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Sagelv EH, Emaus N, Evensen E, Christoffersen T, Dennison E, Furberg AS, Grimnes G, Johansson J, Nielsen CS, Nilsen OA, Winther A. Acquisition of peak bone mass in a Norwegian youth cohort: longitudinal findings from the Fit Futures study 2010-2022. Arch Osteoporos 2024; 19:58. [PMID: 38960953 PMCID: PMC11222189 DOI: 10.1007/s11657-024-01414-2] [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: 02/20/2024] [Accepted: 06/20/2024] [Indexed: 07/05/2024]
Abstract
In a Norwegian youth cohort followed from adolescence to young adulthood, bone mineral density (BMD) levels declined at the femoral neck and total hip from 16 to 27 years but continued to increase at the total body indicating a site-specific attainment of peak bone mass. PURPOSE To examine longitudinal trends in bone mineral density (BMD) levels in Norwegian adolescents into young adulthood. METHOD In a prospective cohort design, we followed 980 adolescents (473 (48%) females) aged 16-19 years into adulthood (age of 26-29) on three occasions: 2010-2011 (Fit Futures 1 (FF1)), 2012-2013 (FF2), and 2021-2022 (FF3), measuring BMD (g/cm2) at the femoral neck, total hip, and total body with dual x-ray absorptiometry (DXA). We used linear mixed models to examine longitudinal BMD changes from FF1 to FF3. RESULTS From the median age of 16 years (FF1), femoral neck BMD (mean g/cm2 (95% CI)) slightly increased in females from 1.070 (1.059-1.082) to 1.076 (1.065-1.088, p = 0.015) at the median age of 18 years (FF2) but declined to 1.041 (1.029-1.053, p < 0.001) at the median age of 27 years (FF3). Similar patterns were observed in males: 16 years, 1.104 (1.091-1.116); 27 years, 1.063 (1.050-1.077, p < 0.001); and for the total hip in both sexes (both p < 0.001). Total body BMD increased from age 16 to 27 years in both sexes (females: 16 years, 1.141 (1.133-1.148); 27 years, 1.204 (1.196-1.212), p < 0.001; males: 16 years, 1.179 (1.170-1.188); 27 years, 1.310 (1.296-1.315), p < 0.001). CONCLUSION BMD levels increased from 16 to 18 years at the femoral and total hip sites in young Norwegian females and males, and a small decline was observed at the femoral sites when the participants were followed up to 27 years. Total body BMD continued to increase from adolescence to young adulthood.
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Affiliation(s)
- Edvard H Sagelv
- Division of Neurosciences, Orthopedics and Rehabilitation Services, University Hospital of North Norway, Tromsø, Norway.
| | - Nina Emaus
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Elin Evensen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Tore Christoffersen
- School of Sports Sciences, Faculty of Health Sciences, UiT the Arctic University of Norway, Alta, Norway
- Finnmark Hospital Trust, Alta, Norway
| | - Elaine Dennison
- MRC, Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
| | - Anne-Sofie Furberg
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Department of Health and Social Sciences, Molde University College, Molde, Norway
| | - Guri Grimnes
- Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
- Division of Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Jonas Johansson
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Christopher Sivert Nielsen
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Ole Andreas Nilsen
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Anne Winther
- Division of Neurosciences, Orthopedics and Rehabilitation Services, University Hospital of North Norway, Tromsø, Norway
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Boisvert NMJ, McElroy MR, Hayden KA, Doyle-Baker PK. Familial Resemblance of Bone Health in Maternal Lineage Pairs and Triads: A Scoping Review. Life (Basel) 2024; 14:819. [PMID: 39063575 PMCID: PMC11277880 DOI: 10.3390/life14070819] [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: 05/21/2024] [Revised: 06/14/2024] [Accepted: 06/16/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Female bone health is influenced by familial resemblance, health parameters and maturational periods (puberty and menopause); this combination has been researched using familial multi-generational cross-sectional studies. AIM This scoping review aimed to compile bone health research which uses sexually mature (grandmother-) mother-daughter pairs (and triads) and to determine the trends in its methodologies and familial comparisons. METHODS The Joanna Briggs Institute methodology for scoping reviews was used. Extraction included study and population characteristics, methodology (with an emphasis on imaging) and family-based results. RESULTS Twenty-nine studies were included, and their generations were categorized into four developmental categories: late adolescent to young adult, pre-menopause, mixed-menopause, and post-menopause. Eleven different pair/triad combinations were observed; the most common was pre-menopausal daughters and post-menopausal mothers. Dual-energy X-ray absorptiometry (DXA) was the most utilized imaging modality, and the hip was the most imaged region of interest (ROI). Regardless of pairing, imaging modality and ROI, there was often a trend toward significant familial resemblance and heritability (h2 and h2L). CONCLUSION This scoping review highlights the trends in bone health linked to familial resemblance, as well as the importance of menopause and late adolescence. This review compiles the commonalities and challenges within these studies to inform future research.
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Affiliation(s)
- Nicole M. J. Boisvert
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Melissa R. McElroy
- Northern Ontario School of Medicine University, Sudbury, ON P3E 5Z6, Canada;
| | - K. Alix Hayden
- Libraries and Cultural Resources, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Patricia K. Doyle-Baker
- Human Performance Lab, Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
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Xue Y, Wang X, Liu H, Kang J, Liang X, Yao A, Dou Z. Assessment of the relationship between gut microbiota and bone mineral density: a two-sample Mendelian randomization study. Front Microbiol 2024; 15:1298838. [PMID: 38841058 PMCID: PMC11150656 DOI: 10.3389/fmicb.2024.1298838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 05/01/2024] [Indexed: 06/07/2024] Open
Abstract
Background Emerging evidence from observational studies and clinical trials suggests a connection between the gut microbiota and variations in bone mineral density (BMD). Nonetheless, the specific association between gut microbiota and BMD alterations at different skeletal sites has not been comprehensively explored. To address this, we employed Genome-Wide Association Study (GWAS) summary statistics from a publicly accessible database, conducting a two-sample Mendelian Randomization analysis to elucidate the potential causal relationship between gut microbiota composition and BMD. Methods This study utilized two distinct thresholds for screening instrumental variables (IVs), followed by an extensive series of quality control procedures to identify IVs that were significantly related to exposure. Gut microbiota were classified into two sets based on hierarchical levels: phylum, class, order, family, and genus. Bone mineral density (BMD) data were systematically collected from four skeletal sites: femoral neck, lumbar spine, forearm, and heel. For Mendelian Randomization (MR) analysis, robust methods including Inverse-Variance Weighting (IVW) and the Wald Ratio Test were employed. Additional analytical tests such as the Outlier Test, Heterogeneity Test, 'Leave-One-Out' Test, and Pleiotropy Test were conducted to assess the impact of horizontal pleiotropy, heterogeneities, and the genetic variation stability of gut microbiota on BMD causal associations. The MR Steiger Directionality Test was applied to exclude studies with potential directional biases. Results In this two-sample Mendelian randomization analysis, we utilized five sets of exposure GWAS (Genome-Wide Association Studies) summary statistics and four sets of outcome GWAS summary statistics. The initial analysis, applying a threshold of p < 5 × 10-6, identified 48 significant causal relationships between genetic liability in the gut microbiome and bone mineral density (BMD). A subsequent analysis with a more stringent threshold of p < 5 × 10-8 uncovered 14 additional causal relationships. Upon applying the Bonferroni correction, 9 results from the first analysis and 10 from the second remained statistically significant. Conclusion Our MR analysis revealed a causal relationship between gut microbiota and bone mineral density at all sites, which could lead to discoveries in future mechanistic and clinical studies of microbiota-associated osteoporosis.
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Affiliation(s)
- Yuan Xue
- Graduate School, College of Basic Medical Sciences, Shanxi University of Traditional Chinese Medicine, Taiyuan, China
- Department of Traditional Chinese Medicine, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xuan Wang
- Graduate School, College of Basic Medical Sciences, Shanxi University of Traditional Chinese Medicine, Taiyuan, China
- Dean’s Office, Shanxi Vocational College of Health, Taiyuan, China
| | - Honglin Liu
- Graduate School, College of Basic Medical Sciences, Shanxi University of Traditional Chinese Medicine, Taiyuan, China
| | - Junfeng Kang
- Department of Orthopedics, Affiliated Hospital of Shanxi University of Traditional Chinese Medicine, Taiyuan, China
| | - Xiaohong Liang
- Department of Orthopedics, Affiliated Hospital of Shanxi University of Traditional Chinese Medicine, Taiyuan, China
| | - Aina Yao
- Department of Brain Disease, Shanxi Acupuncture and Moxibustion Hospital, Taiyuan, China
| | - Zhifang Dou
- Graduate School, College of Basic Medical Sciences, Shanxi University of Traditional Chinese Medicine, Taiyuan, China
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Yen BL, Wang LT, Wang HH, Hung CP, Hsu PJ, Chang CC, Liao CY, Sytwu HK, Yen ML. Excess glucose alone depress young mesenchymal stromal/stem cell osteogenesis and mitochondria activity within hours/days via NAD +/SIRT1 axis. J Biomed Sci 2024; 31:49. [PMID: 38735943 PMCID: PMC11089752 DOI: 10.1186/s12929-024-01039-0] [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: 10/13/2023] [Accepted: 04/24/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND The impact of global overconsumption of simple sugars on bone health, which peaks in adolescence/early adulthood and correlates with osteoporosis (OP) and fracture risk decades, is unclear. Mesenchymal stromal/stem cells (MSCs) are the progenitors of osteoblasts/bone-forming cells, and known to decrease their osteogenic differentiation capacity with age. Alarmingly, while there is correlative evidence that adolescents consuming greatest amounts of simple sugars have the lowest bone mass, there is no mechanistic understanding on the causality of this correlation. METHODS Bioinformatics analyses for energetics pathways involved during MSC differentiation using human cell information was performed. In vitro dissection of normal versus high glucose (HG) conditions on osteo-/adipo-lineage commitment and mitochondrial function was assessed using multi-sources of non-senescent human and murine MSCs; for in vivo validation, young mice was fed normal or HG-added water with subsequent analyses of bone marrow CD45- MSCs. RESULTS Bioinformatics analyses revealed mitochondrial and glucose-related metabolic pathways as integral to MSC osteo-/adipo-lineage commitment. Functionally, in vitro HG alone without differentiation induction decreased both MSC mitochondrial activity and osteogenesis while enhancing adipogenesis by 8 h' time due to depletion of nicotinamide adenine dinucleotide (NAD+), a vital mitochondrial co-enzyme and co-factor to Sirtuin (SIRT) 1, a longevity gene also involved in osteogenesis. In vivo, HG intake in young mice depleted MSC NAD+, with oral NAD+ precursor supplementation rapidly reversing both mitochondrial decline and osteo-/adipo-commitment in a SIRT1-dependent fashion within 1 ~ 5 days. CONCLUSIONS We found a surprisingly rapid impact of excessive glucose, a single dietary factor, on MSC SIRT1 function and osteogenesis in youthful settings, and the crucial role of NAD+-a single molecule-on both MSC mitochondrial function and lineage commitment. These findings have strong implications on future global OP and disability risks in light of current worldwide overconsumption of simple sugars.
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Affiliation(s)
- B Linju Yen
- Regenerative Medicine Research Group, Institute of Cellular & System Medicine, National Health Research Institutes (NHRI), No.35, Keyan Road, Zhunan, 35053, Taiwan.
| | - Li-Tzu Wang
- Department of Obstetrics & Gynecology, National Taiwan University (NTU) Hospital & College of Medicine, NTU, No.1, Section 1, Jen-Ai Road, Taipei, 10051, Taiwan
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, No. 250, Wuxing Street, Taipei, 11042, Taiwan
- Ph.D. Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, No.250, Wuxing Street, Taipei, 11042, Taiwan
| | - Hsiu-Huang Wang
- Regenerative Medicine Research Group, Institute of Cellular & System Medicine, National Health Research Institutes (NHRI), No.35, Keyan Road, Zhunan, 35053, Taiwan
| | - Chin-Pao Hung
- Department of Obstetrics & Gynecology, National Taiwan University (NTU) Hospital & College of Medicine, NTU, No.1, Section 1, Jen-Ai Road, Taipei, 10051, Taiwan
| | - Pei-Ju Hsu
- Regenerative Medicine Research Group, Institute of Cellular & System Medicine, National Health Research Institutes (NHRI), No.35, Keyan Road, Zhunan, 35053, Taiwan
| | - Chia-Chi Chang
- Regenerative Medicine Research Group, Institute of Cellular & System Medicine, National Health Research Institutes (NHRI), No.35, Keyan Road, Zhunan, 35053, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center (NDMC), No.161, Section 6, Minquan East Road, Taipei, 11490, Taiwan
| | - Chien-Yu Liao
- Regenerative Medicine Research Group, Institute of Cellular & System Medicine, National Health Research Institutes (NHRI), No.35, Keyan Road, Zhunan, 35053, Taiwan
| | - Huey-Kang Sytwu
- National Institute of Infectious Diseases & Vaccinology, NHRI, No.35, Keyan Road, Zhunan, 35053, Taiwan
- Graduate Institute of Microbiology & Immunology, NDMC, No.161, Section 6, Minquan East Road, Taipei, 11490, Taiwan
| | - Men-Luh Yen
- Department of Obstetrics & Gynecology, National Taiwan University (NTU) Hospital & College of Medicine, NTU, No.1, Section 1, Jen-Ai Road, Taipei, 10051, Taiwan.
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Kutac P, Jandacka D, Elavsky S, Uchytil J, Bunc V, Krajcigr M, Barot T. The effect of regular running on the bone tissue of middle-aged men and women. J Sports Med Phys Fitness 2024; 64:455-464. [PMID: 38261331 DOI: 10.23736/s0022-4707.23.15279-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
BACKGROUND Many authors consider running to be a protective physical activity (PA) in bone health. However, many studies also show inconsistencies in their results. The objective of the study is to analyze the effect of cumulative loading rate (TCL) on the bone mass of middle-aged runners and non-runners is assessed. METHODS This cross-sectional study included 322 individuals. There were 212 runners (109 male, 103 female) and those were individuals who did >10 km of running per week. There were 110 non-runners (54 male, 56 female). This group included individuals who did not adhere to the WHO (2020) recommendations for PA. The average age in the individual groups ranged from 40.9±4.1 to 42.3±4.8 years. Bone parameters were measured on the lower extremities and vertebral spine using the DXA method (Hologic QDR Horizon A). Multi-regression dependencies analysis was used to assess the results. RESULTS The results of the multi-regression dependencies analysis showed that the bone mineral content (BMC) and bone mineral density (BMD) are significantly influenced by the TCL and gender. CONCLUSIONS Therefore, we can conclude that running could be a suitable PA for preventing the reduction of BMD in the middle-aged population, especially in the lower limbs.
