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Gifre L, Massó E, Fusaro M, Haarhaus M, Ureña P, Cozzolino M, Mazzaferro S, Calabia J, Peris P, Bover J. Vertebral fractures in patients with CKD and the general population: a call for diagnosis and action. Clin Kidney J 2024; 17:sfae191. [PMID: 39099567 PMCID: PMC11294886 DOI: 10.1093/ckj/sfae191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Indexed: 08/06/2024] Open
Abstract
Vertebral fractures (VFs) are the most common osteoporotic fractures in the general population, and they have been associated with high mortality, decreased quality of life, and high risk of subsequent fractures, especially when recent, multiple, or severe. Currently, VF diagnosis and classification determine fracture risk and the most appropriate anti-osteoporotic treatment. However, VFs are clearly underdiagnosed, especially in patients with chronic kidney disease (CKD), and CKD-associated osteoporosis has been disregarded until recently. VFs are associated with higher morbidity and mortality, and their prevalence and incidence differ depending on the grade of renal dysfunction (CKD G1-G5) and/or the type of renal replacement therapy (dialysis or transplantation). In addition to classical risk factors [such as higher age, female sex, reduced bone mineral density, diabetes and steroid use], various other factors have been associated with an increased risk of VFs in CKD, including CKD grade, haemodialysis vintage, time since renal transplantation, low or high intact parathyroid hormone and phosphate levels, and/or vitamin D and K1 deficiencies. Importantly, several clinical societies have recently modified their algorithms according to the fracture risk classification (including the presence of VFs) and determined the most appropriate anti-osteoporotic treatment for the general population. However, there are no specific guidelines addressing this topic in patients with CKD despite an important paradigm shift regarding the prognostic value of bone mineral density in 2017 after the publication of the CKD-Mineral and Bone Disorder Kidney Disease: Improving Global Outcomes guidelines. A proactive attitude towards diagnosis, treatment, and research is proposed to avoid therapeutic nihilism.
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Affiliation(s)
- Laia Gifre
- Rheumatology Department, Hospital Germans Trias i Pujol, Research Institute Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Catalonia, Spain
| | - Elisabet Massó
- Nephrology Department, University Hospital Germans Trias i Pujol, REMAR-IGTP Group, Research Institute Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Catalonia, Spain
| | - Maria Fusaro
- National Research Council (CNR), Institute of Clinical Physiology, Pisa (Italy). Department of Medicine, University of Padua, Padua, Italy
| | - Mathias Haarhaus
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden
- Diaverum AB, Hyllie Boulevard 53, Malmö, Sweden
| | - Pablo Ureña
- Department of Nephrology and Dialysis, AURA Nord Saint-Ouen, Saint-Ouen, Paris, France
- Department of Renal Physiology, Necker Hospital, University of Paris Descartes, Paris, France
| | - Mario Cozzolino
- Renal Division, Department of Health Sciences, University of Milan, Milan, Italy
| | - Sandro Mazzaferro
- Department of Translation and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Jordi Calabia
- Nephrology Department, University Hospital Josep Trueta. IdIBGi Research Institute. Universitat de Girona, Catalonia, Spain
| | - Pilar Peris
- Rheumatology Department, Hospital Clinic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Catalonia, Spain
| | - Jordi Bover
- Nephrology Department, University Hospital Germans Trias i Pujol, REMAR-IGTP Group, Research Institute Germans Trias i Pujol (IGTP), Universitat Autònoma de Barcelona, Badalona (Barcelona), Catalonia, Spain
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Nie M, Chen Z, Shi L, Cao H, Xu L. Prediction of new vertebral compression fracture within 3 years after percutaneous vertebroplasty for osteoporotic vertebral compression fracture: Establishment and validation of a nomogram prediction model. PLoS One 2024; 19:e0303385. [PMID: 38771842 PMCID: PMC11108139 DOI: 10.1371/journal.pone.0303385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/23/2024] [Indexed: 05/23/2024] Open
Abstract
New vertebral compression fractures (NVCF) are common in patients with osteoporotic vertebral compression fractures (OVCF) who have undergone percutaneous vertebroplasty (PVP). We sought to develop a nomogram prediction model for better identification and prevention of NVCF within 3 years after PVP in patients with OVCF. The demographic, clinical, and imaging data of patients who underwent PVP for OVCF between January 2010 and December 2019 were reviewed. Multivariate logistic regression analysis was used to screen for risk factors for NVCF within 3 years after PVP. A nomogram prediction model was then developed and validated to visually predict NVCF. The samples in the model were randomly divided into training and validation sets at a ratio of 7:3. Twenty-seven percent of patients experienced NVCF in other segments within 3 years after PVP. Older age, lower bone mineral density (BMD), smoking, lack of anti-osteoporosis therapy, and postoperative trauma were risk factors for NVCF. The area under the receiver operating characteristic curve suggested good discrimination of this model: training set (0.781, 95% confidence interval: 0.731-0.831) and validation set (0.786, 95% confidence interval: 0.708-0.863). The calibration curve suggested good prediction accuracy between the actual and predicted probabilities in the training and validation sets. The DCA results suggested that, when the probability thresholds were 0.0452-08394 and 0.0336-0.7262 in the training and validation set, respectively, patients can benefit from using this model to predict NVCF within 3 years after PVP. In conclusion, this nomogram prediction model that included five risk factors (older age, lower BMD, smoking, postoperative minor trauma, and lack of anti-osteoporosis treatment can effectively predict NVCF within 3 years after PVP. Postoperative smoking cessation, standard anti-osteoporosis treatment, and reduction in incidental minor trauma are necessary and effective means of reducing the incidence of NVCF.
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Affiliation(s)
- Mingxi Nie
- Department of Emergency, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Shiyan City, Hubei Province, China
| | - Zefu Chen
- Department of Emergency, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Shiyan City, Hubei Province, China
| | - Liang Shi
- Department of Orthopedics, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Shiyan City, Hubei Province, China
| | - HongXia Cao
- Department of Rehabilitation Medicine, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Shiyan City, Hubei Province, China
| | - Lei Xu
- Department of Emergency, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Shiyan City, Hubei Province, China
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Chen Z, Xu L, Shi L, Cao H, Nie M. Long-term outcome of percutaneous vertebroplasty versus conservative treatment for osteoporotic vertebral compression fractures: a retrospective cohort study with three-year follow-up. Front Med (Lausanne) 2024; 11:1391243. [PMID: 38765251 PMCID: PMC11099242 DOI: 10.3389/fmed.2024.1391243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024] Open
Abstract
Background Osteoporotic vertebral compression fractures (OVCF) appear to be more common as the population ages. Previous studies have found that percutaneous vertebroplasty (PVP) can achieve better short-term clinical outcomes than conservative treatment (CT) for OVCF. However, the long-term outcomes of PVP compared with CT for OVCF has been rare explored. This study was designed to explore the clinical outcomes of PVP or CT within 3 years after OVCF. Methods This study reviewed the clinical outcomes of patients who underwent PVP or CT for OVCF in a single center from January 2015 to December 2019. The back pain visual analogue scale (VAS), Oswestry disability index (ODI) and satisfaction rate were compared between the two groups at baseline, 1 week, 1 month, 3 months, 6 months, 12 months, 24 months and 36 months after treatment. Outcomes The baseline data including gender, age, bone mineral density, body mass index, back pain VAS, and ODI were not significantly different between the two groups. The back pain VAS and ODI of CT patients were significantly higher than those of PVP group at 1 week, 1 month, 3 months, 6 months and 12 months after treatment. The satisfaction rate in the PVP group were significantly higher than those in the CT group at 1 week, 1 month, 3 months and 6 months after treatment. Subsequently, the back pain VAS and ODI showed no significant difference between the two groups at 24 and 36 months. In addition, there was no significant difference in treatment satisfaction between the two groups at 36 months. There was no significant difference in the rate of new vertebral compression fractures between the two groups within 36 months after treatment. Conclusion The clinical outcomes within 12 months after PVP and patient satisfaction rate within 6 months after PVP were significantly higher than CT. However, during 12 months to 36 months, this advantage generated by PVP was gradually diluted over time. Compared with CT, the long-term effect of PVP on OVCF should not be overestimated.
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Affiliation(s)
- Zefu Chen
- Department of Emergency, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Lei Xu
- Department of Emergency, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Liang Shi
- Department of Orthopedics, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - HongXia Cao
- Department of Rehabilitation Medicine, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Mingxi Nie
- Department of Emergency, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
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Li Q, Yang Z, Zhu M, Li J, Lu C, Li Z, Kong C, Li H, Niu M, Kang P. Prevalence and risk factors of osteoporotic fracture among the elderly population in China: a multicenter cross-sectional study. INTERNATIONAL ORTHOPAEDICS 2024; 48:1323-1330. [PMID: 38467869 DOI: 10.1007/s00264-024-06145-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/08/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE Prevalence of osteoporotic fracture (OPF) is increasing with ageing, resulting in a significant financial burden for healthcare. However, research on the nationwide epidemiological data of OPF in Chinese elderly is still scarce. The aim of this study was to investigate the prevalence and risk factors of OPF in Chinese population aged 60 years or order. METHODS A cross-sectional survey was conducted in an elderly Chinese population in five centres. Questionnaire investigation and imaging examination were taken in all participants to identify OPF prevalence and risk factors. Diagnosis of OPF was determined based on imaging of vertebral fractures or history of fall-related fractures. We then used multivariate logistic regression model to analyze the associations between the potential risk factors and OPF. RESULTS The overall prevalence of OPF in population aged 60 years or older was 24.7% (1,071/4,331), showing an increasing trend with age (P < 0.001). The prevalence of OPF was geographically distinct (P < 0.001), but similar between men and women (P > 0.05). Up to 96.8% of OPFs consisted of vertebral fractures, especially involving T11, T12, and L1 segments. Advanced age (≥ 80), vision loss, severe hearing loss, multiple exercise forms, chronic kidney disease, osteoarthritis, and trauma-related vertebral fractures were significantly associated with risk factors, while education level and vitamin D supplementation were associated with protective factors of OPF. CONCLUSION High prevalence of OPF is a serious threat to bone health among elderly people in China. There is an urgent need for effective strategies to diagnose, prevent, and treat OPF in elderly adults.
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Affiliation(s)
- Qianhao Li
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Zhouyuan Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Mengli Zhu
- Research Core Facility, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Li
- Research Center of Clinical Epidemiology and Evidence-Based Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chunyan Lu
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Zhirui Li
- Department of Orthopaedics, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Changchun Rd. 45, Xicheng District, 100053, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Changchun Rd. 45, Beijing, 100053, China
| | - Haifeng Li
- Department of Orthopedics, Wuxi Ninth People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Ming Niu
- Department of Orthopedics, Ganzhou District People's Hospital, Zhangye Gansu, 734000, China
| | - Pengde Kang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China.
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Zhao Y, Liu Q, Chen Y, Kwok TCY, Leung JCS, Feng H, Wong SYS. Trajectories of depressive symptom and its association with air pollution: evidence from the Mr. OS and Ms. OS Hong Kong cohort study. BMC Geriatr 2024; 24:318. [PMID: 38580934 PMCID: PMC10996234 DOI: 10.1186/s12877-024-04731-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 01/19/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Depression is a global health priority. Maintaining and delaying depressive symptoms in older adults is a key to healthy aging. This study aimed to identify depressive symptom trajectories, predictors and mortality, while also exploring the relationship between air quality and depressive symptoms in older adults in the Hong Kong community over 14 years. METHODS This study is a longitudinal study in Hong Kong. The target population was community-dwelling older adults over age 65. Depressive symptoms were measured by the Geriatric Depression Scale (GDS-15). Group-based trajectory model was used to identify heterogeneity in longitudinal changes over 14 years and examine the associations between baseline variables and trajectories for different cohort members using multinomial logistic regression. The Kaplan-Meier method was employed to conduct survival analysis and explore the variations in survival probabilities over time among different trajectory group. Linear mixed model was used to explore the relationship between air quality and depressive symptoms. RESULTS A total of 2828 older adults were included. Three different trajectories of depressive symptoms in older people were identified: relatively stable (15.4%), late increase (67.1%) and increase (17.5%). Female, more number of chronic diseases, poor cognitive function, and poor health-related quality of life (HRQOL) were significantly associated with other less favorable trajectories compared with participants with stable levels of depressive symptoms. The late increase group had a lower mortality rate than the relatively stable and increased groups. Lower baseline ambient air pollutant exposure to NO2 over 14 years was significantly associated with fewer depressive symptoms. CONCLUSIONS In this study, we found that a late increase in depressive symptoms was the predominant trend in older Chinese people in Hong Kong. Poorer HRQOL was predictive of less favorable trajectories of depressive symptoms. Ambient air pollution was associated with depressive symptoms. This novel observation strengthens the epidemiological evidence of longitudinal changes in depressive symptoms and associations with late-life exposure to air pollution.
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Affiliation(s)
- Yinan Zhao
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Qingcai Liu
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Yifei Chen
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Timothy C Y Kwok
- Department of Medicine & Therapeutics, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - Jason C S Leung
- Department of Medicine & Therapeutics, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Hui Feng
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China.
- Xiangya-Oceanwide Health Management Research Institute, Central South University, Changsha, Hunan Province, China.
| | - Samuel Yeung Shan Wong
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Yang Q, Cheng H, Qin J, Loke AY, Ngai FW, Chong KC, Zhang D, Gao Y, Wang HH, Liu Z, Hao C, Xie YJ. A Machine Learning-Based Preclinical Osteoporosis Screening Tool (POST): Model Development and Validation Study. JMIR Aging 2023; 6:e46791. [PMID: 37986117 PMCID: PMC10686208 DOI: 10.2196/46791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 09/16/2023] [Accepted: 10/02/2023] [Indexed: 11/22/2023] Open
Abstract
Background Identifying persons with a high risk of developing osteoporosis and preventing the occurrence of the first fracture is a health care priority. Most existing osteoporosis screening tools have high sensitivity but relatively low specificity. Objective We aimed to develop an easily accessible and high-performance preclinical risk screening tool for osteoporosis using a machine learning-based method among the Hong Kong Chinese population. Methods Participants aged 45 years or older were enrolled from 6 clinics in the 3 major districts of Hong Kong. The potential risk factors for osteoporosis were collected through a validated, self-administered questionnaire and then filtered using a machine learning-based method. Bone mineral density was measured with dual-energy x-ray absorptiometry at the clinics; osteoporosis was defined as a t score of -2.5 or lower. We constructed machine learning models, including gradient boosting machines, support vector machines, and naive Bayes, as well as the commonly used logistic regression models, for the prediction of osteoporosis. The best-performing model was chosen as the final tool, named the Preclinical Osteoporosis Screening Tool (POST). Model performance was evaluated by the area under the receiver operating characteristic curve (AUC) and other metrics. Results Among the 800 participants enrolled in this study, the prevalence of osteoporosis was 10.6% (n=85). The machine learning-based Boruta algorithm identified 15 significantly important predictors from the 113 potential risk factors. Seven variables were further selected based on their accessibility and convenience for daily self-assessment and health care practice, including age, gender, education level, decreased body height, BMI, number of teeth lost, and the intake of vitamin D supplements, to construct the POST. The AUC of the POST was 0.86 and the sensitivity, specificity, and accuracy were all 0.83. The positive predictive value, negative predictive value, and F1-score were 0.41, 0.98, and 0.56, respectively. Conclusions The machine learning-based POST was conveniently accessible and exhibited accurate discriminative capabilities for the prediction of osteoporosis; it might be useful to guide population-based preclinical screening of osteoporosis and clinical decision-making.
