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Han H, Chen S, Wang X, Jin J, Li X, Li Z. Association between muscle strength and mass and bone mineral density in the US general population: data from NHANES 1999-2002. J Orthop Surg Res 2023; 18:397. [PMID: 37264353 DOI: 10.1186/s13018-023-03877-4] [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: 03/07/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023] Open
Abstract
PURPOSE It is known that muscle strength and muscle mass play a crucial role in maintaining bone mineral density (BMD). Despite this, there are uncertainties about how muscle mass, lower extremity muscular strength, and BMD are related. We examined the impact of lower extremity muscle strength and mass on BMD in the general American population using cross-sectional analysis. METHODS In the study, we extracted 2165 individuals from the National Health and Nutrition Examination Survey 1999-2002. Multivariate logistic regression models were used to examine the association between muscle strength, muscle mass, and BMD. Fitted smoothing curves and generalized additive models were also performed. To ensure data stability and avoid confounding factors, subgroup analysis was also conducted on gender and race/ethnicity. RESULTS After full adjustment for potential confounders, significant positive associations were detected between peak force (PF) [0.167 (0.084, 0.249) P < 0.001], appendicular skeletal muscle index (ASMI) [0.029 (0.022, 0.036) P < 0.001], and lumbar spine BMD. A positive correlation was also found between PF, ASMI, and pelvis and total BMD. Following stratification by gender and race/ethnicity, our analyses illustrated a significant correlation between PF and lumbar spine BMD in both men [0.232 (0.130, 0.333) P < 0.001] and women [0.281 (0.142, 0.420) P < 0.001]. This was also seen in non-Hispanic white [0.178 (0.068, 0.288) P = 0.002], but not in non-Hispanic black, Mexican American and other race-ethnicity. Additionally, there was a positive link between ASMI and BMD in both genders in non-Hispanic whites, and non-Hispanic blacks, but not in any other racial group. CONCLUSION PF and ASMI were positively associated with BMD in American adults. In the future, the findings reported here may have profound implications for public health in terms of osteopenia and osteoporosis prevention, early diagnosis, and treatment.
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Affiliation(s)
- Huawei Han
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, No.23, Nanhu Road, Jianye District, Nanjing, 210017, Jiangsu Province, People's Republic of China
| | - Shuai Chen
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, No.23, Nanhu Road, Jianye District, Nanjing, 210017, Jiangsu Province, People's Republic of China
| | - Xinzhe Wang
- Department of Gynecology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, People's Republic of China
| | - Jie Jin
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, No.23, Nanhu Road, Jianye District, Nanjing, 210017, Jiangsu Province, People's Republic of China
| | - Xianghui Li
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, No.23, Nanhu Road, Jianye District, Nanjing, 210017, Jiangsu Province, People's Republic of China.
| | - Zhiwei Li
- Department of Orthopaedics, The Second Affiliated Hospital of Nanjing University of Chinese Medicine, No.23, Nanhu Road, Jianye District, Nanjing, 210017, Jiangsu Province, People's Republic of China.
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Li X, Liu X. Associations of serum vitamins levels with bone mineral density in the different race-ethnicities US adults. BMC Musculoskelet Disord 2021; 22:137. [PMID: 33541331 PMCID: PMC7860041 DOI: 10.1186/s12891-021-03997-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The conclusions on the associations of specific vitamin levels with bone mineral density (BMD) were controversial. Therefore, the aims of this study were to examine the associations of serum vitamins levels with BMD and the modified effect of race/ ethnicity on these associations in the US adults. METHODS This study was from the third National Health and Nutrition Examination Survey. All participants aged ≥18 years with complete data were eligible. Serum vitamins A, B9, B12, C, and E levels were assayed using the Quantaphase II Radioassay Kit (Bio-Rad). Dual-energy X-ray absorptiometry was employed to measure BMD, including femur neck and the total hip. RESULTS There were 6023 participants included in the final analysis. Serum folate, vitamins A and C levels were positively associated with BMD. No significant associations of serum vitamins B12 and E levels with BMD were observed. There were positive associations of serum folate level (β = 0.00027 and 0.00032; and 95% CI: 0.00002-0.00057 and 0.00002-0.00063, respectively), vitamin A level (β = 0.01132 and 0.01115; and 95% CI: 0.00478-0.01787 and 0.00430-0.01799, respectively), and vitamin C level (β = 0.00027 and 0.00029; and 95% CI: 0.00012-0.00042 and 0.00013-0.00045, respectively) with BMD at femur neck and the total hip only in the Not Hispanic participants. CONCLUSION Elevated serum folate, vitamins A and C levels were associated with a higher BMD. Furthermore, sex and race/ ethnicity modified the associations of serum vitamins levels with BMD.
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Affiliation(s)
- Xiang Li
- Department of Orthopedics, Tianjin Fifth Central Hospital, Tianjin, 300450, China
| | - Xun Liu
- Department of Ultrasonics, Tianjin Fifth Central Hospital, No 41 Zhejiang Road, Tianjin, 300450, China.
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3
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Väänänen SP, Grassi L, Venäläinen MS, Matikka H, Zheng Y, Jurvelin JS, Isaksson H. Automated segmentation of cortical and trabecular bone to generate finite element models for femoral bone mechanics. Med Eng Phys 2019; 70:19-28. [PMID: 31280927 DOI: 10.1016/j.medengphy.2019.06.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 05/16/2019] [Accepted: 06/23/2019] [Indexed: 02/02/2023]
Abstract
Finite element (FE) models based on quantitative computed tomography (CT) images are better predictors of bone strength than conventional areal bone mineral density measurements. However, FE models require manual segmentation of the femur, which is not clinically applicable. This study developed a method for automated FE analyses from clinical CT images. Clinical in-vivo CT images of 13 elderly female subjects were collected to evaluate the method. Secondly, proximal cadaver femurs were harvested and imaged with clinical CT (N = 17). Of these femurs, 14 were imaged with µCT and three had earlier been tested experimentally in stance-loading, while collecting surface deformations with digital image correlation. Femurs were segmented from clinical CT images using an automated method, based on the segmentation tool Stradwin. The method automatically distinguishes trabecular and cortical bone, corrects partial volume effect and generates input for FE analysis. The manual and automatic segmentations agreed within about one voxel for in-vivo subjects (0.99 ± 0.23 mm) and cadaver femurs (0.21 ± 0.07 mm). The strains from the FE predictions closely matched with the experimentally measured strains (R2 = 0.89). The method can automatically generate meshes suitable for FE analysis. The method may bring us one step closer to enable clinical usage of patient-specific FE analyses.
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Affiliation(s)
- Sami P Väänänen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FIN-70211 Kuopio, Finland; Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, POB 100, 70029 Kuopio, Finland; Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital, POB 100, FIN-70029 Kuopio, Finland; Department of Medical Physics, Central Finland Central Hospital, Keskussairaalantie 19, FIN-40620 Jyväskylä, Finland.
| | - Lorenzo Grassi
- Department of Biomedical Engineering, Lund University, BMC D13, 221 84 Lund, Sweden.
| | - Mikko S Venäläinen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FIN-70211 Kuopio, Finland; Turku Bioscience Centre, University of Turku and Åbo Akademi University, Tykistökatu 6, FIN-20520 Turku, Finland.
| | - Hanna Matikka
- Department of Clinical Radiology, Diagnostic Imaging Center, Kuopio University Hospital, POB 100, 70029 Kuopio, Finland.
| | - Yi Zheng
- Department of Physics, Technical University of Denmark, Fysikvej, building 311, 2800 Kgs. Lyngby, Denmark.
| | - Jukka S Jurvelin
- Department of Applied Physics, University of Eastern Finland, POB 1627, FIN-70211 Kuopio, Finland.
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, BMC D13, 221 84 Lund, Sweden.
