Changes in soft tissue composition are the primary predictors of 4-year bone mineral density changes in postmenopausal women

Anti-osteoporosis treatments changed body composition in postmenopausal women: A systematic review and meta-analysis

BACKGROUND

Whether the widespread anti-osteoporosis treatments in postmenopausal women also benefit the change of body composition (lean body mass [LBM] and body fat mass [FM]) remains controversial. In order to solve this issue and find out the most effective treatment, we conducted this meta-analysis.

METHODS

We searched the literature, via PubMed, Embase, Scopus, Web of Science, and Cochrane to screen citations from inception to March 26, 2022, for inclusion in this study. Only clinical trials that used anti-osteoporosis treatments in postmenopausal women and displayed the alteration of body composition were included. Stata 14.0 was used for the meta-analysis.

RESULTS

Our meta-analysis results presented that: compared with placebo, hormone replacement therapy (HRT) was associated with increased LBM (standardized mean differences [SMD] = 0.32, 95% confidence interval [CI] = 0.02-0.61) and reduced FM (SMD = -0.30, 95% CI = -0.51 to -0.09) in postmenopausal women. Compared with placebo, physical exercise training showed an effect of decreasing FM (SMD = -0.66, 95% CI = -0.94 to -0.38) but not significant influence LBM (SMD = 1.31, 95% CI = -0.29 to 2.91). The network meta-analysis of our study showed that oral estrogen and progestogen plus exercise (OEPE) treatment might be the most effective anti-osteoporosis treatment (surface under the cumulative ranking curve 99.9) to reduce FM in postmenopausal women.

CONCLUSIONS

anti-osteoporosis treatments, especially HRT, affect body composition. Furthermore, the combination of HRT and exercise training are the most effective treatment to reduce FM while maintaining LBM.

Long-term rates of change in musculoskeletal aging and body composition: findings from the Health, Aging and Body Composition Study

Musculoskeletal disorders are common among older people. Preventive strategies require understanding of age-related changes in strength, function and body composition, including how they interrelate. We have described, and examined associations between, 9-year changes in these parameters among 2917 Health, Aging and Body Composition Study participants (aged 70-79 years). Appendicular lean mass (ALM), whole body fat mass and total hip BMD were ascertained using DXA; muscle strength by grip dynamometry; and muscle function by gait speed. For each characteristic annualised percentage changes were calculated; measures of conditional change (independent of baseline) were derived and their interrelationships were examined using Pearson correlations; proportion of variance at 9-year follow-up explained by baseline level was estimated; and mean trajectories in relation to age were estimated using linear mixed models. Analyses were stratified by sex. Median [lower quartile, upper quartile] annual percentage declines were grip strength (1.5 [0.0, 2.9]), gait speed (2.0 [0.6, 3.7]), ALM (0.7 [0.1, 1.4]), fat mass (0.4 [- 1.1, 1.9]) and hip BMD (0.5 [0.0, 1.1]). Declines were linear for ALM and accelerated over time for other characteristics. Most conditional change measures were positively correlated, most strongly between ALM, fat mass and hip BMD (r > 0.28). Proportion of variation at follow-up explained by baseline was lower for grip strength and gait speed (39-52%) than other characteristics (69-86%). Strength and function declined more rapidly, and were less correlated between baseline and follow-up, than measures of body composition. Therefore, broader intervention strategies to prevent loss of strength and function in later life are required as those targeting body composition alone may be insufficient.

Relationship between the changes over time of bone mass and muscle health in children and adults: a systematic review and meta-analysis

Background

Various cross-sectional studies provide an abundance of evidence that shows a relationship between bone quantity and muscle health. However, one question remains, less-often studied: is their development - or decline – associated? The aim of the research was to conduct a systematic review and meta-analysis to summarize the studies exploring the association between changes in bone mineral density (BMD) and changes in muscle parameters (registration CRD42018093813).

Methods

We searched for prospective studies, both in children and adults, by consulting electronic databases (Ovid-MEDLINE, Ovid-AMED, Scopus). Each review steps were performed by two independent reviewers. For outcomes reported by less of 3 studies, we synthetized the results narratively. In other cases, a meta-analysis was performed, giving an overall r coefficient and its 95% confidence interval (CI).

Results

Fifteen papers were included. In connection with the change of BMD, 10 studies concerned the parallel change of lean mass, 4 were about grip strength, and 1 was about physical performance. Children were the population of interest for 5 studies, while the aging population was the focus of the other studies. The correlation between hip BMD and lean mass was significant, with an overall coefficient r = 0.37 (95% CI 0.23–0.49). High heterogeneity was observed between studies but the length of follow-up, sex and study quality did not seem to significantly influence results. The systematic review allowed some other highlights: a significant link between changes in BMD and changes in muscle strength was observed (p-value < 0.05 in the 4 studies), in addition to changes in performance (1 study, r = 0.21, p-value = 0.004).

Conclusion

Despite the heterogeneity between studies, we highlighted a significant association between the change of BMD and the change of various muscle parameters. Future studies should investigate preventive and therapeutic strategies that are based on a single entity: the ‘muscle-bone unit’.

Effect of 2 years of endurance and high-impact training on preventing osteoporosis in postmenopausal women: randomized clinical trial

OBJECTIVE

The aim of the study was to analyze the effects of endurance and high-impact training oriented toward preventing osteoporosis in postmenopausal women with calcium and vitamin D supplementation.

METHODS

This study was a randomized clinical trial. Thirty-six postmenopausal women were randomized to the control and experimental groups. Thirty-four women completed the 2-year interventions. The control group training involved walking at an intense pace. The experimental group conducted high-impact training specifically oriented to prevent osteoporosis. Dual-energy x-ray absorptiometry was used to estimate the T-scores of the lumbar spine and femoral neck.