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Affiliation(s)
- Qingling Yang
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Huilin Cheng
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Jing Qin
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Alice Yuen Loke
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Fei Wan Ngai
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ka Chun Chong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dexing Zhang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yang Gao
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Hong Kong SAR, China
| | - Harry Haoxiang Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
- College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, United Kingdom
| | - Zhaomin Liu
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Chun Hao
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
- Sun Yat‑Sen Global Health Institute, Institute of State Governance, Sun Yat-Sen University, Guangzhou, China
| | - Yao Jie Xie
- School of Nursing, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Wáng YXJ, Diacinti D, Iannacone A, Kripa E, Leung JCS, Kwok TCY, Diacinti D. A comparison of radiographic degeneration features of older Chinese women and older Italian Caucasian women with a focus on thoracic spine. Aging Clin Exp Res 2023; 35:2583-2591. [PMID: 37646923 DOI: 10.1007/s40520-023-02537-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/15/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Compared with Caucasians, East Asians have a lower incident of back pain, lower prevalence and severity of osteoporotic vertebral fracture and lumbar spine degeneration. AIM This study compares radiographic spine degeneration features of older Chinese women (as an example of East Asians) and older Italian women (as an example of Caucasians) with a focus on the thoracic spine. METHODS From two population-based epidemiological studies conducted in Hong Kong, China and Rome, Italy, 297 pairs (mean age: 73.6 years) age-matched older community women's lateral spine radiographs were sampled. Existence (or absence) of seven degeneration features were assessed including: (1) hyper-kyphosis, (2) disc space narrowing (T3/T4 ~ T11/T12), (3) osteoarthritic (OA) wedging (T4 ~ T12), (4) generalised osteophyte formation (T4 ~ T12); (5) acquired short vertebrae (T4 ~ T12), (6) Schmorl node (T4 - L5), (7) disc calcification (T4-L5). RESULTS Italian women were more likely to have hyper-kyphosis (53.4% vs 25.6%), disc space narrowing (34.4% vs. 17.2%), OA wedging (6.4% vs. 0.67%), Schmorl node (19.5% vs. 4.4%, all P < 0.001). However, there was no statistically significant difference in osteophyte formation (7.7% vs. 9.4%, P > 0.1) and acquired short vertebrae (8.0% vs. 10.4%, P > 0.1). Disc calcification was uncommon among both Chinese and Italians. DISCUSSION AND CONCLUSION For the first time, this study documented a lower prevalence of a number of thoracic spine degeneration features among Chinese. This study further affirms the concept of a generally healthier spine in older Chinese relative to older Caucasians. The observed differences may reflect a foundational background influence of genetic predisposition that represents an important line of future research.
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Affiliation(s)
- Yi Xiang Jshiang Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
| | - Davide Diacinti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
- Department of Diagnostic and Molecular Imaging, Radiology and Radiotherapy, University Foundation Hospital Tor Vergata, Rome, Italy
| | - Antonio Iannacone
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Endi Kripa
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Jason Chi Shun Leung
- Faculty of Medicine, JC Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Timothy Chi Yui Kwok
- Faculty of Medicine, JC Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Daniele Diacinti
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy.
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Chu L, Gong X, Lay JC, Zhang F, Fung HH, Kwok T. The perks of doing housework: Longitudinal associations with survival and underlying mechanisms. BMC Geriatr 2023; 23:355. [PMID: 37280557 DOI: 10.1186/s12877-023-04039-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 05/14/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Although the majority of existing literature has suggested positive effects of housework on older adults' health and survival rate, the underlying mechanisms of such effects remain unclear. To address potential mechanisms, the present study examined the association between older adults' housework engagement and days of survival across 14 years and tested three potential mediation pathways in this association. METHODS Four thousand Hong Kong older adults (50% female; aged between 65 and 98 years) participated in a longitudinal study in which they reported initial housework engagement and health status across three domains (cognitive functioning, physical health, and mental health) at the baseline, and the numbers of days they survived over the subsequent 14-year period were recorded. Linear regression, Cox proportional hazard, and parallel mediation analyses were performed to examine the relationship between housework engagement and days survived, and the mediating effects of these three health factors. RESULTS The results showed a positive association between housework engagement and days survived after controlling for demographic variables (age, sex, education, marital status, subjective social status, and living alone). Physical health and mental health, but not cognitive functioning, partially mediated the relationship between housework engagement and days survived. The findings suggest that doing housework may contribute to longer survival by improving older adults' physical and mental health. CONCLUSION The current study confirms positive relations of housework with health and mortality among Hong Kong older adults. As the first study examining the relationships and mediation pathways between doing housework and survival in later life, the findings advance our understanding of the mechanisms underlying the positive association between housework and mortality and provide insights for future daily-life health-promotion interventions for older adults.
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Affiliation(s)
- Li Chu
- Department of Psychology, Stanford University, Stanford, USA
| | - Xianmin Gong
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR, China
- Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jennifer C Lay
- Department of Psychology, University of Exeter, Exeter, England
| | - Fan Zhang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.
| | - Helene H Fung
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy Kwok
- Department of Medicine and Therapeutic, The Chinese University of Hong Kong, Hong Kong SAR, China
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Wáng YXJ, Leung JC, Lam PM, Kwok TC. Conversion of osteoporotic-like vertebral fracture severity score to osteoporosis T-score equivalent status: A framework study for older Chinese men. Osteoporos Sarcopenia 2023; 9:14-21. [PMID: 37082356 PMCID: PMC10111950 DOI: 10.1016/j.afos.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/28/2023] [Accepted: 03/09/2023] [Indexed: 04/22/2023] Open
Abstract
Objectives To define what portion of older community men with what severity of radiographic osteoporotic-like vertebral fracture (OLVF) correspond to what low T-score status. Methods There were 755 community Chinese men (age: 76.4 ± 6.7 years) with thoracic and lumbar spine radiographs, and hip and lumbar spine bone mineral density measures. For each vertebra in a subject, a score of 0, -0.5, -1, -1.5, -2, -2.5, and -3 was assigned for no OLVF or OLVF of <20%, ≥ 20-25%, ≥ 2 5%-1/3, ≥ 1/3-40%, ≥ 40%-2/3, and ≥ 2/3 vertebral height loss, respectively. OLVFss was defined as the summed score of vertebrae T4 to L5. OLVFss and T-scores were ranked from the smallest to the largest values. Results OLVFss of -2, -2.5, -3, corresponded to a mean femoral neck T-score of -2.297 (range: -2.355∼-2.247), -2.494 (range: -2.637∼ -2.363), and -2.773 (range: -2.898∼-2.643), a mean hip T-score of-2.311 (range: -2.420∼-2.234), -2.572 (range: -2.708∼-2.432), -2.911 (range: -3.134∼-2.708), a mean lumbar spine T-score of -2.495 (range: -2.656∼-2.403), -2.931 (range: -3.255∼-2.664), and -3.369 (range: -3.525∼-3.258). The Pearson correlation value of OLVFss and T-score of femoral neck, hip and lumbar spine was r = 0.21, 0.26, and 0.22 (all P < 0.0001). Conclusions A single severe grade radiological OLVF (≥ 40% height loss) or OLVFss ≤ -2.5 suggest the subject is osteoporotic, and a single collapse grade (≥ 2/3 height loss) OLVF or OLVFss ≤ -3 meets osteoporosis diagnosis criterion. The results highlight the difficulty of diagnosing osteoporotic vertebral fractures among Chinese older men.
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Affiliation(s)
- Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Corresponding author.
| | - Jason C.S. Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Patti M.S. Lam
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Timothy C.Y. Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
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Auyeung TW, Leung JCS, Lu ZH, Tsang C, Lee JSW, Kwok TCY, Woo J. Comparison of the Physical Function Trajectories in Three Birth Cohorts of Chinese Older Adults: A 14-Year Longitudinal Study. J Nutr Health Aging 2023; 27:1056-1062. [PMID: 37997728 DOI: 10.1007/s12603-023-2026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/12/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVES It remains uncertain whether the favorable trend of reduction in physical disabilities has become reversed in the recent-born cohorts of older adults. This study aimed to compare the rate of decline with time in self-reported Instrumental Activity of Daily Living (IADL) difficulties, objective measurement of gait speed and grip strength, in three birth cohorts of Chinese older adults. DESIGN A prospective cohort study. SETTING AND PARTICIPANTS Four thousand Chinese older adults aged 65 years or above in three birth cohorts (1934-1938, 1929-1933, 1905-1928) were recruited from the community in Hong Kong. MEASUREMENTS Grip strength, gait speed and IADL difficulties were measured between 2001 to 2017. Joint models were used to examine the trajectories of grip strength, gait speed and IADL difficulties over time, and the interaction effect of age-by-cohort (or also age2-by-cohort) was also examined. RESULTS The recently born cohort (1934 - 1938) had worse grip strength and more IADL difficulties at the same age than the earlier two cohorts (1929 - 1933; 1905 - 1928). Furthermore, the most recently born cohort also followed a more rapid decline longitudinally with a greater decline observed in gait speed, grip strength and IADL difficulties for women whereas a greater decline in grip strength and IADL difficulties for men. CONCLUSIONS The continuous improvement of physical limitations in old age may have halted and there appears to be a reversal of this favourable trend in the recent born cohort of older adults living in Hong Kong.
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Affiliation(s)
- T W Auyeung
- Zhi-Hui Lu, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China, Tel: (852) 2252 8895
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11
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Lower Prevalence and Severity of Degenerative Changes in the Lumbar Spine in Elderly Hong Kong Chinese Compared With Age-Matched Italian Caucasian Women. Spine (Phila Pa 1976) 2022; 47:1710-1718. [PMID: 35943213 DOI: 10.1097/brs.0000000000004445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/06/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional observational study. OBJECTIVE The aim was to compare the prevalence and severity of radiographic lumbar spine degeneration between elderly Hong Kong Chinese and elderly Italian Caucasian women. SUMMARY OF BACKGROUND DATA Rates of symptomatic low back pain and osteoporotic vertebral fracture have been shown to be lower in Asian and Chinese populations compared with Caucasians, but ethnic differences in spinal degeneration are less established. METHODS Lumbar spine lateral radiographs of 566 age-matched (mean: 73.6 yr; range: 65-87 yr) female subjects from two population-based epidemiological studies from Hong Kong (n=283) and Rome, Italy (n=283) were reviewed. Grading of degeneration categories: disk height loss (none, <30%, 30%-60%, >60%), osteophyte formation (not present, minimal, small, large), endplate sclerosis (none, mild, moderate, severe), and antero/retrolisthesis (none, <25%, 25%-50%, >50%) was performed for vertebral levels from L1/2 to L5/S1 (five levels). Each category was assigned a score (0, 1, 2, 3) at individual vertebral level according to severity. The total degeneration score was obtained by adding scores for all categories across the vertebral levels. RESULTS Italian subjects [total score (mean±SD): 7.0±5.5] had a higher severity of overall degenerative changes compared with Hong Kong subjects (5.7±4.4), P <0.01. Italian subjects had higher scores for individual findings of disk height loss (Italian, 3.6±2.8 vs. Hong Kong 2.5±2.1, P <0.01); antero/retrolisthesis (Italian 0.3±0.7 vs. Hong Kong 0.2±0.4, P =0.01); and endplate sclerosis (Italian 1.0±1.2 vs. Hong Kong 0.6±1.0, P <0.01). At each individual level from L1/2 to L5/S1, total degeneration scores were higher in Italian than Hong Kong subjects ( P <0.01-0.04). CONCLUSION Degenerative changes in the lumbar spine are less prevalent and less severe in elderly Hong Kong Chinese women than in age-matched Italian Caucasian women. The observed differences may reflect a foundational background influence of genetic predisposition that requires further studies.
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12
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Vandenput L, Johansson H, McCloskey EV, Liu E, Åkesson KE, Anderson FA, Azagra R, Bager CL, Beaudart C, Bischoff-Ferrari HA, Biver E, Bruyère O, Cauley JA, Center JR, Chapurlat R, Christiansen C, Cooper C, Crandall CJ, Cummings SR, da Silva JAP, Dawson-Hughes B, Diez-Perez A, Dufour AB, Eisman JA, Elders PJM, Ferrari S, Fujita Y, Fujiwara S, Glüer CC, Goldshtein I, Goltzman D, Gudnason V, Hall J, Hans D, Hoff M, Hollick RJ, Huisman M, Iki M, Ish-Shalom S, Jones G, Karlsson MK, Khosla S, Kiel DP, Koh WP, Koromani F, Kotowicz MA, Kröger H, Kwok T, Lamy O, Langhammer A, Larijani B, Lippuner K, Mellström D, Merlijn T, Nordström A, Nordström P, O'Neill TW, Obermayer-Pietsch B, Ohlsson C, Orwoll ES, Pasco JA, Rivadeneira F, Schei B, Schott AM, Shiroma EJ, Siggeirsdottir K, Simonsick EM, Sornay-Rendu E, Sund R, Swart KMA, Szulc P, Tamaki J, Torgerson DJ, van Schoor NM, van Staa TP, Vila J, Wareham NJ, Wright NC, Yoshimura N, Zillikens MC, Zwart M, Harvey NC, Lorentzon M, Leslie WD, Kanis JA. Update of the fracture risk prediction tool FRAX: a systematic review of potential cohorts and analysis plan. Osteoporos Int 2022; 33:2103-2136. [PMID: 35639106 DOI: 10.1007/s00198-022-06435-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 05/18/2022] [Indexed: 12/15/2022]
Abstract
We describe the collection of cohorts together with the analysis plan for an update of the fracture risk prediction tool FRAX with respect to current and novel risk factors. The resource comprises 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. INTRODUCTION The availability of the fracture risk assessment tool FRAX® has substantially enhanced the targeting of treatment to those at high risk of fracture with FRAX now incorporated into more than 100 clinical osteoporosis guidelines worldwide. The aim of this study is to determine whether the current algorithms can be further optimised with respect to current and novel risk factors. METHODS A computerised literature search was performed in PubMed from inception until May 17, 2019, to identify eligible cohorts for updating the FRAX coefficients. Additionally, we searched the abstracts of conference proceedings of the American Society for Bone and Mineral Research, European Calcified Tissue Society and World Congress of Osteoporosis. Prospective cohort studies with data on baseline clinical risk factors and incident fractures were eligible. RESULTS Of the 836 records retrieved, 53 were selected for full-text assessment after screening on title and abstract. Twelve cohorts were deemed eligible and of these, 4 novel cohorts were identified. These cohorts, together with 60 previously identified cohorts, will provide the resource for constructing an updated version of FRAX comprising 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. For each known and candidate risk factor, multivariate hazard functions for hip fracture, major osteoporotic fracture and death will be tested using extended Poisson regression. Sex- and/or ethnicity-specific differences in the weights of the risk factors will be investigated. After meta-analyses of the cohort-specific beta coefficients for each risk factor, models comprising 10-year probability of hip and major osteoporotic fracture, with or without femoral neck bone mineral density, will be computed. CONCLUSIONS These assembled cohorts and described models will provide the framework for an updated FRAX tool enabling enhanced assessment of fracture risk (PROSPERO (CRD42021227266)).
