Relation of height and weight to the regional variations in bone mass among Japanese-American men and women

Cross-Sectional and Longitudinal Associations between Forearm Bone Mineral Density and Anthropometry in Adult Japanese Men and Women

BACKGROUND

No consensus exists regarding which anthropometric measurements are related to bone mineral density (BMD), and this relationship may vary according to sex and age. A large Japanese cohort was analyzed to provide an understanding of the relationship between BMD and anthropometry while adjusting for known confounding factors.

METHODS

Our cohort included 10,827 participants who underwent multiple medical checkups including distal forearm BMD scans. Participants were stratified into four groups according to age (≥50 years or <50 years) and sex. The BMD values were adjusted for confounding factors, after which single and partial correlation analyses were performed. The prevalence of osteopenia was plotted for each weight index (weight or body mass index [BMI]) class.

RESULTS

Cross-sectional studies revealed that weight was more favorably correlated than BMI in the older group (R=0.278 and 0.212 in men and R=0.304 and 0.220 in women, respectively), whereas weight and BMI were weakly correlated in the younger age groups. The prevalence of osteopenia exhibited a negative linear relationship with weight among older women ≥50 years of age, and an accelerated increase was observed with decreasing weight in older men weighing <50 kg and younger women weighing <60 kg. When weight was replaced with BMI, the prevalence was low in most subgroups classified by weight.

CONCLUSIONS

Weight, rather than BMI, was the most important indicator of osteopenia but it might not be predictive of future bone loss.

Bone mineral density of proximal femur in adult Chinese females

OBJECTIVE

This study was designed to establish bone mineral density (BMD) reference data of proximal femur, research the effect of age, height and weight on BMD of proximal femur, and estimate the prevalence of osteoporosis in a Chinese female population. In addition we compared the results with Lebanese and USA white women reference data.

METHODS

Our study was conducted at one center, including 1578 Chinese women, aged 20-79years. We measured the BMD for proximal femur using dual-energy X-ray absorptiometry, and then established a reference database of proximal femur and set up regression equations of age, height and weight for BMD at proximal femur to research the effects of age, height and weight on BMD. After that, we calculated the standardized BMD and compared them with Lebanese and USA white women reference data.

RESULTS

The peak BMD occurred in the age range 30-39 years for femoral neck and Ward's triangle, and 40-49 years for trochanter in Chinese women, which were later than in Lebanese and USA white women. The BMD of proximal femur in Chinese women were lower than Lebanese and USA white women in most age ranges. Weight profoundly influenced BMD in all age groups, and age and height mainly effected BMD in older age groups. The standardized prevalence of osteoporosis among Chinese women of 50-79 years old was 9.6% in femoral neck, which was higher than Lebanese but lower than USA white women.

CONCLUSION

The BMD database of proximal femur in Chinese women we established is normative and different from Lebanese and USA white women reference data, which provides more reliable information on the prevalence of osteoporosis in China.

Quantitative analysis of local bone graft harvested from the posterior elements during posterior spinal fusion in Adolescent Idiopathic Scoliosis patients

Objective

This study analyses the quantity of local bone graft obtained from different anatomical parts of the posterior elements during corrective surgery for Adolescent Idiopathic Scoliosis patients.

Summary of background data

Locally harvested autogenous bone graft eliminates possible donor site morbidity and has all the important basic bone graft properties such as osteoinductivity, osteogenicity and osteoconductivity. Its usage was reported to be adequate to achieve fusion but none had quantifies the amount of local bone graft harvested.

Methods

Total of 40 AIS patients were recruited in the study. All posterior spinal fusion surgeries were performed by the same dual surgeons and same anesthetist with a single observer collecting and measuring bone grafts harvested. The bone grafts harvested from each respective posterior element (spinous processes, laminas, facets and transverses processes) and measured accordingly.

Results

There were 36 females and 4 males. Amongst cases recruited, there were 32% Lenke 1, 28% Lenke 2, 8%Lenke 3, 22%Lenke 5 and 10% Lenke 6. Total thoracic levels involved were 333, whereas lumbar levels were 81. The mean total weight of bone graft obtained per case was 36.5 ± 13.7 g. The total weight of lumbar bone graft to the number of lumbar fusion levels (4.5 ± 1.2 g/fusion level) was significantly higher than the total weight of thoracic bone graft to the number of thoracic fusion levels (3.2 ± 1.2 g/fusion level). The amount of bone graft was obtained was highest from lumbar spinous process (42%), followed by thoracic spinous process (32%), lumbar lamina (29%), lumbar facet (28%), thoracic lamina (25%), thoracic facet (22%), and thoracic transverse process (21%).

Conclusions

Lumbar vertebra provided more bone graft than thoracic vertebra. Spinous processes contributed the highest amount of local bone graft in the thoracic and lumbar spine.

