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Zahedi H, Atayie F, Samii Kondrud F, Balali A, Beyene J, Tahery N, Asadi M, Sadeghi O. Associations of abdominal obesity with different types of bone fractures in adults: A systematic review and dose-response meta-analysis of prospective cohort studies. Crit Rev Food Sci Nutr 2024; 64:6239-6250. [PMID: 36655423 DOI: 10.1080/10408398.2023.2166456] [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] [Indexed: 01/20/2023]
Abstract
Findings on the association between abdominal obesity and hip fracture were summarized in a meta-analysis in 2017; however, no study has examined the dose-response association between abdominal fat indices and hip fracture. Also, we found no meta-analysis investigating other types of bone fractures including any vertebral fractures in relation to abdominal obesity. Therefore, the present systematic review and dose-response meta-analysis of prospective cohort studies were conducted to examine the association between abdominal obesity and different types of bone fractures. A comprehensive literature search was done by searching PubMed, Scopus, Web of Science, and Google Scholar until October 2021. In total, 23 articles from prospective cohort studies with a total sample size of 3,456,631 participants were included. During the follow-up periods ranging between 4 and 26 years, 137,989 cases of bone fracture were recorded. After comparing the highest and lowest categories of abdominal fat indices, the summary relative risks (RRs) of any, hip, and vertebral fractures were 0.99 (95% CI: 0.81-1.20), 1.09 (95% CI: 0.82-1.43), and 1.18 (95% CI: 1.05-1.33), respectively, indicating a significant positive association between abdominal obesity and risk of vertebral fracture. In the non-linear dose-response analysis, abdominal obesity based on the waist-to-hip ratio (WHR) was positively associated with an increased risk of hip fracture from 0.7 to 1.1 units of WHR. In the linear analysis, a 10 cm increase in waist circumference (WC) was associated with a 3% higher risk of vertebral fracture. We found no other dose-response association for other types of bone fractures. In conclusion, abdominal obesity may be associated with a higher risk of hip and vertebral fractures.
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Affiliation(s)
- Hoda Zahedi
- Department of Nutrition and Dietetics, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Atayie
- Department of Nutrition, Electronic Health and Statistics Surveillance Research Center, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Faezeh Samii Kondrud
- Department of Nutrition, Electronic Health and Statistics Surveillance Research Center, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Arghavan Balali
- Student Research Committee and Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Chanchlani Research Centre, McMaster University, Hamilton, ON, Canada
| | | | | | - Omid Sadeghi
- Nutrition and Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
- Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
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Li HL, Shen Y, Tan LH, Fu SB, Guan CH, Zhen DH, Lv HH, Wu XY, Tang XL. Association between BMI and osteoporotic fractures at different sites in Chinese women: a case-control retrospective study in Changsha. BMC Musculoskelet Disord 2024; 25:187. [PMID: 38424521 PMCID: PMC10903060 DOI: 10.1186/s12891-024-07271-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Osteoporotic fractures are a growing problem in an aging society. The association between body mass index (BMI) and osteoporotic fractures varies by fracture site and ethnicity. Limited knowledge exists regarding this association in native Chinese, particularly utilizing local databases as reference sources. OBJECTIVE To investigate the association between BMI and osteoporotic fractures at different sites in Chinese women. METHODS Three thousand ninety-eight female patients with radiographic fractures and 3098 age- and sex-matched healthy controls without fractures were included in the study. Both of them underwent assessment using dual-energy X-ray absorptiometry (DXA), with BMD measurements calculated using our own BMD reference database. Participants were classified into underweight (BMI < 18.5 kg/m2), normal weight (18.5 ≤ BMI < 24.0 kg/m2), overweight (24 ≤ BMI < 28 kg/m2) and obese (BMI ≥ 28 kg/m2) according to the Chinese BMI classification standard. RESULTS There were 2296 (74.1%) vertebral fractures, 374 (12.1%) femoral neck fractures, and 428 (13.8%) other types of fractures in the case group. Bone mineral density (BMD) was almost lower in the fracture groups compared to the control groups (p = 0.048 to < 0.001). Compared with normal weight, underweight had a protective effect on total [odds ratio (OR) = 0.61; 95% confidence interval (CI), 0.49 -0.75; P< 0.001], and lumbar fractures (OR = 0.52; 95% CI, 0.41 - 0.67; P < 0.001), while obesity was associated with an increased risk for total (OR = 2.26; 95% CI, 1.85 - 2.76; P < 0.001), lumbar (OR = 2.17; 95% CI, 1.72 - 2.73; P < 0.001), and femoral neck fractures (OR = 4.08; 95% CI, 2.18 - 7.63; P < 0.001). Non-linear associations were observed between BMI and fractures: A J-curve for total, lumbar, and femoral neck fractures, and no statistical change for other types of fractures. Underweight was found to be a risk factor for other types of fracturess after adjusting for BMD (OR = 2.29; 95% CI, 1.09 - 4.80; P < 0.001). Osteoporosis and osteopenia were identified as risk factors for almost all sites of fracture when compared to normal bone mass. CONCLUSIONS Underweight has a protective effect on total and lumbar spine fractures in Chinese women, while obesity poses a risk factor for total, lumbar, and femoral neck fractures. The effect of BMI on fractures may be mainly mediated by BMD.
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Affiliation(s)
- Hong-Li Li
- Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, Lanzhou, Gansu, 730000, PR China
- Department of Metabolism and Endocrinology, and Hunan Provincial Key Laboratory for Metabolic Bone Diseases, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, PR China
| | - Yi Shen
- Department of Orthopaedics, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, PR China
| | - Li-Hua Tan
- Department of Radiology, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, PR China
| | - Song-Bo Fu
- Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, Lanzhou, Gansu, 730000, PR China
| | - Cong-Hui Guan
- Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, Lanzhou, Gansu, 730000, PR China
| | - Dong-Hu Zhen
- Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, Lanzhou, Gansu, 730000, PR China
| | - Hai-Hong Lv
- Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, Lanzhou, Gansu, 730000, PR China
| | - Xi-Yu Wu
- Department of Metabolism and Endocrinology, and Hunan Provincial Key Laboratory for Metabolic Bone Diseases, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital, Central South University, No.139 Middle Renmin Road, Changsha, Hunan, 410011, PR China.
| | - Xu-Lei Tang
- Department of Endocrinology, The First Hospital of Lanzhou University, No.1 DongGang West Road, Lanzhou, Gansu, 730000, PR China.
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Qi H, Hu C, Zhang J, Lin L, Wang S, Lin H, Jia X, Zhu Y, Zhang Y, Wu X, Li M, Xu M, Xu Y, Wang T, Zhao Z, Wang W, Bi Y, Dai M, Chen Y, Lu J. Early-life famine exposure, adulthood obesity patterns, and risk of low-energy fracture. Front Med 2024; 18:192-203. [PMID: 37938429 DOI: 10.1007/s11684-023-1023-9] [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: 03/05/2023] [Accepted: 07/20/2023] [Indexed: 11/09/2023]
Abstract
Malnutrition in early life increases the risk of osteoporosis, but the association of early-life undernutrition combined with adulthood obesity patterns with low-energy fracture remains unknown. This study included 5323 community-dwelling subjects aged ⩾40 years from China. Early-life famine exposure was identified based on the participants' birth dates. General obesity was assessed using the body mass index (BMI), and abdominal obesity was evaluated with the waist-to-hip ratio (WHR). Low-energy fracture was defined as fracture occurring after the age of ⩾40 typically caused by falls from standing height or lower. Compared to the nonexposed group, the group with fetal, childhood, and adolescence famine exposure was associated with an increased risk of fracture in women with odds ratios (ORs) and 95% confidence intervals (CIs) of 3.55 (1.57-8.05), 3.90 (1.57-9.71), and 3.53 (1.05-11.88), respectively, but not in men. Significant interactions were observed between fetal famine exposure and general obesity with fracture among women (P for interaction = 0.0008). Furthermore, compared with the groups with normal BMI and WHR, the group of women who underwent fetal famine exposure and had both general and abdominal obesity had the highest risk of fracture (OR, 95% CI: 3.32, 1.17-9.40). These results indicate that early-life famine exposure interacts with adulthood general obesity and significantly increases the risk of low-energy fracture later in life in women.
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Affiliation(s)
- Hongyan Qi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Chunyan Hu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jie Zhang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Lin Lin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Shuangyuan Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Hong Lin
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xiaojing Jia
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yuanyue Zhu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yi Zhang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Xueyan Wu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Mian Li
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Min Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yu Xu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Tiange Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Zhiyun Zhao
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Weiqing Wang
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Yufang Bi
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Meng Dai
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Yuhong Chen
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
| | - Jieli Lu
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People's Republic of China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
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Maradit Kremers H, Grossardt BR, Miller AR, Kasiske BL, Matas AJ, Khosla S, Kremers WK, Amer H, Kumar R. Fracture Risk Among Living Kidney Donors 25 Years After Donation. JAMA Netw Open 2024; 7:e2353005. [PMID: 38265798 PMCID: PMC10809017 DOI: 10.1001/jamanetworkopen.2023.53005] [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] [Received: 10/04/2023] [Accepted: 12/03/2023] [Indexed: 01/25/2024] Open
Abstract
Importance Living kidney donors may have an increased risk of fractures due to reductions in kidney mass, lower concentrations of serum 1,25-dihydroxyvitamin D, and secondary increases in serum parathyroid hormone. Objective To compare the overall and site-specific risk of fractures among living kidney donors with strictly matched controls from the general population who would have been eligible to donate a kidney but did not do so. Design, Setting, and Participants This survey study was conducted between December 1, 2021, and July 31, 2023. A total of 5065 living kidney donors from 3 large transplant centers in Minnesota were invited to complete a survey about their bone health and history of fractures, and 16 156 population-based nondonor controls without a history of comorbidities that would have precluded kidney donation were identified from the Rochester Epidemiology Project and completed the same survey. A total of 2132 living kidney donors and 2014 nondonor controls responded to the survey. Statistical analyses were performed from May to August 2023. Exposure Living kidney donation. Main Outcomes and Measures The rates of overall and site-specific fractures were compared between living kidney donors and controls using standardized incidence ratios (SIRs). Results At the time of survey, the 2132 living kidney donors had a mean (SD) age of 67.1 (8.9) years and included 1245 women (58.4%), and the 2014 controls had a mean (SD) age of 68.6 (7.9) years and included 1140 women (56.6%). The mean (SD) time between donation or index date and survey date was 24.2 (10.4) years for donors and 27.6 (10.7) years for controls. The overall rate of fractures among living kidney donors was significantly lower than among controls (SIR, 0.89; 95% CI, 0.81-0.97). However, there were significantly more vertebral fractures among living kidney donors than among controls (SIR, 1.42; 95% CI, 1.05-1.83). Conclusions and Relevance This survey study found a reduced rate of overall fractures but an excess of vertebral fractures among living kidney donors compared with controls after a mean follow-up of 25 years. Treatment of excess vertebral fractures with dietary supplements such as vitamin D3 may reduce the numbers of vertebral fractures and patient morbidity.