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Affiliation(s)
- L Vandenput
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - H Johansson
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
| | - E V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK
- MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - E Liu
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - K E Åkesson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopedics, Skåne University Hospital, Malmö, Sweden
| | - F A Anderson
- GLOW Coordinating Center, Center for Outcomes Research, University of Massachusetts Medical School, Worcester, MA, USA
| | - R Azagra
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
- Health Center Badia del Valles, Catalan Institute of Health, Barcelona, Spain
- GROIMAP (Research Group), Unitat de Suport a La Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Santa Coloma de Gramenet, Barcelona, Spain
| | - C L Bager
- Nordic Bioscience A/S, Herlev, Denmark
| | - C Beaudart
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - H A Bischoff-Ferrari
- Department of Aging Medicine and Aging Research, University Hospital, Zurich, and University of Zurich, Zurich, Switzerland
- Centre On Aging and Mobility, University of Zurich and City Hospital, Zurich, Switzerland
| | - E Biver
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - O Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Division of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - J A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Philadelphia, USA
| | - J R Center
- Bone Biology, Healthy Ageing Theme, Garvan Institute of Medical Research, Sydney, NSW, Australia
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
| | - R Chapurlat
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | | | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
- National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
- National Institute for Health Research Oxford Biomedical Research Unit, , University of Oxford, Oxford, UK
| | - C J Crandall
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - S R Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
| | - J A P da Silva
- Coimbra Institute for Clinical and Biomedical Research, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Rheumatology Department, University Hospital and University of Coimbra, Coimbra, Portugal
| | - B Dawson-Hughes
- Bone Metabolism Laboratory, Jean Mayer US Department of Agriculture Human Nutrition Research Center On Aging, Tufts University, Boston, MA, USA
| | - A Diez-Perez
- Department of Internal Medicine, Hospital del Mar and CIBERFES, Autonomous University of Barcelona, Barcelona, Spain
| | - A B Dufour
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - J A Eisman
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, University of Notre Dame Australia, Sydney, NSW, Australia
- Osteoporosis and Bone Biology Division, Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - P J M Elders
- Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - S Ferrari
- Division of Bone Diseases, Department of Medicine, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Y Fujita
- Department of Public Health, Faculty of Medicine, Kindai University, Osaka, Japan
| | - S Fujiwara
- Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
| | - C-C Glüer
- Section Biomedical Imaging, Molecular Imaging North Competence Center, Department of Radiology and Neuroradiology, University Medical Center Schleswig-Holstein Kiel, Kiel University, Kiel, Germany
| | - I Goldshtein
- Maccabitech Institute of Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - D Goltzman
- Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada
| | - V Gudnason
- Icelandic Heart Association, Kopavogur, Iceland
- University of Iceland, Reykjavik, Iceland
| | - J Hall
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - D Hans
- Centre of Bone Diseases, Bone and Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - M Hoff
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Rheumatology, St Olavs Hospital, Trondheim, Norway
| | - R J Hollick
- Aberdeen Centre for Arthritis and Musculoskeletal Health, Epidemiology Group, University of Aberdeen, Aberdeen, UK
| | - M Huisman
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, VU University, Amsterdam, The Netherlands
| | - M Iki
- Department of Public Health, Faculty of Medicine, Kindai University, Osaka, Japan
| | - S Ish-Shalom
- Endocrine Clinic, Elisha Hospital, Haifa, Israel
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - M K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopaedics, Skåne University Hospital, Malmö, Sweden
| | - S Khosla
- Robert and Arlene Kogod Center On Aging and Division of Endocrinology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - D P Kiel
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - W-P Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - F Koromani
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M A Kotowicz
- IMPACT (Institute for Mental and Physical Health and Clinical Translation), Deakin University, Geelong, VIC, Australia
- Barwon Health, Geelong, VIC, Australia
- Department of Medicine - Western Health, The University of Melbourne, St Albans, Victoria, Australia
| | - H Kröger
- Department of Orthopedics and Traumatology, Kuopio University Hospital, Kuopio, Finland
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - T Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - O Lamy
- Centre of Bone Diseases, Lausanne University Hospital, Lausanne, Switzerland
- Service of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - A Langhammer
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, HUNT Research Centre, Norwegian University of Science and Technology, Trondheim, Norway
| | - B Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - K Lippuner
- Department of Osteoporosis, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Sahlgrenska University Hospital Mölndal, Mölndal, Sweden
| | - T Merlijn
- Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - A Nordström
- Division of Sustainable Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- School of Sport Sciences, Arctic University of Norway, Tromsø, Norway
| | - P Nordström
- Unit of Geriatric Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - T W O'Neill
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, UK
| | - B Obermayer-Pietsch
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University Graz, Graz, Austria
- Center for Biomarker Research in Medicine, Graz, Austria
| | - C Ohlsson
- Sahlgrenska Osteoporosis Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Drug Treatment, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - E S Orwoll
- Department of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - J A Pasco
- Institute for Physical and Mental Health and Clinical Translation (IMPACT), Deakin University, Geelong, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, Australia
- Barwon Health, Geelong, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - F Rivadeneira
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - B Schei
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Gynecology, St Olavs Hospital, Trondheim, Norway
| | - A-M Schott
- Université Claude Bernard Lyon 1, U INSERM 1290 RESHAPE, Lyon, France
| | - E J Shiroma
- Laboratory of Epidemiology and Population Sciences, National Institute On Aging, Baltimore, MD, USA
| | - K Siggeirsdottir
- Icelandic Heart Association, Kopavogur, Iceland
- Janus Rehabilitation, Reykjavik, Iceland
| | - E M Simonsick
- Translational Gerontology Branch, National Institute On Aging Intramural Research Program, Baltimore, MD, USA
| | | | - R Sund
- Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - K M A Swart
- Department of General Practice, Amsterdam UMC, Location VUmc, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - P Szulc
- INSERM UMR 1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
| | - J Tamaki
- Department of Hygiene and Public Health, Faculty of Medicine, Educational Foundation of Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - D J Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - N M van Schoor
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - T P van Staa
- Centre for Health Informatics, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - J Vila
- Statistics Support Unit, Hospital del Mar Medical Research Institute, CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - N J Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - N C Wright
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - N Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, The University of Tokyo Hospital, Tokyo, Japan
| | - M C Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Zwart
- Health Center Can Gibert del Plà, Catalan Institute of Health, Girona, Spain
- Department of Medical Sciences, University of Girona, Girona, Spain
- GROIMAP (Research Group), Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain
| | - N C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Lorentzon
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
- Sahlgrenska Osteoporosis Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Geriatric Medicine, Region Västra Götaland, Sahlgrenska University Hospital, Mölndal, Sweden
| | - W D Leslie
- Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - J A Kanis
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK.
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13
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Xia W, Liu Q, Lv J, Zhang Z, Wu W, Xie Z, Chen J, He L, Dong J, Hu Z, Lin Q, Yu W, Wei F, Wang J. Prevalent vertebral fractures among urban-dwelling Chinese postmenopausal women: a population-based, randomized-sampling, cross-sectional study. Arch Osteoporos 2022; 17:120. [PMID: 36070158 PMCID: PMC9452427 DOI: 10.1007/s11657-022-01158-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 08/22/2022] [Indexed: 02/03/2023]
Abstract
In this population-based, cross-sectional study, we investigated vertebral fracture (VF) prevalence among Chinese postmenopausal women. We found 14.7% of population had VFs, which increased with age. Age ≥ 65 years, hip fracture, and densitometric osteoporosis were significantly associated with VFs. The prevalence of osteoporosis was remarkably high. PURPOSE To investigate VF prevalence among Chinese postmenopausal women in this population-based, randomized-sampling, cross-sectional study. METHODS The investigator obtained lists of women from communities. Randomization was performed using SAS programming based on age group in each region. Postmenopausal women aged ≥ 50 years in the urban community were included. The investigator interviewed subjects to collect self-reported data and measured BMD. Spine radiographs were adjudicated by Genant's semi-quantitative method. VFs were defined as fractures of at least one vertebra classified by Genant's score 1-3 and were analyzed using descriptive statistics. RESULTS A total of 31,205 women listed for randomized sampling from 10 Tier-3 hospitals at 5 regions. Of 2634 women in the full analysis set, 14.7% (388/2634, 95% CI: 13.4, 17.1) had prevalent VFs. VF prevalence increased with age (Cochran-Armitage test p < 0.0001) and was significantly higher in women aged ≥ 65. VF prevalence did not differ between North (14.4%, 95% CI: 12.5, 16.4) and South China (15.1%, 95% CI: 13.3, 17.1). In women with no prior VFs, prevalent VFs were 12.4% (95% CI: 11.2, 13.7). Age ≥ 65 years (OR: 2.57, 95% CI: 1.91, 3.48), hip fracture (OR: 2.28, 95% CI: 1.09, 4.76), and densitometric osteoporosis (OR: 2.52, 95% CI: 1.96, 3.22) were significantly associated with prevalent VFs. Prevalence of osteoporosis was 32.9% measured by BMD and 40.8% using NOF/IOF clinical diagnosis criteria. CONCLUSION VFs are prevalent among Chinese postmenopausal women who were ≥ 50 years and community-dwelled. Osteoporosis prevalence is remarkable when fragile fractures were part of clinical diagnosis.
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Affiliation(s)
- Weibo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
| | - Qiang Liu
- Shanxi Dayi Hospital, Taiyuan, Shanxi, China.
| | - Jinhan Lv
- The People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Zhenlin Zhang
- Department of Osteoporosis and Bone Disease, The Sixth People's Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Wen Wu
- Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China
| | - Zhongjian Xie
- National Clinical Research Center for Metabolic Diseases, Hunan Provincial Key Laboratory of Metabolic Bone Diseases, and Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan, China
| | - Jianting Chen
- Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liang He
- Beijing Jishuitan Hospital, Beijing, China
| | - Jian Dong
- Fudan University Zhongshan Hospital, Shanghai, China
| | - Zhenming Hu
- The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiang Lin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Fang Wei
- Medical Affairs & Outcomes Research, Organon China, Shanghai, China
| | - Jue Wang
- Global Medical and Scientific Affairs, Merck Research Laboratories, MSD China, Shanghai, China
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Lu ZH, Lam FMH, Leung JCS, Kwok TCY. The Resilience and the Subsequent Hospitalization of Older People with Different Frailty Status: A Prospective Cohort Study. J Am Med Dir Assoc 2022; 23:1718.e1-1718.e6. [PMID: 36058297 DOI: 10.1016/j.jamda.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the difference in resilience across frailty status by measuring the impact of unplanned hospitalization across people with different frailty condition on (1) 2-year changes in lean mass, physical performance, and quality of life, and (2) subsequent hospitalization. DESIGN A prospective cohort study. SETTING AND PARTICIPANTS Three thousand seventeen older people (73.7 ± 4.9 years) were recruited from the community in Hong Kong. METHODS Frailty status was defined using the Cardiovascular Health Study scale at baseline. Unplanned hospitalization between the 2 visits was obtained from the Hong Kong Hospital Authority. The interaction of frailty and hospitalization status on the 2-year changes in lean mass, physical performance, and quality of life were examined using 2-way analysis of covariance. Risk of subsequent hospitalization was estimated using Poisson regression. The effect of prolonged hospitalization, which was defined as 6 or more total hospitalized days, was also examined. RESULTS Upon unplanned hospitalization, frail older people had significantly augmented decline than prefrail and robust people in appendicular skeletal mass (-0.44 ± 0.08 kg), height-adjusted appendicular skeletal mas (-0.13 ± 0.03 kg/m2), 5-time chair-stand (4.79 ± 0.60 s), and mental health (-3.72 ± 0.88). The reduction increased with the length of hospitalization. Unplanned hospitalization conferred an augmented risk of subsequent hospitalization for those who were prefrail and frail (RR = 1.44, 95% confidence interval = 1.30-1.59 and RR = 1.69, 95% confidence interval = 1.45-1.97, respectively). CONCLUSIONS AND IMPLICATIONS The resilience of older people varies according to their frailty status, and the poor resilience may translate to a higher chance of having subsequent hospitalization for prefrail and frail people. These findings emphasized the importance of having the frailty screening in making posthospitalization plans for older people depending on their frailty status and encouraging prefrail and frail older people to build up their resilience.
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Affiliation(s)
- Zhi-Hui Lu
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Freddy M H Lam
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong; Jockey Club Center for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong
| | - Jason C S Leung
- Jockey Club Center for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; Jockey Club Center for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong.
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15
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Ho HC, Cheng W, Song Y, Liu Y, Guo Y, Lu S, Lum TYS, Chiu R, Webster C. Spatial uncertainty and environment-health association: An empirical study of osteoporosis among "old residents" in public housing estates across a hilly environment. Soc Sci Med 2022; 306:115155. [PMID: 35750005 DOI: 10.1016/j.socscimed.2022.115155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 04/13/2022] [Accepted: 06/14/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Built environment can influence physical conditions of older adults (e.g. osteoporosis). However, traditional methods using 2-dimensional circular buffer as a spatial structure to measure neighbourhood effect may create bias in health estimation, especially for the hilly and compact environment across low-income neighbourhoods (e.g. public housing estates). METHODS We evaluated the environmental influences on self-reported osteoporosis among "old residents" (age≥65) in Hong Kong (n = 2077). Twelve public housing estates across hilly neighbourhoods in Hong Kong were selected as study sites. A cross-validated approach was developed to evaluate four spatial structures (2D circular, 2D service area, 3D circular, 3D service area). To determine problems of spatial uncertainty, we compared odds ratios (OR) and differences in effect sizes from models using different spatial structures. When all adjusted models achieve significant results based on 95% confidence intervals (CI) and with all positive/negative ORs, this study reported to have reached "a result with consistency". Results from the 3D service area were then used to explain the environment-health relationship. RESULTS Different spatial structures can yield different results. Particularly, circular buffers overestimated environmental effects on self-reported osteoporosis. Overestimated measures were related to walkability and accessibility but not greenery. Specifically, results from the 3D service area showed that more public space and health facilities within a walkable distance (500 m) from a location of subject's residence were negatively associated with self-reported osteoporosis (adjusted ORs: 0.44 [0.29, 0.66]; 0.94 [0.90, 0.99]). However, more major transport facilities at the immediate distance from residence (200 m) was positively associated with self-reported osteoporosis (adjusted OR: 1.11 [1.01, 1.23]). CONCLUSIONS Physical conditions (e.g. osteoporosis) of older adults living in a hilly neighbourhood could be driven by walking behaviours. It is necessary to include local terrain and road network to define a walkable neighbourhood for environment-health estimations to minimize spatial bias.
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Affiliation(s)
- Hung Chak Ho
- Healthy High Density Cities Lab, The University of Hong Kong, Hong Kong; Department of Urban Planning and Design, The University of Hong Kong, Hong Kong; Department of Anaesthesiology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Wei Cheng
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong
| | - Yimeng Song
- School of the Environment, Yale University, New Haven, CT, 06511, Unites States
| | - Yuqi Liu
- Department of Urban Planning, School of Architecture, South China University of Technology, Guangzhou, China
| | - Yingqi Guo
- Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Hong Kong
| | - Shiyu Lu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong
| | - Terry Yat Sang Lum
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong; Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Rebecca Chiu
- Department of Urban Planning and Design, The University of Hong Kong, Hong Kong
| | - Chris Webster
- Healthy High Density Cities Lab, The University of Hong Kong, Hong Kong; Faculty of Architecture, The University of Hong Kong, Hong Kong.
