD) have generated inconsistent results and suffer from several methodological limitations. We aim to evaluate whether there are causal associations between smoking, alcohol consumption, and BMD using a Mendelian randomization (MR) design. Genetic variants associated with smoking status (n = 142), no. of cigarettes smoked per day (CPD) (n = 3), smoking initiation (n = 1), and alcohol consumption (n = 6) identified in published genome-wide association studies (GWAS) were used as instruments. Summary statistics data of 32735, 28498, 8143, and 445921 European subjects included in The GEnetic Factors for Osteoporosis Consortium or UK Biobank were used to generate associations of genetically predicted smoking or alcohol consumption with femoral neck (FN-BMD), lumbar spine (LS-BMD), forearm (FA-BMD), and heel BMD, respectively, by using the inverse-variance weighted method. The BMD was measured using either ultrasound (for heel) or Dual-energy X-ray Absorptiometry (for others). In our analyses, smoking status tended to be negatively associated with several types of BMD (heel BMD: β = - 0.053, p = 0.003; FN-BMD: β = - 0.139, p = 0.053; FA-BMD: β = - 0.264, p = 0.077), although the association with LS-BMD was null. Smoking initiation was significantly inversely associated with heel BMD (β = - 0.201, p = 3.60 × 10^-8). CPD was associated with a lower FN-BMD (β = - 0.014, p = 0.047) only. There was no clear association of genetically predicted alcohol consumption with BMD. Our study provided some evidence of a potential association between genetically predicted smoking and lower BMD, especially for heel BMD, but not for alcohol consumption. Considering the inconsistent findings with the different types of BMD and limitations of the current work, further studies are needed to better characterize the exact relationship between smoking, alcohol consumption, and BMD.

Current and former smokers and hip fractures

The purpose of this review is to examine the correlation between tobacco smoking and hip fractures. The literature that was used for this article was based on studies that investigated not only the direct correlation between smoking and hip fractures but also the effect of smoking on bone mineral density. In general, the incidence of hip fracture was found to be higher in current smokers in both genders. Compared with never smokers, former smokers had a slightly higher risk of hip fracture that was inversely proportional to the cessation span. The relative risk (RR) of hip fracture in current male smokers was higher than the RR for nonsmokers (never and former smokers). In postmenopausal women former and current smoking increased the RR. In premenopausal and postmenopausal women, cessation of smoking decreases the risk of hip fracture. Risk rises with greater cigarette consumption. Risk declines among former smokers, but the benefit is not observed until 10 years after cessation.

Association of air particulate pollution with bone loss over time and bone fracture risk: analysis of data from two independent studies

BACKGROUND

Air particulate matter (PM) is a ubiquitous environmental exposure associated with oxidation, inflammation, and age-related chronic disease. Whether PM is associated with loss of bone mineral density (BMD) and risk of bone fractures is undetermined.

METHODS

We conducted two complementary studies of: (i) long-term PM <2.5 μm (PM_2.5) levels and osteoporosis-related fracture hospital admissions among 9.2 million Medicare enrollees of the Northeast/Mid-Atlantic United States between 2003-2010; (ii) long-term black carbon [BC] and PM_2.5 levels, serum calcium homeostasis biomarkers (parathyroid hormone, calcium, and 25-hydroxyvitamin D), and annualized BMD reduction over a 8-year follow-up of 692 middle-aged (46.7±12.3 yrs), low-income BACH/Bone cohort participants.

FINDINGS

In the Medicare analysis, risk of bone fracture admissions at osteoporosis-related sites was greater in areas with higher PM_2.5 levels (Risk ratio [RR] 1.041, 95% Confidence Interval [CI], 1.030, 1.051). This risk was particularly high among low-income communities (RR 1.076; 95% CI, 1.052, 1.100). In the longitudinal BACH/Bone study, baseline BC and PM_2.5 levels were associated with lower serum PTH (Estimate for baseline one interquartile increase in 1-year average BC= -1.16, 95% CI -1.93, -0.38; Estimate for baseline one interquartile increase in 1-year average PM_2.5= -7.39; 95%CI -14.17, -0.61). BC level was associated with higher BMD loss over time at multiple anatomical sites, including femoral neck (-0.08%/year per one interquartile increase; 95% CI -0.14, -0.02%/year) and ultradistal radius (-0.06%/year per one interquartile increase; 95% CI -0.12, -0.01%/year).

INTERPRETATION

Our results suggest that poor air quality is a modifiable risk factor for bone fractures and osteoporosis, especially in low-income communities.