Local bone graft harvesting and volumes in posterolateral lumbar fusion: a technical report

BACKGROUND CONTEXT

In lumbar surgery, local bone graft is often harvested and used in posterolateral fusion procedures. The volume of local bone graft available for posterolateral fusion has not been determined in North American patients. Some authors have described this as minimal, but others have suggested the volume was sufficient to be reliably used as a stand-alone bone graft substitute for single-level fusion.

PURPOSE

To describe the technique used and determine the volume of local bone graft available in a cohort of patients undergoing single-level primary posterolateral fusion by the authors harvesting technique.

STUDY DESIGN

Technical description and cohort report.

PATIENT SAMPLE

Consecutive patients undergoing lumbar posterolateral fusion with or without instrumentation for degenerative processes.

OUTCOME MEASURE

Local bone graft volume.

METHODS

Consecutive patients undergoing lumbar posterolateral fusion with or without instrumentation for degenerative processes of were studied. Local bone graft was harvested by a standard method in each patient and the volume measured by a standard procedure.

RESULTS

Twenty-five patients were studied, and of these 11 (44%) had a previous decompression. The mean volume of local bone graft harvested was measured to be 25 cc (range, 12-36 cc). Local bone graft was augmented by iliac crest bone in six of 25 patients (24%) if the posterolateral fusion bed was not well packed with local bone alone. There was a trend to greater local bone graft volumes in men and in patients without previous decompression.

CONCLUSION

Large volumes of local bone can be harvested during posterolateral lumbar fusion surgery. Even in patients with previous decompression the volume harvested is similar to that reported harvested from the posterior iliac crest for single-level fusion.

Assessment of bone status using speed of sound at multiple anatomical sites

Studies in vitro and in vivo have shown that quantitative ultrasound (QUS) is a valid tool for the assessment of bone status. Current QUS methods using the transmission technique are limited to one peripheral bone site. A new system, Sunlight Omnisense (Omnisense, Sunlight Medical Ltd., Rehovot, Israel), measures speed of sound (SOS, in m/s) along the surface of the bone based on an axial transmission technique. The Omnisense can measure SOS at several anatomical sites. This study evaluated the SOS at different anatomical sites in a healthy population. A total of 334 adult women from three research centers in the USA and Canada with a mean (+/- SD) age of 48.8 (+/- 17.4) years were enrolled in this study. SOS was measured at the proximal third phalanx, distal one third radius, midshaft tibia, and fifth metatarsal. The mean SOS (+/- SD) values for the phalanx, radius, tibia and metatarsal were 3984 (+/- 221), 4087 (+/- 147), 3893 (+/- 150) and 3690 (+/- 246) m/s, respectively. Each anatomical site SOS was significantly different (p < 0.001) from that of the other sites. SOS at the different anatomical sites was modestly, but significantly, correlated (r = 0.31 to 0.56, p < 0.001). Similar correlation coefficients were obtained for the T scores. The mean T scores for subjects over the age of 60 years were -1.94, -2.01, -0.97 and -1.42 for the phalanx, radius, tibia and metatarsal, respectively. The age of peak SOS and the rate of change thereafter varied with anatomical site, implying that the prevalence of osteopenia and osteoporosis was site-dependent if only one T score cut-off point was used. Comparing individuals, 10% to 17% of patients had T scores that differed by more than a factor of 2 between sites. Weight and age were some of the contributing factors to this heterogeneity. The Omnisense provides an opportunity to assess bone status at different anatomical sites. Whether or not combining measurements from all these anatomical sites will improve osteoporosis management still needs to be determined.

Determinants of blood lead levels across the menopausal transition

In this study, the authors sought to evaluate the impact of menopause on lead remobilization from bone-lead stores. The study was conducted between 1993 and 1995 in Mexico City and included 903 women (mean age = 46.8 y [standard deviation = 8.2 y]). Participants provided information about reproductive variables and known risk factors for high PbB levels. PbB levels were determined with graphite furnace atomic absorption spectrophotometry. The authors used linear-regression models to describe the relationship between PbB levels and variables of interest. PbB levels ranged from 1.0 microg/dl to 43.8 microg/dl (mean = 11.0 microg/dl). Menopausal women at baseline had the highest PbB levels; the mean difference between pre- and postmenopausal women was 0.76 microg/dl (95% confidence interval = 0.024, 1.48). We observed an inverted U-shaped relationship between PbB level and age. The highest PbB levels were observed in women aged 47-50 y. Other important predictors of PbB levels were use of lead-glazed ceramics, number of pregnancies, history of cigarette smoking, and height. Our results support the hypothesis that bone lead may be mobilized during menopause and may constitute an important source of exposure.