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16
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Su Y, Elshorbagy A, Turner C, Refsum H, Kwok T. The Association of Circulating Amino Acids and Dietary Inflammatory Potential with Muscle Health in Chinese Community-Dwelling Older People. Nutrients 2022; 14:nu14122471. [PMID: 35745201 PMCID: PMC9229609 DOI: 10.3390/nu14122471] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 02/06/2023] Open
Abstract
Amino acids (AAs) and dietary inflammatory potential play essential roles in muscle health. We examined the associations of dietary inflammatory index (DII) of habitual diet with serum AA profile, and ascertained if the associations between DII and muscle outcomes were mediated by serum AAs, in 2994 older Chinese community-dwelling men and women (mean age 72 years) in Hong Kong. Higher serum branched chain AAs (BCAAs), aromatic AAs and total glutathione (tGSH) were generally associated with better muscle status at baseline. A more pro-inflammatory diet, correlating with higher serum total homocysteine and cystathionine, was directly (90.2%) and indirectly (9.8%) through lower tGSH associated with 4-year decline in hand grip strength in men. Higher tGSH was associated with favorable 4-year changes in hand grip strength, gait speed and time needed for 5-time chair stands in men and 4-year change in muscle mass in women. Higher leucine and isoleucine were associated with decreased risk of sarcopenia in men; the associations were abolished after adjustment for BMI. In older men, perturbations in serum sulfur AAs metabolism may be biomarkers of DII related adverse muscle status, while the lower risk of sarcopenia with higher BCAAs may partly be due to preserved BMI.
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Affiliation(s)
- Yi Su
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha 410013, China;
| | - Amany Elshorbagy
- Department of Physiology, Faculty of Medicine, University of Alexandria, Alexandria 21526, Egypt;
- Department of Pharmacology, University of Oxford, Oxford OX1 2JD, UK;
| | - Cheryl Turner
- Department of Pharmacology, University of Oxford, Oxford OX1 2JD, UK;
| | - Helga Refsum
- Institute of Basic Medical Sciences, Department of Nutrition, University of Oslo, 0316 Oslo, Norway;
| | - Timothy Kwok
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong 999077, China
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong 999077, China
- Correspondence: ; Tel.: +852-2632-3128; Fax: +852-2637-3852
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17
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Su Y, Yeung SSY, Chen YM, Leung JCS, Kwok TCY. The Associations of Dietary Inflammatory Potential With Musculoskeletal Health in Chinese Community-Dwelling Older People: The Mr. OS and Ms. OS (Hong Kong) Cohort Study. J Bone Miner Res 2022; 37:1179-1187. [PMID: 35416312 PMCID: PMC9177744 DOI: 10.1002/jbmr.4556] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 03/16/2022] [Accepted: 04/08/2022] [Indexed: 11/08/2022]
Abstract
Inflammation, an important contributory factor of muscle and bone aging, is potentially modulated by diet. This study examined the associations of dietary inflammatory index (DII) score with musculoskeletal parameters and related disease outcomes in 3995 community-dwelling Chinese men and women aged ≥65 years in Hong Kong. DII score at baseline was estimated from a food frequency questionnaire. Bone mineral density (BMD) and muscle mass estimated by dual-energy X-ray absorptiometry (DXA), hand grip strength, gait speed, and chair stand test were measured at baseline, year 4, and year 14. The associations of DII score with the longitudinal changes of musculoskeletal parameters, and incidence of osteoporosis, sarcopenia, and fractures were examined by using general linear model, multinomial logistic regression model, and Cox proportional hazards regression model, respectively. After multiple adjustments, each tertile increase in DII score in men was associated with 0.37 (95% confidence interval [CI], 0.10-0.64) kg loss in grip strength and 0.02 (95% CI, 0.01-0.03) m/s loss in gait speed over 4 years. In men, the highest tertile of DII was associated with a higher risk of incident fractures, with adjusted and competing death adjusted hazard ratio (HR) (95% CI) of 1.56 (1.14-2.14) and 1.40 (1.02-1.91), respectively. In women, DII score was not significantly associated with any muscle-related outcomes or incidence of fracture, but a significant association between higher DII score and risk of osteoporosis at year 14 was observed, with the highest tertile of DII score having adjusted odds ratio (OR) (95% CI) of 1.90 (1.03-3.52). In conclusion, pro-inflammatory diet consumption promoted loss of muscle strength and physical function, and increased risk of fractures in older Chinese men. Pro-inflammatory diets had no significant association with muscle related outcomes but increased the long-term risk of osteoporosis in older Chinese women. © 2022 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Yi Su
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Suey S Y Yeung
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Yu-Ming Chen
- Department of Epidemiology, Guangdong Provincial Key Laboratory of Food, Nutrition, and Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jason C S Leung
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Timothy C Y Kwok
- Department of Medicine & Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, SAR, China
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18
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Dong Y, Peng R, Kang H, Song K, Guo Q, Zhao H, Zhu M, Zhang Y, Guan H, Li F. Global incidence, prevalence, and disability of vertebral fractures: a systematic analysis of the global burden of disease study 2019. Spine J 2022; 22:857-868. [PMID: 34906740 DOI: 10.1016/j.spinee.2021.12.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/07/2021] [Accepted: 12/07/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In the context of the population growing and aging worldwide, the epidemiology, and burden of vertebral fracture have not been comprehensively analyzed. PURPOSE To delineate the global number and rate of incidence, prevalence and burden of vertebral fracture in 2019, and the temporal trends from 1990 to 2019 by location, age, sex, and the socio-demographic index (SDI). STUDY DESIGN/SETTING A cross-sectional study using data from the Global Burden of Disease Study 2019 (GBD study 2019). PATIENT SAMPLE Patients with vertebral fracture documented in medical records or registrations and included in the GBD study 2019 from different countries worldwide. OUTCOME MEASURES Age standardized incidence rate (ASIR), age standardized prevalence rate (ASPR), and age standardized years lived with disability (YLDs). METHODS The GBD study 2019 was used to obtain data for this analysis. The incidence, prevalence and disability were analyzed by location, year, sex, age, and SDI. DisMod-MR 2.1, a Bayesian meta-regression tool, was used to produce the estimates for each value after adjustment for age, sex, and other variables. Estimated annual percentage change (EAPC) was calculated to represent the temporal trends from 1990 to 2019. Spearman's rank order correlation was used to determine the correlation between SDI and the incidence and burden of vertebral fracture. This work was supported by the Key Research and Development Program of Hubei Province of China (No. 2020BCB049), and no conflicts of interest-associated biases existed in this study. RESULTS Globally, there were 8.6 million (95% uncertainty interval [UI], 6,6-11,3 million) incident cases, 5.3 million (95% UI, 4.6-6.2 million) prevalent cases, and 0.55 million (95% UI, 0.37-0.77 million) YLDs of vertebral fracture. Compared with 1990, the number of incident cases and YLDs in 2019 increased by 38% (95% UI, 23%-48%) and 75% (95% UI, 65%-85%), respectively, while the ASIR (EAPC, -0.28; 95% CI, -0.41 to -0.14), ASPR (EAPC, -0.12; 95% CI, -0.22 to -0.02) and age standardized YLD rate (ASYR) (EAPC, -0.13; 95% CI, -0.23 to -0.04) decreased during this period. High ASIR, ASPR and ASYR were commonly seen in high-SDI countries, such as high-income North America, Australia, Central and Eastern Europe. In the country level, positive correlations were observed between SDI and ASIR (rho, 0.596; p<.001) and ASYR (rho, 0.413; p<.001). Males had higher ASIR and ASYR worldwide in each year from 1990 to 2019. However, the incidence, and YLD rates in females surpassed that in males after 65 years of age. Increasing trends were observed for both incidence and YLD rates with age. Falls were the leading cause for vertebral fracture across all ages. CONCLUSIONS The past thirty years have seen increasing numbers but decreasing rates of global incidence, prevalence, and disability of vertebral fractures, resulting from the growing population worldwide. With population aging, efforts are still in urgent need to address vertebral fracture related health outcomes.
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Affiliation(s)
- Yimin Dong
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Renpeng Peng
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Honglei Kang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kehan Song
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Guo
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongjian Zhao
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Meipeng Zhu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yayun Zhang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hanfeng Guan
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Li
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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19
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Wáng YXJ, Deng M, Griffith JF, Kwok AWL, Leung JCS, Lam PMS, Yu BWM, Leung PC, Kwok TCY. 'Healthier Chinese spine': an update of osteoporotic fractures in men (MrOS) and in women (MsOS) Hong Kong spine radiograph studies. Quant Imaging Med Surg 2022; 12:2090-2105. [PMID: 35284274 PMCID: PMC8899940 DOI: 10.21037/qims-2021-07] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/16/2021] [Indexed: 08/09/2023]
Abstract
For the MrOS (Hong Kong) and MsOS (Hong Kong) baseline (BL) studies, community-dwelling 2,000 Chinese men (mean age: 72.3 years) and 2,000 Chinese women (mean age: 72.5 years) were recruited from 2001 to 2003. These two studies have spanned two decades till now. This review summarizes our spine radiograph results. Senile and post-menopausal osteoporosis were associated with intervertebral disc volume reduction; and in women, menopause accelerates disc degeneration. Elderly women's osteoporotic vertebral fracture (OVF) prevalence was double of that of elderly men. For year-4 follow-up (FU), male participants with BL OVF had little increased risk for further OVF. In our study comparing OVF rates in age-matched Hong Kong Chinese women and Italian Caucasian women (mean age: 74.1 years), endplate and/or cortex fracture (ECF) prevalence was 26% for Chinese and 47% for Italian. OVF with ≥40% vertebral height loss was recorded among 9.5% of the Chinese subjects while among 26% of the Italian subjects. OVFs in Italian subjects were more likely to be multiple and generally severer. Clinical spine fractures were recorded 133 cases/100,000 person-years in MrOS (Hong Kong) participants and 273 cases/100,000 person-years in MsOS (Hong Kong) participants. Literature review suggests the clinical vertebral fracture rates among elderly Hong Kong Chinese subjects are approximately half of those of American, Australian, and Canadian subjects. Data synthesis suggests elderly Caucasians have a higher degenerative spondylolisthesis prevalence, being approximately 70% higher than that of elderly Hong Kong Chinese. Literature review of other authors' publications shows, compared with Caucasians, Chinese have a much lower incident rate of back pain. We conclude that elderly Chinese have a generally healthier spine relative to elderly Caucasians.
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Affiliation(s)
- Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Min Deng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - James F. Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Anthony W. L. Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- School of Medical and Health Sciences, Tung Wah College, Hong Kong SAR, China
| | - Jason C. S. Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Patti M. S. Lam
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Blanche Wai Man Yu
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ping Chung Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy C. Y. Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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20
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Katayanagi J, Iida T, Hayamizu A, Matsumoto K, Furukawa H, Konuma H, Yanase T, Ozeki S. Pre-existing vertebral fracture is a risk factor for postoperative proximal junctional fracture after adult spinal deformity surgery: A propensity score-matched analysis. J Orthop Sci 2022; 27:308-316. [PMID: 33640224 DOI: 10.1016/j.jos.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/08/2020] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Corrective surgery for adult spinal deformity has recently been increasingly performed because of aging populations and advances in minimally invasive surgery. Low bone mineral density is a major contributor to proximal junctional kyphosis after spinal long fusion. Assessment for low bone mineral density ideally involves both dual energy X-ray absorptiometry and identification of pre-existing vertebral fractures, the latter, requiring only standard equipment, being performed more frequently. We therefore aimed to examine the impact of pre-existing vertebral fractures on the incidence of type 2 proximal junctional kyphosis, including proximal junctional fracture and failure, after corrective surgery for adult spinal deformity. METHODS We performed a retrospective, single institution study of 106 women aged over 50 years who had undergone corrective long spinal fusion for severely symptomatic spinal deformity from 2014 to 2017. We allocated them to three groups (with and without pre-existing vertebral fractures and with severe [Grades 2-3 according to Genant et al.'s classification] preexisting vertebral fractures) and used propensity score matching to minimize bias. The primary outcome was postoperative proximal junctional fracture and the secondary outcome proximal junctional kyphosis/failure. RESULTS The primary and secondary endpoints were achieved significantly more often in the 28 patients with than in the 78 without preexisting vertebral fractures (total 41). The former group was also significantly older and had greater pelvic tilt and fewer fused segments than those without vertebral fractures. After propensity score matching, the incidences of the endpoints did not differ with pre-existing vertebral fracture status; however, patients with severe vertebral fractures more frequently had proximal junctional fractures postoperatively. Postoperative improvements in health-related quality of life scores did not differ with pre-existing vertebral fracture status. CONCLUSIONS Severe pre-existing vertebral fractures are a risk factor for proximal junctional fracture after correction of adult spinal deformity.
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Affiliation(s)
| | - Takahiro Iida
- Dokkyo Medical University Saitama Medical Center, Japan
| | | | | | | | - Hiroki Konuma
- Dokkyo Medical University Saitama Medical Center, Japan
| | | | - Satoru Ozeki
- Dokkyo Medical University Saitama Medical Center, Japan
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21
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Wáng YXJ, Xiao BH, Su Y, Leung JCS, Lam PMS, Kwok TCY. Fine-tuning the cutpoint T-score as an epidemiological index with high specificity for osteoporosis: methodological considerations for the Chinese population. Quant Imaging Med Surg 2022; 12:882-885. [PMID: 35111590 DOI: 10.21037/qims-21-845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/11/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ben-Heng Xiao
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Yi Su
- Key Laboratory of Molecular Epidemiology of Hunan Province, School of Medicine, Hunan Normal University, Changsha, Hunan, China
| | - Jason C S Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Patti M S Lam
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Timothy C Y Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
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22
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Wáng YXJ. Fragility fracture prevalence among elderly Chinese is no more than half of that of elderly Caucasians. Quant Imaging Med Surg 2022; 12:874-881. [PMID: 35111589 PMCID: PMC8739125 DOI: 10.21037/qims-21-876] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/15/2021] [Indexed: 08/09/2023]
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Much lower prevalence and severity of radiographic osteoporotic vertebral fracture in elderly Hong Kong Chinese women than in age-matched Rome Caucasian women: a cross-sectional study. Arch Osteoporos 2021; 16:174. [PMID: 34783904 DOI: 10.1007/s11657-021-00987-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/17/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Many earlier studies reported that East Asians and Caucasians have similar radiographic osteoporotic vertebral fracture (OVF) prevalence. Since elderly Chinese's osteoporotic hip fracture prevalence is half (or less than half) of that of their age-match Caucasians, we hypothesize that elderly Chinese's OVF prevalence could be only half, or even less than half, of that of their age-match Caucasians. MATERIALS Age-matched (mean: 74.1 years; range: 65-87 years) elderly women's radiographs (T4-L5) were from two OVF population-based epidemiological studies conducted in Hong Kong (n = 200) and in Rome (n = 200). All radiographs were double read by one reader in Hong Kong and one reader in Rome. Radiological osteoporotic vertebral deformity (ROVD) classification included no ROVD (grade 0), and ROVDs with < 20%, 20 ~ 25%, ≥ 25% ~ 1/3, ≥ 1/3 ~ 40%, ≥ 40% ~ 2/3, and ≥ 2/3 height loss (grade 1 ~ 6) as well as endplate/cortex fracture (ECF). Spinal deformity index (SDI) was calculated with each vertebra assigned a score of 0, 0.5, 1, 1.5, 2, 2.5, and 3 for no ROVD or ROVDs grade 1 ~ 6. RESULTS Seventy-seven (38.5%) Chinese subjects and 123 Italian subjects (61.5%) had ROVD respectively (p < 0.0001). Chinese subjects had ECF in 52 (26%) cases involving 100 vertebrae, while Italian subjects had ECF in 93 (47%) cases involving 230 vertebrae. ROVDs in Italian subjects tended to be more severe (total and mean SDI: 454.5 and 3.71 for Italian, and 212 and 2.72 for Chinese, p < 0.05), more likely to be multiple, more likely to have severe and collapsed grades. The slope of the relationship between age vs. SDI was steeper for the Italian subjects than for the Chinese subjects, suggesting ROVD severity developed faster for aging Italian subjects. A trend suggested earlier onset of ROVD among Italian. CONCLUSION OVFs in Chinese women tend to be less common, less severe, and less likely to have multiple fractures.