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Affiliation(s)
- Hilal Maradit Kremers
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
- Department of Orthopedics, Mayo Clinic, Rochester, Minnesota
| | - Brandon R. Grossardt
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Adam R. Miller
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota
| | - Bertram L. Kasiske
- Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Arthur J. Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis
| | - Sundeep Khosla
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine and Kogod Center on Aging, Mayo Clinic, Rochester, Minnesota
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Walter K. Kremers
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Hatem Amer
- William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota
- Division of Nephrology and Hypertension, Nephrology Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rajiv Kumar
- Division of Nephrology and Hypertension, Nephrology Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
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Li H, Xu Q, Ye Y, Chang B, Wang R, Li G. Association between obesity and fracture risk in Chinese women above 50 years of age: a prospective cohort study. BMC Public Health 2024; 24:28. [PMID: 38167038 PMCID: PMC10763393 DOI: 10.1186/s12889-023-17494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Fractures present serious health challenges for older adults, including premature mortality and reduced quality of life. Obesity has become significantly prevalent in China. However, the association between obesity and fractures remains unclear. This study aimed to assess the association between obesity and fractures among Chinese women above 50 years of age. METHODS A prospective cohort study was designed based on the China Health and Nutrition Survey, using data from 1997 to 2015. The average follow-up duration was seven years. Trained investigators measured body mass index (BMI) and waist circumference (WC) at baseline. Obesity was defined according to World Health Organization recommendations. Waist-to-height ratio (W-HtR) was calculated, with 0.5 as the cutoff value. Onset of fractures, self-reported by the participants during the follow-up period, was the primary outcome. Cox hazard regression models were used to assess the association between BMI, WC, W-HtR and subsequent risk of fracture. A sensitivity analysis was conducted by multiple imputation of missing data on the variables at baseline. RESULTS A total of 2,641 women aged ≥ 50 years were involved in the study. In all the models, no significant association existed between BMI and fracture risk. However, women with WC ≥ 88 cm had significantly higher risk of fracture than those with WC < 80 cm according to both the unadjusted (HR = 1.744, 95% CI: 1.173-2.591) and adjusted models (HR = 1.796, 95% CI: 1.196-2.695). In addition, W-HtR and fracture risk were positively associated according to both the unadjusted (HR = 1.798, 95% CI: 1.230-2.627) and adjusted models (HR = 1.772, 95% CI: 1.209-2.599). Results of the sensitivity analysis were consistent with those of the above analyses. CONCLUSIONS Abdominal obesity increased the risk of all-cause fractures in Chinese women ≥ 50 years old. Intervention strategies and measures to prevent or address abdominal obesity would be helpful to decrease the fracture incidence.
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Affiliation(s)
- Hui Li
- School of Public Health, Southwest Medical University, No. 1 Section 1, Xianglin Road, Longmatan District, Luzhou City, Sichuan Province, 646000, China
| | - Qunying Xu
- School of Public Health, Southwest Medical University, No. 1 Section 1, Xianglin Road, Longmatan District, Luzhou City, Sichuan Province, 646000, China
| | - Yunli Ye
- School of Public Health, Southwest Medical University, No. 1 Section 1, Xianglin Road, Longmatan District, Luzhou City, Sichuan Province, 646000, China.
| | - Bei Chang
- Chinese People's Liberation Army Rocket Force Characteristic Medical Center, Beijing, 100000, China
| | - Rui Wang
- Tangdu Hospital, Air Force Military Medical University, Xi'an, 710032, China
| | - Guangwen Li
- Department of Oral Implantology, The Affiliated Stomatological Hospital of Southwest Medical University, Oral & Maxillofacial Reconstruction and Regeneration of Luzhou Key Laboratory, No. 10, Section 2, Yunfeng Road, Kuanchang Street, Jiangyang District, Luzhou City, 646000, Sichuan Province, China.
- Institute of Stomatology, Southwest Medical University, Luzhou, 646000, China.
- State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Key Laboratory of Oral Diseases, School of Stomatology, The Fourth Military Medical University, Xi'an, 710032, China.
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Leslie WD, Binkley N, Schousboe JT, McCloskey EV, Johansson H, Harvey NC, Kanis JA. Effect of BMI-Discordant Abdominal Tissue Thickness on Fracture Probability: A Registry-Based Study. J Bone Miner Res 2023; 38:1749-1756. [PMID: 37776220 DOI: 10.1002/jbmr.4919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023]
Abstract
FRAX, which is used to assess fracture probability, considers body mass index (BMI), but BMI may not reflect individual variation in body composition and distribution. We examined the effect of BMI-discordant abdominal thickness on FRAX-derived fracture probability for major osteoporotic fracture (MOF) and hip fracture. We studied 73,105 individuals, mean age 64.2 years. During mean 8.7 years, 7048 (9.6%) individuals sustained incident MOF, including 2155 (3.0%) hip fractures. We defined abdominal thickness index (ATI) as the difference between abdominal thickness measured by dual-energy X-ray absorptiometry (DXA) and thickness predicted by BMI using sex-stratified regression. ATI was categorized from lower (<-2 cm, -2 to -1 cm) to higher (1-2 cm, >+2 cm) with referent around zero (-1 to +1 cm). Adjusted for FRAX probability, increasing ATI was associated with incident MOF and hip fracture (p < 0.001). For the highest ATI category, MOF risk was increased (hazard ratio [HR] = 1.23, 95% confidence interval [CI] 1.12-1.35) independent of FRAX probability. Similar findings were noted for hip fracture probability (HR = 1.28, 95% CI 1.09-1.51). There was significant age-interaction with much larger effects before age 65 years (HR = 1.44, 95% CI 1.23-1.69 for MOF; 2.29, 95% CI 1.65-3.18 for hip fracture). In contrast, for the subset of individuals with diabetes, there was also increased risk for those in the lowest ATI category (HR = 1.73, 95% CI 1.12-2.65 for MOF; 2.81, 95% CI 1.59-4.97 for hip fracture). Calibration plots across ATI categories demonstrated deviation from the line of identity in women (calibration slope 2.26 for MOF, 2.83 for hip fracture). An effect of ATI was not found in men, but this was inconclusive as the sex-interaction terms did not show significant effect modification. In conclusion, these data support the need to investigate increased abdominal thickness beyond that predicted by BMI and sex as a FRAX-independent risk factor for fracture. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- William D Leslie
- Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
| | - Neil Binkley
- Division of Medicine, University of Wisconsin, Madison, WI, USA
| | - John T Schousboe
- Division of Health Policy and Management, HealthPartners Institute and the University of Minnesota, Minneapolis, MN, USA
| | - Eugene V McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
| | - Helena Johansson
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - John A Kanis
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Sheffield, UK
- Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
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7
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Zhang P, Lin C, Chen M, He Y, Yan X, Lai J, Fan S, Li S, Teng H. The association between visceral fat and osteoporotic vertebral compression refractures. Nutrition 2022; 103-104:111808. [DOI: 10.1016/j.nut.2022.111808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022]
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Integrative Analysis of Exosomal miR-452 and miR-4713 Downregulating NPY1R for the Prevention of Childhood Obesity. DISEASE MARKERS 2022; 2022:2843353. [PMID: 35401881 PMCID: PMC8986441 DOI: 10.1155/2022/2843353] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 12/25/2022]
Abstract
Neuropeptides are associated with childhood obesity and exploring their regulatory mechanisms may reveal new insights for novel treatments. Childhood obesity data were downloaded from the GEO database and were used to screen for differentially expressed neuropeptides in patients with obesity. NPY1R expression was significantly upregulated in children with obesity compared to children without obesity (p < 0.05). The GEO database was used to filter differentially expressed miRNAs in patients with obesity. And hsa-mir-4713 and hsa-mir-452 were found significantly downregulated in adipose tissue. The GEO, TRRUST, and TFacts databases were used to screen all transcription factors for differentially expressed genes (DEGs). The potential regulatory networks between the differentially expressed miRNAs, TFs, and neuropeptides were mapped. In the constructed NPY1R regulatory network, the transcription factors TCF4, HEY1, and GATA3 are significantly associated with NPY1R. TCF4 and HEY1 were positively correlated with NPY1R, while GATA3 was negatively correlated with NPY1R. In the clinical peripheral blood samples, NPY1R, TCF4, and HEY1 were significantly more expressed in the obesity and the obesity with fracture group compared to the control group, while there was no statistically significant difference between the obesity group and the obesity with fracture group in terms of expression. The expression of GATA3, miR-452, and miR-4713 was also significantly lower in the obesity and the obesity with fracture groups when compared to the NC group. Therefore, NPY1R, TCF4, HEY1, GATA3, miR-452, and miR-4713 may be risk factors for fracture in obese children. The potential NPY1R regulatory function was exerted by two pathways: positive regulation caused by TCF4 and HEY1 acting on miR-4713 and negative regulation via GATA3 acting on miR-452. Potential NPY1R-related targets for the treatment of childhood obesity were provided in this study.