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Affiliation(s)
- Petr Kutac
- Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic -
| | - Daniel Jandacka
- Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
| | - Steriani Elavsky
- Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
| | - Jaroslav Uchytil
- Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
| | - Vaclav Bunc
- Faculty of Education, Charles University, Prague, Czech Republic
| | - Miroslav Krajcigr
- Department of Human Movement Studies, University of Ostrava, Ostrava, Czech Republic
| | - Tomas Barot
- Department of Mathematics with Didactics, University of Ostrava, Ostrava, Czech Republic
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Guðmundsdóttir SL, Berger C, Macdonald H, Adachi JD, Hopman WM, Kaiser SM, Kovacs CS, Davison KS, Morin SN, Goltzman D, Prior JC. Sedentary behavior does not predict low BMD nor fracture-population-based Canadian Multicentre Osteoporosis Study. J Bone Miner Res 2024; 39:231-240. [PMID: 38477796 PMCID: PMC11240152 DOI: 10.1093/jbmr/zjae004] [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: 05/24/2023] [Revised: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 03/14/2024]
Abstract
Sedentary behavior (SB) or sitting is associated with multiple unfavorable health outcomes. Bone tissue responds to imposed gravitational and muscular strain with there being some evidence suggesting a causal link between SB and poor bone health. However, there are no population-based data on the longitudinal relationship between SB, bone change, and incidence of fragility fractures. This study aimed to examine the associations of sitting/SB (defined as daily sitting time), areal BMD (by DXA), and incident low trauma (fragility) osteoporotic fractures (excluding hands, feet, face, and head). We measured baseline (1995-7) and 10-yr self-reported SB, femoral neck (FN), total hip (TH), and lumbar spine (L1-L4) BMD in 5708 women and 2564 men aged 25 to 80+ yr from the population-based, nationwide, 9-center Canadian Multicentre Osteoporosis Study. Incident 10-yr fragility fracture data were obtained from 4624 participants; >80% of fractures were objectively confirmed by medical records or radiology reports. Vertebral fractures were confirmed by qualitative morphological methods. All analyses were stratified by sex. Multivariable regression models assessed SB-BMD relationships; Cox proportional models were fit for fracture risk. Models were adjusted for age, height, BMI, physical activity, and sex-specific covariates. Women in third/fourth quartiles had lower adjusted FN BMD versus women with the least SB (first quartile); women in the SB third quartile had lower adjusted TH BMD. Men in the SB third quartile had lower adjusted FN BMD than those in SB first quartile. Neither baseline nor stable 10-yr SB was related to BMD change nor to incident fragility fractures. Increased sitting (SB) in this large, population-based cohort was associated with lower baseline FN BMD. Stable SB was not associated with 10-yr BMD loss nor increased fragility fracture. In conclusion, habitual adult SB was not associated with subsequent loss of BMD nor increased risk of fracture.
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Affiliation(s)
- Sigríður Lára Guðmundsdóttir
- School of Education, Department of Health Promotion, Sport and Leisure Studies, University of Iceland, 101 Reykjavik, Iceland
| | - Claudie Berger
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC H3H 2R9, Canada
| | - Heather Macdonald
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada
- Active Aging Research Team, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Jonathan D Adachi
- Department of Medicine, McMaster University, Hamilton, ON L8N 3Z5, Canada
| | - Wilma M Hopman
- Kingston General Hospital Research Institute, Kingston Health Sciences Centre, Kingston, ON K7L 2V7, Canada
- Department of Public Health Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Stephanie M Kaiser
- Department of Medicine, Dalhousie University, Halifax, NS B3H 2Y9, Canada
| | - Christopher S Kovacs
- Discipline of Medicine/Endocrinology, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL A1B 3V6, Canada
| | | | - Suzanne N Morin
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC H3H 2R9, Canada
- Department of Medicine, McGill University Health Center, Montreal, QC H4A 3J1, Canada
| | - David Goltzman
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC H3H 2R9, Canada
- Department of Medicine, McGill University Health Center, Montreal, QC H4A 3J1, Canada
| | - Jerilynn C Prior
- Division of Endocrinology, Department of Medicine, Centre for Menstrual Cycle and Ovulation Research, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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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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Mitra AT, Das B, Sarraf KM, Ford-Adams M, Fehervari M, Ashrafian H. Bone health following paediatric and adolescent bariatric surgery: a systematic review and meta-analysis. EClinicalMedicine 2024; 69:102462. [PMID: 38333369 PMCID: PMC10850131 DOI: 10.1016/j.eclinm.2024.102462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 01/17/2024] [Accepted: 01/17/2024] [Indexed: 02/10/2024] Open
Abstract
Background Childhood obesity is a pressing health crisis of epidemic proportions. Bariatric surgery (BS) is an effective weight loss solution however its role in the paediatric population is contentious owing to the paucity of weight specific and generalised health outcomes. This systematic review and meta-analysis aimed to assess the impact of paediatric BS on bone health. Methods This prospectively registered systematic review (PROSPERO ID: CRD42023432035) was performed in accordance with PRISMA guidelines. We searched MEDLINE (1946-1928 September 2023), EMBASE (1947-1928 September 2023) via the Ovid platform, and the Cochrane Review Library to identify scientific publications reporting bone outcome measures in patients under the age of 18 years who underwent BS. Meta-analysis was undertaken on post-operative weight and bone parameters in paediatric patients following BS. Outcomes were reported as weighted or standardized mean difference with 95 percent confidence intervals. Subgroup analysis by intervention, quality scoring and risk of bias were assessed. Findings Twelve studies with 681 patients across 5 countries (mean age 17 ± 0.57 years) were included. The quality of included studies was rated as high and there was substantial between-study heterogeneity for most factors included in the meta-analysis (I2 from 0% to 99.1%). Patients underwent Roux-en-Y gastric bypass (RYGB, n = 216), sleeve gastrectomy (SG, n = 257), gastric band (n = 184) or intragastric balloon placement (n = 24). BS was associated with significant weight reduction, body mass index (BMI) -12.7 kg/m2 (95% CI -14.5 to -10.9, p < 0.001), with RYGB being most effective, BMI -16.58 kg/m2 (95% CI -19.6 to -13.6, p < 0.001). Patients who underwent SG or RYGB had significantly lower lumbar bone mineral density, -0.96 g/cm2 (95% CI -0.1 to -0.03, p < 0.001), Z score, -1.132 (95% CI -1.8 to -0.45, p < 0.001) and subtotal body bone mineral density, -0.7 g/cm2 (95% CI -1.2 to -0.2, p < 0.001) following surgery. This was accompanied with higher markers of bone resorption, C-terminal telopeptide of type 1 collagen 0.22 ng/ml (95% CI 0.12-0.32, p < 0.001) and osteocalcin, 10.83 ng/ml (95% CI 6.01-15.67, p < 0.001). There was a significant reduction in calcium levels following BS, -3.78 mg/dl (95% CI -6.1 to -1.5, p < 0.001) but no difference in 25-hydroxyvitamin D, phosphate, bone alkaline phosphatase, procollagen type 1 N propeptide or parathyroid hormone. Interpretation BS effectively reduces weight in paediatric patients, but RYGB and SG may have adverse effects on bone health in the medium term. It is crucial to monitor and support bone health through appropriate nutritional supplementation and judicious follow-up. Long-term data is needed to fully understand the clinical implications of these findings on bone outcomes. Funding Medical Research Council (MRC), United Kingdom.
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Affiliation(s)
- Anuja Tulip Mitra
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, United Kingdom
| | - Bibek Das
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, United Kingdom
| | - Khalid Maher Sarraf
- Department of Orthopaedics, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, Paddington, London, United Kingdom
| | - Martha Ford-Adams
- Department of Paediatric Endocrinology, Kings College Hospital NHS Foundation Trust, London, United Kingdom
| | - Matyas Fehervari
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, United Kingdom
- Department of Bariatric Surgery, Chelsea and Westminster Hospital, London, United Kingdom
| | - Hutan Ashrafian
- Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, Du Cane Road, London, United Kingdom
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9
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Lee M, Kwon A, Song K, Lee HI, Choi HS, Suh J, Chae HW, Kim HS. Effectiveness and safety of pamidronate treatment in nonambulatory children with low bone mineral density. Ann Pediatr Endocrinol Metab 2024; 29:46-53. [PMID: 38461805 PMCID: PMC10925781 DOI: 10.6065/apem.2346028.014] [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: 01/31/2023] [Revised: 03/03/2023] [Accepted: 05/29/2023] [Indexed: 03/12/2024] Open
Abstract
PURPOSE Nonambulatory pediatric patients may have low bone mineral density (BMD) and increased risk of pathologic fractures. Though bisphosphonate therapy is the mainstream medical intervention in these children, clinical data regarding this treatment are limited. Therefore, this study aimed to evaluate the effectiveness and safety of bisphosphonate therapy in such children. METHODS We conducted a retrospective study of 21 nonambulatory children (Gross Motor Function Classification System level V) with BMD z-score ≤ -2.0 who were treated with intravenous pamidronate for at least 1 year. These patients received pamidronate every 4 months at a dose of 1.0 to 3.0 mg/kg for each cycle and had regular follow-ups for at least 1 year. The main outcome measures were changes in BMD, risk rate of fracture, biochemical data, and adverse events. RESULTS The average duration of pamidronate treatment was 2.0±0.9 years, and the mean cumulative dose of pamidronate according to body weight was 7.7±2.5 mg/kg/yr. After treatment, the mean lumbar spine bone mineral content, BMD, and height-for-age-z-score-adjusted BMD z-score (BMDhazZ) significantly improved. The relative risk of fracture after treatment was 0.21 (p=0.0032), suggesting that pamidronate treatment reduced fracture incidence significantly. The increase in the average dose per body weight in each cycle significantly increased the changes in BMDhazZ. CONCLUSION Pamidronate treatment improved the bone health of nonambulatory children with low bone density without any significant adverse events. Independent of cumulative dosage and duration of treatment, the effectiveness of pamidronate increased significantly with an increase in the average dose per body weight in subsequent cycles.
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Affiliation(s)
- Myeongseob Lee
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ahreum Kwon
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyungchul Song
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hae In Lee
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Han Saem Choi
- Department of Pediatrics, International St. Mary’s Hospital, Catholic Kwandong University, Incheon, Korea
| | - Junghwan Suh
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Wook Chae
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Severance Children’s Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
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10
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Formosa MM, Christou MA, Mäkitie O. Bone fragility and osteoporosis in children and young adults. J Endocrinol Invest 2024; 47:285-298. [PMID: 37668887 PMCID: PMC10859323 DOI: 10.1007/s40618-023-02179-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023]
Abstract
Osteoporosis is a metabolic bone disorder which increases fragility fracture risk. Elderly individuals, especially postmenopausal women, are particularly susceptible to osteoporosis. Although rare, osteoporosis in children and young adults is becoming increasingly evident, highlighting the need for timely diagnosis, management and follow-up. Early-onset osteoporosis is defined as the presence of a low BMD (Z-score of ≤ -2.0 in individuals aged < 20 years; T-score of ≤ -2.5 in those aged between 20 to 50 years) accompanied by a clinically significant fracture history, or the presence of low-energy vertebral compression fractures even in the absence of osteoporosis. Affected children and young adults should undergo a thorough diagnostic workup, including collection of clinical history, radiography, biochemical investigation and possibly bone biopsy. Once secondary factors and comorbidities are excluded, genetic testing should be considered to determine the possibility of an underlying monogenic cause. Defects in genes related to type I collagen biosynthesis are the commonest contributors of primary osteoporosis, followed by loss-of-function variants in genes encoding key regulatory proteins of canonical WNT signalling (specifically LRP5 and WNT1), the actin-binding plastin-3 protein (encoded by PLS3) resulting in X-linked osteoporosis, and the more recent sphingomyelin synthase 2 (encoded by SGMS2) which is critical for signal transduction affecting sphingomyelin metabolism. Despite these discoveries, genetic causes and underlying mechanisms in early-onset osteoporosis remain largely unknown, and if no causal gene is identified, early-onset osteoporosis is deemed idiopathic. This calls for further research to unravel the molecular mechanisms driving early-onset osteoporosis that consequently will aid in patient management and individualised targeted therapy.
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Affiliation(s)
- M M Formosa
- Department of Applied Biomedical Science, Faculty of Health Sciences, University of Malta, Msida, Malta
- Center for Molecular Medicine and Biobanking, University of Malta, Msida, Malta
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M A Christou
- Department of Endocrinology, School of Medicine, University of Ioannina, Ioannina, Greece
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - O Mäkitie
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- Folkhälsan Research Centre, Folkhälsan Institute of Genetics, Helsinki, Finland.
- Department of Molecular Medicine and Surgery, Karolinska Institutet, and Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden.
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11
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Kopiczko A, Czapla M, Juárez-Vela R, Ross C, Uchmanowicz B. Dairy product consumption, eating habits, sedentary behaviour and physical activity association with bone mineral density among adolescent boys: a cross-sectional observational study. BMC Pediatr 2024; 24:53. [PMID: 38233826 PMCID: PMC10792931 DOI: 10.1186/s12887-024-04539-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 01/04/2024] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND During childhood and adolescence, skeletal microarchitecture and bone mineral density (BMD) undergo significant changes. Peak bone mass is built and its level significantly affects the condition of bones in later years of life. Understanding the modifiable factors that improve bone parameters at an early age is necessary to early prevent osteoporosis. To identify these modifiable factors we analysed the relationship between dairy product consumption, eating habits, sedentary behaviour, and level of physical activity with BMD in 115 young boys (14-17 years). METHODS Bone parameters were measured by dual energy x-ray absorptiometry using paediatric specific software to compile the data. Dairy product consumption and eating habits were assessed by means of a dietary interview. Sedentary behaviour and physical activity was assessed in a face-to-face interview conducted using the International Physical Activity Questionnaire. Data collection on total physical activity level was performed by collecting information on the number of days and the duration of vigorous and moderate intensity (MVPA) and average daily time spent in sitting (SIT time). RESULTS The strongest relationships with BMD in distal part of forearm were found for moderate plus vigorous activity, sit time, and intake of dairy products, intake of calcium, protein, vitamin D, phosphorus from diet. Relationships between BMD, bone mineral content (BMC) in the distal and proximal part of the forearm and PA, sit time and eating parameters were evaluated using the multiple forward stepwise regression. The presented model explained 48-67% (adjusted R2 = 0.48-0.67; p < 0.001) of the variance in bone parameters. The predictor of interactions of three variables: protein intake (g/person/day), vitamin D intake (µg/day) and phosphorus intake (mg/day) was significant for BMD dis (adjusted R2 = 0.59; p < 0.001). The predictor of interactions of two variables: SIT time (h/day) and dairy products (n/day) was significant for BMD prox (adjusted R2 = 0.48; p < 0.001). Furthermore, the predictor of interactions dairy products (n/day), protein intake (g/person/day) and phosphorus intake (mg/day) was significant for BMC prox and dis (adjusted R2 = 0.63-0.67; p < 0.001). CONCLUSIONS High physical activity and optimal eating habits especially adequate intake of important dietary components for bone health such as calcium, protein, vitamin D and phosphorus affect the mineralization of forearm bones.