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Longitudinal association of built environment pattern with DXA-derived body fat in elderly Hong Kong Chinese: a latent profile analysis. Int J Obes (Lond) 2021; 45:2629-2637. [PMID: 34433908 DOI: 10.1038/s41366-021-00949-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 07/23/2021] [Accepted: 08/17/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND One major limitation of prior studies regarding the associations between built environment (BE) and obesity has been the use of anthropometric indices (e.g., body mass index [BMI]) for assessing obesity status, and there has been limited evidence of associations between BE and body fat. This study aimed to explore the longitudinal association between BE and body fat in a cohort of elderly Hong Kong Chinese and examine whether the BE-body fat associations differed by BMI categories. METHODS Between 2001 and 2003, 3944 participants aged 65-98 years were recruited and followed for a mean of 6.4 years. BE characteristics were assessed via Geographic Information System. Body fat (%) at whole body and regional areas (trunk, limbs, android, and gynoid) were assessed by dual energy X-ray absorptiometry at baseline and three follow-ups. Latent profile analysis was used to derive BE class, and linear mixed-effects models were used to investigate the associations of BE class with changes in body fat. Stratified analyses by BMI categories were also conducted. RESULTS Three BE classes were identified. Participants in Class 2 (characterized by greater open space and proportion of residential land use) had a slower increase in whole body fat (B = -0.403, 95% confidence interval [CI]: -0.780, -0.014) and limbs fat (-0.471, 95% CI: -0.870, -0.071) compared with participants in Class 1 (characterized by high proportion of commercial land use). There were significant interactions of BE class with BMI, and participants in Class 2 had a slower increase in whole body fat and regional fat compared with participants in Class 1 (B ranging from -0.987 [limbs] to -0.523 [gynoid]) among overweight and obese participants only. CONCLUSIONS We found that those who resided in the areas characterized by greater open space and proportion of residential land use had a slower body fat increase.
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Wang L, Yu W, Yin X, Cui L, Tang S, Jiang N, Cui L, Zhao N, Lin Q, Chen L, Lin H, Jin X, Dong Z, Ren Z, Hou Z, Zhang Y, Zhong J, Cai S, Liu Y, Meng R, Deng Y, Ding X, Ma J, Xie Z, Shen L, Wu W, Zhang M, Ying Q, Zeng Y, Dong J, Cummings SR, Li Z, Xia W. Prevalence of Osteoporosis and Fracture in China: The China Osteoporosis Prevalence Study. JAMA Netw Open 2021; 4:e2121106. [PMID: 34398202 PMCID: PMC8369359 DOI: 10.1001/jamanetworkopen.2021.21106] [Citation(s) in RCA: 184] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE The aging of the population is associated with an increasing burden of fractures worldwide. However, the epidemiological features of fractures in mainland China are not well known. OBJECTIVE To assess the prevalence of and factors associated with osteoporosis, clinical fractures, and vertebral fractures in an adult population 40 years or older in mainland China. DESIGN, SETTING. AND PARTICIPANTS This cross-sectional study, the China Osteoporosis Prevalence Study, was conducted from December 2017 to August 2018. A random sample of individuals aged 20 years or older who represented urban and rural areas of China were enrolled, with a 99% participation rate. MAIN OUTCOMES AND MEASURES Weighted prevalence of osteoporosis, clinical fracture, and vertebral fracture by age, sex, and urban vs rural residence as determined by x-ray absorptiometry, questionnaire, and radiography. RESULTS A total of 20 416 participants were included in this study; 20 164 (98.8%; 11 443 women [56.7%]; mean [SD] age, 53 [13] years) had a qualified x-ray absorptiometry image and completed the questionnaire, and 8423 of 8800 (95.7%) had a qualified spine radiograph. The prevalence of osteoporosis among those aged 40 years or older was 5.0% (95% CI, 4.2%-5.8%) among men and 20.6% (95% CI, 19.3%-22.0%) among women. The prevalence of vertebral fracture was 10.5% (95% CI, 9.0%-12.0%) among men and 9.7% (95% CI, 8.2%-11.1%) among women. The prevalence of clinical fracture in the past 5 years was 4.1% (95% CI, 3.3%-4.9%) among men and 4.2% (95% CI, 3.6%-4.7%) among women. Among men and women, 0.3% (95% CI, 0.0%-0.7%) and 1.4% (95% CI, 0.8%-2.0%), respectively, with osteoporosis diagnosed on the basis of bone mineral density or with fracture were receiving antiosteoporosis treatment to prevent fracture. CONCLUSIONS AND RELEVANCE In this cross-sectional study of an adult population in mainland China, the prevalence of osteoporosis and vertebral fracture were high and the prevalence of vertebral fracture and clinical fracture was similarly high in men and women. These findings suggest that current guidelines for screening and treatment of fractures among patients in China should focus equally on men and women and should emphasize the prevention of vertebral fractures.
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Affiliation(s)
- Linhong Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wei Yu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangjun Yin
- Division of Elderly Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lijia Cui
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shunyu Tang
- Division of Elderly Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ning Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Cui
- Division of Elderly Health, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Nan Zhao
- Medical Sciences Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiang Lin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Chen
- Department of Wound Repair and Rehabilitation Medicine, State Key Laboratory of Trauma, Burns and Combined Injury, Daping Hospital, Army Medical University, Chongqing, China
| | - Hua Lin
- Department of Orthopaedics, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China
| | - Xiaolan Jin
- Department of Endocrinology, Chengdu Military General Hospital, Chengdu, Sichuan Province, China
| | - Zhong Dong
- Beijing Center for Diseases Prevention and Control, Beijing, China
| | - Zeping Ren
- Shanxi Provincial Center for Disease Control and Prevention, Taiyuan, Shanxi Province, China
| | - Zhulin Hou
- Jilin Provincial Center for Disease Control and Prevention, Changchun, Jilin Province, China
| | - Yongqing Zhang
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu Province, China
| | - Jieming Zhong
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
| | - Shunxiang Cai
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei Province, China
| | - Yuan Liu
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan Province, China
| | - Ruilin Meng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong Province, China
| | - Ying Deng
- Sichuan Center for Disease Control and Prevention, Chengdu, Sichuan Province, China
| | - Xianbin Ding
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Jingang Ma
- Shaanxi Provincial Center for Disease Control and Prevention, Xi'an, Shaanxi Province, China
| | - Zhongjian Xie
- Hunan Provincial Key Laboratory of Metabolic Bone Diseases, National Clinical Research Center for Metabolic Diseases, Department of Metabolism and Endocrinology, The Second Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Lin Shen
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wen Wu
- Department of Endocrinology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou, Guangdong Province, China
| | - Mengmeng Zhang
- Department of Osteoporosis, Jilin FAW General Hospital, Changchun, Jilin Province, China
| | - Qifeng Ying
- Center of Osteoporosis, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang Province, China
| | - Yuhong Zeng
- Department of Osteoporosis, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Jin Dong
- Department of Endocrinology, The First Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Steven R. Cummings
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, California
| | - Zhixin Li
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Weibo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Yeap SS, Thambiah SC, Suppiah S, Md-Said S, Appannah G, Samsudin IN, Zainuddin N, Zahari-Sham SY, Hew FL. Asymptomatic morphometric vertebral fractures and its associated factors: A cross-sectional study among adults in a selected urban area in Selangor, Malaysia. PLoS One 2021; 16:e0255069. [PMID: 34293028 PMCID: PMC8297745 DOI: 10.1371/journal.pone.0255069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 07/08/2021] [Indexed: 11/18/2022] Open
Abstract
Objective This study aimed to determine the prevalence of vertebral fractures (VF) in a selected urban population in Malaysia and to explore possible variables associated with VF in the study population. Methods A cross-sectional study involving community-living, healthy subjects aged between 45–90 years from the state of Selangor, Malaysia, were invited to attend a bone health check-up. Subjects with diseases known to affect bone metabolism or were on treatment for osteoporosis (OP) were excluded. Bone mineral density (BMD) was measured using dual energy X-ray absorptiometry (DXA). Lateral and antero-posterior view lumbar spine x-rays were performed and VF was determined by the semi-quantitative Genant method. Results A total of 386 subjects were studied. Asymptomatic morphometric VF were found in 44 (11.4%) subjects. T12 was the most common vertebrae to be fractured. The prevalence of VF was significantly higher in menopausal women (12.4%) compared to non-menopausal women, in those above the age of 60 (18.5%), in those of Chinese ethnicity (16.5%), in those with a low body fat percentage (17.1%) and among those with OP (27.0%). The mean (standard deviation) 25-hydroxyvitamin D [25(OH)D] levels were significantly higher in those with VF compared to those without VF, 67.64 (23.50) and 57.47 (21.71) nmol/L, respectively. However, after multiple regression analysis, age over 60 years and OP on DXA BMD measurement were the only significant associated factors for VF. Conclusion Overall, 11.4% of a selected Malaysian urban population had asymptomatic morphometric VF. Age over 60 years and OP on DXA BMD measurement, but not 25(OH)D levels, were associated with VF.
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Affiliation(s)
- Swan Sim Yeap
- Puchong Specialist Centre, Puchong, Selangor, Malaysia
- Department of Medicine, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
- * E-mail:
| | - Subashini C. Thambiah
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia
| | - Subapriya Suppiah
- Department of Imaging, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia
| | - Salmiah Md-Said
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia
| | - Geeta Appannah
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia
| | - Intan Nureslyna Samsudin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia
| | - Nurunnaim Zainuddin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia
| | - Siti Yazmin Zahari-Sham
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Selangor, Malaysia
| | - Fen Lee Hew
- Puchong Specialist Centre, Puchong, Selangor, Malaysia
- Department of Medicine, Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
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Yu WY, Hwang HF, Chen CY, Lin MR. Situational risk factors for fall-related vertebral fractures in older men and women. Osteoporos Int 2021; 32:1061-1070. [PMID: 33415375 DOI: 10.1007/s00198-020-05799-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/14/2020] [Indexed: 02/07/2023]
Abstract
UNLABELLED Situational factors might help explain why most vertebral fractures occur in older people without a previous osteoporosis diagnosis. After adjusting for predisposing risk factors, the activity before the fall, type of fall, and falling direction remained as strong determinants of fall-related vertebral fractures in older men and women. INTRODUCTION A matched case-control study was conducted to investigate the effects of situational factors, in addition to predisposing factors, on clinical vertebral fractures in older men and women in Taiwan. METHODS Cases were community-dwelling individuals aged ≥ 65 years who visited emergency departments (EDs) of two university-affiliated hospitals due to a fall and had a primary diagnosis of a vertebral fracture during a 1-year period in 2017. Five control patients per case, matched by the time of falling, gender, and age, who sought care in the same ED due to a fall resulting in a soft tissue injury were selected. A total of 64 men (age range: 65 ~ 99 years) and 194 women (age range: 65 ~ 100 years), diagnosed with a vertebral fracture, participated in the study. RESULTS Multivariable logistic models were conducted separately for men and women. Results suggested that the following factors were significantly associated with an increased risk of vertebral fractures in men: a low educational level (adjusted odds ratio [OR] = 1.95; 95% confidence interval (CI), 1.02 ~ 3.71), asthma (OR = 2.96; 95% CI, 1.35 ~ 6.92), depression (OR = 4.31; 95% CI, 1.03 ~ 17.5), toileting (OR = 2.30; 95% CI, 1.04 ~ 4.94), slipping (OR = 5.27; 95% CI, 1.80 ~ 15.4), stepping down (OR = 3.99; 95% CI, 1.40 ~ 11.4), sudden leg weakness (OR = 3.73; 95% CI, 1.13 ~ 12.4), and falling backwards (OR = 3.78; 95% CI, 1.83 ~ 7.80); and in women: a fracture history (OR = 2.00; 95% CI, 1.07 ~ 3.76), osteoporosis (OR = 1.94; 95% CI, 1.15 ~ 3.49), getting in/out of the bed/chair (OR = 1.90; 95% CI, 1.07 ~ 3.39), stepping down (OR = 2.10; 95% CI, 1.17 ~ 3.77), and falling backwards (OR = 4.00; 95% CI, 2.39 ~ 6.68) and sideways (OR = 2.61; 95% CI, 1.38 ~ 4.96). CONCLUSIONS The combination of predisposing and situational risk factors may display a more comprehensive risk profile for the occurrence of VFs, and thus, interventions that add both types of risk factors may result in greater risk reduction of VFs, although those specifically targeted at situational risk factors during falls are limited and their effectiveness and efficiency remained to be explored.
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Affiliation(s)
- W-Y Yu
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan, Republic of China
- Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - H-F Hwang
- Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, Republic of China
| | - C-Y Chen
- Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan, Republic of China
| | - M-R Lin
- Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan, Republic of China.
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Choi HG, Lee JK, Lee MJ, Park B, Sim S, Lee SM. Blindness increases the risk for hip fracture and vertebral fracture but not the risk for distal radius fracture: a longitudinal follow-up study using a national sample cohort. Osteoporos Int 2020; 31:2345-2354. [PMID: 32632509 DOI: 10.1007/s00198-020-05475-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/21/2020] [Indexed: 12/14/2022]
Abstract
UNLABELLED The risks for hip fracture and vertebral fracture, but not the risk for distal radius fracture, were significantly higher in the blindness group than in the control group with a maximum 12-year follow-up. PURPOSE To evaluate the influence of visual impairment on the risk for osteoporotic fractures at common sites: hip, thoracic/lumbar vertebra, and distal radius. METHODS This longitudinal follow-up study used a database of a national sample cohort from 2002 to 2013 provided by the Korean National Health Insurance Service. Of a total of 1,125,691 subjects, 3918 patients with visual impairment and age ≥ 50 years were enrolled in a 1:4 ratio; 15,672 control participants were matched for age, sex, income, and region of residence. Stratified Cox proportional-hazards models were used to evaluate the crude and adjusted (for steroid medication, rheumatoid arthritis, depression, osteoporosis, diabetes mellitus, and stroke history) hazard ratios (HRs) for each fracture site. Fracture diagnoses were based on the ICD-10 codes: hip fracture (S720, S721, S722), vertebral fracture (S220, S320), and distal radius fracture (S525). RESULTS The HRs for hip and vertebral fracture were significantly higher in the blindness group (adjusted HR = 2.46, p < 0.001 for hip fracture; adjusted HR = 1.42, p = 0.020 for thoracic/lumbar vertebral fracture) than in the matched control group. However, the HR for distal radius fracture was not higher in the blindness group. The HRs for all three fracture sites were not significantly higher in the non-blindness visual impairment group after adjustment. CONCLUSION The risks for hip fracture and vertebral fracture were significantly higher in the blindness group. However, the risk for distal radius fracture was not related to visual impairment including blindness.
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Affiliation(s)
- H G Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Republic of Korea
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang, Republic of Korea
| | - J K Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - M J Lee
- Department of Ophthalmology, Hallym University College of Medicine, Anyang, Republic of Korea
| | - B Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, Republic of Korea
| | - S Sim
- Department of Statistics and Institute of Statistics, Hallym University, 1 Hallymdaehak-gil, Chuncheon-si, Gangwon-do, 24252, Republic of Korea.
| | - S-M Lee
- Department of Cornea, External Disease & Refractive Surgery, HanGil Eye Hospital, Catholic Kwandong University College of Medicine, 35 Bupyeong-daero, Bupyeong-gu, Incheon, 21388, Republic of Korea.
