1
|
Battista F, Bettini S, Verde L, Busetto L, Barrea L, Muscogiuri G. Diet and physical exercise in elderly people with obesity: The state of the art. Eur J Intern Med 2024:S0953-6205(24)00345-5. [PMID: 39155179 DOI: 10.1016/j.ejim.2024.08.007] [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: 02/29/2024] [Revised: 07/30/2024] [Accepted: 08/06/2024] [Indexed: 08/20/2024]
Abstract
Obesity is a disease that is assuming pandemic proportions in recent decades. With the advancement of medicine and increased access to care, average survival has increased, resulting in a larger number of elderly people. As a result, the amount of elderly people living with obesity is increasing, and the morbidity and impact of obesity on ageing implies severe limitations for these people. The link between obesity and ageing is not only epidemiological, but also strictly pathophysiological. Obesity accelerates the ageing process and ageing is characterised by pathophysiological mechanisms shared by obesity itself. Some examples of alterations shared by ageing and obesity are metabolic changes, sarcopenia and reduced functional capacity related to both loss of muscle strength and reduced cardiorespiratory fitness, as well as a general reduction in the perception of quality of life. The specific ability to antagonize these mechanisms through non-pharmacological treatment based on nutrition and exercise has always been one of the focal points of the international literature. Therefore, this review provides the state of the art on scientific knowledge regarding the main effects of an adequate nutritional plan and an individualised exercise prescription on the general health of elderly with obesity. In particular, this paper addresses the effect of nutrition and physical exercise on pathophysiological changes peculiar of ageing and obesity, providing also the scientific rational for nutritional and exercise prescription in the population.
Collapse
Affiliation(s)
- Francesca Battista
- Sports and Exercise Medicine Division, Regional Center for the therapeutic prescription of exercise in chronic disease, Department of Medicine, University of Padova, Via N. Giustiniani 2, 35128, Padova, Italy
| | - Silvia Bettini
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Via N. Giustiniani 2, 35128, Padova, Italy.
| | - Ludovica Verde
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy; Department of Public Health, University "Federico II" of Naples, 80138, Naples, Italy
| | - Luca Busetto
- Center for the Study and Integrated Treatment of Obesity (CeSTIO), Internal Medicine 3, Department of Medicine, University of Padova, Via N. Giustiniani 2, 35128, Padova, Italy
| | - Luigi Barrea
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy; Dipartimento di Benessere, Nutrizione e Sport, Università Telematica Pegaso, 80143, Naples, Italy
| | - Giovanna Muscogiuri
- Centro Italiano per la cura e il Benessere del paziente con Obesità (C.I.B.O), Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy; Cattedra Unesco "Educazione alla Salute e Allo Sviluppo Sostenibile", Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy; Unità di Endocrinologia, Diabetologia e Andrologia, Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Naples, Italy
| |
Collapse
|
2
|
Leungsuwan DS, Chandran M. Bone Fragility in Diabetes and its Management: A Narrative Review. Drugs 2024:10.1007/s40265-024-02078-5. [PMID: 39103693 DOI: 10.1007/s40265-024-02078-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/07/2024]
Abstract
Bone fragility is a serious yet under-recognised complication of diabetes mellitus (DM) that is associated with significant morbidity and mortality. Multiple complex pathophysiological mechanisms mediating bone fragility amongst DM patients have been proposed and identified. Fracture risk in both type 1 diabetes (T1D) and type 2 diabetes (T2D) continues to be understated and underestimated by conventional risk assessment tools, posing an additional challenge to the identification of at-risk patients who may benefit from earlier intervention or preventive strategies. Over the years, an increasing body of evidence has demonstrated the efficacy of osteo-pharmacological agents in managing skeletal fragility in DM. This review seeks to elaborate on the risk of bone fragility in DM, the underlying pathogenesis and skeletal alterations, the approach to fracture risk assessment in DM, management strategies and therapeutic options.
Collapse
Affiliation(s)
| | - Manju Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, 20 College Road, ACADEMIA, Singapore, 169856, Singapore.
- DUKE NUS Medical School, Singapore, Singapore.
| |
Collapse
|
3
|
Stratton MT, Siedler MR, Rodriguez C, Harty PS, Boykin JR, Keith DS, Green JJ, White SJ, Tinoco E, DeHaven B, VanDusseldorp TA, Tinsley GM. No Effect of Breakfast Consumption Observed for Afternoon Resistance Training Performance in Habitual Breakfast Consumers and Nonconsumers: A Randomized Crossover Trial. J Acad Nutr Diet 2024; 124:995-1013. [PMID: 37742826 DOI: 10.1016/j.jand.2023.09.008] [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: 05/25/2023] [Revised: 08/23/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Pre-exercise meal frequency is commonly believed to impact exercise performance, but little is known about its impact on resistance training. OBJECTIVE This study investigated the impact of breakfast consumption on afternoon resistance training performance in habitual breakfast consumers and nonconsumers. DESIGN A randomized, crossover study was conducted in Lubbock, TX between November 2021 and May 2022. PARTICIPANTS Thirty-nine resistance-trained male (n = 20) and female (n = 19) adults (mean ± SD age 23.0 ± 4.7 years) who habitually consumed (≥5 d/wk; n = 19) or did not consume (≥5 d/wk; n = 20) breakfast completed the study. INTERVENTION After the establishment of 1-repetition maximums at the first visit, participants completed 2 additional visits, each of which included 4 sets of barbell back squat, bench press, and deadlift, using 80% of their 1-repetition maximum after either consuming breakfast and lunch or the same food at lunch only. MAIN OUTCOME MEASURES Repetitions, along with average and peak average concentric velocity and power, were measured for all repetitions throughout each exercise session. Visual analog scales were used to assess feelings of fatigue, energy, focus, hunger, desire to eat, and fullness throughout each exercise session. STATISTICAL ANALYSES PERFORMED Data were analyzed using linear mixed-effects models. RESULTS No interactions or main effects involving condition or habitual breakfast consumption were observed for resistance training outcomes, although sex differences were noted. Male participants performed significantly fewer repetitions on sets 2, 3, and 4 (P < .014) for total repetitions, on sets 2 and 4 for barbell back squat (P < .023), and set 4 for deadlift (P = .006), with no observed differences between sexes for bench press repetitions. Male participants displayed reductions in average power across all sets and exercises except deadlift. CONCLUSIONS These data suggest that alterations in pre-exercise meal frequency may not influence afternoon resistance training performance provided similar total nutritional intake is consumed.
Collapse
Affiliation(s)
- Matthew T Stratton
- Energy Balance and Body Composition Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas; Department of Health, Kinesiology and Sport, University of South Alabama, Mobile, Alabama
| | - Madelin R Siedler
- Energy Balance and Body Composition Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas
| | - Christian Rodriguez
- Energy Balance and Body Composition Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas
| | - Patrick S Harty
- Energy Balance and Body Composition Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas; Department of Kinesiology, College of Science, Technology, and Health; Lindenwood University, St Charles, Missouri
| | - Jake R Boykin
- Energy Balance and Body Composition Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas; Department of Nutrition and Integrative Physiology, Florida State University, Tallahassee, Florida
| | - Dale S Keith
- Energy Balance and Body Composition Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas
| | - Jacob J Green
- Energy Balance and Body Composition Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas
| | - Sarah J White
- Energy Balance and Body Composition Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas
| | - Ethan Tinoco
- Energy Balance and Body Composition Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas
| | - Brielle DeHaven
- Energy Balance and Body Composition Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas
| | - Trisha A VanDusseldorp
- Bonafide Health, LLC, JDS Therapeutics, Harrison, New York; Department of Health and Exercise Sciences, Jacksonville University, Jacksonville, Florida
| | - Grant M Tinsley
- Energy Balance and Body Composition Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, Texas.
| |
Collapse
|
4
|
Kobayashi T, Hara M, Shimanoe C, Morimoto T, Masaaki M, Ito K, Shimazaki T. Efficacy and safety of romosozumab: a meta-analysis of placebo-controlled trials. J Bone Miner Metab 2024:10.1007/s00774-024-01531-5. [PMID: 38977437 DOI: 10.1007/s00774-024-01531-5] [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: 02/27/2024] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
INTRODUCTION We aimed to comprehensively compile placebo-controlled trials on the efficacy and safety of romosozumab (210 mg, subcutaneously, once monthly) in postmenopausal women and men with osteoporosis. MATERIALS AND METHODS PubMed, Google Scholar, and ClinicalTrials.gov were searched for relevant placebo-controlled trials (as of January 1, 2024). Percent change in bone mineral density (BMD), falls, fractures, and adverse events (AEs) after drug administration were collected. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated. RESULTS Six trials (7990 patients; follow-up period, 6-12 months) were included. Compared with placebo, romosozumab significantly increased lumbar spine BMD (MD = 12.69; 95% CI 11.10-14.29), total hip BMD (MD = 4.42; 95% CI 3.03-5.80), and femoral neck BMD (MD = 3.99; 95% CI 2.42-5.57) at 12 months. Romosozumab significantly decreased falls (RR = 0.80; 95% CI 0.68-0.93) and major osteoporotic fractures (RR = 0.37; 95% CI 0.25-0.54), but increased injection-site reactions (RR = 1.83; 95% CI 1.46-2.30) within 12 months. No significant differences were observed in other AEs (including cardiovascular AEs) within 12 months. CONCLUSION Romosozumab treatment resulted in a significant BMD gain, reduced falls and major osteoporotic fractures. It was generally well-tolerated, including the cardiovascular aspects. However, clinicians should consider the occurrence of minor AEs (e.g., injection-site reactions).
Collapse
Affiliation(s)
- Takaomi Kobayashi
- Department of Orthopaedic Surgery, Taku City Hospital, Saga, Japan.
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan.
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan.
- Department of Clinical Research, Amagi Chuo Hospital, Fukuoka, Japan.
| | - Megumi Hara
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Chisato Shimanoe
- Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan
- Department of Pharmacy, Saga University Hospital, Saga, Japan
| | - Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Mawatari Masaaki
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Koji Ito
- Department of Orthopaedic Surgery, Taku City Hospital, Saga, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Takafumi Shimazaki
- Department of Orthopaedic Surgery, Taku City Hospital, Saga, Japan
- Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| |
Collapse
|
5
|
Peng Y, Zhong Z, Huang C, Wang W. The effects of popular diets on bone health in the past decade: a narrative review. Front Endocrinol (Lausanne) 2024; 14:1287140. [PMID: 38665424 PMCID: PMC11044027 DOI: 10.3389/fendo.2023.1287140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/14/2023] [Indexed: 04/28/2024] Open
Abstract
Bone health encompasses not only bone mineral density but also bone architecture and mechanical properties that can impact bone strength. While specific dietary interventions have been proposed to treat various diseases such as obesity and diabetes, their effects on bone health remain unclear. The aim of this review is to examine literature published in the past decade, summarize the effects of currently popular diets on bone health, elucidate underlying mechanisms, and provide solutions to neutralize the side effects. The diets discussed in this review include a ketogenic diet (KD), a Mediterranean diet (MD), caloric restriction (CR), a high-protein diet (HP), and intermittent fasting (IF). Although detrimental effects on bone health have been noticed in the KD and CR diets, it is still controversial, while the MD and HP diets have shown protective effects, and the effects of IF diets are still uncertain. The mechanism of these effects and the attenuation methods have gained attention and have been discussed in recent years: the KD diet interrupts energy balance and calcium metabolism, which reduces bone quality. Ginsenoside-Rb2, metformin, and simvastatin have been shown to attenuate bone loss during KD. The CR diet influences energy imbalance, glucocorticoid levels, and adipose tissue, causing bone loss. Adequate vitamin D and calcium supplementation and exercise training can attenuate these effects. The olive oil in the MD may be an effective component that protects bone health. HP diets also have components that protect bone health, but their mechanism requires further investigation. In IF, animal studies have shown detrimental effects on bone health, while human studies have not. Therefore, the effects of diets on bone health vary accordingly.
Collapse
Affiliation(s)
- Yue Peng
- China Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zikang Zhong
- China Japan Friendship Hospital (Institute of Clinical Medical Sciences), Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Cheng Huang
- Department of Orthopaedic Surgery, China Japan Friendship Hospital, Beijing, China
| | - Weiguo Wang
- Department of Orthopaedic Surgery, China Japan Friendship Hospital, Beijing, China
| |
Collapse
|
6
|
Maschhoff CW, Oquendo Y, Michaud JB, Carey D, Jamero C, Bishop JA, Jin C, DeBaun M, Gardner MJ. 3D Topographical Scanning for the Detection of Osteoporosis. J Frailty Sarcopenia Falls 2024; 9:4-9. [PMID: 38444543 PMCID: PMC10910256 DOI: 10.22540/jfsf-09-004] [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] [Accepted: 11/22/2023] [Indexed: 03/07/2024] Open
Abstract
Objectives Osteoporosis is associated with greater risk of fracture, which can lead to increased morbidity and mortality. DEXA scans are often inaccessible for patients, leaving many cases of osteoporosis undetected. A portable 3D topographical scan offers an easily accessible and inexpensive potential adjunct screening tool. We hypothesized that 3D scanning of arm and calf circumference and volume would correlate with DEXA T-scores. Methods 96 female patients were enrolled. Patients were consented and completed a topographical scan of bilateral arms and lower legs with a mobile 3D scanner for arm and calf circumference and volume in clinic. Patient charts were then retrospectively reviewed for DEXA T-scores. Results Forearm DEXA T-score was positively correlated with arm circumference (r = 0.49, p<0.01), arm volume (r=0.62, p<0.01), and calf volume (r=0.47, p<0.01). Femoral neck DEXA T-score was positively correlated with calf circumference (r=0.36, p<0.01) and calf volume (r=0.36, p<0.01). Conclusions Our results showed significant correlations between DEXA T-scores and topographical measurements from mobile device acquired 3D scans, although these were in the "moderate" range. Mobile device-based 3D scanning may hold promise as an adjunct screening tool for osteoporosis when DEXA scanning is not available or feasible for patients, although further studies are needed to elucidate the full potential of its clinical utility. At a minimum, identifying a patient as high risk may promote earlier diagnostic DEXA scanning.