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Sarcopenic obesity defined by visceral adiposity was associated with osteoporotic vertebral fracture. Arch Osteoporos 2022; 17:41. [PMID: 35249182 DOI: 10.1007/s11657-022-01087-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 02/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Previous studies have reported that the fracture risk related to sarcopenic obesity (SO) may be influenced by the distribution of fat mass. Therefore, it is useful to explore a body component suitable for defining obesity when predicting fracture risk. This study was an attempt to explore the contribution of SO defined by visceral adiposity on the incidence of osteoporotic fracture. METHODS We enrolled 736 Chinese patients aged > 60 years in this prospective study. Sarcopenia was defined as low skeletal muscle index (SMI) with muscle strength or low SMI with low physical performance. Obesity was categorized as follows: (1) android to gynoid ratio (A/G ratio, men > 0.82, women > 0.65) as an indicator of visceral adiposity; (2) body fat percentage (men > 27.8%; women > 34.5%); and (3) body mass index (≥ 25 kg/m2). A Cox proportional hazard model was used to determine the association between SO and the risk of osteoporotic fracture. RESULTS The incidence of SO was 8.7%; 9.0% in females and 8.1% in males. Of 223 (30.2%) patients with self-reported fractures. SO classified by A/G was associated with an increased risk of osteoporotic vertebral fracture (HR: 1.71, 95% CI: 1.07-2.72). High SMI was associated with a reduced risk of osteoporotic vertebral fracture (HR: 0.82, 95% CI: 0.72-0.93), higher BMI was associated with a higher risk vertebral fracture (HR: 1.12, 95% CI: 0.94-1.63), and higher A/G ratio was associated with a higher risk of any fracture (HR: 1.28, 95% CI: 1.14-1.43) and osteoporotic vertebral fracture (HR: 1.19, 95% CI: 1.05-1.36). CONCLUSIONS Our findings suggest that SO, defined by visceral adiposity, was associated with the risk of osteoporotic vertebral fracture. Moreover, low SMI, low muscle strength and visceral adiposity were independently associated with osteoporotic fracture.
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Lee G, Choi S, Cho Y, Park SM. Risk of Osteoporotic Fractures Among Obese Women Based on Body Mass Index and Waist Circumference: A Nationwide Cohort in South Korea. Clin Nutr Res 2022; 11:32-41. [PMID: 35223679 PMCID: PMC8844534 DOI: 10.7762/cnr.2022.11.1.32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/02/2022] [Accepted: 02/06/2022] [Indexed: 11/19/2022] Open
Abstract
We evaluated the association between obesity status by body mass index (BMI) or waist circumference (WC) and osteoporotic fracture risk. We collected data of 143,673 women with a mean age of 58.5 years without history of osteoporotic fracture from the Korean National Health Insurance Service Cohort. Participants were divided into four groups according to obesity by BMI and WC, normal BMI/WC (BMI 18.5–24.9 kg/m2 and WC < 85 cm, reference), obese BMI/normal WC (BMI ≥ 25 kg/m2 and WC < 85 cm), normal BMI/obese WC (BMI < 25 kg/m2 and WC ≥ 85 cm), and obese BMI/WC (BMI ≥ 25 kg/m2 and WC < 85cm). Cox proportional hazards regression analyses were performed to obtain hazard ratios (HRs) with 95% confidence intervals (CIs) for the subsequent median 6.0 years, which were adjusted for age, socioeconomic status, lifestyle, morbidity index, and osteoporosis medication. Compared with the normal group, normal BMI/obese WC was associated with a higher osteoporotic fracture risk after multivariable adjustment (HRs [95% CI], 1.13 [1.05–1.21]), and obese BMI/normal WC was associated with a lower osteoporotic fracture risk (0.89 [0.84–0.94]). Obese BMI/normal WC was associated with a lower risk for hip fractures (0.75 [0.57–0.99]). Obese BMI/normal WC was associated with decreased risk of osteoporotic fracture, whereas normal BMI/obese WC was associated with increased risk of osteoporotic fracture compared with the normal group among East Asian women in their late 40s or more.
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Affiliation(s)
- Gyeongsil Lee
- Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul 03080, Korea
| | - Yoosun Cho
- Health Promotion Center, Kangbuk Samsung Hospital, Seoul 03080, Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Korea
- Department of Biomedical Sciences, Seoul National University Graduate School, Seoul 03080, Korea
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11
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Turcotte AF, O’Connor S, Morin SN, Gibbs JC, Willie BM, Jean S, Gagnon C. Association between obesity and risk of fracture, bone mineral density and bone quality in adults: A systematic review and meta-analysis. PLoS One 2021; 16:e0252487. [PMID: 34101735 PMCID: PMC8186797 DOI: 10.1371/journal.pone.0252487] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/15/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The association between obesity and fracture risk may be skeletal site- and sex-specific but results among studies are inconsistent. Whilst several studies reported higher bone mineral density (BMD) in patients with obesity, altered bone quality could be a major determinant of bone fragility in this population. OBJECTIVES This systematic review and meta-analysis aimed to compare, in men, premenopausal women and postmenopausal women with obesity vs. individuals without obesity: 1) the incidence of fractures overall and by site; 2) BMD; and 3) bone quality parameters (circulating bone turnover markers and bone microarchitecture and strength by advanced imaging techniques). DATA SOURCES PubMed (MEDLINE), EMBASE, Cochrane Library and Web of Science were searched from inception of databases until the 13th of January 2021. DATA SYNTHESIS Each outcome was stratified by sex and menopausal status in women. The meta-analysis was performed using a random-effect model with inverse-variance method. The risks of hip and wrist fracture were reduced by 25% (n = 8: RR = 0.75, 95% CI: 0.62, 0.91, P = 0.003, I2 = 95%) and 15% (n = 2 studies: RR = 0.85, 95% CI: 0.81, 0.88), respectively, while ankle fracture risk was increased by 60% (n = 2 studies: RR = 1.60, 95% CI: 1.52, 1.68) in postmenopausal women with obesity compared with those without obesity. In men with obesity, hip fracture risk was decreased by 41% (n = 5 studies: RR = 0.59, 95% CI: 0.44, 0.79). Obesity was associated with increased BMD, better bone microarchitecture and strength, and generally lower or unchanged circulating bone resorption, formation and osteocyte markers. However, heterogeneity among studies was high for most outcomes, and overall quality of evidence was very low to low for all outcomes. CONCLUSIONS This meta-analysis highlights areas for future research including the need for site-specific fracture studies, especially in men and premenopausal women, and studies comparing bone microarchitecture between individuals with and without obesity. SYSTEMATIC REVIEW REGISTRATION NUMBER CRD42020159189.
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Affiliation(s)
- Anne-Frédérique Turcotte
- Endocrinology and Nephrology Unit, CHU de Québec-Université Laval Research Center, Québec (QC), Canada
- Obesity, Type 2 Diabetes and Metabolism Unit, Institut universitaire de cardiologie et de pneumologie de Québec–Université Laval Research Center, Québec (QC), Canada
- Department of Medicine, Faculty of Medicine, Laval University, Québec (QC), Canada
| | - Sarah O’Connor
- Institut universitaire de cardiologie et de pneumologie de Québec–Université Laval Research Center, Québec (QC), Canada
- Department of Pharmacy, Faculty of Pharmacy, Laval University, Québec (QC), Canada
- Bureau d’information et études en santé des populations, Institut national de santé publique du Québec, Québec (QC), Canada
| | - Suzanne N. Morin
- Department of Medicine, Faculty of Medicine, McGill University, Montreal (QC), Canada
| | - Jenna C. Gibbs
- Department of Kinesiology and Physical Education, McGill University, Montreal (QC), Canada
| | - Bettina M. Willie
- Department of Pediatric Surgery, Shriners Hospital for Children-Canada, Research Centre, McGill University, Montreal (QC), Canada
| | - Sonia Jean
- Department of Medicine, Faculty of Medicine, Laval University, Québec (QC), Canada
- Bureau d’information et études en santé des populations, Institut national de santé publique du Québec, Québec (QC), Canada
| | - Claudia Gagnon
- Endocrinology and Nephrology Unit, CHU de Québec-Université Laval Research Center, Québec (QC), Canada
- Obesity, Type 2 Diabetes and Metabolism Unit, Institut universitaire de cardiologie et de pneumologie de Québec–Université Laval Research Center, Québec (QC), Canada
- Department of Medicine, Faculty of Medicine, Laval University, Québec (QC), Canada
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Abstract
Diabetes-induced osteoporosis is characterized by an increase in fracture risk. FRAX, the most widely used tool, underestimates the risk of fracture in both type 1 and type 2 diabetes. Specific adjustments to FRAX can help to better identify patients with diabetes at increased risk of fracture and select those at high fracture risk for treatment. Although clinical trial data are limited, the available evidence indicates that the presence of diabetes does not alter antiosteoporotic treatment response in patients with diabetes.
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Affiliation(s)
- G Isanne Schacter
- Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, GF-335, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada
| | - William D Leslie
- Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, C5121, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada.
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Toselli S, Campa F, Matias CN, de Alencar Silva BS, Dos Santos VR, Maietta Latessa P, Gobbo LA. Predictive equation for assessing appendicular lean soft tissue mass using bioelectric impedance analysis in older adults: Effect of body fat distribution. Exp Gerontol 2021; 150:111393. [PMID: 33965554 DOI: 10.1016/j.exger.2021.111393] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Low muscle mass is associated with sarcopenia and increased mortality. Muscle mass, especially that of the limbs, is commonly estimated by dual-energy X-ray absorptiometry (DXA) or bioimpedance analysis (BIA). However, BIA-based predictive equations for estimating lean appendicular soft tissue mass (ALST) do not take into account body fat distribution, an important factor influencing DXA and BIA measurements. OBJECTIVES To develop and cross-validate a BIA-based equation for estimating ALST with DXA as criterion, and to compare our new formula to three previously published models. METHODS One-hundred eighty-four older adults (140 women and 44 men) (age 71.5 ± 7.3 years, body mass index 27.9 ± 5.3 kg/m2) were recruited. Participants were randomly split into validation (n = 118) and cross-validation groups (n = 66). Bioelectrical resistance was obtained with a phase-sensitive 50 kHz BIA device. RESULTS A BIA-based model was developed for appendicular lean soft tissue mass [ALST (kg) = 5.982 + (0.188 × S2 / resistance) + (0.014 × waist circumference) + (0.046 × Wt) + (3.881 × sex) - (0.053 × age), where sex is 0 if female or 1 if male, Wt is weight (kg), and S is stature (cm) (R2 = 0.86, SEE = 1.35 kg)]. Cross validation revealed r2 of 0.91 and no mean bias. Two of three previously published models showed a trend to significantly overestimate ALST in our sample (p < 0.01). CONCLUSIONS The new equation can be considered valid, with no observed bias and trend, thus affording practical means to quantify ALST mass in older adults.