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Elderly men have much lower vertebral fracture risk than elderly women even at advanced age: the MrOS and MsOS (Hong Kong) year 14 follow-up radiology results. Arch Osteoporos 2020; 15:176. [PMID: 33159570 DOI: 10.1007/s11657-020-00845-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
UNLABELLED MrOS MsOS (Hong Kong) studies year 14 follow-up shows for subjects without baseline osteoporotic vertebral deformity, women's incident vertebral fracture (VF) rate was twice that of men. For subjects with vertebral deformity of baseline ≥ 20% height loss, counting subject, women's incident VF rate was three times higher than that of men. INTRODUCTION For MrOS MsOS (Hong Kong) baseline (BL) studies, 2000 men and 2000 women ≥ 65 years were recruited during 2001 to 2003. This study presents the year 14 follow-up (FU). MATERIALS Whole spine MRI was performed in 271 males (mean, 82.8 ± 3.6 years) and 150 females (mean, 82.0 ± 4.29 years). Osteoporotic vertebral deformity (OVD) classification included no OVD (grade 0), and OVDs with < 20%, 20~25%, > 25%~1/3, > 1/3~40%, > 40%~2/3, and > 2/3 height loss (grade 1~6). With an existing VD, a further height loss of ≥ 15% was a VD progression. A new incident VD was a change from grade 0 to ≥ grade 2 or to grade 1 with ≥ 10% height loss. OVD progression and new incident OVD were considered incident VF. RESULTS The proportion of osteoporotic subjects only slightly increased during FU for men but doubled for women. Groupwise, OVD was not associated with back pain in men; but OVD with > 1/3 height loss was associated with back pain in women. For subjects without BL OVD, 7.9% of men and 14.6% of women had incident VF. For subjects with BL OVD of ≥ 20% height loss, men's and women's incident VF were 17.6% and 52.6%, respectively, counting subject and 1.68% and 7.89%, respectively, counting vertebra. CONCLUSION Elderly men with or without existing osteoporotic VD have much lower future VF risk than elderly women.
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Cumulative and Incremental Value of Sarcopenia Components on Predicting Adverse Outcomes. J Am Med Dir Assoc 2020; 21:1481-1489.e3. [DOI: 10.1016/j.jamda.2020.05.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 12/27/2022]
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Wáng YXJ, Lentle BC. Radiographic osteoporotic vertebral fractures in elderly men: a brief review focusing on differences between the sexes. Quant Imaging Med Surg 2020; 10:1863-1876. [PMID: 32879863 PMCID: PMC7417751 DOI: 10.21037/qims-2020-21] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 06/28/2020] [Indexed: 12/16/2022]
Abstract
Bone loss occurs in both sexes as a result of ageing but is exacerbated in women by the hormonal changes associated with menopause. Unlike in women, secondary osteoporosis occurs in almost half of men diagnosed with osteoporosis. Moreover, vertebral fractures (VFs) seen in elderly men may more likely be the result of high energy trauma. The osteoporotic vertebral fracture (OVF) radiograph diagnosis criteria for women may not be directly applicable for men. Particular attention should be paid to the mid-thoracic level where over-diagnosis commonly occurs. For wedge-shaped vertebral deformities (VDs) or VDs with anterior height reduction only, a diagnosis of OVF requires great caution, as they are poorly correlated to bone mineral density (BMD). For age-matched subjects, it is likely that elderly men's prevalent radiographic OVFs are approximately half of the elderly women's. This male-female ratio is very similar to other clinical fractures such as those occurring at the hip. Even so, the clinical relevance of OVF in elderly men may be less than that of elderly women. On the other hand, for elderly men with hip BMD-based osteoporosis, the OVF risk is as high as that of osteoporotic women. Elderly Chinese men have a lower OVF prevalence than age-matched Caucasian men.
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Affiliation(s)
- Yì Xiáng J. Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Brian C. Lentle
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
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Su Y, Lam FMH, Leung J, Cheung WH, Ho SC, Kwok T. The Predictive Value of Sarcopenia and Falls for 2-Year Major Osteoporotic Fractures in Community-Dwelling Older Adults. Calcif Tissue Int 2020; 107:151-159. [PMID: 32472390 PMCID: PMC7382674 DOI: 10.1007/s00223-020-00709-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 05/19/2020] [Indexed: 12/26/2022]
Abstract
To evaluate the associations of sarcopenia and previous falls with 2-year major osteoporotic fractures (MOFs) in community-dwelling older adults. Four thousand Chinese men and women ≥ 65 years recruited from Hong Kong communities were prospectively followed up. Measures of muscle mass, grip strength, gait speed and falls in the previous year were recorded at baseline, the 2nd year and the 4th year visit for each subject. The associations of fall history, sarcopenia and its components with 2-year MOFs were evaluated using generalized linear mixed models. Poor grip strength and poor gait speed were significantly associated with a higher 2-year MOFs risk, with an adjusted OR (95% CI) per one SD decrease of 1.48 (1.17, 1.87) and 1.17 (1.00, 1.36), respectively. Falls in the previous year was a significant predictor for 2-year MOFs risk, with an adjusted OR (95% CI) per one added fall of 1.85 (1.40, 2.44) in men and 1.26 (1.01, 1.58) in women. The adjusted OR (95% CI) of height adjusted appendicular lean muscle mass (ALM/height2) per one SD decrease and sarcopenia for 2-year MOFs risk were 1.34 (0.87, 2.06) and 1.72 (0.92, 3.21) in men, and were 0.73 (0.57, 0.93) and 0.76 (0.39, 1.47) in women, respectively (P for interaction by gender = 0.012 and 0.017, respectively). Poor sarcopenia-related physical performance and falls in the previous year were significant predictors for 2-year MOFs in community-dwelling older adults. The predictive value of ALM by DXA for near-term fracture risk is limited and different across genders.
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Affiliation(s)
- Yi Su
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Freddy M H Lam
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Jason Leung
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Wing-Hoi Cheung
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Suzanne C Ho
- Division of Epidemiology, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Timothy Kwok
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
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Yang J, Mao Y, Nieves JW. Identification of prevalent vertebral fractures using Vertebral Fracture Assessment (VFA) in asymptomatic postmenopausal women: A systematic review and meta-analysis. Bone 2020; 136:115358. [PMID: 32268210 DOI: 10.1016/j.bone.2020.115358] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/20/2020] [Accepted: 04/03/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Vertebral fracture (VF) is the most common osteoporotic fracture in postmenopausal women, although most VFs are subclinical. Prevalent VFs are a significant predictor of subsequent fracture and therefore, identification of VF improves the identification of those with high fracture risk. The aim of present study was to systematically review the literature that assessed the prevalence of VF in asymptomatic postmenopausal women, using Vertebral Fracture Assessment (VFA) by dual-energy X-ray absorptiometry. METHOD Medline, Web of Science and Cochrane databases were searched between Jan 1st, 2000 and Jan 31st, 2018, for publications in English that reported the prevalence of VFA-detected VF in asymptomatic postmenopausal women. We also searched for reports, conference papers and grey literature. Reviewers screened studies for eligibility and extracted data for included studies. Random effects meta-analyses were performed to calculate the prevalence of VF. The presence of publication bias was assessed using funnel plots by precision and Egger's Test of the Intercept. RESULTS A total of 1777 articles were identified, 94 studies were fully reviewed and 28 studies (n = 25,418) met the inclusion criteria and were analyzed. More than two thirds of the studies were cross-sectional and the sample size varied widely across the studies (from 63 to 5156). The mean age ranged from 59.5 to 86.2 years old. The prevalence of osteoporosis and osteopenia varied between 6-57.0% and 25.1-58.9%, respectively. However, among women who had prevalent VFs, up to 43% had osteopenia and as many as 32% had normal bone density. The weighted pooled prevalence of VFA-detected VF in asymptomatic women was 28% (95% CI: 23%-32%). CONCLUSION VFA is able to identify prevalent VF in asymptomatic postmenopausal women. The use of VFA identified an average of 28% of asymptomatic women with VFs, many of whom did not have a diagnosis of osteoporosis. Implementation of VFA as a routine screening tool may detect high risk women. Detection of VF might lead to pharmacological treatment in individuals who may not otherwise be treated.
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Affiliation(s)
- Jingyan Yang
- Institute for Social and Economic Research and Policy (ISERP), Columbia University, New York, NY, USA; Patient Health and Impact, Pfizer Inc., New York, NY, USA
| | - Yushan Mao
- Department of Endocrinology, The Affiliated Hospital of Medical School, Ningbo University, Zhejiang, China
| | - Jeri W Nieves
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Hospital for Special Surgery, New York, NY, USA.
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Lin JS, Chan FYF, Leung J, Yu B, Lu ZH, Woo J, Kwok T, Lau KKL. Longitudinal Association of Built Environment Pattern with Physical Activity in a Community-Based Cohort of Elderly Hong Kong Chinese: A Latent Profile Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124275. [PMID: 32549289 PMCID: PMC7344458 DOI: 10.3390/ijerph17124275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/11/2020] [Accepted: 06/12/2020] [Indexed: 12/12/2022]
Abstract
A large number of studies have focused on the associations between single built environment (BE) characteristics and physical activity (PA). Combinations of BE characteristics offer a more comprehensive approach to identify the BE–PA associations. We aimed to examine the BE–PA associations in a cohort of elderly Hong Kong Chinese. Between 2001 and 2003, 3944 participants (65–98 years of age) were recruited and followed for a mean of 7.8 years. BE characteristics were assessed via geographic information system. PA levels were obtained using the Physical Activity Scale for the Elderly questionnaire at baseline and three follow-ups. Latent profile analysis was first conducted to classify the BE characteristics, and linear mixed-effects models were then used to explore the longitudinal associations between the BE classes and changes in the PA levels. Three classes of BE were identified. Class 3 (characterized by greater green space and sky view factor) demonstrated a significant decline in household PA (β = −1.26, 95% confidence interval: −2.20, −0.33) during the study period, and a slower decline in walking PA (1.19 (0.42, 1.95)) compared with Class 2 (characterized by a greater proportion of residential land use). Our results indicate that BE patterns characterized by high green space and a sky view factor may help promote the walking PA level.
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Affiliation(s)
- Jie-Sheng Lin
- Institute of Future Cities, The Chinese University of Hong Kong, Hong Kong 99077, China;
- Correspondence: (J.-S.L.); (K.K.-L.L.); Tel.: +852-39435399 (J.-S.L.); +852-39435398 (K.K.-L.L.)
| | - Faye Ya-Fen Chan
- Institute of Future Cities, The Chinese University of Hong Kong, Hong Kong 99077, China;
| | - Jason Leung
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong 99077, China; (J.L.); (B.Y.); (T.K.)
| | - Blanche Yu
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong 99077, China; (J.L.); (B.Y.); (T.K.)
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 99077, China; (Z.-H.L.); (J.W.)
| | - Zhi-Hui Lu
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 99077, China; (Z.-H.L.); (J.W.)
| | - Jean Woo
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 99077, China; (Z.-H.L.); (J.W.)
- CUHK Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong 99077, China
| | - Timothy Kwok
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong 99077, China; (J.L.); (B.Y.); (T.K.)
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 99077, China; (Z.-H.L.); (J.W.)
| | - Kevin Ka-Lun Lau
- Institute of Future Cities, The Chinese University of Hong Kong, Hong Kong 99077, China;
- CUHK Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong 99077, China
- Correspondence: (J.-S.L.); (K.K.-L.L.); Tel.: +852-39435399 (J.-S.L.); +852-39435398 (K.K.-L.L.)
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Horii C, Asai Y, Iidaka T, Muraki S, Oka H, Tsutsui S, Hashizume H, Yamada H, Yoshida M, Kawaguchi H, Nakamura K, Akune T, Oshima Y, Tanaka S, Yoshimura N. The incidence and risk factors for adjacent vertebral fractures in community-dwelling people with prevalent vertebral fracture: the 3rd and 4th survey of the ROAD study. Arch Osteoporos 2020; 15:74. [PMID: 32424619 DOI: 10.1007/s11657-020-00747-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 04/29/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED In this 3-year follow-up study of 66 community-dwelling adults with severely deformed vertebral fractures, the annual incidence of adjacent vertebral fracture (AVF) was 6.1%/year. Lower bone mineral density at the femoral neck and spinopelvic malalignment were risk factors for AVF. PURPOSE This study aimed to clarify the incidence and risk factors of adjacent vertebral fractures (AVFs)-fractures adjacent to a prevalent vertebral fracture (VF)-using an established population-based cohort from the ROAD study. METHODS Among the 1213 participants who underwent whole-spine radiography in ROAD's third (2012-2013, the baseline) and fourth surveys (2015-2016, the follow-up), 66 (12 men, 54 women) had at least one VF at the baseline. VF and AVF were determined radiographically using Genant's semi-quantitative (SQ) method, where VF was SQ ≥ 2 and AVF was a one-level cranial or caudal vertebra with an SQ grade one or more higher at the follow-up. An interviewer-administered questionnaire was applied, and anthropometric measurements and bone mineral density (BMD) measurements at the lumbar spine and femoral neck were performed. Sagittal imbalance of the spine was defined as a mismatch between pelvic incidence and lumbar lordosis (PI-LL) of > 20°. Multivariate logistic regression analyses were performed to identify risk factors for AVF. RESULTS AVF occurred in 12 participants (1 man, 11 women). The annual incidence of AVF was estimated at 6.1%/year. Logistic regression analyses revealed that lower BMD at the femoral neck and PI-LL > 20° were risk factors for AVF. CONCLUSIONS The annual incidence of AVF in a general population with prevalent VF was 6.1%/year. In addition, lower BMD at the femoral neck and PI-LL > 20° were risk factors for AVF.
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Affiliation(s)
- Chiaki Horii
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshiki Asai
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Toshiko Iidaka
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical & Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shigeyuki Muraki
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical & Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama, 641-8510, Japan
| | - Hiroshi Kawaguchi
- JCHO Tokyo Shinjuku Medical Center, 5-1, Tsukudo-cho, Shinjyuku-ku, Tokyo, 162-8543, Japan
| | - Kozo Nakamura
- National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa City, Saitama, 359-0042, Japan
| | - Toru Akune
- National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa City, Saitama, 359-0042, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical & Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.
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Tong X, Ho JMW, Li Z, Lui KH, Kwok TCY, Tsoi KKF, Ho KF. Prediction model for air particulate matter levels in the households of elderly individuals in Hong Kong. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 717:135323. [PMID: 31839290 DOI: 10.1016/j.scitotenv.2019.135323] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/14/2019] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
Abstract
Air pollution has shown to cause adverse health effects on mankind. Aging causes functional decline and leaves elderly people more susceptible to health threats associated with air pollution exposure. Elderly spend approximately 80% of their lifetime at home every day. To understand air pollution exposure, indoor air pollutants are the targets for consideration especially for the elderly population. However, indoor air monitoring for epidemiological studies requires a large population, is labor intensive and time consuming. As a result, a prediction model is necessary. For 3 consecutive days in summer and winter, 24-h average of mass concentrations of fine particulate matter (aerodynamic diameter <2.5 μm: PM2.5) were measured in indoors for 116 households. A PM2.5 prediction model for elderly households in Hong Kong has been developed by combining ambient PM2.5 concentrations obtained from land use regression model and questionnaire-elicited information related to the indoor PM2.5 sources. The fitted linear mixed-effects model is moderately predictive for the observed indoor PM2.5, with R2 = 0.67 (or R2 = 0.61 by cross-validation). The model shows indoor PM2.5 was positively influenced by outdoor PM2.5 levels. Meteorological factors (e.g. temperature and relative humidity) were related to the indoor PM2.5 in a relatively complex manner. Congested living areas, opening windows for extended periods for ventilation and use of liquefied petroleum gas for cooking were the factors determining the ultimate indoor air quality. This study aims to provide information about controlling household air quality and can be used for future epidemiological studies associated with indoor air pollution in large population.