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4
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Bigelow EM, Patton DM, Ward FS, Ciarelli A, Casden M, Clark A, Goulet RW, Morris MD, Schlecht SH, Mandair GS, Bredbenner TL, Kohn DH, Jepsen KJ. External Bone Size Is a Key Determinant of Strength-Decline Trajectories of Aging Male Radii. J Bone Miner Res 2019; 34:825-837. [PMID: 30715752 PMCID: PMC6536328 DOI: 10.1002/jbmr.3661] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/06/2018] [Accepted: 12/19/2018] [Indexed: 12/13/2022]
Abstract
Given prior work showing associations between remodeling and external bone size, we tested the hypothesis that wide bones would show a greater negative correlation between whole-bone strength and age compared with narrow bones. Cadaveric male radii (n = 37 pairs, 18 to 89 years old) were evaluated biomechanically, and samples were sorted into narrow and wide subgroups using height-adjusted robustness (total area/bone length). Strength was 54% greater (p < 0.0001) in wide compared with narrow radii for young adults (<40 years old). However, the greater strength of young-adult wide radii was not observed for older wide radii, as the wide (R2 = 0.565, p = 0.001), but not narrow (R2 = 0.0004, p = 0.944) subgroup showed a significant negative correlation between strength and age. Significant positive correlations between age and robustness (R2 = 0.269, p = 0.048), cortical area (Ct.Ar; R2 = 0.356, p = 0.019), and the mineral/matrix ratio (MMR; R2 = 0.293, p = 0.037) were observed for narrow, but not wide radii (robustness: R2 = 0.015, p = 0.217; Ct.Ar: R2 = 0.095, p = 0.245; MMR: R2 = 0.086, p = 0.271). Porosity increased with age for the narrow (R2 = 0.556, p = 0.001) and wide (R2 = 0.321, p = 0.022) subgroups. The wide subgroup (p < 0.0001) showed a significantly greater elevation of a new measure called the Cortical Pore Score, which quantifies the cumulative effect of pore size and location, indicating that porosity had a more deleterious effect on strength for wide compared with narrow radii. Thus, the divergent strength-age regressions implied that narrow radii maintained a low strength with aging by increasing external size and mineral content to mechanically offset increases in porosity. In contrast, the significant negative strength-age correlation for wide radii implied that the deleterious effect of greater porosity further from the centroid was not offset by changes in outer bone size or mineral content. Thus, the low strength of elderly male radii arose through different biomechanical mechanisms. Consideration of different strength-age regressions (trajectories) may inform clinical decisions on how best to treat individuals to reduce fracture risk. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Erin Mr Bigelow
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Daniella M Patton
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.,Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Ferrous S Ward
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.,Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Antonio Ciarelli
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.,Mechanical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Michael Casden
- School of Kinesiology, University of Michigan, Ann Arbor, MI, USA
| | - Andrea Clark
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Robert W Goulet
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Michael D Morris
- College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA
| | | | - Gurjit S Mandair
- Biological and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Todd L Bredbenner
- Department of Mechanical and Aerospace Engineering, University of Colorado-Colorado Springs, Colorado Springs, CO, USA
| | - David H Kohn
- Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.,Biological and Materials Sciences, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Karl J Jepsen
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.,Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
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5
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Chan GMF, Riandini T, Ng SHX, Goh SY, Tan CS, Tai ES, Duque G, Ng ACM, Venkataraman K. Role of Fat and Bone Biomarkers in the Relationship Between Ethnicity and Bone Mineral Density in Older Men. Calcif Tissue Int 2018; 102:64-72. [PMID: 29052745 PMCID: PMC5760609 DOI: 10.1007/s00223-017-0342-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 10/05/2017] [Indexed: 12/21/2022]
Abstract
Osteoporosis is an important health issue for older adults, and has been relatively understudied in older men. This study aimed to examine ethnic differences in bone mineral density (BMD), and elucidate the role of bone turnover markers (BTMs), fat and fat biomarkers on these ethnic differences. BMD at the lumbar spine and femoral neck, marrow fat at femoral neck, visceral adipose tissue (VAT) and subcutaneous adipose tissue, bone and fat biomarkers were evaluated in 120 healthy men aged ≥ 60 years. Indians had higher BMD values compared to Chinese at the lumbar spine (β = 20.336, SE = 4.749, p < 0.001) and the femoral neck (e β = 1.105, SE = 0.032, p < 0.001), after adjusting for BTMs, fat composition and lifestyle choices. Marrow fat, VAT and adiponectin were independent predictors of BMD. However, these factors did not explain the lower BMD observed in older Chinese men. Our findings suggest that older Chinese men are at significant risk of osteoporotic fractures due to lower BMD. Fat appears to be a key factor associated with lower BMD, and warrants further longitudinal studies to elucidate the complex interactions between adipose tissue and bone strength.
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Affiliation(s)
- Grace M F Chan
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 11, NUHS Tower Block, Singapore, 119228, Singapore
| | - Tessa Riandini
- Saw Swee Hock School of Public Health, National University of Singapore, #10-03 J, Level 10, Tahir Foundation Building (MD1), 12 Science Drive 2, Singapore, 117549, Singapore
| | - Sheryl Hui Xian Ng
- Saw Swee Hock School of Public Health, National University of Singapore, #10-03 J, Level 10, Tahir Foundation Building (MD1), 12 Science Drive 2, Singapore, 117549, Singapore
| | - Su Yen Goh
- Department of Endocrinology, Singapore General Hospital, Academia, Level 3, Outram Road, Singapore, 169608, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, #10-03 J, Level 10, Tahir Foundation Building (MD1), 12 Science Drive 2, Singapore, 117549, Singapore
| | - E Shyong Tai
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Level 11, NUHS Tower Block, Singapore, 119228, Singapore
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), University of Melbourne and Western Health, St. Albans, VIC, Australia
| | - Alvin Choon-Meng Ng
- The Endocrine Clinic, Mount Elizabeth Medical Centre, 3 Mount Elizabeth, #15-04, Singapore, 228510, Singapore
- Singapore General Hospital, Singapore, Singapore
| | - Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore, #10-03 J, Level 10, Tahir Foundation Building (MD1), 12 Science Drive 2, Singapore, 117549, Singapore.
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6
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Reider L, Beck T, Alley D, Miller R, Shardell M, Schumacher J, Magaziner J, Cawthon PM, Barbour KE, Cauley JA, Harris T. Evaluating the relationship between muscle and bone modeling response in older adults. Bone 2016; 90:152-8. [PMID: 27352990 PMCID: PMC5494965 DOI: 10.1016/j.bone.2016.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/14/2016] [Accepted: 06/20/2016] [Indexed: 12/25/2022]
Abstract
Bone modeling, the process that continually adjusts bone strength in response to prevalent muscle-loading forces throughout an individual's lifespan, may play an important role in bone fragility with age. Femoral stress, an index of bone modeling response, can be estimated using measurements of DXA derived bone geometry and loading information incorporated into an engineering model. Assuming that individuals have adapted to habitual muscle loading forces, greater stresses indicate a diminished response and a weaker bone. The purpose of this paper was to evaluate the associations of lean mass and muscle strength with the femoral stress measure generated from the engineering model and to examine the extent to which lean mass and muscle strength account for variation in femoral stress among 2539 healthy older adults participating in the Health ABC study using linear regression. Mean femoral stress was higher in women (9.51, SD=1.85Mpa) than in men (8.02, SD=1.43Mpa). Percent lean mass explained more of the variation in femoral stress than did knee strength adjusted for body size (R(2)=0.187 vs. 0.055 in men; R(2)=0.237 vs. 0.095 in women). In models adjusted for potential confounders, for every percent increase in lean mass, mean femoral stress was 0.121Mpa lower (95% CI: -0.138, -0.104; p<0.001) in men and 0.139Mpa lower (95% CI: -0.158, -0.121; p<0.001) in women. The inverse association of femoral stress with lean mass and with knee strength did not differ by category of BMI. Results from this study provide insight into bone modeling differences as measured by femoral stress among older men and women and indicate that lean mass may capture elements of bone's response to load.