RESULTS

The fast-walking group showed constant T-scores in the femoral neck and improved T-scores in the lumbar spine. High-impact exercises produced improvements in both anatomical levels. Significant differences were found in the femoral neck (ΔControl = -0.04, ΔExperimental = 0.28). The differences were not significant in the lumbar spine (ΔControl = 0.27, ΔExperimental = 0.47). Cohen's effect size (d = 0.52) suggested a medium practical significance of the trial. The power was 51%.

CONCLUSIONS

Calcium plus vitamin D supplementation combined with specifically oriented exercises had a higher impact in the femoral neck than walking at an intense pace. As there were no differences at the lumbar spine level, the results were, however, inconclusive concerning which type of exercise was the most convenient. Importantly, the fact that the T-scores did not decrease after 2 years supports the belief that both proposed interventions can be conveniently used to prevent osteoporosis in postmenopausal women. A trial with a larger sample size would provide consistency to the findings and is warranted given the possible effects and benefits.

Long-term changes in bone mineral density in kidney transplant recipients

BACKGROUND

Alterations in bone mineral metabolism occur when kidney function declines and often continue after transplantation. We investigated long-term changes in bone mineral density (BMD) among kidney transplant recipients undergoing routine clinical BMD monitoring and management.

METHODS

We identified adults receiving a kidney transplant in the province of Manitoba, Canada (1996-2011) who had greater than or equal to 2 posttransplant dual energy X-ray absorptiometry examinations. Bone mineral density was expressed as Z scores (standard deviation above/below sex-matched and age-matched reference data). The main outcome was the change in BMD.

RESULTS

A total of 326 kidney transplant recipients were included (mean age, 45 years; 61% men). Recipients were followed up for an average of 8.2 years (766 follow-up dual energy X-ray absorptiometry measurements). At baseline (first scan; median, 0.5 years after transplantation), bone density was slightly below average for age and sex (mean Z scores: lumbar spine, -0.4 ± 1.6; femoral neck, -0.7 ± 1.1; total hip, -0.7 ± 1.1). At the second scan (mean, 2.7 years after first scan), mean bone density Z scores have increased (lumbar spine, -0.2 ± 1.6; femoral neck, -0.6 ± 1; total hip, -0.6 ± 1.1; matched, P < 0.01 at all sites). The only factor associated with a significant BMD change at all sites was osteoporosis treatment (BMD increase). Even after restricting the analysis to recipients who had not received osteoporosis treatment, final mean bone density (mean, 8.2 years after first scan) was average for age and sex (lumbar spine, +0.7 ± 1.6; femoral neck, -0.1 ± 1.1; total hip, 0.0 ± 1.1).

CONCLUSION

With routine BMD monitoring and management, posttransplant bone density typically remains stable or improves with mean values that are average for age and sex.

Relationship of calf circumference with bone mineral density and hip geometry: a hospital-based cross-sectional study

Calf circumference has significant predictive value for bone mineral density (BMD) at hip and spine and for fracture at spine in both genders and hence may be used as a clinical risk factor for fracture when BMD is not available.

INTRODUCTION

Lean muscle mass and higher regular physical ability has been shown to correlate with BMD and hip geometry. Calf circumference is an indicator of muscle mass. We examined the association of calf circumference (CC), thigh circumference (TC), and physical performances with BMD and hip geometry.

MATERIALS AND METHODS

Females above 45 years (at least 5 years postmenopausal) and males above 55 years were enrolled. Bilateral CC and TC were measured, and BMD was assessed at neck of femur (NF), trochanter (TR), inter-trochanter (IT), spine, and forearm. Dual energy X-ray absorptiometry scan-based hip geometry parameters were analyzed.

RESULTS

One hundred sixteen subjects (29 males and 87 females) were enrolled. CC correlated significantly with BMD at NF, IT, TR, and spine in male and female, respectively, and at forearm in female. Multivariate regression analysis showed CC as a significant predictor of BMD (at TR, IT, NF, and spine in both genders) and fracture (at spine in both genders). CC had significant positive correlation with hip parameters-cross-sectional area; cortical thickness; and section modulus at NF, IT, and TR in both genders and negative correlation with buckling ratio at NF and IT in females.

CONCLUSION

CC is a significant predictor of BMD at hip and spine and fracture at spine in both genders.

Usefulness of estimated height loss for detection of osteoporosis in women

PURPOSE

This study was done to examine the threshold value of estimated height loss at which the risk of osteoporosis increases and to verify its discriminative ability in the detection of osteoporosis.

METHODS

It was conducted based on epidemiological descriptive methods on 732 Korean women at a public healthcare center in Seoul between July and November 2010. ANOVA, Pearson correlation, logistic regression analysis and receiver operating characteristics (ROC) curve were used for data analysis.

RESULTS

There was an age-related correlation between bone mineral density (lumbar spine: F=37.88, p<.001; femur: F=54.27, p<.001) and estimated height loss (F=27.68, p<.001). Estimated height loss increased significantly with decreasing bone mineral density (lumbar spine: r=-.23, p<.001; femur: r=-.34, p<.001). The odds ratio for the point at which the estimated height loss affects the occurrence of osteoporosis was found to increase at a cut-off value of 2 cm and the area under ROC curve was .71 and .82 in lumbar spine and femur, respectively.

CONCLUSION

The optimal cut-off value of the estimated height loss for detection of osteoporosis was 2 cm. Height loss is therefore a useful indicator for the self-assessment and prognosis of osteoporosis.

The role of fat and lean mass in bone loss in older men: findings from the CHAMP study

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.