Relationship between bone mineral density and dietary intake of β-carotene, vitamin C, zinc and vegetables in postmenopausal Korean women: a cross-sectional study

Objective

To examine the relationship between nutritional intake and bone mineral density (BMD) in postmenopausal Korean women.

Methods

Dietary intake was recorded in postmenopausal Korean women using a semiquantitative questionnaire. The frequency of consumption of various food groups and nutrient intake were calculated. BMD T-scores were measured at the lumbar spine, femoral neck and total hip using dual-energy X-ray absorptiometry. Associations between T-scores and dietary intake were analysed using partial correlation coefficients and multiple linear regression analysis.

Results

A total of 189 postmenopausal women were included in the study. β-Carotene intake was positively correlated with the lumbar spine T-score. Sodium and vitamin C intake were positively associated and folate intake negatively associated with the femoral neck T-score. Sodium, zinc and vitamin C intake were positively correlated and potassium intake was negatively correlated with the total hip T-score. Vegetable intake showed a positive association with the femoral neck and total hip T-scores.

Conclusion

In postmenopausal Korean women, β-carotene, vitamin C, zinc and sodium intakes were positively associated with bone mass. Furthermore, frequency of vegetable consumption was positively associated with femoral neck and total hip T-scores.

Comparison of Peri-Implant Soft Tissue Parameters and Crestal Bone Loss Around Immediately Loaded and Delayed Loaded Implants in Smokers and Non-Smokers: 5-Year Follow-Up Results

BACKGROUND

The aim of this study is to compare peri-implant soft tissue parameters (plaque index [PI], bleeding on probing [BOP], and probing depth [PD] ≥4 mm) and crestal bone loss (CBL) around immediately loaded (IL) and delayed loaded (DL) implants in smokers and non-smokers.

METHODS

Thirty-one patients with IL implants (16 smokers and 15 non-smokers) and 30 patients with DL implants (17 smokers and 13 non-smokers) were included. Personal data regarding age, sex, and duration and daily frequency of smoking were gathered using a questionnaire. Peri-implant PI, BOP, and PD ≥4 mm were recorded, and mesial and distal CBL was measured on standardized digital radiographs. Multiple group comparisons were performed using the Bonferroni post hoc test (P <0.05).

RESULTS

All implants replaced mandibular premolars or molars. Mean scores of PI (P <0.05) and PD ≥4 mm (P <0.05) were statistically significantly higher in smokers compared with non-smokers in patients with IL and DL dental implants. The mean score of BOP (P <0.05) was statistically significantly higher in non-smokers compared with smokers in both groups. CBL (P <0.05) was statistically significantly higher in smokers compared with non-smokers in both groups. There was no statistically significant difference in PI, BOP, PD ≥4 mm, and total CBL among smokers with IL and DL implants.

CONCLUSIONS

Tobacco smoking enhances peri-implant soft tissue inflammation and CBL around IL and DL implants. Loading protocol did not show a significant effect on peri-implant hard and soft tissue status in healthy smokers and non-smokers.

Assessment of smoking for low bone mineral density in postmenopausal Turkish women

OBJECTIVE

To investigate the effect of cigarette smoking on bone mineral density (BMD) in postmenopausal Turkish women.

STUDY DESIGN

A total of 175 postmenopausal Turkish women admitted to Tepecik Training and Research Hospital for a routine menopausal checkup were included in this study. All participants completed a questionnaire regarding their age, educational status, parity, number of abortus, time since menopause, caffeine intake, tobacco use, alcohol consumption, history of a previous fracture related to trauma, and taking any medication for menopause and osteoporosis. Of all subjects, 23.3% (n = 39) were smokers and 77.7% (n = 136) were nonsmokers. T-scores and Z-scores of vertebra and femur neck were assessed using dual energy X-ray absorptiometry (DXA). For analyzing the results, Student t-test, one-way ANOVA, Mann-Whitney U test, Pearson correlation, and Kruskal-Wallis test were performed.

RESULTS

Femur T-scores (- 0.78 ± 1.07 vs. - 0.32 ± 1.56) and vertebra T-scores (- 2.26 ± 1.23 vs. - 1.82 ± 1.04) were significantly lower in smoking women than nonsmoking women (p < 0.05). However, there were no significant difference between duration of smoking, number of cigarettes consumed per day, and BMD (p > 0.05) CONCLUSION: Cigarette smoking is one of the modifiable risk factors influencing bone density in postmenopausal Turkish women. "Cessation of cigarette" should be recommended for lifestyle modifications to prevent postmenopausal osteoporosis.