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Affiliation(s)
- Lisa Reider
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, United States.
| | - Thomas Beck
- Beck Radiological Innovations, Inc., United States
| | - Dawn Alley
- Center for Medicare and Medicaid Innovation, Centers for Medicare and Medicaid Services, Baltimore, MD, United States
| | - Ram Miller
- Novartis Institute for Biomedical Research, United States; Department of Epidemiology and Public Health, University of Maryland, School of Medicine, United States
| | - Michelle Shardell
- National Institute on Aging, Longitudinal Study Section, United States
| | - John Schumacher
- Department of Sociology and Anthropology, University of Maryland Baltimore County, United States
| | - Jay Magaziner
- University of Maryland, School of Medicine, United States
| | - Peggy M Cawthon
- Research Institute, California Pacific Medical Center, San Francisco, CA, United States; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
| | - Kamil E Barbour
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control, United States
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, United States
| | - Tamara Harris
- Laboratory of Epidemiology and Population Sciences Intramural Research Program, National Institute on Aging, United States
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7
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Akeroyd JM, Suarez EA, Bartali B, Chiu GR, Yang M, Schwartz AV, Araujo AB. Differences in skeletal and non-skeletal factors in a diverse sample of men with and without type 2 diabetes mellitus. J Diabetes Complications 2014; 28:679-83. [PMID: 24973938 DOI: 10.1016/j.jdiacomp.2014.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 05/16/2014] [Accepted: 05/18/2014] [Indexed: 12/25/2022]
Abstract
AIMS Patients with type 2 diabetes mellitus (T2DM) have increased fracture risk yet higher bone mineral density (BMD), but data are inconsistent in men. We compared skeletal and non-skeletal (e.g., muscle mass, strength) factors in men with/without T2DM. METHODS Cross-sectional study of 1137 Boston men 30-79years in the Boston Area Community Health/Bone Survey. Diabetes status was self-reported, and BMD and body composition were measured by DXA, and grip strength by hand dynamometer. Physical function was assessed by walking speed and chair stands. Multivariable linear regressions examined associations of T2DM with skeletal/non-skeletal factors. RESULTS Mean age was 48years. The population was 24.6% Black, 13.0% Hispanic, and 62.4% White. Prevalence of T2DM was 12.5%; average disease duration was 7.4years. While subjects with T2DM did not differ in skeletal factors (e.g., BMD), they had significantly lower appendicular lean mass [mean difference (MD)=-1.04kg; standard error (SE)=0.50; p=0.04], arms lean mass (MD=-0.42kg; SE=0.15; p=0.006) and grip strength (MD=-3.02kg; SE=1.25; p=0.025) after adjustment for age, race/ethnicity, and BMI. CONCLUSIONS Men with T2DM have lower muscle mass and strength, but similar BMD, compared to their non-diabetic counterparts. These differences in non-skeletal factors might explain, at least in part, the higher incidence of falls and fractures observed in T2DM patients.
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Affiliation(s)
- Julia M Akeroyd
- Department of Epidemiology, New England Research Institutes, Inc., Watertown, MA, USA
| | - Elizabeth A Suarez
- Department of Epidemiology, New England Research Institutes, Inc., Watertown, MA, USA
| | - Benedetta Bartali
- Department of Epidemiology, New England Research Institutes, Inc., Watertown, MA, USA.
| | - Gretchen R Chiu
- Department of Epidemiology, New England Research Institutes, Inc., Watertown, MA, USA
| | - May Yang
- Department of Epidemiology, New England Research Institutes, Inc., Watertown, MA, USA
| | - Ann V Schwartz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Andre B Araujo
- Department of Epidemiology, New England Research Institutes, Inc., Watertown, MA, USA
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8
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Shin MH, Zmuda JM, Barrett-Connor E, Sheu Y, Patrick AL, Leung PC, Kwok A, Kweon SS, Nam HS, Cauley JA. Race/ethnic differences in associations between bone mineral density and fracture history in older men. Osteoporos Int 2014; 25:837-45. [PMID: 24146094 PMCID: PMC4058886 DOI: 10.1007/s00198-013-2503-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 08/27/2013] [Indexed: 12/21/2022]
Abstract
SUMMARY To determine whether there are race/ethnic differences in bone mineral density (BMD) by fracture history in men aged 65 years and older, we performed cross-sectional analysis in five large independent cohorts. Low BMD was associated with a higher prevalence of fracture in all cohorts, and the magnitude of the BMD differences by fracture status was similar across groups. INTRODUCTION We aimed to determine whether there are race/ethnic and geographic differences in bone mineral density by fracture history in men aged 65 years and older. METHOD The datasets included the Osteoporotic Fractures in Men (MrOS) Study (5,342 White, 243 African-American, 190 Asian, and 126 Hispanic), MrOS Hong Kong (1,968 Hong Kong Chinese), Tobago Bone Health Study (641 Afro-Caribbean), Namwon Study (1,834 Korean), and Dong-gu Study (2,057 Korean). The two Korean cohorts were combined. RESULTS The prevalence of self-reported non-traumatic fracture was US white, 17.1 %; Afro-Caribbean, 5.5 %; US African-American, 15.1 %; US Hispanic, 13.7 %; US Asian, 10.5 %; Hong Kong Chinese, 5.6 %, and Korean, 5.1 %. The mean differences in hip and lumbar spine BMD between subjects with fracture and without fracture were statistically significant in all cohorts except US African American and US Asian men. There was a significant race/ethnic interaction for lumbar spine BMD by fracture status (p for interaction = 0.02), which was driven by the small number of Hispanic men. There was no interaction for femoral neck or total hip BMD. There were no significant race/ethnic differences in the odds ratio of fracture by BMD. CONCLUSIONS Low BMD was associated with a higher prevalence of fracture in all cohorts and the magnitude of the BMD differences by fracture status was similar across groups suggesting homogeneity in the BMD-fracture relationship among older men.
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Affiliation(s)
- Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph M. Zmuda
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Barrett-Connor
- Department of Family and Preventive Medicine, University of California at San Diego, San Diego, California, USA
| | - Yahtyng Sheu
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alan L. Patrick
- Tobago Health Studies Office, Scarborough, Tobago, Trinidad and Tobago
| | - Ping Chung Leung
- The Chinese University of Hong Kong Jockey Club Centre for Osteoporosis Care and Control, Hong Kong, China
| | - Anthony Kwok
- The Chinese University of Hong Kong Jockey Club Centre for Osteoporosis Care and Control, Hong Kong, China
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Hae-Sung Nam
- Department of Preventive Medicine, Chungnam National University Medical School, Daejeon, South Korea
| | - Jane A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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9
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Ripamonti C, Lisi L, Avella M. Femoral neck shaft angle width is associated with hip-fracture risk in males but not independently of femoral neck bone density. Br J Radiol 2014; 87:20130358. [PMID: 24678889 DOI: 10.1259/bjr.20130358] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To investigate the specificity of the neck shaft angle (NSA) to predict hip fracture in males. METHODS We consecutively studied 228 males without fracture and 38 with hip fracture. A further 49 males with spine fracture were studied to evaluate the specificity of NSA for hip-fracture prediction. Femoral neck (FN) bone mineral density (FN-BMD), NSA, hip axis length and FN diameter (FND) were measured in each subject by dual X-ray absorptiometry. Between-mean differences in the studied variables were tested by the unpaired t-test. The ability of NSA to predict hip fracture was tested by logistic regression. RESULTS Compared with controls, FN-BMD (p < 0.01) was significantly lower in both groups of males with fractures, whereas FND (p < 0.01) and NSA (p = 0.05) were higher only in the hip-fracture group. A significant inverse correlation (p < 0.01) was found between NSA and FN-BMD. By age-, height- and weight-corrected logistic regression, none of the tested geometric parameters, separately considered from FN-BMD, entered the best model to predict spine fracture, whereas NSA (p < 0.03) predicted hip fracture together with age (p < 0.001). When forced into the regression, FN-BMD (p < 0.001) became the only fracture predictor to enter the best model to predict both fracture types. CONCLUSION NSA is associated with hip-fracture risk in males but is not independent of FN-BMD. ADVANCES IN KNOWLEDGE The lack of ability of NSA to predict hip fracture in males independent of FN-BMD should depend on its inverse correlation with FN-BMD by capturing, as the strongest fracture predictor, some of the effects of NSA on the hip fracture. Conversely, NSA in females does not correlate with FN-BMD but independently predicts hip fractures.