Collapse
Affiliation(s)
- Clayton W. Maschhoff
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Yousi Oquendo
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - John B. Michaud
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - David Carey
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Christopher Jamero
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Julius A. Bishop
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Christopher Jin
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - Malcolm DeBaun
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Michael J. Gardner
- Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA, USA
| |
Collapse
|
7
|
ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Cusi K, Ekhlaspour L, Fleming TK, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Napoli N, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Verduzco-Gutierrez M, Younossi ZM, Gabbay RA. 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S52-S76. [PMID: 38078591 PMCID: PMC10725809 DOI: 10.2337/dc24-s004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
Collapse
|
8
|
Kim T, Kim G, Park HW, Kang EK, Baek S. Back Extensor Strength as a Potential Marker of Frailty Using Propensity Score Matching and Machine Learning. J Clin Med 2023; 12:6156. [PMID: 37834800 PMCID: PMC10573638 DOI: 10.3390/jcm12196156] [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: 08/15/2023] [Revised: 09/16/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
This study assessed the potential of back extensor strength as an alternative marker of frailty. A total of 560 farmers were included. Computed tomography scans measured fat and muscle mass volumes at the mid-L4 vertebral level. Back extensor strength was measured in a seated posture. Multivariate linear regression was used to analyze the associations between back extensor strength and trunk muscle/fat compositions. The participants were divided into two groups based on back extensor strength. Propensity score matching, multivariate logistic regression, and Extreme Gradient Boosting (XGBoost) were employed to evaluate the relationship between Fried's frailty criteria and back extensor strength. Back extensor strength exhibited positive associations with abdominal muscle volume (r = 1.12) as well as back muscle volume (r = 0.89) (p < 0.05). Back extensor strength was linked to more frail status, such as reduced grip strength, walking speed, and frequent self-reported exhaustion. Multivariate logistic regression indicated that back extensor strength was associated with higher frail status (OR = 0.990), and XGBoost analysis identified back extensor strength as the most important predictor (gain = 0.502) for frailty. The prediction models using grip strength produced similar results (OR = 0.869, gain = 0.482). These findings suggested the potential of back extensor strength as an alternative frailty marker.
Collapse
Affiliation(s)
- Taewook Kim
- Department of Education & Human Resources Development, Seoul National University Hospital, Seoul 03080, Republic of Korea;
| | - Gowun Kim
- Department of Rehabilitation Medicine, Kangwon National University College of Medicine, Chuncheon-si 24341, Republic of Korea; (G.K.); (H.-w.P.)
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon-si 24289, Republic of Korea
- Center for Farmers’ Safety and Health, Kangwon National University Hospital, Chuncheon-si 24289, Republic of Korea
| | - Hee-won Park
- Department of Rehabilitation Medicine, Kangwon National University College of Medicine, Chuncheon-si 24341, Republic of Korea; (G.K.); (H.-w.P.)
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon-si 24289, Republic of Korea
- Center for Farmers’ Safety and Health, Kangwon National University Hospital, Chuncheon-si 24289, Republic of Korea
| | - Eun Kyoung Kang
- Technological Laboratory, KakaoHealthcare Corp., Seongnam-si 13529, Republic of Korea;
| | - Sora Baek
- Department of Rehabilitation Medicine, Kangwon National University College of Medicine, Chuncheon-si 24341, Republic of Korea; (G.K.); (H.-w.P.)
- Department of Rehabilitation Medicine, Kangwon National University Hospital, Chuncheon-si 24289, Republic of Korea
- Center for Farmers’ Safety and Health, Kangwon National University Hospital, Chuncheon-si 24289, Republic of Korea
| |
Collapse
|
9
|
Moretti A, Iolascon G. Sclerostin: clinical insights in muscle-bone crosstalk. J Int Med Res 2023; 51:3000605231193293. [PMID: 37632438 PMCID: PMC10467411 DOI: 10.1177/03000605231193293] [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: 03/14/2023] [Accepted: 07/21/2023] [Indexed: 08/28/2023] Open
Abstract
Sclerostin, a protein encoded by the sclerostin (SOST) gene, is mostly expressed in osteocytes. First described in the pathogenesis of three disorders, sclerosteosis, van Buchem's disease, and craniodiaphyseal dysplasia, sclerostin has been identified as an important regulator of bone homeostasis, controlling bone formation by osteoblasts through inhibition of the canonical Wnt signaling pathway. Recent studies have highlighted a hypothetical role of sclerostin in myogenesis, thus modulating the interaction between bone and muscle. This narrative review provides an overview of the clinical implications of sclerostin modulation on skeletal muscle mass and function, and bone metabolism. Improving knowledge about muscle-bone crosstalk may represent a turning point in the development of therapeutic strategies for musculoskeletal disorders, particularly osteosarcopenia.
Collapse
Affiliation(s)
- Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| |
Collapse
|
10
|
Tang J. COVID-19 Pandemic and Osteoporosis in Elderly Patients. Aging Dis 2022; 13:960-969. [PMID: 35855327 PMCID: PMC9286914 DOI: 10.14336/ad.2021.1201] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 12/01/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), which is caused by an infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is rapidly becoming a worldwide epidemic and poses a significant threat to human life and health. SARS-CoV-2 can cause damage to organs throughout the body through ACE2 receptors. It may have direct and indirect effects on osteoclasts, and osteoblasts and lead to osteoporosis. Vitamin D (VitD) is a key hormone for bone health and has immunomodulatory actions of relevance in the context of the COVID-19 pandemic. Vitamin D deficiency has a significant positive association with both infection and the mortality rate of COVID-19. Elderly patients infected by COVID-19 were more likely to develop acute respiratory distress syndrome (ARDS), which was primarily caused by an inflammation storm. The production of proinflammatory cytokines increases with COVID-19 infection and immobilization may result in bone loss and bone resorption in seriously ill patients, especially aging patients. It is well known that glucocorticoids are beneficial in the treatment of acute respiratory distress syndrome (ARDS) because they reduce inflammation and improve the functioning of the lung and extrapulmonary organs. Glucocorticoid therapy is widely used to treat patients with COVID-19 in most parts of the world. During COVID-19 clinical treatment, glucocorticoids may accelerate bone loss in elderly people, making them more susceptible to the development of osteoporosis. Therefore, it is worthwhile to draw the attention of clinicians and researchers to the linkages and interactions between COVID-19, glucocorticoids, and osteoporosis (especially in elderly patients).
Collapse
Affiliation(s)
- Jun Tang
- Department of Endocrinology, Zhongnan Hospital of Wuhan University, Wuhan, China
| |
Collapse
|
11
|
Tahrani AA, Morton J. Benefits of weight loss of 10% or more in patients with overweight or obesity: A review. Obesity (Silver Spring) 2022; 30:802-840. [PMID: 35333446 DOI: 10.1002/oby.23371] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 11/23/2021] [Accepted: 12/10/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Modest weight loss (5%-10%) is clinically meaningful in patients with overweight or obesity. However, greater weight loss may be required to achieve improvements in or remission of certain weight-related complications. Therefore, this study reviewed the effect of large weight loss (≥10%). Most studies reporting large weight loss and relevant outcomes used bariatric surgery or lifestyle modifications. RESULTS Benefits of large weight loss were observed in patients with various overweight- or obesity-related complications, including improvements in comorbidities such as type 2 diabetes and hypertension. Improvements in glucose metabolism and cardiovascular risk factors were observed in patients who achieved large weight loss through lifestyle interventions or pharmacotherapy (phentermine/topiramate 15/92 mg once daily or subcutaneous semaglutide 2.4 mg once weekly). Other benefits associated with large weight loss included reduced cancer risk and improvements in knee osteoarthritis, sleep apnea, fertility-related end points, and health-related quality of life. While costly, bariatric surgery is currently the most cost-effective intervention, although most weight-management programs are deemed cost-effective. CONCLUSIONS Overall, large weight loss has a major beneficial impact on overweight- and obesity-related complications. Large weight loss should be the main treatment target when modest weight loss has had insufficient effects on obesity-related complications and for patients with severe obesity.
Collapse
Affiliation(s)
| | - John Morton
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| |
Collapse
|
12
|
Hofbauer LC, Busse B, Eastell R, Ferrari S, Frost M, Müller R, Burden AM, Rivadeneira F, Napoli N, Rauner M. Bone fragility in diabetes: novel concepts and clinical implications. Lancet Diabetes Endocrinol 2022; 10:207-220. [PMID: 35101185 DOI: 10.1016/s2213-8587(21)00347-8] [Citation(s) in RCA: 130] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 12/12/2022]
Abstract
Increased fracture risk represents an emerging and severe complication of diabetes. The resulting prolonged immobility and hospitalisations can lead to substantial morbidity and mortality. In type 1 diabetes, bone mass and bone strength are reduced, resulting in up to a five-times greater risk of fractures throughout life. In type 2 diabetes, fracture risk is increased despite a normal bone mass. Conventional dual-energy x-ray absorptiometry might underestimate fracture risk, but can be improved by applying specific adjustments. Bone fragility in diabetes can result from cellular abnormalities, matrix interactions, immune and vascular changes, and musculoskeletal maladaptation to chronic hyperglycaemia. This Review summarises how the bone microenvironment responds to type 1 and type 2 diabetes, and the mechanisms underlying fragility fractures. We describe the value of novel imaging technologies and the clinical utility of biomarkers, and discuss current and future therapeutic approaches that protect bone health in people with diabetes.
Collapse
Affiliation(s)
- Lorenz C Hofbauer
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine III, and Center for Healthy Aging, University Medical Center, Technische Universität Dresden, Dresden, Germany.
| | - Björn Busse
- Department of Osteology and Biomechanics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Richard Eastell
- Department of Oncology and Metabolism, Mellanby Centre for Musculoskeletal Research, University of Sheffield, Sheffield, UK
| | - Serge Ferrari
- Service and Laboratory of Bone Diseases, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
| | - Morten Frost
- Molecular Endocrinology Laboratory and Steno Diabetes Centre Odense, Odense University Hospital, Odense, Denmark
| | - Ralph Müller
- Institute of Biomechanics, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Andrea M Burden
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | | | - Nicola Napoli
- RU of Endocrinology and Diabetes, Campus Bio-Medico University of Rome and Fondazione Policlinico Campus Bio-Medico, Rome, Italy; Division of Bone and Mineral Diseases, Washington University in St Louis, St Louis, MO, USA
| | - Martina Rauner
- Division of Endocrinology, Diabetes and Bone Diseases, Department of Medicine III, and Center for Healthy Aging, University Medical Center, Technische Universität Dresden, Dresden, Germany
| |
Collapse
|
13
|
Shevroja E, Cafarelli FP, Guglielmi G, Hans D. DXA parameters, Trabecular Bone Score (TBS) and Bone Mineral Density (BMD), in fracture risk prediction in endocrine-mediated secondary osteoporosis. Endocrine 2021; 74:20-28. [PMID: 34245432 PMCID: PMC8440280 DOI: 10.1007/s12020-021-02806-x] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/16/2021] [Indexed: 12/31/2022]
Abstract
Osteoporosis, a disease characterized by low bone mass and alterations of bone microarchitecture, leading to an increased risk for fragility fractures and, eventually, to fracture; is associated with an excess of mortality, a decrease in quality of life, and co-morbidities. Bone mineral density (BMD), measured by dual X-ray absorptiometry (DXA), has been the gold standard for the diagnosis of osteoporosis. Trabecular bone score (TBS), a textural analysis of the lumbar spine DXA images, is an index of bone microarchitecture. TBS has been robustly shown to predict fractures independently of BMD. In this review, while reporting also results on BMD, we mainly focus on the TBS role in the assessment of bone health in endocrine disorders known to be reflected in bone.
Collapse
Affiliation(s)
- Enisa Shevroja
- Center of Bone Diseases, Bone & Joint Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Francesco Pio Cafarelli
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Foggia University School of Medicine, Foggia, Italy
| | - Didier Hans
- Center of Bone Diseases, Bone & Joint Department, Lausanne University Hospital, Lausanne, Switzerland.
| |
Collapse
|
14
|
Yin YH, Liu JYW, Fan TM, Leung KM, Ng MW, Tsang TY, Wong KP, Välimäki M. Effectiveness of Nutritional Advice for Community-Dwelling Obese Older Adults With Frailty: A Systematic Review and Meta-Analysis. Front Nutr 2021; 8:619903. [PMID: 34268326 PMCID: PMC8275925 DOI: 10.3389/fnut.2021.619903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 06/07/2021] [Indexed: 12/22/2022] Open
Abstract
Objectives: This systematic review was aimed to examine the effectiveness of nutritional advise interventions compared with usual care, or exercise, or exercise combined with nutritional advice as a means of improving the body weight, body composition, physical function, and psychosocial well-being of frail, obese older adults. Methods: CINAHL, Cochrane Library, Embase, MEDLINE, PsycINFO, and Scopus databases were searched to identify relevant studies. The quality of the included studies was assessed using Cochrane's risk of bias tool 2. Meta-analysis was performed with respect to body weight and fat mass. Other outcomes were synthesized narratively. Results: Eight articles (from two studies) with a total of 137 participants were included in the review. The results revealed that nutritional advice was more effective than exercise in reducing body weight and fat mass. The nutritional advice was also beneficial in enhancing physical function and psychosocial well-being. However, it was less effective than exercise or combined interventions in increasing muscle strength and preventing lean mass loss. Conclusions: Nutritional advice is an essential intervention for reducing body weight and fat mass, for enhancing physical function, and for improving the psychosocial well-being of obese older adults experiencing frailty. The limited number of studies included in this review suggests that there is a need for more well-designed interventional studies in order to confirm these findings.
Collapse
Affiliation(s)
- Yue-Heng Yin
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Justina Yat Wa Liu
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Tsz Man Fan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Kit Man Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Man Wai Ng
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Tsun Yee Tsang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Ka Po Wong
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Maritta Välimäki
- Xiangya Center for Evidence-Based Practice and Healthcare Innovation: A Joanna Briggs Institute Affiliated Group, Xiangya Nursing School, Central South University, Changsha, China.,Department of Nursing Science, University of Turku, Turku, Finland
| |
Collapse
|
15
|
Napoli N, Incalzi RA, De Gennaro G, Marcocci C, Marfella R, Papalia R, Purrello F, Ruggiero C, Tarantino U, Tramontana F, Conte C. Bone fragility in patients with diabetes mellitus: A consensus statement from the working group of the Italian Diabetes Society (SID), Italian Society of Endocrinology (SIE), Italian Society of Gerontology and Geriatrics (SIGG), Italian Society of Orthopaedics and Traumatology (SIOT). Nutr Metab Cardiovasc Dis 2021; 31:1375-1390. [PMID: 33812734 DOI: 10.1016/j.numecd.2021.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 01/24/2021] [Accepted: 01/25/2021] [Indexed: 02/08/2023]
Abstract
Bone fragility is one of the possible complications of diabetes, either type 1 (T1D) or type 2 (T2D). Bone fragility can affect patients of different age and with different disease severity depending on type of diabetes, disease duration and the presence of other complications. Fracture risk assessment should be started at different stages in the natural history of the disease depending on the type of diabetes and other risk factors. The risk of fracture in T1D is higher than in T2D, imposing a much earlier screening and therapeutic intervention that should also take into account a patient's life expectancy, diabetes complications etc. The therapeutic armamentarium for T2D has been enriched with drugs that may influence bone metabolism, and clinicians should be aware of these effects. Considering the complexity of diabetes and osteoporosis and the range of variables that influence treatment choices in a given individual, the Working Group on bone fragility in patients with diabetes mellitus has identified and issued recommendations based on the variables that should guide screening of bone fragility and management of diabetes and bone fragility: (A)ge, (B)MD, (C)omplications, (D)uration of disease, & (F)ractures (ABCD&F). Consideration of these parameters may help clinicians identify the best time for screening, the appropriate glycaemic target and anti-osteoporosis drug for patients with diabetes at risk of or with bone fragility.