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Affiliation(s)
- S Toselli
- Department of Biomedical and Neuromotor Science, University of Bologna, Italy
| | - F Campa
- Department for Life Quality Studies, University of Bologna, 47921 Rimini, Italy.
| | - C N Matias
- CIDEFES -Universidade Lusófona, 1749-024 Lisboa, Portugal; Bioperformance & Nutrition Research Unit, Ingrediente Métrico S.A., 2740-262 Lisbon, Portugal
| | | | | | - P Maietta Latessa
- Department for Life Quality Studies, University of Bologna, 47921 Rimini, Italy
| | - L A Gobbo
- Department of Physical Education, São Paulo State University, Presidente Prudente, Brazil
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Consequences of fall-induced hip fractures on cognitive function, physical activity, and mortality: Korean longitudinal study of aging 2006-2016. Injury 2021; 52:933-940. [PMID: 33082027 DOI: 10.1016/j.injury.2020.10.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/25/2020] [Accepted: 10/13/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Few studies have investigated the consequences of fall-induced hip fractures among healthy, community-dwelling middle-aged adults. OBJECTIVES To investigate the effects of fall-induced hip fractures on cognitive function, activities of daily living, and mortality from the time the fractures increase. DESIGN A secondary data analysis based on data from the Korean Longitudinal Study of Aging (2006-2016). METHODS Participants were 8,571 people over 45 years in South Korea who had never experienced a fall-induced hip fracture by 2006. Participants were divided into a hip-fracture group (those who experienced one or more hip fractures between 2008 and 2016; N = 306), and a non-hip-fracture group (those who did not experience a hip fracture during this period; N = 8,265). A linear mixed model, Kaplan-Meier analysis, and Cox regression were used to analyze the effects of hip fractures on mortality, the Mini Mental State Examination, Activities of Daily Living, and Instrumental Activities of Daily Living scores during 2008-2016. RESULTS In the hip-fracture group, compared to the non-fracture group, the change in Mini Mental State Examination score was significantly greater (p = 001); however, although there was a significant difference at each time point (p < .001), the cumulative difference over time was not significant (p = .560). The hip-fracture group showed a faster time to initial decline in Mini Mental State Examination scores (hazard ratio = 1.16, CI = 1.022-1.318). The hip-fracture group showed significantly larger changes in Activities of Daily Living and Instrumental Activities of Daily Living scores (p < .001), shorter time until decline began (p < .001), and larger decline as time passed (p < .001). Furthermore, the time before assistance was required from others for activities of daily living and instrumental activities of daily living was also shorter (hazard ratio = 2.18, CI= 1.728-2.759; odds ratio = 1.44, CI = 1.198-1.732). Hip fractures also increased mortality (hazard ratio = 1.42, CI = 1.013-2.002). CONCLUSIONS Our study found that hip fractures accelerate the decline of cognitive function, physical activity, and increased mortality. Our findings can be used to develop fall-prevention programs.
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Watanabe D, Kimura T, Yamashita A, Minowa T, Miura K, Mizushima A. The influence of androgen deprivation therapy on hip geometric properties and bone mineral density in Japanese men with prostate cancer and its relationship with the visceral fat accumulation. Aging Male 2020; 23:1158-1164. [PMID: 31959023 DOI: 10.1080/13685538.2020.1713741] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The influence of androgen deprivation therapy (ADT) for prostate cancer on the hip geometric properties evaluated by dual-energy X-ray absorptiometry (DXA) has not yet been demonstrated. This study aimed to investigate the changes in these properties after 1 year of ADT. A total of 65 Japanese men with prostate cancer who underwent ADT for the first time in our facility were included in the study. The hip geometric parameters and the bone mineral density (BMD) taken before and after 1 year of ADT were retrospectively examined. With ADT, we not only confirmed significant BMD annual changes in the lumbar spine, the femoral neck, and the total hip of -1.65%, -1.91%, and -2.20%, respectively, but we also confirmed significant annual changes in cross-sectional areas, cross-sectional moments of inertia, and section modulus in the narrow femoral neck of -2.55%, -3.50%, and -3.14%, respectively. The annual rate of decrease in the femoral neck BMD was significantly higher in patients with visceral fat obesity than in those without visceral obesity (-1.79% vs. -0.28%). One year of ADT for Japanese men with prostate cancer might decrease the strength of bending and the structural rigidity as well as BMD at the femoral neck.
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Affiliation(s)
- Daisuke Watanabe
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Urology, Koto Hospital, Tokyo, Japan
| | - Takahiro Kimura
- Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | | | | | - Kunihisa Miura
- Department of Anesthesiology and Pain Medicine, Koto Hospital, Tokyo, Japan
| | - Akio Mizushima
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Lee JH, Kim JH, Hong AR, Kim SW, Shin CS. Optimal body mass index for minimizing the risk for osteoporosis and type 2 diabetes. Korean J Intern Med 2020; 35:1432-1442. [PMID: 31564086 PMCID: PMC7652649 DOI: 10.3904/kjim.2018.223] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/01/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND/AIMS Body mass index (BMI) is positively associated with bone mineral density and type 2 diabetes. We investigated an optimal BMI range for osteoporosis and type 2 diabetes. METHODS This cross-sectional study used data from the Korea National Health and Nutrition Examination Survey (KNHANES), 2008 to 2011. We included 3,774 men aged > 50 years and 4,982 postmenopausal women. Logistic regression models were applied to elucidate each BMI category's osteoporosis and diabetes risks. RESULTS The prevalence of osteoporosis was 9.0% for men and 40.8% for women. The prevalence of type 2 diabetes in men was 19.7% and in women was 15.5%. In men with BMI > 25 kg/m2, the osteoporosis risk did not further increase as BMI increased. In women, BMI was linearly associated with osteoporosis risk without a plateau. In both men and women, higher BMI was associated with a higher type 2 diabetes risk. Men with a BMI of 23.0 to 24.9 kg/m2 harbored about a 30% lower osteoporosis risk than and a similar diabetes risk to those with a BMI of 21.0 to 22.9 kg/m2. In women with a BMI of 23.0 to 24.9 kg/m2, the adjusted odds ratio for osteoporosis was 0.72 (95% confidence interval, 0.59 to 0.87); the diabetes risk was not higher than in those with a BMI of 21.0 to 22.9 kg/m2. CONCLUSION For Korean men aged > 50 years and postmenopausal women, a BMI of 23.0 to 24.9 kg/m2 was the optimal range for minimizing osteoporosis and type 2 diabetes risks simultaneously.
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Affiliation(s)
- Ji Hyun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- VHS Medical Center, Seoul, Korea
| | - Jung Hee Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Correspondence to Jung Hee Kim, M.D. Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-4839 Fax: +82-2-764-2199 E-mail:
| | - A Ram Hong
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
| | - Chan Soo Shin
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Moon HU, Lee N, Chung YS, Choi YJ. Reduction of visceral fat could be related to the improvement of TBS in diabetes mellitus. J Bone Miner Metab 2020; 38:702-709. [PMID: 32399674 DOI: 10.1007/s00774-020-01107-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 04/01/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Diabetes has been proposed as a risk factor for increased skeletal fragility. Visceral fat is known to yield adverse effects on bone metabolism in people with diabetes. We investigated the relationship between the change in visceral fat mass over time and TBS or BMD. MATERIALS AND METHODS This retrospective study enrolled 690 (male: 367; female: 323) subjects with type 2 diabetes mellitus. Visceral fat mass, lumbar and femoral neck BMD, and lumbar spine TBS were measured via dual-energy X-ray absorptiometry (DXA), including the follow-up data within a 3-year period. RESULTS TBS significantly increased as visceral fat mass decreased in both sexes (p < 0.001), whereas lumbar BMD and femoral neck BMD showed meaningful changes only in men. The multiple regression model with adjustment for age, weight, creatinine level, lipid profile, HbA1C, and status of osteoporosis medication use revealed that TBS and femoral neck BMD were correlated with visceral fat mass. However, regarding longitudinal changes, only the change in visceral fat mass had a significant relationship with TBS (males: β = - 0.298, p < 0.001; females: β = - 0.216, p < 0.001). CONCLUSIONS The results of this study may suggest the beneficial effect of controlling visceral fat mass on bone health in type 2 diabetes patients. Besides, DXA-derived TBS could be a useful diagnostic tool for evaluating the bone changes according to metabolic changes in type 2 diabetes, which are not entirely achieved with BMD.
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Affiliation(s)
- Hyun Uk Moon
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Nami Lee
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Yoon-Sok Chung
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, South Korea
| | - Yong Jun Choi
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon, 16499, South Korea.
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Ofir O, Buch A, Rouach V, Goldsmith R, Stern N, Monsonego-Ornan E. Association between abdominal obesity and fragility fractures among elderly Israeli women. Aging Clin Exp Res 2020; 32:1459-1467. [PMID: 31522392 DOI: 10.1007/s40520-019-01347-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/03/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Obesity has been traditionally viewed as a protective factor for fractures. Recent studies have challenged this concept, particularly regarding abdominal obesity. We aimed to investigate the association between abdominal obesity, body mass index (BMI) and fragility fractures prevalence in a sample of community-dwelling elderly Israeli women. METHODS The data in this cross-sectional study were based on 'Mabat Zahav'-a survey of a nationally representative sample of elderly Israelis. The study population included 669 women. Data on fragility fractures site and circumstances were self-reported, and height, weight, waist and calf circumferences were measured. Waist circumference (WC) variable was divided into tertiles: < 88 cm, 88-99 cm and > 99 cm. RESULTS Sixty-five women reported fragility fractures (14 hip fractures, 18 vertebral fractures and 39 wrist fractures). Mean age was 73.9 ± 5.9 years, mean BMI was 29.9 ± 5 kg/m2 and mean WC was 93.9 ± 12 cm. While BMI was not associated with osteoporotic fractures, abdominal obesity (WC > 88 cm) was positively associated with fragility fractures, independently of age, smoking, physical activity [middle and high WC tertiles {3.15 (95% CI 1.41-7.02), 2.78 (95% CI 1.05-7.31), respectively}]. CONCLUSIONS Among this sample of elderly women, abdominal obesity was positively associated with fragility fractures, independently of age, smoking, physical activity and BMI. Waist circumference, an easily measured anthropometric indicator, may be useful for assessing the risk of fragility fractures in elderly women, particularly among those with normal or high BMI-a vast population which has been traditionally considered as having lower fracture risk.