An evaluation of bone mineral density in Australian women of Asian descent

Asian women have been reported to have lower bone mineral density (BMD) than Caucasians, but this could be due to body habitus rather than ethnicity. The purpose of the present study was to determine whether Australian women of Asian descent have intrinsically dissimilar BMD compared to Australian women of Caucasian origin. We compared Australian Asian (n = 36) and Caucasian (n = 304) women who were referred for bone densitometry and in whom disorders or medications known to interfere with bone metabolism were excluded. Covariables including age, postmenopausal status, years since menopause (YSM), alcohol and smoking consumption, family history, current exercise levels, height, weight, body mass index (BMI) and Asian origin were analysed by multivariate linear regression to determine the independent predictors of BMD in the spine, hip and distal radius. The BMD in the spine (R2 = 0.31), hip (R2 = 0.27) and distal radius (R2 = 0.31) were associated with YSM (all sites), postmenopausal status, weight and smoking (spine and hip), BMI (spine and wrist), family history (hip) and height (wrist). The BMD at these sites were similar for Asian and Caucasian women after adjusting for these variables. Thus, Asian-Australians have similar BMD to Caucasian-Australians after adjusting for potential confounding variables. Bone mineral density is independently related to a number of clinical and lifestyle-related factors, but not ethnicity.

Predicting clinical discordance of bone mineral density

OBJECTIVE

To identify clinical and lifestyle factors that may predict clinical discordance of bone mineral density (BMD) in otherwise healthy perimenopausal and postmenopausal women referred for bone densitometry.

MATERIAL AND METHODS

Data from 304 white women referred for bone densitometry were retrospectively reviewed in order to determine predictors of BMD status at the lumbar spine, femoral neck, and distal radius. In addition, a cross-validation study in a further independent sample of 50 patients was undertaken. Dual-energy x-ray absorptiometry of all three sites was performed, and T-scores were determined with use of standard criteria established by the World Health Organization. Covariables including age, postmenopausal status, years since menopause, use of alcohol and cigarettes, family history of osteoporosis, exercise, height, weight, and body mass index were analyzed by canonical discriminant functions.

RESULTS

Seventy-six patients (25%) had normal BMD at all three sites (group A); 55 patients (18%) had osteopenia or osteoporosis at all sites (group B); and 173 patients (57%) showed regional discordance of BMD (group C). Menopausal status, years since menopause, use of alcohol and cigarettes, exercise levels, and weight allowed distinct separation of these three groups by using the plot of one canonical discriminant function against the other. When tested, this method of assignment correctly predicted the regional BMD status in 38 of 50 women (76%) in the independent sample.

CONCLUSION

Thus, the combination of certain clinical and lifestyle factors may be helpful in predicting variations in the clinical classification of BMD in an ambulatory healthy perimenopausal or postmenopausal woman.

Body anthropometry and the risk of hip and wrist fractures in men: results from a prospective study

Available epidemiological information on the associations between body anthropometry and the incidence of fractures in men is limited. We therefore prospectively investigated the association between body anthropometry and the incidence of hip and wrist fractures from low and moderate trauma among 43,053 men who were 40 years to 75 years of age in 1986 when they first enrolled in the Health Professionals Follow-Up Study. After 8 years of follow-up, 201 wrist fracture cases and 56 hip fracture cases were reported. Greater height was associated with significant elevations in both hip and wrist fractures, whereas nonsignificant inverse associations were observed with weight and body mass index. Men in the highest quintile of waist circumference had a relative risk (RR) of 2.57 (95% confidence interval [CI] 0.64 to 10.3) for hip fracture and 2.05 (95% CI 1.06 to 3.96) for wrist fracture when compared with men in the lowest quintile. Waist-to-hip ratio was also positively related to fracture incidence; comparing highest with lowest quintile, the RRs were 3.92 (95% CI 1.07 to 14.3) for hip fracture and 1.50 (95% CI 0.85 to 2.66) for wrist fracture. These anthropometric indicators, in particular waist-to-hip ratio, may be useful for the prediction of hip fracture in adult men.

Usefulness of panoramic radiography in the diagnosis of postmenopausal osteoporosis in women. Width and morphology of inferior cortex of the mandible

OBJECTIVES

To evaluate the usefulness of width and morphology of the inferior cortex of the mandible on panoramic radiographs in the diagnosis of postmenopausal osteoporosis.

METHODS

The width and morphology of the mandibular inferior cortex on panoramic radiographs were compared with trabecular bone mineral density (TBMD) of the 3rd lumbar vertebrae (L3) measured by dual energy quantitative computed tomography in 29 premenopausal and 95 postmenopausal women.

RESULTS

There was a significant negative correlation between the width (Kendall's tau = -0.36, p < 0.001) and morphology (Kendall's tau = -0.49, p < 0.001) of the mandibular inferior cortex and the L3 TBMD. Regression analysis showed that significant linear relationships were observed between the L3 TBMD and age (p < 0.001), cortical width (p < 0.05), morphology (p < 0.05), controlling body mass index, number of teeth present and menopausal status (R2 = 0.42).

CONCLUSION

Our results suggest that panoramic radiography could be reliable in screening for osteoporosis.