Collapse
Affiliation(s)
- Nicola Napoli
- Unit of Endocrinology and Diabetes, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy; Division of Bone and Mineral Diseases, Washington University in St. Louis, St. Louis, MO, USA.
| | - Raffaele A Incalzi
- Unit of Geriatrics, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
| | - Giovanni De Gennaro
- Diabetes Center, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Claudio Marcocci
- Endocrinology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rocco Papalia
- Unit of Orthopedic and Trauma Surgery, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Francesco Purrello
- Department of Clinical and Experimental Medicine, University of Catania, 95100 Catania, Italy; Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - Carmelinda Ruggiero
- Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, Perugia, Italy
| | - Umberto Tarantino
- Department of Clinical Sciences and Translational Medicine, Faculty of Medicine and Surgery, "Tor Vergata" University of Rome, Rome, Italy; Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Rome, Italy
| | - Flavia Tramontana
- Unit of Endocrinology and Diabetes, Departmental Faculty of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy
| | - Caterina Conte
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy; Department of Endocrinology, Nutrition and Metabolic Diseases, IRCCS MultiMedica, Milan, Italy
| |
Collapse
|
16
|
Miller MG, Starr KNP, Rincker J, Orenduff MC, McDonald SR, Pieper CF, Fruik AR, Lyles KW, Bales CW. Rationale and Design for a Higher (Dairy) Protein Weight Loss Intervention That Promotes Muscle Quality and Bone Health in Older Adults with Obesity: A Randomized, Controlled Pilot Study. J Nutr Gerontol Geriatr 2021; 40:150-170. [PMID: 33719918 PMCID: PMC9351499 DOI: 10.1080/21551197.2021.1896615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In contrast to recommendations for young and middle-aged adults, intentional weight loss among older adults remains controversial and is inconsistently advised. Recent research suggests that a higher protein diet can mitigate loss of lean mass during periods of intentional weight loss among older adults with obesity; however, the effects of intentional weight loss on skeletal muscle and bone are not fully understood. The Dairy in the Diet Yields New Approaches for Muscle Optimization (DDYNAMO) trial is a 6-month, randomized, controlled pilot study assessing the effects of combining regular, generous intakes of high quality protein (30 g/meal; primarily from dairy) with caloric restriction (-500kcal/d) and low-intensity resistance exercise (30 min/3 times per week) on muscle quality, muscle composition, bone mineral density in men and women aged ≥60 years with obesity and mild to moderate functional impairment (Short Physical Performance Battery [SPPB] score ≥4 to ≤10). Participants will be re-assessed at 18 months to evaluate weight maintenance, bone mineral density, physical function, and other secondary measures. ClinicalTrials.gov Identifier: NCT02437643.
Collapse
Affiliation(s)
- Marshall G. Miller
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Kathryn N. Porter Starr
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Durham VA Medical Center, Durham, NC, USA
| | - Jamie Rincker
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Melissa C. Orenduff
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Shelley R. McDonald
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Carl F. Pieper
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA
| | - Angela R. Fruik
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
| | - Kenneth W. Lyles
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Durham VA Medical Center, Durham, NC, USA
| | - Connie W. Bales
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Durham VA Medical Center, Durham, NC, USA
| |
Collapse
|
17
|
Rossello X, Fuster V, Oliva B, Sanz J, Fernández Friera LA, López-Melgar B, Mendiguren JM, Lara-Pezzi E, Bueno H, Fernández-Ortiz A, Ibanez B, Ordovás JM. Association Between Body Size Phenotypes and Subclinical Atherosclerosis. J Clin Endocrinol Metab 2020; 105:5900885. [PMID: 32879953 PMCID: PMC7521861 DOI: 10.1210/clinem/dgaa620] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/31/2020] [Indexed: 12/15/2022]
Abstract
CONTEXT The underlying relationship between body mass index (BMI), cardiometabolic disorders, and subclinical atherosclerosis is poorly understood. OBJECTIVE To evaluate the association between body size phenotypes and subclinical atherosclerosis. DESIGN Cross-sectional. SETTING Cardiovascular disease-free cohort. PARTICIPANTS Middle-aged asymptomatic subjects (n = 3909). A total of 6 cardiometabolic body size phenotypes were defined based on the presence of at least 1 cardiometabolic abnormality (blood pressure, fasting blood glucose, triglycerides, low high-density lipoprotein cholesterol, homeostasis model assessment-insulin resistance index, high-sensitivity C-reactive protein) and based on BMI: normal-weight (NW; BMI <25), overweight (OW; BMI = 25.0-29.9) or obese (OB; BMI >30.0). MAIN OUTCOME MEASURES Subclinical atherosclerosis was evaluated by 2D vascular ultrasonography and noncontrast cardiac computed tomography. RESULTS For metabolically healthy subjects, the presence of subclinical atherosclerosis increased across BMI categories (49.6%, 58.0%, and 67.7% for NW, OW, and OB, respectively), whereas fewer differences were observed for metabolically unhealthy subjects (61.1%, 69.7%, and 70.5%, respectively). When BMI and cardiometabolic abnormalities were assessed separately, the association of body size phenotypes with the extent of subclinical atherosclerosis was mostly driven by the coexistence of cardiometabolic risk factors: adjusted OR = 1.04 (95% confidence interval [CI], 0.90-1.19) for OW and OR = 1.07 (95% CI, 0.88-1.30) for OB in comparison with NW, whereas there was an increasing association between the extent of subclinical atherosclerosis and the number of cardiometabolic abnormalities: adjusted OR = 1.21 (95% CI, 1.05-1.40), 1.60 (95% CI, 1.33-1.93), 1.92 (95% CI, 1.48-2.50), and 2.27 (95% CI, 1.67-3.09) for 1, 2, 3, and >3, respectively, in comparison with noncardiometabolic abnormalities. CONCLUSIONS The prevalence of subclinical atherosclerosis varies across body size phenotypes. Pharmacologic and lifestyle interventions might modify their cardiovascular risk by facilitating the transition from one phenotype to another.
Collapse
Affiliation(s)
- Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBER de Enfermedades CardioVasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Health Research Institute of the Balearic Islands (IdISBa), Hospital Universitari Son Espases, Palma, Spain
| | - Valentin Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Icahn School of Medicine at Mount Sinai, New York, New York
- Correspondence and Reprint Requests: Valentin Fuster, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), C/Melchor Fernandez Almagro 3, 28029 Madrid, Spain. E-mail: ; or José M. Ordovás, Nutrition and Genomics, JM-USDA-HNRCA at Tufts University, 711 Washington Street, Boston, Massachusetts 02111. E-mail:
| | - Belén Oliva
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Javier Sanz
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Leticia A Fernández Friera
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Hospital Universitario HM Montepríncipe-CIEC, Madrid, Spain
- Universidad CEU San Pablo, Madrid, Spain
| | - Beatriz López-Melgar
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Hospital Universitario HM Montepríncipe-CIEC, Madrid, Spain
- Universidad CEU San Pablo, Madrid, Spain
| | | | - Enrique Lara-Pezzi
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 deOctubre (imas12), Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- Hospital Clínico San Carlos, Universidad Complutense, IdISSC, Madrid, Spain
| | - Borja Ibanez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBER de Enfermedades CardioVasculares (CIBERCV), Madrid, Spain
- IIS-Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - José María Ordovás
- U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts
- IMDEA Food Institute, CEI UAM+CSIC, Madrid, Spain
- Correspondence and Reprint Requests: Valentin Fuster, Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), C/Melchor Fernandez Almagro 3, 28029 Madrid, Spain. E-mail: ; or José M. Ordovás, Nutrition and Genomics, JM-USDA-HNRCA at Tufts University, 711 Washington Street, Boston, Massachusetts 02111. E-mail:
| |
Collapse
|
18
|
Möckel L. Risk of falls in patients with low bone mineral density : Analysis of placebo arms from clinical trials. Z Gerontol Geriatr 2020; 54:576-581. [PMID: 32965541 DOI: 10.1007/s00391-020-01784-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/26/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Falls are a major risk factor for osteoporotic fractures. Therefore, the aim of this study was to analyze the risk of falls in patients with low bone mineral density (BMD) and osteoporosis. METHODS The risk of falls in patients with low BMD and/or osteoporosis was analyzed using data from placebo arms of clinical trials, indexed on clinicaltrials.gov. The risk was estimated using a single arm meta-analysis method and by applying a binary random effects model. In addition, meta-regression analyses were performed to identify associations between risk of falls and age, body mass index (BMI) and BMD. RESULTS A total of 8762 patients from placebo arms of clinical trials were included into the analysis. Risk of falls was 5.2% (0.052, 95% confidence interval [95% CI] 0.022-0.082; n = 8714; I2 = 97.3%, p ≤ 0.001) in patients with low BMD and/or osteoporosis and 5.9% (0.059, 95% CI 0.036-0.083; n = 7819; I2 = 87.8%, p ≤ 0.001) in patients with osteoporosis. A significant association with risk of falls was identified for age in patients with low BMD and/or osteoporosis. BMD at total hip (TH; coefficient -0.077, 95% CI: -0.113--0.040, p ≤ 0.001; n = 7715) and femoral neck (FN; coefficient -0.044, 95% CI -0.065--0.023, p ≤ 0.001; n = 7662) were significantly associated with risk of falls in patients with osteoporosis. CONCLUSION This analysis identified the risk of falls in patients with low BMD and osteoporosis and an association of falls with age and BMD. Therefore, patients with osteoporosis need to receive mandatory fall risk mitigation measures, and the BMD at total hip or femoral neck could function as an indicator for the risk of falling.
Collapse
Affiliation(s)
- Luis Möckel
- HSD Hochschule Döpfer, University of Applied Sciences Cologne, Waidmarkt 3 & 9, 50676, Cologne, Germany.
| |
Collapse
|
19
|
Makarova EV, Marchenkova LA, Eryomushkin MA, Styazkina EM, Chesnikova EI. Balance and muscle strength tests in patients with osteoporotic vertebral fractures to develop tailored rehabilitation programs. Eur J Transl Myol 2020; 30:9236. [PMID: 33117510 PMCID: PMC7582409 DOI: 10.4081/ejtm.2020.9236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 07/30/2020] [Indexed: 01/01/2023] Open
Abstract
Authors perform a cross-sectional study of functional abilities of the patients with osteoporotic vertebral fractures (VFs). Trunk muscle isometric strength and postural balance impairments were estimated. The development of osteoporotic VFs is associated with a significant decrease in strength of all the body muscles, especially the deep spinal stabilization system, i.e trunk extensor (TE), trunk flexsor (TF), where the VFs contribute to inappropriate distribution of back muscle strength with TE:TF ration of 1:1 instead of 3:2, observed both normally and in patients with uncomplicated osteoporosis. There is also a deterioration of stabilometry and functional coordination assessment tests in patients with pathological VFs, that indicate abnormalities of both static and dynamic postural balance. The obtained data should be taken into account when developing rehabilitation programmes for osteoporosis patients who have suffered compression VFs.
Collapse
Affiliation(s)
- Ekaterina V Makarova
- Somatic rehabilitation, anti-aging and reproductive health department of FSBI "National Medical Research Center of Rehabilitation and Balneology" of Ministry of Health of Russian Federation
| | - Larisa A Marchenkova
- Somatic rehabilitation, anti-aging and reproductive health department of FSBI "National Medical Research Center of Rehabilitation and Balneology" of Ministry of Health of Russian Federation
| | - Mikhail A Eryomushkin
- Orthopedics, biomechanics, kinesiotherapy and manual therapy department of FSBI 'National Medical Research Center of Rehabilitation and Balneology' of the Ministry of Health of Russian Federation
| | - Elena M Styazkina
- Orthopedics, biomechanics, kinesiotherapy and manual therapy department of FSBI 'National Medical Research Center of Rehabilitation and Balneology' of the Ministry of Health of Russian Federation
| | - Ekaterina I Chesnikova
- Orthopedics, biomechanics, kinesiotherapy and manual therapy department of FSBI 'National Medical Research Center of Rehabilitation and Balneology' of the Ministry of Health of Russian Federation
| |
Collapse
|
20
|
Tramontana F, Napoli N, El-Hajj Fuleihan G, Strollo R. The D-side of COVID-19: musculoskeletal benefits of vitamin D and beyond. Endocrine 2020; 69:237-240. [PMID: 32632722 PMCID: PMC7338117 DOI: 10.1007/s12020-020-02407-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/26/2020] [Indexed: 12/16/2022]
Abstract
Coronavirus 2019 disease (COVID-19) mostly adversely affects the elderly, a population at higher risk for low serum 25-hydroxyvitamin D (25(OH)D) levels. In this viewpoint, we highlight the well-known musculoskeletal properties of vitamin D, which are particularly relevant in the context of COVID-19, suggesting further potential benefits through extra-skeletal effects. Maintaining optimal 25(OH)D is crucial to prevent falls, frailty and fractures in elderly patients, with low activity levels due to lockdown, or who are relatively immobilized during hospitalization and after discharge for prolonged periods of time. Hypovitaminosis D is also associated with susceptibility to respiratory infections, admissions to the intensive care unit, and mortality. We underscore the importance of achieving desirable serum 25(OH)D in COVID-19 elderly patients, to ensure beneficial musculoskeletal effects and possibly respiratory effects of vitamin D, in the context of COVID-19.
Collapse
Affiliation(s)
- Flavia Tramontana
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Via Alvaro di Portillo 21, 00128, Rome, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Via Alvaro di Portillo 21, 00128, Rome, Italy.
- Division of Bone and Mineral Diseases, Washington University in St Louis, St Louis, MO, USA.
| | - Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, American University of Beirut, Beirut, Lebanon.
- Scholars in HeAlth Research Program (SHARP), American University of Beirut Medical Center, Beirut, Lebanon.
| | - Rocky Strollo
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Via Alvaro di Portillo 21, 00128, Rome, Italy
| |
Collapse
|
21
|
Buttan A, Cui J, Guo X, Chen YDI, Hsueh WA, Rotter JI, Goodarzi MO. Physical Activity Associations with Bone Mineral Density and Modification by Metabolic Traits. J Endocr Soc 2020; 4:bvaa092. [PMID: 32803094 PMCID: PMC7417873 DOI: 10.1210/jendso/bvaa092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/02/2020] [Indexed: 11/19/2022] Open
Abstract
Objective To assess the relationship of physical activity with bone mineral density (BMD) at various sites and examine potential modifying metabolic factors. Methods Responses from physical activity questionnaires were used to determine total physical activity (PA), moderate physical activity (mod-PA), and sedentary time. Regression analyses were performed to evaluate association of activity traits with insulin sensitivity by euglycemic clamp, adiponectin, C-reactive protein (CRP), and plasminogen activator inhibitor-1 (PAI-1) in 741 healthy subjects. Results The cohort was relatively sedentary. Activity level was associated with arm, pelvis, and leg BMD in univariate analyses. In multivariate association analyses of arm BMD, only female sex (β = -0.73, P < 0.0001) and adiponectin (β = -0.076, P = 0.0091) were significant. Multivariate analyses of pelvis BMD found independent associations with body mass index (BMI) (β = 0.33, P < 0.0001), adiponectin (β = -0.10, P = 0.013), female sex (β = -0.18, P < 0.0001), sedentary time (β = -0.088, P = 0.034), PA (β = 0.11, P = 0.01), and mod-PA (β = 0.11, P = 0.014). Age (β = -0.10, P = 0.0087), female sex (β = -0.63, P < 0.0001), BMI (β = 0.24, P < 0.0001), and mod-PA (β = 0.10, P = 0.0024) were independently associated with leg BMD. Conclusions These results suggest that BMD increases with physical activity in the arms, legs, and pelvis and is inversely related to sedentary time in the pelvis and legs; these associations may be modified by age, sex, BMI, and adiponectin, depending on the site, with physical activity being more important to pelvis and leg BMD than arm BMD and sedentary time being important for pelvis BMD. Moreover, we demonstrated that CRP, PAI-1, and insulin sensitivity play a minor role in BMD.