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Affiliation(s)
- C Ripamonti
- Struttura Semplice Dipartimentale di Medicina Generale, Istituto Ortopedico Rizzoli, Bologna, Italy
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Sheu Y, Cauley JA, Patrick AL, Wheeler VW, Bunker CH, Zmuda JM. Risk factors for fracture in middle-age and older-age men of African descent. J Bone Miner Res 2014; 29:234-41. [PMID: 23775783 PMCID: PMC3830695 DOI: 10.1002/jbmr.2016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/17/2013] [Accepted: 06/03/2013] [Indexed: 11/06/2022]
Abstract
Although fracture rates are lower in individuals of African descent compared to individuals of European ancestry, morbidity and mortality following a fracture may be greater in individuals of African ancestry. However, fracture risk and associated clinical risk factors have not been well-defined among African ancestry populations, especially among men of African ancestry. We used data collected from the Tobago Bone Health Study to examine potential clinical risk factors for incident fractures, including demographic information, anthropometric measurements, medical history, lifestyle factors, bone mineral density (BMD), and hip structural geometry. Among 1933 Afro-Caribbean men aged ≥40 years at study entry (mean age: 57.2 ± 11.0 years), 65 reported at least one new fracture during 10 years of subsequent follow-up. Younger age, mixed Afro-Caribbean ancestry, prior fracture history, BMD, and hip structural geometry were statistically significant risk factors for incident fractures. A 1-SD change in several skeletal parameters (hip BMD, cross-sectional area, outer diameter, cortical thickness, and buckling ratio) were each associated with a 35% to 56% increase in incident fracture risk after adjusting for age. Men with a prior fracture history were three times more likely to experience a new fracture during follow-up, and the association remained strong after adjusting for age, mixed Afro-Caribbean ancestry, and skeletal parameters (hazard ratios ranged from 2.72 to 2.82). Our findings suggest that except for age, risk factors for fracture in men of African ancestry are similar to established risk factors in white populations. Prior fracture history is a powerful and independent risk factor for incident fractures among men of African ancestry and could easily be incorporated into clinical risk evaluation.
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Affiliation(s)
- Yahtyng Sheu
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
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11
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Danielson ME, Beck TJ, Lian Y, Karlamangla AS, Greendale GA, Ruppert K, Lo J, Greenspan S, Vuga M, Cauley JA. Ethnic variability in bone geometry as assessed by hip structure analysis: findings from the hip strength across the menopausal transition study. J Bone Miner Res 2013; 28:771-9. [PMID: 23044816 PMCID: PMC3586935 DOI: 10.1002/jbmr.1781] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 09/17/2012] [Accepted: 10/01/2012] [Indexed: 11/10/2022]
Abstract
Racial/ethnic origin plays an important role in fracture risk. Racial/ethnic differences in fracture rates cannot be fully explained by bone mineral density (BMD). Studies examining the influence of bone geometry and strength on fracture risk have focused primarily on older adults and have not included people from diverse racial/ethnic backgrounds. Our goal was to explore racial/ethnic differences in hip geometry and strength in a large sample of midlife women. We performed hip structure analysis (HSA) on hip dual-energy X-ray absorptiometry (DXA) scans from 1942 premenopausal and early perimenopausal women. The sample included white (50%), African American (27%), Chinese (11%), and Japanese (12%) women aged 42 to 52 years. HSA was performed using software developed at Johns Hopkins University. African American women had higher conventional (8.4% to 9.7%) and HSA BMD (5.4% to 19.8%) than other groups with the exception being Japanese women, who had the highest HSA BMD (9.7% to 31.4%). HSA indices associated with more favorable geometry and greater strength and resistance to fracture were more prevalent in African American and Japanese women. Femurs of African American women had a smaller outer diameter, a larger cross-sectional area and section modulus, and a lower buckling ratio. Japanese women presented a different pattern with a higher section modulus and lower buckling ratio, similar to African American women, but a wider outer diameter; this was offset by a greater cross-sectional area and a more centrally located centroid. Chinese women had similar conventional BMD as white women but a smaller neck region area and HSA BMD at both regions. They also had a smaller cross-sectional area and section modulus, a more medially located centroid, and a higher buckling ratio than white women. The observed biomechanical differences may help explain racial/ethnic variability in fracture rates. Future research should explore the contribution of hip geometry to fracture risk across all race/ethnicities.
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Affiliation(s)
- Michelle E Danielson
- University of Pittsburgh, Department of Epidemiology, Pittsburgh, PA 15261, USA.
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12
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Osborne DL, Weaver CM, McCabe LD, McCabe GP, Novotny R, Van Loan MD, Going S, Matkovic V, Boushey CJ, Savaiano DA. Body size and pubertal development explain ethnic differences in structural geometry at the femur in Asian, Hispanic, and white early adolescent girls living in the U.S. Bone 2012; 51:888-95. [PMID: 22944607 PMCID: PMC3491564 DOI: 10.1016/j.bone.2012.08.125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 08/16/2012] [Accepted: 08/18/2012] [Indexed: 12/21/2022]
Abstract
UNLABELLED Variation in structural geometry is present in adulthood, but when this variation arises and what influences this variation prior to adulthood remains poorly understood. Ethnicity is commonly the focus of research of skeletal integrity and appears to explain some of the variation in quantification of bone tissue. However, why ethnicity explains variation in skeletal integrity is unclear. METHODS Here we examine predictors of bone cross sectional area (CSA) and section modulus (Z), measured using dual-energy X-ray absorptiometry (DXA) and the Advanced Hip Analysis (AHA) program at the narrow neck of the femur in adolescent (9-14 years) girls (n=479) living in the United States who were classified as Asian, Hispanic, or white if the subject was 75% of a given group based on parental reported ethnicity. Protocols for measuring height and weight follow standardized procedures. Total body lean mass (LM) and total body fat mass (FM) were quantified in kilograms using DXA. Total dietary and total dairy calcium intakes from the previous month were estimated by the use of an electronic semi-quantitative food frequency questionnaire (eFFQ). Physical activity was estimated for the previous year by a validated self-administered modifiable activity questionnaire for adolescents with energy expenditure calculated from the metabolic equivalent (MET) values from the Compendium of Physical Activities. Multiple regression models were developed to predict CSA and Z. RESULTS Age, time from menarche, total body lean mass (LM), total body fat mass (FM), height, total calcium, and total dairy calcium all shared a significant (p<0.05), positive relationship with CSA. Age, time from menarche, LM, FM, and height shared significant (p<0.05), positive relationships with Z. For both CSA and Z, LM was the most important covariate. Physical activity was not a significant predictor of geometry at the femoral neck (p≥0.339), even after removing LM as a covariate. After adjusting for covariates, ethnicity was not a significant predictor in regression models for CSA and Z. CONCLUSION Variability in bone geometry at the narrow neck of the femur is best explained by body size and pubertal maturation. After controlling for these covariates there were no differences in bone geometry between ethnic groups.
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Affiliation(s)
- D L Osborne
- Dept. of Anthropology, University of Nebraska, Lincoln, NE 68588, USA.