Skeletal Effects of Smoking

Smoking is a leading cause of preventable death and disability. Smoking has long been identified as a risk factor for osteoporosis, with data showing that older smokers have decreased bone mineral density and increased fracture risk compared to nonsmokers, particularly at the hip. The increase in fracture risk in smokers is out of proportion to the effects on bone density, indicating deficits in bone quality. Advanced imaging techniques have demonstrated microarchitectural deterioration in smokers, particularly in the trabecular compartment. The mechanisms by which smoking affects skeletal health remain unclear, although multiple pathways have been proposed. Smoking cessation may at least partially reverse the adverse effects of smoking on the skeleton.

Association between the awareness of osteoporosis and the quality of care for bone health among Korean women with osteoporosis

Background

The prevalence of osteoporosis is increasing and is a socio-economic burden worldwide. Although screening tests for osteoporosis in Korea are easily accessible, this condition remains undertreated. Evaluating post-diagnostic behavior changes may be helpful for improving the quality of care for bone health in osteoporotic patients.

Methods

After reviewing the Fourth Korean National Health and Nutrition Examination Survey 2008–2009, 1,114 women with osteoporosis aged >50 years were included in this cross-sectional study. Factors related to bone health were categorized into the following groups: (1) behavioral health (smoking, alcohol consumption, and physical activity); (2) measured factors (lean body mass [kg], appendicular skeletal muscle mass [kg], and serum vitamin D level [nmol/L]); and (3) nutritional factors (calcium intake, vitamin/mineral supplementation, and healthy supplementary food). Logistic regression analysis and analysis of covariance was conducted after adjusting for age, education, income, residential area, height, weight, and self-perceived health using a weighted method.

Results

Doctors diagnosed 39.5% of patients with osteoporosis, and these patients were compared with the control group. The awareness group, who had been diagnosed with osteoporosis by a doctor, had a lower proportion of smokers and higher serum vitamin D level than the control group, who had never been diagnosed with osteoporosis. No other associations were found for quality of bone health care variables. The awareness group had higher odds ratios of vitamin/mineral replacement and healthy supplementary food but no other differences were observed, indicating the patients’ beliefs in bone health care do not follow the recommended clinical guidelines (e.g. higher physical activity, lower alcohol consumption).

Conclusion

To improve the quality of care for bone health in osteoporotic patients, an initial step should be the development of post-diagnostic procedures such as patient counseling and education through a multi-team care approach.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2474-15-334) contains supplementary material, which is available to authorized users.

Selective serotonin reuptake inhibitors and the risk of osseointegrated implant failure: a cohort study

Selective serotonin reuptake inhibitors (SSRIs), the most widely used drugs for the treatment of depression, have been reported to reduce bone formation and increase the risk of bone fracture. Since osseointegration is influenced by bone metabolism, this study aimed to investigate the association between SSRIs and the risk of failures in osseointegrated implants. This retrospective cohort study was conducted on patients treated with dental implants from January 2007 to January 2013. A total of 916 dental implants in 490 patients (94 implants on 51 patients using SSRIs) were used to estimate the risk of failure associated with the use of SSRIs. Data analysis involved Cox proportional hazards, generalized estimating equation models, multilevel mixed effects parametric survival analysis, and Kaplan-Meier analysis. After 3 to 67 mo of follow-up, 38 dental implants failed and 784 succeeded in the nonusers group, while 10 failed and 84 succeeded in the SSRI-users group. The main limitation of this retrospective study was that drug compliance dose and treatment period could not be acquired from the files of the patients. The primary outcome was that compared with nonusers of SSRIs, SSRI usage was associated with an increased risk of dental implants failure (hazard ratio, 6.28; 95% confidence interval, 1.25-31.61; p = .03). The failure rates were 4.6% for SSRI nonusers and 10.6% for SSRI users. The secondary outcomes were that small implant diameters (≤4 mm; p = .02) and smoking habits (p = .01) also seemed to be associated with higher risk of implant failure. Our findings indicate that treatment with SSRIs is associated with an increased failure risk of osseointegrated implants, which might suggest a careful surgical treatment planning for SSRI users.

The effect of cigarette smoking habits on the outcome of dental implant treatment

The aim of this study was to analyze the influence of smoking habits and other possibly relevant factors on dental implant survival. The study population included all patients who underwent dental implants between the years 1999 and 2008 at a large military dental clinic and were examined in the periodic medical examination center.

Correlation between implant characteristics and patients’ smoking habits, as mentioned in the questionnaire answered by patients in the periodic examination, was performed.