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Affiliation(s)
- Orit Ofir
- Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O.B 12, 76100, Rehovot, Israel.
| | - Assaf Buch
- Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O.B 12, 76100, Rehovot, Israel
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel-Aviv, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Dr Ya'ackov Klachkin 35 St, 6997801, Tel-Aviv, Israel
| | - Vanessa Rouach
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel-Aviv, Israel
| | - Rebecca Goldsmith
- Nutrition Division, Ministry of Health Israel, Yirmiyahu 39 St, Jerusalem, Israel
| | - Naftali Stern
- Institute of Endocrinology, Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, 6 Weizmann St, 64239, Tel-Aviv, Israel
- The Sackler Faculty of Medicine, Tel-Aviv University, Dr Ya'ackov Klachkin 35 St, 6997801, Tel-Aviv, Israel
| | - Efrat Monsonego-Ornan
- Robert H Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, P.O.B 12, 76100, Rehovot, Israel
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Khalid SI, Omotosho PA, Spagnoli A, Torquati A. Association of Bariatric Surgery With Risk of Fracture in Patients With Severe Obesity. JAMA Netw Open 2020; 3:e207419. [PMID: 32520360 PMCID: PMC7287567 DOI: 10.1001/jamanetworkopen.2020.7419] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
IMPORTANCE Given the complex relationship between body mass index, body composition, and bone density and the correlative nature of the studies that have established the prevailing notion that higher body mass indices may be protective against osteopenia and osteoporosis and, therefore, fracture, the absolute risk of fracture in patients with severe obesity who undergo either Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) compared with those who do not undergo bariatric surgery is unknown. OBJECTIVE To assess the rates of fractures associated with obesity and compare rates between those who do not undergo bariatric surgery, those who undergo RYGB, and those who undergo SG. DESIGN, SETTING, AND PARTICIPANTS In this retrospective multicenter cohort study of Medicare Standard Analytic Files derived from Medicare parts A and B records from January 2004 to December 2014, patients classified as eligible for bariatric surgery using the US Centers of Medicare & Medicaid criteria who either did not undergo bariatric surgery or underwent RYGB or SG were exactly matched in a 1:1 fashion based on their age, sex, Elixhauser Comorbidity Index, hypertension, smoking status, nonalcoholic fatty liver disease, hyperlipidemia, type 2 diabetes, osteoporosis, osteoarthritis, and obstructive sleep apnea status. Data were analyzed from November to December 2019. EXPOSURES RYGB or SG. MAIN OUTCOMES AND MEASURES The primary outcome measured in this study was the odds of fracture overall based on exposure to bariatric surgery. Secondary outcomes included the odds of type of fracture (humerus, radius or ulna, pelvis, hip, vertebrae, and total fractures) based on exposure to bariatric surgery. RESULTS A total of 49 113 patients were included and were equally made up of 16 371 bariatric surgery-eligible patients who did not undergo weight loss surgery, 16 371 patients who had undergone RYGB, and 16 371 patients who had undergone SG. Each group consisted of an equal number of 4109 men (25.1%) and 12 262 women (74.9%) and had an equal distribution of ages, with 11 780 patients (72.0%) 64 years or younger, 4230 (25.8%) aged 65 to 69 years, 346 (2.1%) aged 70 to 74 years, and 15 (0.1%) aged 75 to 79 years. Patients undergoing RYGB were found to have no significant difference in odds of fractures compared with bariatric surgery-eligible patients who did not undergo surgery. Patients undergoing undergone SG were found to have decreased odds of fractures of the humerus (odds ratio [OR], 0.57; 95% CI, 0.45-0.73), radius or ulna (OR, 0.38; 95% CI, 0.25-0.58), hip (OR, 0.49; 95% CI, 0.33-0.74), pelvis (OR, 0.34; 95% CI, 0.18-0.64), vertebrae (OR, 0.60; 95% CI, 0.48-0.74), or fractures in general (OR, 0.53; 95% CI, 0.46-0.62). Compared with patients undergoing SG, patients undergoing RYGB had a significantly greater risk of total fractures (OR, 1.79; 95% CI, 1.55-2.06) and humeral fractures (OR, 1.60; 95% CI, 1.24-2.07). CONCLUSIONS AND RELEVANCE In this cohort study, bariatric surgery was associated with a reduced risk of fracture in bariatric surgery-eligible patients. Sleeve gastrectomy might be the best option for weight loss in patients in which fractures could be a concern, as RYGB may be associated with an increased fracture risk compared with SG.
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Affiliation(s)
- Syed I. Khalid
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Philip A. Omotosho
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Anna Spagnoli
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Alfonso Torquati
- Department of Surgery, Rush University Medical Center, Chicago, Illinois
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Wong MCS, Huang J, Wang J, Chan PSF, Lok V, Chen X, Leung C, Wang HHX, Lao XQ, Zheng ZJ. Global, regional and time-trend prevalence of central obesity: a systematic review and meta-analysis of 13.2 million subjects. Eur J Epidemiol 2020; 35:673-683. [PMID: 32448986 PMCID: PMC7387368 DOI: 10.1007/s10654-020-00650-3] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 05/18/2020] [Indexed: 01/01/2023]
Abstract
We aimed to examine the global prevalences of central obesity according to age, sex, race, place of residence, geographical region, national income level, and the definitions of central obesity. MEDLINE and Embase were searched. Studies with sample size of ≥ 500 and investigated individuals aged ≥ 15 years were included. Metaprop (a Stata command) was adopted to conduct a meta-analysis of prevalence, and the Freeman-Tukey Double Arcsine Transformation was used to stabilize the variances. A random-effects model was used to evaluate the prevalence and 95% confidence intervals (CI) of central obesity. There were 288 studies involving 13,233,675 individuals in this analysis. The overall prevalence of central obesity was 41.5% (95% CI 39.9–43.2%). A higher prevalence was found in older individuals, female subjects, urban residents, Caucasians, and populations of higher income level countries. Regarding regional variations, the highest prevalence was found in Sothern America (55.1%, 95% CI 45.8–64.3%) and Central American (52.9%, 95% CI 32.7–72.7%). Its prevalence was rapidly rising from 1985 to 2014. From 1985–1999 to 2010–2014, younger subjects aged 15–40 years showed a more drastic rise in prevalence (16.3 to 33.9%) than subjects aged > 40 years (43.6 to 57.9%). Male individuals have a more drastic rise (25.3 to 41.6%) than females (38.6 to 49.7%). Major increasing in prevalence of the condition in the past three decades, particularly in certain subgroups. These findings could act as a useful reference to inform public health strategies to minimize the impact of central obesity on population health.
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Affiliation(s)
- Martin C. S. Wong
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, 4/F, School of Public Health, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Junjie Huang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, 4/F, School of Public Health, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Jingxuan Wang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, 4/F, School of Public Health, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Paul S. F. Chan
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, 4/F, School of Public Health, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Veeleah Lok
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, 4/F, School of Public Health, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Xiao Chen
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, 4/F, School of Public Health, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Colette Leung
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, 4/F, School of Public Health, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Harry H. X. Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Xiang Qian Lao
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, 4/F, School of Public Health, Prince of Wales Hospital, Hong Kong, Hong Kong
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, 38, Xue Yuan Road, Haidian District, Beijing, China
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21
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Vala CH, Kärrholm J, Kanis JA, Johansson H, Sten S, Sundh V, Karlsson M, Lorentzon M, Mellström D. Risk for hip fracture before and after total knee replacement in Sweden. Osteoporos Int 2020; 31:887-895. [PMID: 31832694 PMCID: PMC7170830 DOI: 10.1007/s00198-019-05241-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/19/2019] [Indexed: 11/29/2022]
Abstract
UNLABELLED We studied the risk for hip fracture before and after total knee replacement (TKR) in the entire population in Sweden. Women and men had a low risk for hip fracture before TKR but an increased risk the first year after TKR. PURPOSE It is known that osteoarthritis is associated with high bone mass. We therefore studied the risk of hip fracture before and after total knee replacement (TKR), risk of different hip fracture types, and risk subdivided in genders and age groups. METHODS We followed the total Swedish population born between 1902 and 1952 (n = 4,258,934) during the period 1987-2002 and identified all patients with TKR due to primary OA (n = 39,291), and all patients with hip fracture (n = 195,860) in the Swedish National Inpatient Register. The risk time analyses were based on Poisson regression models. RESULTS The hazard ratio (HR) for hip fracture the last year before TKR was 0.86 (95% CI 0.74 to 1.00) and the first year after 1.26 (95% CI 1.11 to 1.42) compared to individuals without TKR. The HR for femoral neck fracture 0-10 years after TKR was 0.95 (95% CI 0.89 to 1.01) and for trochanteric fracture was 1.13 (95% CI 1.06 to 1.21). The HR for hip fracture in the age group 50-74 was 1.28 (95% CI 1.14 to 1.43) and in the age group 75-90 years was 0.99 (95% CI 0.94 to 1.04) 0-10 years after TKR, compared to individuals without TKR. CONCLUSION Individuals had a low risk for hip fracture before TKR but an increased risk the first year after TKR. The risk in individuals below age 75 years and for trochanteric fractures was increased after TKR. Possible explanations include changed knee kinematics after a TKR, physical activity level, fall risk, and other unknown factors.
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Affiliation(s)
- C H Vala
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 413 45, Göteborg, Sweden.
- Region Västra Götaland, Geriatric Medicine Clinic, Sahlgrenska University Hospital, 431 80, Mölndal, Sweden.