Collapse
Affiliation(s)
- Anshu Buttan
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jinrui Cui
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Xiuqing Guo
- Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation and Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California
| | - Yii-Der I Chen
- Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation and Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California
| | - Willa A Hsueh
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, The Ohio State University, Columbus, Ohio
| | - Jerome I Rotter
- Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation and Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, California
| | - Mark O Goodarzi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| |
Collapse
|
22
|
Seimon RV, Wild-Taylor AL, McClintock S, Harper C, Gibson AA, Johnson NA, Fernando HA, Markovic TP, Center JR, Franklin J, Liu PY, Grieve SM, Lagopoulos J, Caterson ID, Byrne NM, Sainsbury A. 3-Year effect of weight loss via severe versus moderate energy restriction on body composition among postmenopausal women with obesity - the TEMPO Diet Trial. Heliyon 2020; 6:e04007. [PMID: 32613096 PMCID: PMC7322133 DOI: 10.1016/j.heliyon.2020.e04007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/06/2020] [Accepted: 05/13/2020] [Indexed: 12/15/2022] Open
Abstract
We have previously shown that a severely energy-restricted diet leads to greater loss of weight, fat, lean mass and bone mineral density (BMD) at 12 months in postmenopausal women with obesity than a moderately energy-restricted diet. We now aim to evaluate whether these effects are sustained longer term (ie, at 36 months). 101 postmenopausal women were randomized to either 12 months of moderate (25 to 35%) energy restriction with a food-based diet (moderate intervention), or 4 months of severe (65 to 75%) energy restriction with a total meal replacement diet followed by moderate energy restriction for 8 months (severe intervention). Body weight and composition were measured at 0, 24 and 36 months. Participants in the severe intervention lost ~1.5 to 1.7 times as much weight, waist circumference, whole-body fat mass and visceral adipose tissue compared to those in the moderate intervention, and were 2.6 times more likely (42% versus 16%) to have lost 10% or more of their initial body weight at 36 months (P < 0.01 for all). However, those in the severe versus moderate intervention lost ~1.4 times as much whole-body lean mass (P < 0.01), albeit this was proportional to total weight lost and there was no greater loss of handgrip strength, and they also lost ~2 times as much total hip BMD between 0 and 36 months (P < 0.05), with this bone loss occurring in the first 12 months. Thus, severe energy restriction is more effective than moderate energy restriction for reducing weight and adiposity in postmenopausal women in the long term (3 years), but attention to BMD loss in the first year is required. Trial registration Australian New Zealand Clinical Trials Registry Reference Number: 12612000651886, anzctr.org.au.
Collapse
Affiliation(s)
- Radhika V. Seimon
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Corresponding author.
| | - Anthony L. Wild-Taylor
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sally McClintock
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Claudia Harper
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alice A. Gibson
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Nathan A. Johnson
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
| | - Hamish A. Fernando
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Tania P. Markovic
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Jacqueline R. Center
- Bone Biology Program, Garvan Institute of Medical Research, St Vincent's Hospital Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Janet Franklin
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Peter Y. Liu
- Division of Endocrinology, Department of Medicine, Harbor-University of California Los Angeles Medical Center and Los Angeles BioMedical Research Institute, Los Angeles
| | - Stuart M. Grieve
- Imaging and Phenotyping Laboratory, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Radiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Jim Lagopoulos
- Sunshine Coast Mind and Neuroscience–Thompson Institute, University of the Sunshine Coast, Queensland, Australia
| | - Ian D. Caterson
- The Boden Collaboration for Obesity, Nutrition, Exercise, and Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Metabolism & Obesity Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Nuala M. Byrne
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - Amanda Sainsbury
- School of Human Sciences, Faculty of Science, The University of Western Australia, Crawley, Western Australia, Australia
- Corresponding author.
| |
Collapse
|
23
|
Möckel L, Bartneck M, Möckel C. Risk of falls in postmenopausal women treated with romosozumab: Preliminary indices from a meta-analysis of randomized, controlled trials. Osteoporos Sarcopenia 2020; 6:20-26. [PMID: 32226829 PMCID: PMC7093685 DOI: 10.1016/j.afos.2020.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/29/2019] [Accepted: 02/08/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Falls are the well-known risk factor for osteoporotic fractures and some medications can increase the risk of falls. Therefore, the aim of our study is to evaluate the effect of romosozumab on risk of falls in postmenopausal women. METHODS Studies were searched on PubMed, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov using the search term "romosozumab." Randomized, clinical trials with romosozumab in postmenopausal women, which met the inclusion criteria and in particular reported on falls in safety or efficacy data, were included into the meta-analysis. Risk ratios (RRs) and corresponding 95% confidence intervals (CIs) were calculated using a binary effects model. RESULTS A total of four studies with overall 12,128 postmenopausal women with osteoporosis were included into the meta-analysis. Twelve-months treatment with romosozumab reduced the risk of falls nonsignificantly by 16% (RR, 0.84; 95% CI, 0.67-1.04; P = 0.10; n = 11,829). A subgroup analysis with double-blind studies indicated a statistically significant reduction in risk of falls by 20% (RR, 0.80; 95% CI, 0.71-0.92; P ≤ 0.01; n = 11,211). A sequential treatment of romosozumab followed by an antiresorptive medication resulted in a 12% (RR, 0.88; 95% CI, 0.80-0.96; P ≤ 0.01; n = 11,211) reduction of falls in the romosozumab group compared to the control group. CONCLUSIONS This analysis indicates that romosozumab has a tendency to reduce risk of falls in postmenopausal women with osteoporosis. Nevertheless, our findings are preliminary results with a low significance and to confirm these findings more data and analyses are needed.
Collapse
Affiliation(s)
- Luis Möckel
- HSD Hochschule Döpfer, University of Applied Sciences Cologne, Cologne, Germany
| | - Matthias Bartneck
- Department of Medicine III, RWTH University Hospital Aachen, Aachen, Germany
| | - Christina Möckel
- Forschungszentrum Jülich, Wilhelm-Johnen-Straße, Jülich, Germany
| |
Collapse
|
24
|
Colleluori G, Chen R, Turin CG, Vigevano F, Qualls C, Johnson B, Mediwala S, Villareal DT, Armamento-Villareal R. Aromatase Inhibitors Plus Weight Loss Improves the Hormonal Profile of Obese Hypogonadal Men Without Causing Major Side Effects. Front Endocrinol (Lausanne) 2020; 11:277. [PMID: 32499757 PMCID: PMC7243137 DOI: 10.3389/fendo.2020.00277] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/14/2020] [Indexed: 12/29/2022] Open
Abstract
Objective: In obese men, the increased expression of the aromatase enzyme in adipose tissue leads to high conversion of androgens to estrogens contributing to hypogonadotropic hypogonadism (HHG). Our objective is to evaluate efficacy and safety of weight loss (WL) plus aromatase inhibitor (AI) therapy in severely obese men with HHG. We hypothesize that AI+WL will be more effective as compared to WL alone in improving the hormonal profile, thus muscle strength and symptoms of HHG (primary outcomes), with no significant adverse effects on lean mass, metabolic profile, and bone mineral density (secondary outcomes). Design: Randomized double-blind placebo-controlled pilot trial. Methods: Twenty-three obese men (BMI≥35 kg/m2), 35-65 years old, were randomized to weight loss (diet and exercise) plus either anastrozole (AI+WL, n = 12) at 1 mg daily or placebo (PBO+WL, n = 11) for 6 months. Inclusion criteria: total testosterone <300 ng/mL (average of 2 measurements), estradiol≥10.9 pg/ml, LH <9 IU/l. Symptoms of hypogonadism by questionnaires; muscle strength by Biodex dynamometer; body composition and bone mineral density by dual-energy X-ray absorptiometry; bone microarchitecture and finite element analysis by high resolution peripheral quantitative-computed tomography. Results: After 6 months of therapy, AI+WL group had higher testosterone (p = 0.003) and lower estradiol (p = 0.001) compared to PBO+WL. Changes in symptoms and muscle strength did not differ between groups. AI+WL resulted in higher fat mass loss than PBO+WL (p = 0.04) without differences in changes in lean mass. Total and LDL cholesterol reduced more in the PBO+WL group compared to AI+WL (p = 0.03 for both), who experienced a minimal increase with unlikely meaningful clinical impact. Tibial trabecular bone area decreased more in PBO+WL than AI+WL group for which it remained stable (p = 0.03). Conclusions:Although AI+WL is effective in reversing the hormonal profile of HHG in severely obese men without causing major side effects, it does not lead to greater improvements in muscle strength and symptoms of hypogonadism compared to WL alone. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02959853.
Collapse
Affiliation(s)
- Georgia Colleluori
- Division of Endocrinology, Diabetes and Metabolism, Baylor College of Medicine, Houston, TX, United States
- Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Rui Chen
- Division of Endocrinology, Diabetes and Metabolism, Baylor College of Medicine, Houston, TX, United States
- Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Christie G. Turin
- Division of Endocrinology, Diabetes and Metabolism, Baylor College of Medicine, Houston, TX, United States
- Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Francesca Vigevano
- Division of Endocrinology, Diabetes and Metabolism, Baylor College of Medicine, Houston, TX, United States
- Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Clifford Qualls
- Division of Mathematics and Statistics, University of New Mexico School of Medicine, Albuquerque, NM, United States
| | - Biju Johnson
- Research Pharmacy, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Sanjay Mediwala
- Division of Endocrinology, Diabetes and Metabolism, Baylor College of Medicine, Houston, TX, United States
- Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Dennis T. Villareal
- Division of Endocrinology, Diabetes and Metabolism, Baylor College of Medicine, Houston, TX, United States
- Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Reina Armamento-Villareal
- Division of Endocrinology, Diabetes and Metabolism, Baylor College of Medicine, Houston, TX, United States
- Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, Houston, TX, United States
- *Correspondence: Reina Armamento-Villareal
| |
Collapse
|
25
|
Leonard MB, Wehrli FW, Ziolkowski SL, Billig E, Long J, Nickolas TL, Magland JF, Nihtianova S, Zemel BS, Herskovitz R, Rajapakse CS. A multi-imaging modality study of bone density, bone structure and the muscle - bone unit in end-stage renal disease. Bone 2019; 127:271-279. [PMID: 31158505 DOI: 10.1016/j.bone.2019.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/16/2019] [Accepted: 05/16/2019] [Indexed: 01/10/2023]
Abstract
End stage renal disease (ESRD) is associated with sarcopenia and skeletal fragility. The objectives of this cross-sectional study were to (1) characterize body composition, bone mineral density (BMD) and bone structure in hemodialysis patients compared with controls, (2) assess whether DXA areal BMD (aBMD) correlates with peripheral quantitative CT (pQCT) measures of volumetric BMD (vBMD), cortical dimensions and MRI measures of trabecular microarchitecture, and (3) determine the magnitude of bone deficits in ESRD after adjustment for muscle mass. Thirty ESRD participants, ages 25 to 64 years, were compared with 403 controls for DXA and pQCT outcomes and 104 controls for MRI outcomes; results were expressed as race- and sex- specific Z-scores relative to age. DXA appendicular lean mass index (ALMI kg/m2) and total hip, femoral neck, ultradistal and 1/3rd radius aBMD were significantly lower in ESRD, vs. controls (all p < 0.01). pQCT trabecular vBMD (p < 0.01), cortical vBMD (p < 0.001) and cortical thickness (due to a greater endosteal circumference, p < 0.02) and MRI measures of trabecular number, trabecular thickness, and whole bone stiffness were lower (all p < 0.01) in ESRD, vs. controls. ALMI was positively associated with total hip, femoral neck, ultradistal radius and 1/3rd radius aBMD and with tibia cortical thickness (R = 0.46 to 0.64). Adjustment for ALMI significantly attenuated bone deficits at these sites: e.g. mean femoral neck aBMD was 0.79 SD lower in ESRD, compared with controls and this was attenuated to 0.33 with adjustment for ALMI. In multivariate models within the dialysis participants, pQCT trabecular vBMD and cortical area Z-scores were significant and independently (all p < 0.02) associated with DXA femoral neck, total hip, and ultradistal radius aBMD Z-scores. Cortical vBMD (p = 0.01) and cortical area (p < 0.001) Z-scores were significantly and independently associated with 1/3rd radius areal aBMD Z-scores (R2 = 0.62). These data demonstrate that DXA aBMD captures deficits in trabecular and cortical vBMD and cortical area. The strong associations with ALMI, as an index of skeletal muscle, highlight the importance of considering the role of sarcopenia in skeletal fragility in patients with ESRD.