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Affiliation(s)
- Xinning Tong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason Man Wai Ho
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Zhiyuan Li
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka-Hei Lui
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Timothy C Y Kwok
- CUHK Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China; Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, China
| | - Kelvin K F Tsoi
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; Stanley Ho Big Data Decision Analytics Research Centre, The Chinese University of Hong Kong, Hong Kong, China
| | - K F Ho
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
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Su Y, Leung J, Lee J, Ho KF, Kwok T. The effect of physical activity on dose-relationship between serum 25-hydroxyvitamin D and cardiovascular health events in older adults. Nutr Metab Cardiovasc Dis 2020; 30:656-665. [PMID: 32151483 PMCID: PMC7203507 DOI: 10.1016/j.numecd.2019.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/09/2019] [Accepted: 12/05/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Reverse J- or U-shaped associations between serum 25-hydroxyvitamin D (25[OH]D) concentrations and cardiovascular outcomes have been reported, which need clarifications in older adults. Physical activity, correlating with both serum 25[OH]D concentration and cardiovascular health, may have an effect on the dose-relationships. METHODS AND RESULTS At baseline, 2790 participants aged 65 years and over, free of vitamin D supplementation use, had assays for serum 25[OH]D concentrations and health related characteristics and measurements, were followed up for cardiovascular events and death by up to 7 and 15 years, respectively. The dose-response associations of serum 25[OH]D concentrations with cardiovascular events and mortality risk were examined using Cox regression models. After adjusting for physical activity and other covariates, serum 25[OH]D concentration was non-linearly associated with cardiovascular mortality risk (U-shaped, P = 0.009). According to the Institute of Medicine categories, the HR(95% CI) of cardiovascular mortality risk separately in deficient (<25 nmol/L), inadequate (25 to < 50 nmol/L) and potentially harmful (≥125 nmol/L) level was 1.67 (0.23, 12.01), 1.66 (1.25, 2.20) and 2.21 (0.30, 16.37), respectively. The risk of 25[OH]D inadequacy for cardiovascular mortality was significantly attenuated by increased physical activity, especially leisure activity (P for trend = 0.008 and 0.021, respectively). No significant finding was observed for incident cardiovascular events. CONCLUSION Both lower and higher serum 25[OH]D concentrations were associated with risk of cardiovascular mortality in Chinese community-dwelling older adults. Physical activity may attenuate the cardiovascular mortality risk of vitamin D inadequacy, but its role in individuals with higher 25[OH]D concentrations remains unclear.
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Affiliation(s)
- Yi Su
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason Leung
- Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jenny Lee
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; Department of Medicine and Geriatrics, Alice Ho Miu Ling Nethersole Hospital and Tai Po Hospital, Hong Kong SAR, China
| | - Kin-Fai Ho
- Division of Occupational and Environmental Health, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Timothy Kwok
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR, China; Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Lau LCM, Fan JCH, Chung KY, Cheung KW, Man GCW, Hung YW, Kwok CKB, Ho KKW, Chiu KH, Yung PSH. Satisfactory long-term survival, functional and radiological outcomes of open-wedge high tibial osteotomy for managing knee osteoarthritis: Minimum 10-year follow-up study. J Orthop Translat 2020; 26:60-66. [PMID: 33437624 PMCID: PMC7773956 DOI: 10.1016/j.jot.2020.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/17/2020] [Accepted: 03/02/2020] [Indexed: 01/23/2023] Open
Abstract
Background This prospective cohort study was designed to evaluate the survivorship and functional outcomes associated with long-term results of medial open-wedge high tibial osteotomy (MOWHTO) for the treatment of medial compartment knee osteoarthritis in the Chinese population. Although MOWHTO is a well-established procedure in the management of medial osteoarthritis of the knee, the long-term outcome in the Chinese population has not been reported in current literature. We hypothesised that MOWHTO would result in long-term preservation of knee function in Chinese, similar to that reported in the Caucasian population. Methods A cohort of 22 young adult patients (age < 55 years old) undergoing MOWHTO for the treatment of symptomatic medial compartment knee osteoarthritis between 2002 and 2008 was retrospectively surveyed with a minimum follow-up of 10 years. Kaplan–Meier survival analysis was performed, and the failure modes were investigated. The outcomes on survival (not requiring arthroplasty), clinical outcome (Knee Society Knee Score and Knee Society Function Score) and range of motion (numeric rating scale) at preoperative, 1-year postoperative follow-up and at last follow-up (>10 years) were evaluated. In addition, the mechanical tibiofemoral angle was also measured. The Wilcoxon signed-rank test was used for statistical evaluation of nonparametric data in these related samples. Result A total of 31 knees in these 22 cases were included. The follow-up rate was 100% at 13.4 ± 1.9 years (11–17). Mean age at time of surgery was 45.8 ± 9.5 years (18–53). At 10-year follow-up, four knees converted to require total knee arthroplasty (survival: 87.1%). Preoperative varus alignment with mechanical tibiofemoral angle of −9.26 ± 2.83 was corrected to 2.58 ± 2.46 after surgery and remained 2.01 ± 3.52 at the latest follow-up. Knee Society Knee Score increased significantly from 53.7 ± 11.1 preoperatively to 93.8 ± 6.8 at 1-year follow-up and 91.8 ± 9.7 at latest follow-up. Similarly, the functional score also increased significantly from 67.4 ± 21.0 preoperatively to 86.3 ± 14.5 at 1-year follow-up and 82.1 ± 16.6 at latest follow-up (p < 0.01). Whereas, the range of motion significantly decreased from 122.7 ± 6.6 preoperatively to 116.1 ± 15.5 at the latest follow-up. Conclusion Even in cases of severe medial osteoarthritis and varus malalignment, MOWHTO would be a good treatment option for management in active Chinese population less than 55 years. Although the long-term survival and functional outcome after MOWHTO was proven to be satisfactory in our cohort during the 10-year follow-up, a larger cohort to illustrate the long-term functional outcome is still warranted. Translational potential The finding in this study indicated MOWHTO is a feasible treatment option for young adult patients with osteoarthritis to achieve long-term satisfactory results.
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Affiliation(s)
- Lawrence C M Lau
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong.,Department of Orthopedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Shatin, Hong Kong
| | - Jason C H Fan
- Department of Orthopedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Shatin, Hong Kong
| | - Kwong-Yin Chung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong
| | - Kin-Wing Cheung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong
| | - Gene C W Man
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong
| | - Yuk-Wah Hung
- Department of Orthopedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Shatin, Hong Kong
| | - Carson K B Kwok
- Department of Orthopedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Shatin, Hong Kong
| | - Kevin K W Ho
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong
| | - Kwok-Hing Chiu
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong
| | - Patrick S H Yung
- Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong
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Wong SPY, Mok CC. Management of glucocorticoid-related osteoporotic vertebral fracture. Osteoporos Sarcopenia 2020; 6:1-7. [PMID: 32226826 PMCID: PMC7093682 DOI: 10.1016/j.afos.2020.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/15/2019] [Accepted: 02/08/2020] [Indexed: 12/11/2022] Open
Abstract
The vertebral column is the most common site of osteoporotic fractures in long-term users of glucocorticoids. Vertebral fracture leads to significant morbidities such as unrelenting pain, spinal deformities and reduced mobility, leading to diminished quality of life. Epidemiological data on the prevalence of glucocorticoid-induced vertebral fractures are limited. As vertebral fracture is a strong risk factor for further fragility fractures and mortality, it should be treated appropriately. This article reviews recent data on the prevalence of vertebral fractures in glucocorticoid users, fracture risk stratification, and evidence-based treatment options. The risk of osteoporotic fractures estimated by FRAX should be adjusted for glucocorticoid users. The first-line treatment of glucocorticoid-induced osteoporosis remains the bisphosphonates. Teriparatide and denosumab are alternative options. Percutaneous vertebroplasty and kyphoplasty may be considered for symptomatic control of acute vertebral fracture-related pain when conservative measures fail.
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Affiliation(s)
| | - Chi Chiu Mok
- Department of Medicine, Tuen Mun Hospital, Hong Kong, China
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40
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Abstract
Supplemental Digital Content is available in the text
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41
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Wáng YXJ, Che-Nordin N, Deng M, Griffith JF, Leung JCS, Kwok AWL, Leung PC, Kwok TCY. Elderly males with or without existing osteoporotic vertebral fracture have much lower future vertebral fracture risk than elderly females: the MrOS (Hong Kong) year-4 follow-up spine radiograph study. Osteoporos Int 2019; 30:2505-2514. [PMID: 31478068 DOI: 10.1007/s00198-019-05136-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/16/2019] [Indexed: 12/18/2022]
Abstract
UNLABELLED MrOS (Hong Kong)'s year-4 follow-up shows, for subjects at baseline without vertebral deformity (VD) and endplate or/and cortex fracture (ECF), the VD progression/new VD rate during follow-up in males was half of our paired MsOS (Hong Kong) study's results. For those with VD or ECF, the VD progression/new VD was less than one sixth of females' rate. INTRODUCTION This study documents MrOS (Hong Kong)'s year-4 follow-up, and the results are compared with the MsOS (Hong Kong) study. Of elderly females with Genant's grade-0, -1, -2, and -3 VD, at year-4 follow-up, 4.6%, 8%, 10.6%, and 28.9% had at least one VD progression or incident VD, respectively. METHODS Spine radiographs of 1500 Chinese males with baseline (mean age 71.7 years, range 65-91 years) and year-4 follow-up were evaluated according to Genant's VD criteria and ECF (non-existent, ECF0; or existent, ECF1). Grade-2 VDs were divided into mild (VD2m, 25-34% height loss) and severe (VD2s, 34-40% height loss) subgroups. Study subjects were graded into eight categories: VD0/ECF0, VD1/ECF0, VD2m/ECF0, VD0/ECF1, VD1/ECF1, VD2m/ECF1, VD2s/ECF1, and VD3/ECF1. With an existing VD, a further height loss of ≥ 15% was a VD progression. A new VD incident was a change from grade-0 to grade-2/3, or to grade-1 with ≥ 10% height loss. RESULTS Of subjects with Genant's grade-0, 2.05% (25/1219) developed at least one VD progression or/and new VD, while of subjects with Genant's grade-1, -2, and -3 VD, only 2% (3/149), 3.1% (3/96), and 2.8% (1/36) developed at least one VD progression/new VD, respectively. Among the three ECF0 groups, there was a significant difference in new ECF incidence, with VD0/ECF0 being the lowest and VD2m/ECF0 being the highest. CONCLUSION VD progression/new VD is much less common in elderly men than in elderly women. Vertebrae with VD had a higher risk of developing ECF.
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Affiliation(s)
- Y X J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China.
| | - N Che-Nordin
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - M Deng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - J F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - J C S Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - A W L Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - P C Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
| | - T C Y Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, SAR, China
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Su Y, Elshorbagy A, Turner C, Refsum H, Chan R, Kwok T. Circulating amino acids are associated with bone mineral density decline and ten-year major osteoporotic fracture risk in older community-dwelling adults. Bone 2019; 129:115082. [PMID: 31622772 PMCID: PMC6925590 DOI: 10.1016/j.bone.2019.115082] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/17/2019] [Accepted: 09/26/2019] [Indexed: 11/18/2022]
Abstract
With aging, poor bone mineral density (BMD) and accelerated decrease in BMD are strong risk factors for fracture. Reports of the associations of dietary protein intake with bone strength are inconsistent, possibly owing to differences in protein sources and amino acid (AA) composition. We examined the associations of serum AA with 4-year hip BMD loss and subsequent fracture risk within 10 years in older community-dwelling adults, and further addressed whether lifestyle, dietary protein intake and its source, and body composition would affect the associations. In 1424 men and 1573 women (mean age 72 years), using binary logistic regression, higher serum valine, leucine, isoleucine and tryptophan concentrations were associated (or approaching a borderline significance in case of the last three ones) with less hip BMD decline (defined as BMD loss ≥ 2.8 times the precision error of the BMD measurement at femoral neck) in 4 years later, with the OR (95%CI) /SD of AA increase, ranging from 0.83 (0.75, 0.91) to 0.92 (0.87, 0.98) after multiple adjustments for baseline age, gender, BMI, BMD, estimated glomerular filtration rate (eGFR), dietary protein intake (animal- and plant-derived protein intakes), calcium intake, established lifestyles (physical activity level, smoking and alcohol drinking status), osteoporosis medications, and changes of body fat and lean muscle mass. Higher serum total homocysteine (tHcy) concentration was independently associated with BMD decline 4 years later (OR (95%CI) /SD of 1.16 (1.05, 1.27)). Using multivariate Cox regression, higher serum tryptophan concentration potentially predicted low risk of incident major osteoporotic fractures (MOFs) (HR/SD (95%CI)=0.86 (0.75, 0.98)) after multiple adjustments. Higher serum tHcy was associated with MOFs (HR/SD (95%CI)=1.29 (1.12, 1.50)) risk after multiple adjustments in men. These findings suggest that a specific AA profile correlates with greater BMD and lower subsequent fracture risk, independent of diet and lifestyle factors.
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Affiliation(s)
- Yi Su
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Amany Elshorbagy
- Department of Physiology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Cheryl Turner
- Department of Pharmacology, University of Oxford, Oxford, United Kingdom
| | - Helga Refsum
- Institute of Basic Medical Sciences, Department of Nutrition, University of Oslo, Oslo, Norway
| | - Ruth Chan
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Timothy Kwok
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China; Jockey Club Centre for Osteoporosis Care and Control, The Chinese University of Hong Kong, Hong Kong, China.
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Horii C, Asai Y, Iidaka T, Muraki S, Oka H, Tsutsui S, Hashizume H, Yamada H, Yoshida M, Kawaguchi H, Nakamura K, Akune T, Tanaka S, Yoshimura N. Differences in prevalence and associated factors between mild and severe vertebral fractures in Japanese men and women: the third survey of the ROAD study. J Bone Miner Metab 2019; 37:844-853. [PMID: 30607619 DOI: 10.1007/s00774-018-0981-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/21/2018] [Indexed: 01/06/2023]
Abstract
Vertebral fracture (VF) is a common osteoporotic fracture, while its epidemiology varies according to regions and ethnicities, little is known about it in Japan. Using whole-spine radiographs from a population-based cohort study, the Research on Osteoarthritis/Osteoporosis Against Disability study 3rd survey performed in 2012-2013, we estimated the sex- and age-specific prevalence of VF in the Japanese. Genant's semiquantitative method (SQ) was used to define VF; SQ ≥ 1 as VF, SQ = 1 as mild VF, SQ≥ 2 as severe VF. We also revealed accurate site-specific prevalence, and associated factors with mild and severe VF. The participants were 506 men [mean age 66.3 years, standard deviation (SD):13.0] and 1038 women (mean age 65.3 years, SD: 12.6). The prevalence of VF in participants aged under 40, in their 40s, 50s, 60s, 70s, and ≥ 80 years was 17.4, 7.9, 18.5, 25.6, 26.3, and 41.5%, respectively, in men, and 2.9%, 2.4%, 7,3, 10.3, 27.1, and 53.0%, respectively, in women. Men had a significantly higher prevalence of mild VF (21.2%) than women (10.0%, p < 0.001); whereas, severe VF was significantly more prevalent in women (9.1%) than in men (4.7%, p = 0.003). VF was distributed with 2 peaks regarding site; one large peak at the thoracolumbar region, and another at the middle thoracic lesion. Low back pain and decreased walking ability were independently associated with severe VF, but not with mild VF, after adjustment for participant characteristics. Decreased walking ability was associated with multiple VFs in women, but not in men.