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Affiliation(s)
- Anna Kopiczko
- Department of Human Biology, Józef Piłsudski University of Physical Education in Warsaw, Warsaw, Poland
| | - Michał Czapla
- Department of Emergency Medical Service, Wrocław Medical University, Wrocław, Poland.
- Institute of Heart Diseases, University Hospital, Wroclaw, 50-566, Poland.
- Group of Research in Care (GRUPAC), Faculty of Health Science, University of La Rioja, Logrono, 26006, Spain.
| | - Raúl Juárez-Vela
- Group of Research in Care (GRUPAC), Faculty of Health Science, University of La Rioja, Logrono, 26006, Spain
| | - Catherine Ross
- Centre for Cardiovascular Health, School of Health and Social Care, Edinburgh Napier University, Edinburgh, EH11 4BN, UK
| | - Bartosz Uchmanowicz
- Department of Nursing and Obstetrics, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
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12
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Zhou H, Chen L, Su H, Chen G, Tong P. Risk of low bone mineral density in patients with haemophilia: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19:52. [PMID: 38212803 PMCID: PMC10782745 DOI: 10.1186/s13018-023-04499-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION Patients with haemophilia (PWH) may have lower bone mineral density (BMD). The risk of low BMD in PWH has not been comprehensively analysed. This study aimed to examine the risk of low BMD and changes in BMD in PWH. METHODS A comprehensive systematic search was performed in 4 databases: PubMed, Embase, Web of Science, and Cochrane Library. The last search was carried out on 11 December 2022. Review Manager 5.4 and Stata 16 were used for meta-analysis. Odds ratios were calculated by the incidence of low BMD between the haemophilia and control groups in each study. A meta-analysis of the odds ratios for each study was performed to estimate pooled odds ratios. Fixed effects models or random effects models were used to assess outcomes. Heterogeneity was evaluated using Higgins' I2. Subgroup analysis and sensitivity analysis were performed to interpret the potential source of heterogeneity. A funnel plot, Egger's regression test, and the trim-and-fill method were used to assess publication bias. RESULTS 19 of 793 studies, published between 2004 and 2022, that were identified by search strategy were included in this meta-analysis. The risk for low BMD was approximately four times higher compared to controls. PWH have significantly lower lumbar spine, femoral neck, and total hip BMD. Subgroup analysis showed that the risk of low BMD did not increase significantly in developed countries. Very low heterogeneity was observed in the meta-analysis of the risk of low BMD. The result from Egger's regression test suggested that there may be publication bias. However, the meta-analysis results did not alter after the trim-and-fill correction and the findings were robust. CONCLUSION Haemophilia was associated with an increased risk of low BMD. However, the risk of low BMD did not increase significantly in developed countries. And BMD was reduced in PWH, regardless of age, region, or economic ability. For PWH, our concerns should extend beyond bleeding and osteoarthritis to encompass BMD starting at a young age.
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Affiliation(s)
- Haojing Zhou
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Lei Chen
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Hai Su
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Guoqian Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang Province, China.
| | - Peijian Tong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, Zhejiang Province, China.
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13
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Sethuram C, Brown W, Gill G, Liddy C, Afkham A, Keely E. Improving Access to Osteoporosis Specialists Using Electronic Consultations. Endocr Pract 2023; 29:955-959. [PMID: 37722596 DOI: 10.1016/j.eprac.2023.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/20/2023]
Abstract
OBJECTIVE To identify the types of osteoporosis-related questions being asked by primary care providers (PCPs) and describe the impact of the advice provided by osteoporosis specialists using eConsult. METHODS We performed a cross-sectional study of osteoporosis-related eConsults submitted to endocrinologists between January 2018 and December 2020 on the Champlain eConsult BASE™ Service in Ontario, Canada. Each eConsult was coded according to clinical question and answer type through consensus between 2 authors, based on predetermined taxonomies. We analyzed eConsult utilization data, including response times, PCP satisfaction, and referral outcomes (collected via PCP surveys). RESULTS Of the 2,528 eConsults sent to endocrinologists during the study period, 408 (16%) were specific to osteoporosis. The most common questions asked by PCPs were regarding whether or not to start treatment (35%), the initial therapy choice (25%), and how often to complete bone mineral density scans (15%). The most common responses from specialists included recommendations for bone mineral density scanning (34%), recommendation to start therapy (24%), and recommendation to treat using a bisphosphonate without the dose specified (23%). The median response interval was 3.1 days. Most cases (84%) were resolved without requiring an in-person referral. Clear advice for a new course of action for PCPs to implement was provided in 54% of cases. CONCLUSION Osteoporosis eConsults provide timely access to valuable specialist advice while avoiding unnecessary face-to-face clinic visits. We identified commonly recurring osteoporosis questions asked by PCPs, which can be used to inform planning of future continuing professional development events.
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Affiliation(s)
- Claire Sethuram
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada; Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Warren Brown
- Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Gurleen Gill
- Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Clare Liddy
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada; Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amir Afkham
- Ontario Health East, Ottawa, Ontario, Canada
| | - Erin Keely
- Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ontario eConsult Centre of Excellence, The Ottawa Hospital, Ottawa, Ontario, Canada.
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14
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Rosenqvist L, Hebelka H, Baranto A, Brisby H, Lagerstrand K. Detailed MRI evaluation of the spine: a 2-year follow-up study of young individuals reporting different training doses. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4145-4152. [PMID: 37815636 DOI: 10.1007/s00586-023-07961-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/21/2023] [Accepted: 09/16/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To characterize the discs and vertebrae in detail over time in a group of adolescent individuals with varying training doses using magnetic resonance imaging (MRI). METHOD Thirty-five students were recruited from regular high schools (n=13) as well as schools with athlete competitive skiing programmes (n = 22). The thoraco-lumbar spine of all individuals was examined at baseline and at 2-year follow-up using the same 1.5T scanner and imaging protocol. The individuals were grouped based on their reported training dose: low-to-normal training dose (≤5 h/week, n = 11, mean age 16.5 ± 0.5 years) and high training dose (>5 h/week, n = 24, mean age 17.2 ± 0.6 years.) RESULTS: At baseline, the signal intensity in the discs and vertebrae were significantly lower in individuals reporting high compared to low-to-normal training dose. The vertebral signal changed significantly over the 2-year period in both groups. However, only individuals reporting low-to-normal training dose displayed an overall disc signal change. Interestingly, the regional analysis displayed at baseline high annular signals in the more training-active individuals followed by a reduction over the two-year period. CONCLUSION This study suggests that disc degeneration is manifested earlier in individuals reporting a higher training dose. Over a 2-year period, however, the degeneration process did not accelerate further. Also, a significant difference in the vertebral signal, at baseline and follow-up as well as over time, could be seen between groups of individuals reporting high versus low-to-normal training dose.
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Affiliation(s)
- Louise Rosenqvist
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Hanna Hebelka
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adad Baranto
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helena Brisby
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Lagerstrand
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
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15
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Gao H, Zhao Y, Zhao L, Wang Z, Yan K, Gao B, Zhang L. The Role of Oxidative Stress in Multiple Exercise-Regulated Bone Homeostasis. Aging Dis 2023; 14:1555-1582. [PMID: 37196112 PMCID: PMC10529750 DOI: 10.14336/ad.2023.0223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/23/2023] [Indexed: 05/19/2023] Open
Abstract
Bone is a tissue that is active throughout the lifespan, and its physiological activities, such as growth, development, absorption, and formation, are always ongoing. All types of stimulation that occur in sports play an important role in regulating the physiological activities of bone. Here, we track the latest research progress locally and abroad, summarize the recent, relevant research results, and systematically summarize the effects of different types of exercise on bone mass, bone strength and bone metabolism. We found that different types of exercise have different effects on bone health due to their unique technical characteristics. Oxidative stress is an important mechanism mediating the exercise regulation of bone homeostasis. Excessive high-intensity exercise does not benefit bone health but induces a high level of oxidative stress in the body, which has a negative impact on bone tissue. Regular moderate exercise can improve the body's antioxidant defense ability, inhibit an excessive oxidative stress response, promote the positive balance of bone metabolism, delay age-related bone loss and deterioration of bone microstructures and have a prevention and treatment effect on osteoporosis caused by many factors. Based on the above findings, we provide evidence for the role of exercise in the prevention and treatment of bone diseases. This study provides a systematic basis for clinicians and professionals to reasonably formulate exercise prescriptions and provides exercise guidance for patients and the general public. This study also provides a reference for follow-up research.
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Affiliation(s)
- Haoyang Gao
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Yilong Zhao
- Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Linlin Zhao
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Zhikun Wang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Kai Yan
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Bo Gao
- Institute of Orthopedic Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an, China
| | - Lingli Zhang
- College of Athletic Performance, Shanghai University of Sport, Shanghai, China
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16
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Prior JC, Shirin S, Goshtasebi A. Bone health and prevalent fractures in women with polycystic ovary syndrome: a meta-analysis and endocrine-context pathophysiology review. Expert Rev Endocrinol Metab 2023; 18:283-293. [PMID: 37254511 DOI: 10.1080/17446651.2023.2216294] [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: 01/29/2023] [Revised: 04/05/2023] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Bone health in those with Polycystic Ovary Syndrome (PCOS) is complex, but the general consensus is that cortical areal bone mineral density (aBMD) sites will be higher in PCOS than in age- and BMI-similar controls. However, spine aBMD sites may be lower, especially in non-obese PCOS. Whether or not incident fracture risk is increased in PCOS is currently controversial; no meta-analysis has yet assessed prevalent fractures. AREAS COVERED We assessed the bone effects of PCOS-related ovarian hormone alterations, e.g. androgen excess, tonically normal/higher estradiol, and lower-than-normal progesterone levels. We also highlighted evidence that common PCOS medications (e.g. combined hormonal contraceptives [CHC], metformin, and spironolactone) have important bone effects. In adolescents, meta-analysis of CHC showed significant negative aBMD changes. Inflammation has negative PCOS bone effects and is linked with CHC use. EXPERT OPINION Is fracture risk altered by PCOS? Our meta-analysis showed a 25% increased risk of prevalent fracture in PCOS versus controls; this did not reach statistical significance. Future prospective research needs to collect and evaluate ovulation characteristics, progesterone exposure, and adolescent CHC use, in addition to the complex variables that may influence risks for prevalent or incident fragility fractures and/or for cortical and cancellous aBMD values in PCOS.
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Affiliation(s)
- Jerilynn C Prior
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia, University Endowment Lands, Canada
- Division of Endocrinology, Department of Medicine, University of British Columbia, University Endowment Lands, Canada
- Women's Health Research Institute, University of British Columbia, University Endowment Lands, Canada
- School of Population and Public Health, University of British Columbia, University Endowment Lands, Canada
| | - Sonia Shirin
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia, University Endowment Lands, Canada
- Women's Health Research Institute, University of British Columbia, University Endowment Lands, Canada
| | - Azita Goshtasebi
- Centre for Menstrual Cycle and Ovulation Research, Endocrinology, University of British Columbia, University Endowment Lands, Canada
- Women's Health Research Institute, University of British Columbia, University Endowment Lands, Canada
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17
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White L, Losciale JM, Squier K, Guy S, Scott A, Prior JC, Whittaker JL. Combined hormonal contraceptive use is not protective against musculoskeletal conditions or injuries: a systematic review with data from 5 million females. Br J Sports Med 2023; 57:1195-1202. [PMID: 37225254 DOI: 10.1136/bjsports-2022-106519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Assess the association between combined hormonal contraceptives (CHC) use and musculoskeletal tissue pathophysiology, injuries or conditions. DESIGN Systematic review with semiquantitative analyses and certainty of evidence assessment, guided by the Grading of Recommendations Assessment, Development and Evaluation approach. DATA SOURCES MEDLINE, EMBASE, CENTRAL, SPORTDiscus, CINAHL searched from inception to April 2022. ELIGIBILITY Intervention and cohort studies that assessed the association between new or ongoing use of CHC and an outcome of musculoskeletal tissue pathophysiology, injury or condition in postpubertal premenopausal females. RESULTS Across 50 included studies, we assessed the effect of CHC use on 30 unique musculoskeletal outcomes (75% bone related). Serious risk of bias was judged present in 82% of studies, with 52% adequately adjusting for confounding. Meta-analyses were not possible due to poor outcome reporting, and heterogeneity in estimate statistics and comparison conditions. Based on semiquantitative synthesis, there is low certainty evidence that CHC use was associated with elevated future fracture risk (risk ratio 1.02-1.20) and total knee arthroplasty (risk ratio 1.00-1.36). There is very low certainty evidence of unclear relationships between CHC use and a wide range of bone turnover and bone health outcomes. Evidence about the effect of CHC use on musculoskeletal tissues beyond bone, and the influence of CHC use in adolescence versus adulthood, is limited. CONCLUSION Given a paucity of high certainty evidence that CHC use is protective against musculoskeletal pathophysiology, injury or conditions, it is premature and inappropriate to advocate, or prescribe CHC for these purposes. PROSPERO REGISTRATION NUMBER This review was registered on PROSPERO CRD42021224582 on 8 January 2021.