Besides standard statistical methods, multiple linear regression models were constructed for estimation of the relative influence of some factors on implant survival rate. The long-term results of the implant treatment were good. The study refers to 7,680 implants. 7,359 (95.8%) survived and 321 (4.2%) did not survive. Concerning smoking habits, in a uni-variable analysis, factors found to have an association with implant survival were the smoking status of the patients (smoking/no smoking), the amount of smoking, passive smoking, and the time elapsed in ex-smokers from the time they ceased smoking to the time of implantation. In a multi-variable analysis, factors found to have an association with implant survival were smoking status (smoking/no smoking) and amounts of smoking as expressed in pack years.

Prevalence and correlates of osteoporosis in chronic obstructive pulmonary disease patients in India

Background:

Chronic obstructive pulmonary disease (COPD) is a syndrome of progressive airflow limitation caused by the abnormal inflammatory reaction of the airway and lung parenchyma. Osteoporosis is one of the major extrapulmonary manifestations of COPD. The, prevalence of osteoporosis in COPD patients in Indian population is unknown.

Objectives:

To study the prevalence of osteoporosis in COPD and to define various risk factors associated with reduced bone mineral density (BMD) in COPD.

Materials and Methods:

The study was done in the department of Pulmonary Medicine of a tertiary care hospital. All the diagnosed cases of COPD according to the Global Initiative for Obstructive Lung Disease (GOLD) guidelines were included in this study. The present study was a prospective study in for a period of 1 year. A brief history of the patients was taken, especially regarding duration of illness, number of exacerbations in the past 3 years, smoking in pack years, and history of steroid use (both systemic and inhaled steroids) after which cumulative dose of steroids was calculated. Spirometry was done in all these patients to stage the severity of COPD according to GOLD criteria. DEXA scan of the lumbar spine was done using bone densitometer to determine osteoporosis. A world Health Organization (WHO) criterion for definition of osteoporosis was applied and patients with T-score of > –2.5 standard deviation (SD) were diagnosed to have osteoporosis, –1 SD to –2.5 SD were diagnosed to have osteopenia and < –1 SD as normal. Statistical analysis for association of COPD with osteoporosis was done using chi-square test. Risk factors for osteoporosis were identified by univariate and multivariate logistic regression analysis.

Results:

A total of 102 COPD patients were included in the study. Among these, 68 patients (66.6%) had osteoporosis and 20 patients (19.6%) had osteopenia. Majority (64.7%) of the patients who had osteoporosis had stage III and stage IV COPD disease. It was observed that as the severity grade of COPD increased, the risk of osteoporosis also increased. The bone mineral density (BMD) showed a significant difference among different stages of COPD. As the severity of the stage of COPD increased, BMD decreased. It was also observed that patients with lower body mass index (BMI) had higher prevalence of osteoporosis (37.3%) as compared to overweight patients. On univariate analysis, it was observed that risk factors for osteoporosis were female sex, higher number of exacerbations, BMI, and severity of COPD. After using multivariate logistic regression analysis, stage IV COPD (odds ratio (OR): 34.48, 95% confidence interval (CI): 1.59–1,000, P < 0.02), number of acute exacerbations >3 (OR: 30.3, 95% CI: 4.74–200, P < 0.01), and steroid cumulative dose >1,000 mg (OR: 7.35, 95% CI: 0.92–58.5, P < 0.04) were observed to be significant risk factors for osteoporosis in COPD patients.

Conclusions:

In the present study, the prevalence of osteoporosis was 66.6% and another 19.6% had osteopenia. As the severity of COPD increased, the risk of osteoporosis increased. GOLD stage III and stage IV patient had significantly lower BMD as compared to stage I and stage II of COPD disease. Stage IV COPD disease, use of oral or parenteral glucocorticoids, and repeated number of exacerbations were found to be independent risk factors for osteoporosis in COPD patients. Thus, high clinical suspicion and early diagnosis and treatment is required in the evaluation of osteoporosis in COPD patients so that the quality of life can be improved in these patients.

Osteoporosis prevention and management: nonpharmacologic and lifestyle options

The purpose of this review is to evaluate current evidence regarding the use of dietary and exercise interventions to prevent fractures in postmenopausal women with osteoporosis. The key lifestyle modifications that can decrease risk of fracture in postmenopausal women include regular weight-bearing exercise and a balanced diet with adequate calcium and vitamin D intake. Other modifiable lifestyle factors critical to bone health and to decrease fracture risk include the avoidance of smoking, an excessively low body weight, excessive alcohol intake, and fall risks at home. Emerging modifiable factors may include B-vitamin, omega-3 fatty acid, soy isoflavone, and dehydroepiandrosterone supplementation.