Collapse
Affiliation(s)
- Mary B Leonard
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America; Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America.
| | - Felix W Wehrli
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Susan L Ziolkowski
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Erica Billig
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Jin Long
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Thomas L Nickolas
- Department of Medicine, Columbia University, New York, NY, United States of America
| | - Jeremy F Magland
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Snejana Nihtianova
- Susanne M. Glasscock School of Continuing Studies, Rice University, Houston, TX, United States of America
| | - Babette S Zemel
- Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Rita Herskovitz
- Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Chamith S Rajapakse
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, United States of America; Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, United States of America
| |
Collapse
|
26
|
Aguirre LE, Colleluori G, Robbins D, Dorin R, Shah VO, Chen R, Jan IZ, Qualls C, Villareal DT, Armamento-Villareal R. Bone and body composition response to testosterone therapy vary according to polymorphisms in the CYP19A1 gene. Endocrine 2019; 65:692-706. [PMID: 31325085 PMCID: PMC8077393 DOI: 10.1007/s12020-019-02008-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 07/06/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE To evaluate the influence of single nucleotide polymorphisms (SNPs) of CYP19A1 on the response and susceptibility to side effects from testosterone therapy. This is a prospective, single-arm study of men with low-morning serum testosterone (<10.68 nmol/l) administered testosterone cypionate 200 mg intramuscularly every 2 weeks for 18 months. METHODS We measured areal bone mineral density (aBMD) and body composition by dual energy X-ray absorptiometry, tibial volumetric BMD and geometry by peripheral quantitative computer tomography, bone turnover markers by enzyme-linked immunosorbent assay, testosterone, and estradiol by liquid-chromatography/mass-spectroscopy, genotyping by microarray, CYP19A1 expression by quantitative polymerase chain reaction, hematocrit and prostate-specific antigen (PSA). RESULTS We enrolled 105 men (40-74-years-old). SNPs rs1062033 and rs700518 were associated with significant differences in outcomes at 18 months. The GG genotype in rs1062033 had significant increase in whole body aBMD, but had significant decrease in tibial bone size compared to the CG and CC genotypes. Body composition analysis showed that the CC genotype of rs1062033, and the AA genotype of rs700518, had significant increase in total lean and appendicular lean mass compared to CG and GG, and AG and GG, respectively. The GG genotype of rs700518 had significant increase in PSA (GG = 105.8 ± 23.3% vs. AG + AA = 53.4 ± 11.3%, p = 0.046) while hematocrit changes were comparable among genotypes. CYP19A1 expression was highest in GG genotype in both SNPs. CONCLUSIONS For the first time, we demonstrated that CYP19A1 SNPs influence response to testosterone therapy in hypogonadal men, highlighting the importance of genetic profiling in therapeutics even for common clinical conditions.
Collapse
Affiliation(s)
- Lina E Aguirre
- New Mexico VA Health Care System, Albuquerque, NM, USA
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Georgia Colleluori
- Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - David Robbins
- New Mexico VA Health Care System, Albuquerque, NM, USA
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Richard Dorin
- New Mexico VA Health Care System, Albuquerque, NM, USA
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Vallabh O Shah
- New Mexico VA Health Care System, Albuquerque, NM, USA
- University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Rui Chen
- Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Irum Zeb Jan
- New Mexico VA Health Care System, Albuquerque, NM, USA
| | - Clifford Qualls
- New Mexico VA Health Care System, Albuquerque, NM, USA
- University of New Mexico School of Medicine, Albuquerque, NM, USA
- Biomedical Research Institute of New Mexico, Albuquerque, NM, USA
| | - Dennis T Villareal
- Baylor College of Medicine, Houston, TX, USA
- Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Reina Armamento-Villareal
- Baylor College of Medicine, Houston, TX, USA.
- Michael E. DeBakey VA Medical Center, Houston, TX, USA.
| |
Collapse
|
27
|
Al-Nimr RI. Optimal Protein Intake during Weight Loss Interventions in Older Adults with Obesity. J Nutr Gerontol Geriatr 2019; 38:50-68. [PMID: 30806592 DOI: 10.1080/21551197.2018.1544533] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Obesity rates in people 60 years and older are increasing. While obesity is linked with detrimental health risks, weight loss in this population has previously been considered controversial due to potential worsening of age-related sarcopenia. Protein intake during energy restriction has been linked to lean body mass preservation. No formal guidelines for optimal protein intake during structured weight loss interventions exist for this population, but it appears that the current Recommended Dietary Allowance of 0.8 grams per kilogram of body weight per day may be inadequate. The purpose of this review is to discuss optimal protein intake during structured weight loss interventions in persons 60 years and older with obesity and to present a framework for guidelines to be used by health professionals focusing on weight loss interventions in older adults. Goals for the amount, source, and timing of protein intake, from both food and supplements, are presented and discussed.
Collapse
Affiliation(s)
- Rima Itani Al-Nimr
- a The Geisel School of Medicine at Dartmouth , Hanover , NH , USA.,b Department of Medicine , Dartmouth-Hitchcock Medical Center , Lebanon , NH , USA
| |
Collapse
|
28
|
Jiang BC, Villareal DT. Weight Loss-Induced Reduction of Bone Mineral Density in Older Adults with Obesity. J Nutr Gerontol Geriatr 2019; 38:100-114. [PMID: 30794099 DOI: 10.1080/21551197.2018.1564721] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Obesity in older adults is a growing public health problem, yet the appropriate treatment remains controversial partly due to evidence that weight loss reduces bone mass and may increase fracture risk. The purpose of this review is to summarize the research to date on the effects of diet-induced weight loss on bone health in obese (body mass index 30 kg/m2 and above) older (aged 65 years or older) adults. Observational studies have shown that weight loss in this population decreases total hip bone mineral density and increases the risk of frailty fractures (composite of proximal femur, pelvis, and proximal humerus fractures). Randomized controlled trials have largely confirmed these earlier observations but have also shown that exercise, particularly progressive resistance training, can attenuate or even alleviate this bone loss. Further research incorporating outcomes concerning bone quality and mass are needed to identify the optimal exercise and nutritional regimens to counteract the bone loss.
Collapse
Affiliation(s)
- Bryan C Jiang
- a Center for Translational Research in Inflammatory Diseases (CTRID) , Michael E DeBakey VA Medical Center , Houston , TX , USA.,b Department of Medicine-Endocrinology, Metabolism, and Diabetes , Baylor College of Medicine , Houston , TX , USA
| | - Dennis T Villareal
- a Center for Translational Research in Inflammatory Diseases (CTRID) , Michael E DeBakey VA Medical Center , Houston , TX , USA.,b Department of Medicine-Endocrinology, Metabolism, and Diabetes , Baylor College of Medicine , Houston , TX , USA
| |
Collapse
|
29
|
Marchenkova LA, Makarova EV. [Exercise therapy and bracing in patients with osteoporotic compression vertebral fractures]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2019; 96:69-75. [PMID: 31513171 DOI: 10.17116/kurort20199604169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Osteoporotic vertebral fractures (VF) have a negative impact on quality of life within a year after injury. A recent-onset vertebral body compression fracture in the presence of osteoporosis (OP) is generally accompanied by acute back pain, hypokinesia, and a reduction in daily physical and social activities, further leading to social isolation. Rehabilitation measures are of particular importance to restore quality of life in OP patients, especially in the people who have a history of fractures. Exercise therapy is the mainstay of management in patients with OP and VF; however, pain and limited mobility can be a barrier to exercises. Competent bracing is a method that can assist in reducing pain in VF, stabilizing the spine, and increasing motor activity. The use of an orthosis not only improves quality of life, but also gives an opportunity to take physical exercises. Semi-rigid and elastic corsets are preferable to rigid structures that are less convenient to use and associated with a large number of undesirable phenomena. Wearing a brace continuously (with its obligatory taking off overnight) is rational for 6-8 weeks. Above this period, there is an increased risk of muscle atrophy. It is acceptable to longer use orthoses situationally, if there is a need to be in an upright position, during long walks, trips, or physical exercises.
Collapse
Affiliation(s)
- L A Marchenkova
- National Medical Research Center for Rehabilitation and Balneology, Ministry of Health of Russia, Moscow, Russia
| | - E V Makarova
- National Medical Research Center for Rehabilitation and Balneology, Ministry of Health of Russia, Moscow, Russia
| |
Collapse
|
30
|
Ferrari SL, Abrahamsen B, Napoli N, Akesson K, Chandran M, Eastell R, El-Hajj Fuleihan G, Josse R, Kendler DL, Kraenzlin M, Suzuki A, Pierroz DD, Schwartz AV, Leslie WD. Diagnosis and management of bone fragility in diabetes: an emerging challenge. Osteoporos Int 2018; 29:2585-2596. [PMID: 30066131 PMCID: PMC6267152 DOI: 10.1007/s00198-018-4650-2] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 07/19/2018] [Indexed: 12/11/2022]
Abstract
Fragility fractures are increasingly recognized as a complication of both type 1 and type 2 diabetes, with fracture risk that increases with disease duration and poor glycemic control. Yet the identification and management of fracture risk in these patients remains challenging. This review explores the clinical characteristics of bone fragility in adults with diabetes and highlights recent studies that have evaluated bone mineral density (BMD), bone microstructure and material properties, biochemical markers, and fracture prediction algorithms (i.e., FRAX) in these patients. It further reviews the impact of diabetes drugs on bone as well as the efficacy of osteoporosis treatments in this population. We finally propose an algorithm for the identification and management of diabetic patients at increased fracture risk.
Collapse
Affiliation(s)
- S L Ferrari
- Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospital & Faculty of Medicine, 1205, Geneva, Switzerland.
| | - B Abrahamsen
- Department of Medicine, Holbaek Hospital, Holbaek, Denmark
- OPEN, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - N Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
- Division of Bone and Mineral Diseases, Washington University in St Louis, St Louis, MO, USA
| | - K Akesson
- Department of Clinical Sciences, Clinical and Molecular Osteoporosis Unit, Lund University, Malmö, Sweden
| | - M Chandran
- Osteoporosis and Bone Metabolism Unit, Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - R Eastell
- Academic Unit of Bone Metabolism, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - G El-Hajj Fuleihan
- Department of Internal Medicine, Division of Endocrinology, Calcium Metabolism and Osteoporosis Program, WHO Collaborating Center for Metabolic Bone Disorders, American University of Beirut Medical Center, Riad El Solh, Beirut, Lebanon
| | - R Josse
- Department of Medicine and Department of Nutritional Sciences, University of Toronto, Toronto, ON, Canada
- Division of Endocrinology and Metabolism, St. Michael's Hospital, Toronto, ON, Canada
| | - D L Kendler
- Department of Medicine, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - M Kraenzlin
- Endonet, Endocrine Clinic and Laboratory, Basel, Switzerland
| | - A Suzuki
- Division of Endocrinology and Metabolism, Fujita Health University, Toyoake, Aichi, Japan
| | - D D Pierroz
- International Osteoporosis Foundation, Nyon, Switzerland
| | - A V Schwartz
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - W D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
31
|
Papageorgiou M, Martin D, Colgan H, Cooper S, Greeves JP, Tang JCY, Fraser WD, Elliott-Sale KJ, Sale C. Bone metabolic responses to low energy availability achieved by diet or exercise in active eumenorrheic women. Bone 2018; 114:181-188. [PMID: 29933113 DOI: 10.1016/j.bone.2018.06.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 06/13/2018] [Accepted: 06/18/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE We aimed to explore the effects of low energy availability (EA)[15 kcal·kg lean body mass (LBM)-1·d-1] achieved by diet or exercise on bone turnover markers in active, eumenorrheic women. METHODS By using a crossover design, ten eumenorrheic women (VO2 peak: 48.1 ± 3.3 ml·kg-1·min-1) completed all three, 3-day conditions in a randomised order: controlled EA (CON; 45 kcal·kgLBM-1·d-1), low EA through dietary energy restriction (D-RES; 15 kcal·kgLBM-1·d-1) and low EA through increasing exercise energy expenditure (E-RES; 15 kcal·kgLBM-1·d-1), during the follicular phase of three menstrual cycles. In CON, D-RES and E-RES, participants consumed diets providing 45, 15 and 45 kcal·kgLBM-1·d-1. In E-RES only, participants completed supervised running sessions (129 ± 10 min·d-1) at 70% of their VO2 peak that resulted in an exercise energy expenditure of 30 kcal·kg LBM-1·d-1. Blood samples were collected at baseline (BASE) and at the end of the 3-day period (D6) and analysed for bone turnover markers (β-CTX and P1NP), markers of calcium metabolism (PTH, albumin-adjusted Ca, Mg and PO4) and hormones (IGF-1, T3, insulin, leptin and 17β-oestradiol). RESULTS In D-RES, P1NP concentrations at D6 decreased by 17% (BASE: 54.8 ± 12.7 μg·L-1, D6: 45.2 ± 9.3 μg·L-1, P < 0.001, d = 0.91) and were lower than D6 concentrations in CON (D6: 52.5 ± 11.9 μg·L-1, P = 0.001). P1NP did not change significantly in E-RES (BASE: 55.3 ± 14.4 μg·L-1, D6: 50.9 ± 15.8 μg·L-1, P = 0.14). β-CTX concentrations did not change following D-RES (BASE: 0.48 ± 0.18 μg·L-1, D6: 0.55 ± 0.17 μg·L-1) or E-RES (BASE: 0.47 ± 0.24 μg·L-1, D6: 0.49 ± 0.18 μg·L-1) (condition × time interaction effect, P = 0.17). There were no significant differences in P1NP (P = 0.25) or β-CTX (P = 0.13) responses between D-RES and E-RES. Both conditions resulted in reductions in IGF-1 (-13% and - 23% from BASE in D-RES and E-RES, both P < 0.01) and leptin (-59% and - 61% from BASE in D-RES and E-RES, both P < 0.001); T3 decreased in D-RES only (-15% from BASE, P = 0.002) and PO4 concentrations decreased in E-RES only (-9%, P = 0.03). CONCLUSIONS Low EA achieved through dietary energy restriction resulted in a significant decrease in bone formation but no change in bone resorption, whereas low EA achieved through exercise energy expenditure did not significantly influence bone metabolism. Both low EA conditions elicited significant and similar changes in hormone concentrations.
Collapse
Affiliation(s)
- Maria Papageorgiou
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Clifton Campus, NG11 8NS, UK; Academic Diabetes, Endocrinology and Metabolism, Hull Medical School, University of Hull, Brocklehurst Building, Hull Royal Infirmary, Anlaby Road, Hull HU3 2RW, UK.
| | - Daniel Martin
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Clifton Campus, NG11 8NS, UK; School of Sport and Exercise Science, University of Lincoln, LN6 7TS, UK.
| | - Hannah Colgan
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Clifton Campus, NG11 8NS, UK.
| | - Simon Cooper
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Clifton Campus, NG11 8NS, UK.
| | - Julie P Greeves
- Army Personnel Research Capability, HQ Army, Monxton Road, Andover, Hampshire, SP11 8HT, UK.
| | - Jonathan C Y Tang
- Norwich Medical School, University of East Anglia, UK, Norfolk and Norwich University Hospital, Norfolk, NR4 7UQ, UK.
| | - William D Fraser
- Norwich Medical School, University of East Anglia, UK, Norfolk and Norwich University Hospital, Norfolk, NR4 7UQ, UK.
| | - Kirsty J Elliott-Sale
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Clifton Campus, NG11 8NS, UK.
| | - Craig Sale
- Musculoskeletal Physiology Research Group, Sport, Health and Performance Enhancement Research Centre, School of Science and Technology, Nottingham Trent University, Clifton Campus, NG11 8NS, UK.
| |
Collapse
|
32
|
Wysham KD, Shoback DM, Imboden JB, Katz PP. Association of High Anti-Cyclic Citrullinated Peptide Seropositivity and Lean Mass Index With Low Bone Mineral Density in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2018; 70:961-969. [PMID: 29106028 DOI: 10.1002/acr.23440] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 09/26/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Osteoporotic fractures are associated with high morbidity and mortality. Persons with rheumatoid arthritis (RA) have twice the risk of osteoporosis-related fracture than age-matched controls, the causes for which remain unknown. We investigated contributions of RA characteristics, medication use, and body composition to low bone mineral density (BMD) in patients with RA. METHODS Data were from the Arthritis, Body Composition, and Disability Study (n = 138; 82 women, 56 men). Demographic, clinical, laboratory, and functional variables were collected at study visits. Body composition (fat, lean muscle, and BMD) was measured by dual x-ray absorptiometry. Linear regression analyses evaluated the association between predictors and femoral neck BMD. RESULTS Average disease duration was 19 years, 70% of patients were rheumatoid factor positive, and 55% were high-positive anti-cyclic citrullinated peptide (anti-CCP). Age and high anti-CCP positivity were negatively associated with BMD after controlling for other variables (β = -0.003 and -0.055, respectively, P < 0.05). Appendicular lean mass index (ALMI) was positively associated with BMD (β = 0.053, P < 0.0001). In high anti-CCP positivity participants, increasing anti-CCP levels were associated with a negative linear trend in BMD (β = -0.011, P = 0.026). CONCLUSION High anti-CCP positivity and ALMI were strongly associated with BMD in patients with RA. The linear relationship of anti-CCP levels with lower BMD supports the hypothesis that processes specific to RA negatively impact BMD. In contrast, ALMI was positively associated with BMD, emphasizing the importance of this potentially modifiable risk factor. Our findings highlight the complicated interplay of RA disease-specific and functional factors and their impact on bone mass.