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Affiliation(s)
- Lynita White
- Tall Tree Physiotherapy and Health Centre, Vancouver, British Columbia, Canada
| | - Justin M Losciale
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kipling Squier
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Guy
- City Sport + Physiotherapy Clinic, Vancouver, British Columbia, Canada
| | - Alex Scott
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jerilynn C Prior
- Centre for Menstrual Cycle and Ovulation Research, The University of British Columbia, Vancouver, British Columbia, Canada
- Women's Health Research Institute, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jackie L Whittaker
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
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18
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Macdonald HM, Maan EJ, Berger C, Côte HCF, Murray MCM, Pick N, Prior JC. Long-Term Change in Bone Mineral Density in Women Living With HIV: A 10-Year Prospective Controlled Cohort Study. JBMR Plus 2023; 7:e10761. [PMID: 37614300 PMCID: PMC10443077 DOI: 10.1002/jbm4.10761] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 08/25/2023] Open
Abstract
Women living with HIV (WLWH) may be at higher risk for osteoporosis and fragility fractures. However, limited prospective data describe long-term trajectories of bone mineral density (BMD) in WLWH versus women without HIV. Thus, in this prospective study, we aimed to compare 10-year change in areal BMD (aBMD) between WLWH (n = 49; 36.8 ± 8.8 years; 96% pre/perimenopausal) and HIV-negative women (population-based controls; n = 49; 41.9 ± 9.2 years; 80% pre/perimenopausal). In an exploratory analysis, we compared fracture history between WLWH and controls. Outcomes were lumbar spine (L1 to L4), total hip, and femoral neck aBMD at baseline and follow-up, which occurred at 13 and 10 years in WLWH and controls, respectively. We fit multivariable regression models to compare baseline and 10-year change in aBMD between groups, adjusting for osteoporosis risk factors. Within WLWH, we examined associations between aBMD and HIV-related factors, including combination antiretroviral therapy (cART) duration. WLWH were diagnosed 6.5 ± 3.7 years before baseline, 80% were on cART for 241 ± 142 weeks, and 49% had HIV plasma viral load <40 copies/mL. Before and after adjusting for osteoporosis risk factors, baseline and 10-year change in aBMD did not differ between WLWH and controls at any site. At baseline, more WLWH than controls reported a history of low-trauma fracture (30% versus 10%, p < 0.05) and major osteoporotic fracture (17% versus 4%, p < 0.05). During follow-up, the number of WLWH and controls with incident fragility fracture was not significantly different. Lifetime cART duration and tenofovir use were not associated with aBMD 10-year percent change. Higher CD4 count at baseline was positively associated with femoral neck aBMD 10-year percent change. Long-term aBMD change in this small WLWH cohort paralleled normal aging, with no evidence of influence from cART use; however, these results should be interpreted with caution given the small sample size. Larger cohort studies are needed to confirm these findings. © 2023 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)
- Heather M. Macdonald
- Active Aging Research TeamUniversity of British ColumbiaVancouverBCCanada
- Department of Family PracticeFaculty of Medicine, University of British ColumbiaVancouverBCCanada
| | - Evelyn J. Maan
- Oak Tree Clinic, BC Women's Hospital and Health CentreVancouverBCCanada
| | - Claudie Berger
- Research Institute of the McGill University Health CentreMontrealQCCanada
| | - Hélène C. F. Côte
- Department of Pathology & Laboratory MedicineUniversity of British ColumbiaVancouverBCCanada
- Centre for Blood ResearchFaculty of Medicine, University of British ColumbiaVancouverBCCanada
- Women's Health Research InstituteVancouverBCCanada
| | - Melanie C. M. Murray
- Oak Tree Clinic, BC Women's Hospital and Health CentreVancouverBCCanada
- Women's Health Research InstituteVancouverBCCanada
- Department of Medicine, Division of Infectious DiseasesUniversity of British ColumbiaVancouverBCCanada
| | - Neora Pick
- Oak Tree Clinic, BC Women's Hospital and Health CentreVancouverBCCanada
- Women's Health Research InstituteVancouverBCCanada
- Department of Medicine, Division of Infectious DiseasesUniversity of British ColumbiaVancouverBCCanada
| | - Jerilynn C. Prior
- Women's Health Research InstituteVancouverBCCanada
- Centre for Menstrual Cycle and Ovulation Research, Department of Medicine, Division of EndocrinologyUniversity of British ColumbiaVancouverBCCanada
- School of Population and Public HealthFaculty of Medicine, University of British ColumbiaVancouverBCCanada
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Zhu B, Hu S, Guo J, Dong Z, Dong Y, Li F. Differences in the global exposure, mortality and disability of low bone mineral density between men and women: the underestimated burden in men. BMC Public Health 2023; 23:991. [PMID: 37248448 DOI: 10.1186/s12889-023-15947-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 05/21/2023] [Indexed: 05/31/2023] Open
Abstract
Talking about osteoporosis, we tend to focus on post-menopause women who are at increased risk due to estrogen depletion, while less attention has been paid to the disease in men. Currently, there is a lack of understanding about the difference of osteoporosis incidence and burden by sex. In this study, we used data from the Global Burden of Disease Study 2019 (GBD 2019) to compare the difference in the prevalence and burden of low bone mineral density (LBMD) between men and women, by location, year, age and socio-demographic index. We found the prevalence of LBMD was higher in women than in men. However, the age standardized mortality rate was greatly higher in men than in women. Using disability-adjusted life year (DALY) to measure the burden, we also observed higher age standardized DALY rate in men. Using sociodemographic index (SDI) as the measure of social development level, we found that higher mortality and DALY rates were mainly seen in middle and high SDI countries. Falls were the leading cause for of deaths and disabilities in both men and women with LBMD, followed by transport injuries. Fall-related mortality was higher in women, while transport injuries caused more deaths and disabilities in men. Conclusively, more attention should be paid to osteoporosis in men, and related policies, clinical practices, and guidelines are in need to reduce the burden of LBMD and osteoporosis in men.
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Affiliation(s)
- Binxiang Zhu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road, Qiaokou District, Wuhan, Hubei Province, China
| | - Shian Hu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road, Qiaokou District, Wuhan, Hubei Province, China
| | - Jianfeng Guo
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road, Qiaokou District, Wuhan, Hubei Province, China
| | - Zijian Dong
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road, Qiaokou District, Wuhan, Hubei Province, China
| | - Yimin Dong
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road, Qiaokou District, Wuhan, Hubei Province, China.
| | - Feng Li
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Road, Qiaokou District, Wuhan, Hubei Province, China.
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20
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Hassanabadi N, Berger C, Papaioannou A, Cheung AM, Rahme E, Leslie WD, Goltzman D, Morin SN. Variation in bone mineral density and fractures over 20 years among Canadians: a comparison of the Canadian Multicenter Osteoporosis Study and the Canadian Longitudinal Study on Aging. Osteoporos Int 2023; 34:357-367. [PMID: 36449036 PMCID: PMC9852141 DOI: 10.1007/s00198-022-06623-4] [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: 10/21/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022]
Abstract
UNLABELLED International variations in osteoporosis and fracture rates have been reported, with temporal trends differing between populations. We observed higher BMD and lower fracture prevalence in a recently recruited cohort compared to that of a cohort recruited 20 years ago, even after adjusting for multiple covariates. PURPOSE We explored sex-specific differences in femoral neck bone mineral density (FN-BMD) and in prevalent major osteoporotic fractures (MOF) using two Canadian cohorts recruited 20 years apart. METHODS We included men and women aged 50-85 years from the Canadian Multicentre Osteoporosis Study (CaMos, N = 6,479; 1995-1997) and the Canadian Longitudinal Study on Aging (CLSA, N = 19,534; 2012-2015). We created regression models to compare FN-BMD and fracture risk between cohorts, adjusting for important covariates. Among participants with prevalent MOF, we compared anti-osteoporosis medication use. RESULTS Mean (SD) age in CaMos (65.4 years [8.6]) was higher than in CLSA (63.8 years [9.1]). CaMos participants had lower mean body mass index and higher prevalence of smoking (p < 0.001). Adjusted linear regression models (estimates [95%CI]) demonstrated lower FN-BMD in CaMos women (- 0.017 g/cm2 [- 0.021; - 0.014]) and men (- 0.006 g/cm2 [- 0.011; 0.000]), while adjusted odds ratios (95%CI) for prevalent MOF were higher in CaMos women (1.99 [1.71; 2.30]) and men (2.33 [1.82; 3.00]) compared to CLSA. In women with prevalent MOF, menopausal hormone therapy use was similar in both cohorts (43.3% vs 37.9%, p = 0.076), but supplements (32.0% vs 48.3%, p < 0.001) and bisphosphonate use (5.8% vs 17.3%, p < 0.001) were lower in CaMos. The proportion of men with MOF who received bisphosphonates was below 10% in both cohorts. CONCLUSION Higher BMD and lower fracture prevalence were noted in the more recently recruited CLSA cohort compared to CaMos, even after adjusting for multiple covariates. We noted an increase in bisphosphonate use in the recent cohort, but it remained very low in men.
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Affiliation(s)
- Nazila 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
| | - Claudie 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
| | | | - Angela M Cheung
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Elham 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
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Canada
| | - David 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
| | - Suzanne 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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21
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Morin SN, Berger C, Papaioannou A, Cheung AM, Rahme E, Leslie WD, Goltzman D. Race/ethnic differences in the prevalence of osteoporosis, falls and fractures: a cross-sectional analysis of the Canadian Longitudinal Study on Aging. Osteoporos Int 2022; 33:2637-2648. [PMID: 36044061 DOI: 10.1007/s00198-022-06539-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/22/2022] [Indexed: 10/14/2022]
Abstract
UNLABELLED Most of the published epidemiology on osteoporosis is derived from White populations; still many countries have increasing ethno-culturally diverse populations, leading to gaps in the development of population-specific effective fracture prevention strategies. We describe differences in prevalent fracture and bone mineral density patterns in Canadians of different racial/ethnic backgrounds. INTRODUCTION We described prevalent fracture and bone mineral density (BMD) patterns in Canadians by their racial/ethnic backgrounds. METHODS For this cross-sectional analysis, we used the Canadian Longitudinal Study on Aging baseline data (2011-2015) of 22,091 randomly selected participants of Black, East Asian, South or Southeast Asian (SSEA) and White race/ethnic backgrounds, aged 45-85 years with available information on the presence or absence of self-reported prevalent low trauma fractures and femoral neck BMD (FNBMD) measurement. Logistic and linear regression models examined associations of race/ethnic background with fracture and FNBMD, respectively. Covariates included sex, age, height, body mass index (BMI), grip strength and physical performance score. RESULTS We identified 11,166 women and 10,925 men. Self-reported race/ethnic backgrounds were: 139 Black, 205 East Asian, 269 SSEA and 21,478 White. White participants were older (mean 62.5 years) than the other groups (60.5 years) and had a higher BMI (28.0 kg/m2) than both Asian groups, but lower than the Black group. The population-weighted prevalence of falls was 10.0%, and that of low trauma fracture was 12.0% ranging from 3.3% (Black) to 12.3% (White), with Black and SSEA Canadians having lower adjusted odds ratios (aOR) of low trauma fractures than White Canadians (Black, aOR = 0.3 [95% confidence interval: 0.1-0.7]; SSEA, aOR = 0.5 [0.3-0.8]). The mean (SD) FNBMD varied between groups: Black, 0.907 g/cm2 (0.154); East Asian, 0.748 g/cm2 (0.119); SSEA, 0.769 g/cm2 (0.134); and White, 0.773 g/cm2 (0.128). Adjusted linear regressions suggested that Black and both Asian groups had higher FNBMD compared to White. CONCLUSION Our results support the importance of characterizing bone health predictors in Canadians of different race/ethnic backgrounds to tailor the development of population-specific fracture prevention strategies.
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Affiliation(s)
- Suzanne N Morin
- McGill University, Montreal, Quebec, 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.
| | - Claudie 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
| | | | | | - Elham Rahme
- McGill University, Montreal, Quebec, 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
| | | | - David Goltzman
- McGill University, Montreal, Quebec, 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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22
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Lopes MP, Robinson L, Stubbs B, Dos Santos Alvarenga M, Araújo Martini L, Campbell IC, Schmidt U. Associations between bone mineral density, body composition and amenorrhoea in females with eating disorders: a systematic review and meta-analysis. J Eat Disord 2022; 10:173. [PMID: 36401318 PMCID: PMC9675098 DOI: 10.1186/s40337-022-00694-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 10/23/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Lower bone mineral density (BMD) increases the risk of osteoporosis in individuals with eating disorders (EDs), particularly women with anorexia nervosa (AN), making them susceptible to pain and fractures throughout adulthood. In AN, low weight, hypothalamic amenorrhoea, and longer illness duration are established risk factors for low BMD, and in people with other EDs a history of AN seems to be an important risk factor for low BMD. PURPOSE To conduct a systematic review and meta-analysis of BMD in individuals with EDs, including AN, bulimia nervosa (BN), binge-eating disorder (BED) and other specified feeding or eating disorders (OSFED) compared to healthy controls (HC). METHODS Following PRISMA guidelines, electronic databases were reviewed and supplemented with a literature search until 2/2022 of publications measuring BMD (dual-energy X-ray absorptiometry or dual photon absorptiometry) in females with any current ED diagnosis and a HC group. Primary outcomes were spine, hip, femur and total body BMD. Explanatory variables were fat mass, lean mass and ED clinical characteristics (age, illness duration, body mass index (BMI), amenorrhoea occurrence and duration, and oral contraceptives use). RESULTS Forty-three studies were identified (N = 4163 women, mean age 23.4 years, min: 14.0, max: 37.4). No study with individuals with BED met the inclusion criteria. BMD in individuals with AN (total body, spine, hip, and femur), with BN (total body and spine) and with OSFED (spine) was lower than in HC. Meta-regression analyses of women with any ED (AN, BN or OSFED) (N = 2058) showed low BMI, low fat mass, low lean mass and being amenorrhoeic significantly associated with lower total body and spine BMD. In AN, only low fat mass was significantly associated with low total body BMD. CONCLUSION Predictors of low BMD were low BMI, low fat mass, low lean mass and amenorrhoea, but not age or illness duration. In people with EDs, body composition measurement and menstrual status, in addition to BMI, are likely to provide a more accurate assessment of individual risk to low BMD and osteoporosis.
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Affiliation(s)
- Mariana P Lopes
- Nutrition Department, School of Public Health University of São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, São Paulo, 01246-904, Brazil. .,Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK.
| | - Lauren Robinson
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK
| | - Brendon Stubbs
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK.,Maudsley Hospital, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
| | - Marle Dos Santos Alvarenga
- Nutrition Department, School of Public Health University of São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, São Paulo, 01246-904, Brazil
| | - Ligia Araújo Martini
- Nutrition Department, School of Public Health University of São Paulo, Av. Dr. Arnaldo, 715 - Cerqueira César, São Paulo, São Paulo, 01246-904, Brazil
| | - Iain C Campbell
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 6 De Crespigny Park, London, SE5 8AF, UK.,Maudsley Hospital, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
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23
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Kim MJ, Jillian H, Rachael T, Debra W, Sean H, Sandhya R, Richie P. Is repeated childhood fracture related to areal bone density or body composition in middle age? Osteoporos Int 2022; 33:2369-2379. [PMID: 35918403 PMCID: PMC9568436 DOI: 10.1007/s00198-022-06500-0] [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: 02/09/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022]
Abstract
Childhood fracture is common, but whether it predicts adult fracture is not clear. Repeat childhood fracture was associated with adult (≤ 45 years) fracture, and in women, lower areal bone density was associated with repeat childhood fracture. Identifying fracture-prone children can modify adult fracture risk management. INTRODUCTION A quarter of boys and 15% of girls will suffer multiple fractures, but it is not clear whether multiple fractures during growth predict fracture risk and areal bone density in adulthood. This study evaluated whether children who repeatedly fracture were at increased risk of low areal bone density, abnormal body composition, and fractures by age 45. METHODS A subsample of a large birth cohort study with childhood fracture cases had areal bone density assessed at age 45 years. Participants were questioned regularly across their lifetime about fractures during childhood (ages 0-18 years of age) and adulthood (any fracture between 18 and 45 years). The number of fractures was collapsed into three categories: no fractures; 1 fracture; and > 1 fracture, separately for child and adult groups. RESULTS At age 45 years, areal bone mineral density (g/cm2) and body composition were measured with dual X-ray absorptiometry in n = 555 participants. Compared to no fractures, twice as many girls (14% vs 7%, P = 0.156) and boys (31.4% vs 14.1%, P = 0.004) who repeatedly fractured in childhood sustained multiple fractures as adults. Both girls and boys who were fracture-free tended to remain fracture-free as adults (79.8% compared with 62.8%, P = 0.045, and 64.8% compared with 51.4%, P = 0.025, in males and females, respectively). Participants were more than twice as likely to fracture repeatedly as adults if they had sustained multiple fractures as a child (OR 2.5 95% CI: 1.4, 4.6). Women who repeatedly fractured during childhood had lower areal bone density, whereas repeated fracturing during childhood was not associated with areal bone density or body composition in men, even after adjustment for other factors known to influence fracture history. CONCLUSION Childhood fracture history is associated with persistent skeletal fragility in adulthood (≤ 45 years), even after adjustment for behavioral and demographic factors known to influence fracture history.