The relationship between pulmonary function and bone mineral density in healthy nonsmoking women: the Korean National Health and Nutrition Examination Survey (KNHANES) 2010

The aim of this study was to examine the association between pulmonary function and bone mineral density (BMD) in subjects who had never smoked. Pulmonary function was associated with BMD in premenopausal, but not postmenopausal, women.

INTRODUCTION

It has been reported that low bone mass is common in patients with pulmonary disorders such as chronic obstructive pulmonary disease. However, in healthy nonsmoking women, the relationship between bone mass and pulmonary function has yet to be clarified. The object of this study was to determine whether pulmonary function is related to BMD in healthy nonsmoking women based on menopausal status.

METHODS

This study was a cross-sectional study based on data obtained from the Korean National Health and Nutrition Examination Survey (KNHANES), a nationwide representative survey conducted by the Korean Ministry of Health and Welfare in 2010. This study included 456 subjects who had never smoked and analyzed data concerning pulmonary function and BMD.

RESULTS

Functional vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were correlated with BMD at lumbar spine, femur neck (FN), and total hip in premenopausal women (p = 0.030, p = 0.003, p = 0.019, respectively, for FVC; p = 0.015, p = 0.006, p = 0.059, respectively, for FEV1). However, FVC and FEV1 were only correlated with BMD at FN in postmenopausal women (p = 0.003 for FVC; p = 0.006 for FEV1). Body mass index (BMI), FVC, and FEV1 were significantly related with BMD at FN, even after adjusting for age and other confounding factors (β = 0.334, p < 0.001; β = 0.145, p = 0.017; and β = 0.129, p = 0.037, respectively) in premenopausal women. However, only age and BMI were correlated with BMD at FN (β = -0.268, p = 0.001 and β = 0.384, p > 0.001) in postmenopausal women after adjusting for confounding factors.

CONCLUSIONS

Pulmonary function, including FVC and FEV1 are associated with BMD at FN in healthy nonsmoking premenopausal women but not in postmenopausal women.

Osteoporosis in postmenopausal women: considerations in prevention and treatment: (women's health series)

Osteoporosis, the most common human bone disease, affects 8 million American women and has significant morbidity and mortality. Screening is important in older women and younger postmenopausal women with additional risk factors for osteoporosis/fracture. Preventive measures include avoiding smoking, excessive alcohol/caffeine intake, and falls in addition to maintaining adequate calcium/vitamin D intake and exercise. Estrogen/hormone therapy may be considered in some patients. Various medications have proven efficacy in treating postmenopausal osteoporosis; however, potential adverse effects such as hypocalcemia, worsening of renal impairment, and osteonecrosis of the jaw must be considered. The optimal duration of therapy requires further investigation.

Bone mineral density among elderly patients with chronic obstructive pulmonary disease patients in India

BACKGROUND

Osteoporosis is one of the major extra-pulmonary manifestations of chronic obstructive pulmonary disease (COPD), which limits the physical activity. The present study was undertaken to study the bone mineral density (BMD) and osteoporosis in the elderly COPD patients.

MATERIALS AND METHODS

This was a cross-sectional study carried out among elderly COPD patients. After a detailed clinical history spirometry was done to stage the severity of COPD. DEXA scan of the lumbar spine was performed using bone densitometer to determine osteoporosis. Statistical analysis was based on Chi-square test. Risk factors were identified by univariate and multivariate logistic regression analysis.

RESULTS

A total of 70 elderly COPD patients were included. Fourty-six patients (65.7%) had osteoporosis and 13 (18.6%) had osteopenia. Majority of the osteoporosis patients had stage III or stage IV COPD disease (77.2%). As the severity grade of COPD increased, the risk of osteoporosis also increased. Also, with the increasing severity of COPD, BMD decreased. Patients with lower body mass index (BMI) had higher prevalence of osteoporosis (45.7%). Using multivariate regression analysis, stage IV COPD, number of acute exacerbations >3 and steroid cumulative dose >1000 mg were independent risk factors for osteoporosis in elderly COPD patients.

CONCLUSIONS

The prevalence of osteoporosis was 65.7%, and 18.6% had osteopenia. Stage III and IV patients had significantly lower BMI in elderly COPD patients. High clinical suspicion and early diagnosis and treatment are required in the evaluation of osteoporosis in elderly COPD patients.