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13
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Walker Harris V, Sutcliffe CG, Araujo AB, Chiu GR, Travison TG, Mehta S, Sulkowski MS, Higgins Y, Thomas DL, Dobs AS, Beck TJ, Brown TT. Hip bone geometry in HIV/HCV-co-infected men and healthy controls. Osteoporos Int 2012; 23:1779-87. [PMID: 21901477 PMCID: PMC3568923 DOI: 10.1007/s00198-011-1769-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 07/12/2011] [Indexed: 10/17/2022]
Abstract
UNLABELLED People with both HIV and hepatitis C are more likely than those with HIV alone to have wrist, hip, and spine fractures. We compared hip strength between HIV/HCV-co-infected men and healthy men and found that HIV/HCV-co-infected men had decreased hip strength due to lower lean body mass. INTRODUCTION Hepatitis C co-infection is a risk factor for fragility fracture among HIV-infected populations. Whether bone strength is compromised in HIV/HCV-co-infected patients is unknown. METHODS We compared dual-energy x-ray absorptiometry (DXA)-derived hip geometry, a measure of bone strength, in 88 HIV/HCV-co-infected men from the Johns Hopkins HIV Clinic to 289 men of similar age and race and without HIV or HCV from the Boston Area Community Health Survey/Bone Survey. Hip geometry was assessed at the narrow neck, intertrochanter, and shaft using hip structural analysis. Lean body mass (LBM), total fat mass (FM), and fat mass ratio (FMR) were measured by whole-body DXA. Linear regression was used to identify body composition parameters that accounted for differences in bone strength between cohorts. RESULTS HIV/HCV-co-infected men had lower BMI, LBM, and FM and higher FMR compared to controls (all p < 0.05). At the narrow neck, significant differences were observed between HIV/HCV-co-infected men and controls in bone mineral density, cross-sectional area, section modulus, buckling ratio, and centroid position. After adjustment for race, age, smoking status, height, and weight, only buckling ratio and centroid position remained significantly different between cohorts (all p < 0.05). Substituting LBM, FM, and FMR for weight in the multivariate model revealed that differences in LBM, but not FM or FMR, accounted for differences in all narrow neck parameters between cohorts, except buckling ratio and centroid position. CONCLUSION HIV/HCV-co-infected men have compromised hip strength at the narrow neck compared to uninfected controls, which is attributable in large part to lower lean body mass.
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Affiliation(s)
- V Walker Harris
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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14
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DongMei N, Iki M, Tamaki J, Sato Y, Kagamimori S, Kagawa Y, Yoneshima H. Association between weight changes and changes in hip geometric indices in the Japanese female population during 10-year follow-up: Japanese Population-based Osteoporosis (JPOS) Cohort Study. Osteoporos Int 2012; 23:1581-91. [PMID: 21811865 DOI: 10.1007/s00198-011-1733-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Accepted: 06/01/2011] [Indexed: 11/27/2022]
Abstract
UNLABELLED During a 10-year follow-up of 893 women of various ages from the Japanese Population-based Osteoporosis Cohort Study, we evaluated the relationship between weight changes and hip geometric strength assessed by hip structure analysis. Our findings suggest that maintaining weight may help retain geometric strength and reduce hip fracture risk. INTRODUCTION The effects of changes in anthropometric indices on hip geometry in women of various ages are unclear. We evaluated these effects by analyzing 10-year longitudinal data from a representative sample of Japanese women. METHODS Dual-energy X-ray absorptiometry scans of the proximal femur were performed at baseline and at the 10-year follow-up. Data were analyzed with the Hip Structure Analysis (HSA) program, which yields geometric strength indices including cross-sectional area (CSA), section modulus (SM) and subperiosteal diameter (PD) at regions of interest (ROIs) in the narrow neck (NN), intertrochanter, and femoral shaft (FS) regions. Annual percent change of each HSA index was determined. Height and weight were measured at baseline and follow-up. RESULTS After excluding subjects with factors affecting bone metabolism, we evaluated 893 women (18-79 years old at baseline). The greatest changes in most HSA indices during the follow-up were observed in subjects aged ≥ 70 years at all ROIs. PD modestly but significantly expanded with age, but this change was not significant in subjects aged ≥ 70 years or those who had entered menopause ≥ 20 years before baseline. An increasing trend in weight was associated with an increase or smaller decline in CSA and SM at the NN and FS regions regardless of menopausal status after adjusting for age, height, and weight at baseline and change of estimated volumetric bone mineral density. Changes in height showed a much weaker association with HSA indices. CONCLUSIONS Maintaining weight may help retain hip geometric strength and reduce the risk of hip fracture.
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Affiliation(s)
- N DongMei
- Department of Public Health, Kinki University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka 589-8511, Japan
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15
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Alwis G, Karlsson C, Stenevi-Lundgren S, Rosengren BE, Karlsson MK. Femoral neck bone strength estimated by hip structural analysis (HSA) in Swedish Caucasians aged 6-90 years. Calcif Tissue Int 2012; 90:174-85. [PMID: 22271247 DOI: 10.1007/s00223-011-9566-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 12/23/2011] [Indexed: 11/26/2022]
Abstract
Dual-energy X-ray absorptiometry hip scans of 1,760 population-based Caucasians, 599 girls and 642 boys aged 6-19 years and 270 women and 249 men aged 20-90 years, were analyzed with the hip structural analysis (HSA) software to present age- and sex-specific normative HSA data of the femoral neck (FN). Measured traits included bone mineral density (BMD), cross-sectional area (CSA), section modulus (Z), periosteal diameter (PD), endosteal diameter (ED), cortical thickness (CT), and cross-sectional moment of inertia (CSMI). When plotting the measured traits versus age, the curves increased with higher ages until statistically significant break points were reached, for all traits at age 17 in girls and age 19 in boys. After the break points, PD and ED increased with higher ages but, as ED increased more than PD, BMD and CT decreased significantly with higher ages. The decline in BMD was counteracted by the increase in bone size so that there was only a nonstatistically significant decrease in bone strength, estimated as Z and CSMI, from break point to age 90. The partial preservation of bone strength was more obvious in men than in women as the decline in BMD was higher in women than in men, while the expansion in PD was larger in men than in women. The sex difference in the normative FN bone strength data seems to be related to sex discrepancies in the development of both bone mass and geometrical parameters during both growth and adulthood.
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Affiliation(s)
- Gayani Alwis
- Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, 205 02 Malmö, Sweden
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16
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Bleicher K, Cumming RG, Naganathan V, Travison TG, Sambrook PN, Blyth FM, Handelsman DJ, Le Couteur DG, Waite LM, Creasey HM, Seibel MJ. The role of fat and lean mass in bone loss in older men: findings from the CHAMP study. Bone 2011; 49:1299-305. [PMID: 21925297 DOI: 10.1016/j.bone.2011.08.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 08/03/2011] [Accepted: 08/23/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE Weight loss is associated with bone loss; however, it is unclear whether loss of fat or loss of lean body mass plays the key role in this relationship. The aim of this longitudinal analysis was to clarify the relationship between hip BMD, hip BMC and whole body BMC with changes in fat and lean tissue mass in older men. METHODS The Concord Health and Aging in Men Project (CHAMP) is a population-based study in Sydney, Australia, involving 1705 men aged 70-97 years. Bone mineral density (BMD) of the total hip, and bone mineral content (BMC) of the hip and whole body (WB), lean mass and fat mass were measured with Dual X-ray Absorptiometry (DXA). Multivariate linear regression models were used to assess relationships. RESULTS Over 2.2 years of follow-up, 368(33%) men lost at least 2% of their body weight, which included a mean loss of 0.8 kg/year of lean body mass and 0.9 kg/year of fat body mass. Fat loss was strongly associated with BMD loss in men who lost weight. As a group, weight losers lost 1.0% of hip BMD annually compared to 0.2% in men who gained weight, with each kilo of fat loss associated with 0.6%/year hip BMD loss (p<0.0001). Lean mass was not associated with hip BMD loss in weight losers, however, lean mass change was associated with BMD change in men who gained weight (0.3% hip BMD increase per kilo increase of lean mass p<0.01). CONCLUSION Maintaining body weight is important for bone health in elderly men. Body fat plays an important role in this relationship, which may reflect the additional metabolic function of adipose tissue.