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Affiliation(s)
- Chiaki Horii
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yoshiki Asai
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Toshiko Iidaka
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shigeyuki Muraki
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroyuki Oka
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Shunji Tsutsui
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Hiroshi Hashizume
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Munehito Yoshida
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | - Hiroshi Kawaguchi
- JCHO Tokyo Shinjuku Medical Center, 5-1, Tsukudo-cho, Shinjyuku-ku, Tokyo, 162-8543, Japan
| | - Kozo Nakamura
- National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama, 359-0042, Japan
| | - Toru Akune
- National Rehabilitation Center for Persons with Disabilities, 4-1 Namiki, Tokorozawa, Saitama, 359-0042, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo Hospital, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113-8655, Japan.
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Wang XR, Kwok TCY, Griffith JF, Man Yu BW, Leung JCS, Wáng YXJ. Prevalence of cervical spine degenerative changes in elderly population and its weak association with aging, neck pain, and osteoporosis. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:486. [PMID: 31700922 DOI: 10.21037/atm.2019.07.80] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background To investigate the prevalence of MRI degenerative findings of cervical spine in elderly Chinese males and females. Methods From a general population sample, cervical spine T2 weighted sagittal MR images were acquired in 272 males (mean age: 82.9±3.83) and 150 females (mean age: 81.5±4.27). Images were interpreted and degenerative changes were classified. Study subjects were divided into younger group (group A, ≤81 years) and older group (group B, >81 years). For neck pain, question was structured as 'during the past 12 months, have you had any neck pain?'. Two hundred and fifty-two males and 134 females also had hip bone mineral density (BMD) measured. Results 98.1% subjects exhibited at least one degenerative change at one or more vertebral levels. The C5/6 level had the highest overall frequency for degenerative changes. Most of the degenerative changes were more common in females. The older female group had higher prevalence or higher severity of degenerative findings than the younger group. Eleven point four percent of the males and 20.6% of the females reported neck pain, and male subjects with neck pain tended to have slightly higher prevalence of cervical degenerative changes. There was a weak trend that osteoporosis was associated with a higher prevalence of spinal cord high signal and a higher prevalence of spinal canal stenosis. Conclusions The age-dependence of cervical spine degenerative changes was more notable in females. Subjects with neck pain and subjects with osteoporosis were weakly associated with higher prevalence of cervical degenerative changes.
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Affiliation(s)
- Xiao-Rong Wang
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.,Department of Radiology, Ningbo First Hospital, Ningbo 315000, China
| | - Timothy C Y Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine and Therapeutics, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Blanche Wai Man Yu
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason C S Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
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Lam FMH, Leung JCS, Kwok TCY. The Clinical Potential of Frailty Indicators on Identifying Recurrent Fallers in the Community: The Mr. Os and Ms. OS Cohort Study in Hong Kong. J Am Med Dir Assoc 2019; 20:1605-1610. [PMID: 31399362 DOI: 10.1016/j.jamda.2019.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/20/2019] [Accepted: 06/23/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To compare the clinical value of 3 frailty indicators in a screening pathway for identifying older men and women who are at risk of falls. DESIGN A prospective cohort study. SETTING AND PARTICIPANTS Four thousand Chinese adults (2000 men) aged ≥65 years were recruited from the community in Hong Kong. METHODS The Cardiovascular Health Study Criteria, the FRAIL scale, and the Study for Osteoporosis and Fracture Criteria (SOF) were included for evaluation. Fall history was used as a comparative predictor. Recurrent falls during the second year after baseline was the primary outcome. The area under the receiver operating characteristic curve (AUC) was used to evaluate the ability of the frailty indicators and fall history to predict recurrent falls. Independent predictors identified in logistic regression were put in the Classification and Regression Tree (CART) analysis to evaluate their performance in screening high-risk fallers. RESULTS Fall history predicts recurrent falls in both men and women (AUC: men = 0.681; women = 0.645) better than all frailty indicators (AUC ≤ 0.641). After adjusting for fall history, only FRAIL (AUC = 0.676) and SOF (AUC = 0.673) remained as significant predictors for women whereas no frailty indicator remained significant in men. FRAIL could classify older women into 2 groups with distinct chances of being a recurrent faller in people with no fall history (3.8% vs 7.5%), a single fall history (9.5% vs 37.5%), and history of recurrent falls (16.0% vs 30.8%). SOF has limited ability in identifying recurrent fallers in the group of older adults with a single fall history (no fall history: 3.9% vs 8.6%; single fall history: 10.2% vs 10.9%; history of recurrent falls: 16.5% vs 20.6%). CONCLUSIONS AND IMPLICATIONS SOF and FRAIL could provide some additional prediction value to fall history in older women but not men. FRAIL could be clinically useful in identifying older women at risk of recurrent falls, especially in those with a single fall history.
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Affiliation(s)
- Freddy M H Lam
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jason C S Leung
- Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Timothy C Y Kwok
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong; Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Deng M, Zeng XJ, He LC, Leung JCS, Kwok AWL, Griffith JF, Kwok T, Leung PC, Wáng YXJ. Osteoporotic Vertebral Fracture Prevalence in Elderly Chinese Men and Women: A Comparison of Endplate/Cortex Fracture-Based and Morphometrical Deformity-Based Methods. J Clin Densitom 2019; 22:409-419. [PMID: 29307693 DOI: 10.1016/j.jocd.2017.11.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/14/2017] [Accepted: 11/17/2017] [Indexed: 11/16/2022]
Abstract
This study aims to evaluate endplate/cortex fracture (ECF)-based method for detecting osteoporotic vertebral fracture (VF) in elderly Chinese population (age ≥ 65 years). The radiographs of 1954 elderly Chinese men (mean: 72.3 years) and 1953 elderly Chinese women (mean: 72.5 years) were evaluated according to Genant's morphometrical vertebral deformity (VD) severity criteria, as well as identified VF according to ECF without necessary requirement of VD. According to ECF, grade-1, -2, and -3 VF prevalence was 1.89%, 1.74%, and 2.25% in men, and 3.33%, 3.07%, and 5.89% in women, respectively. In men and women, 15.7% (35 of 223) and 34.5% (48 of 139) of vertebrae with VD grade-1 deformity were ECF(+, with fracture), respectively. In men and women, 89.7% (35 of 39) and 66.7% (48 of 72) of vertebrae with ECF grade-1 fracture had VD grade-1 deformity. For grade-1 change, ECF(+) subjects tended to have a lower BMD than the VD(+) subjects. In subjects with VD grade-2 deformity, those who were also EC (+) tended to have a lower BMD than those were ECF(-). In all grades, VD(-) and ECF(-) subjects tended to have highest BMD, whereas VD(+) and ECF(+) subjects tended to have lowest BMD. ECF may be more specific for assessing mild VF than the criteria based on vertebral deformity.
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Affiliation(s)
- Min Deng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Xian Jun Zeng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lai-Chang He
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jason C S Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Anthony W L Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Timothy Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China; Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Ping Chung Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China
| | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
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Wáng YXJ, Che-Nordin N, Deng M, Leung JCS, Kwok AWL, He LC, Griffith JF, Kwok TCY, Leung PC. Osteoporotic vertebral deformity with endplate/cortex fracture is associated with higher further vertebral fracture risk: the Ms. OS (Hong Kong) study results. Osteoporos Int 2019; 30:897-905. [PMID: 30666373 DOI: 10.1007/s00198-019-04856-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/13/2019] [Indexed: 12/12/2022]
Abstract
UNLABELLED Compared with vertebrae without deformity, vertebrae with mild/moderate deformity have a higher risk of endplate or/and cortex fracture (ecf). Compared with subjects without ecf, subjects with ecf are at a higher risk of short-term (4-year period) deformity progression and new incident deformity. INTRODUCTION The progression and incidence of osteoporotic vertebral deformity/fracture (VD/VF) in elderly Chinese females remain not well documented. METHODS Spine radiographs of 1533 Chinese females with baseline and year-4 follow-up (mean age 75.7 years) were evaluated according to Genant's VD criteria and endplate/cortex fracture (non-existent: ecf0 or existent: ecf1). Grade-2 VDs were divided into mild (vd2m, 25-34% height loss) and severe (vd2s, 34-40% height loss) subgroups. According to their VD/VF, subjects were graded into seven categories: vd0/ecf0, vd1/ecf0, vd2m/ecf0, vd1/ecf1, vd2m/ecf1, vd2s/ecf1, and vd3/ecf1. With an existing VD, a further height loss of ≥ 15% was a VD progression. A new incident VD was a change from grade-0 to grade-2/3 or to grade-1 with ≥ 10% height loss. RESULTS Of subjects with Genant's grades 0, - 1, - 2, and - 3 VD, at follow-up, 4.6%, 8%, 10.6%, and 28.9% had at least one VD progression or new incident VD respectively. Among the three ecf0 groups, there was no difference in VD progression or new VD; while there was a significant difference in new ecf incidence, with vd0/ecf0 being lowest and vd2m/ecf0 being highest. Vd1/ecf0 and vd2m/ecf0 vertebrae had a higher risk of turning to ecf1 than vd0/ecf0 vertebrae. If vd1/ecf0 and vd2m/ecf0 subjects were combined together (range 20-34% height loss) to compare with vd1/ecf1 and vd2m/ecf1 subjects, the latter had significantly higher VD progression and new VD rates. CONCLUSION Vertebrae with grade-1/2 VDs had a higher risk of developing ECF. Subjects with pre-existing ECFs had a higher risk of worsening or new vertebral deformities.
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Affiliation(s)
- Y X J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China.
| | - N Che-Nordin
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - M Deng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - J C S Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - A W L Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - L C He
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - J F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - T C Y Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
- Department of Medicine and Therapeutics, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - P C Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, SAR, China
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The epidemiology of osteoporosis, associated fragility fractures, and management gap in China. Arch Osteoporos 2019; 14:32. [PMID: 30848398 DOI: 10.1007/s11657-018-0549-y] [Citation(s) in RCA: 134] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/12/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Osteoporosis has been one of the most common but largely under-diagnosed clinical problems among elderly population. The disease burden is even greater in China because of limited medical resources and large population size. This article is aimed to provide an overview of disease burden, secular trend, and management gap of osteoporosis and related fractures in China. METHODS Based on the related studies published in English and Chinese from 1990 to 2017, we investigated the prevalence/incidence of osteoporosis and osteoporotic fracture in Chinese mainland, Hong Kong, and Taiwan, characterizing the secular trend and disease burden in different regions. Strict inclusion criteria were applied to control the study quality. We further examined the diagnosis and treatment gap of osteoporosis management observed in clinical practice in China and summarized the efforts made by Chinese government and scholars to combat this situation. RESULTS Twenty-seven studies concerning osteoporosis prevalence in China (including Chinese mainland, Hong Kong, and Taiwan) met the inclusion criteria and were included in the final analysis. Another 15 studies about hip fracture incidence and 13 studies about vertebral fracture prevalence/incidence were also included. The epidemiological data varied greatly across studies due to different design and population included. A higher prevalence was indicated in female population, older age groups, and residents in northern China compared to their counterparts. Though attenuated increased rates or slight decline patterns have been observed in Hong Kong and Taiwan, osteoporotic fracture incidence still showed steady increase in Chinese mainland. The diagnosis and treatment of osteoporosis as well as post-fracture management were still insufficient in China. CONCLUSION Due to its silent nature, osteoporosis and its related fractures remain largely under-diagnosed and under-managed in China. It also highlights the scarcity of high-quality studies specifically focus on longtime documentation of disease burden change and male population, especially in mainland area.
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Vertebral Fractures among Patients Referred for Bone Densitometry Screening in Dubai Primary Health Care Facilities. Int J Rheumatol 2019; 2019:7974534. [PMID: 30956664 PMCID: PMC6431384 DOI: 10.1155/2019/7974534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/24/2019] [Accepted: 02/14/2019] [Indexed: 01/21/2023] Open
Abstract
Vertebral fractures are one of the most common fractures associated with low bone mineral density. However two-thirds to three-fourths of patients with vertebral fractures are not clinically recognized. The objective of this study was to determine the prevalence of vertebral fractures in patients referred for bone densitometry and the most common site of fracture. The study was carried out in the osteoporosis clinic in Dubai primary health care center. A total of 120 patients were examined using the dual energy X-ray absorptiometry. Of all the patients, 48.3% were osteoporotic and 40.9% were osteopenic. The overall prevalence of vertebral fracture was 14.2%. The result showed that the prevalence of vertebral fracture was higher in female compared to male (15.7% and 9.7%, respectively). It was found that patients aged 80 and above had the highest prevalence of vertebral fracture (54.5%). Undiagnosed vertebral fractures were common. Therefore, it is crucial to prevent vertebral fracture through early diagnosis and appropriate treatment of osteoporosis.
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Che-Nordin N, Deng M, Griffith JF, Leung JCS, Kwok AWL, Zhu YQ, So RHY, Kwok TCY, Leung PC, Wáng YXJ. Prevalent osteoporotic vertebral fractures more likely involve the upper endplate than the lower endplate and even more so in males. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:442. [PMID: 30596072 DOI: 10.21037/atm.2018.10.61] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background While the importance of identifying osteoporotic vertebral endplate fracture (EPF) is being recognized; the pathophysiological understanding of EPF till now remain insufficient. In this population-based cross-sectional radiograph study, we aim to investigate the anatomic location characteristics of osteoporotic EPF. Methods This study analyzed the anatomical location of osteoporotic EPFs in elderly Chinese population (age ≥65 years). The T4-L4 radiographs of 1,954 elderly Chinese men (mean: 72.3 years) and 1,953 elderly Chinese women (mean: 72.5 years) were evaluated to identify EPF, and vertebral bodies were graded according to Genant's vertebral deformity criteria. Results Of the 101,582 endplates analyzed, there were 505 EPFs (males: 27.7%; females: 72.3%). Excluding those with both upper endplate and lower endplate involvements, the ratio of upper EPF to lower EPF was 9.63 for males and 4.3 for females (P<0.05). Thoracolumbar junction, particularly L1 (26.4% for males and 24.1% for females) and followed by T12 (20.7% for males and 19.7% for females), had highest prevalence of EPF. With an endplate divided into 5 segments of equal length in the anteroposterior direction and grade 0.5 & 1, grade 2 vertebral deformities analyzed, fractures occurred mostly at the middle segment (70.1% for upper endplates in males and 78.6% for upper endplates in females), followed by second anterior segment (20.9% for upper endplates in males and 14.4% for upper endplates in females). The most anterior and most posterior segments were not primarily involved in EPF. Conclusions Osteoporotic EPFs more likely involve the upper endplate rather than lower endplate, with a trend for this effect to be greater in men than in women. These characteristics may help radiographic differential diagnosis for osteoporotic EPF.
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Affiliation(s)
- Nazmi Che-Nordin
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Min Deng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - James F Griffith
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Jason C S Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Anthony W L Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Yue-Qi Zhu
- Department of Diagnostic and Interventional Radiology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Richard H Y So
- Department of Industrial Engineering and Decision Analytics, Hong Kong University of Science and Technology, Clearwater Bay, Hong Kong, China
| | - Timothy C Y Kwok
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.,Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Ping Chung Leung
- JC Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
| | - Yì Xiáng J Wáng
- Department of Imaging and Interventional Radiology, Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China
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