Factors associated with osteoporosis in Brazilian women: a population-based household survey

The aging of Brazilian population has been well-documented. A longer time since menopause, poor self-perception of health, and having arthrosis and balance problems are factors associated with postmenopausal osteoporosis. Poor self-perception of health, menopausal treatment with natural remedies, smoking, and decreased functional capacity are associated with early onset of the disease.

PURPOSE

This study aims to evaluate the prevalence of osteoporosis and its associated factors in Brazilian women over 50 years of age and to obtain information on factors related to the early onset of the disease.

METHODS

A cross-sectional study with 622 women over 50 years of age residing in Campinas/Brazil was conducted between May 10 and October 31, 2011 in the form of a population survey. A questionnaire was applied by trained interviewers. Osteoporosis was classified either as self-reported or as osteoporosis diagnosed by bone densitometry. Statistical analysis was carried out by chi-square test, Poisson regression analysis, and Cox multiple regression model.

RESULTS

The mean age of the women was 64.1 years. The prevalence of self-reported osteoporosis was 21.3 %. A longer time since menopause (prevalence ratios (PR), 1.04; 95 % CI, 1.03-1.05; p < 0.001); self-perception of health as fair/poor/very poor (PR, 1.73; 95 % CI, 1.29-2.33; p < 0.001); having arthrosis (PR, 1.83; 95 % CI, 1.30-2.59; p < 0.002) and having problems maintaining balance when taking a bath or going down stairs (PR, 1.52; 95 % CI, 1.07-2.14; p = 0.020) were associated with osteoporosis. The variables associated with early onset of the disease were: self-perception of health as fair/poor/very poor (coefficient, 0.77; p < 0.001), menopausal treatment with natural remedies (coefficient, 1.01; p < 0.001), smoking or having smoked >20 cigarettes/day (coefficient, 1.02; p = 0.003), and problems in running/lifting something heavy/practicing sports/doing heavy work (coefficient, 0.60; p = 0.029).

CONCLUSIONS

The results of this study have improved understanding of the factors associated with osteoporosis in the Brazilian population and may help identify those women who should undergo bone densitometry.

Relationship between Weight, Body Mass Index and Bone Mineral Density of Lumbar Spine in Women

Objectives

This study aims to identify a relationship between bone mineral density (BMD) of lumbar spine, and the weight and body mass index (BMI) in women.

Methods

The subjects were 1,143 females who visited the public health center. BMD (T-score), height and weight were measured and age, menopause, diabetes and hypertension, exercising status and smoking status were inquired by interview.

Results

Among the subjects, 362 (31.7%) were in the normal group and 781 (68.3%) were in the abnormal group. As the result of the logistic regression analysis with BMI (Model I), the odds ratio of getting into the abnormal BMD group as age increases by 1 year marked 1.044 (95% CI = 1.009-1.080). The odds ratio of getting into the abnormal BMD group due to menopause was 2.663 (1.516-4.679) and the odds ratio according to lack of walking exercise was 2.597 (1.878-3.591). The odds ratio with 1 kg/m² of BMI increase was 0.909 (0.862-0.959). In the logistic regression analysis with weight (Model II), the odds ratio of getting into the abnormal BMD group as age increases by 1 year marked 1.044 (1.009-1.080). The odds ratio of getting into the abnormal bone density group due to menopause was 2.575 (1.472-4.507) and the odds ratio according to lack of walking exercise was 2.598 (1.881-3.587). The odds ratio with 1 kg of weight increase was 0.963 (0.942-0.984). The Akaike's information criterion (AIC) values of Model I and Model II were 1196.18 and 1197.14 respectively, indicating Model I has the better compatibility of regression analysis model.

Conclusion

Weight, BMI and BMD had a positive correlation. However, the coefficient of correlation between weight and BMD was higher than the coefficient between BMI and BMD, which means low weight is much more likely to be related to osteoporosis with no other factor considered. On the other hand, under the condition considering age, height, menopause and walking exercise smoking status, low BMI is much more compatible as a risk factor for osteoporosis.

The effects of smoking on bone metabolism

Osteoporosis is a common, morbid and costly disorder characterized by deterioration in bone strength. Cigarette smoking is associated with reduced bone mineral density (BMD) and increased fracture risk. There are basic, clinical, and observational studies that define several of the underlying pathophysiologic mechanisms that predispose smokers to bone loss. Such mechanisms include alterations in calciotropic hormone metabolism and intestinal calcium absorption, dysregulation in sex hormone production and metabolism, alterations in adrenal cortical hormone metabolism and in the receptor activator of nuclear factor kappa-B (RANK), receptor activator of nuclear factor kappa-B ligand (RANKL), and osteoprotegerin (OPG) system (RANK-RANKL-OPG system), and direct cellular effects of cigarette use on bone cells. In addition, there is evidence of reversibility in the aforementioned mechanisms with smoking cessation. In summary, cigarette smoking is a reversible risk factor for osteoporosis and osteoporotic fractures through diverse pathophysiologic mechanisms.