| | - J Kärrholm
- Department of Orthopedic Surgery, Sahlgrenska Academy, University of Gothenburg, 431 80, Mölndal, Sweden
| | - J A Kanis
- Centre for Metabolic Bone Disease, Medical School, University of Sheffield, S10 2RX, Sheffield, UK
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, VIC, 3000, Australia
| | - H Johansson
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 413 45, Göteborg, Sweden
| | - S Sten
- Department of Archaeology and Ancient History, Uppsala University- Campus Gotland, 621 57, Visby, Sweden
| | - V Sundh
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 413 45, Göteborg, Sweden
| | - M Karlsson
- Department of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, 205 02, Malmö, Sweden
| | - M Lorentzon
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 413 45, Göteborg, Sweden
- Region Västra Götaland, Geriatric Medicine Clinic, Sahlgrenska University Hospital, 431 80, Mölndal, Sweden
- Mary McKillop Health Institute, Australian Catholic University, Melbourne, VIC, 3000, Australia
- Center for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
| | - D Mellström
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, 413 45, Göteborg, Sweden
- Region Västra Götaland, Geriatric Medicine Clinic, Sahlgrenska University Hospital, 431 80, Mölndal, Sweden
- Center for Bone and Arthritis Research (CBAR), Sahlgrenska Academy, University of Gothenburg, 413 45, Gothenburg, Sweden
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22
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The risk of eating disorders and bone health in young adults: the mediating role of body composition and fitness. Eat Weight Disord 2019; 24:1145-1154. [PMID: 29134506 DOI: 10.1007/s40519-017-0458-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022] Open
Abstract
PURPOSE To analyze the independent relationship between the risk of eating disorders and bone health and to examine whether this relationship is mediated by body composition and cardiorespiratory fitness (CRF). METHODS In this cross-sectional study, bone-related variables, lean mass, fat mass (by DXA), risk of eating disorders (SCOFF questionnaire), height, weight, waist circumference and CRF were measured in 487 university students aged 18-30 years from the University of Castilla-La Mancha, Spain. ANCOVA models were estimated to test mean differences in bone mass categorized by body composition, CRF or risk of eating disorders. Subsequently, linear regression models were fitted according to Baron and Kenny's procedures for mediation analysis. RESULTS The marginal estimated mean ± SE values of total body bone mineral density for the categories "no risk of eating disorders" and "risk of eating disorders" were 1.239 ± 0.126 < 1.305 ± 0.089, P = 0.021. However, this relationship disappeared after adjustment for any of the parameters of body composition or CRF. Therefore, all body composition parameters (except for lean mass) and CRF turned out to be full mediators in the association between the risk of eating disorders and bone health in young adults. CONCLUSIONS Body composition and CRF mediate the association between the risk of eating disorders and bone health. These findings highlight the importance of maintaining a healthy weight and good CRF for the prevention of the development of eating disorders and for the maintenance of good bone health in young adults. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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23
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Martinez-Laguna D, Soria-Castro A, Carbonell-Abella C, Orozco-López P, Estrada-Laza P, Nogues X, Díez-Perez A, Prieto-Alhambra D. Validation of fragility fractures in primary care electronic medical records: A population-based study. ACTA ACUST UNITED AC 2019; 15:e1-e4. [DOI: 10.1016/j.reuma.2017.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
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Paik JM, Rosen HN, Katz JN, Rosner BA, Rimm EB, Gordon CM, Curhan GC. BMI, Waist Circumference, and Risk of Incident Vertebral Fracture in Women. Obesity (Silver Spring) 2019; 27:1513-1519. [PMID: 31318497 PMCID: PMC6707901 DOI: 10.1002/oby.22555] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/10/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The study aimed to investigate the association between BMI, waist circumference, and vertebral fracture (VF) risk in women. METHODS This prospective study was conducted in 54,934 Nurses' Health Study participants. BMI was assessed biennially, and waist circumference was assessed in the year 2000. Self-reports of VF were confirmed by record review. BMI reflects lean body mass, and waist circumference reflects abdominal adiposity when included in the same regression model. RESULTS This study included 536 VF cases (2002 to 2014). Compared with women with BMI of 21.0 to 24.9 kg/m2 , the multivariable-adjusted relative risk (RR) of VF for women with BMI ≥ 32.0 was 0.84 (95% CI: 0.61-1.14; Ptrend = 0.08). After further adjustment for waist circumference, the multivariable-adjusted RR of VF for women with BMI ≥ 32.0 was 0.70 (95% CI: 0.49-0.98; Ptrend = 0.003). Compared with women with waist circumference < 71.0 cm, the multivariable-adjusted RR of VF for women with waist circumference ≥ 108.0 cm was 1.76 (95% CI: 1.06-2.92; Ptrend = 0.01), and after further adjustment for BMI, the multivariable-adjusted RR of VF was 2.49 (95% CI: 1.44-4.33; Ptrend < 0.001). CONCLUSIONS Greater lean body mass was independently associated with lower VF risk. Larger waist circumference was independently associated with higher VF risk. These findings suggest that fat distribution is an important predictor of VF and that avoiding central adiposity, as well as maintaining muscle mass, may potentially confer reduced risk of VF in older women.
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Affiliation(s)
- Julie M Paik
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Harold N Rosen
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Endocrinology Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jeffrey N Katz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Rheumatology Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bernard A Rosner
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Eric B Rimm
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Catherine M Gordon
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Gary C Curhan
- Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
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Abstract
There has been very limited analysis of the relationship between obesity and fractures in the orthopaedic literature. It has been established for some years that underweight individuals are at greater risk of proximal femoral fractures but recently there has been interest in the susceptibility of obese post-menopausal females to fracture. We have undertaken an analysis of 4886 adult patients who presented with a fracture and had their BMI assessed. Analysis has confirmed the relationship between underweight individuals and proximal femoral fractures but there is also a negative association between obesity and clavicle fractures in males and females and with calcaneal fractures in females. There is a positive relationship between obesity and proximal humeral, finger phalangeal and ankle fractures in males and with humeral diaphyseal, carpal and ankle fractures in females. There was no relationship found between open or multiple fractures and obesity.
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Affiliation(s)
| | - A D Duckworth
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - S Ralston
- Institute of Genetics and Molecular Medicine, Western General Hospital, Edinburgh, United Kingdom
| | - M M McQueen
- University of Edinburgh, Edinburgh, United Kingdom
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Kangalgil M, Canbolat E, Çakıroğlu FP. A Research on the Incidence of Risk Factors of Osteoporosis in Women. ANKARA MEDICAL JOURNAL 2018. [DOI: 10.17098/amj.461380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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27
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Ma C, Tonks KT, Center JR, Samocha-Bonet D, Greenfield JR. Complex interplay among adiposity, insulin resistance and bone health. Clin Obes 2018; 8:131-139. [PMID: 29334695 DOI: 10.1111/cob.12240] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 10/31/2017] [Accepted: 11/23/2017] [Indexed: 12/28/2022]
Abstract
Obesity and osteoporosis are common public health problems. Paradoxically, while obesity is associated with higher bone density, type 2 diabetic obese individuals have an increased fracture risk. Although obesity and insulin resistance co-exist, some obese individuals remain insulin-sensitive. We suggest that the apparent paradox relating obesity, bone density and fracture risk in type 2 diabetes may be at least partly influenced by differences in bone strength and quality between insulin-resistant and insulin-sensitive obese individuals. In this review, we focus on the complex interplay between, adiposity, insulin resistance and osteoporotic fracture risk and suggest that this is an important area of study that has implications for individually tailored and targeted treatment to prevent osteoporotic fracture in obese type 2 diabetic individuals.
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Affiliation(s)
- C Ma
- Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China
| | - K T Tonks
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, Australia
- Diabetes and Metabolism Program, Garvan Institute of Medical Research, Sydney, Australia
| | - J R Center
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, Australia
- Bone Biology Research Program, Garvan Institute of Medical Research, Sydney, Australia
| | - D Samocha-Bonet
- Diabetes and Metabolism Program, Garvan Institute of Medical Research, Sydney, Australia
- Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - J R Greenfield
- Department of Endocrinology and Diabetes, St Vincent's Hospital, Sydney, Australia
- Diabetes and Metabolism Program, Garvan Institute of Medical Research, Sydney, Australia
- Faculty of Medicine, St Vincent's Clinical School, University of New South Wales, Sydney, Australia
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Klingberg S, Mehlig K, Sundh V, Heitmann BL, Lissner L. Lower risk of hip fractures among Swedish women with large hips? Osteoporos Int 2018; 29:927-935. [PMID: 29374771 PMCID: PMC5854726 DOI: 10.1007/s00198-017-4363-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 12/21/2017] [Indexed: 01/03/2023]
Abstract
UNLABELLED In women, a large hip circumference (HC) related to lower hip fracture risk, independent of age and regardless if HC was measured long before or closer to the fracture. In older women, body mass index (BMI) explained the protection. INTRODUCTION In postmenopausal women, HC has been suggested to inversely associate with hip fracture while this has not been investigated in middle-aged women. We examined the association between HC, measured at two different time points, and hip fracture in a Swedish female population-based sample monitored for incident hip fractures over many years. METHODS Baseline HC, measured in 1968 or 1974 (n = 1451, mean age 47.6 years), or the HC measures that were the most proximal before event or censoring (n = 1325, mean age 71.7 years), were used to assess the effects of HC on hip fracture risk in women participating in the Prospective Population Study of Women in Gothenburg. HC was parameterized as quintiles with the lowest quintile (Q1) as reference. Incident hip fractures over 45 years of follow-up (n = 257) were identified through hospital registers. RESULTS Higher quintiles of HC at both baseline and proximal to event were inversely associated with hip fracture risk in age-adjusted models, but only baseline HC predicted hip fractures independently of BMI and other covariates (HR (95% CI) Q2, 0.85 (0.56-1.27); Q3, 0.59 (0.36-0.96); Q4, 0.57 (0.34-0.96); Q5, 0.58 (0.31-1.10)). CONCLUSIONS A large HC is protective against hip fracture in midlife and in advanced age, but the association between proximal HC and hip fracture was explained by concurrent BMI suggesting that padding was not the main mechanism for the association. The independent protection seen in middle-aged women points to other mechanisms influencing bone strength.
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Affiliation(s)
- S Klingberg
- Department of Public Health and Community Medicine, Section for Epidemiology and Social Medicine (EPSO), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, P.O Box 454, 405 30, Gothenburg, Sweden.
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - K Mehlig
- Department of Public Health and Community Medicine, Section for Epidemiology and Social Medicine (EPSO), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, P.O Box 454, 405 30, Gothenburg, Sweden
| | - V Sundh
- Department of Public Health and Community Medicine, Section for Epidemiology and Social Medicine (EPSO), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, P.O Box 454, 405 30, Gothenburg, Sweden
- Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - B L Heitmann
- Research Unit for Dietary Studies, The Parker Institute and the Institute of Preventive Medicine, Bispebjerg and Fredriksberg Hospitals, The Capital Region, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- The Section for General Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - L Lissner
- Department of Public Health and Community Medicine, Section for Epidemiology and Social Medicine (EPSO), Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, P.O Box 454, 405 30, Gothenburg, Sweden
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Feskanich D, Meyer HE, Fung TT, Bischoff-Ferrari HA, Willett WC. Milk and other dairy foods and risk of hip fracture in men and women. Osteoporos Int 2018; 29:385-396. [PMID: 29075804 PMCID: PMC6814380 DOI: 10.1007/s00198-017-4285-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 10/23/2017] [Indexed: 12/31/2022]
Abstract
UNLABELLED The role of dairy foods for hip fracture prevention remains controversial. In this study, among US men and women, a glass of milk per day was associated with an 8% lower risk of hip fracture. This contrasts with a reported increased risk with higher milk intake in Swedish women. INTRODUCTION The purpose of this study was to examine whether higher milk and dairy food consumption are associated with risk of hip fracture in older adults following a report of an increased risk for milk in Swedish women. METHODS In two US cohorts, 80,600 postmenopausal women and 43,306 men over 50 years of age were followed for up to 32 years. Cox proportional hazards models were used to calculate the relative risks (RR) of hip fracture per daily serving of milk (240 mL) and other dairy foods that were assessed every 4 years, controlling for other dietary intakes, BMI, height, smoking, activity, medications, and disease diagnoses. RESULTS Two thousand one hundred thirty-eight incident hip fractures were identified in women and 694 in men. Each serving of milk per day was associated with a significant 8% lower risk of hip fracture in men and women combined (RR = 0.92, 95% confidence interval (CI) 0.87 to 0.97). A suggestive inverse association was found for cheese in women only (RR = 0.91, CI 0.81 to 1.02). Yogurt consumption was low and not associated with risk. Total dairy food intake, of which milk contributed about half, was associated with a significant 6% lower risk of hip fracture per daily serving in men and women (RR = 0.94, CI 0.90 to 0.98). Calcium, vitamin D, and protein from non-dairy sources did not modify the association between milk and hip fracture, nor was it explained by contributions of these nutrients from milk. CONCLUSIONS In this group of older US adults, higher milk consumption was associated with a lower risk of hip fracture.