Collapse
Affiliation(s)
| | - Dolores M Shoback
- San Francisco Department of Veterans Affairs Medical Center, and University of California, San Francisco
| | | | | |
Collapse
|
33
|
Colleluori G, Napoli N, Phadnis U, Armamento-Villareal R, Villareal DT. Effect of Weight Loss, Exercise, or Both on Undercarboxylated Osteocalcin and Insulin Secretion in Frail, Obese Older Adults. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:4807046. [PMID: 28951766 PMCID: PMC5603129 DOI: 10.1155/2017/4807046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/25/2017] [Accepted: 07/06/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Obesity exacerbates age-related decline in glucometabolic control. Undercarboxylated osteocalcin (UcOC) regulates pancreatic insulin secretion. The long-term effect of lifestyle interventions on UcOC and insulin secretion has not been investigated. METHODS One hundred seven frail, obese older adults were randomized into the control (N = 27), diet (N = 26), exercise (N = 26), and diet-exercise (N = 28) groups for 1 year. Main outcomes included changes in UcOC and disposition index (DI). RESULTS UcOC increased in the diet group (36 ± 11.6%) but not in the other groups (P < 0.05 between groups). Although similar increases in DI occurred in the diet-exercise and diet groups at 6 months, DI increased more in the diet-exercise group (92.4 ± 11.4%) than in the diet group (61.9 ± 15.3%) at 12 months (P < 0.05). UcOC and body composition changes predicted DI variation in the diet group only (R2 = 0.712), while adipocytokines and physical function changes contributed to DI variation in both the diet (∆R2 = 0.140 and 0.107) and diet-exercise (∆R2 = 0.427 and 0.243) groups (P < 0.05 for all). CONCLUSIONS Diet, but not exercise or both, increases UcOC, whereas both diet and diet-exercise increase DI. UcOC accounts for DI variation only during active weight loss, while adipocytokines and physical function contribute to diet-exercise-induced DI variation, highlighting different mechanisms for lifestyle-induced improvements in insulin secretion. This trial was registered with ClinicalTrials.gov number NCT00146107.
Collapse
Affiliation(s)
- Georgia Colleluori
- Division of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, TX 77030, USA
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
- University Campus-Biomedico, 00128, Rome, Italy
| | | | - Uma Phadnis
- Division of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, TX 77030, USA
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
| | - Reina Armamento-Villareal
- Division of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, TX 77030, USA
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
| | - Dennis T. Villareal
- Division of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine, Houston, TX 77030, USA
- Center for Translational Research on Inflammatory Diseases (CTRID), Michael E. DeBakey VA Medical Center, Houston, TX 77030, USA
| |
Collapse
|
34
|
Giangregorio L, El-Kotob R. Exercise, muscle, and the applied load-bone strength balance. Osteoporos Int 2017; 28:21-33. [PMID: 27738713 DOI: 10.1007/s00198-016-3780-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 09/14/2016] [Indexed: 12/01/2022]
Abstract
A fracture occurs when the applied load is greater than the bone can withstand. Clinical practice guidelines for the management of osteoporosis include recommendations for exercise; one of the few therapies where the proposed anti-fracture mechanisms that include effects on both bone strength and applied loads, where applied loads can come in the form of a fall, externally applied loads, body weight, or muscle forces. The aim of this review is to provide an overview of the clinical evidence pertaining to the potential efficacy of exercise for preventing fractures in older adults, including its direct effects on outcomes along the causal pathway to fractures (e.g., falls, posture, bone strength) and the indirect effects on muscle or the muscle-bone relationship. The evidence is examined as it pertains to application in clinical practice. Considerations for future research are discussed, such as the need for trials in individuals with low bone mass or students that evaluate whether changes in muscle mediate changes in bone. Future trials should also consider adequacy of calorie or protein intake, the confounding effect of exercise-induced weight loss, or the most appropriate therapeutic goal (e.g., strength, weight bearing, or hypertrophy) and outcome measures (e.g., fracture, disability, cost-effectiveness).
Collapse
Affiliation(s)
- L Giangregorio
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada.
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada.
| | - R El-Kotob
- Department of Kinesiology, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| |
Collapse
|
35
|
Weiss EP, Jordan RC, Frese EM, Albert SG, Villareal DT. Effects of Weight Loss on Lean Mass, Strength, Bone, and Aerobic Capacity. Med Sci Sports Exerc 2017; 49:206-217. [PMID: 27580151 PMCID: PMC5161655 DOI: 10.1249/mss.0000000000001074] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE This study aimed to evaluate the hypothesis that exercise attenuates the reductions in lean mass, muscle strength, bone mineral density, and V˙O2max that accompany modest weight loss induced by calorie restriction (CR). METHODS Overweight, sedentary women and men (n = 52, 45-65 yr) were randomized to 6%-8% weight loss by using CR, endurance exercise training (EX), or both (CREX). The CR and the CREX groups underwent counseling to reduce energy intake by 20% and 10%, respectively. The EX and the CREX groups exercised 7.4 ± 0.5 and 4.4 ± 0.5 h·wk, respectively. Before and after 16.8 ± 1.1 wk of weight loss, lean mass and bone mineral density were measured with dual-energy x-ray absorptiometry, strength was measured with dynamometry, and aerobic capacity (V˙O2max) was measured with indirect calorimetry during maximal-intensity treadmill exercise. RESULTS Weight loss was ~7% in all groups. Decreases in whole-body (~2%, P = 0.003) and lower extremity (~4%, P < 0.0001) lean mass occurred in the CR group (both P < 0.05). Despite similar weight loss, these reductions were attenuated in the CREX group (~1%, P = 0.44 and ~2%, P = 0.05, respectively) and absent in the EX group. Absolute aerobic capacity decreased ~6% in the CR group (P = 0.04), was unchanged in the CREX group (P = 0.28), and increased ~15% in the EX group (P < 0.0001). No changes in muscle strength or bone were observed. CONCLUSIONS Modest weight loss (~7%) induced by 20% CR in overweight women and men decreases lean mass and reduces absolute V˙O2max. Exercise protects against these effects. Although the CR-induced changes might be considered physiologically appropriate for a reduced body weight, exercise preserves and/or improves these parameters during weight loss, which likely improves physical function. These findings support the notion of using exercise as an important component of weight loss programs.
Collapse
Affiliation(s)
- Edward P. Weiss
- Department of Nutrition and Dietetics, Saint Louis University, St. Louis, MO
- Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St. Louis, MO
| | - Richard C. Jordan
- Department of Nutrition and Dietetics, Saint Louis University, St. Louis, MO
| | - Ethel M. Frese
- Department of Physical Therapy and Athletic Training, Saint Louis University, St. Louis, MO
| | - Stewart G. Albert
- Division of Endocrinology, School of Medicine, Saint Louis University, St. Louis, MO
| | - Dennis T. Villareal
- Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St. Louis, MO
- Division of Endocrinology, Diabetes, and Metabolism, Baylor College of Medicine and Michael E DeBakey VA Medical Center, Houston, TX
| |
Collapse
|
36
|
Huovinen V, Bucci M, Lipponen H, Kiviranta R, Sandboge S, Raiko J, Koskinen S, Koskensalo K, Eriksson JG, Parkkola R, Iozzo P, Nuutila P. Femoral Bone Marrow Insulin Sensitivity Is Increased by Resistance Training in Elderly Female Offspring of Overweight and Obese Mothers. PLoS One 2016; 11:e0163723. [PMID: 27669153 PMCID: PMC5036877 DOI: 10.1371/journal.pone.0163723] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/09/2016] [Indexed: 12/25/2022] Open
Abstract
Bone marrow insulin sensitivity may be an important factor for bone health in addition to bone mineral density especially in insulin resistant conditions. First we aimed to study if prenatal maternal obesity plays a role in determining bone marrow insulin sensitivity in elderly female offspring. Secondly we studied if a four-month individualized resistance training intervention increases bone marrow insulin sensitivity in elderly female offspring and whether this possible positive outcome is regulated by the offspring’s mother’s obesity status. 37 frail elderly females (mean age 71.9 ± 3.1 years) of which 20 were offspring of lean/normal-weight mothers (OLM, maternal BMI ≤ 26.3 kg/m2) and 17 were offspring of obese/overweight mothers (OOM, maternal BMI ≥ 28.1 kg/m2) were studied before and after a four-month individualized resistance training intervention. Nine age- and sex-matched non-frail controls (maternal BMI ≤ 26.3 kg/m2) were studied at baseline. Femoral bone marrow (FBM) and vertebral bone marrow (VBM) insulin sensitivity were measured using [18F]fluoro-2-deoxy-D-glucose positron emission tomography with computer tomography under hyperinsulinemic euglycemic clamp. We found that bone marrow insulin sensitivity was not related to maternal obesity status but FBM insulin sensitivity correlated with whole body insulin sensitivity (R = 0.487, p = 0.001). A four-month resistance training intervention increased FBM insulin sensitivity by 47% (p = 0.006) only in OOM, while VBM insulin sensitivity remained unchanged regardless of the maternal obesity status. In conclusion, FBM and VBM glucose metabolism reacts differently to a four-month resistance training intervention in elderly women according to their maternal obesity status. TRIAL REGISTRATION ClinicalTrials.gov NCT01931540.
Collapse
Affiliation(s)
- Ville Huovinen
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Marco Bucci
- Turku PET Centre, University of Turku, Turku, Finland
| | - Heta Lipponen
- Turku PET Centre, University of Turku, Turku, Finland
| | - Riku Kiviranta
- Department of Endocrinology, Turku University Hospital, Turku, Finland
- Departments of Medicine and Medical Biochemistry and Genetics, University of Turku, Turku, Finland
| | - Samuel Sandboge
- Folkhälsan Research Centre, Helsinki, Finland
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki, Finland
| | - Juho Raiko
- Turku PET Centre, University of Turku, Turku, Finland
| | - Suvi Koskinen
- Turku PET Centre, University of Turku, Turku, Finland
| | | | - Johan G. Eriksson
- National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, and Helsinki University Hospital Finland, Helsinki, Finland
| | - Riitta Parkkola
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Patricia Iozzo
- Turku PET Centre, University of Turku, Turku, Finland
- Institute of Clinical Physiology, National Research Council (CNR), Pisa, Italy
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Endocrinology, Turku University Hospital, Turku, Finland
- * E-mail:
| |
Collapse
|
37
|
Batsis JA, Gill LE, Masutani RK, Adachi-Mejia AM, Blunt HB, Bagley PJ, Lopez-Jimenez F, Bartels SJ. Weight Loss Interventions in Older Adults with Obesity: A Systematic Review of Randomized Controlled Trials Since 2005. J Am Geriatr Soc 2016; 65:257-268. [PMID: 27641543 DOI: 10.1111/jgs.14514] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To identify geriatric obesity interventions that can guide clinical recommendations. DESIGN Systematic review using Medline (PubMed), Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, EMBASE (Ovid), and PsycINFO (Proquest) from January 1, 2005, to October 12, 2015, to identify English-language randomized controlled trials. PARTICIPANTS Individuals aged 60 and older (mean age ≥65) and classified as having obesity (body mass index ≥30 kg/m2 ). INTERVENTIONS Behavioral weight loss interventions not involving pharmacological or procedural therapies lasting 6 months or longer. MEASUREMENTS Two investigators performed the systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria and achieved a high concordance rate (97.3%) in summarizing the primary outcomes. The three primary outcomes were weight loss, physical performance, and quality of life. RESULTS Of 5,741 citations, 19 were included. (Six studies were unique, and the remaining 13 were based on the same study population.) Duration ranged from 6 to 18 months (n = 405 participants, age range 66.7-71.1). Weight loss in the intervention groups ranged from 0.5 to 10.7 kg (0.1-9.3%). Five studies had a resistance exercise program accompanying a dietary component. Greater weight loss was observed in groups with a dietary component than those with exercise alone. Exercise alone led to better physical function but no significant weight loss. Combined dietary and exercise components led to the greatest improvement in physical performance measures and quality of life and mitigated reductions in muscle and bone mass observed in diet-only study arms. Heterogeneous outcomes were observed, which limited the ability to synthesize the data quantitatively. CONCLUSIONS The evidence supporting geriatric obesity interventions to improve physical function and quality of life is of low to moderate quality. Well-designed trials are needed in this population.