The effects of smoke carcinogens on bone

The greatest cause of preventable morbidity and mortality is smoking, and one of the often-underappreciated effects of smoking is profound bone loss. The existing clinical paradigm for smoking is that there is a low turnover osteoporosis. This review highlights findings from recent clinical trials and animal research demonstrating either support or conflict with the existing paradigm. Clinically, it is noted that markers of bone formation are often normal in smokers; these clinical findings conflict with well-conducted animal research demonstrating that carcinogens acting on the aryl hydrogen receptor can significantly reduce osteoblast formation and function. Regarding bone resorption, highlights from recent clinical studies suggest that bone remodeling is increased in smokers. Directly contradicting this enhanced osteoclastogenesis are several animal studies all demonstrating significant inhibition of osteoclast formation and function upon exposure to smoke carcinogens. Future research is needed to clarify whether smoking is truly a low bone remodeling osteoporosis, or an osteoclast-driven bone destruction, with inappropriately normal bone formation.

Influence of nicotine on the biological activity of rabbit osteoblasts

OBJECTIVES

To assess the influence of nicotine on the proliferation and gene expression of osteogenic and angiogenic mediators of osteoblasts.

MATERIAL AND METHODS

Rabbit primary osteoblasts were exposed to various concentrations of nicotine (0.001, 0.1 and 10 μmol/l). The cell proliferation was assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide. The gene expression of transforming growth factor (TGF)-β(1), bone morphogenetic protein (BMP)-2, platelet-derived growth factor (PDGF)-AA and vascular endothelial growth factor (VEGF) was evaluated using real-time reverse transcription - polymerase chain reaction.

RESULTS

The osteoblast proliferation was inhibited by nicotine at the concentration of 0.001-10 μM at 48 and 72 h of culture, but with no significant effect at 24 h. The expression of TGF-β(1), BMP-2, PDGF-AA and VEGF was inhibited by nicotine at the concentrations of 0.1 and 10 μM, but with no significant difference at the low concentration of 0.001 μM.

CONCLUSIONS

Nicotine suppresses osteoblast proliferation and inhibits the expression of some key osteogenic and angiogenic mediators in the in vitro experimental model. These inhibitory effects of nicotine on the osteoblast activity may reflect, to a certain degree, the overall detrimental effects of tobacco use on the survival rate of dental implants.

Nicotinic modulation of gene expression in osteoblast cells, MG-63

Exposure to nicotine causes a broad range of biological and molecular effects on osteoblasts which are known to play a crucial role in bone metabolism and fracture healing. Most effects of nicotine on the osteoblasts are long-term adaptations at the genomic level. To identify the nicotine-regulated genes, the Agilent technologies whole human genome gene expression microarray was performed on RNA samples from osteoblast-like cells, MG-63, exposed to 100 μM nicotine. Repeat and cross-controlled microarray analyses revealed 842 genes whose expression was consistently altered at P<0.05 level following nicotine treatment. Gene ontology analysis suggested effects of nicotine on various biological and cellular processes which were associated with survival, proliferation, differentiation and apoptosis processes within the cell. Quantitative real-time reverse transcriptase PCR analysis confirmed altered expression in 7 out of 9 genes tested. The identified genes tested in the current study support our previous report that nicotine regulates the expression of genes that promote osteoblast proliferation and/or anti-apoptosis processes. Furthermore, using nicotinic acetylcholine receptor antagonists blocked the majority of the nicotine effects, indicating that these changes are dependent on nAChR activation. These results established a novel and consistent nicotinic activation of nAChR in osteoblast cells which has a broad role affecting cellular physiology through modulation of gene expression.

The Effect of Cigarette Smoking on Bone Healing in Elderly Individuals with Colle's Fracture

Background

Elderly men and women who smoke for many years are more likely to sustain fractures after minimal trauma than are nonsmokers. The two major risk factors for fractures are low bone mineralization density (BMD) and a propensity for falling in smokers known to have poorer neuromuscular function compared with nonsmokers. Smokers are weaker and have poorer balance, gait, and integrated physical function. Older people who smoke cigarettes have significantly lower BMD than those who do not. Cadaveric studies show that a decrease of BMD by 10% results in decrease of bone strength by three-fold. Thus, it is reasonable to expect an increased incidence of fractures among smokers on the basis of BMD level alone.