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Affiliation(s)
- Meredith-Jones Kim
- Department of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand.
| | - Haszard Jillian
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - Taylor Rachael
- Department of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Waters Debra
- Department of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Hogan Sean
- Department of Psychology, The Dunedin Multidisciplinary Health and Development Research Unit, Dunedin, New Zealand
| | - Ramrakha Sandhya
- Department of Psychology, The Dunedin Multidisciplinary Health and Development Research Unit, Dunedin, New Zealand
| | - Poulton Richie
- Department of Psychology, The Dunedin Multidisciplinary Health and Development Research Unit, Dunedin, New Zealand
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Chin KY, Ng BN, Rostam MKI, Muhammad Fadzil NFD, Raman V, Mohamed Yunus F, Syed Hashim SA, Ekeuku SO. A Mini Review on Osteoporosis: From Biology to Pharmacological Management of Bone Loss. J Clin Med 2022; 11:6434. [PMID: 36362662 PMCID: PMC9657533 DOI: 10.3390/jcm11216434] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 07/25/2023] Open
Abstract
Osteoporosis refers to excessive bone loss as reflected by the deterioration of bone mass and microarchitecture, which compromises bone strength. It is a complex multifactorial endocrine disease. Its pathogenesis relies on the presence of several endogenous and exogenous risk factors, which skew the physiological bone remodelling to a more catabolic process that results in net bone loss. This review aims to provide an overview of osteoporosis from its biology, epidemiology and clinical aspects (detection and pharmacological management). The review will serve as an updated reference for readers to understand the basics of osteoporosis and take action to prevent and manage this disease.
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DiFrancisco-Donoghue J, Southard V, Margulies M, Jung MK, Allera A, Riley B. Assessment of gastrointestinal function and its' effect on bone mineral density and body composition in hypermobility spectrum disorder and hypermobile Ehlers-Danlos syndrome. J Clin Densitom 2022; 25:536-543. [PMID: 35945116 DOI: 10.1016/j.jocd.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypermobile Ehlers-Danlos Syndrome (hEDS) and Hypermobility Spectrum Disorders (HSD) are associated with hypermobility, musculoskeletal pain, a decreased bone mineral density (BMD) and gastrointestinal (GI) complications. The role of GI symptoms and diet in BMD has not been established in this population. The GI complications can lead to an energy deficit due to lack of essential macronutrients. The primary objective of this study was to determine the severity of GI symptoms compared to body composition and BMD in individuals with hEDS/HSD. The secondary objective is to examine GI symptoms on energy balance, body composition and strength. METHODOLOGY This study was IRB approved. Eighteen female participants (aged 28.2 ± 4.9; BMI 22.5 ± 4.9) with a diagnosis of hEDS or HSD and 18 female healthy control participants (aged 28.1 ± 3.8; BMI 22.8 ±3.9) signed consent to participate. Participants were matched by sex, age, and BMI. The Gastrointestinal Symptom Rating Scale (GSRS) was used to investigate severity of GI symptoms. Dual X-ray absorptiometry was used to determine body composition (body fat%, lean body mass (LBM). BMD was measured by Z- scores of both femurs and lumbar spine. Resting metabolic rate (RMR) was measured using indirect calorimetry and strength was determined using a hand grip dynamometer. RESULTS All hEDS/HSD participants reported GI symptoms. There was no difference in body composition between hEDS/HSD and controls. Participants with hEDS/HSD had lower BMD both femoral z scores (p=0.02,0.004) and spine z scores (p= 0.04). There was no difference in caloric intake between groups; yet both groups demonstrated caloric deficits. Additionally, hEDS/HSD consumed less protein and more carbohydrates (p=0.03, p=0.03). There were no differences in grip strength. CONCLUSIONS This study identified that pre-menopausal women with hEDS/HSD presented with significant GI complications and lower BMD than age matched controls. The GI complications and the reduced protein intake long-term may have a lasting impact on bone health. This study found that the GSRS identified and quantified GI symptoms in persons with hEDS/HSD. Future studies are needed for the longitudinal effects of a caloric/protein deficit in this population and to help guide future preventive and nutritional treatment approaches in individuals with hEDS/HSD.
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Affiliation(s)
- Joanne DiFrancisco-Donoghue
- New York Institute of Technology College of Osteopathic Medicine (NYIT-COM), Department of Osteopathic Medicine, Old Westbury, NY, USA.
| | | | | | | | - Arline Allera
- NYIT-COM, Department of Research, Old Westbury, NY, USA
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Bone mass in Saudi women aged 20-40 years: the association with obesity and vitamin D deficiency. Arch Osteoporos 2022; 17:123. [PMID: 36107272 DOI: 10.1007/s11657-022-01164-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 05/23/2022] [Indexed: 02/03/2023]
Abstract
This study describes that low bone density is prevalent in premenopausal Saudi women, especially women of normal weight and vitamin D deficiency. Although BMD is higher in obese young women, this may not be beneficial later in life in conjunction with persistent vitamin D deficiency. INTRODUCTION Not attaining peak bone mass is one crucial factor contributing to the risk of developing osteoporosis and suffering fractures in later life. The objectives of this study were to describe the normal range of bone mineral density (BMD) and bone mineral content (BMC) in premenopausal Saudi women in relation to obesity and vitamin D insufficiency. METHODS A cross-sectional study involving 312 healthy Saudi women aged 20-40. All women were clinically examined. BMD (g/cm2) and BMC (g) assessed at total body (TB), femoral neck (FN) and lumbar spine (LS) were performed using dual-energy X-ray absorptiometry (DXA). Obesity was defined as BMI ≥ 30 kg/m2 and vitamin D deficiency defined as 25(OH)D < 50 nmol/L. RESULTS Almost half of the studied women were obese, and the majority (86.2%) were deficient in vitamin D. Mean BMD in TB 1.060 ± 0.091, FN 0.918 ± 0.153 and LS 1.118 ± 0.123 g/cm2, while TB-BMC 2077 ± 272 g. When classified by BMI, the proportion with low bone density was 2-3 times higher among the normal weight compared to the obese women, p < 0.001. In the cohort overall, ~ 19% of these young premenopausal women had osteopenia or osteoporosis at the femoral neck, but 26% in normal weight, vitamin D deficient women. CONCLUSION This study shows low bone density in premenopausal Saudi women, particularly those with normal weight. While obesity appears to confer some protection against vitamin D deficiency at this age, this is assumed to change in later life.
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Skeletal Characteristics of Children and Adolescents with Turner Syndrome. ENDOCRINES 2022. [DOI: 10.3390/endocrines3030038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Turner syndrome (TS) is a chromosomal disorder characterized by a short stature and gonadal dysgenesis, the latter of which requires estrogen replacement therapy (ERT) to induce and maintain secondary sexual characteristics. Insufficient ERT is associated with compromised skeletal health, including bone fragility, in adults with TS. In particular, estrogen insufficiency during adolescence is critical because the acquisition of a defective bone mass during this period results in impaired bone strength later in the life. In addition to bone mass, bone geometry is also a crucial factor influencing bone strength; therefore, a more detailed understanding of the skeletal characteristics of both bone mass and geometry during childhood and adolescence and their relationships with the estrogen status is needed to prevent compromised skeletal health during adulthood in TS. Although a delay in the initiation of ERT is associated with a lower bone mineral density during adulthood, limited information is currently available on the effects of ERT during adolescence on bone geometry. Herein, we summarize the current knowledge on skeletal characteristics in children and adolescents with TS and their relationships with estrogen sufficiency, and discuss the potential limitations of the current protocol for ERT during adolescence in order to achieve better skeletal health in adulthood.
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Lau GJ, Ibrahim M, O'Brien S, Loiselle CG. Fragilité osseuse due au traitement du cancer du sein : rôle essentiel des infirmières dans l’élaboration, la mise en œuvre et l’évaluation d’un programme pour la santé des os. Can Oncol Nurs J 2022; 32:408-415. [PMID: 38919672 PMCID: PMC11195581 DOI: 10.5737/23688076323408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Le traitement du cancer du sein modifie les taux d’œstrogène et entraîne une importante perte osseuse, de l’ostéoporose et des risques de fracture. Bien qu’il existe des lignes directrices sur les soins des os soient, les personnes à risque ne bénéficient pas systématiquement des interventions en ce sens. Le présent article fait état du processus de conception et de mise en œuvre d’un Programme Santé seins et os (PSSO) bilingue et dirigé par des infirmières, offert en personne et en ligne dans un centre de cancérologie de Montréal, dans la province de Québec (https://santeseinsetos.ca/ ). Le PSSO propose des interventions personnalisées pour préserver la santé des os : évaluation des risques, information sur la réadaptation, prescription d’exercices, conseils nutritionnels et accompagnement pour l’adoption d’un mode de vie sain. Pendant 2 ans, des femmes traitées pour un cancer du sein (N = 430) ont pris part au programme. De ce nombre, 40 % (n = 97) ont dit au départ ignorer que certains traitements anticancéreux pouvaient fragiliser considérablement les os. À la suite de la première séance d’information avec l’infirmière responsable du PSSO, leurs connaissances autoévaluées à ce sujet se sont grandement améliorées, et 96 % ont dit en savoir suffisamment pour gérer leur santé osseuse. Le PSSO a été créé à l’intention des professionnels de la santé et des femmes atteintes de cancer du sein. Il offre une évaluation du risque en ligne et en personne ainsi que des activités et des outils visant à promouvoir la bonne santé des os. Le présent article décrit le contexte ayant mené à l’élaboration et à la mise en œuvre du PSSO, de même que l’évaluation préliminaire du programme.
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Affiliation(s)
- Garnet J Lau
- Programme de recherche clinique, Institut Lady Davis, Centre du cancer Segal, Hôpital général juif, CIUSSS du Centre-Ouest-de-l'Île-de-Montréal
| | | | | | - Carmen G Loiselle
- L'espoir, c'est la vie ; Centre du cancer Segal, Hôpital général juif, CIUSSS du Centre-Ouest-de-l'Île-de-Montréal ; Département d'oncologie, École de sciences infirmières Ingram, Université McGill
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Lau GJ, Ibrahim M, O'Brien S, Loiselle CG. Bone fragility related to breast cancer treatment: The pivotal role of nurses in bone health program development, implementation, and testing. Can Oncol Nurs J 2022; 32:401-407. [PMID: 38919669 PMCID: PMC11195586 DOI: 10.5737/23688076323401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Breast cancer treatment can affect estrogen levels leading to significant bone loss, osteoporosis, and risks for fracture. Although bone care guidelines are published, bone health interventions are often not routinely offered to at-risk individuals. This paper reports on the process of developing and implementing a nurse-led bilingual Breast and Bone Health Program (BBHP) in-person and online at a cancer centre in Montreal, Quebec (www.breastandbonehealth.ca, www.santeseinsetos.ca). The BBHP offers tailored bone health interventions (e.g., risk screening, information, rehabilitation, exercise prescriptions, nutritional counselling, and support for a health-promoting lifestyle). Over a two-year period, women treated for breast cancer (N = 430) took part in the program. Forty percent of surveyed participants (n = 97) initally reported being unaware that some breast cancer treatment could significantly affect bone health. Following the initial informational session with the BBHP nurse, self-reported bone health knowledge significantly increased, with 96% reporting sufficient information to manage their bone health. The BBHP offers both online and in-person risk assessment and bone health promotion activities and tools to both health care professionals and women with breast cancer. Herein, we review the background, BBHP development and implementation as well as preliminary program evaluation.
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Affiliation(s)
- Garnet J Lau
- Clinical Research Program, Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, CIUSSS du Centre-Ouest-de-l'Île-de-Montréal
| | | | | | - Carmen G Loiselle
- Hope & Cope; Segal Cancer Centre, Jewish General Hospital, CIUSSS du Centre-Ouest-de-l'Îlede-Montréal; Department of Oncology and Ingram School of Nursing, McGill University
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Abstract
Osteoporosis is a skeletal disorder with enhanced bone fragility, usually affecting the elderly. It is very rare in children and young adults and the definition is not only based on a low BMD (a Z-score < - 2.0 in growing children and a Z-score ≤ - 2.0 or a T-score ≤ - 2.5 in young adults) but also on the occurrence of fragility fractures and/or the existence of underlying chronic diseases or secondary factors such as use of glucocorticoids. In the absence of a known chronic disease, fragility fractures and low BMD should prompt extensive screening for secondary causes, which can be found in up to 90% of cases. When fragility fractures occur in childhood or young adulthood without an evident secondary cause, investigations should explore the possibility of an underlying monogenetic bone disease, where bone fragility is caused by a single variant in a gene that has a major role in the skeleton. Several monogenic forms relate to type I collagen, but other forms also exist. Loss-of-function variants in LRP5 and WNT1 may lead to early-onset osteoporosis. The X-chromosomal osteoporosis caused by PLS3 gene mutations affects especially males. Another recently discovered form relates to disturbed sphingolipid metabolism due to SGMS2 mutations, underscoring the complexity of molecular pathology in monogenic early-onset osteoporosis. Management of young patients consists of treatment of secondary factors, optimizing lifestyle factors including calcium and vitamin D and physical exercise. Treatment with bone-active medication should be discussed on a personalized basis, considering the severity of osteoporosis and underlying disease versus the absence of evidence on anti-fracture efficacy and potential harmful effects in pregnancy.
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Affiliation(s)
- Outi Mäkitie
- Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
- Folkhälsan Research Center, Biomedicum Helsinki, P.O. Box 63, FI-00014, Helsinki, Finland.
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, 3015, Rotterdam, The Netherlands
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Coll JC, Garceau É, Leslie WD, Genest M, Michou L, Weisnagel SJ, Mac-Way F, Albert C, Morin SN, Rabasa-Lhoret R, Gagnon C. Prevalence of Vertebral Fractures in Adults With Type 1 Diabetes: DenSiFy Study (Diabetes Spine Fractures). J Clin Endocrinol Metab 2022; 107:e1860-e1870. [PMID: 35090169 DOI: 10.1210/clinem/dgac031] [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: 09/03/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Vertebral fracture (VF) prevalence up to 24% has been reported among young people with type 1 diabetes (T1D). If this high prevalence is confirmed, individuals with T1D could benefit from preventative VF screening. OBJECTIVE We compared the prevalence of VFs between adults with T1D and nondiabetic controls. METHODS This cross-sectional study included 127 adults with T1D, and 65 controls with a similar age, sex, and BMI distribution, from outpatient clinics of 2 tertiary care centers. Vertebral fracture assessment (VFA) by dual-energy x-ray absorptiometry (DXA) was used for prevalent VFs. The modified algorithm-based qualitative (mABQ) method was applied. Bone mineral density (BMD) and trabecular bone score (TBS) were assessed by DXA. Serum bone turnover markers and sclerostin were measured in a subgroup of participants. RESULTS Participants with T1D (70 women, 57 men) had a mean age of 42.8 ± 14.8 years, median diabetes duration of 25.8 (15.8-34.4) years, mean BMI of 26.6 ± 5.4 kg/m2 and mean HbA1c over the past 3 years of 7.5 ± 0.9%. Controls (35 women, 30 men) had mean age of 42.2 ± 15.9 years and mean BMI of 26.1 ± 5.1 kg/m2. VF prevalence was comparable between groups (2.4% vs 3.1%, P = 0.99). TBS, BMD at the total hip and femoral neck, and bone formation and resorption markers were lower while sclerostin levels were similar in participants with T1D vs controls. CONCLUSION Our VFA results using the mABQ method do not confirm increased prevalence of VFs in men and women with relatively well-controlled T1D.