Collapse
Affiliation(s)
- John A Batsis
- Section of General Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Weight & Wellness Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Geisel School of Medicine at Dartmouth, Dartmouth College, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.,Health Promotion Research Center at Dartmouth, Lebanon, New Hampshire
| | - Lydia E Gill
- Dartmouth Centers for Health and Aging, Dartmouth College, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire
| | - Rebecca K Masutani
- Geisel School of Medicine at Dartmouth, Dartmouth College, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, New Hampshire
| | - Anna M Adachi-Mejia
- Geisel School of Medicine at Dartmouth, Dartmouth College, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.,Health Promotion Research Center at Dartmouth, Lebanon, New Hampshire
| | - Heather B Blunt
- Biomedical Libraries, Dartmouth College, Hanover, New Hampshire
| | - Pamela J Bagley
- Biomedical Libraries, Dartmouth College, Hanover, New Hampshire
| | - Francisco Lopez-Jimenez
- Division of Cardiovascular Disease, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Stephen J Bartels
- Geisel School of Medicine at Dartmouth, Dartmouth College, New Hampshire.,Dartmouth Centers for Health and Aging, Dartmouth College, New Hampshire.,The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire.,Health Promotion Research Center at Dartmouth, Lebanon, New Hampshire
| |
Collapse
|
38
|
Soltani S, Hunter GR, Kazemi A, Shab-Bidar S. The effects of weight loss approaches on bone mineral density in adults: a systematic review and meta-analysis of randomized controlled trials. Osteoporos Int 2016; 27:2655-2671. [PMID: 27154437 DOI: 10.1007/s00198-016-3617-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 04/26/2016] [Indexed: 12/15/2022]
Abstract
UNLABELLED We assessed the impact of weight loss strategies including calorie restriction and exercise training on BMD in adults using a systematic review of randomized controlled trials. Weight reduction results in reduced BMD at the hip, but has less effect on the spine. Both calorie restriction and a combination of calorie restriction and exercise result in a decrease in hip bone density, whereas weight loss response to exercise training without dietary restriction leads to increased hip BMD. INTRODUCTION Findings are not consistent on the effect of weight loss on bone mineral density (BMD). We conducted a systematic review on the randomized controlled trials to assess the effect of weight loss strategies, including calorie restriction and exercise programs on BMD in adults. METHODS A structured and comprehensive search of MEDLINE and EMBASE databases was undertaken up to March 2016. Study-specific mean differences (MD) were pooled using a random-effects model. Subgroup analysis and meta-regression were used to find possible sources of between-study heterogeneity. RESULTS Thirty-two randomized controlled trials met predetermined inclusion criteria. The meta-analysis revealed no significant difference on total BMD (MD 0.007, 95 % CI -0.020-0.034, p = 0.608). In contrast, the pooled data of studies showed a significant effect of weight loss on hip BMD (MD -0.008, 95 % CI -0.09 to -0.006 g/cm(2), p < 0.001) and also lumbar spine BMD (MD -0.018 g/cm(2), 95 % CI -0.019 to -0.017, p < 0.001). BMD in the hip site decreased after more than 4 months, especially in those who were obese. Moreover, calorie restriction interventions longer than 13 months showed a significant decreased in lumbar spine BMD. CONCLUSION Weight loss led to significant decreases at the hip and lumbar spine BMD but not at the total. Weight loss response following calorie restriction resulted in a decrease in hip and lumbar spine bone density especially more than 1 year; whereas an exercise-induced weight loss did not.
Collapse
Affiliation(s)
- S Soltani
- Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Hemaat Highway, 1449614535, Tehran, Iran
| | - G R Hunter
- Department of Human Studies School of Education, University of Alabama at Birmingham, EB 205 1720 2nd Ave South, Birmingham, AL, 34294-1250, USA
| | - A Kazemi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P. O. Box 14155/6117, Amir Abad, Keshavarz Boulevard, Tehran, Iran
| | - S Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, P. O. Box 14155/6117, Amir Abad, Keshavarz Boulevard, Tehran, Iran.
| |
Collapse
|
39
|
Bergouignan A, Stein TP, Habold C, Coxam V, O’ Gorman D, Blanc S. Towards human exploration of space: The THESEUS review series on nutrition and metabolism research priorities. NPJ Microgravity 2016; 2:16029. [PMID: 28725737 PMCID: PMC5515527 DOI: 10.1038/npjmgrav.2016.29] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/30/2016] [Accepted: 07/08/2016] [Indexed: 01/01/2023] Open
Abstract
Nutrition has multiple roles during space flight from providing sufficient nutrients to meet the metabolic needs of the body and to maintain good health, to the beneficial psychosocial aspects related to the meals. Nutrition is central to the functioning of the body; poor nutrition compromises all the physiological systems. Nutrition is therefore likely to have a key role in counteracting the negative effects of space flight (e.g., radiation, immune deficits, oxidative stress, and bone and muscle loss). As missions increase in duration, any dietary/nutritional deficiencies will become progressively more detrimental. Moreover, it has been recognized that the human diet contains, in addition to essential macronutrients, a complex array of naturally occurring bioactive micronutrients that may confer significant long-term health benefits. It is therefore critical that astronauts be adequately nourished during missions. Problems of nutritional origin are often treatable by simply providing the appropriate nutrients and adequate recommendations. This review highlights six key issues that have been identified as space research priorities in nutrition field: in-flight energy balance; altered feeding behavior; development of metabolic stress; micronutrient deficiency; alteration of gut microflora; and altered fluid and electrolytes balance. For each of these topics, relevance for space exploration, knowledge gaps and proposed investigations are described. Finally, the nutritional questions related to bioastronautics research are very relevant to multiple ground-based-related health issues. The potential spin-offs are both interesting scientifically and potentially of great clinical importance.
Collapse
Affiliation(s)
- Audrey Bergouignan
- Anschutz Health and Wellness Center, Division of Endocrinology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
- Université de Strasbourg, IPHC, Strasbourg, France
- CNRS, UMR7178, Strasbourg, France
| | - T Peter Stein
- Department of Surgery, Rowan University, Stratford, NJ, USA
| | - Caroline Habold
- Université de Strasbourg, IPHC, Strasbourg, France
- CNRS, UMR7178, Strasbourg, France
| | - Veronique Coxam
- Centre de Recherche en Nutrition Humaine d’Auvergne, Clermont-Ferrand, France
| | - Donal O’ Gorman
- Department of Health & Human Performance, Dublin City University, Dublin, Republic of Ireland
| | - Stéphane Blanc
- Université de Strasbourg, IPHC, Strasbourg, France
- CNRS, UMR7178, Strasbourg, France
| |
Collapse
|
40
|
Zibellini J, Seimon RV, Lee CMY, Gibson AA, Hsu MSH, Sainsbury A. Effect of diet-induced weight loss on muscle strength in adults with overweight or obesity - a systematic review and meta-analysis of clinical trials. Obes Rev 2016; 17:647-63. [PMID: 27126087 DOI: 10.1111/obr.12422] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/26/2016] [Accepted: 04/04/2016] [Indexed: 12/20/2022]
Abstract
We conducted a systematic review and meta-analysis to identify how diet-induced weight loss in adults with overweight or obesity impacts on muscle strength. Twenty-seven publications, including 33 interventions, most of which were 8-24 weeks in duration, were included. Meta-analysis of seven interventions measuring knee extensor strength by isokinetic dynamometry in 108 participants found a significant decrease following diet-induced weight loss (-9.0 [95% confidence interval: -13.8, -4.1] N/m, P < 0.001), representing a 7.5% decrease from baseline values. Meta-analysis of handgrip strength from 10 interventions in 231 participants showed a non-significant decrease (-1.7 [-3.6, 0.1] kg, P = 0.070), with significant heterogeneity (I(2) = 83.9%, P < 0.001). This heterogeneity may have been due to diet type, because there was a significant decrease in handgrip strength in seven interventions in 169 participants involving moderate energy restriction (-2.4 [-4.8, -0.0] kg, P = 0.046), representing a 4.6% decrease from baseline values, but not in three interventions in 62 participants involving very-low-energy diet (-0.4 [-2.0, 1.2] kg, P = 0.610). Because of variability in methodology and muscles tested, no other data could be meta-analyzed, and qualitative assessment of the remaining interventions revealed mixed results. Despite varying methodologies, diets and small sample sizes, these findings suggest a potential adverse effect of diet-induced weight loss on muscle strength. While these findings should not act as a deterrent against weight loss, due to the known health benefits of losing excess weight, they call for strategies to combat strength loss - such as weight training and other exercises - during diet-induced weight loss. © 2016 World Obesity.
Collapse
Affiliation(s)
- J Zibellini
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - R V Seimon
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - C M Y Lee
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - A A Gibson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - M S H Hsu
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - A Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| |
Collapse
|
41
|
Marinho SMSDA, Mafra D, Pelletier S, Hage V, Teuma C, Laville M, Carraro Eduardo JC, Fouque D. In Hemodialysis Patients, Intradialytic Resistance Exercise Improves Osteoblast Function: A Pilot Study. J Ren Nutr 2016; 26:341-5. [PMID: 27113628 DOI: 10.1053/j.jrn.2016.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Abnormalities in mineral and bone metabolism are frequent in chronic kidney disease patients. Physical exercise can improve many indicators of physical functioning, and recent studies showed beneficial effects on bone mineral density in the general population. The aim of this study was to evaluate the effects of resistance exercise training on bone markers and body composition in hemodialysis (HD) patients. DESIGN This was a randomized controlled trial. SUBJECTS The study included 13 HD patients (46.2% men). INTERVENTION Patients were divided into a control group and an exercise group, which performed 8 weeks of intradialytic resistance exercise. Serum sclerostin, bone alkaline phosphatase (BAP), insulin, leptin, 25-hydroxyvitamin D, 1,25-dihydroxyvitamin D, and body composition were measured before and after the exercise period. RESULTS In the exercise group, BAP levels increased from 11.4 ± 6.5 to 14.6 ± 6.4 U/L (P < .05) and serum 1,25-dihydroxyvitamin D levels from 46.0 ± 23.5 to 87.2 ± 31.8 ng/mL (P < .05). After exercise, serum BAP levels were inversely correlated with serum sclerostin (r = -0.96, P < .05). There was no change in body composition in either group. CONCLUSION Resistance exercise training appears to be an interesting approach for stimulating BAP production in HD patients and may prevent bone loss and stimulate bone formation.
Collapse
Affiliation(s)
- Sandra Mara S de A Marinho
- Graduate Program in Medical Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil.
| | - Denise Mafra
- Graduate Program in Medical Sciences, Fluminense Federal University (UFF), Niterói, Rio de Janeiro, Brazil
| | - Solenne Pelletier
- Department of Nephrology, Centre Hospitalier Lyon-Sud, CARMEN, CENS, Université de Lyon, Lyon, France
| | - Valerie Hage
- Department of Nephrology, Centre Hospitalier Lyon-Sud, CARMEN, CENS, Université de Lyon, Lyon, France
| | - Cécile Teuma
- Department of Nephrology, Centre Hospitalier Lyon-Sud, CARMEN, CENS, Université de Lyon, Lyon, France
| | - Maurice Laville
- Department of Nephrology, Centre Hospitalier Lyon-Sud, CARMEN, CENS, Université de Lyon, Lyon, France
| | | | - Denis Fouque
- Department of Nephrology, Centre Hospitalier Lyon-Sud, CARMEN, CENS, Université de Lyon, Lyon, France
| |
Collapse
|
42
|
Mason C, Tapsoba JDD, Duggan C, Imayama I, Wang CY, Korde L, McTiernan A. Effects of Vitamin D3 Supplementation on Lean Mass, Muscle Strength, and Bone Mineral Density During Weight Loss: A Double-Blind Randomized Controlled Trial. J Am Geriatr Soc 2016; 64:769-78. [PMID: 27060050 PMCID: PMC4840082 DOI: 10.1111/jgs.14049] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To compare the effects of 12 months of vitamin D3 supplementation with that placebo on lean mass, bone mineral density (BMD), and muscle strength in overweight or obese postmenopausal women completing a structured weight-loss program. DESIGN Double-blind, placebo-controlled randomized clinical trial. SETTING Fred Hutchinson Cancer Research Center, Seattle, Washington. PARTICIPANTS Postmenopausal women aged 50 to 75 with a body mass index (BMI) of 25 kg/m(2) or greater and a serum 25-hydroxyvitamin D (25(OH)D) concentration between 10.0 and 32.0 ng/mL (insufficient) (N = 218). INTERVENTION Oral vitamin D3 2,000 IU/d or placebo in combination with a lifestyle-based weight loss intervention consisting of a reduction of 500 kcal to 1,000 kcal per day and 225 min/wk of moderate- to vigorous-intensity aerobic exercise. MEASUREMENTS Serum 25(OH)D, body composition, and muscle strength were measured before randomization (baseline) and at 12 months. Mean changes of the groups were compared (intention to treat) using generalized estimating equations. RESULTS Change in 25(OH)D was significantly different between the vitamin D and placebo groups at 12 months (13.6 ng/mL vs -1.3 ng/mL, P < .001), but no differences in change in lean mass (-0.8 kg vs -1.1 kg, P = .53) or BMD of the spine (-0.01 g/cm(2) vs 0.0 g/cm(2) , P = .82) or right femoral neck (both -0.01 g/cm(2) , P = .49) were detected between the groups. Leg strength decreased in the vitamin D group but not in the placebo group (-2.6 pounds vs 1.8 pounds, P = .03). In women randomized to vitamin D, achieving repletion (25(OH)D ≥ 32 ng/mL) did not alter results. CONCLUSION Vitamin D3 supplementation during weight-loss decreased leg strength but did not alter changes in lean mass or BMD in postmenopausal women with vitamin D insufficiency.
Collapse
Affiliation(s)
- Caitlin Mason
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jean De Dieu Tapsoba
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ikuyo Imayama
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Ching-Yun Wang
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- School of Public Health, University of Washington, Seattle, WA
| | - Larissa Korde
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- Department of Medicine, University of Washington, Seattle, WA
| | - Anne McTiernan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
- School of Public Health, University of Washington, Seattle, WA
| |
Collapse
|
43
|
Villareal DT, Fontana L, Das SK, Redman L, Smith SR, Saltzman E, Bales C, Rochon J, Pieper C, Huang M, Lewis M, Schwartz AV. Effect of Two-Year Caloric Restriction on Bone Metabolism and Bone Mineral Density in Non-Obese Younger Adults: A Randomized Clinical Trial. J Bone Miner Res 2016; 31:40-51. [PMID: 26332798 PMCID: PMC4834845 DOI: 10.1002/jbmr.2701] [Citation(s) in RCA: 121] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 08/22/2015] [Accepted: 08/26/2015] [Indexed: 01/08/2023]
Abstract
Although caloric restriction (CR) could delay biologic aging in humans, it is unclear if this would occur at the cost of significant bone loss. We evaluated the effect of prolonged CR on bone metabolism and bone mineral density (BMD) in healthy younger adults. Two-hundred eighteen non-obese (body mass index [BMI] 25.1 ± 1.7 kg/m(2) ), younger (age 37.9 ± 7.2 years) adults were randomly assigned to 25% CR (CR group, n = 143) or ad libitum (AL group, n = 75) for 2 years. Main outcomes were BMD and markers of bone turnover. Other outcomes included body composition, bone-active hormones, nutrient intake, and physical activity. Body weight (-7.5 ± 0.4 versus 0.1 ± 0.5 kg), fat mass (-5.3 ± 0.3 versus 0.4 ± 0.4 kg), and fat-free mass (-2.2 ± 0.2 versus -0.2 ± 0.2 kg) decreased in the CR group compared with AL (all between group p < 0.001). Compared with AL, the CR group had greater changes in BMD at 24 months: lumbar spine (-0.013 ± 0.003 versus 0.007 ± 0.004 g/cm(2) ; p < 0.001), total hip (-0.017 ± 0.002 versus 0.001 ± 0.003 g/cm(2) ; p < 0.001), and femoral neck (-0.015 ± 0.003 versus -0.005 ± 0.004 g/cm(2) ; p = 0.03). Changes in bone markers were greater at 12 months for C-telopeptide (0.098 ± 0.012 versus 0.025 ± 0.015 μg/L; p < 0.001), tartrate-resistant acid phosphatase (0.4 ± 0.1 versus 0.2 ± 0.1 U/L; p = 0.004), and bone-specific alkaline phosphatase (BSAP) (-1.4 ± 0.4 versus -0.3 ± 0.5 U/L; p = 0.047) but not procollagen type 1 N-propeptide; at 24 months, only BSAP differed between groups (-1.5 ± 0.4 versus 0.9 ± 0.6 U/L; p = 0.001). The CR group had larger increases in 25-hydroxyvitamin D, cortisol, and adiponectin and decreases in leptin and insulin compared with AL. However, parathyroid hormone and IGF-1 levels did not differ between groups. The CR group also had lower levels of physical activity. Multiple regression analyses revealed that body composition, hormones, nutrients, and physical activity changes explained ∼31% of the variance in BMD and bone marker changes in the CR group. Therefore, bone loss at clinically important sites of osteoporotic fractures represents a potential limitation of prolonged CR for extending life span. Further long-term studies are needed to determine if CR-induced bone loss in healthy adults contributes to fracture risk and if bone loss can be prevented with exercise.