Aim

The aim of the study is to find the effects of cigarettes smoking on the time of healing in comparison with nonsmoker patients with colles fracture.

Patients and Methods

A cross-sectional study was done in AlKindy Teaching Hospital, AlKarkh General Hospital, and AlJarah Private Hospital in the period between March 1999 and February 2006. 280 patients with colles fracture were included and divided into two groups (smokers and nonsmokers). Age, sex, causes of the trauma type of the fracture, number of cigarettes smoking, body mass index, time of healing and others were studied.

Results

Group A • Male to female ratio was 1:2.29. • The commonest age group was between (60–69) years 64.3%. • Body mass index (BMI), 50% of patients were within 20–24 score and 25% were within 25–29 score. • The type of fracture was 86.6% displaced fracture. • The time of healing was 61.6% within 4 weeks and 33.93% healed within 5–6 weeks. Group B • Male to female ratio was 1:2.36. • The commonest age group was 50–59 years 52.4. • The type of fracture was 86.9% displaced. • Regarding BMI, 51.2% of patients were within score less than 20, and 34.5% were within 20–40 score. • The time of healing was 67.3% within 5–6 weeks and 18.5% healed within 4 weeks.

Conclusion

Cigarette smoking increases the time of healing in elderly individuals with colles fracture.

Effects of smoking on tibial and radial bone mass and strength may diminish with age

PURPOSE

The purpose of the study was to assess the effect of cigarette smoking on indicators of bone strength across a wide age range, controlling for physical activity and neuromuscular performance.

METHODS

We conducted a cross-sectional study with 41 smokers (mean age +/- SD, 41.0 +/- 16.1 yr) and 53 nonsmokers (47.5 +/- 18.2 yr) of both sexes. Bone strength indicators (BSI) were assessed in the lower leg and forearm by peripheral quantitative computed tomography along with physical activity, muscle cross-sectional area, and maximal voluntary muscle force.

RESULTS

Physical activity level and muscle cross-sectional area of the leg and arm were similar in smokers and nonsmokers. Although trabecular volumetric bone mineral density and epiphyseal bone mineral content, both indicators of BSI, decreased with age in the nonsmokers' tibia (P < 0.001), this was not observed in the smokers (interaction age x smoking: P = 0.014 and P = 0.032 for density and content, respectively). Regression coefficients were nonsignificant in nonsmokers, whereas coefficients in smokers were -1.24 mg/cm x yr [95% confidence interval (CI) = -2.16-0.33; P = 0.01] for content and -1.20 mg/cm(3) x yr (95% CI = -1.76-0.62; P < 0.001) for trabecular density. The BSI values in the smokers were independent of their smoking history (r(2) = 0.000-0.021), and no effects of sex were observed in the smoking-related differences in BSI.

CONCLUSIONS

Smoking compromises bone strength by diaphyseal marrow cavity expansion and epiphyseal trabecular bone content reductions. These effects seem to wane with age. The causes of the attenuated effect of smoking on bone at old age remain enigmatic but might be linked to an interaction between the smoke-related factors and senescence processes affecting bone.

Supplementation of ascorbic acid and alpha-tocopherol is useful to preventing bone loss linked to oxidative stress in elderly

OBJECTIVE

To determine the effect of ascorbic acid and alpha-tocopherol on oxidative stress and bone mineral density (BMD) in elderly people.

DESIGN

A double-blind, controlled clinical assay was carried out in a sample of 90 elderly subjects divided into three age-paired random groups with 30 subjects in each group. Group Tx0 received placebo, group Tx1 received 500 mg of ascorbic acid and 400 IU of alpha-tocopherol, whereas group Tx2 received 1,000 mg of ascorbic acid and 400 IU of alpha-tocopherol, for a 12-month period.

MEASUREMENTS

We measured thiobarbituric acid reactive substances (TBARS), total antioxidant status (TAS), superoxide dismutase (SOD), and glutation peroxidase (GPx); BMD was obtained on DXA of hip and spine before and after the 12-month treatment period with supplementation of vitamins C and E.

RESULTS

We found a positive correlation between hip-BMD and SOD (r = 0.298, p < 0.05) and GPx (r = 0.214, p < 0.05). Also, a significantly lower decrease of LPO (p < 0.05) was observed as linked with hip bone loss in the Tx2 group than in the Tx0 group.

CONCLUSIONS

Our findings suggest that that administration of 1,000 mg of ascorbic acid together with 400 IU of alpha-tocopherol could be useful in preventing or aiding in the treatment of age-related osteoporosis.