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Affiliation(s)
| | - Élodie Garceau
- Centre de recherche, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - William D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Mathieu Genest
- Centre de recherche, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - Laëtitia Michou
- Centre de recherche, CHU de Québec-Université Laval, Quebec City, QC, Canada
- Department of Medicine, Université Laval, Quebec City, QC, Canada
| | - S John Weisnagel
- Centre de recherche, CHU de Québec-Université Laval, Quebec City, QC, Canada
- Department of Medicine, Université Laval, Quebec City, QC, Canada
| | - Fabrice Mac-Way
- Centre de recherche, CHU de Québec-Université Laval, Quebec City, QC, Canada
- Department of Medicine, Université Laval, Quebec City, QC, Canada
| | - Caroline Albert
- Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Suzanne N Morin
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Claudia Gagnon
- Centre de recherche, CHU de Québec-Université Laval, Quebec City, QC, Canada
- Department of Medicine, Université Laval, Quebec City, QC, Canada
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Tang H, Di W, Qi H, Liu J, Yu J, Cai J, Lai B, Ding G, Cheng P. Age-Related Changes in Trabecular Bone Score and Bone Mineral Density in Chinese Men: A Cross-Sectional and Longitudinal Study. Clin Interv Aging 2022; 17:429-437. [PMID: 35418748 PMCID: PMC8999684 DOI: 10.2147/cia.s358951] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/30/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose This study was designed to explore age-related changes in trabecular bone score (TBS) and bone mineral density (BMD) in Chinese men through cross-sectional and longitudinal studies. Patients and Methods We included adult men who had at least twice TBS and BMD examinations in our hospital between January 2013 and December 2020. All men were divided into an age subgroup per 10 years, comparing differences in baseline lumbar spine (LS) TBS and BMD at various parts between each age group and analyzing age-related changes in TBS and BMD during follow-up. Results Baseline data showed that in men aged 36 to 85 years, BMD in the hip region showed a decreasing trend with age (P for trend < 0.01). However, TBS reached a high value around the age of 50, after which it decreased with age (P for trend = 0.03). During a mean follow-up of 3 years, the average annual change rate at TBS was −0.17% in men aged 36 to 85 years, with the fastest decrease rate −1.08% at 66 to 75 years (P < 0.05). The mean annual rate of change in LS BMD in different age subgroups increased with age (P for trend = 0.001). There was no significant decrease in mean annual change in BMD in hip regions. Conclusion In men aged 36~85 years, the trend of TBS was inconsistent with BMD. Men experience a high value of LS TBS around age 50, later than the commonly believed age of peak BMD, which may reflect developmental differences between bone microstructure and bone minerals. The TBS may be used as a better indicator of changes in bone strength than BMD in adult men at short-term follow-up. The rapid loss of TBS at age 66 to 75 may have implications for the prevention and medication of osteoporosis in men.
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Affiliation(s)
- Huan Tang
- Department of Gerontology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Wenjuan Di
- Department of Gerontology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Hanmei Qi
- Department of Gerontology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Juan Liu
- Department of Gerontology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Jing Yu
- Department of Gerontology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Jinmei Cai
- Department of Gerontology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Bing Lai
- Department of Gerontology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Guoxian Ding
- Department of Gerontology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Peng Cheng
- Department of Gerontology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
- Correspondence: Peng Cheng, Department of Gerontology, The First Affiliated Hospital of Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, People’s Republic of China, Tel +86-25-68305171, Fax +86-25-83724440, Email
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Lee YA, Kwon A, Kim JH, Nam HK, Yoo JH, Lim JS, Cho SY, Cho WK, Shim KS. Clinical practice guidelines for optimizing bone health in Korean children and adolescents. Ann Pediatr Endocrinol Metab 2022; 27:5-14. [PMID: 35368191 PMCID: PMC8984748 DOI: 10.6065/apem.2244060.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 02/10/2022] [Indexed: 11/25/2022] Open
Abstract
The Committee on Pediatric Bone Health of the Korean Society of Pediatric Endocrinology has newly developed evidence-based clinical practice guidelines for optimizing bone health in Korean children and adolescents. These guidelines present recommendations based on the Grading of Recommendations, which includes the quality of evidence. In the absence of sufficient evidence, conclusions were based on expert opinion. These guidelines include processes of bone acquisition, definition, and evaluation of low bone mineral density (BMD), causes of osteoporosis, methods for optimizing bone health, and pharmacological treatments for enhancing BMD in children and adolescents. While these guidelines provide current evidence-based recommendations, further research is required to strengthen these guidelines.
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Affiliation(s)
- Young Ah Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Ahreum Kwon
- Department of Pediatrics, Severance Children's Hospital, Endocrine Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyo-Kyoung Nam
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Jae-Ho Yoo
- Department of Pediatrics, Dong-A University Hospital, Busan, Korea
| | - Jung Sub Lim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Sung Yoon Cho
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Kyoung Cho
- Department of Pediatrics, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kye Shik Shim
- Department of Pediatrics, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
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Koy EHS, Amouzougan A, Biver E, Chapurlat R, Chevalley T, Ferrari SL, Fouilloux A, Locrelle H, Marotte H, Normand M, Rizzoli R, Vico L, Thomas T. Reference microarchitectural values measured by HR-pQCT in a Franco-Swiss cohort of young adult women. Osteoporos Int 2022; 33:703-709. [PMID: 34642812 DOI: 10.1007/s00198-021-06193-x] [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: 03/01/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
UNLABELLED Bone microarchitecture assessed by high-resolution peripheral quantitative computed tomography varies across populations of different origin. The study presents a reference dataset of microarchitectural parameters in a homogeneous group of participants aged within 22-27 range determined by a discriminant analysis of a larger cross-sectional cohort of 339 women. INTRODUCTION High-resolution peripheral quantitative computed tomography (HR-pQCT) non-invasively measures three-dimensional bone microarchitectural parameters and volumetric bone mineral density. Previous studies established normative reference HR-pQCT datasets for several populations, but there were few data assessed in a reference group of young women with Caucasian ethnicity living in Western Europe. It is important to obtain different specific reference dataset for a valid interpretation of cortical and trabecular microarchitecture data. The aim of our study was to find the population with the most optimal bone status in order to establish a descriptive reference HR-pQCT dataset in a young and healthy normal-weight female cohort living in a European area including Geneva, Switzerland, Lyon and Saint-Etienne, France. METHODS We constituted a cross-sectional cohort of 339 women aged 19-41 years with a BMI > 18 and < 30 kg/m2. All participants had HR-pQCT measurements at both non-dominant distal radius and tibia sites. RESULTS We observed that microarchitectural parameters begin to decline before the age of 30 years. Based on a discriminant analysis, the optimal bone profile in this population was observed between the age range of 22 to 27 years. Consequently, we considered 43 participants aged 22-27 years to establish a reference dataset with median values and percentiles. CONCLUSION This is the first study providing reference values of HR-pQCT measurements considering specific age bounds in a Franco-Swiss female cohort at the distal radius and tibia sites.
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Affiliation(s)
- E How Shing Koy
- Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
- INSERM U1059, Université de Lyon, Saint-Etienne, France
| | - A Amouzougan
- Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
- INSERM U1059, Université de Lyon, Saint-Etienne, France
| | - E Biver
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - R Chapurlat
- INSERM U1033, Hôpital Edouard Herriot, HCL, Lyon, France
| | - T Chevalley
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - S L Ferrari
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - A Fouilloux
- INSERM U1059, Université de Lyon, Saint-Etienne, France
| | - H Locrelle
- Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
- INSERM U1059, Université de Lyon, Saint-Etienne, France
| | - H Marotte
- Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
- INSERM U1059, Université de Lyon, Saint-Etienne, France
| | - M Normand
- INSERM U1059, Université de Lyon, Saint-Etienne, France
| | - R Rizzoli
- Service of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - L Vico
- INSERM U1059, Université de Lyon, Saint-Etienne, France
| | - T Thomas
- Department of Rheumatology, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France.
- INSERM U1059, Université de Lyon, Saint-Etienne, France.
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Tajaldeen A, Alghamdi SS, Aljondi R, Awan Z, Helmi N, Lingawi K, Mujalad A, Alzahrani W. Associations between body mass index, body composition and bone density in young adults: Findings from Saudi cohort. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zouhal H, Berro AJ, Kazwini S, Saeidi A, Jayavel A, Clark CCT, Hackney AC, VanDusseldorp TA, Ben Abderrahman A, El Hage R. Effects of Exercise Training on Bone Health Parameters in Individuals With Obesity: A Systematic Review and Meta-Analysis. Front Physiol 2022; 12:807110. [PMID: 35237177 PMCID: PMC8883041 DOI: 10.3389/fphys.2021.807110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/20/2021] [Indexed: 01/07/2023] Open
Abstract
Background Osteoporosis causes bone fragility, increasing the risk of fractures. Evidence suggests a strong correlation between obesity and fracture risk. Physical training is known to enhance bone resistance and protect from fracture; however, its osteogenic effect in the presence of obesity remains unknown. Objective We sought to evaluate the influence of exercise training on bone health indices in individuals with obesity. Methods This systematic literature search was conducted using common electronic databases from inception - December 2019. The following key terms (and synonyms searched for by the MeSH database) were included and combined using the operators “AND,” “OR,” “NOT”: [(“body mass index” OR obesity OR obese OR overweight OR fat mass) AND (“bone mineral density” OR “bone mineral content” OR “peak bone mass” OR “mechanical loading” OR “Osteoporosis” OR “bone geometry” OR “bone resistance”) AND (“exercise training” OR “physical training” OR “strength training,” OR “resistance training” OR “aerobic training” OR “combined training”)]. Results After screening, 10 studies (889 initial records) were included in the final analysis (8 different countries, 263 participants). Two studies investigated males, six females, and two, both sexes. The training duration was at least eight weeks with 2–3 sessions/week. Physical training displayed a significant trivial impact on the whole body (WB) BMD (0.13 SMD; 95% CI [0.00, 0.26], p = 0.046). Subgroup analyses indicated a significant small increase in the WB BMD (0.27 SMD; 95% CI [0.00, 0.53], p = 0.048) in the endurance training group, a non-significant trivial increase in the WB BMD (0.11 SMD; 95% CI [−0.06, 0.29], p = 0.203) in the resistance group, and a non-significant trivial increase in the WB BMD (0.03 SMD; 95% CI [−0.26, 0.32], p = 0.86) in the combined training group. In addition, a significant small decrease was found in the weight of trained subjects (−0.24 SMD; 95% CI [−0.42, −0.05], p = 0.011). Conclusion Physical training has little to no effect on the WB BMD in subjects with overweight/obesity. Currently, insufficient evidence to advocate for any specific type of exercise for enhancing bone health exists for overweight/obese individuals. Investigations examining the impact of varying types of physical exercise on WB BMD of obese individuals are needed.
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Affiliation(s)
- Hassane Zouhal
- University Rennes, M2S (Laboratoire Mouvement, Sport, Santé), Rennes, France
- Institut International des Sciences du Sport (2I2S), Irodouer, France
- *Correspondence: Hassane Zouhal
| | - Abdel Jalil Berro
- Division of Education, Faculty of Arts and Sciences, Department of Physical Education, University of Balamand, Tripoli, Lebanon
| | - Sarah Kazwini
- Division of Education, Faculty of Arts and Sciences, Department of Physical Education, University of Balamand, Tripoli, Lebanon
| | - Ayoub Saeidi
- Department of Physical Education and Sport Sciences, Faculty of Humanities and Social Sciences, University of Kurdistan, Sanandaj, Iran
| | - Ayyappan Jayavel
- SRM College of Physiotherapy, SRM Institute of Science and Technology, Chennai, India
| | - Cain C. T. Clark
- Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Anthony C. Hackney
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC, United States
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, United States
| | - Trisha A. VanDusseldorp
- Department of Exercise & Sport Management, Kennesaw State University, Kennesaw, GA, United States
- Trisha A. VanDusseldorp
| | | | - Rawad El Hage
- Division of Education, Faculty of Arts and Sciences, Department of Physical Education, University of Balamand, Tripoli, Lebanon
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Baxter-Jones ADG, Jackowski SA. Sex differences in bone mineral content and bone geometry accrual: a review of the Paediatric Bone Mineral Accural Study (1991-2017). Ann Hum Biol 2022; 48:503-516. [PMID: 35105203 DOI: 10.1080/03014460.2021.2014568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
CONTEXT Girls' and boys' growth patterns differ in timing and tempo, and they have different lifestyles with regards to diet and physical activity. These factors have all been linked with bone mineral accrual. OBJECTIVE To identify the associations of boys' and girls' growth, maturation, and lifestyle choices relating to parameters of bone geometry and mineral accrual. METHODS Between 1991 and 1993, 251 children aged 8-15 years were recruited into a mixed-longitudinal cohort study (The Paediatric Bone Mineral Accrual Study (PBMAS)) and followed repeatedly over 26 years. RESULTS It was found that girls matured approximately two years earlier than boys (11.8 vs. 13.4 years) but on average were shorter, had less lean mass and had greater fat mass (p < 0.05). There was a dissociation between the growth of bone and its mineralisation in both sexes. Boys had greater bone mass and bone geometry (p < 0.05). Both a healthy childhood diet and high levels of physical activity were associated with improved bone parameters. CONCLUSIONS Most, but not all, of the sex differences observed, were explained by height and lean mass differences. The importance of diet and physical activity on obtaining optimal bone mass during adolescence in both sexes was also paramount.