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Affiliation(s)
- D Feskanich
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Drive, Boston, MA, 02115, USA.
| | - H E Meyer
- Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway
- Norwegian Institute of Public Health, Oslo, Norway
| | - T T Fung
- Department of Nutrition, Simmons College, Boston, MA, USA
| | - H A Bischoff-Ferrari
- Department of Geriatrics and Aging Research, University Hospital and University of Zurich, Zürich, Switzerland
| | - W C Willett
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, 181 Longwood Drive, Boston, MA, 02115, USA
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Beattie JR, Feskanich D, Caraher MC, Towler MR. A Preliminary Evaluation of the Ability of Keratotic Tissue to Act as a Prognostic Indicator of Hip Fracture Risk. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2018; 11:1179544117754050. [PMID: 29371785 PMCID: PMC5774738 DOI: 10.1177/1179544117754050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 12/27/2017] [Indexed: 11/17/2022]
Abstract
Studies have shown that Raman spectroscopic analysis of fingernail clippings can help differentiate between post-menopausal women who have and who have not suffered a fracture. However, all studies to date have been retrospective in nature, comparing the proteins in nails sourced from women, post-fracture. The objective of this study was to investigate the potential of a prospective test for hip fracture based on spectroscopic analysis of nail tissue. Archived toenail samples from post-menopausal women aged 50 to 63 years in the Nurses' Health Study were obtained and analysed by Raman spectroscopy. Nails were matched case-controls sourced from 161 women; 82 who underwent a hip fracture up to 20 years after nail collection and 81 age-matched controls. A number of clinical risk factors (CRFs) from the Fracture Risk Assessment (FRAX) tool had been assessed at toenail collection. Using 80% of the spectra, models were developed for increasing time periods between nail collection and fracture. Scores were calculated from these models for the other 20% of the sample and the ability of the score to predict hip fracture was tested in model with and without the CRFs by comparing the odds ratios (ORs) per 1 SD increase in standardised predictive values. The Raman score successfully distinguished between hip fracture cases and controls. With only the score as a predictor, a statistically significant OR of 2.2 (95% confidence interval [CI]: 1.5-3.1) was found for hip fracture for up to 20 years after collection. The OR increased to 3.8 (2.6-5.4) when the CRFs were added to the model. For fractures limited to 13 years after collection, the OR was 6.3 (3.0-13.1) for the score alone. The test based on Raman spectroscopy has potential for identifying individuals who may suffer hip fractures several years in advance. Higher powered studies are required to evaluate the predictive capability of this test.
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Affiliation(s)
- J Renwick Beattie
- J Renwick Beattie Consulting, Causeway Enterprise Agency, Ballycastle, UK
| | - Diane Feskanich
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Mark R Towler
- Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, ON, Canada
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31
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Sadeghi O, Djafarian K, Ghorabi S, Khodadost M, Nasiri M, Shab-Bidar S. Dietary intake of fish, n-3 polyunsaturated fatty acids and risk of hip fracture: A systematic review and meta-analysis on observational studies. Crit Rev Food Sci Nutr 2017; 59:1320-1333. [DOI: 10.1080/10408398.2017.1405908] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Omid Sadeghi
- Larestan University of Medical Sciences, Larestan, Iran
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Kurosh Djafarian
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sima Ghorabi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
- Research Center of Oils and Fats, Food and Drug administration, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mahmoud Khodadost
- Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Nasiri
- Department of Operating Room Technology, School of Paramedicine, Qom University of Medical Sciences, Qom, Iran
| | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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32
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Li X, Gong X, Jiang W. Abdominal obesity and risk of hip fracture: a meta-analysis of prospective studies. Osteoporos Int 2017; 28:2747-2757. [PMID: 28702682 DOI: 10.1007/s00198-017-4142-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/30/2017] [Indexed: 01/20/2023]
Abstract
UNLABELLED We conducted a meta-analysis to qualitatively summarize the evidence of the association between abdominal obesity and hip fracture risk. The results indicated that abdominal obesity as measured by waist circumference and waist-hip ratio might be associated with an increased risk of hip fracture. INTRODUCTION Epidemiological investigations evaluating the association of abdominal obesity with hip fracture risk have yielded conflicting results. Therefore, a meta-analysis was conducted to qualitatively summarize the evidence of the associations between waist circumference, waist-hip ratio, and hip circumference and the risk of hip fracture, respectively. METHODS PubMed, Embase, and Web of Science were searched for relevant articles published up to March 2017. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated with a random-effects model. Dose-response relationship was assessed by restricted cubic spline. RESULTS Seven studies involving 180,600 participants for hip circumference, six studies involving 199,828 participants for waist-hip ratio, and five studies involving 170,796 participants for waist circumference were finally included in this meta-analysis. The combined RRs with 95% CIs of hip fracture for the highest versus lowest category of waist circumference, waist-hip ratio, and hip circumference were 1.58 (95% CI 1.20-2.08), 1.32 (95% CI 1.15-1.52), and 0.87 (95% CI 0.74-1.02), respectively. For dose-response analysis, a nonlinear relationship was found (P nonlinearity < 0.001) between waist circumference and the risk of hip fracture, and a linear relationship (P nonlinearity = 0.911) suggested that the risk of hip fracture increased about 3.0% (1.03 (1.01-1.04)) for each 0.1 unit increment of waist-hip ratio. CONCLUSIONS This meta-analysis suggested that abdominal obesity as measured by waist circumference and waist-hip ratio might be associated with an increased risk of hip fracture. From a public health perspective, indicators of abdominal obesity may be usable predictors of hip fracture risk.
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Affiliation(s)
- X Li
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, No. 38 Dengzhou Road, Qingdao, 266021, China
| | - X Gong
- Surgical Department, Songshan Hospital of Qingdao University, No. 38 Dengzhou Road, Qingdao, Shandong, 266021, China
| | - W Jiang
- Department of Epidemiology and Health Statistics, School of Public Health, Qingdao University, No. 38 Dengzhou Road, Qingdao, 266021, China.
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33
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Sadeghi O, Saneei P, Nasiri M, Larijani B, Esmaillzadeh A. Abdominal Obesity and Risk of Hip Fracture: A Systematic Review and Meta-Analysis of Prospective Studies. Adv Nutr 2017; 8:728-738. [PMID: 28916573 PMCID: PMC5593104 DOI: 10.3945/an.117.015545] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Data on the association between general obesity and hip fracture were summarized in a 2013 meta-analysis; however, to our knowledge, no study has examined the association between abdominal obesity and the risk of hip fracture. The present systematic review and meta-analysis of prospective studies was undertaken to summarize the association between abdominal obesity and the risk of hip fracture. We searched online databases for relevant publications up to February 2017, using relevant keywords. In total, 14 studies were included in the systematic review and 9 studies, with a total sample size of 295,674 individuals (129,964 men and 165,703 women), were included in the meta-analysis. Participants were apparently healthy and aged ≥40 y. We found that abdominal obesity (defined by various waist-hip ratios) was positively associated with the risk of hip fracture (combined RR: 1.24, 95% CI: 1.05, 1.46, P = 0.01). Combining 8 effect sizes from 6 studies, we noted a marginally significant positive association between abdominal obesity (defined by various waist circumferences) and the risk of hip fracture (combined RR: 1.36; 95% CI: 0.97, 1.89, P = 0.07). This association became significant in a fixed-effects model (combined effect size: 1.40, 95% CI: 1.25, 1.58, P < 0.001). Based on 5 effect sizes, we found that a 0.1-U increase in the waist-hip ratio was associated with a 16% increase in the risk of hip fracture (combined RR: 1.16, 95% CI: 1.04, 1.29, P = 0.007), whereas a 10-cm increase in waist circumference was not significantly associated with a higher risk of hip fracture (combined RR: 1.13, 95% CI: 0.94, 1.36, P = 0.19). This association became significant, however, when we applied a fixed-effects model (combined effect size: 1.21, 95% CI: 1.15, 1.27, P < 0.001). We found that abdominal obesity was associated with a higher risk of hip fracture in 295,674 individuals. Further studies are needed to test whether there are associations between abdominal obesity and fractures at other bone sites.