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Affiliation(s)
- Kerrin Bleicher
- University of Sydney, Sydney, Australia Centre for Education and Research on Ageing: CHAMP Project, Concord Hospital, NSW, Australia.
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17
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Travison TG, Chiu GR, McKinlay JB, Araujo AB. Accounting for racial/ethnic variation in bone mineral content and density: the competing influences of socioeconomic factors, body composition, health and lifestyle, and circulating androgens and estrogens. Osteoporos Int 2011; 22:2645-54. [PMID: 21210082 PMCID: PMC3123392 DOI: 10.1007/s00198-010-1520-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Accepted: 12/06/2010] [Indexed: 10/18/2022]
Abstract
UNLABELLED The relative importance of various contributors to racial/ethnic variation in BMC/BMD is not established. Using population-based data, we determined that body composition differences (specifically skeletal muscle and fat mass) are among the strongest contributors to these variations. INTRODUCTION Racial/ethnic variation in fracture risk is well documented, but the mechanisms by which such heterogeneity arises are poorly understood. We analyzed data from black, Hispanic, and white men enrolled in the Boston Area Community Health/Bone (BACH/Bone) Survey to determine the contributions of risk factors to racial/ethnic differences in bone mineral content (BMC) and density (BMD). METHODS In a population-based study, BMC, BMD, and body composition were ascertained by DXA. Socioeconomic status, health history, and dietary intake were obtained via interview. Hormones and markers of bone turnover were obtained from non-fasting blood samples. Multivariate analyses measured percentage reductions in estimated racial/ethnic differences in BMC/BMD, accompanying the successive removal of covariates from linear regression models. RESULTS Black men demonstrated greater BMC than their Hispanic and white counterparts. At the femoral neck, adjustment for covariables was sufficient to reduce these differences by 46% and 35%, respectively. While absolute differences in BMC were smaller at the distal radius than femoral neck, the proportionate reductions in racial/ethnic differences after covariable adjustment were comparable or greater. Multivariate models provided evidence that lean and fat mass, serum 25(OH)D, osteocalcin, estradiol, and aspects of socioeconomic status influence the magnitude of racial/ethnic differences in BMC, with lean and fat mass providing the strongest effects. Results for BMD were similar, but typically of lesser magnitude and statistical significance. CONCLUSIONS These cross-sectional analyses demonstrate that much of the racial/ethnic heterogeneity in measures of bone mass and density can be accounted for through variation in body composition, diet, and socio-demographic factors.
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Affiliation(s)
- Thomas G. Travison
- Section of Endocrinology, Diabetes and Nutrition; Boston University School of Medicine, Boston, MA, USA
| | - Gretchen R. Chiu
- Department of Epidemiology; New England Research Institutes, Inc., Watertown, MA, USA
| | - John B. McKinlay
- Department of Epidemiology; New England Research Institutes, Inc., Watertown, MA, USA
| | - Andre B. Araujo
- Department of Epidemiology; New England Research Institutes, Inc., Watertown, MA, USA
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Djonic D, Milovanovic P, Nikolic S, Ivovic M, Marinkovic J, Beck T, Djuric M. Inter-sex differences in structural properties of aging femora: implications on differential bone fragility: a cadaver study. J Bone Miner Metab 2011; 29:449-57. [PMID: 21127922 DOI: 10.1007/s00774-010-0240-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 10/07/2010] [Indexed: 02/06/2023]
Abstract
In this paper we examined age-related and sex-specific deterioration in bone strength of the proximal femur reflected in mechanical properties from dual energy X-ray absorptiometry (DXA)-based hip structural analysis (HSA) on a cadaveric sample from the Balkans. Cadaveric studies permit more precise measurement of HSA parameters and allow further analyses by micromorphometric methods. DXA and HSA analysis was performed on a total of 138 cadaveric proximal femora (63 female, 75 male, age range 20-101 years) from Belgrade. HSA parameters are reported for three standard regions of the proximal femur (narrow neck, intertrochanteric, and shaft). Major age-related findings include an increase in the radius of gyration (first reported in this study), a decline in the cross-sectional area (CSA), a shift in the centroid towards the medial cortex, higher buckling ratios and lower section moduli. Whereas age appears to affect mostly the neck region in men, weakening is also evident in the intertrochanteric region in women, particularly after the age of 80. Aging femoral neck declines in bending strength and increases in buckling susceptibility. The reduced bone mass tends to be distributed farther from the centroidal axis (increase in radius of gyration with decline in CSA). Bone mass is preferentially lost from the lateral part of the cross-section shifting the centroid towards the medial cortex which may increase fragility of the lateral part during fall impact. Results of this study contribute to the epidemiologic data on gender differences and age trends in aging male and female femora.
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Affiliation(s)
- Danijela Djonic
- Laboratory for Anthropology, Institute of Anatomy, School of Medicine, University of Belgrade, 4/2 Dr Subotica, 11000 Belgrade, Serbia
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Iki M, DongMei N, Tamaki J, Sato Y, Kagamimori S, Kagawa Y, Yoneshima H. Age-specific reference values of hip geometric indices from a representative sample of the Japanese female population: Japanese Population-based Osteoporosis (JPOS) Study. Osteoporos Int 2011; 22:1987-96. [PMID: 20882272 DOI: 10.1007/s00198-010-1406-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 09/01/2010] [Indexed: 11/26/2022]
Abstract
UNLABELLED We analyzed 2,107 hip dual-energy X-ray absorptiometry (DXA) images from the Japanese Population-based Osteoporosis Study with the Hip Structure Analysis (HSA) program to obtain age-specific reference values of HSA indices for the Japanese female population. These references may help physicians accurately assess HSA results and aid researchers in making interracial comparisons of the indices. INTRODUCTION Hip geometry is expected to improve hip fracture risk assessment, which is usually assessed by bone mineral density (BMD) alone. We aimed to establish a reference database for Japanese women. METHODS We studied 2,107 Japanese women (15-79 years old) with no history of bone metabolism-related diseases from the Japanese Population-based Osteoporosis Study performed in 1996. Hip geometry was conducted on DXA images with the HSA program, which yielded data for cross-sectional area (CSA), subperiosteal diameter (PD), endocortical diameter (ED), mean cortical thickness (CT), section modulus (SM), and buckling ratio at the narrow neck (NN), intertrochanter (IT), and femoral shaft (FS) regions. Mean HSA indices were determined for each 5-year age group after adjustment for height and weight based on most recent Japanese population values. RESULTS Age-related changes in HSA indices were evident for the 50-54 year group in the NN and IT regions and for the 55-59 year group in the FS region; these changes increased with age thereafter. Age-related changes in CSA and CT were almost identical to that of BMD. Japanese subjects exhibited BMD and CT values similar to those reported for US non-Hispanic white women, but had 16-23% smaller SM values. CSA and CT were highly correlated with conventional BMD, whereas ED, SM, and PD showed lower correlations. CONCLUSIONS Age-specific reference values of HSA indices for the Japanese female population were obtained. This database will form the foundation for accurate HSA result evaluation.
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Affiliation(s)
- M Iki
- Department of Public Health, Kinki University Faculty of Medicine, 377-2 Oono-higashi, Osaka-Sayama, Osaka 589-8511, Japan.