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Affiliation(s)
| | - Stefan A Jackowski
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada.,Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Canada
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Castillo EJ, Croft S, Jiron JM, Aguirre JI. Bone Structural, Biomechanical and Histomorphometric Characteristics of the Hindlimb Skeleton in the Marsh Rice Rat (Oryzomys palustris). Anat Rec (Hoboken) 2022; 305:3133-3149. [PMID: 35090092 PMCID: PMC10394686 DOI: 10.1002/ar.24876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/30/2021] [Accepted: 12/21/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The rice rat (Oryzomys palustris) is a non-conventional laboratory rodent species used to model some human bone disorders. However, no studies have been conducted to characterize the postcranial skeleton. Therefore, we aimed to investigate age- and gender-related features of the hindlimb skeleton of this species. METHODS We used femurs and tibiae from 94 rats of both genders aged 4-28 wks. Bone mineral content (BMC), volumetric bone mineral density (vBMD), and biomechanical properties were determined in femurs. In addition, bone histomorphometry of tibiae was conducted to assess bone cell activities and bone turnover over time. RESULTS Bone length, total metaphysis BMC and vBMD, mid-diaphyseal BMC and vBMD, cortical thickness, and cortical area progressively augmented with age. Whereas the increase in these parameters plateaued at age 16-22 wks in female rats, they continued to rise to age 28 wks in male rats. Furthermore, bone strength parameters increased with age, with few differences between genders. We also observed a rapid decrease in longitudinal growth between ages 4-16 wks. Whereas young rats had a greater bone formation rate and bone turnover, older rice rats had greater bone volume and trabecular thickness, with no differences between genders. CONCLUSIONS 1) Sexual dimorphism in the rice rat becomes grossly evident at age 16 wks; 2) the age-related increases in bone mass, structural cortical parameters, and in some biomechanical property parameters plateau at an older age in male than in female rats; and 3) bone growth and remodeling significantly decreased with age irrespective of the gender.
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Affiliation(s)
- E J Castillo
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL
| | - S Croft
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL
| | - J M Jiron
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL
| | - J I Aguirre
- Department of Physiological Sciences, University of Florida (UF), Gainesville, FL
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Slim M, Vanstone CA, Morin SN, Rahme E, Bacon SL, Weiler HA. Evaluation of Increasing Dairy Intake on Bone Density in Post-pubertal Youth: A Randomized Controlled Trial Using Motivational Interviewing. J Nutr 2022; 152:1031-1041. [PMID: 36967160 DOI: 10.1093/jn/nxab385] [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: 04/14/2021] [Revised: 06/22/2021] [Accepted: 11/04/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Adequate nutrition is important for bone health, especially for bone mineral accretion. OBJECTIVE The primary objective tested whether increasing dairy intake using the motivational interviewing technique (MInt) improves lumbar spine (LS) bone mineral density (BMD) after 2 years in post-pubertal adolescents with habitual dairy intake of < 2 dairy servings/day. DESIGN Participants (14-18.9 y) were randomized to: Group 1 (control), group 2 (target of 3 dairy servings/d), or group 3 (target of ≥ 4 dairy servings/d) for 12 months with groups 2 and 3 using MInt, with an additional 12-month non-intervention follow-up. The primay outcome was LS BMD, and secondary outcomes: whole body (WB), total hip (TH), and 33% distal radius BMD using dual-energy x-ray absorptiometry, bone geometry using peripheral quantitative computed tomography, and bone biomarkers. RESULTS Ninety-four adolescents (16.6 ± 1.5 y) were recruited. Seventy-six (80.9%) completed the 12-month assessments. From baseline to 12 months, dairy intake in female groups 2 and 3 increased by 107% and 208%, respectively; and by 48% and 153% in males of group 2 and 3, respectively. In females, group 3 had greater increases in THBMD (4.3 to 7.5%) compared to control (3.7 to 4.9%, P = 0.04) and group 2 (0.0 to 1.7%, P = 0.04) at 12 and 24 months. No effects due to dairy intake were observed for DXA outcomes in males or radial and tibial volumetric BMD in both sexes. None of the bone biomarkers were different among the dairy groups in females or males. CONCLUSION MInt effectively increased dairy intake with benefits to bone health only in female adolescents with previously low calcium intake who consumed 4 dairy serving or more/day for 12 months. Larger studies are required to explain the lack of intervention effect in males.This trial was registered at ClinicalTrials.gov as. NCT02236871.
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Affiliation(s)
- May Slim
- School of Human Nutrition, McGill University, Ste Anne de Bellevue, QC
| | | | - Suzanne N Morin
- Department of Medicine, Division of General Internal Medicine, McGill University, Montreal, QC
| | - Elham Rahme
- Department of Medicine, Division of Clinical Epidemiology, McGill University, Montreal, QC
| | - Simon L Bacon
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC.,Montreal Behavioural Medicine Centre, CIUSSS-NIM, Montreal, QC
| | - Hope A Weiler
- School of Human Nutrition, McGill University, Ste Anne de Bellevue, QC
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40
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Kim JH, Park HS, Pae M, Park KH, Kwon O. Evidence and suggestions for establishing vitamin D intake standards in Koreans for the prevention of chronic diseases. Nutr Res Pract 2022; 16:S57-S69. [PMID: 35651832 PMCID: PMC9127520 DOI: 10.4162/nrp.2022.16.s1.s57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/25/2022] [Accepted: 03/23/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/OBJECTIVES Vitamin D is produced in the skin during sun exposure and is also ingested from foods. The role of vitamin D needs to be considered in the prevention and management of various diseases. Moreover, since the majority of Koreans spend their days indoors, becoming susceptible to the risk of vitamin D deficiency. The current study aims to prepare a basis for determining dietary reference intake of vitamin D in Korea, by reviewing the evidence against various diseases and risks. MATERIALS/METHODS Literature published in Korea and other countries between 2014 and 2018 was prioritized based on their study design and other criteria, and evaluated using the RoB 2.0 assessment form and United States Department of Agriculture Nutrition Evidence Library Conclusion Statement Evaluation Criteria. RESULTS Of the 1,709 studies, 128 studies were included in the final systematic analysis after screening. To set the dietary reference intakes of vitamin D based on the selected articles, blood 25(OH)D levels and indicators of bone health were used collectively. Blood vitamin D levels and ultraviolet (UV) exposure time derived from the Korean National Health and Nutrition Examination Survey were analyzed to establish the dietary reference intakes of vitamin D for each stage of the life cycle. The adequate intake levels of vitamin D, according to age and gender, were determined to be in the range of 5–15 μg/day, and the tolerable upper intake level was established at 25–100 μg/day. CONCLUSIONS The most important variable for vitamin D nutrition is lifestyle. A balanced diet comprising foods with high contents of vitamin D is important, as is vitamin D synthesis after UV exposure. The adequate intake level of vitamin D mentioned in the 2015 Dietary Reference Intakes for Korean (KDRI) remained unchanged in the 2020 KDRI for the management of vitamin D nutrition in Koreans.
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Affiliation(s)
- Jung Hyun Kim
- Major of Food and Nutrition, PaiChai University, Daejeon 35345, Korea
| | - Hyoung Su Park
- R&D Unit, Maeil Health Nutrition Co., Ltd., Pyeongtaek 17714, Korea
| | - Munkyong Pae
- Department of Food and Nutrition, Chungbuk National University, Cheongju 28644, Korea
| | - Kyung Hee Park
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
| | - Oran Kwon
- Department of Nutritional Science and Food Management, Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul 03760, Korea
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Curley N, Yang Y, Dean J, Salorio C, Sadowsky C. Description of Bone Health Changes in a Cohort of Children With Acute Flaccid Myelitis (AFM). Top Spinal Cord Inj Rehabil 2022; 28:42-52. [PMID: 35145334 PMCID: PMC8791422 DOI: 10.46292/sci21-00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To qualitatively describe bone health changes in children with acute flaccid myelitis (AFM) and assess relationships with muscle mass and strength and functional performance. METHODS Retrospective analysis of a cohort of 79 children with AFM seen consecutively in one specialized academic center between January 1, 2007, and December 31, 2019. RESULTS Of the 79 participants who were aged 4 months to 21 years old, 41 (52%) had bone density measured by dual energy absorptiometry (DXA) and 32 of them (78%) were diagnosed with low bone mass (LBM). We recorded 25 fractures that occurred after onset of neurologic deficit in 14 of the children in the cohort (18%). Lean muscle mass correlated with bone mass and functional performance as assessed by Physical Abilities and Mobility Scale (PAMS) but not with muscle strength as assessed by manual muscle testing (MMT). Bone density in the lower limbs was associated with ambulatory status. CONCLUSION Children with AFM have a high likelihood of muscle and bone loss and frequently sustain pathologic fractures. Bone health in children with AFM should be carefully monitored, and efforts should be made to preserve bone mass and maximize muscle mass.
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Affiliation(s)
- Natalie Curley
- Arizona College of Osteopathic Medicine, Glendale, Arizona
| | - Yilin Yang
- Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Janet Dean
- International Center for Spinal Cord Injury at Kennedy Krieger Institute, Baltimore, Maryland
,Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Cynthia Salorio
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
,Rehabilitation Outcomes and Related Research at Kennedy Krieger Institute, Baltimore, Maryland
| | - Cristina Sadowsky
- International Center for Spinal Cord Injury at Kennedy Krieger Institute, Baltimore, Maryland
,Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
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Su X, Zhang H, Lei F, Wang R, Lin T, Liao L. Epigenetic therapy attenuates oxidative stress in BMSCs during ageing. J Cell Mol Med 2021; 26:375-384. [PMID: 34874118 PMCID: PMC8743666 DOI: 10.1111/jcmm.17089] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 11/09/2021] [Accepted: 11/15/2021] [Indexed: 02/05/2023] Open
Abstract
Oxidative stress, a hallmark of ageing, inhibits the osteogenic differentiation of bone marrow-derived mesenchymal stem cells in long bone. The dysfunction of the cellular antioxidant defence system is a critical cause of oxidative stress, but the mechanism of the decline of antioxidant defence in senescent stem cells remains elusive. Here, we found that EZH2, an epigenetic regulator of histone methylation, acted as a suppressor of the antioxidative defence system in BMSCs from the femur. The increased EZH2 led to a decrease in the levels of antioxidant enzymes and exaggerated oxidative damage in aged BMSCs, resulting in the defect of bone formation and regeneration. Mechanistically, EZH2 enhanced the modification of H3K27me3 on the promoter of Foxo1 and suppressed its function to activate the downstream genes in antioxidant defence. Moreover, epigenetic therapy targeting EZH2-mediated H3K27me3 modification largely recovered the antioxidant defence in BMSCs and attenuate oxidative damage, leading to the recovery of the osteogenesis in old BMSCs. Taken together, our findings revealed novel crosstalk between histone epigenetic modification and oxidative stress during stem cell ageing, suggesting a possibility of epigenetic therapy in the recovery of BMSCs senescence and treatment of age-related bone disease.
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Affiliation(s)
- Xiaoxia Su
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry & Engineering Research Center of Oral Translational Medicine & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Haoyu Zhang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry & Engineering Research Center of Oral Translational Medicine & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Fengzhen Lei
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Rui Wang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Tingting Lin
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, Department of Orthodontics, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Li Liao
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Pediatric Dentistry & Engineering Research Center of Oral Translational Medicine & National Engineering Laboratory for Oral Regenerative Medicine, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Bliuc D, Tran T, Adachi JD, Atkins GJ, Berger C, van den Bergh J, Cappai R, Eisman JA, van Geel T, Geusens P, Goltzman D, Hanley DA, Josse R, Kaiser S, Kovacs CS, Langsetmo L, Prior JC, Nguyen TV, Solomon LB, Stapledon C, Center JR. Cognitive decline is associated with an accelerated rate of bone loss and increased fracture risk in women: a prospective study from the Canadian Multicentre Osteoporosis Study. J Bone Miner Res 2021; 36:2106-2115. [PMID: 34289172 DOI: 10.1002/jbmr.4402] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 01/11/2023]
Abstract
Cognitive decline and osteoporosis often coexist and some evidence suggests a causal link. However, there are no data on the longitudinal relationship between cognitive decline, bone loss and fracture risk, independent of aging. This study aimed to determine the association between: (i) cognitive decline and bone loss; and (ii) clinically significant cognitive decline (≥3 points) on Mini Mental State Examination (MMSE) over the first 5 years and subsequent fracture risk over the following 10 years. A total of 1741 women and 620 men aged ≥65 years from the population-based Canadian Multicentre Osteoporosis Study were followed from 1997 to 2013. Association between cognitive decline and (i) bone loss was estimated using mixed-effects models; and (ii) fracture risk was estimated using adjusted Cox models. Over 95% of participants had normal cognition at baseline (MMSE ≥ 24). The annual % change in MMSE was similar for both genders (women -0.33, interquartile range [IQR] -0.70 to +0.00; and men -0.34, IQR: -0.99 to 0.01). After multivariable adjustment, cognitive decline was associated with bone loss in women (6.5%; 95% confidence interval [CI], 3.2% to 9.9% for each percent decline in MMSE from baseline) but not men. Approximately 13% of participants experienced significant cognitive decline by year 5. In women, fracture risk was increased significantly (multivariable hazard ratio [HR], 1.61; 95% CI, 1.11 to 2.34). There were too few men to analyze. There was a significant association between cognitive decline and both bone loss and fracture risk, independent of aging, in women. Further studies are needed to determine mechanisms that link these common conditions. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Dana Bliuc
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.,Clinical School, St Vincent's Hospital, Faculty of Medicine, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Thach Tran
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.,Clinical School, St Vincent's Hospital, Faculty of Medicine, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | | | - Gerald J Atkins
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, Australia
| | - Claudie Berger
- Canadian Multicentre Osteoporosis Study (CaMos) National Coordinating Centre, McGill University, Montreal, QC, Canada
| | - Joop van den Bergh
- Research School Nutrim, Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Internal Medicine, VieCuri Medical Centre of Noord-Limburg, Venlo, The Netherlands
| | - Roberto Cappai
- School of Biomedical Sciences, University of Melbourne, Melbourne, Australia
| | - John A Eisman
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.,Clinical School, St Vincent's Hospital, Faculty of Medicine, University of New South Wales (UNSW) Sydney, Sydney, Australia.,School of Medicine Sydney, University of Notre Dame Australia, Sydney, Australia
| | - Tineke van Geel
- Department of Data and Analytics, Máxima Medical Center, Veldhoven, The Netherlands
| | - Piet Geusens
- Biomedical Research Institute, University Hasselt, Hasselt, Belgium
| | - David Goltzman
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - David A Hanley
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Robert Josse
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Stephanie Kaiser
- Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Lisa Langsetmo
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jerilynn C Prior
- Department of Medicine and Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - Tuan V Nguyen
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.,Clinical School, St Vincent's Hospital, Faculty of Medicine, University of New South Wales (UNSW) Sydney, Sydney, Australia
| | - Lucian B Solomon
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, Australia.,Orthopaedic and Trauma Service, Royal Adelaide Hospital, Adelaide, Australia
| | - Catherine Stapledon
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, Australia
| | - Jacqueline R Center
- Osteoporosis and Bone Biology, Garvan Institute of Medical Research, Sydney, Australia.,Clinical School, St Vincent's Hospital, Faculty of Medicine, University of New South Wales (UNSW) Sydney, Sydney, Australia
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Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause 2021; 28:973-997. [PMID: 34448749 DOI: 10.1097/gme.0000000000001831] [Citation(s) in RCA: 156] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To review evidence regarding osteoporosis screening, prevention, diagnosis, and management in the past decade and update the position statement published by The North American Menopause Society (NAMS) in 2010 regarding the management of osteoporosis in postmenopausal women as new therapies and paradigms have become available. DESIGN NAMS enlisted a panel of clinician experts in the field of metabolic bone diseases and/or women's health to review and update the 2010 NAMS position statement and recommendations on the basis of new evidence and clinical judgement. The panel's recommendations were reviewed and approved by the NAMS Board of Trustees. RESULTS Osteoporosis, especially prevalent in older postmenopausal women, increases the risk of fractures that can be associated with significant morbidity and mortality. Postmenopausal bone loss, related to estrogen deficiency, is the primary contributor to osteoporosis. Other important risk factors for postmenopausal osteoporosis include advanced age, genetics, smoking, thinness, and many diseases and drugs that impair bone health. An evaluation of these risk factors to identify candidates for osteoporosis screening and recommending nonpharmacologic measures such as good nutrition (especially adequate intake of protein, calcium, and vitamin D), regular physical activity, and avoiding smoking and excessive alcohol consumption are appropriate for all postmenopausal women. For women at high risk for osteoporosis, especially perimenopausal women with low bone density and other risk factors, estrogen or other therapies are available to prevent bone loss. For women with osteoporosis and/or other risk factors for fracture, including advanced age and previous fractures, the primary goal of therapy is to prevent new fractures. This is accomplished by combining nonpharmacologic measures, drugs to increase bone density and to improve bone strength, and strategies to reduce fall risk. If pharmacologic therapy is indicated, government-approved options include estrogen agonists/antagonists, bisphosphonates, RANK ligand inhibitors, parathyroid hormone-receptor agonists, and inhibitors of sclerostin. CONCLUSIONS Osteoporosis is a common disorder in postmenopausal women. Management of skeletal health in postmenopausal women involves assessing risk factors for fracture, reducing modifiable risk factors through dietary and lifestyle changes, and the use of pharmacologic therapy for patients at significant risk of osteoporosis or fracture. For women with osteoporosis, lifelong management is necessary. Treatment decisions occur continuously over the lifespan of a postmenopausal woman. Decisions must be individualized and should include the patient in the process of shared decision-making.