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Affiliation(s)
- Omid Sadeghi
- Students’ Scientific Center,,Department of Community Nutrition, School of Nutritional Sciences and Dietetics
| | | | - Morteza Nasiri
- Department of Operating Room Technology, School of Paramedicine, Qom University of Medical Sciences, Qom, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, and
| | - Ahmad Esmaillzadeh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics,,Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran;,Food Security Research Center, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran; and
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34
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Styner M, Pagnotti GM, McGrath C, Wu X, Sen B, Uzer G, Xie Z, Zong X, Styner MA, Rubin CT, Rubin J. Exercise Decreases Marrow Adipose Tissue Through ß-Oxidation in Obese Running Mice. J Bone Miner Res 2017; 32:1692-1702. [PMID: 28436105 PMCID: PMC5550355 DOI: 10.1002/jbmr.3159] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 03/17/2017] [Accepted: 04/20/2017] [Indexed: 12/23/2022]
Abstract
The relationship between marrow adipose tissue (MAT) and bone health is poorly understood. We used running exercise to ask whether obesity-associated MAT can be attenuated via exercise and whether this correlates with gains in bone quantity and quality. C57BL/6 mice were divided into diet-induced obesity (DIO, n = 14) versus low-fat diet (LFD, n = 14). After 3 months, 16-week-old mice were allocated to an exercise intervention (LFD-E, DIO-E) or a control group (LFD, DIO) for 6 weeks (4 groups, n = 7/group). Marrow adipocyte area was 44% higher with obesity (p < 0.0001) and after exercise 33% lower in LFD (p < 0.0001) and 39% lower in DIO (p < 0.0001). In LFD, exercise did not affect adipocyte number; however, in DIO, the adipocyte number was 56% lower (p < 0.0001). MAT was 44% higher in DIO measured by osmium-μCT, whereas exercise associated with reduced MAT (-23% in LFD, -48% in DIO, p < 0.05). MAT was additionally quantified by 9.4TMRI, and correlated with osmium-µCT (r = 0.645; p < 0.01). Consistent with higher lipid beta oxidation, perilipin 3 (PLIN3) rose with exercise in tibial mRNA (+92% in LFD, +60% in DIO, p < 0.05). Tibial µCT-derived trabecular bone volume (BV/TV) was not influenced by DIO but responded to exercise with an increase of 19% (p < 0.001). DIO was associated with higher cortical periosteal and endosteal volumes of 15% (p = 0.012) and 35% (p < 0.01), respectively, but Ct.Ar/Tt.Ar was lower by 2.4% (p < 0.05). There was a trend for higher stiffness (N/m) in DIO, and exercise augmented this further. In conclusion, obesity associated with increases in marrow lipid-measured by osmium-μCT and MRI-and partially due to an increase in adipocyte size, suggesting increased lipid uptake into preexisting adipocytes. Exercise associated with smaller adipocytes and less bone lipid, likely invoking increased ß-oxidation and basal lipolysis as evidenced by higher levels of PLIN3. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Maya Styner
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, NC, USA
| | - Gabriel M Pagnotti
- Department of Biomedical Engineering, State University of New York, Stony Brook, Stony Brook, NY, USA
| | - Cody McGrath
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, NC, USA
| | - Xin Wu
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, NC, USA
| | - Buer Sen
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, NC, USA
| | - Gunes Uzer
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, NC, USA
- Department of Mechanical and Biomedical Engineering, Boise State University, Boise, ID, USA
| | - Zhihui Xie
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, NC, USA
| | - Xiaopeng Zong
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
| | - Martin A Styner
- Department of Computer Science, University of North Carolina, Chapel Hill, NC, USA
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
| | - Clinton T Rubin
- Department of Biomedical Engineering, State University of New York, Stony Brook, Stony Brook, NY, USA
| | - Janet Rubin
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina, Chapel Hill, NC, USA
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35
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Hind K, Pearce M, Birrell F. Total and Visceral Adiposity Are Associated With Prevalent Vertebral Fracture in Women but Not Men at Age 62 Years: The Newcastle Thousand Families Study. J Bone Miner Res 2017; 32:1109-1115. [PMID: 28261864 DOI: 10.1002/jbmr.3085] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/17/2017] [Accepted: 01/19/2017] [Indexed: 12/11/2022]
Abstract
Low body weight is an established risk factor for osteoporosis and fracture, but the skeletal risks of higher adiposity are unclear and appear sex-specific and site-dependent. The aim of this study was to investigate associations of total fat mass (TFM), visceral adipose tissue (VAT), and C-reactive protein (CRP) with bone mineral density (BMD) and prevalent vertebral fracture (VF) in men and women aged 62 years. A total of 352 men and women aged 62.5 ± 0.5 years from the Newcastle Thousand Families Study cohort received dual-energy X-ray absorptiometry (DXA) evaluations of femoral neck and lumbar spine BMD, of the lateral spine for vertebral fracture assessment, and of the whole body for TFM and VAT (GE Lunar CoreScan, Madison, WI, USA). Plasma CRP, FRAX scores, falls in the last 12 months, and occupation at age 50 years were also included in the analysis. Vertebral fractures were less prevalent in women than in men (odds ratio [OR] = 0.33, p < 0.001) and BMD or FRAX scores did not differ between participants with and without VF. Women with VF were heavier and had higher TFM, VAT, and CRP than women without (p < 0.001). In women, greater (+1 SD) TFM and VAT increased the odds of any grade VF (TFM: OR = 1.06, p = 0.001; VAT: OR = 2.50, p = 0.002), and greater VAT mass increased the odds of prevalent mild VF (OR = 2.60, p = 0.002). In contrast, there were no associations in men. In both sexes, after controlling for body weight, neither VAT nor CRP were associated with BMD. In conclusion, irrespective of BMD, total and visceral adiposity were associated with prevalent VF in women but not in men. High fat mass, particularly if visceral, should be considered when assessing VF risk in women. Risk factors for VF in men require further investigation, particularly given their high prevalence. © 2017 American Society for Bone and Mineral Research.
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Affiliation(s)
- Karen Hind
- Carnegie Research Institute, Leeds Beckett University, Leeds, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Mark Pearce
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Fraser Birrell
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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36
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Min J. RE: "AGE AND SEX DIFFERENCES IN BODY MASS INDEX AS A PREDICTOR OF HIP FRACTURE: A NOREPOS STUDY". Am J Epidemiol 2017; 185:511. [PMID: 28399568 DOI: 10.1093/aje/kwx026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/26/2017] [Indexed: 01/25/2023] Open
Affiliation(s)
- Jae Min
- Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL
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38
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Abstract
The World Health Organization estimates that diabetes mellitus occurs in more than 415 million people; this number could double by the year 2040. Epidemiologic data have shown that the skeletal system may be a target of diabetes-mediated damage, leading to the development of diabetes-induced osteoporosis. T1D and T2D have been associated with an increased risk of fracture. Bone mineral density and fracture risk prediction tools developed for the general population capture some of the risk associated with diabetes. Recent adaptations to these tools have improved their efficacy in patients with diabetes.
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Affiliation(s)
- G Isanne Schacter
- Department of Medicine, University of Manitoba, GF-335, 820 Sherbrook Street, Winnipeg, Manitoba R3A 1R9, Canada
| | - William D Leslie
- Department of Medicine, University of Manitoba, C5121, 409 Tache Avenue, Winnipeg, Manitoba R2H 2A6, Canada.
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Sornay-Rendu E, Duboeuf F, Boutroy S, Chapurlat RD. Muscle mass is associated with incident fracture in postmenopausal women: The OFELY study. Bone 2017; 94:108-113. [PMID: 27989649 DOI: 10.1016/j.bone.2016.10.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/20/2016] [Accepted: 10/24/2016] [Indexed: 12/28/2022]
Abstract
The relationships between body composition and bone mineral density are well established but the contribution of body composition to the risk of fracture (Fx) has rarely been evaluated prospectively. We analyzed the risk of Fx by body composition in 595 postmenopausal women (mean age 66±8years) from a longitudinal cohort study (Os des Femmes de Lyon). We assessed the risk of the first incident fragility Fx according to body composition obtained from whole-body DXA: abdominal visceral (VFAT) and subcutaneous fat mass (SFAT), total body fat mass (FM), lean mass index (LMI) and appendicular skeletal muscle mass index (ASMI). During a median [IQ] follow-up of 13.1years [1.9], 138 women sustained a first incident Fx, including 85 women with a major osteoporotic Fx (MOP Fx: hip, clinical spine, humerus or wrist). After adjustment for age, women who sustained Fx had lower BMI (-4%, p=0.01), LMI (-6%, p=0.002) and ASMI (-3%, p=0.003), compared with women without Fx. After adjustment for age, prevalent Fx, physical activity, incident falls and FN BMD, each SD increase of baseline values of LMI and ASMI was associated with decreased Fx risk with adjusted hazard ratios of 0.76 for both of p≤0.02. Those associations were similar after accounting for the competing risk of death. VFAT and SFAT were associated with Fx risk in the multivariate model only for MOP Fx and the association did not persist after consideration of competing mortality. We conclude that lean mass and appendicular muscle mass indexes are associated with the risk of fracture in postmenopausal women independently of BMD and clinical risk factors.
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Affiliation(s)
| | - F Duboeuf
- INSERM UMR 1033, Université de Lyon, France.
| | - S Boutroy
- INSERM UMR 1033, Université de Lyon, France.
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40
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BMI and BMD: The Potential Interplay between Obesity and Bone Fragility. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13060544. [PMID: 27240395 PMCID: PMC4924001 DOI: 10.3390/ijerph13060544] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 05/12/2016] [Accepted: 05/19/2016] [Indexed: 01/05/2023]
Abstract
Recent evidence demonstrating an increased fracture risk among obese individuals suggests that adipose tissue may negatively impact bone health, challenging the traditional paradigm of fat mass playing a protective role towards bone health. White adipose tissue, far from being a mere energy depot, is a dynamic tissue actively implicated in metabolic reactions, and in fact secretes several hormones called adipokines and inflammatory factors that may in turn promote bone resorption. More specifically, Visceral Adipose Tissue (VAT) may potentially prove detrimental. It is widely acknowledged that obesity is positively associated to many chronic disorders such as metabolic syndrome, dyslipidemia and type 2 diabetes, conditions that could themselves affect bone health. Although aging is largely known to decrease bone strength, little is yet known on the mechanisms via which obesity and its comorbidities may contribute to such damage. Given the exponentially growing obesity rate in recent years and the increased life expectancy of western countries it appears of utmost importance to timely focus on this topic.
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Challenges in the Management of Geriatric Obesity in High Risk Populations. Nutrients 2016; 8:nu8050262. [PMID: 27153084 PMCID: PMC4882675 DOI: 10.3390/nu8050262] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/12/2016] [Accepted: 04/25/2016] [Indexed: 01/26/2023] Open
Abstract
The global prevalence of obesity in the older adult population is growing, an increasing concern in both the developed and developing countries of the world. The study of geriatric obesity and its management is a relatively new area of research, especially pertaining to those with elevated health risks. This review characterizes the state of science for this “fat and frail” population and identifies the many gaps in knowledge where future study is urgently needed. In community dwelling older adults, opportunities to improve both body weight and nutritional status are hampered by inadequate programs to identify and treat obesity, but where support programs exist, there are proven benefits. Nutritional status of the hospitalized older adult should be optimized to overcome the stressors of chronic disease, acute illness, and/or surgery. The least restrictive diets tailored to individual preferences while meeting each patient’s nutritional needs will facilitate the energy required for mobility, respiratory sufficiency, immunocompentence, and wound healing. Complications of care due to obesity in the nursing home setting, especially in those with advanced physical and mental disabilities, are becoming more ubiquitous; in almost all of these situations, weight stability is advocated, as some evidence links weight loss with increased mortality. High quality interdisciplinary studies in a variety of settings are needed to identify standards of care and effective treatments for the most vulnerable obese older adults.
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