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Nelson DA, Beck TJ, Wu G, Lewis CE, Bassford T, Cauley JA, LeBoff MS, Going SB, Chen Z. Ethnic differences in femur geometry in the women's health initiative observational study. Osteoporos Int 2011; 22:1377-88. [PMID: 20737265 DOI: 10.1007/s00198-010-1349-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 07/02/2010] [Indexed: 10/19/2022]
Abstract
SUMMARY Participants in the observational study of the Women's Health Initiative (WHI) were studied to determine if ethnic differences in femur geometry can help to explain differences in hip fracture rates. Structural differences in femurs of African and Mexican-American women appear to be consistent with lower rates of hip fractures vs. whites. INTRODUCTION Ethnic origin has a major influence on hip fractures, but the underlying etiology is unknown. We evaluated ethnic differences in hip fracture rates among 159,579 postmenopausal participants in the WHI then compared femur bone mineral density (BMD) and geometry among a subset with dual X-ray absorptiometry (DXA) scans of the hip and total body. METHODS The subset included 8,206 non-Hispanic whites, 1,476 African-American (AA), 704 Mexican-American (MA), and 130 Native Americans (NA). Femur geometry derived from hip DXA using hip-structure analysis (HSA) in whites was compared to minority groups after adjustment for age, height, weight, percent lean mass, neck-shaft angle and neck length, hormone use, chronic disease (e.g., diabetes, rheumatoid arthritis, cancer), bone active medications (e.g., corticosteroids, osteoporosis therapies), and clinical center. RESULTS Both AA and MA women suffered hip fractures at half the rate of whites while NA appeared to be similar to whites. The structural advantage among AA appears to be due to a slightly narrower femur that requires more bone tissue to achieve similar or lower section moduli (SM) vs. whites. This also underlies their higher BMD (reduces region area) and lower buckling ratios (buckling susceptibility). Both MA and NA women had similar advantages vs. whites at the intertrochanter region where cross-sectional area and SM were higher but with no differences at the neck. NA and MA had smaller bending moments vs. whites acting in a fall on the hip (not significant in small NA sample). Buckling ratios of MA did not differ from whites at any region although NA had 4% lower values at the IT region. CONCLUSION Differences in the geometry at the proximal femur are consistent with the lower hip fracture rates among AA and MA women compared to whites.
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Affiliation(s)
- D A Nelson
- Wayne State University School of Medicine, 5057 Woodward Avenue, Suite 6305, Detroit, MI 48202, USA.
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Abstract
A number of potential effects of mobile cellular phones on human health have been pinpointed, but the question of whether they affect bone mineralization has rarely been addressed. This study assessed differences in bone mineralization in the right and left hip of healthy male adult volunteers who were either nonusers of mobile phones (n=24) or users who carried the phone close to the right hip, for at least 1 year (n=24). Dual-energy x-ray absorptiometry (GE Lunar Prodigy) was performed in dual femur mode for each subject. Right and left hip bone mineral density (BMD) and bone mineral content (BMC) were compared. No difference in mean BMDs and BMCs between groups was found. Nonusers had higher BMC in the right femoral neck (P=0.0044), a difference absent in mobile phone users (P=0.028 for the right-left difference in nonusers vs users). Mobile phone users, but not nonusers, had lower BMD at the right trochanter (P=0.027) and lower BMC at the right trochanter (P=0.014) and right total hip (P=0.039). Linear regression showed a correlation between estimated cumulative hours carrying a cell phone on the right hip and differences between right and left trochanter BMD (r=0.434; P=0.034). The different asymmetries between right and left hip dual-energy x-ray absorptiometry values in nonusers and mobile phone users suggest that these devices may adversely affect bone mineralization.
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Nam HS, Shin MH, Zmuda JM, Leung PC, Barrett-Connor E, Orwoll ES, Cauley JA. Race/ethnic differences in bone mineral densities in older men. Osteoporos Int 2010; 21:2115-23. [PMID: 20204598 PMCID: PMC2974925 DOI: 10.1007/s00198-010-1188-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 01/15/2010] [Indexed: 11/24/2022]
Abstract
SUMMARY BMD was compared across race/ethnic groups. There were substantial race/ethnic differences in BMD even within African or Asian origin. Additional adjustment for body size greatly attenuated or reversed the differences between US Caucasian men vs Asian men. It illustrates the role of body size on the difference between these groups. INTRODUCTION There is insufficient epidemiologic information about men's bone mineral density (BMD) levels across race/ethnic groups and geographic locations. METHODS In a cross-sectional design, we compared BMD in older men across seven race/ethnic groups in four countries. Femoral neck, total hip, and lumbar spine BMD were measured in men (age 65 to 78 years) from the Osteoporotic Fractures in Men (MrOS) Study (4,074 Caucasian, 208 African-American, 157 Asian, and 116 Hispanic men in USA), Tobago Bone Health Study (422 Afro-Caribbean men), MrOS Hong Kong Study (1,747 Hong Kong Chinese men), and the Namwon Study (1,079 South Korean men). BMD was corrected according to the cross-site calibration results for all scanners. RESULTS When compared with US Caucasian men, Afro-Caribbean and African-American men had, respectively, 8-20% and 6-11% higher age-adjusted mean BMD at all three bone sites. Hip BMD was similar in US Caucasian and Hispanic men, US Asian, Hong Kong Chinese, and Korean men had 3-14% lower BMD at all bone sites except femoral neck in Korean men. Additional adjustment for weight and height greatly attenuated or reversed the differences between US Caucasian men vs Asian men including US Asian, Hong Kong Chinese, and South Korean men. Among Asian groups, Korean men had higher femoral neck BMD and lower total hip BMD. CONCLUSION These findings show substantial race/ethnic differences in BMD even within African or Asian origin and illustrate the important role of body size on the difference between Asian men and others.
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Affiliation(s)
- H.-S. Nam
- Department of Preventive Medicine, Research Institute for Medical Sciences, Chungnam National University College of Medicine, Daejeon, South Korea
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A524, Pittsburgh, PA 15261 USA
| | - M.-H. Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - J. M. Zmuda
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A524, Pittsburgh, PA 15261 USA
| | - P. C. Leung
- Jockey Club Centre for Osteoporosis Care and Control, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - E. Barrett-Connor
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA USA
| | - E. S. Orwoll
- Bone and Mineral Unit, Oregon Health and Sciences University, Portland, OR USA
| | - J. A. Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A524, Pittsburgh, PA 15261 USA
| | - Osteoporotic Fractures in Men (MrOS) Research Group
- Department of Preventive Medicine, Research Institute for Medical Sciences, Chungnam National University College of Medicine, Daejeon, South Korea
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Crabtree Hall A524, Pittsburgh, PA 15261 USA
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, South Korea
- Jockey Club Centre for Osteoporosis Care and Control, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA USA
- Bone and Mineral Unit, Oregon Health and Sciences University, Portland, OR USA
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Ribeiro RR, Santos-Ribeiro KD, Guerra-Junior G, Barros-Filho ADA. Comparison of bone quantity by ultrasound measurements of phalanges between white and black children living in Paraná, Brazil, with Europeans. Braz J Med Biol Res 2010; 43:976-81. [PMID: 20802978 DOI: 10.1590/s0100-879x2010007500089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 08/11/2010] [Indexed: 11/21/2022] Open
Abstract
The objective of this study was to determine bone quantity by ultrasound measurements of the proximal finger phalanges (AD-SoS = amplitude-dependent speed of sound) of healthy Brazilian schoolchildren living in Paraná, Brazil and to compare these values with European populations. The sample was composed of 1356 Brazilian schoolchildren of both genders (660 males, 696 females), aged 6 to 11 years, divided into white (840) and black (516) groups and compared to age- and gender-matched Europeans. AD-SoS of the schoolchildren increased significantly with age for both genders. Significantly higher AD-SoS values were observed for the white children (1916 ± 58) compared to their black counterparts (1898 ± 72) and for the female gender (1920 ± 61) compared to the male gender (1898 ± 66). Overall, the AD-SoS outcomes for females were similar to those of European studies. However, the AD-SoS of the Brazilian schoolchildren of both genders and skin colors was lower than that reported for children in Poland. AD-SoS outcomes for Brazilian schoolboys were similar to those obtained in Italian studies and were lower than those of the Spanish children. In conclusion, Brazilian schoolchildren of both genders and skin colors showed lower bone quantities than Polish children and Spanish males, and levels similar to Italian children and Spanish females.