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Impact of 1.0 mg/Day Dienogest Treatment on Bone Metabolism Markers in Young Women with Dysmenorrhea. ENDOCRINES 2021. [DOI: 10.3390/endocrines2030027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A low dose of dienogest (DNG) 1 mg/day is useful for treating dysmenorrhea in young women. However, the effect of DNG on bone turnover during bone growth and formation, rather than at maturity, is currently unknown even at low doses. We investigated change in bone turnover after 3 months of DNG 1 mg/day. This retrospective cohort study included young women aged 10–24 years with dysmenorrhea and irregular menstruation. Gonadotropins and the bone metabolism markers TRACP-5b and BAP were compared before and at 3 months after administration of DNG 1 mg/day. There were no significant changes in TRACP-5b (before, 455.6 ± 323.6 mU/dL; 3 months after, 462.1 ± 346.1 mU/dL), BAP (before, 24.7 ± 19.0 μg/L; 3 months after, 25.2 ± 22.3 μg/L), or the TRACP-5b/BAP ratio (before, 22.1 ± 7.0; 3 months after, 21.5 ± 6.3). Administration of DNG 1 mg/day had no significant effect on bone turnover after 3 months during the bone-growth phase in young women.
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Billington EO, Leslie WD, Brown JP, Prior JC, Morin SN, Kovacs CS, Kaiser SM, Lentle BC, Anastassiades T, Towheed T, Kline GA. Simulated effects of early menopausal bone mineral density preservation on long-term fracture risk: a feasibility study. Osteoporos Int 2021; 32:1313-1320. [PMID: 33438038 DOI: 10.1007/s00198-021-05826-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022]
Abstract
UNLABELLED Prevention of early menopausal bone loss may reduce the future burden of osteoporosis. In this modelling exercise, an osteoporosis prevention strategy involving 5-year infusions of zoledronic acid, beginning early in menopause, reduced long-term fracture risk and the proportion of aging women with femoral neck densitometric osteoporosis. This strategy warrants further evaluation. INTRODUCTION Preventing early menopausal bone loss may substantially reduce the future burden of osteoporosis. We modelled the effects of infrequent zoledronic acid infusions on long-term fracture risk. METHODS Data from the Canadian Multicentre Osteoporosis Study (CaMos) were used to determine the expected natural history of femoral neck areal bone mineral density (BMD) and fracture risk (using FRAX®) from ages 50-80 for women with no antiresorptive drug exposures. We modelled the effects of three infusions of zoledronic acid (at ages 50, 55, 60) on long-term fracture risk, assuming this intervention would preserve BMD until age 65 years, followed by losses mirroring early menopausal BMD loss. RESULTS At age 65, untreated women and zoledronic acid recipients had expected mean (SD) femoral neck T-scores of - 1.5(1.0) and - 0.8(1.0), 10-year major osteoporotic fracture (MOF) risks of 9.8%(5.0) and 8.0%(3.7) and hip fracture risks of 1.7%(2.4) and 0.8%(1.2), respectively. At age 80, untreated women and zoledronic acid recipients had expected femoral neck T-scores of - 1.9(0.9) and - 1.4(0.9), MOF risks of 17.9%(8.2) and 14.9%(6.4) and hip fracture risks of 6.3%(6.2) and 4.4%(4.5), respectively. The expected proportion of women with femoral neck T-score ≤ - 2.5 was 14.9% for untreated women and 3.8% for zoledronic acid recipients at age 65, increasing to 28.1% and 12.0%, respectively, at age 80. Numbers-needed-to-treat to prevent one case of densitometric osteoporosis were 9 at age 65 and 5 at age 80. CONCLUSION Infrequent infusions of zoledronic acid, initiated early in menopause, are expected to reduce long-term fracture risk and result in a substantial reduction in the proportion of women with densitometric osteoporosis after age 65.
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Affiliation(s)
- E O Billington
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
- Dr. David Hanley Osteoporosis Centre, Richmond Road Diagnostic & Treatment Centre, 1820 Richmond Road SW, Calgary, Alberta, T2T 5C7, Canada.
| | - W D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - J P Brown
- Department of Medicine, Université Laval, Québec, Québec, Canada
| | - J C Prior
- Faculty of Medicine, Endocrinology/Medicine and Centre for Menstrual Cycle and Ovulation Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - S N Morin
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - C S Kovacs
- Faculty of Medicine - Endocrinology, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - S M Kaiser
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - B C Lentle
- Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - T Anastassiades
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - T Towheed
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - G A Kline
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Dr. David Hanley Osteoporosis Centre, Richmond Road Diagnostic & Treatment Centre, 1820 Richmond Road SW, Calgary, Alberta, T2T 5C7, Canada
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Nishigaki S, Itonaga T, Hasegawa Y, Kawai M. Starting age of oestrogen-progestin therapy is negatively associated with bone mineral density in young adults with Turner syndrome independent of age and body mass index. Clin Endocrinol (Oxf) 2021; 95:84-91. [PMID: 33872421 DOI: 10.1111/cen.14484] [Citation(s) in RCA: 12] [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] [Received: 01/15/2021] [Revised: 03/24/2021] [Accepted: 04/09/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoporosis is an important health issue in patients with Turner syndrome (TS), and oestrogen sufficiency has been implicated in increased bone mineral density (BMD); however, the impact of the starting age of hormone replacement therapy (HRT) on bone mineral density remains unclear, particularly during young adulthood. DESIGN A retrospective study from three tertiary care hospitals in Japan. PATIENTS One hundred and three patients with TS aged between 18 and 30 years of age who underwent dual-energy X-ray absorptiometry. MEASUREMENTS Anthropometric parameters, lumbar bone mineral density (L-BMD), including areal BMD (aBMD) and volumetric BMD (vBMD), karyotypes, the presence of spontaneous menarche, the starting ages of oestrogen replacement therapy (ERT) and oestrogen-progestin therapy (EPT), and the duration between starting ages of oestrogen replacement therapy and oestrogen-progestin therapy were investigated. vBMD was calculated based on the Kröger method. RESULTS aBMD was lower in young adults with TS than in an age-matched reference population. L-BMD positively correlated with weight and body mass index (BMI). L-BMD was higher in subjects with spontaneous menarche (N = 22) than in those without. A dose escalation regimen of oestrogen replacement therapy was used in 84% of subjects without spontaneous menarche (N = 81). The starting age of oestrogen replacement therapy and the duration between the starting ages of oestrogen replacement therapy and oestrogen-progestin therapy negatively and independently correlated with aBMD, but not with vBMD, after adjustment with age and BMI. The starting age of oestrogen-progestin therapy negatively correlated with L-BMD independent of age and BMI. CONCLUSIONS Early introduction of hormone replacement therapy, particularly oestrogen-progestin therapy, is important to accrue better L-BMD in young adults with TS.
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Affiliation(s)
- Satsuki Nishigaki
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tomoyo Itonaga
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Fuchu, Japan
| | - Yukihiro Hasegawa
- Division of Endocrinology and Metabolism, Tokyo Metropolitan Children's Medical Center, Fuchu, Japan
| | - Masanobu Kawai
- Department of Gastroenterology, Nutrition, and Endocrinology, Osaka Women's and Children's Hospital, Izumi, Japan
- Department of Bone and Mineral Research, Research Institute, Osaka Women's and Children's Hospital, Izumi, Japan
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Xue S, Zhang Y, Qiao W, Zhao Q, Guo D, Li B, Shen X, Feng L, Huang F, Wang N, Oumer KS, Getachew CT, Yang S. An Updated Reference for Calculating Bone Mineral Density T-Scores. J Clin Endocrinol Metab 2021; 106:e2613-e2621. [PMID: 33735391 DOI: 10.1210/clinem/dgab180] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Indexed: 12/27/2022]
Abstract
CONTEXT Bone mineral density (BMD) T-score references may be updated when the peak BMD of the population is unclear and warrants reevaluation. OBJECTIVE To update BMD T-score references using the peak BMD from the most recent National Health and Nutrition Examination Survey (NHANES) data. METHODS This cross-sectional study used NHANES data from 2005 to 2014. Non-Hispanic White females between the ages of 10 and 40 years (N = 1549) were our target population to estimate peak BMD (SD). Individuals aged ≥ 50 years (N = 5523) were used to compare the percentages of osteoporosis and low bone mass based on existing and updated BMD T-score references. BMD data within the age at attainment of peak BMD ± 5 years were used to calculate updated BMD T-score references. RESULTS The updated average of BMD (SD) for diagnosing osteoporosis at the femoral neck and lumbar spine were 0.888 g/cm2 (0.121 g/cm2) and 1.065 g/cm2 (0.122 g/cm2), respectively. The percentages of individuals with osteoporosis at the femoral neck and low bone mass at the femoral neck and lumbar spine based on the updated BMD T-score references were higher than the percentages of people designated with these outcomes under the existing guidelines (P < 0.001). However, we observed the opposite pattern for lumbar spine osteoporosis (P < 0.001). CONCLUSIONS We calculated new BMD T-score references at the femoral neck and lumbar spine. We found significant differences in the percentages of individuals classified as having osteoporosis and low bone mass between the updated and existing BMD T-score references.
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Affiliation(s)
- Shanshan Xue
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yuzheng Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
- Division of Clinical Research, First Hospital of Jilin University, Changchun, China
| | - Wenjing Qiao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Qianqian Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Dingjie Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Binbin Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Xue Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Lijie Feng
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Fengyi Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Na Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Kemal Sherefa Oumer
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Charkos Tesfaye Getachew
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Shuman Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
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Kurabayashi T, Nagai K, Morikawa K, Kamimura N, Yanase T, Hayashi K. Prevalence of osteoporosis and osteopenia assessed by densitometry in Japanese puerperal women. J Obstet Gynaecol Res 2021; 47:1388-1396. [PMID: 33559219 DOI: 10.1111/jog.14694] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/23/2021] [Indexed: 01/13/2023]
Abstract
AIM The aim is to examine the prevalence of low bone mineral density (BMD) (osteoporosis and osteopenia) of lumbar and femoral bones in puerperal women for the prenatal and postnatal care to ensure their optimal bone health. METHODS We analyzed the first scan data of 1079 Japanese puerperal women without bone fracture (mean age 33.5 ± 4.5 years) who had undergone deliveries at Niigata City General Hospital for 10 years. We measured BMDs of the lumbar spine [LS], femoral neck [FN], and total hip [TH] with dual-energy X-ray absorptiometry (DXA) within 30 days after delivery. RESULTS The rates of osteoporosis of LS, FN, TH, and comprehensive diagnosis (CD) were 0.6%, 4.8%, 1.5%, and 5.4%, respectively, and osteopenia were 20.2%, 39.5%, 29.3%, and 44.3%, respectively. The multivariable-adjusted odds ratio (OR) for body mass index (BMI) before pregnancy reflected significant decreases in risk for low BMD with an OR of 0.78 (95% CI: 0.74-0.82) with the 1 kg/m2 increases. In lean women (BMI < 18.5), 71% of them had low BMD. CONCLUSIONS Approximately 50% of puerperal women had low BMD without bone fracture. BMD measurements at puerperium, especially for lean women, may be very useful for identifying at risk of osteoporosis in future.
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Affiliation(s)
- Takumi Kurabayashi
- Department of Obstetrics & Gynecology, Niigata City General Hospital, Niigata, Japan
| | - Kazue Nagai
- Unit of Community Health Sciences, School of Health Sciences, Gunma University, Gunma, Japan
| | - Kyoko Morikawa
- Department of Obstetrics & Gynecology, Niigata City General Hospital, Niigata, Japan
| | - Naomi Kamimura
- Department of Obstetrics & Gynecology, Niigata City General Hospital, Niigata, Japan
| | - Toru Yanase
- Department of Obstetrics & Gynecology, Niigata City General Hospital, Niigata, Japan
| | - Kunihiko Hayashi
- Unit of Community Health Sciences, School of Health Sciences, Gunma University, Gunma, Japan
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Abstract
Bone mass is a key determinant of osteoporosis and fragility fractures. Epidemiologic studies have shown that a 10% increase in peak bone mass (PBM) at the population level reduces the risk of fracture later in life by 50%. Low PBM is possibly due to the bone loss caused by various conditions or processes that occur during adolescence and young adulthood. Race, gender, and family history (genetics) are responsible for the majority of PBM, but other factors, such as physical activity, calcium and vitamin D intake, weight, smoking and alcohol consumption, socioeconomic status, age at menarche, and other secondary causes (diseases and medications), play important roles in PBM gain during childhood and adolescence. Hence, the optimization of lifestyle factors that affect PBM and bone strength is an important strategy to maximize PBM among adolescents and young people, and thus to reduce the low bone mass or osteoporosis risk in later life. This review aims to summarize the available evidence for the common but important factors that influence bone mass gain during growth and development and discuss the advances of developing high PBM.
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Affiliation(s)
- Xiaowei Zhu
- Disease & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, Hangzhou, 310024, China
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Westlake University, Hangzhou, 310024, China
- School of Life Sciences, Fudan University, Shanghai, 200433, China
| | - Houfeng Zheng
- Disease & Population (DaP) Geninfo Lab, School of Life Sciences, Westlake University, Hangzhou, 310024, China.
- Institute of Basic Medical Sciences, Westlake Institute for Advanced Study, Westlake University, Hangzhou, 310024, China.
- School of Life Sciences, Fudan University, Shanghai, 200433, China.
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