Collapse
Affiliation(s)
- Dennis T Villareal
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Baylor College of Medicine and Center for Translational Research on Inflammatory Diseases (CTRID), Michael E DeBakey VA Medical Center, Houston, TX, USA
| | - Luigi Fontana
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA.,Department of Clinical and Experimental Sciences, University Medical School, Brescia, Italy.,CEINGE Biotecnologie Avanzate, Napoli, Italy
| | - Sai Krupa Das
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Leanne Redman
- Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Steven R Smith
- Pennington Biomedical Research Center, Baton Rouge, LA, USA.,Translational Research Institute for Metabolism and Diabetes, Florida Hospital and Sanford Burnham Prebys Medical Discovery Institute, Orlando, FL, USA
| | - Edward Saltzman
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Connie Bales
- Durham VA Medical Center and Duke University Medical Center, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - James Rochon
- Duke Clinical Research Institute, Durham, NC, USA.,Rho Federal Systems, Chapel Hill, NC, USA
| | - Carl Pieper
- Duke Clinical Research Institute, Durham, NC, USA
| | - Megan Huang
- Duke Clinical Research Institute, Durham, NC, USA
| | | | - Ann V Schwartz
- University of California, San Francisco, San Francisco, CA, USA
| | | |
Collapse
|
44
|
Modulation and predictors of periprosthetic bone mineral density following total knee arthroplasty. BIOMED RESEARCH INTERNATIONAL 2015; 2015:418168. [PMID: 25793194 PMCID: PMC4352471 DOI: 10.1155/2015/418168] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/21/2014] [Accepted: 10/30/2014] [Indexed: 11/17/2022]
Abstract
Total knee arthroplasty (TKA) leads to a loss of periprosthetic bone mineral density (BMD). Great importance is attached to the prevention of periprosthetic bone loss with a view to ensuring a long service life of the prosthesis. In order to provide appropriate recommendations for preventive movement therapy measures to combat peri-implant bone loss, it is necessary to know the predictors of periprosthetic BMD. The aim of this study was (1) to determine the change of periprosthetic BMD of the femur and tibia and (2) to analyse the effects of different predictors on periprosthetic BMD. Twenty-three patients with primary TKA were evaluated 10 days and 3 months postoperatively. The data analysis comprised (1) the change in periprosthetic BMD from pretest to posttest and (2) the correlations between BMD and the variables isometric maximum voluntary force, lean mass, physical activity (step count), and BMI using multiple linear regression and structural equation modelling (SEM). BMD of the distal femur was significantly reduced by 19.7% (P = 0.008) 3 months after surgery, while no changes were found in BMD of the tibia. The results of SEM demonstrate that 55% of the BMD variance was explained by the model (χ2 = 0.002; df = 1; P = 0.96; χ2/df = 0.002; RMSEA < 0.01; TLI = 1.5; CFI = 1.0). A significant direct effect was only evidenced by the variable lean mass (β = 0.38; b = 0.15; SE = 0.07; C.R. = 2.0; P = 0.046). It can be assumed that a large muscle mass with accompanying distribution of high mechanical load in the bones can contribute to local changes of periprosthetic BMD. Concrete recommendations for preventing peri-implant bone loss therefore include exercises which have the aim of maintaining or building up muscle mass.
Collapse
|
45
|
Skowrońska-Jóźwiak E, Lewandowski KC, Adamczewski Z, Krawczyk-Rusiecka K, Lewiński A. Mechanisms of Normalisation of Bone Metabolism during Recovery from Hyperthyroidism: Potential Role for Sclerostin and Parathyroid Hormone. Int J Endocrinol 2015; 2015:948384. [PMID: 26366174 PMCID: PMC4561097 DOI: 10.1155/2015/948384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 08/11/2015] [Accepted: 08/11/2015] [Indexed: 11/17/2022] Open
Abstract
Sclerostin, a protein expressed by osteocytes, is a negative regulator of bone formation. The aim of the study was to investigate the relationship between parathyroid hormone (PTH) and markers of bone metabolism and changes of sclerostin concentrations before and after treatment of hyperthyroidism. Patients and Methods. The study involved 33 patients (26 women), age (mean ± SD) 48 ± 15 years, with hyperthyroidism. Serum sclerostin, PTH, calcium, and bone markers [osteocalcin (OC) and collagen type I cross-linked C-telopeptide I (CTX)] were measured at diagnosis of hyperthyroidism and after treatment with thiamazole. Results. After treatment of hyperthyroidism a significant decrease in free T3 (FT3) and free T4 (FT4) concentrations was accompanied by marked decrease of serum sclerostin (from 43.7 ± 29.3 to 28.1 ± 18.4 pmol/L; p < 0.001), OC (from 35.6 ± 22.0 to 27.0 ± 14.3 ng/mL; p < 0.001), and CTX (from 0.49 ± 0.35 to 0.35 ± 0.23 ng/dL; p < 0.005), accompanied by an increase of PTH (from 29.3 ± 14.9 to 39.8 ± 19.8; p < 0.001). During hyperthyroidism there was a positive correlation between sclerostin and CTX (r s = 0.41, p < 0.05) and between OC and thyroid hormones (with FT3 r s = 0.42, with FT4 r s = 0.45, p < 0.05). Conclusions. Successful treatment of hyperthyroidism results in a significant decrease in serum sclerostin and bone markers concentrations, accompanied by an increase of PTH.
Collapse
Affiliation(s)
- Elżbieta Skowrońska-Jóźwiak
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 281/289 Rzgowska Street, 90-338 Lodz, Poland
| | - Krzysztof C. Lewandowski
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 281/289 Rzgowska Street, 90-338 Lodz, Poland
| | - Zbigniew Adamczewski
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 281/289 Rzgowska Street, 90-338 Lodz, Poland
| | - Kinga Krawczyk-Rusiecka
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 281/289 Rzgowska Street, 90-338 Lodz, Poland
| | - Andrzej Lewiński
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 281/289 Rzgowska Street, 90-338 Lodz, Poland
- *Andrzej Lewiński:
| |
Collapse
|
46
|
Patient-specific bone modeling and analysis: the role of integration and automation in clinical adoption. J Biomech 2014; 48:750-60. [PMID: 25547022 DOI: 10.1016/j.jbiomech.2014.12.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2014] [Indexed: 12/11/2022]
Abstract
Patient-specific analysis of bones is considered an important tool for diagnosis and treatment of skeletal diseases and for clinical research aimed at understanding the etiology of skeletal diseases and the effects of different types of treatment on their progress. In this article, we discuss how integration of several important components enables accurate and cost-effective patient-specific bone analysis, focusing primarily on patient-specific finite element (FE) modeling of bones. First, the different components are briefly reviewed. Then, two important aspects of patient-specific FE modeling, namely integration of modeling components and automation of modeling approaches, are discussed. We conclude with a section on validation of patient-specific modeling results, possible applications of patient-specific modeling procedures, current limitations of the modeling approaches, and possible areas for future research.
Collapse
|
47
|
Abstract
PURPOSE OF REVIEW Discovery of the Wnt signaling pathway and understanding the central role of osteocyte in skeletal homeostasis have been the major advances in skeletal biology over the past decade. Sclerostin, secreted mainly (but not exclusively) by osteocytes, has emerged as a key player in skeletal homeostasis. This review highlights the most relevant recent advances. RECENT FINDINGS Sclerostin by inhibiting Wnt signaling pathway decreases bone formation and osteoblast differentiation and promotes osteoblast apoptosis. Ability to measure serum sclerostin levels better clarified the role of sclerostin in various physiologic and pathologic states. Early clinical trials with antibodies to sclerostin have produced robust increases in bone mineral density, and fracture prevention trials are underway. SUMMARY Since the discovery of Wnt signaling pathway and sclerostin's association with high bone mass, there has been a remarkable progress. Clinical trials with fracture endpoints, already underway, should expand osteoanabolic therapeutic horizon in the very near future. Measurement of sclerostin levels in a number of conditions has advanced our knowledge about pathophysiology of skeletal and nonskeletal disorders in an altogether new light.
Collapse
Affiliation(s)
- Mahalakshmi Honasoge
- aDivision of Endocrinology, Diabetes, and Bone & Mineral Disorders, Henry Ford Hospital, Detroit, Michigan bSection of Endocrinology, Diabetes and Metabolism, Temple University School of Medicine, Philadelphia, Pennslyvania cBone and Mineral Research Laboratory, Henry Ford Hospital, Detroit, Michigan, USA
| | | | | |
Collapse
|
48
|
Abstract
PURPOSE OF REVIEW Despite evidence that energy deficit produces multiple physiological and metabolic benefits, clinicians are often reluctant to prescribe weight loss in older individuals or those with low bone mineral density (BMD), fearing BMD will be decreased. Confusion exists concerning the effects that weight loss has on bone health. RECENT FINDINGS Bone density is more closely associated with lean mass than total body mass and fat mass. Although rapid or large weight loss is often associated with loss of bone density, slower or smaller weight loss is much less apt to adversely affect BMD, especially when it is accompanied with high intensity resistance and/or impact loading training. Maintenance of calcium and vitamin D intake seems to positively affect BMD during weight loss. Although dual energy X-ray absorptiometry is normally used to evaluate bone density, it may overestimate BMD loss following massive weight loss. Volumetric quantitative computed tomography may be more accurate for tracking bone density changes following large weight loss. SUMMARY Moderate weight loss does not necessarily compromise bone health, especially when exercise training is involved. Training strategies that include heavy resistance training and high impact loading that occur with jump training may be especially productive in maintaining, or even increasing bone density with weight loss.
Collapse
Affiliation(s)
- Gary R Hunter
- Division of Kinesiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | |
Collapse
|
49
|
Aguirre L, Napoli N, Waters D, Qualls C, Villareal DT, Armamento-Villareal R. Increasing adiposity is associated with higher adipokine levels and lower bone mineral density in obese older adults. J Clin Endocrinol Metab 2014; 99:3290-7. [PMID: 24878039 PMCID: PMC4154102 DOI: 10.1210/jc.2013-3200] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
CONTEXT Although obesity is associated with high bone mass, recent reports suggest an increase in the incidence of fractures in obese patients. OBJECTIVES The objectives of the study were to evaluate the influence of increasing body fat on bone mineral density (BMD) and to determine the influence of the different adipokines on BMD in frail obese elderly patients. DESIGN AND SETTING This is a cross-sectional study of baseline characteristics of elderly obese patients participating in a lifestyle therapy with diet with or without exercise and conducted in a university setting. PATIENTS One hundred seventy-three, elderly (≥65 y old), obese (body mass index of ≥30 kg/m(2)) who were mostly frail participated in the study. OUTCOME MEASURES BMD, percentage of total body fat, percentage of fat-free mass, percentage of lean mass, body mass index, adiponectin, leptin, IL-6, bone turnover markers (osteocalcin and C-telopeptide), high-sensitivity C-reactive protein, free estradiol, and 25-hydroxyvitamin D were measured. RESULTS Higher tertiles of percentage body fat and lower lean mass were associated with a lower BMD. High-sensitivity C-reactive protein levels were highest in the highest fat tertile (third, 5.5 ± 5.4 vs first, 1.5 ± 1.3 mg/L, P < .05) for women, whereas IL-6 levels were highest in the highest tertile in men (third, 3.5 ± 3.1 vs first, 1.7 ± 0.8 pg/mL, P < .05). Leptin increased with increasing fat tertiles in both genders (P < .05), whereas adiponectin increased with increasing fat tertiles only in men (P < .05). A multivariate analysis revealed adiponectin as an important mediator of the effect of fat mass on BMD. Osteocalcin levels were highest in the highest fat tertile in women but not in men. Physical function test scores decreased with increasing fat tertiles in women (P < .05) but not in men. CONCLUSIONS Increasing adiposity together with decreasing lean mass is associated with lower BMD, higher adipokine levels, and worsening frailty in elderly obese adults.
Collapse
Affiliation(s)
- Lina Aguirre
- Medicine and Research Services (L.A., D.W., C.Q., D.T.V., R.A.-V.), New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico; Biomedical Research Institute of New Mexico (L.A., C.Q.), Albuquerque, New Mexico 87108; Department of Medicine (N.N., D.T.V.), Washington University School of Medicine, St Louis, Missouri 63110; Department of Medicine (N.N.), Campus Biomedico, 00128 Rome, Italy; Departments of Medicine, Mathematics, and Statistics (C.Q., D.T.V., R.A.-V.), University of New Mexico, Albuquerque, New Mexico 87131; and Department of Preventive and Social Medicine (D.W.), University of Otago, Dunedin 9054, New Zealand
| | | | | | | | | | | |
Collapse
|
50
|
Napoli N, Strollo R, Paladini A, Briganti SI, Pozzilli P, Epstein S. The alliance of mesenchymal stem cells, bone, and diabetes. Int J Endocrinol 2014; 2014:690783. [PMID: 25140176 PMCID: PMC4124651 DOI: 10.1155/2014/690783] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 06/11/2014] [Indexed: 12/15/2022] Open
Abstract
Bone fragility has emerged as a new complication of diabetes. Several mechanisms in diabetes may influence bone homeostasis by impairing the action between osteoblasts, osteoclasts, and osteocytes and/or changing the structural properties of the bone tissue. Some of these mechanisms can potentially alter the fate of mesenchymal stem cells, the initial precursor of the osteoblast. In this review, we describe the main factors that impair bone health in diabetic patients and their clinical impact.
Collapse
Affiliation(s)
- Nicola Napoli
- Division of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
- Division of Bone and Mineral Diseases, Washington University in St Louis, St Louis, MO, USA
- *Nicola Napoli:
| | - Rocky Strollo
- Division of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Angela Paladini
- Division of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Silvia I. Briganti
- Division of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Paolo Pozzilli
- Division of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Rome, Italy
- Centre for Diabetes, The Blizard Building, Barts and The London School of Medicine, Queen Mary, University of London, London, UK
| | - Sol Epstein
- Division of Endocrinology, Mount Sinai School of Medicine, New York, USA
| |
Collapse
|