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Affiliation(s)
- R R Ribeiro
- Centro de Investigação em Pediatria, Departamento de Pediatria, Universidade Estadual de Campinas, SP, Brasil
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Saeed I, Carpenter RD, Leblanc AD, Li J, Keyak JH, Sibonga JD, Lang TF. Quantitative computed tomography reveals the effects of race and sex on bone size and trabecular and cortical bone density. J Clin Densitom 2009; 12:330-6. [PMID: 19577939 DOI: 10.1016/j.jocd.2009.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 03/27/2009] [Accepted: 04/05/2009] [Indexed: 11/28/2022]
Abstract
To examine the effects of race and sex on bone density and geometry at specific sites within the proximal femur and lumbar spine, we used quantitative computed tomography to image 30 Caucasian American (CA) men, 25 African American (AA) men, 30 CA women, and 17 AA women aged 35-45 yr. Volumetric integral bone mineral density (BMD), trabecular BMD (tBMD), and cross sectional area were measured in the femoral neck, trochanter, total femur, and L1/L2 vertebrae. Volumetric cortical BMD (cBMD) was also measured in the femur regions of interest. Differences were ascertained using a multivariate regression model. Overall, AA subjects had denser bones than CA subjects, but there were no racial differences in bone size. Men had larger femoral necks but not larger vertebrae than women. The AA men had higher tBMD and cBMD in the femur than CA men, whereas AA women had higher femoral tBMD but not higher femoral cBMD than CA women. These data support the idea that higher hip fracture rates in women compared with men are associated with smaller bone size. Lower fracture rates in AA elderly compared with CA elderly are consistent with higher peak bone density, particularly in the trabecular compartment, and potentially lower rates of age-related bone loss rather than larger bone size.
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Affiliation(s)
- Isra Saeed
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA 94143-0946, USA
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Travison TG, Araujo AB, Beck TJ, Williams RE, Clark RV, Leder BZ, McKinlay JB. Relation between serum testosterone, serum estradiol, sex hormone-binding globulin, and geometrical measures of adult male proximal femur strength. J Clin Endocrinol Metab 2009; 94:853-60. [PMID: 19106273 PMCID: PMC2681275 DOI: 10.1210/jc.2008-0668] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Although previous studies have indicated associations between circulating testosterone (T) or estradiol (E2) concentrations and bone mineral density, the relationship between gonadal steroids and skeletal geometry is not well defined. OBJECTIVE Our objective was to uncover the relation between circulating T or E2 and proximal femur geometry in a diverse sample of men. DESIGN We used data on 808 men enrolled in the Boston Area Community Health/Bone Study. Serum concentrations of total and calculated free T and E2 were obtained via early-morning blood sampling. The geometry of the proximal femur at three sites (the narrow neck, intertrochanter, and shaft) was obtained using the Hip Structural Analysis technology. Analyses adjusted for subjects' age, height, total body lean mass and fat mass, and level of physical activity were performed. SETTING In-home interviews accompanied by subject visits to the General Clinical Research Center at Boston University School of Medicine were performed. STUDY PARTICIPANTS A randomly selected cohort of men living in Boston, MA (ages 30-79 yr) was included in the study. INTERVENTIONS These were not applicable. MAIN OUTCOME MEASURES Bone mineral density and bone outer diameter, cross-sectional area (measuring bone material), and section modulus (an index of bending strength) were calculated. RESULTS In age-adjusted models, E2 was positively associated with hip strength parameters, whereas T was not. Adjustment for age and other parameters resulted in substantial reductions in, but not complete elimination of, associations between E2 and hip strength parameters. CONCLUSION Circulating E2 is strongly associated with proximal femur strength, an association that is partially mediated by body composition.
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Affiliation(s)
- Thomas G Travison
- New England Research Institutes, 9 Galen Street, Watertown, Massachusetts 02472, USA.
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Ribeiro RR, Guerra-Junior G, de Azevedo Barros-Filho A. Bone mass in schoolchildren in Brazil: the effect of racial miscegenation, pubertal stage, and socioeconomic differences. J Bone Miner Metab 2009; 27:494-501. [PMID: 19283337 DOI: 10.1007/s00774-009-0062-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Accepted: 11/05/2008] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to evaluate bone mass by phalanges ultrasound in healthy white and black schoolchildren in relationship to socioeconomic level, pubertal stage, and body composition. Included were 1,356 healthy schoolchildren aged from 6 to 11 years from different socioeconomic levels and both genders; all were placed into white and black groups. Weight, height, body mass index, fat percentage, fat mass, and lean mass were evaluated by anthropometric methods, and AD-SoS bone quantity and UBPI bone quality were evaluated using a third-generation IGEA phalanges DBM Sonic BP ultrasound. Data were compared using the Mann-Whitney, chi-squared, correlation coefficient, and analyses of multiple linear regression statistical tests with 5% significance. Black schoolchildren predominated in the low socioeconomic levels. Higher values of weight and height for black boys and girls were observed in the lean mass in relation to white children of the same gender and age. An increasing variation in the bone quantity mean was observed from 6 to 11 years of age and with pubertal stage for both genders and skin color. The white schoolchildren presented higher values of bone quantity and quality in relation to the black children. The anthropometric, gender, and socioeconomic level variables explained only 16 and 11% of the variability of bone quantity and quality, respectively. As such, the present study, carried out with healthy black and white Brazilian schoolchildren, demonstrated higher bone mass, as evaluated by ultrasound, in white than in black schoolchildren.
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Affiliation(s)
- Roberto Regis Ribeiro
- Department of Pediatrics, Center of Investigation in Pediatrics, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, SP, 13083-970, Brazil
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Travison TG, Araujo AB, Esche GR, Beck TJ, McKinlay JB. Lean mass and not fat mass is associated with male proximal femur strength. J Bone Miner Res 2008; 23:189-98. [PMID: 17922610 PMCID: PMC2665700 DOI: 10.1359/jbmr.071016] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2007] [Revised: 09/10/2007] [Accepted: 10/03/2007] [Indexed: 01/23/2023]
Abstract
UNLABELLED Obesity is suspected to confer protection against fracture, but evidence is mixed. We examined proximal femur geometry and body composition measures in a diverse group of 1171 men (30-79 yr of age). Analyses showed that nonbone lean mass, but not fat mass, is independently associated with measures of proximal femur density, axial and bending strength, and resistance to buckling. INTRODUCTION Obesity is often said to confer protection against fracture, but the mechanisms driving such an association remain poorly understood. We hypothesized that the effect of increased body mass on bone structure would be accounted for by total and/or appendicular nonbone lean mass, and that once these trends were removed, fat mass would show no protective influence. To test this hypothesis, we examined body composition and geometric indices of proximal femur strength in an ethnically diverse (black, Hispanic, and white) sample of randomly selected men, 30-79 yr of age. MATERIALS AND METHODS Data were obtained from N = 1171 community-dwelling subjects enrolled in the cross-sectional Boston Area Community Health/Bone study. Body composition was obtained by DXA. Hip geometry parameters at the narrow neck, intertrochanter, and shaft were obtained using Hip Structural Analysis of DXA images. These measures included BMD, bone material in cross-sections (cross-sectional area), bending strength (section modulus), and propensity to buckle under compression (average buckling ratio). Analyses controlled for age, race/ethnicity, height, and physical activity. RESULTS In exploratory analyses, lean mass, fat mass, and BMI were each positively associated with hip strength. However, controlling for lean mass was sufficient to remove the positive, and induce a negative, association for fat mass or BMI. Associations between lean mass and hip strength were strongest and resistant to control for other measures. Lean mass alone was sufficient to account for a substantial proportion of racial/ethnic difference in hip strength measures, whereas fat mass exhibited no comparable explanatory power. CONCLUSIONS The positive association between relative weight and proximal femur strength is accounted for by lean mass, suggesting that, in men, the protective effect of BMI in preventing fracture is mediated not by adipose tissue but by the influence of increased muscle mass accompanying elevated BMI.
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Affiliation(s)
- Thomas G Travison
- New England Research Institutes, Watertown, Massachusetts 02472, USA.
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